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This policy statement articulates the positions of the American Academy of Pediatrics on graduate medical education and the associated costs and funding mechanisms. It reaffirms the policy of the American Academy of Pediatrics that graduate medical education is a public good and is an essential part of maintaining a high-quality physician workforce. The American Academy of Pediatrics advocates for lifelong learning across the continuum of medical education. This policy statement focuses on the financing of one component of this continuum, namely residency education. The statement calls on federal and state governments to continue their support of residency education and advocates for stable means of funding such as the establishment of an all-payer graduate medical education trust fund. It further proposes a portable authorization system that would allocate graduate medical education funds for direct medical education costs to accredited residency programs on the basis of the selection of the program by qualified student or residents. This system allows the funding to follow the residents to their program. Recognizing the critical workforce needs of many pediatric medical subspecialties, pediatric surgical specialties, and other pediatric specialty disciplines, this statement maintains that subspecialty fellowship training and general pediatrics research fellowship training should receive adequate support from the graduate medical education financing system, including funding from the National Institutes of Health and other federal agencies, as appropriate. Furthermore, residency education that is provided in freestanding children's hospitals should receive a level of support equivalent to that of other teaching hospitals. The financing of graduate medical education is an important and effective tool to ensure that the future pediatrician workforce can provide optimal heath care for infants, children, adolescents, and young adults.

Psychological sequelae are important elements of the burden of disease among caregivers. Recognition of the impact of adversity and stress biomarkers is important to prevent mental health problems that affect rearing practices and child well-being. This cross-sectional study explored social determinants of health (SDoH)-mediated stressors during COVID-19 and risks for mental health problems among caregivers of children with prenatal Zika virus exposure. Twenty-five Hispanic caregivers completed surveys assessing SDoH vulnerabilities, COVID-exposures and impact, post-traumatic stress disorder (PTSD) symptomatology, and provided a hair sample for cortisol concentration (HCC). Most caregivers had low education, household income < $15,000/year, and were unemployed. Stressors included disrupted child education and specialized services, and food insecurity. While most reported PTSD symptomatology, multivariate linear regression models adjusted for the caregiver’s age, education, and the child’s sex, revealed that caregivers with high symptomatology had significantly lower HCC than those with low symptomatology and those with food insecurity had significantly higher HCC than participants without food insecurity. The impact of COVID-19 on daily life was characterized on average between worse and better, suggesting variability in susceptibility and coping mechanisms, with the most resilient identifying community support and spirituality resources. SDoH-mediators provide opportunities to prevent adverse mental health outcomes for caregivers and their children.

Background Dengue, the most prevalent arboviral infection disease worldwide affects more than 2.5 billion people. Puerto Rico has endemic transmission of dengue virus (DENV). Chronic diseases like diabetes mellitus (DM) tend to increase susceptibility to infectious diseases. Diabetes mellitus (DM) is also one of the chronic diseases with higher prevalence in the United States (9.1%) and Puerto Rico (12.8%), and its effect on arboviral infections is understudied. Methods A Sentinel Enhanced Dengue Surveillance System was established in a tertiary hospital in the southern region of Puerto Rico. Study aims are to describe and compare the clinical course and prognosis of dengue in patients with and without the DM co-morbidity. A retrospective case-control study (2012-2015) was performed, where 1,005 participants with confirmed dengue were identified. Results In those with dengue, we examined 57 cases with DM and 171 controls without DM on presentation. Mean age of participants was 40 years old, 31 (54.4%) were males. Relevant clinical features of cases were high blood pressure (HBP) in 51%, muscle pain (70.2%) and joint pain (63.2%). Laboratory results were thrombocytopenia (40%), high creatinine &gt;1.2mg/dl (18.5%), high BUN &gt;20mg/dl (16.6%) and low albumin &lt; 3.4 g/dl (28.7%). For controls, clinical and laboratory results were HBP in 26.9%, muscle pain (64.3%) and joint pain (56.7%); thrombocytopenia (38.6%), high creatinine (4.7%), high BUN (1.8%) and low albumin (21.6%). ANOVA test compared the means of clinical features and laboratory parameters between the case and control groups. The results indicate that high blood pressure, high creatinine and high BUN were significantly more common in cases than in controls (P &lt; 0.01). Cases that had high creatinine (OR = 2.03 [CI: 0.01 – 6.08]), high BUN (OR = 1.30 [CI: 0.93 – 1.81]) and high blood pressure (OR = 1.02 [CI: 0.93 – 1.11]) were more likely to present bleeding, a warning sign for severe dengue. Also, diabetic cases that presented thrombocytopenia were more likely to be admitted to the hospital (OR = 2.64 [CI: 0.36 – 19.37]). Conclusion Understanding the clinical manifestation of dengue in patients with DM can increase clinician awareness of the importance of this co-morbidity in order to implement preventive measures and improve clinical outcomes. Disclosures All Authors: No reported disclosures

Background Influenza is one of the most common viral respiratory diseases in the United States with 9–45 million cases per year. In Puerto Rico, more than 18,000 cases of influenza were reported during the 2019/20 season. The Sentinel Enhanced Dengue Surveillance System (SEDSS) conducts acute febrile illness surveillance for inpatient and outpatients at a southern Puerto Rico tertiary care hospital. Methods We performed a retrospective analysis of disease severity among laboratory-confirmed influenza cases enrolled in SEDSS. Cases with complications such as pneumonia or bronchitis evidenced by chest x-ray or clinical diagnosis were classified as severe. Results Between January 2016 and December 2019, there were 2,835 laboratory-confirmed influenza cases. More than half (1,662, 59%) were aged 0–20 years, 51% (n=1,447)were female, and 4% (n=124)required hospital admission. Among all influenza cases, influenza A virus was most common (n = 1,963, 69%) followed by influenza B virus (n = 872, 31%). Odds of having influenza A were higher among adults (OR=1.62; 95% CI:1.38-1.92). Chronic disease history among influenza cases included: asthma (n= 507, 18%), hypertension (n = 337, 12%), hypercholesterolemia (n = 157, 6%), coronary heart disease (n = 79, 3%), immunodeficiency (n = 11, 1%), and kidney disease (n = 10, 1%). Overall, 61(2%) influenza cases developed complications, 21 developed pneumonia of which 85% had chest x-ray performed. One-third of influenza cases with pneumonia or bronchitis had preexisting conditions like asthma (33%) and hypertension (34%). Seventy five percent of Influenza A cases with asthma developed bronchitis or pneumonia. The odds of having severe Influenza were higher among patients with underlying hypertension compared to those without hypertension (OR= 3.8; 95% CI:2.0–7.1). Moreover, influenza cases with asthma had a higher odd of developing pneumonia or bronchitis as compared to those without asthma (OR=2.3; 95% CI: 1.3–4.0). While asthma is a recognized risk factor for influenza complications, isolated hypertension is not. Conclusion Identifying people at risk for influenza complications provides a guide for clinicians and public health officials to implement preventive measures and improve clinical outcomes. Disclosures All Authors: No reported disclosures