Bibliographic record
Abstract
Introduction: Pediatric stone disease incidence has increased steadily over the last several years.Several interrelated factors have been proposed to contribute to these epidemiologic trends including increased ambient temperature, body habitus, and food insecurity.Given the significant cohort of children living with food insecurity in the United States, the aim of this study is to explore the relationship between food desert residence and surgical intervention for stone disease in a cohort of pediatric patients.We also discuss a potential new association with pediatric stone disease: psychiatric comorbidity and the medical management of such diagnoses.Methods: Records of pediatric patients who presented to a single tertiary pediatric medical center for nephrolithiasis between 2009 and 2023 were retrospectively reviewed.Patients were included in the study if they were older than five years of age, lacked anatomical predispositions for stone formation, and were regularly consuming a solid diet.Variables studied included demographics, body mass index (BMI), medical comorbidities and family history, procedures performed, and stone burden.Patients' likelihood of living in a food desert was approximated using the United States Department of Agriculture Food Access Research Atlas.Results: Of 572 patients reviewed, 191 pediatric patients (88 male and 103 female) were included in our analysis.Of these, 69.1% (n=132) had undergone ureteroscopy.Fifty-seven patients (28.6%) had a documented psychiatric comorbidity at time of presentation, with attention-deficit/hyperactivity disorder (ADHD) being the most common psychiatric comorbidity treated via medical management (n=25, 43.9%).Our analysis demonstrated a significant association between surgical intervention and medical history of urinary tract infections (UTI) (p=0.038),food desert residence (p=0.002), or increased stone size (p<0.001).Factors associated with longer time between discharge and surgery decision were past medical history of stones (p=0.015),food desert residence (p=0.047), and psychiatric comorbidity (p=0.050).Among patients with psychiatric comorbidities, ADHD diagnosis and stimulant therapy were also significantly associated with longer mean time before procedural intervention (p=0.009 and p=0.02, respectively).Conclusions: In this study, we found a significant association between food desert residence and surgical intervention for pediatric nephrolithiasis.To our knowledge, our study is among the first to assess association between food insecurity and surgical intervention for pediatric nephrolithiasis, as well as a possible relationship between ADHD and surgical management for stones.Given the importance diet plays in medical management of stone development, clinicians should take care to assess food security status of pediatric nephrolithiasis patients.Further research to determine association between ADHD, pediatric nephrolithiasis, and food insecurity is warranted.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.451 | 0.280 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".