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Anales de Pediatria Mar 2021Since 2009, the use of off-label and unlicensed drugs has been regulated in Spain. In pediatrics, this exceptional use is more common than in other medical specialties....
Since 2009, the use of off-label and unlicensed drugs has been regulated in Spain. In pediatrics, this exceptional use is more common than in other medical specialties. It varies from 10% to 90% of all prescriptions in children. This variability is due to differences in methodology, classification and sources of information used, and also to the different pediatrics subspecialties. In addition, the knowledge of several pediatricians on this issue is limited and more than half do not comply with the law, in many cases due to ignorance. However, the use of off-label and unlicensed drugs is legal and necessary. The Medicines Committee of the Spanish Association of Pediatrics (CM-AEP) considers that it is necessary to improve the existing information on medicines in the pediatric population. Therefore, the CM-AEP works out a document where suggestions and actions are proposed to achieve it, because children's health deserves it.
Topics: Child; Humans; Off-Label Use; Pediatricians; Pediatrics; Prescriptions; Spain
PubMed: 33509731
DOI: 10.1016/j.anpedi.2020.12.008 -
Jornal de Pediatria 2021To review, analyze, and present the available evidence on the usefulness of point-of-care pulmonary ultrasound in the diagnosis and monitoring of community-acquired... (Review)
Review
OBJECTIVES
To review, analyze, and present the available evidence on the usefulness of point-of-care pulmonary ultrasound in the diagnosis and monitoring of community-acquired pneumonia (CAP), aiming to facilitate its potential inclusion into pediatric clinical reference guidelines.
SOURCE OF DATA
A non-systematic research was carried out in the MEDLINE (PubMed), LILACS, and SciELO databases, from January 1985 to September 2019. The articles that were considered the most relevant were selected.
SYNTHESIS OF DATA
CAP is a relevant cause of morbidity and mortality in pediatrics and its clinical management remains a major challenge. The systematic use of chest X-ray for its diagnosis is controversial because it exposes the child to ionizing radiation and there are interobserver differences in its interpretation. Recently, the use of point-of-care pulmonary ultrasound by the pediatrician has been presented as an alternative for the diagnosis and monitoring of CAP. A great deal of evidence has disclosed its high sensitivity and diagnostic specificity, with the advantages of no ionizing radiation, relatively low cost, immediate results, portability, and the possibility of repetition according to the requirements of disease evolution. Moreover, its use can help rule out possible bacterial etiology and thus prevent inappropriate antibiotic treatments that favor bacterial resistance.
CONCLUSIONS
Point-of-care ultrasonography represents an opportunity to improve the diagnosis and monitoring of CAP. However, as an operator-dependent technique, training is required for adequate image acquisition, correct interpretation, and integration with clinical data for correct decision-making.
Topics: Child; Community-Acquired Infections; Follow-Up Studies; Humans; Pediatricians; Pneumonia; Point-of-Care Systems; Ultrasonography
PubMed: 32781037
DOI: 10.1016/j.jped.2020.07.003 -
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 -
Journal of Paediatrics and Child Health Mar 2022Paediatricians may face the notion of 'virginity' in various situations while caring for children and adolescents, but are often poorly prepared to address this...
Paediatricians may face the notion of 'virginity' in various situations while caring for children and adolescents, but are often poorly prepared to address this sensitive topic. Virginity is a social construct. Despite medical evidence that there is no scientifically reliable way to determine virginity, misconceptions about the hymen and its supposed association with sexual history persist and lead to unethical practices like virginity testing, certificate of virginity or hymenoplasty, which can be detrimental to the health and well-being of females of all ages. The paediatrician has a crucial role in providing evidence-based information and promoting positive sexual education to children, adolescents and parents. Improving knowledge can help counter misconceptions and reduce harms to girls and women.
Topics: Adolescent; Child; Female; Humans; Hymen; Parents; Pediatricians; Sexual Abstinence; Sexual Behavior
PubMed: 35000235
DOI: 10.1111/jpc.15887 -
European Journal of Pediatrics Jan 2021The current outbreak of COVID-19 raging globally is taking a heavy toll on the adult population, with a rapidly growing number of newly infected and critically ill...
The current outbreak of COVID-19 raging globally is taking a heavy toll on the adult population, with a rapidly growing number of newly infected and critically ill patients. However, to date, mortality rate among children is low as they mostly suffer from a mild disease. Yet, other more routinely encountered childhood diseases do not stand still and continue to be the main share of pediatricians' everyday challenges. Here we describe a case series of routinely seen pediatric diseases with delayed diagnosis due to different aspects of what we call "Corona-phobia". These cases were easily collected within a 1-week period which implies that this is a more widespread phenomenon.In conclusion, this raises the possibility that measures taken to mitigate this pandemic may be more damaging to children overall than the virus itself. We believe that pediatricians as well as policy makers should take this important aspect into consideration. What is Known: • COVID-19 manifests as a mild disease in most children; however, children are an important reservoir and may become spreaders of the disease. • Social distancing and isolation are important tools in mitigating COVID-19 transmission. What is New: • This case series describes 7 cases with delayed diagnosis of every-day pediatric diseases that were not caused by COVID-19 but were highly influenced by different aspects of "Corona-phobia". • Our objective is to highlight the possibility that measures taken to mitigate this pandemic may lead to a substantial delay in the diagnosis of other non-COVID-19 related diseases.
Topics: Adolescent; COVID-19; Child; Child, Preschool; Female; Humans; Incidence; Infant, Newborn; Male; Occupational Exposure; Pandemics; Pediatricians; Phobic Disorders; SARS-CoV-2
PubMed: 32661937
DOI: 10.1007/s00431-020-03736-y -
The Laryngoscope Oct 2021To assess and characterize online ratings and comments on pediatric otolaryngologists and determine factors that correlate with higher ratings.
OBJECTIVE/HYPOTHESIS
To assess and characterize online ratings and comments on pediatric otolaryngologists and determine factors that correlate with higher ratings.
STUDY DESIGN
Online database analysis.
METHODS
All American Society of Pediatric Otolaryngology (ASPO) members were queried on Healthgrades, Vitals, RateMDs, and Yelp for their online ratings and comments as of June 2020. Ratings were normalized for comparison on a five-point Likert scale. All comments were categorized based on context and positive or negative quality.
RESULTS
Of the 561 ASPO members, 489 (87%) were rated on at least one online platform. Of those rated, 410 (84%) were on Healthgrades, 429 (88%) on Vitals, 236 (48%) on RateMDs, and 72 (15%) on Yelp. Across all platforms, the average overall rating was 4.13 ± 0.03 (range, 1.00-5.00). We found significant positive correlations between overall ratings and specific ratings (P < .001) on all individual topics. In addition, the majority of all narrative comments were related to perceived physician bedside manner and clinical outcome, with negative comments correlating negatively with overall score (P < .05). Time spent with the physician was the only category in which both positive and negative comments showed significant correlation with the overall physician rating (P = .016 and P = .017, respectively). Attending a top-ranked medical school or residency program did not correlate with higher or lower ratings.
CONCLUSIONS
Online ratings and comments for pediatric otolaryngologists are largely influenced by patient and parent perceptions of physician competence, comforting bedside manner, and office and time management.
LEVEL OF EVIDENCE
NA Laryngoscope, 131:2356-2360, 2021.
Topics: Clinical Competence; Humans; Internet; Internship and Residency; Otolaryngologists; Patient Satisfaction; Pediatricians; Perception; Schools, Medical; Surgeons; United States
PubMed: 33625763
DOI: 10.1002/lary.29479 -
Pediatric Clinics of North America Feb 2023Children suffer disproportionately from disease and disability due to environmental hazards, for reasons rooted in their biology. The contribution is substantial and... (Review)
Review
Children suffer disproportionately from disease and disability due to environmental hazards, for reasons rooted in their biology. The contribution is substantial and increasingly recognized, particularly due to ever-increasing awareness of endocrine disruption. Regulatory actions can be traced directly to reductions in toxic exposures, with tangible benefits to society. Deep flaws remain in the policy framework in industrialized countries, failing to offer sufficient protection, but are even more limited in industrializing nations where the majority of chemical production and use will occur by 2030. Evidence-based steps for reducing chemical exposures associated with adverse health outcomes exist and should be incorporated into anticipatory guidance.
Topics: Child; Humans; Developed Countries; Pediatricians
PubMed: 36402464
DOI: 10.1016/j.pcl.2022.09.003 -
Pediatrician and Child Adolescent Psychiatrist Perspectives of Coordinated Care for Emerging Adults.The Journal of Adolescent Health :... May 2023To explore pediatrician and child/adolescent psychiatrists' perspectives of the role of coordinated care for emerging adults with serious mental health conditions,...
PURPOSE
To explore pediatrician and child/adolescent psychiatrists' perspectives of the role of coordinated care for emerging adults with serious mental health conditions, particularly as they transition to adult care.
METHODS
Semi-structured individual interviews of a purposive sample of 10 pediatricians and 11 child/adolescent psychiatrists in Massachusetts were used to explore coordinated care for emerging adults. Following verbatim transcription and double coding, we conducted a thematic analysis to identify key themes. Care coordination concepts explored included a case discussion, teamwork, communication methods, medication management, transition to adult care, the healthcare home, and youth and family role. Organizational and societal barriers were also discussed.
RESULTS
Providers described key barriers to continuous, coordinated care for youth with serious mental health conditions, including poor communication systems between providers, no organized process for the transition from pediatric to adult care, state licensing laws (particularly impacting college-age youth), inadequate connection to community supports, and poor reimbursement rates for psychiatric care. Termination of primary care in young adults and inadequate medication side effect monitoring were described as key gaps in care.
DISCUSSION
The current system of coordinated care for emerging adults with serious mental health conditions is a perfect storm of challenges that creates a vicious cycle of interconnected barriers which lead to fragmented, discontinuous, and sub-par care for this population.
Topics: Young Adult; Humans; Adolescent; Child; Transition to Adult Care; Delivery of Health Care; Mental Disorders; Psychiatry; Pediatricians; Qualitative Research
PubMed: 36604207
DOI: 10.1016/j.jadohealth.2022.12.002 -
Revista Chilena de Pediatria 2016Current evidence supports the notion that alterations in intrauterine growth and during the first years of life have a substantial effect on the risk for the development... (Review)
Review
Current evidence supports the notion that alterations in intrauterine growth and during the first years of life have a substantial effect on the risk for the development of chronic disease, which in some cases is even higher than those due to genetic factors. The persistence and reproducibility of the phenotypes associated with altered early development suggest the participation of mechanisms that would record environmental cues, generating a cellular reprogramming (i.e., epigenetic mechanisms). This review is an introduction to a series of five articles focused on the participation of epigenetic mechanisms in the development of highly prevalent chronic diseases (i.e., cardiovascular, metabolic, asthma/allergies and cancer) and their origins in the foetal and neonatal period. This series of articles aims to show the state of the art in this research area and present the upcoming clues and challenges, in which paediatricians have a prominent role, developing strategies for the prevention, early detection and follow-up.
Topics: Chronic Disease; Epigenesis, Genetic; Female; Fetal Development; Genetic Predisposition to Disease; Humans; Infant; Infant, Newborn; Pediatricians; Physician's Role; Pregnancy; Reproducibility of Results
PubMed: 26872716
DOI: 10.1016/j.rchipe.2015.12.002 -
Pediatrics and Neonatology Feb 2021
Topics: Humans; Infant, Newborn; Neonatologists; Neonatology; Pediatricians; Surveys and Questionnaires
PubMed: 33610265
DOI: 10.1016/j.pedneo.2021.01.011