Lee Pachter, DO

Senior Physician Scientists, Community Engagement & Outreach Core Lead with DE ACCEL-CTR

Publications

Racism, Discrimination, and Biomedical Research: The Role of the Academic Journal in Transforming Health Care
Racism, Discrimination, and Biomedical Research: The Role of the Academic Journal in Transforming Health Care
Pachter LM

J Dev Behav Pediatr 2020 Sep;41(7):511-512

PMID: 32833871

Abstract

No abstract available.
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Peer Mediated Groups:: Nonpharmacologic Management of Pain for and By Those with Sickle Cell Disease
Peer Mediated Groups:: Nonpharmacologic Management of Pain for and By Those with Sickle Cell Disease
Guarino S, Wright CS, Pachter LM, Lanzkron SM

Dela J Public Health 2022 Oct;8(4):8-11

PMID: 36340952

Abstract

No abstract available.
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Adverse childhood experiences in children and adolescents with sickle cell disease: A retrospective cohort study
Adverse childhood experiences in children and adolescents with sickle cell disease: A retrospective cohort study
Pernell B, Nagalapuram V, Lebensburger J, Lin CP, Baskin ML, Pachter LM

Pediatr Blood Cancer 2022 Mar;69(3):e29494

PMID: 34913574

Abstract

BACKGROUND">Adverse childhood experiences (ACEs) are linked to poor health outcomes; however, the relationship between ACEs and health outcomes among children and adolescents with sickle cell disease (SCD) has limited documentation in the published literature.</Abstr: Adverse childhood experiences (ACEs) are linked to poor health outcomes; however, the relationship between ACEs and health outcomes among children and adolescents with sickle cell disease (SCD) has limited documentation in the published literature.

PROCEDURE">This retrospective cohort study involved 45 children and 30 adolescents. Participants were screened using the Center for Youth Wellness ACE Questionnaire. Parents completed the questionnaire for children. Adolescents provided self-report. ACEs were treated as continuous and categorical scales: 0-1 verus ≥2 original ACEs (individual and/or familial level); 0-1 versus ≥2 additional ACEs (community level); and 0-3 versus ≥4 expanded ACEs (original + additional). Pain and acute chest syndrome events were compared using Wilcoxon rank-sum tests, and correlated with cumulative ACE scores using Spearman's correlation. Multivariable models were fitted to examine the association between ACEs and pain/acute chest syndrome.</Abstr: This retrospective cohort study involved 45 children and 30 adolescents. Participants were screened using the Center for Youth Wellness ACE Questionnaire. Parents completed the questionnaire for children. Adolescents provided self-report. ACEs were treated as continuous and categorical scales: 0-1 verus ≥2 original ACEs (individual and/or familial level); 0-1 versus ≥2 additional ACEs (community level); and 0-3 versus ≥4 expanded ACEs (original + additional). Pain and acute chest syndrome events were compared using Wilcoxon rank-sum tests, and correlated with cumulative ACE scores using Spearman's correlation. Multivariable models were fitted to examine the association between ACEs and pain/acute chest syndrome.

RESULTS">The cumulative number of original ACEs positively correlated with acute chest syndrome events (rho = .53, p = .003) and pain (rho = .40, p = .028) among adolescents. Adolescents with ≥2 versus 0-1 original ACEs had a higher number of acute chest syndrome events (4.9 ± 2.6 vs. 1.6 ± 2.2, p = .002); however, this association was confounded by asthma. Acute chest syndrome events and hospitalizations for pain did not differ among child ACE groups. Emergency department (ED) pain visits were higher among children with ≥4 versus 0-3 expanded ACEs (1.6 ± 2.8 vs. 3.3 ± 3.2, p = .042), even after controlling for SCD genotype, asthma, disease-modifying treatment, and follow-up years (p = .027).</Abstr: The cumulative number of original ACEs positively correlated with acute chest syndrome events (rho = .53, p = .003) and pain (rho = .40, p = .028) among adolescents. Adolescents with ≥2 versus 0-1 original ACEs had a higher number of acute chest syndrome events (4.9 ± 2.6 vs. 1.6 ± 2.2, p = .002); however, this association was confounded by asthma. Acute chest syndrome events and hospitalizations for pain did not differ among child ACE groups. Emergency department (ED) pain visits were higher among children with ≥4 versus 0-3 expanded ACEs (1.6 ± 2.8 vs. 3.3 ± 3.2, p = .042), even after controlling for SCD genotype, asthma, disease-modifying treatment, and follow-up years (p = .027).

CONCLUSION">ACEs are linked to increased morbidity among children and adolescents with SCD. Prospective studies are needed to further understand this relationship and test ACE-protective remedies.© 2021 Wiley Periodicals LLC.</CopyrightInfo: ACEs are linked to increased morbidity among children and adolescents with SCD. Prospective studies are needed to further understand this relationship and test ACE-protective remedies.

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"Racism as a public health issue" APS racism series: at the intersection of equity, science, and social justice
"Racism as a public health issue" APS racism series: at the intersection of equity, science, and social justice
Wright JL, Jarvis JN, Pachter LM, Walker-Harding LR

Pediatr Res 2020 Nov;88(5):696-698

PMID: 32916682

Abstract

No abstract available.
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Pediatric primary care clinicians' views on needs and challenges in caring for infants with intrauterine opioid exposure and their families
Pediatric primary care clinicians' views on needs and challenges in caring for infants with intrauterine opioid exposure and their families
Rohde JF, Canter K, Houff M, Bodt B, Pachter LM, Di Guglielmo MD, Goyal N

J Child Health Care 2023 Apr;():13674935231168676

PMID: 37043307

Abstract

Opioid use disorder (OUD) during pregnancy has risen in the U.S. over the past two decades, resulting in a growing number of children with intrauterine opioid exposure (IOE). Limited research exists supporting best practices to optimize primary care for these children and their families, particularly mothers with OUD. Using a modified Delphi method, we surveyed pediatric primary care clinicians from a single children's health care system regarding their experiences in caring for this population. In Phase 1, open-ended survey questions inquired about needs and challenges facing these infants, their families, and clinicians and resources within primary care. After thematic analysis, the most frequent responses were presented as a Phase 2 survey for clinicians to select their top five. Percentages for the most commonly selected top five themes were tabulated. Survey response rates were 58/139 (42%) for Phase 1 and 45/137 (33%) for Phase 2. For infants with IOE and their families, respondents identified parenting knowledge and family issues related to maternal OUD as top challenges, with limited resources to address them in primary care. Clinicians identified time constraints and follow-up issues as top challenges. Future intervention in pediatric primary care could include addressing parenting education, resource gaps, and best practice recommendations in caring for children with IOE.
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Association of Positional Plagiocephaly and Developmental Delay Within a Primary Care Network
Association of Positional Plagiocephaly and Developmental Delay Within a Primary Care Network
Rohde JF, Goyal NK, Slovin SR, Hossain J, Pachter LM, Di Guglielmo MD

J Dev Behav Pediatr ;42(2):128-134

PMID: 33538454

Abstract

OBJECTIVE">Previous research has suggested an association between plagiocephaly and developmental delay. However, study samples drawn from children seen in subspecialty clinics increase the potential for selection and referral bias. Our study evaluates the association between plagiocephaly and developmental delay and the timing of these diagnoses in a primary care setting, where plagiocephaly is commonly diagnosed and managed.</Abstr: Previous research has suggested an association between plagiocephaly and developmental delay. However, study samples drawn from children seen in subspecialty clinics increase the potential for selection and referral bias. Our study evaluates the association between plagiocephaly and developmental delay and the timing of these diagnoses in a primary care setting, where plagiocephaly is commonly diagnosed and managed.

METHODS">Our retrospective analysis used electronic medical record data from 45 primary care sites within a children's health system from 1999 to 2017, including children aged 0 to 5 years with diagnoses determined by physician diagnosis codes at primary care visits. Children were classified in the plagiocephaly group if diagnosis occurred by 12 months of age. Primary outcome was any developmental delay. Pearson χ2 test, Fisher exact test, and logistic regression analyses were conducted, with multivariable models adjusted for sex, race, ethnicity, insurance, prematurity status (22-36 weeks' gestation), primary care sites, birth year, and diagnoses of abnormal tone and torticollis.</Abstr: Our retrospective analysis used electronic medical record data from 45 primary care sites within a children's health system from 1999 to 2017, including children aged 0 to 5 years with diagnoses determined by physician diagnosis codes at primary care visits. Children were classified in the plagiocephaly group if diagnosis occurred by 12 months of age. Primary outcome was any developmental delay. Pearson χ2 test, Fisher exact test, and logistic regression analyses were conducted, with multivariable models adjusted for sex, race, ethnicity, insurance, prematurity status (22-36 weeks' gestation), primary care sites, birth year, and diagnoses of abnormal tone and torticollis.

RESULTS">Of 77,108 patients seen by 12 months, 2315 (3.0%) were diagnosed with plagiocephaly, with an increase in diagnosis prevalence over the study time frame. Plagiocephaly was independently associated with an increased odds of any developmental delay diagnosis (adjusted odds ratio 1.50, 95% confidence interval 1.32-1.70). The diagnosis of plagiocephaly was recorded before the diagnosis of developmental delay in most cases when both diagnoses were present (374 of 404, 92.6%).</Abstr: Of 77,108 patients seen by 12 months, 2315 (3.0%) were diagnosed with plagiocephaly, with an increase in diagnosis prevalence over the study time frame. Plagiocephaly was independently associated with an increased odds of any developmental delay diagnosis (adjusted odds ratio 1.50, 95% confidence interval 1.32-1.70). The diagnosis of plagiocephaly was recorded before the diagnosis of developmental delay in most cases when both diagnoses were present (374 of 404, 92.6%).

CONCLUSION">Data from a large primary care cohort demonstrate an association between plagiocephaly and developmental delay, affirming findings in previous subspecialty literature.Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.</CopyrightInfo: Data from a large primary care cohort demonstrate an association between plagiocephaly and developmental delay, affirming findings in previous subspecialty literature.

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A Social Network Analysis Approach for Contact Tracing in the Hospital Setting
A Social Network Analysis Approach for Contact Tracing in the Hospital Setting
Ostovari M, Jurkovitz C, Pachter L, Chen D

Dela J Public Health 2020 Aug;6(3):22-25

PMID: 34467124

Abstract

Since the beginning of the COVID-19 pandemic, the State of Delaware has implemented various strategies including a stay-at-home order, mask-wearing requirements in public places, and community-based testing to control the spread of the disease. Health systems across the U.S. have taken actions including symptom monitoring and screening for visitors and healthcare workers, providing personal protection equipment (PPE), and contact tracing of confirmed infected individuals to provide maximum possible protection for healthcare workers. Despite such efforts, there remains a significant risk of intra-hospital transmission of COVID-19. Healthcare workers who contact patients with COVID-19 or were exposed to the disease in the community may transmit the infection to coworkers in the inpatient setting. In addition to universal and case-based precautions to prevent exposure and disease transmission, contact tracing is essential to minimizing the impact of outbreaks among healthcare workers and the community. A rapid increase in cases can quickly diminish hospital infection control and prevention program capacity to perform high-quality contact tracing. This article will describe an approach using the application of social network analysis (SNA) and Electronic Medical Records (EMR) to enhance the current efforts in COVID-19 contact tracings.
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Assessing the Impact of COVID-19 on Children and Youth
Assessing the Impact of COVID-19 on Children and Youth
Pachter LM, Coll CG, Perez-Brena NJ, Lopez LM, Halgunseth LC, Mistry RS, Stein GL, Carlo G

Dela J Public Health 2020 Jul;6(2):40-41

PMID: 34467107

Abstract

No abstract available.
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"Racism as a public health issue" APS racism series: at the intersection of equity, science, and social justice
"Racism as a public health issue" APS racism series: at the intersection of equity, science, and social justice
Wright JL, Jarvis JN, Pachter LM, Walker-Harding LR

Pediatr Res 2020 11;88(5):696-698

PMID: 32916682

Abstract

No abstract available.
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Capacity Building for a New Multicenter Network Within the ECHO IDeA States Pediatric Clinical Trials Network
Capacity Building for a New Multicenter Network Within the ECHO IDeA States Pediatric Clinical Trials Network
Annett RD, Bickel S, Carlson JC, Cowan K, Cox S, Fisher MJ, Jarvis JD, Kong AS, Kosut JS, Kulbeth KR, Laptook A, McElfish PA, McNally MM, Pachter LM, Pahud BA, Pyles LA, Shaw J, Simonsen K, Snowden J, Turley CB, Atz AM

Front Pediatr 2021 ;9():679516

PMID: 34336738

Abstract

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