Faculty Bibliography

Health literacy is a foundational component of providing accessible pediatric care, influencing whether families can understand, access, and use health information. As families increasingly rely on online health resources, health literacy skills applied to digital information, or e-health literacy, has become an evolving dimension of pediatric health literacy. The concept of health literacy extends beyond an individual's abilities, intersecting with the demands placed on individuals by healthcare systems. There is a growing focus on organizational health literacy (OHL), which reflects how effectively systems support equitable communication, but this remains infrequently assessed or implemented. Limited parent, child, and adolescent health literacy is common and disproportionately affects families with lower income, minoritized racial/ethnic backgrounds, lower educational attainment, and who use languages other than English for care. Limited health literacy has been associated with decreased disease-specific knowledge, suboptimal health behaviors, and worse clinical outcomes. Although health literacy-informed strategies can improve comprehension and outcomes, best practices, such as teach-back, remain underutilized across pediatric care settings. The rapid expansion of digital tools offers new opportunities to enhance health literacy-informed communication but also introduces challenges related to equity, accuracy, and safety. Advancing pediatric health literacy requires coordinated efforts: embedding health literacy principles into institutional and national policies, integrating universal health literacy precautions into clinical workflows, expanding clinician and patient health literacy education, and advancing health literacy-focused research, including on digital interventions and artificial intelligence (AI)-supported communication. Prioritizing these efforts is essential to creating health literate-systems that enable all families to access, understand and use health information.

BACKGROUND:Idiopathic clubfoot is a complex congenital foot and ankle anomaly commonly treated with the Ponseti method. While gross motor function and activity level are similar in children with clubfoot treated with this method compared with children without clubfoot, data are lacking on sports participation following this treatment. This study aimed to describe the prevalence of sports participation among children with idiopathic clubfoot treated with the Ponseti method. METHODS:This was a multicenter retrospective cross-sectional study. Patients aged 5 to 17 years were included if they had been diagnosed with idiopathic clubfoot and treated with the Ponseti method during infancy. Parents of subjects were asked to complete a 1-time REDCap survey that included basic demographic questions, 2 validated activity scores (PROMIS Physical Activity Short Form and PACE+), and questions relating to sports participation. The comparison group consisted of the siblings of patients with clubfoot. RESULTS:One hundred fifty-one patients with clubfoot and 45 siblings without clubfoot were included from 4 institutions. In the clubfoot group, 72.2% of participants were male compared with 60% in the sibling group ( P =0.12). Median PROMIS-PA t-scores were 53.3 [interquartile range (IQR) 8.6] and 56.3 (IQR 13.2) in the clubfoot and sibling groups, respectively ( P =0.016). The median PACE+ scores were 4 (IQR 3.5) in the clubfoot group and 4.75 (IQR 2.75) ( P =0.261) in the sibling group. Sports participation was reported in 120 (79.5%) patients with clubfoot and 43 siblings (95.6%) ( P =0.006). Soccer, baseball, basketball, football, and swimming were the most commonly played sports in both groups. CONCLUSIONS:Children treated for idiopathic clubfoot with the Ponseti method remain active and participate in sports similar to their siblings. Further prospective studies examining sports participation and injury prevalence are needed to better understand long-term clinical and functional outcomes in patients treated with the Ponseti method for idiopathic clubfoot. STUDY DESIGN/METHODS:Retrospective. LEVEL OF EVIDENCE/METHODS:Level IV.

OBJECTIVE/UNASSIGNED:To examine the effect of DT56a (Femarelle®), a non-hormonal oral treatment for the management of menopause, on symptoms of vulvovaginal atrophy (VVA)/genitourinary syndrome of menopause (GSM) in postmenopausal women. METHODS/UNASSIGNED: = 12) postmenopausal women with severe VVA (100% parabasal cells on cervical cytology) and at least one severe VVA symptom were recruited for a 12-week open-label pilot study. At baseline and week 12, participants underwent physical examination, Pap smear, vaginal ultrasound, vaginal cultures, vaginal pH assessment, and vaginal maturation index evaluation. Subjects also completed questionnaires assessing atrophy symptoms and quality of life using the Utian Quality of Life (UQoL) scale. Follow-up at 24 months was available for several participants. RESULTS/UNASSIGNED:After 12 weeks of treatment, all patients showed a significant reduction in vaginal pH. In addition, 11 of the 12 women demonstrated significant improvement in the vaginal maturation index and UQoL questionnaire scores. CONCLUSIONS/UNASSIGNED:DT56a significantly improved subjective and objective parameters of VVA/GSM, including vaginal pH, vaginal maturation index, and quality of life. These findings support its potential role as a non-hormonal systemic treatment option for women with VVA/GSM.

BACKGROUND AND OBJECTIVES/UNASSIGNED:Patients with neurologic disease have a variety of unmet palliative care needs. Both the Accreditation Council for Graduate Medical Education and Academy of Neurology have emphasized the need for neuropalliative care education in recent years. Neurology training programs have widely variable practices in teaching neuropalliative care. This study aims to characterize current practices in providing neuropalliative care education across graduate neurology training and to identify barriers to its delivery. METHODS/UNASSIGNED:We surveyed program directors (PDs) of neurology residency and fellowship training programs in the United States regarding their current methods of teaching neuropalliative care topics, perceived importance of these topics, relevant subspecialty resources, and perceived barriers to providing neuropalliative care education. RESULTS/UNASSIGNED:Our survey was emailed to 777 PDs and fellowship directors. In total, 118 responses were included in the analytic sample (response rate 15.2%). Program directors generally perceived neuropalliative care education as important, with a median rank of 7 of 10. 91% of adult neurology residency programs and 66% of fellowship programs included palliative care topics in their didactics curricula. Topics emphasized varied depending on the training program's subspecialty. Respondents highlighted barriers to implementing neuropalliative care training, including inadequate trainee and faculty time and lack of adequate teaching faculty. DISCUSSION/UNASSIGNED:Neurology training programs continue to exhibit considerable variability in palliative care education curricula. Although most programs reported a presence of palliative care in their institutions, variability exists in the amount of palliative care education taught, the topics emphasized, and the teaching methods. Notably, there is an opportunity for fellowship programs to increase the amount of neuropalliative care topics taught in their curricula. Neurology residency and fellowship directors may benefit from using existing neuropalliative care curricula to enhance this area of education, partnering with local non-neurology faculty to teach palliative topics, and integrating palliative care topics into subspecialty training.

OBJECTIVES/OBJECTIVE:Anemia is common in critically ill patients. In prior trials, a restrictive transfusion strategy was at least as effective as, and possibly superior to, a liberal strategy in critically ill adult patients. However, the Transfusion Requirements in Critical Care (TRICC) trial suggested that a restrictive strategy might be harmful in critically ill patients with ischemic heart disease. Our objective was to compare outcomes for restrictive and liberal transfusion strategies in critically ill and noncritically ill patients with acute myocardial infarction (AMI) and anemia. DESIGN/METHODS:Subgroup analysis of a parallel, two-arm randomized, controlled trial. SETTING/METHODS:One hundred forty-four sites in the United States, Canada, France, Brazil, New Zealand, and Australia. PATIENTS/METHODS:Adult patients with AMI and anemia enrolled in the Myocardial Ischemia and Transfusion (MINT) trial. Patients being treated in an ICU at randomization were considered critically ill. INTERVENTIONS/METHODS:Patients were randomly assigned to a restrictive (transfuse when hemoglobin < 7-8 g/dL) or liberal (transfuse when hemoglobin < 10 g/dL) transfusion strategy. MEASUREMENTS AND MAIN RESULTS/RESULTS:We determined the effect of transfusion strategy on death and the composite of death/myocardial infarction (MI) at 30 days among critically ill and noncritically ill patients. Of 3504 patients enrolled in MINT, 1679 (47.9%) were critically ill. At 30 days, death (11.9% vs. 6.5%) and death/MI (18.9% vs. 12.7%) occurred more frequently in critically ill patients compared with noncritically ill patients. A restrictive, compared with a liberal, transfusion strategy resulted in a nonsignificant increase in the risk of death by 9% (risk ratio [RR], 1.09; 95% CI, 0.77-1.54) and death/MI by 9% (RR, 1.09; 95% CI, 0.85-1.38) in noncritically ill patients and a nonsignificant increase in the risk of death by 24% (RR, 1.24; 95% CI, 0.95-1.61; interaction p = 0.55) and death/MI by 21% (RR, 1.21; 95% CI, 0.99-1.47; interaction p = 0.52) in critically ill patients. CONCLUSIONS:There is no evidence that the overall MINT trial results, which generally favor a liberal transfusion strategy in AMI patients, apply differently to noncritically ill and critically ill patients.

Enteric hyperoxaluria (EH) results from increased oxalate bioavailability in the gastrointestinal (GI) tract, often affecting patients with inflammatory bowel disease (IBD). We investigated the pathophysiology of EH in an ileitis mouse model, hypothesizing that fat malabsorption, increased gut permeability, and microbial shifts collectively contribute to the hyperoxaluric phenotype in the setting of GI tract inflammation. SAMP1/YitFc (SAMP1) mice and their parental AKR controls were fed one of three diets varying in fat content (10%, 45%, or 60% kcal), each supplemented with 1% oxalate, for 6 weeks. Plasma (P), urine (U), oxalate (Ox), and creatinine (Cr) levels were measured, while stool lipid species were analyzed using mass spectrometry. Intestinal permeability was assessed using sucralose and ¹³C₂ oxalate gastric gavage in SAMP1 and AKR mice. Histology, qPCR, and Western blotting were performed on kidney, liver, and GI tissues. Microbial DNA was analyzed at the community, genus, and functional levels. Changes in bacterial metabolic pathways were investigated in the mice fed the highest fat content. The oxalobiome of SAMP1 and AKR mice was characterized using our bioinformatics pipeline. On high-fat diets, SAMP1 mice had higher UOx, POx, and PCr levels than AKR mice. Increased levels of diacylglycerols and free fatty acids in SAMP1 stool samples suggested fat malabsorption. A decrease in ZO1 and occludin intestinal expression, coupled with significantly increased urinary sucralose and oxalate levels, indicated increased intestinal permeability. Microbiome analysis revealed the enrichment of Lactobacilli and Bacteroides in SAMP1 mice, with bacterial pathways favoring lipid synthesis and glyoxylate metabolism. Ileal SLC26A6 protein expression was significantly reduced in SAMP1 mice. SAMP1 mice also developed progressive kidney injury with interstitial inflammation. These findings highlight fat malabsorption as a central pathophysiologic disturbance in EH that reduces luminal calcium availability for oxalate binding, is associated with enhanced intestinal permeability, and accompanies microbiome and enzymatic pathway alterations.

OBJECTIVES/OBJECTIVE:Chronic hepatitis C can complicate the treatment of coronary artery disease (CAD), especially among racial and ethnic minority patients. This study explores racial and ethnic differences in the prevalence of hepatitis C and inpatient mortality among patients admitted to the hospital primarily for a CAD event in the USA. METHODS:An observational analysis was conducted using data from the 2016 to 2021 National Inpatient Sample, including 1,946,182 CAD patients, of whom 7426 (0.38%) had chronic hepatitis C. We performed weighted logistic regressions to analyze the relationship between race and ethnicity (non-Hispanic White, non-Hispanic Black, Hispanic, and other races) regarding the prevalence of hepatitis C and inpatient mortality, adjusting for patient sociodemographic characteristics and comorbidities. RESULTS:Non-Hispanic Black patients had the highest prevalence of hepatitis C (adjusted odds ratio [aOR] = 1.57, 95% confidence interval [CI] 1.48-1.67) and Hispanic patients with underlying hepatitis C had the highest in-hospital mortality (aOR = 1.56, 95% CI 1.11-2.20) compared to non-Hispanic White patients and other racial groups. CONCLUSIONS:We found significant racial and ethnic differences in the prevalence of hepatitis C and mortality among patients with underlying chronic hepatitis C admitted primarily for CAD events in the USA. This disparity may exist due to lower rates of hepatitis C virus (HCV) treatment, higher severity and prevalence of underlying health conditions, poorer healthcare access and insurance coverage, and a higher rate of alcohol use and cirrhosis progression in minority populations.

BACKGROUND:Accurate measurement of pharmacy access is central to understanding spatial inequities in healthcare availability. The two-step floating catchment area (2SFCA) method is widely used to integrate proximity and availability, yet key challenges remain unresolved in dense urban settings, including catchment sensitivity, and the lack of uncertainty quantification despite reliance on survey-based population estimates. OBJECTIVE:To assess catchment sensitivity to specification using a mode-adjusted 2SFCA approach while propagating uncertainty from the American Community Survey (ACS). METHODS:We conducted a cross-sectional analysis of pharmacy access across 2222 census tracts in New York City using multiple distance- and time-based catchments. We applied a mode-adjusted 2SFCA method that incorporates walking and driving accessibility by decomposing populations demand using tract-level transportation proportions from the ACS. Uncertainty in access estimates was quantified via hierarchical Monte Carlo simulation propagating the margins of errors from the ACS. We used cross-tabulation to quantify agreement in classifying tracts as having fewer than one pharmacy per 10,000 residents across transportation modes. RESULTS:Relative pharmacy access patterns were stable across a wide range of catchment specifications, indicating limited sensitivity to reasonable changes in distance or travel-time thresholds in this dense urban setting. The mode-adjusted approach increased median access and introduced additional variability by accounting for transportation differences. Uncertainty in access estimates was generally negligible but may matter where driving and walking catchments do not overlap. CONCLUSIONS:These findings suggest that, in New York City, catchment size and ACS uncertainty have limited impact on access estimates, while transportation differences and border effects play a larger role.