The Burden of COVID-19 in Children and Its Prevention by Vaccination: A Joint Statement of the Israeli Pediatric Association and the Israeli Society for Pediatric Infectious Diseases.

As of October 2021, SARS-CoV-2 infections were reported among 512,613 children and adolescents in Israel (~33% of all COVID-19 cases). The 5-11-year age group accounted for about 43% (223,850) of affected children and adolescents. In light of the availability of the Pfizer-BioNTech BNT162b2 vaccine against COVID-19 for children aged 5-11 years, we aimed to write a position paper for pediatricians, policymakers and families regarding the clinical aspects of COVID-19 and the vaccination of children against COVID-19. The first objective of this review was to describe the diverse facets of the burden of COVID-19 in children, including the direct effects of hospitalization during the acute phase of the disease, multisystem inflammatory syndrome in children, long COVID and the indirect effects of social isolation and interruption in education. In addition, we aimed to provide an update regarding the efficacy and safety of childhood mRNA COVID-19 vaccination and to instill confidence in pediatricians regarding the benefits of vaccinating children against COVID-19. We reviewed up-to-date Israeli and international epidemiological data and literature regarding COVID-19 morbidity and its sequelae in children, vaccine efficacy in reducing COVID-19-related morbidity and SARS-CoV-2 transmission and vaccine safety data. We conducted a risk-benefit analysis regarding the vaccination of children and adolescents. We concluded that vaccines are safe and effective and are recommended for all children aged 5 to 11 years to protect them from COVID-19 and its complications and to reduce community transmissions. Based on these data, after weighing the benefits of vaccination versus the harm, the Israeli Ministry of Health decided to recommend vaccination for children aged 5-11 years.

The future of telemedicine visits after COVID-19: perceptions of primary care pediatricians.

BACKGROUND: Facing the global health crisis of COVID-19, health systems are increasingly supporting the use of telemedicine in ambulatory care settings. It is not clear whether the increased use of telemedicine will persist after the pandemic has resolved. The aims of this study were to assess the use of telemedicine by Israeli pediatricians before and during the first lockdown phase of the pandemic, and to elucidate how they foresee telemedicine as a medium of medical practice in the post-pandemic era. METHODS: A web-based survey was distributed among Israeli pediatricians in May 2020, soon after the end of first lockdown was announced. The survey assessed the frequency of telemedicine use as well as its influence on clinical decision making before and during the first COVID-19 lockdown, using two hypothetical clinical scenarios. The same scenarios were also used to assess how the pediatricians foresaw telemedicine in the post-pandemic period. In addition, administrative data from Maccabi on telemedicine use before, during and after the first lockdown were retrieved and analyzed. RESULTS: One hundred and sixty-nine pediatricians responded to the survey (response rate = 40%). The percentage of respondents who reported daily use of text messages, pictures and videoconferencing increased from 24, 15 and 1% before COVID-19 to 40, 40 and 12% during the lockdown, respectively (p < 0.05). After the pandemic, projected use of text messages and pictures/videoclips was expected to decrease to 27 and 26% of respondents, respectively (p < 0.05), but pictures/videoclips were expected to increase from 15% of respondents before to 26% of respondents after (p < 0.05). The reported high likelihood of treating suspected pneumonia or prescribing antibiotics for suspected otitis media via telemedicine was expected to decrease from 20% of respondents during the COVID-19 lockdown to 6%% of respondents after (p < 0.05), and from 14% of respondents during the lockdown to 3% of respondents after, respectively. (p < 0.05). Maccabi administrative data indicated that during the lockdown, there was an increase in phone visits and a decrease in in-person visits compared to the pre-lockdown levels of use. One month after the end of the first lock-down there was a partial return to baseline levels of in-person visits and a sustained increase in phone visits. Phone visits accounted for 0% of pediatrician visits before the first lockdown, 17% of them during the lockdown, and 19% of them 1 month after the lockdown relaxation. CONCLUSIONS: The study indicates that use of telemedicine technologies by primary care pediatricians increased substantially during the first COVID-19 lockdown. The study also found that pediatricians expected that use levels will recede after the pandemic. As the pandemic continues and evolves, it will be important to continue to monitor the level of telemedicine use as well as expectations regarding post-pandemic use levels.

Burnout and intentions to quit the practice among community pediatricians: associations with specific professional activities.

BACKGROUND: Burnout is an occupational disease expressed by loss of mental and physical energy due to prolonged and unsuccessful coping with stressors at work. A prior survey among Israeli pediatricians published in 2006 found a correlation between burnout and job structure match, defined as the match between engagement with, and satisfaction from, specific professional activities. The aims of the present study were to characterize the current levels of burnout and its correlates among community pediatricians, to identify changes over time since the prior survey, and to identify professional activities that may reduce burnout. METHODS: A questionnaire was distributed among pediatricians both at a medical conference and by a web-based survey. RESULTS: Of the 518 pediatricians approached, 238 (46%) responded to the questionnaire. High burnout levels were identified in 33% (95% CI:27-39%) of the respondents. Higher burnout prevalence was found among pediatricians who were not board-certified, salaried, younger, and working long hours. The greater the discrepancy between the engagement of the pediatrician and the satisfaction felt in the measured professional activities, the greater was the burnout level (p < 0.01). The following activities were especially associated with burnout: administrative work (frequent engagement, disliked duty) and research and teaching (infrequent engagement, satisfying activities). A comparison of the engagement-satisfaction match between 2006 and 2017 showed that the discrepancy had increased significantly in research (p < 0.001), student tutoring (P < 0.001), continuing medical education and participation in professional conferences (P = 0.0074), management (p = 0.043) and community health promotion (P = 0.006). A significant correlation was found between burnout and thoughts of quitting pediatrics or medicine (p < 0.001). CONCLUSIONS: Healthcare managers should encourage diversification of the pediatrician's job by enabling greater engagement in the identified "anti-burnout" professional activities, such as: participation in professional consultations, management, tutoring students and conducting research.

[NEWBORN DISCHARGE LETTER AS A COMMUNICATION DOCUMENT FOR CONTINUITY OF CARE].

AIMS: To check information items in newborn discharge letters from various delivery rooms and compare them to the expectations of community pediatricians. BACKGROUND: The newborn discharge letter is the document that supports the transition of care from the hospital stay to life at home and in the community. It usually summarizes medical information related to the baby's family, maternal pregnancies, delivery and the stay in hospital until discharge. It is primarily a communication tool between healthcare professionals. It is also a legal document that records basic anthropomorphic and physiologic measurements. METHODS: A comparison of items in discharge letters and a survey among pediatricians. RESULTS: A survey of 104 community pediatricians revealed that the most important information that is expected to appear in a discharge letter includes duration of pregnancy, mode of delivery, APGAR score, birth weight, head circumference, weight at the time of discharge, and the results of hearing screening test and red reflex in the examination of the eyes. Except for the red reflex, all this information appears in the discharge letters of the 19 hospital delivery centers that were checked. Items of information that were rated less important for the community pediatricians were history of previous pregnancies, maternal blood type, time of delivery, baby's length and size of the fontanelle. Inconsistency in the presentation of information in discharge letters was the major concern indicated by community pediatricians. There was a major difference between hospitals with regard to the detailing of instructions to parents about the baby's safety, feeding, and further follow-up in the community. CONCLUSIONS: It is desirable that newborn discharge letters from different hospitals will have more uniformity and more detailed information.

Five-year outcome of children with "growing pains": correlations with pain threshold.

OBJECTIVE: To examine the 5-year outcome in a cohort of children with "growing pains" and the association with changes in pain threshold. STUDY DESIGN: Subjects were 44 children with growing pains studied previously, and controls were 38 pain-free children matched by sex and age. Current status of growing pains and other pain syndromes were assessed by parental questionnaires. Pain threshold was measured with a Fisher-type dolorimeter. Outcomes were correlated with the pain threshold. RESULTS: We examined 35/44 patients (80%) after 5 years. Eighteen patients (51%) experienced resolution of growing pains. In 14 of the 17 patients with persistent growing pains (83%), episodes were less frequent and milder. The prevalence of accompanying pain syndromes decreased from 20% to 14%. No patient developed fibromyalgia. Pain thresholds were similar in the entire growing pains cohort and healthy controls, but those with continued growing pains had significantly lower thresholds than controls (P <.05) and patients with resolved growing pains (P <.02). CONCLUSIONS: We confirm that growing pains has a benign prognosis and probably represents a pain amplification syndrome of early childhood.

Nitrous Oxide sedation for intra-articular injection in juvenile idiopathic arthritis.

BACKGROUND: Intra-articular corticosteroid injection in juvenile idiopathic arthritis (JIA) is often associated with anxiety and pain. Recent reports advocate the use of nitrous oxide (NO), a volatile gas with analgesic, anxiolytic and sedative properties. OBJECTIVE: To prospectively evaluate the effectiveness and safety of NO analgesia for intra-articular corticosteroid injection in JIA, and to assess patients and staff satisfaction with the treatment. METHODS: NO was administered to JIA patients scheduled for joint injection. The patient, parent, physician and nurse completed visual-analog scores (VAS) (0-10) for pain, and a 5-point satisfaction scale. Change in heart rate (HR) during the procedure was recorded in order to examine physiologic response to pain and stress. Patient's behavior and adverse reactions were recorded. RESULTS: 54 procedures (72 joints) were performed, 41 females, 13 males; 39 Jewish, 13 Arab; mean age was 12.2 +/- 4.7 year. The median VAS pain score for patients, parents, physicians and nurses was 3. The HR increased >/= 15% in 10 patients. They had higher VAS scores as evaluated by the staff. The median satisfaction level of the parents and staff was 3.0 and 5.0 respectively. Adverse reactions were mild. CONCLUSION: NO provides effective and safe sedation for JIA children undergoing intra-articular injections.