Previous missed visits and independent risk of loss to follow-up in the high-risk neonatal follow-up clinic.

BACKGROUND: Neonatal intensive care unit (NICU) patients are at high risk for developmental delays. As a result, many are seen in neonatal follow-up (NFU) clinics. Disparities in NFU follow-up rates by social determinants of health exist. AIMS: Determine how the number of missed visits (composed of patient-canceled visits and no-show visits) relates to risk of loss to follow-up in the NFU clinic. STUDY DESIGN: Retrospective cohort study at a regional specialty center in the United States. SUBJECTS: 262 patients born between January 1, 2014, and December 31, 2017, who were referred to the NFU clinic. OUTCOME MEASURES: Logistic binomial regression was used to model risk ratio of loss to follow-up over two years, defined as not attending a recommended follow-up visit and not informing the clinic of a reason for discontinued care. RESULTS: Of 262 infants, 220 patients (84 %) were seen for at least one visit and 143 (65 %) completed follow-up. Younger maternal age, maternal smoking during pregnancy, maternal drug use during pregnancy, and public insurance were all associated with missing more visits. For each additional missed visit, the risk of loss to follow-up was 1.73 times higher unadjusted (95 % CI: 1.33, 2.26) and 1.81 times higher (95 % CI: 1.36, 2.40) after adjusting for confounders. The risk ratio of loss to follow-up for no-show visits was three times higher than that for patient-canceled visits. CONCLUSIONS: Each missed visit was independently associated with higher risk of loss to follow-up from NFU clinic, even after adjusting for other risk factors.

Statewide Physician Survey Regarding Pediatric Muslim Fasting.

During Ramadan, Muslims fast from dawn to dusk for the duration of the month. The current literature focuses on adults who fast, with little attention to pediatric practices. An anonymous, digital survey was conducted using Qualtrics software and distributed to residents, fellows, or attendings in Michigan in 2019. Overall, 278 participants were included in the analysis, with 87% (242/278) identifying as pediatric trained physicians. In all, 82% (228/278) of physicians identified as non-Muslim and 76% (211/278) had never partaken in the Muslim fast. About 52% (141/273) of participants had at least a moderate amount of exposure to Muslim pediatric patients in their clinical practice. Most physicians (66%; 175/265) reported they never asked their pediatric patients or their families about fasting. About 61% (167/273) of participants rated their understanding of fasting as minimal to none. Another 52% (142/273) of participants reported feeling somewhat or extremely uncomfortable discussing fasting recommendations with their pediatric patients and their families. Our study is the first of its kind in assessing current knowledge and practice regarding pediatric Muslim fasting among physicians in the United States. In addition, it highlights a gap in physicians' understanding and comfort in providing anticipatory guidance for their Muslim patients.

Pediatric Muslim Fasting Practices in Southeast Michigan: A Community Survey.

During the holy month of Ramadan, Muslims fast from all water, food, and medications from dawn till dusk. To date, the existing medical literature focuses on adult fasting with little attention paid to pediatric fasting practices. An anonymous, digital, bilingual survey was conducted using Qualtrics software. Participants were recruited in-person at various community clinics, businesses, and mosques as well as online via social media. To be eligible for the study, participants must identify as Muslim and be parents or guardians of child/ren between the age/s of 7 and 18. Between July 2017 and May 2018, 918 people took part in the initial survey, with 70% (524/751) of participants living in Wayne County, MI. Approximately 80% (624/779) identified as Arab American and 57% (437/773) as immigrants to the US. Over 63% (522/827) of participants reported that their child's health care provider was unaware that their child/ren fasted during Ramadan. In addition, 75% (613/820) of participants indicated that their child's health care provider did not offer them any medical advice regarding fasting. However, 69% (554/805) of participants reported being comfortable discussing fasting practices with their child's doctor. Furthermore, 80% (569/714), of participants reported that their child/ren's doctor had a good or an advanced understanding of fasting. Our study is an important first step in helping elucidate beliefs and practices about Muslim pediatric fasting in Michigan. In addition, it highlights a stark contrast between the perceptions of parents and the current clinical practice of their physicians.

Partnership for Diversity: A Multidisciplinary Approach to Nurturing Cultural Competence at an Emerging Medical School.

Fostering cultural competence in higher education institutions is essential, particularly in training future health care workers to care for diverse populations. The opportunity to explore techniques to address diversity and cultural competence at a new medical school was undertaken by a multidisciplinary team of librarians, faculty, staff, and medical students. From 2011 to 2015, the team sponsored a voluntary programming series to promote cultural competence and raise awareness of health care disparities for the medical school. Thirteen events were hosted with 562 participants across all. This approach to diversity proved effective and could be adapted in any higher education setting.