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Current Problems in Pediatric and... Mar 2022Pediatricians are uniquely and well positioned to recognize risk factors for and experiences of labor and sex trafficking in children. While clinical and social...
Pediatricians are uniquely and well positioned to recognize risk factors for and experiences of labor and sex trafficking in children. While clinical and social interventions are well discussed in the literature, the underlying mechanisms that cause and contribute to trafficking are poorly addressed among healthcare professionals. A "colorblind" or otherwise "apolitical" approach to trafficking prevention is ineffective and may be detrimental to the patient-practitioner relationship. Pediatricians must be historico-socially aware of the contexts in which they practice to improve the health of pediatric populations. This article addresses the relevant trafficking legal terminology that may be unfamiliar to most pediatricians and focuses on a few "ism"-schisms (capitalism, racism, sexism, cis-heteronormativity, nativism, and classism) that create vulnerability to trafficking in pediatric populations. The article closes with some intervention recommendations and many more prevention-measure recommendations.
Topics: Child; Family; Human Trafficking; Humans; Pediatricians; Policy
PubMed: 35367130
DOI: 10.1016/j.cppeds.2022.101167 -
The Journal of Law, Medicine & Ethics :... 2015Dealing with the continuously increasing rates of families wanting to either significantly delay or completely postpone their infant's vaccines has created an alarmingly...
Dealing with the continuously increasing rates of families wanting to either significantly delay or completely postpone their infant's vaccines has created an alarmingly untenable dilemma for the general pediatricians dealing with these families on a daily basis. Pediatricians must decide whether to continue to provide substandard care by foregoing many or most of the infant's highly recommended protective vaccines, or whether to dismiss from the practice the family who refuses vaccines. Much has been written about why they should retain these families, but this paper will discuss some reasonable rationales as to why nearly 40% of pediatricians choose dismissal of these families.
Topics: Attitude of Health Personnel; Emotions; Humans; Infant; Parents; Pediatricians; Risk; Vaccination Refusal
PubMed: 26479573
DOI: 10.1111/jlme.12306 -
Pediatrics Nov 2018In this article, I explore a tension between one of the aspirations of the standard algorithm for decision-making at the bedside and what will often actually happen at...
In this article, I explore a tension between one of the aspirations of the standard algorithm for decision-making at the bedside and what will often actually happen at the bedside. The aspiration is to avoid physician paternalism, but the algorithm has had the effect of limiting the scope for the exercise of the physician's capacity for practical wisdom, and yet clinical practice often requires the exercise of that capacity. Against this background, I examine the content of shared decision-making in pediatrics. I do the following: point to a feature of the standard algorithm for patient and surrogate (and so also parental) decision-making, make an analytical point about the use of rules versus individual judgments, and examine the elements of the patient-doctor conversation or, in the pediatric realm, the parent-doctor conversation.
Topics: Algorithms; Decision Making; Humans; Parents; Paternalism; Pediatricians; Physician's Role; Physician-Patient Relations; Professional-Family Relations
PubMed: 30385627
DOI: 10.1542/peds.2018-0516K -
Indian Pediatrics Aug 2022
Topics: Humans; Infant, Newborn; Intubation, Intratracheal; Pediatricians; Trachea
PubMed: 35962659
DOI: No ID Found -
BMC Pediatrics Feb 2024The early identification of infants with a risk for neurodevelopmental disorders in the first few years of life is essential for better developmental outcomes....
BACKGROUND
The early identification of infants with a risk for neurodevelopmental disorders in the first few years of life is essential for better developmental outcomes. Screenings should be carried out by combining the family pediatricians' and parents' perspectives, the two fundamental sources of information on children's health. The present study has three aims: (a) to test the feasibility of parent-report instruments to detect warning signs in their children's development; (b) to ascertain whether there is an agreement between the family pediatricians' (FP) clinical judgments of warning signs and the parental perceptions; (c) to determine whether there is a link between parents' distress and child development.
METHODS
Within the NASCITA birth cohort, in addition to the family pediatrician's clinical evaluation with routine tools, the Modified Checklist for Autism in Toddlers, Revised (M-CHAT-R) was completed by parents to assess the child's language, social skills, behavior, and sensory areas. Parents were also asked to complete the Parenting Stress Index, Short Form (PSI-SF) to verify the magnitude of stress in the parent-child system. Univariate and multivariate analyses were performed to evaluate the association between child and parental characteristics and the presence of warning signs.
RESULTS
The follow-up assessment was completed for 435 infants: 69 (15.8%) presented warning signs: 43 in the pediatrician's assessment and 36 in the M-CHAT-R (10 in both). A total of 16 children (14 with warning signs) received a diagnosis after a specialist evaluation. Being male (OR 2.46, 95%CI: 1.23-4.91) and having sleep disorders (OR 2.43, 95% CI 1.17-5.04) was associated with a greater likelihood of warning signs in the multivariate analysis, while reading aloud was a protective factor (not exposed versus exposed (OR = 3.14; 95% CI 1.60-6.17). For 73 children (18.4%), at least one parent tested positive for PSI-SF. An increased prevalence of parental distress was observed in children with warning signs (OR 2.36, 95% CI 1.27-4.37).
CONCLUSIONS
Integrating physician and parental perspectives during well-child visits and in clinical practice appears feasible and can improve the identification of children at risk of developmental disorders.
Topics: Infant; Humans; Male; Female; Parents; Child Development; Autistic Disorder; Neurodevelopmental Disorders; Pediatricians
PubMed: 38388376
DOI: 10.1186/s12887-024-04616-2 -
The Journal of Adolescent Health :... Apr 2018Early intervention for adolescent substance use and mental health problems may mitigate potential harm. We examined patient outcomes from a pragmatic trial of two...
PURPOSE
Early intervention for adolescent substance use and mental health problems may mitigate potential harm. We examined patient outcomes from a pragmatic trial of two modalities of delivering screening, brief intervention, and referral to treatment (SBIRT) and usual care (UC) in pediatric primary care.
METHODS
All clinic pediatricians (n = 52) were randomized to three arms: (1) pediatrician-only, in which pediatricians were trained to deliver SBIRT; (2) embedded behavioral clinician (BC), in which pediatricians were trained to refer eligible adolescents to a BC who administered SBIRT; and (3) UC. Using electronic health record data, changes in past year substance use and depression symptoms between the index visit and next screening visit were examined across treatment arms.
RESULTS
Among patients who endorsed substance use and/or depression symptoms or were eligible for further assessments, brief interventions, and referrals based on clinician assessment at the index visit, 648 patients (mean age = 15.2 [standard deviation = 1.2]) were rescreened at a follow-up visit between 6 months and 2 years later. Among all patients, self-reported substance use rates did not differ over time or across arms, and depression symptoms increased over time. The embedded BC arm had lower odds of having depression symptoms at follow-up than the physician-only arm, and lower odds than the UC arm although not significant; we found no differences between the pediatrician-only and UC arms.
CONCLUSIONS
The increase in depression symptoms over time highlights this population's vulnerability and the importance of developing appropriate interventions. An embedded BC in pediatric primary care trained in SBIRT may benefit patients with depression symptoms.
Topics: Adolescent; Cognitive Behavioral Therapy; Delivery of Health Care; Depression; Female; Humans; Male; Mass Screening; Pediatricians; Primary Health Care; Referral and Consultation; Substance-Related Disorders
PubMed: 29396080
DOI: 10.1016/j.jadohealth.2017.10.016 -
The Journal of Pediatrics Mar 2019
Topics: Health Planning; Health Workforce; Humans; Internship and Residency; Israel; Pediatricians; Pediatrics; Personnel Selection
PubMed: 30798835
DOI: 10.1016/j.jpeds.2018.12.060 -
European Journal of Pediatrics Jan 2021There is limited information on the prevalence of dyslipidemia in the Italian pediatric population. Aim of the study was to evaluate total cholesterol, high-density...
There is limited information on the prevalence of dyslipidemia in the Italian pediatric population. Aim of the study was to evaluate total cholesterol, high-density lipoprotein (HDL)-cholesterol and triglyceride levels, and associated factors in a large sample of Italian children, applying a micro-sampling procedure in the family pediatrician's office. In a population of 1910 children (50.2% males, age 7-11 years), 27.6% was overweight or obese and 28.3% had at least one parent with referred hypercholesterolemia. Total cholesterol and triglyceride levels were elevated in 4.5% and 23.5% of the subjects, respectively, while HDL cholesterol was below 40 mg/dl in 3.3%. Male gender (OR 1.58, 95% CI 1.01-2.49) and positive family history (OR 2.13, 95% CI 1.36-3.32) were independent predictors of hypercholesterolemia, while BMI z-score was associated with low HDL cholesterol (OR 1.46, 95% CI 1.13-1.88) and high levels of triglycerides (OR 1.39, 95% CI 1.26-1.55).Conclusion: The prevalence of dyslipidemia in our sample is worthy of attention. The study suggests the opportunity and feasibility to check for the presence of dyslipidemia at the family pediatrician's office. Familiarity is associated with high cholesterol levels, regardless of the children's weight class, while weight excess identifies subjects with the typical lipid profile of metabolic syndrome. What is Known: • Few data are available on the lipid profile in Italian children. • Early treatment of hypercholesterolemia is effective in reducing cardiovascular events later in life; there is no agreement on how to screen for dyslipidemia in childhood, however. What is New: • In a large sample of Italian children, familiarity doubles the risk of hypercholesterolemia, while increased BMI is associated with low HDL cholesterol levels and hypertriglyceridemia. • The pediatrician may perform an assessment of plasma lipids in his office as a first step to diagnose familial hypercholesterolemia.
Topics: Child; Cholesterol, HDL; Dyslipidemias; Female; Humans; Hypercholesterolemia; Lipids; Male; Pediatricians; Risk Factors; Triglycerides
PubMed: 32613309
DOI: 10.1007/s00431-020-03726-0 -
Military Medicine Jan 2017
Topics: Child; Humans; Interpersonal Relations; Male; Pediatricians; Professional-Family Relations; Pyelonephritis
PubMed: 28051955
DOI: 10.7205/MILMED-D-16-00389 -
JAMA Network Open Jul 2020The 2017 Addendum Guidelines for the Prevention of Peanut Allergy in the United States recommend that pediatricians assess infant peanut allergy risk and introduce...
IMPORTANCE
The 2017 Addendum Guidelines for the Prevention of Peanut Allergy in the United States recommend that pediatricians assess infant peanut allergy risk and introduce peanut in the diet at age 4 to 6 months. Early introduction has the potential to prevent peanut allergy development.
OBJECTIVES
To measure the rates of guideline awareness and implementation and to identify barriers to and factors associated with implementation among US pediatricians.
DESIGN, SETTING, AND PARTICIPANTS
This population-based study survey used a 29-item electronic survey instrument that was administered to pediatricians practicing across the United States from June 1, 2018, to December 1, 2018. Invitations to complete a survey were emailed to all pediatricians in the American Academy of Pediatrics vendor database. Eligible participants were nonretired US-based pediatricians providing general care to infants aged 12 months or younger.
MAIN OUTCOMES AND MEASURES
The primary outcome was the prevalence of guideline implementation, which was measured by 1 survey item about awareness followed by a second item about implementation. Secondary outcomes included identification of guidelines-focused services provided by pediatricians, knowledge of the guidelines (measured with 3 clinical scenarios), barriers to guideline implementation, need for training, and facilitators of guideline implementation.
RESULTS
A total of 1781 pediatricians were eligible to participate and completed the entire survey. Most respondents self-identified as white (1287 [72.5%]) and female (1210 [67.4%]) individuals. Overall, 1725 (93.4%; 95% CI, 92.2%-94.5%) pediatricians reported being aware of the guidelines. Of those pediatricians who had knowledge of the guidelines, 497 (28.9%; 95% CI, 26.8%-31.1%) reported full implementation and 1105 (64.3%; 95% CI, 62.0%-66.6%) reported partial implementation. Common barriers to implementation included parental concerns about allergic reactions (reported by 575 respondents [36.6%; 95% CI, 34.3%-39.1%]), uncertainty in understanding and correctly applying the guidelines (reported by 521 respondents [33.2%; 95% CI, 30.9%-35.6%]), and conducting in-office supervised feedings (reported by 509 respondents [32.4%; 95% CI, 30.1%-34.8%]). Many pediatricians (1175 [68.4%; 95% CI, 66.1%-70.5%]) reported a need for further training on the guidelines.
CONCLUSIONS AND RELEVANCE
This survey found that most pediatrician respondents appeared to know of the 2017 guidelines, but less than one-third of respondents reported full implementation. Results of this study may inform future efforts to eliminate barriers to guideline implementation and adherence, thereby reducing the incidence of peanut allergy in infants.
Topics: Female; Guideline Adherence; Health Knowledge, Attitudes, Practice; Humans; Infant; Male; Peanut Hypersensitivity; Pediatricians; Practice Guidelines as Topic; Practice Patterns, Physicians'; Surveys and Questionnaires; United States
PubMed: 32667655
DOI: 10.1001/jamanetworkopen.2020.10511