RESUMO
OBJECTIVE: To conduct a scoping review of the literature to describe current conceptualization and measurement of socioeconomic status in pediatric health research. STUDY DESIGN: Four databases were used to identify relevant studies, followed by selection and data extraction. Inclusion criteria for studies were the following: enrolled subjects <18 years old, included a health-related outcome, published from 1999 to 2018, and explicitly measured socioeconomic status (SES). RESULTS: Our literature search identified 1768 publications and 1627 unique records. After screening for duplication and relevance, 228 studies satisfied the inclusion criteria, with 75% (n = 170) published since 2009. There were 52 unique singular measures and an additional 20 composite measures. Income-related measures were used in 65% of studies (n = 147) and measures of education in 42% (n = 95). The majority of studies using census-derived variables or insurance status were conducted within the previous 10 years. CONCLUSIONS: Pediatric studies use a variety of SES measures, which limits comparisons between studies. Few studies provide an evidenced-based rationale that connects the SES indicator to the health outcome, but the majority of studies do find a significant impact of SES on outcomes. SES should be comprehensively studied so that meaningful measures can be used to identify specific SES mechanisms that impact child health.
Assuntos
Pesquisa sobre Serviços de Saúde/organização & administração , Pediatria/organização & administração , Classe Social , Adolescente , Criança , Bases de Dados Factuais , Feminino , Nível de Saúde , Disparidades nos Níveis de Saúde , Disparidades em Assistência à Saúde , Humanos , Renda , Masculino , Avaliação de Resultados em Cuidados de Saúde , Pais , Projetos de Pesquisa , Fatores SocioeconômicosRESUMO
OBJECTIVES: To identify risk factors associated with cognitive impairment as assessed by neuropsychologic tests in neurotypical children after critical illness. DATA SOURCES: For this systematic review, we searched the Cochrane Library, Scopus, PubMed, Ovid, Embase, and CINAHL databases from January 1960 to March 2017. STUDY SELECTION: Included were studies with subjects 3-18 years old at the time of post PICU follow-up evaluation and use of an objective standardized neuropsychologic test with at least one cognitive functioning dimension. Excluded were studies featuring patients with a history of cardiac arrest, traumatic brain injury, or genetic anomalies associated with neurocognitive impairment. DATA EXTRACTION: Twelve studies met the sampling criteria and were rated using the Newcastle-Ottawa Quality Assessment Scale. DATA SYNTHESIS: Ten studies reported significantly lower scores in at least one cognitive domain as compared to healthy controls or normed population data; seven of these-four case-control and three prospective cohort studies-reported significant lower scores in more than one cognitive domain. Risk factors associated with post critical illness cognitive impairment included younger age at critical illness and/or older age at follow-up, low socioeconomic status, high oxygen requirements, and use of mechanical ventilation, sedation, and pain medications. CONCLUSIONS: Identifying risk factors for poor cognitive outcomes post critical illness may help healthcare teams modify patient risk and/or provide follow-up services to improve long-term cognitive outcomes in high-risk children.