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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 -
WMJ : Official Publication of the State... Apr 2021Primary care providers (PCPs) provide general care to patients, including those who are followed by specialists. In the field of rare diseases, there is growing research...
BACKGROUND
Primary care providers (PCPs) provide general care to patients, including those who are followed by specialists. In the field of rare diseases, there is growing research that the primary care needs of these patients are unique to their individual disease state. The purpose of this study is to determine the prevalence of patients with pediatric neuromuscular diseases among a subset of pediatric practices in Southeastern Wisconsin.
METHODS
A retrospective review of all patients with neuromuscular diseases seen at Children's Hospital of Wisconsin (CW) was conducted from January 1, 2016 through September 30, 2018. All patients who were seen by Children's Medical Group (CMG) providers were included, with a division of patients by provider.
RESULTS
Eight hundred eleven (811) unique pediatric neuromuscular patients were identified; 188 patients were included in the study cohort. The median number of patients per provider was 2.5, mean number of patients was 2.68, and mode number of patients was 1.74; 51% of pediatricians within CMG did not care for a pediatric neuromuscular patient.
DISCUSSION
The prevalence of patients with neuromuscular diseases followed by an individual CMG provider is low, with over half of the CMG providers not caring for any patients with neuromuscular diseases. Given the specific primary care knowledge needed to care for these patients, this suggests the need for a novel method of help support these providers.
Topics: Child; Health Personnel; Hospitals, Pediatric; Humans; Pediatricians; Primary Health Care; Retrospective Studies
PubMed: 33974769
DOI: No ID Found -
Annali Di Igiene : Medicina Preventiva... 2022Invasive Meningococcal Disease is a severe disease mainly affecting infants and young children. Most infections are caused by serogroups A, B, C, W, X, and Y. In the... (Observational Study)
Observational Study
BACKGROUND
Invasive Meningococcal Disease is a severe disease mainly affecting infants and young children. Most infections are caused by serogroups A, B, C, W, X, and Y. In the last 10 years, serogroup B has been the main cause of Invasive Meningococcal Disease in Europe. Recent data resulting from an observational study conducted in Italy show a significant reduction in the number of Invasive Meningococcal Disease cases due to Neisseria meningitidis B after the introduction of vaccine 4CMenB. Thus, the Naples Team of Federation of Italian Primary Care Pediatricians and the Public Health Department started an active collaboration focused on vaccination process management (named "Progetto Via") with the aim of increasing Meningococcal B vaccination coverage.
STUDY DESIGN
Source of data is the regional platform "GE.VA.". Every Primary care Pediatrician uses daily to record vaccination activity. This platform is integrated with data entered by operators of the District/Vaccination Center.
METHODS
Time: January 2019 - December 2019. The Federation of Italian Primary Care Pediatricians/Naples organized a meeting to identify six coordinators. The pediatricians could choose to counsel in their own offices and send children to the vaccination center or to counsel and vaccinate directly in their own clinics.
RESULTS
A total of 78 pediatricians took part in the project: 46 did only counseling and 32 did both counseling and vaccination in their medical clinic. Data obtained show an overall average vaccination coverage growth of about 13% in the first 4 months of the survey, and a further growth of about 11% in the following seven months, with a total growth in the entire period of 24%. The pediatricians' counseling is essential to recover non-compliant subjects, considering both the relationship of trust with the families and the visits already scheduled as an ideal moment for vaccinations' status check.
CONCLUSIONS
The project highlights how an effective collaboration between family pediatricians and the Local Health Authority becomes valuable in getting closer to reach the Ministerial goal of 95%. Vaccination coverage increased significantly when family pediatricians supported the activity of vaccine centers in distress in many regional situations. The trust relationship, the hourly availability and the capillary network of family pediatricians' clinics were key elements for the success of this project and were also recognized by parents.
Topics: Child; Child, Preschool; Humans; Infant; Italy; Meningococcal Infections; Meningococcal Vaccines; Pediatricians; Public Health; Vaccination; Vaccination Coverage
PubMed: 34882165
DOI: 10.7416/ai.2021.2490 -
Pediatrics May 2019Most studies on adolescent screening, brief intervention, and referral to treatment (SBIRT) have examined substance use outcomes. However, it may also impact service use... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Most studies on adolescent screening, brief intervention, and referral to treatment (SBIRT) have examined substance use outcomes. However, it may also impact service use and comorbidity-an understudied topic. We address this gap by examining effects of SBIRT on health care use and comorbidities.
METHODS
In a randomized trial sample, we assessed 3 SBIRT care modalities: (1) pediatrician-delivered, (2) behavioral clinician-delivered, and (3) usual. Medical comorbidity and health care use were compared between a brief-intervention group with access to SBIRT for behavioral health (combined pediatrician and behavioral clinician arms) and a group without (usual care) over 1 and 3 years.
RESULTS
Among a sample of eligible adolescents ( = 1871), the SBIRT group had fewer psychiatry visits at 1 year (incidence rate ratio [iRR] = 0.76; = .05) and 3 years (iRR = 0.65; < .05). Total outpatient visits did not differ in year 1. The SBIRT group was less likely to have mental health diagnoses (odds ratio [OR] = 0.69; 95% confidence interval [CI] = 0.48-1.01) or chronic conditions (OR = 0.66; 95% CI = 0.45-0.98) at 1 year compared with those in usual care. At 3 years, the SBIRT group had fewer total outpatient visits (iRR = 0.85; < .05) and was less likely to have substance use diagnoses (OR = 0.64; 95% CI = 0.45-0.91) and more likely to have substance use treatment visits (iRR = 2.04; < .01).
CONCLUSIONS
Providing SBIRT in pediatric primary care may improve health care use and health, mental health, and substance use outcomes. We recommend further exploring the effects of SBIRT on these outcomes.
Topics: Adolescent; Behavior Therapy; Child; Delivery of Health Care, Integrated; Electronic Health Records; Female; Health Behavior; Humans; Male; Patient Acceptance of Health Care; Pediatricians; Primary Health Care; Substance-Related Disorders; Time Factors
PubMed: 31018988
DOI: 10.1542/peds.2018-2803 -
Israel Journal of Health Policy Research Mar 2019Physician burnout and depression have been recognized as serious international problems and the secondary costs of poor physician mental health are substantial....
Physician burnout and depression have been recognized as serious international problems and the secondary costs of poor physician mental health are substantial. Interventions to address this problem can be split into two categories: those focusing on the individual, and those addressing the work environment. Individual-focused programs often include instruction in mindfulness, nutrition, and exercise, while those in the work environment have focused largely on stressors such as administrative burden, electronic health records, and productivity pressures.The recent IJHPR article entitled "Burnout and intentions to quit the practice among community pediatricians: Associations with specific professional activities", by Grosman et al., offers an additional path to address burnout and well-being in pediatricians through increasing of hours in more satisfying professional activities. While "satisfaction" was the metric in this study, what lay at the root of that satisfaction may be deeper and more profound. What the study does not measure is that the less-burned out physicians who felt greater satisfaction may have also felt a greater sense of meaning in their lives.Grossman et al. rightly urge health care managers to encourage diversification of the pediatrician's job by enabling greater engagement in the identified 'anti- burnout' professional activities, however more can and should be done. Physicians themselves should take an active role in both the seeking of, and connection to, meaning. Burnout and frustration, understandably, may have led some doctors to possess a sense of cynicism that has obscured meaning in their lives. If physicians cannot find a path to meaning on their own, they should seek colleague partners, coaches, or therapists to assist. Physicians can advocate for programs to reduce work-force stressors, but they can also advocate for formal programs such as Healers Arts programs, Schwartz rounds, and narrative medicine programs to help reconnect to meaning in their daily clinical work. Brief courses in cognitive behavioral techniques may also help in combating problematic mindsets endemic in medicine such as negativity bias, maladaptive perfectionism, and pessimistic explanatory style. With effort, a growth mindset, and when needed, guidance and some reinforcement, these negative and toxic mindsets can diminish; they can fade, and further open physicians to the healing power of meaning.
Topics: Burnout, Psychological; Humans; Intention; Job Satisfaction; Pediatricians; Personal Satisfaction
PubMed: 30917870
DOI: 10.1186/s13584-019-0303-y -
Indian Pediatrics Jan 2021
Topics: Common Cold; Exanthema; Female; Fever; Humans; Pediatricians
PubMed: 33452799
DOI: 10.1007/s13312-021-2122-9 -
Maternal and Child Health Journal Jan 2024The American Academy of Pediatrics and the American College of Obstetricians and Gynecologists recommend that expectant parents receive a preventive visit with a...
INTRODUCTION
The American Academy of Pediatrics and the American College of Obstetricians and Gynecologists recommend that expectant parents receive a preventive visit with a pediatrician in the prenatal period (a pediatric prenatal visit, or PPV). Discussing newborn health topics in the prenatal period tends to be more effective than immediately postpartum, and research suggests, for example, that the PPV increases timely childhood immunizations. However, only 22% of expectant parents have these visits, and there are significant disparities by race and income.
METHODS
A 2-min online survey with open-ended questions was emailed to 304 eligible obstetrics providers in Rochester, NY. Simple descriptive statistics and chisquare analysis were applied to survey responses. Responses were organized within the framework of knowledge, attitudes, and practices to identify barriers to guideline adherence resulting in chronic under-utilization of the PPV.
RESULTS
Ninety obstetric providers completed the survey. 66 reported awareness of the PPV, and 45 reported referring patients for a PPV. However, in open-ended questions, respondents expressed confusion between the PPV and a "meet and greet" visit with a pediatrician. Some respondents believed that the PPV is not covered by insurance, even though these visits are covered by Medicaid and marketplace insurance. Providers who had personally received one as a parent expressed positive attitudes.
DISCUSSION
These findings indicate that unfamiliarity with the PPV is one barrier to referral. Educating providers about the guideline recommendations, evidence base, and insurance coverage could overcome this barrier. Doing so could reduce disparities in utilization of the pediatric prenatal visit.
Topics: Infant, Newborn; Pregnancy; Female; Child; Humans; United States; Prenatal Care; Obstetrics; Parents; Pediatricians; Surveys and Questionnaires
PubMed: 37864772
DOI: 10.1007/s10995-023-03791-5 -
Current Problems in Pediatric and... Jan 2021This clinical scenario-based review will discuss how telehealth programs improve access to specialty care for neonates, their caregivers, and primary care pediatricians....
This clinical scenario-based review will discuss how telehealth programs improve access to specialty care for neonates, their caregivers, and primary care pediatricians. Tele-resuscitation supports pediatricians during complex, high-risk newborn resuscitations, improves the quality of delivery room care, and reduces odds of transfer to a higher level of care. Neonatologists and other pediatric specialists use telehealth to provide more effective consultations that positively influence management decisions and patient outcomes. When neonatologists provide video visits to home and meet virtually with primary care pediatricians, infants discharged from the NICU experience fewer emergency room visits and hospital re-admissions. With further implementation and dissemination of neonatal telemedicine programs, it is important that these programs continue to be thoughtfully designed to achieve measurable value that is relevant to patients and caregivers, providers, healthcare systems, and payers.
Topics: Child; Humans; Infant, Newborn; Pediatricians; Referral and Consultation; Telemedicine
PubMed: 33531258
DOI: 10.1016/j.cppeds.2021.100952 -
European Journal of Paediatric Dentistry Mar 2022Tooth decay is the main oral pathology and a worldwide public health problem. The paediatrician is the first medical professional to assess and treat children....
AIM
Tooth decay is the main oral pathology and a worldwide public health problem. The paediatrician is the first medical professional to assess and treat children. Therefore, it is important that they are well informed. The aim is to determine the level of dental knowledge of paediatricians practising in the public and private health sectors in Catalonia (Spain).
MATERIAL AND METHODS
Cross-sectional, descriptive, and analytical study of the basic dental knowledge of paediatricians through an anonymous and voluntary survey of 17 questions on prevention, trauma and dental cavities. The results are segmented based on professional experience, type of centre and whether it has a paediatric dentistry area.
RESULTS
A total of 129 paediatricians from Catalonia participated. Almost all paediatricians (86.82%) normally perform an oral examination in a routine visit; 31.8% refer the child to the paediatric dentist when the first permanent molars have erupted, and 41.9% indicate that toothpaste should contain a minimum of 1,000 ppm of fluoride. It is proven that paediatricians practising in the private sector have greater dental knowledge than those in the public sector (p = 0.019). Experience is not related to knowledge (p = 0.0691). The paediatricians who have a paediatric dentistry area in their workplace show greater knowledge (p = 0.046).
CONCLUSION
Only half of the surveyed paediatricians follow the recommendations of paediatric societies on prevention aspects. In dental traumatology, professionals mostly follow the recommendations supported by the literature with high scientific evidence.
Topics: Child; Cross-Sectional Studies; Fluorides; Humans; Pediatric Dentistry; Pediatricians; Surveys and Questionnaires; Toothpastes
PubMed: 36172924
DOI: 10.23804/ejpd.2022.23.01.11 -
International Journal of Environmental... Jul 2020Climate change (CC) is one of the main contributors to health emergencies worldwide. CC appears to be closely interrelated with air pollution, as some pollutants like... (Review)
Review
Climate change (CC) is one of the main contributors to health emergencies worldwide. CC appears to be closely interrelated with air pollution, as some pollutants like carbon dioxide (CO), nitrogen oxides (NOx) and black carbon are naturally occurring greenhouse gases. Air pollution may enhance the allergenicity of some plants and, also, has an adverse effect on respiratory health. Children are a uniquely vulnerable group that suffers disproportionately from CC burden. The increasing global warming related to CC has a big impact on plants' lifecycles, with earlier and longer pollen seasons, as well as higher pollen production, putting children affected by asthma and allergic rhinitis at risk for exacerbations. Extreme weather events may play a role too, not only in the exacerbations of allergic respiratory diseases but, also, in favouring respiratory infections. Even though paediatricians are already seeing the impacts of CC on their patients, their knowledge about CC-related health outcomes with specific regards to children's respiratory health is incomplete. This advocates for paediatricians' increased awareness and a better understanding of the CC impact on children's respiratory health. Having a special responsibility for children, paediatricians should actively be involved in policies aimed to protect the next generation from CC-related adverse health effects. Hence, there is an urgent need for them to take action and successfully educate families about CC issues. This paper aims at reviewing the evidence of CC-related environmental factors such as temperature, humidity, rainfall and extreme events on respiratory allergic diseases and respiratory infections in children and proposing specific actionable items for paediatricians to deal with CC-related health issues in their clinical practice.
Topics: Air Pollution; Allergens; Child; Child Welfare; Climate Change; Humans; Hypersensitivity; Pediatricians
PubMed: 32722291
DOI: 10.3390/ijerph17155344