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Megan M. Tschudy

Bio: Megan M. Tschudy is an academic researcher from Johns Hopkins University. The author has contributed to research in topics: Health policy & Health care. The author has an hindex of 11, co-authored 23 publications receiving 454 citations. Previous affiliations of Megan M. Tschudy include Johns Hopkins University School of Medicine.

Papers
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Journal ArticleDOI
TL;DR: Observed racial disparities in pediatric asthma are lessened after controlling for material hardship and home ownership, and policy makers could target improving housing quality as a means of potentially reducing asthma disparities.

123 citations

Journal ArticleDOI
TL;DR: The ongoing work of the Health Care Delivery Subcommittee of the Academic Pediatric Association Task Force on Child Poverty is highlighted in defining the ways in which child health care practice can be adapted to improve the approach to addressing child poverty.

88 citations

Journal ArticleDOI
TL;DR: The US should make a commitment to fully addressing the needs of children as part of its national response to the coronavirus disease 2019 pandemic, and target child health and well-being programs that help alleviate disparities in access to health care services.
Abstract: For general pediatricians who have worked in busy practices delivering well-child care, administering immunizations, and supporting children and families with social needs, the empty clinic hallways and examination rooms are a stark reminder of who is missing from the daily news feed about the coronavirus disease 2019 (COVID-19) pandemic: children, particularly those who live in poverty. The rate of serious illness among young children from the novel coronavirus is very low.1 Yet to slow the spread of the virus, all states have closed schools, disrupting routines critical to learning, nutrition, and social development. Directly and indirectly, lowincome children have been forced to subordinate their own well-being for the greater good. To recognize and respect this sacrifice, the US should make a commitment to provide them with the opportunities they have long deserved. In the pre–COVID-19 era, the US was not known for its generosity toward children. Nearly 1 in 5 children in the US live in poverty, a substantially greater proportion than for adults. Poverty disproportionately affects African American, Hispanic, and American Indian/ Alaska Native children.2 The effects of poverty, especially childhood poverty, are pervasive. Childhood poverty is associated with injuries, chronic illness, and mental health difficulties, with consequences lasting not only throughout childhood but also the life course and well into adulthood. Rather than ameliorate these inequities, the US educational system has often reinforced them through insufficient and inequitable funding systems. School districts serving low-income children have more rundown school facilities, fewer curricular offerings, and less experienced teachers.3 Restrictions imposed because of the coronavirus make these challenges more formidable. While school districts are engaging in distance learning, reports indicate wide variability in access to quality educational instruction, digital technology, and internet access. Students in rural and urban school districts are faced with challenges accessing the internet. In some urban areas, as many as one-third of students are not participating in online classes.4 Chronic absenteeism, or missing 10% or more of the school year, affects educational outcomes, including reading levels, grade retention, graduation rates, and high school dropout rates. Chronic absenteeism already disproportionately affects children living in poverty.5 The consequences of missing months of school will be even more marked. Compounding the loss of educational time is the challenge of accessing school resources. More than 30 million children rely on school nutrition programs. With schools closed, emergency food assistance is reaching only a fraction of the children previously served.6 Schools also provide access to consistent and caring adults who can help build resiliency and offer holistic support. School-based health centers, nursing services, and mental health programs help alleviate disparities in access to health care services. To date, the US pandemic response has focused on the health and economic effects facing adults. Children will experience some downstream benefits from this response. However, these measures are insufficient to address their substantial needs and no relief packages have targeted children directly and holistically. The first bill, the US Coronavirus Preparedness and Response Supplemental Appropriations Act, provides $8 billion of support for health care institutions and their workers through funding and personal protective equipment. The second bill, the US Families First Coronavirus Response Act, provides more than $3 billion to support access to free coronavirus testing, paid sick leave, unemployment benefits, and nutrition assistance programs. The third bill, the US Coronavirus Aid, Relief, and Economic Security Act, is a $2 trillion piece of legislation that provides relief for unemployed individuals, including nutrition assistance, small businesses, large corporations, and state and local governments. The fourth bill, the US Paycheck Protection Program and Health Care Enhancement Act, allocates $484 billion for paycheck support, small businesses, hospitals and health care clinicians, and coronavirus testing. This legislation has understandably aimed to contain the pandemic and its economic fallout. While many adults will experience months of challenges, lowincome children are at risk of experiencing consequences for a lifetime. To prevent these harms, the US should commit to fully addressing the needs of children as part of its national response. Future COVID-19 legislation should target child health and well-being. Congress should expand critical programs for low-income children, including additional funding for Medicaid to cover rising demand. The Supplemental Nutrition Assistance Program and the Special Supplemental Nutrition Program for Women, Infants, and Children need an expansion of benefits to reach the rising number of families experiencing food insecurity and income loss. Congress should increase the size of the Earned Income Tax Credit and phase it in more rapidly. The child tax credit should be fully refundable to maximally benefit children in low-income families. Evidencebased programs, such as home visiting and Head Start (US Department of Health & Human Services), need investments to build strong foundations for child development and resilience. VIEWPOINT

74 citations

Journal ArticleDOI
01 Mar 2021-BMJ
TL;DR: The most common symptoms in children with acute SARS-CoV-2 infection (covid-19 disease) are fever and cough, and other symptoms may include sore throat, rhinorrhoea, or congestion, myalgias, headache, fatigue, and gastrointestinal symptoms including nausea, vomiting, or diarrhoea.
Abstract: ### What you need to know The most common symptoms in children with acute SARS-CoV-2 infection (covid-19 disease) are fever and cough. Other symptoms may include sore throat, rhinorrhoea, or congestion, myalgias, headache, fatigue, and gastrointestinal symptoms including nausea, vomiting, or diarrhoea. The range of symptom prevalence is reported from three large meta-analyses, one with 131 studies and 7780 paediatric patients,1 the second with 28 studies and 1614 patients,2 and the third with 46 studies and 551 patients3 and summarised in table 1. Though children have a similar distribution of initial symptoms as compared with adults, children are more likely to have mild, self-resolving symptoms without progression to the lower pulmonary disease that necessitates hospitalisation.4 Dermatological manifestations in children with mild disease are uncommon: acute infection has at times been associated with a maculopapular exanthem, but the pseudo chilblain lesions or “covid toes” seen in adults are rare.56 Although assessing the prevalence of loss of taste or smell among children may be challenging (especially when children …

56 citations

Journal ArticleDOI
TL;DR: How care structures and processes can be altered in ways that align with the needs of families living in poverty are described and adapted depending on the degree of patient need and the availability of practice resources devoted to intervening on the social determinants of health.
Abstract: More than 20% of children nationally live in poverty. Pediatric primary care practices are critical points-of-contact for these patients and their families. Practices must consider risks that are rooted in poverty as they determine how to best deliver family-centered care and move toward action on the social determinants of health. The Practice-Level Care Delivery Subgroup of the Academic Pediatric Association's Task Force on Poverty has developed a roadmap for pediatric providers and practices to use as they adopt clinical practice redesign strategies aimed at mitigating poverty's negative impact on child health and well-being. The present article describes how care structures and processes can be altered in ways that align with the needs of families living in poverty. Attention is paid to both facilitators of and barriers to successful redesign strategies. We also illustrate how such a roadmap can be adapted by practices depending on the degree of patient need and the availability of practice resources devoted to intervening on the social determinants of health. In addition, ways in which practices can advocate for families in their communities and nationally are identified. Finally, given the relative dearth of evidence for many poverty-focused interventions in primary care, areas that would benefit from more in-depth study are considered. Such a focus is especially relevant as practices consider how they can best help families mitigate the impact of poverty-related risks in ways that promote long-term health and well-being for children.

54 citations


Cited by
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01 Sep 2015
TL;DR: An interactive integration self-assessment checklist with immediate feedback linked to guidance and access to the Academy Community, an online forum for peer-topeer networking and sharing.
Abstract: “North Star” goals toward an ideal integrated behavioral health and ambulatory care setting Tips, resources, and real-world examples of how others are doing it What not to do, or the pitfalls to avoid when integrating behavioral health An interactive integration self-assessment checklist with immediate feedback linked to guidance Access to the Academy Community, an online forum for peer-topeer networking and sharing

690 citations

Journal ArticleDOI
23 Aug 2016-JAMA
TL;DR: Funding will allow grantees to test a novel model of health care that includes identifying and addressing social determinants of health for Centers for Medicare & Medicaid Services beneficiaries.
Abstract: Screening for social determinants of health, which are the health-related social circumstances (eg, food insecurity and inadequate or unstable housing) in which people live and work, has gained momentum as evidenced by the recent Centers for Medicare & Medicaid Services innovation initiative of $157 million toward creation of accountable health communities.1 Funding will allow grantees to test a novel model of health care that includes identifying and addressing social determinants of health for Centers for Medicare & Medicaid Services beneficiaries. The initiative promotes collaboration between the clinical realm and the community through screening of beneficiaries to (1) identify unmet health-related social needs and (2) assist high-risk beneficiaries (ie, >2 emergency department visits and a health-related social need) with accessing available community services. Some health policy makers have embraced screening of social determinants as the next hope for achieving the triple aim of better health, improved health care delivery, and reduced costs because social and environmental factors are thought to contribute half

273 citations

Journal ArticleDOI
TL;DR: Clinicians need tools to screen for social determinants of health and to be familiar with available local and national resources to address these issues and are provided with practical screening tools and resources.

200 citations

Journal ArticleDOI
12 Nov 2019-JAMA
TL;DR: This report and its related products ultimately aim to help improve health and health equity, during COVID-19 and beyond by focusing on the integration of social care into the delivery of health care.
Abstract: This report and its related products ultimately aim to help improve health and health equity, during COVID-19 and beyond by focusing on the integration of social care into the delivery of health care

186 citations

Journal ArticleDOI
06 Aug 2020-Obesity
TL;DR: This study aimed to describe changes in families’ home food environment and parent feeding practices, from before to during the coronavirus disease 2019 pandemic, and examine whether changes differed by food security status.
Abstract: OBJECTIVE: This study aimed to describe changes in families' home food environment and parent feeding practices, from before to during the coronavirus disease 2019 (COVID-19) pandemic, and examine whether changes differed by food security status. METHODS: Parents (N = 584) in the US completed a single online survey, reporting on food security, home food availability, and feeding practices both retrospectively (considering before COVID-19) and currently (during COVID-19). χ2 and univariate regressions examined associations by food security status. RESULTS: The percent of families reporting very low food security increased by 20% from before to during COVID-19 (P < 0.01). About one-third of families increased the amount of high-calorie snack foods, desserts/sweets, and fresh foods in their home; 47% increased nonperishable processed foods. Concern about child overweight increased during COVID-19, with a greater increase for food-insecure versus food-secure parents (P < 0.01). Use of restriction, pressure to eat, and monitoring increased, with a greater increase in pressure to eat for parents with food insecurity compared with food-secure parents (P < 0.05). CONCLUSIONS: During COVID-19, increases in very low food security and changes in the home food environment and parent feeding practices were observed. Results highlight the need to address negative impacts of COVID-19 on children's obesity risk, particularly among those facing health disparities.

174 citations