Dietas vegetarianas en niños: conocimientos de pediatras de la Sociedad Uruguaya de Pediatría: encuesta 2020 / Vegetarian diet in children: pediatric knowledge from the Uruguayan Society of Pediatrics: 2020 survey / Dietas vegetarianas em crianças: conhecimento dos pediatras da Sociedade Uruguaia de Pediatria: inquérito 2020

Introducción: en los últimos años el incremento de vegetarianos es considerable. Se debe tener cautela al incorporar este tipo de dietas en la población pediátrica. No son contempladas en las actuales guías de nutrición nacionales, generando incertidumbre al realizar recomendaciones. Objetivo: describir los conocimientos sobre dietas vegetarianas en niños por parte de médicos pediatras, posgrados y residentes socios de la Sociedad Uruguaya de Pediatría en el período de junio-setiembre 2020. Determinar la necesidad de incorporar dietas vegetarianas a las guías uruguayas de nutrición pediátrica por parte de los encuestados. Material y método: estudio observacional descriptivo, tipo encuesta transversal, en el período entre junio y setiembre de 2020. Los criterios de inclusión fueron médicos residentes/posgrados en pediatría y pediatras de la Sociedad Uruguaya de Pediatría, de Montevideo y el interior del país. La fuente de datos fue una encuesta online anónima. El análisis de datos fueron frecuencias relativas y absolutas para variables cualitativas. Resultados: se enviaron 1.080 encuestas online, de las que se incluyeron 119. Sobre la autopercepción en el conocimiento de los encuestados, el 58,0% se calificó dentro del rango medio. Acerca del concepto de dieta ovolactovegetariana, 63,9% seleccionó la opción correcta. Más de 50,0% respondió correctamente acerca de conocimientos sobre nutrientes en la mayoría de los ítems. Iniciar estas dietas en la alimentación complementaria fue desaconsejado por el 58% de los socios. Un 79,8% pretende adquirir más conocimientos del tema. Conclusiones: más de la mitad de los profesionales tiene los conocimientos correctos acerca de la correcta planificación y suplementación de dietas vegetarianas en niños. Se destaca la necesidad de incluir dietas vegetarianas en las guías de alimentación pediátrica en territorio uruguayo.

Introduction: the number of vegetarian people has increased considerably in recent years. Caution is suggested when incorporating this type of diet to the pediatric population. This diet has not been contemplated in the current national nutritional guidelines, generating uncertainty among pediatricians when making recommendations. Objective: describe the knowledge Pediatric Physicians and graduate / resident members of the Uruguayan Society of Pediatrics have regarding vegetarian diets in children during the period June-September 2020. Determine the need of the participants of the survey to incorporate vegetarian diet information into the Uruguayan Pediatric Nutritional Guidelines. Materials and methods: descriptive observational study, cross-sectional survey carried out from June to September 2020. The inclusion criteria included resident doctors / postgraduate pediatricians and pediatricians from the Uruguayan Society of Pediatrics of Montevideo and the interior of the country. The data source was an anonymous online survey. The data analyses were relative and absolute frequencies of qualitative variables. Results: 1.080 online surveys were sent and 119 were included. Regarding the respondents' self-perception of knowledge, 58.0% were rated within the medium range. Regarding the concept of lacto-ovo-vegetarian diet, 63.9% selected the correct option. Regarding knowledge about nutrients, we obtained more than 50.0% of correct answers in most of the items. Starting these diets as supplementary food was discouraged by 58% of the participants. 79.8% expressed the intention to acquire more knowledge regarding the subject. Conclusions: more than half of the professionals have the correct knowledge about the correct planning and supplementation of vegetarian diets in children. They stressed the need to include vegetarian diets in pediatric food guidelines in Uruguay.

Introdução: nos últimos anos, o aumento das pessoas vegetarianas tem sido considerável. Deve-se ter cuidado ao incorporar esse tipo de dieta na população pediátrica. Ela não está incluída nas atuais diretrizes nacionais de nutrição, gerando incerteza nos pediatras no momento de fazer recomendações. Objetivo: descrever o conhecimento sobre dietas vegetarianas em crianças dos Pediatras e pós-graduados/residentes da Sociedade Uruguaia de Pediatria no período de junho a setembro de 2020 para poder determinar a necessidade de incorporar dietas vegetarianas às diretrizes nutricionais pediátricas uruguaias. Material e métodos: estudo observacional descritivo, tipo de pesquisa transversal realizada no período de junho a setembro de 2020. Os critérios de inclusão foram médicos residentes/pós-graduados em pediatria e pediatras da Sociedade Uruguaia de Pediatria, Montevidéu e interior do país. A fonte de dados foi uma pesquisa on-line anônima sobre a necessidade de incorporar dietas vegetarianas às diretrizes uruguaias para nutrição pediátrica. As análises dos dados foram frequências relativas e absolutas de variáveis qualitativas. Resultados: 1.080 pesquisas online foram enviadas e 119 foram incluídas. Quanto à autopercepção de conhecimento dos entrevistados, 58,0% foram avaliados dentro da faixa média. Quanto ao conceito de dieta lacto-ovo-vegetariana, 63,9% selecionaram a opção correta. Quanto ao conhecimento sobre nutrientes, obtivemos mais de 50,0% das respostas corretas na maioria dos itens. O início dessas dietas como alimentos suplementares foi desencorajado por 58% dos participantes. 79,8% expressaram a intenção de adquirir mais conhecimento sobre o assunto. Conclusões: mais da metade dos profissionais têm o conhecimento correto sobre o planejamento correto e suplementação de dietas vegetarianas em crianças. Eles enfatizaram a necessidade de incluir dietas vegetarianas nas diretrizes de alimentos pediátricos no Uruguai.

Desenvolvimento de um ambiente virtual de aprendizagem sobre linguagem infantil para pediatras / Development of a virtual learning environment on children's language for pediatricians / Desarrollo de un entorno virtual de aprendizaje del lenguaje infantil para pediatría

Objetivo: desenvolver e analisar um ambiente virtual de aprendizagem (AVA) sobre a aquisição e desenvolvimento da linguagem infantil voltado à orientação de médicos pediatras. Métodos: o conteúdo abordado foi delimitado considerando as dúvidas que os médicos pediatras possuíam sobre a aquisição e o desenvolvimento da linguagem infantil, e construído a partir de revisão da literatura científica. A produção do material seguiu as fases de desenvolvimento de design instrucional englobando análise e planejamento, modelagem, implementação e avaliação. Foram convidados fonoaudiólogos para participar da avaliação da qualidade do conteúdo e dos recursos tecnológicos utilizando o questionário Health-Related Web Site Evaluation Form Emory e o Questionário de Conteúdo desenvolvido pela pesquisadora. Resultados: o conteúdo contemplou as etapas de desenvolvimento da linguagem, principais características e os marcos do desenvolvimento em cada fase. O material confeccionado está disponível no endereço eletrônico http://fonoaudiologiaparapediatras.wordpress.com. Na etapa de avaliação do AVA, participaram 63 fonoaudiólogos que classificaram o blog como excelente para a qualidade e conteúdo. Conclusão: portanto, um AVA, em formato de blog, contendo informações sobre a aquisição e desenvolvimento da linguagem foi desenvolvido a fim de orientar médicos/pediatras desde fases típicas até alterações, prevenção, fases do desenvolvimento e possíveis encaminhamentos.

Objective: to develop and analyze a virtual learning environment (AVA) on the acquisition and development of children's language for the guidance of pediatric physicians. Methods: the content was delimited considering the doubts that pediatricians had about the acquisition and development of children's language and was constructed from a review of the scientific literature. The production of the material followed the developmental stages of instructional design encompassing analysis and planning, modeling, implementation and evaluation. Speech-language pathologists were invited to participate in the assessment of the quality of content and technological resources using the Health-Related Web Site Evaluation Form Emory questionnaire and the Content Questionnaire developed by the researcher. Results: the content included the stages of language development, main characteristics and development milestones in each phase. The material prepared is available at http://fonoaudiologiaparapediatras.wordpress.com. At the AVA evaluation stage, 63 speech-language pathologists who classified the blog as excellent for quality and content participated. Conclusion: an AVA, in a blog format, containing information about the acquisition and development of language was developed in order to guide physicians / pediatricians from typical phases to alterations, prevention, development phases and possible referrals.

Objetivo: desarrollar y analizar un ambiente de aprendizaje virtual (AVA) sobre la adquisición y desarrollo del lenguaje infantil dirigido a la orientación de los médicos pediatras. Metodos: el contenido cubierto se delimitó de las dudas que tenían los médicos pediatras sobre la adquisición y desarrollo del lenguaje infantil, y se construyó a partir de una revisión de la literatura científica. La producción del material siguió las fases de desarrollo del diseño instruccional, incluido el análisis y la planificación, el modelado, la implementación y la evaluación. Se invitó a los logopedas a participar en la evaluación de la calidad del contenido y los recursos tecnológicos utilizando el cuestionario Emory del Formulario de evaluación del sitio web relacionado con la salud y el Cuestionario de contenido desarrollado por el investigador. Resultados: el contenido incluyó las etapas del desarrollo del lenguaje, las principales características e hitos del desarrollo en cada fase. El material elaborado está disponible en la dirección electrónica http://fonoaudiologiaparapediatras.wordpress.com. En la etapa de evaluación de la AVA participaron 63 logopedas, quienes calificaron el blog como excelente por su calidad y contenido. Conclusión: por lo tanto, se desarrolló un AVA, en formato de blog, que contiene información sobre la adquisición y el desarrollo del lenguaje con el fin de orientar a los médicos / pediatras, que van desde las fases típicas hasta los cambios, prevención, fases de desarrollo y posibles derivaciones.

Effect of Training Pediatric Clinicians in Human Papillomavirus Communication Strategies on Human Papillomavirus Vaccination Rates: A Cluster Randomized Clinical Trial.

Importance: Missed opportunities for human papillomavirus (HPV) vaccination during pediatric health care visits are common. Objectives: To evaluate the effect of online communication training for clinicians on missed opportunities for HPV vaccination rates overall and at well-child care (WCC) visits and visits for acute or chronic illness (hereafter referred to as acute or chronic visits) and on adolescent HPV vaccination rates. Design, Setting, and Participants: From December 26, 2018, to July 30, 2019, a longitudinal cluster randomized clinical trial allocated practices to communication training vs standard of care in staggered 6-month periods. A total of 48 primary care pediatric practices in 19 states were recruited from the American Academy of Pediatrics Pediatric Research in Office Settings network. Participants were clinicians in intervention practices. Outcomes were evaluated for all 11- to 17-year-old adolescents attending 24 intervention practices (188 clinicians) and 24 control practices (177 clinicians). Analyses were as randomized and performed on an intent-to-treat basis, accounting for clustering by practice. Interventions: Three sequential online educational modules were developed to help participating clinicians communicate with parents about the HPV vaccine. Weekly text messages were sent to participating clinicians to reinforce learning. Statisticians were blinded to group assignment. Main Outcomes and Measures: Main outcomes were missed opportunities for HPV vaccination overall and for HPV vaccine initiation and subsequent doses at WCC and acute or chronic visits (visit-level outcome). Secondary outcomes were HPV vaccination rates (person-level outcome). Outcomes were compared during the intervention vs baseline. Results: Altogether, 122 of 188 clinicians in intervention practices participated; of these, 120, 119, and 116 clinicians completed training modules 1, 2, and 3, respectively. During the intervention period, 29 206 adolescents (14 664 girls [50.2%]; mean [SD] age, 14.2 [2.0] years) made 15 888 WCC and 28 123 acute or chronic visits to intervention practices; 33 914 adolescents (17 069 girls [50.3%]; mean [SD] age, 14.2 [2.0] years) made 17 910 WCC and 35 281 acute or chronic visits to control practices. Intervention practices reduced missed opportunities overall by 2.4 percentage points (-2.4%; 95% CI, -3.5% to -1.2%) more than controls. Intervention practices reduced missed opportunities for vaccine initiation during WCC visits by 6.8 percentage points (-6.8%; 95% CI, -9.7% to -3.9%) more than controls. The intervention had no effect on missed opportunities for subsequent doses of the HPV vaccine or at acute or chronic visits. Adolescents in intervention practices had a 3.4-percentage point (95% CI, 0.6%-6.2%) greater improvement in HPV vaccine initiation compared with adolescents in control practices. Conclusions and Relevance: This scalable, online communication training increased HPV vaccination, particularly HPV vaccine initiation at WCC visits. Results support dissemination of this intervention. Trial Registration: ClinicalTrials.gov Identifier: NCT03599557.

O pediatra e a Educação Permanente em saúde no Núcleo Ampliado de Saúde da Família e Atenção Básica (Nasf-AB) / The pediatrician and Permanent Health Education in the Amplified Family Health and Primary Care Nucleus (NASF-AB) / El pediatra y la Educación Permanente en Salud en el Núcleo Ampliado de Salud de la Familia y Atención Básica (NASF-AB)

Este estudo teve por objetivo conhecer como se dá a Educação Permanente de pediatras do Núcleo Ampliado de Saúde da Família (Nasf), conhecer sua base de conhecimentos, habilidades, valores, dificuldades e necessidades. Foi realizado estudo exploratório, descritivo qualitativo com informações coletadas em entrevista por escrito e grupo focal com nove dos onze pediatras atuantes. Foram construídas categorias e unidades de análise com base nos elementos essenciais para aprendizagem significativa no núcleo. Observaram-se aspectos educacionais, políticos, sociais e humanos de modo heterogêneo entre equipes de saúde, que levam à construção do autoconhecimento e da autonomia dos atores envolvidos, mas há limitações na compreensão do exercício da Educação Permanente pelos profissionais da saúde. Portanto, faz-se necessário o desenvolvimento de competências desses profissionais e gestores, instrumentalizando-os para a atividade diária de reconhecimento de necessidades, mobilização de saberes, aplicação com reflexão crítica, valores humanos e ética. (AU)

This study aimed to investigate the Permanent Education process of pediatricians belonging to the Amplified Family Health Nucleus and to survey their basis of knowledge, skills, values, difficulties and needs. A descriptive, qualitative and exploratory study analyzed information collected by means of a written interview and a focus group with nine of the eleven active pediatricians. Categories and units of analysis were constructed based on essential elements for significant learning in the nucleus. We found educational, political, social and human aspects that were heterogeneous between health teams. These lead to the construction of the self-knowledge and autonomy of the players involved, but there are limitations to the understanding of the exercise of permanent education by the health professionals. Therefore, it is necessary to develop competences in these professionals and managers, equipping them for the daily activity of recognizing needs, mobilizing knowledge, and applying it with critical reflection, human values and ethics. (AU)

El objetivo de este estudio fue conocer cómo se realiza la Educación Permanente de pediatras del Núcleo Ampliado de Salud de la Familia, conocer su base de conocimientos, habilidades, valores, dificultades y necesidades. Se realizó un estudio exploratorio, descriptivo, cualitativo con informaciones colectadas en entrevista por escrito y grupo focal con nueve de los once pediatras actuantes. Se construyeron categorías y unidades de análisis con base en los elementos esenciales para el aprendizaje significativo en el núcleo. Se observaron aspectos educativos, políticos, sociales y humanos de modo heterogéneo entre equipos de salud que llevan a la construcción del autoconocimiento y de la autonomía de los actores envueltos, pero hay limitaciones en la comprensión del ejercicio de la educación permanente por parte de los profesionales de la salud. Por lo tanto, resulta necesario el desarrollo de competencias en estos profesionales y gestores, instrumentalizándolos para la actividad diaria de reconocimiento de necesidades, movilización de saberes, aplicación con reflexión crítica, valores humanos y ética. (AU)

The impact of pulse oximetry and Integrated Management of Childhood Illness (IMCI) training on antibiotic prescribing practices in rural Malawi: A mixed-methods study.

BACKGROUND: The misdiagnosis of non-malarial fever in sub-Saharan Africa has contributed to the significant burden of pediatric pneumonia and the inappropriate use of antibiotics in this region. This study aims to assess the impact of 1) portable pulse oximeters and 2) Integrated Management of Childhood Illness (IMCI) continued education training on the diagnosis and treatment of non-malarial fever amongst pediatric patients being treated by the Global AIDS Interfaith Alliance (GAIA) in rural Malawi. METHODS: This study involved a logbook review to compare treatment patterns between five GAIA mobile clinics in Mulanje, Malawi during April-June 2019. An intervention study design was employed with four study groups: 1) 2016 control, 2) 2019 control, 3) IMCI-only, and 4) IMCI and pulse oximeter. A total of 3,504 patient logbook records were included based on these inclusion criteria: age under five years, febrile, malaria-negative, and treated during the dry season. A qualitative questionnaire was distributed to the participating GAIA providers. Fisher's Exact Testing and odds ratios were calculated to compare the prescriptive practices between each study group and reported with 95% confidence intervals. RESULTS: The pre- and post-exam scores for the providers who participated in the IMCI training showed an increase in content knowledge and understanding (p<0.001). The antibiotic prescription rates in each study group were 75% (2016 control), 85% (2019 control), 84% (IMCI only), and 42% (IMCI + pulse oximeter) (p<0.001). An increase in pneumonia diagnoses was detected for patients who received pulse oximeter evaluation with an oxygen saturation <95% (p<0.001). No significant changes in antibiotic prescribing practices were detected in the IMCI-only group (p>0.001). However, provider responses to the qualitative questionnaires indicated alternative benefits of the training including improved illness classification and increased provider confidence. CONCLUSION: Clinics that implemented both the IMCI course and pulse oximeters exhibited a significant decrease in antibiotic prescription rates, thus highlighting the potential of this tool in combatting antibiotic overconsumption in low-resource settings. Enhanced detection of hypoxia in pediatric patients was regarded by clinicians as helpful for identifying pneumonia cases. GAIA staff appreciated the IMCI continued education training, however it did not appear to significantly impact antibiotic prescription rates and/or pneumonia diagnosis.

Delivery and Impact of a Motivational Intervention for Smoking Cessation: A PROS Study.

OBJECTIVES: We tested a Public Health Service 5As-based clinician-delivered smoking cessation counseling intervention with adolescent smokers in pediatric primary care practice. METHODS: We enrolled clinicians from 120 practices and recruited youth (age ≥14) from the American Academy of Pediatrics Pediatric Research in Office Settings practice-based research network. Practices were randomly assigned to training in smoking cessation (intervention) or social media counseling (attentional control). Youth recruited during clinical visits completed confidential screening forms. All self-reported smokers and a random sample of nonsmokers were offered enrollment and interviewed by phone at 4 to 6 weeks, 6 months, and 12 months after visits. Measures included adolescents' report of clinicians' delivery of screening and counseling, current tobacco use, and cessation behaviors and intentions. Analysis assessed receipt of screening and counseling, predictors of receiving 5As counseling, and effects of interventions on smoking behaviors and cessation at 6 and 12 months. RESULTS: Clinicians trained in the 5As intervention delivered more screening (ß = 1.0605, P < .0001) and counseling (ß = 0.4354, P < .0001). In both arms, clinicians more often screened smokers than nonsmokers. At 6 months, study arm was not significantly associated with successful cessation; however, smokers in the 5As group were more likely to have quit at 12 months. Addicted smokers more often were counseled, regardless of study arm, but were less likely to successfully quit smoking. CONCLUSIONS: Adolescent smokers whose clinicians were trained in 5As were more likely to receive smoking screening and counseling than controls, but the ability of this intervention to help adolescents quit smoking was limited.

Early Detection and Diagnosis of Autism Spectrum Disorder: Why Is It So Difficult?

Autism spectrum disorder (ASD) affects approximately 2% of children in the United States (US). Therapeutic interventions are most effective if applied early, yet diagnosis often remains delayed, partly because the diagnosis is based on identifying abnormal behaviors that may not emerge until the disorder is well established. Universal screening has been recommended by the America Academy of Pediatrics at 18 and 24 months yet studies show low compliance by pediatricians and the US Preventive Services Task Force does not support universal screening. To better understand the limitations of universal screening this article looks at the performance of screening tests given the prevalence of ASD. Specifically, although the sensitivity and specificity of the Modified Checklist for Autism in Toddlers, Revised with Follow-up, the de facto screening tool, exceeds 90%, the relatively low prevalence of ASD in the general population (∼2%) results in a positive predictive value of about 33%, resulting in only 1 of 3 children identified by the Modified Checklist for Autism in Toddlers, Revised with Follow-up actually having ASD. To mitigate this issue, the America Academy of Pediatrics has recently recommended the use of a Level 2 screener after failing a Level 1 screener, before referring children on for a full comprehensive evaluation for ASD. In this way, a series of screening tools are used to enrich the population of children referred for further evaluation so fewer without an ASD diagnosis are evaluated. We have developed a program to train pediatricians to utilize these instruments as well as learn to diagnose ASD so children can effectively be referred for appropriate services at the front lines. Given the current burden on the medical system with the diagnosis and evaluation of children with ASD, it is important to create efficient systems for screening children which can best identify those most likely to have ASD. Developing methods to identify those children most at risk for developing ASD, either through consideration of medical or family history or through the use of biomarkers, may be helpful in identifying the children that require increased surveillance and those that do not need screening.

Children's Palliative Care; the identified Learning Needs of Paediatricians.

Aim To determine baseline learning needs of Paediatricians in Ireland when caring for children with palliative care needs. Methods A questionnaire based online survey was conducted. Results One hundred and fourteen paediatricians responded to the survey, the majority were Specialist Registrars but almost half were consultant paediatricians (46% n=52). Most had never had formal education in the paediatric palliative care (57% n=48). Areas of future training that were ranked as important or highly important (percentage of respondents) included: pain management (98% n=81), management of the dying child (96% n=80), palliative care resources (95%n=79), advanced care planning (95% n=79) and communication skills (86% n=71). Those surveyed were asked to comment on the challenges of recent clinical interactions, on analysis three overarching themes emerged; best interests of the child, inadequate training and confidence and co-ordinating care. Conclusion This survey highlights the learning needs of paediatricians and will inform the development of meaningful education sessions for doctors.

Conocimiento sobre cuidados paliativos pediátricos de los pediatras de atención primaria del Principado de Asturias, España / Knowledge of primary care pediatricians about pediatric palliative care in the Principality of Asturias, Spain

Resumen Introducción: Es importante conocer y evaluar la experiencia y el conocimiento de los pediatras de atención primaria del Principado de Asturias (España) sobre los cuidados paliativos pediátricos. Métodos: Se llevó a cabo un estudio descriptivo y transversal mediante un cuestionario dirigido a los pediatras de atención primaria del Principado de Asturias entre mayo y junio de 2018. Resultados: El 77% de los participantes no poseía formación previa y el 100% consideró que sus conocimientos en cuanto al tema no eran adecuados, a pesar de que el 37% había atendido en alguna ocasión a pacientes subsidiarios de este tipo de cuidados. Casi la totalidad de los encuestados (97%) consideraron necesaria la creación de una unidad de cuidados paliativos pediátricos. Conclusiones: El conocimiento del pediatra de atención primaria del Principado de Asturias con respecto a los cuidados paliativos pediátricos es muy escaso en una región en la que no se dispone de una unidad pediátrica exclusiva. Sería interesante aprovechar la gran disposición de este grupo de profesionales para mejorar su formación, además de incorporar la materia en facultades y en la formación del médico interno residente.

Abstract Background: To know and assess the experience and knowledge among primary care pediatricians about pediatric palliative care in the Principality of Asturias (Spain). Methods: A descriptive and cross-sectional analysis was conducted using a survey among primary care pediatricians in the Principality of Asturias between May and June 2018. Results: The majority of participants (77%) did not receive previous training, and 100% considered that their knowledge on the subject was insufficient, although 37% had occasionally attended to palliative care patients. Almost all participants (97%) considered that a pediatric palliative care unit is necessary. Conclusions: The knowledge of primary care pediatricians about pediatric palliative care is deficient in the Principality of Asturias, a region where no exclusive pediatric unit exists. It would be interesting to seize the opportunity to improve the training of these pediatricians, given their great willingness, and to incorporating the subject into colleges and medical intern formation as well.

Knowledge of primary care pediatricians about pediatric palliative care in the Principality of Asturias, Spain.

Background: To know and assess the experience and knowledge among primary care pediatricians about pediatric palliative care in the Principality of Asturias (Spain). Methods: A descriptive and cross-sectional analysis was conducted using a survey among primary care pediatricians in the Principality of Asturias between May and June 2018. Results: The majority of participants (77%) did not receive previous training, and 100% considered that their knowledge on the subject was insufficient, although 37% had occasionally attended to palliative care patients. Almost all participants (97%) considered that a pediatric palliative care unit is necessary. Conclusions: The knowledge of primary care pediatricians about pediatric palliative care is deficient in the Principality of Asturias, a region where no exclusive pediatric unit exists. It would be interesting to seize the opportunity to improve the training of these pediatricians, given their great willingness, and to incorporating the subject into colleges and medical intern formation as well.

Introducción: Es importante conocer y evaluar la experiencia y el conocimiento de los pediatras de atención primaria del Principado de Asturias (España) sobre los cuidados paliativos pediátricos. Métodos: Se llevó a cabo un estudio descriptivo y transversal mediante un cuestionario dirigido a los pediatras de atención primaria del Principado de Asturias entre mayo y junio de 2018. Resultados: El 77% de los participantes no poseía formación previa y el 100% consideró que sus conocimientos en cuanto al tema no eran adecuados, a pesar de que el 37% había atendido en alguna ocasión a pacientes subsidiarios de este tipo de cuidados. Casi la totalidad de los encuestados (97%) consideraron necesaria la creación de una unidad de cuidados paliativos pediátricos. Conclusiones: El conocimiento del pediatra de atención primaria del Principado de Asturias con respecto a los cuidados paliativos pediátricos es muy escaso en una región en la que no se dispone de una unidad pediátrica exclusiva. Sería interesante aprovechar la gran disposición de este grupo de profesionales para mejorar su formación, además de incorporar la materia en facultades y en la formación del médico interno residente.

Increasing Vaginal Chlamydia Trachomatis Testing in Adolescent and Young Adults.

OBJECTIVE: The Centers for Disease Control and Prevention recommend testing for Chlamydia trachomatis in sexually active female patients <25 years old using nucleic-acid amplification tests (NAAT) from a vaginal swab. Our providers were typically testing using the less sensitive urine NAATs. We aimed to increase the percentage of urogenital C trachomatis NAATs performed by using vaginal swabs in adolescent female patients ages 10 through 20 years from 1.4% to 25%. METHODS: We implemented 3 interventions at 3 pediatric practices over 12 months including education, process standardization, and cross-training. We used statistical process control to analyze the effect of interventions on our primary outcome: the percentage of urogenital C trachomatis tests performed with a vaginal swab. Our balance measure was the total number of urogenital C trachomatis tests. RESULTS: There were 818 urogenital C trachomatis tests performed: 289 before and 529 after the first intervention. Of urogenital C trachomatis tests in the preintervention time period, 1.4% were performed by using vaginal swabs. We surpassed our aim of 25% 6 weeks after the first intervention. We noted sustained improvement after the second intervention, with an average of 68.3% of tests performed by using vaginal swabs for the remaining postintervention period. There was no difference in the overall number of urogenital C trachomatis tests pre- and postintervention. CONCLUSIONS: Using quality improvement methodology and implementing easily replicable interventions, we significantly and sustainably increased use of vaginal swabs. The interventions standardizing processes were associated with a higher impact than the educational intervention.

A Statewide Tiered System for Screening and Diagnosis of Autism Spectrum Disorder.

Although autism spectrum disorder (ASD) can be reliably detected in the second year of life, the average age of diagnosis is 4 to 5 years. Limitations in access to timely ASD diagnostic evaluations delay enrollment in interventions known to improve developmental outcomes. As such, developing and testing streamlined methods for ASD diagnosis is a public health and research priority. In this report, we describe the Early Autism Evaluation (EAE) Hub system, a statewide initiative for ASD screening and diagnosis in the primary care setting. Development of the EAE Hub system involved geographically targeted provision of developmental screening technical assistance to primary care, community outreach, and training primary care clinicians in ASD evaluation. At the EAE Hubs, a standard clinical pathway was implemented for evaluation of children, ages 18 to 48 months, at risk for ASD. From 2012 to 2018, 2076 children were evaluated (mean age: 30 months; median evaluation wait time: 62 days), and 33% of children received a diagnosis of ASD. Our findings suggest that developing a tiered system of developmental screening and early ASD evaluation is feasible in a geographic region facing health care access problems. Through targeted delivery of education, outreach, and intensive practice-based training, large numbers of young children at risk for ASD can be identified, referred, and evaluated in the local primary care setting. The EAE Hub model has potential for dissemination to other states facing similar neurodevelopmental health care system burdens. Implementation lessons learned and key system successes, challenges, and future directions are reviewed.

Disseminating Education and Treatment for Children and Adolescents with Eating Disorders Across Levels of Care.

BACKGROUND: Eating disorders (EDs) are psychiatric illnesses with high rates of morbidity and mortality. Healthcare providers often receive inadequate training in evidence-based ED assessment and treatment. DESIGN: Project CORE (Creating Opportunities for Rhode Island Eating Disorders Professionals) was developed to disseminate ED training/education and treatment approaches to the healthcare workforce. An interdisciplinary research team partners with pediatric healthcare professionals/trainees and supports them to better understand how to diagnose, manage, and collaborate across disciplines in the care of patients with EDs. METHODS: Phase I involves a needs assessment of pediatric healthcare professionals' knowledge, attitudes and needs in treating EDs. Phase II involves the development of training/education approaches, and therapeutic interventions for patients with EDs. In Phase III approaches/interventions are further developed and disseminated across RI. PRINCIPAL CONCLUSIONS: Project CORE's goals will address barriers to effective ED treatment in RI and broaden the workforce of interdisciplinary providers trained to recognize and treat patients with EDs across multiple healthcare settings.

Analyzing a follow-up needs assessment: Increased use of internet-based APSA educational programs by pediatric surgeons.

PURPOSE: Needs assessment is a critical component of educational program design. Follow-up is important for improvement. Two electronic educational programs, Exam-based Pediatric surgery Educational Reference Tool (ExPERT) and Pediatric Surgery Not a Textbook (NaT), offered by the American Pediatric Surgical Association (APSA) have been functional for over three years, allowing for follow-up assessment. METHODS: A 22-question survey was distributed via email to APSA members. Questions included practice demographics, learning preferences and APSA material use. Mann-Whitney analysis was performed (p<0.05). RESULTS: 294 members responded. 43% were in academic practice with a pediatric surgery fellowship. Top preferences for obtaining/maintaining medical knowledge were national meetings (27%), ExPERT (24%), and the NaT (20%). Comparatively, in a 2014 assessment, electronic programs were less desired (16%). Cost was cited by >1/3 for not subscribing to ExPERT or NaT. Question discussions were often read regardless of response. >86% would subscribe to APSA resources if there were no CME requirement. The most frequently cited knowledge gap was fetal therapy (30%). CONCLUSIONS: This is the first publication documenting increased acceptance of electronic educational platforms for pediatric surgeons. Well-utilized and valued, the data justify and encourage continued development of electronic educational resources. Room for improvement exists in affordability, knowledge gaps, and individualizing curriculum development. LEVEL OF EVIDENCE: IV.

Virtual learning environment in pediatric rheumatology for pediatric residents / Ambiente virtual de aprendizagem em reumatologia pediátrica para residentes em pediatria

ABSTRACT Objective: To develop, implement and evaluate an online virtual learning environment (VLE) on pediatric rheumatology, aimed at pediatric residents, analyzing its effectiveness and satisfaction rates. Methods: A total of 92 first and second year pediatric residents at two pediatric reference centers were invited to participate in the study. Residents were randomized into a case group (that answered the pre-course test, attended the six virtual pediatric rheumatology modules, and then responded to the post-course test and a satisfaction questionnaire) and a control group (that only answered the pre-course test and, after 4 weeks, the post-course test). Results: Forty-seven residents (51%) completed their participation. In the case group (n=24), the mean percentage of correct answers was 14% higher on the post-course test (p<0.001). The number of correct answers was larger in the case group than in the control one (n=23) in the post-course test (p=0.045). In the assessment of satisfaction with VLE use, residents considered the site easy to navigate (91%), suitable as a learning tool (91%), and attractive in design (79%). They reported poor prior knowledge in pediatric rheumatology (91%) and agreed that there was good learning with the methodology (75%). Conclusions: The virtual learning environment in pediatric rheumatology proved to be an effective teaching tool with high satisfaction rates, providing pediatrician residents with adequate knowledge regarding the initial assessment and management of children with rheumatic diseases.

RESUMO Objetivo: Elaborar, implementar e avaliar um ambiente virtual de aprendizagem online em reumatologia pediátrica, direcionado aos residentes em pediatria, analisando sua efetividade e seus índices de satisfação. Métodos: Foram convidados 92 residentes de pediatria do primeiro e segundo anos de dois centros de referência em pediatria. Os residentes foram divididos, de forma randomizada, em grupo caso (que respondeu ao teste pré-curso, assistiu aos seis módulos virtuais de reumatologia pediátrica e, ao término das aulas virtuais, respondeu ao teste pós-curso e ao questionário de satisfação) e grupo controle (que apenas respondeu ao teste pré-curso e, após quatro semanas, ao teste pós-curso). Resultados: Completaram a participação 47 (51%) residentes. No grupo caso (n=24), o percentual de acertos foi 14% maior no teste pós-curso (p<0,001). Houve um percentual de acertos maior no grupo caso em relação ao grupo controle (n=23) na comparação do resultado do teste pós-curso (p=0,045). Na avaliação da satisfação em relação ao uso do ambiente virtual, os residentes consideraram o site de fácil navegação (91%), adequado como ferramenta de aprendizagem (91%) e com design atrativo (79%). Eles relataram um conhecimento prévio ruim em reumatologia pediátrica (91%) e concordaram que houve um bom aprendizado por meio da metodologia (75%). Conclusões: O ambiente virtual de aprendizado em reumatologia pediátrica mostrou-se uma ferramenta de ensino eficaz e com altos índices de satisfação na sua utilização, fornecendo ao residente em pediatria um conhecimento adequado para avaliação e conduta inicial de pacientes com doenças reumáticas da infância.

Accuracy of Closed Reduction of Pediatric Supracondylar Humerus Fractures Is Training in Pediatric Orthopedic Surgery Necessary?

BACKGROUND: Supracondylar humerus fractures account for two thirds of all hospitalizations for elbow injuries in children. A prevailing assumption exists regarding whether treatment quality varies by surgeon training background. This study compares radiographic outcomes of pediatric supracondylar humerus fractures treated by fellowship trained pediatric orthopedists (PO) and non-pediatric orthopedists (adult traumatologists, AT) with regard specifically to ability to obtain and maintain an operative closed reduction. METHODS: We retrospectively reviewed all pediatric patients between 2007 and 2013 operatively treated for closed extension-type supracondylar humerus fractures. Inclusion criteria included skeletally immature patients with Gartland classification type II and III fractures. Eighty-five cases were included with 37 fractures treated by four fellowship trained adult traumatologists at a level I trauma center and 48 fractures treated by five fellowship trained pediatric orthopedists at a tertiary referral center. Radiographs were analyzed for Baumann's angle and shaft-condylar angle, then statistical comparisons were performed to compare preoperative and postoperative measurements. RESULTS: There was no difference in age, gender, laterality, fracture classification, use of medial pins, or neurovascular injuries between PO and AT (p > 0.05). Change in Baumann's angle (p = 0.61) or shaft-condylar angle (p = 0.87) did not differ between PO and AT. There was no significant difference in operative and postoperative Baumann's angle (p = 0.18 and p = 0.59, respectively) and shaft-condylar angle measurements (p = 0.05 and p = 0.09, respectively) between PO and AT. There was no difference in loss of reduction between the two groups (p = 0.64). CONCLUSIONS: Radiographic analysis of supracondylar humerus fractures showed no significant difference in alignment or loss of reduction when treated by pediatric orthopedists compared to non-pediatric orthopedists. Though it seems that the trend is to send pediatric fracture care to tertiary referral centers it may not be necessary for simple fracture management.

Conhecimento de pediatras e residentes sobre fatores de risco associados ao glaucoma cortisônico / Knowledge of pediatricians and residents about risk factors associated with cortisone glaucoma / Conocimiento de pediatras y residentes sobre factores de riesgo asociados al glaucoma cortisónico

Objetivo: avaliar o conhecimento de pediatras e residentes sobre fatores de risco associados ao glaucoma cortisônico. Método: trata-se de um estudo descritivo, quantitativo e prospectivo, realizado em novembro de 2018 com médicos pediatras e residentes de pediatria atuantes na cidade Rio de Janeiro, Brasil, que responderam a um questionário com 12 questões sobre o seu nível de conhecimento em relação aos fatores de risco para o glaucoma cortisônico. As variáveis foram apresentadas por frequência absoluta e relativa, e por medida de tendência central seguida de uma medida de dispersão. Resultados: a maioria dos participantes desconhecem a relação entre o uso de corticosteroides e o desenvolvimento de glaucoma secundário, desconhecem os fatores de risco associados ao desenvolvimento da referida doença, e não encaminham os pacientes sob uso de corticoides para acompanhamento com o oftalmologista. Conclusão: verifica-se a necessidade de criação de campanhas visando informar os médicos sobre a importância de se prescrever os corticosteroides com cautela, e quando a prescrição for necessária. Ressalta-se também, a importância da avaliação por profissional habilitado, especialmente buscando evitar o desenvolvimento do glaucoma cortisônico.(AU)

Objective: to evaluate the pediatricians and pediatric residents' knowledge regarding the risk factors associated with cortisone-induced glaucoma. Method: this is a descriptive, quantitative and prospective study conducted in November 2018 with pediatricians and pediatric residents in the city of Rio de Janeiro, Brazil, who answered a questionnaire with 12 questions about their level of knowledge in relation to the risk factors for cortisone glaucoma. The variables were presented by absolute and relative frequency, and by central tendency measure followed by a dispersion measure. Results: most respondents are unaware of the relationship between the use of corticosteroids and the development of secondary glaucoma, do not know the risk factors associated with the development of this disease, and do not refer patients using corticosteroids for a follow-up with the ophthalmologist. Conclusion: it is necessary to create campaigns to inform physicians about the importance of caution in the corticosteroids prescription, especially in order to avoid the development of cortisone-induced glaucoma.(AU)

Objetivo: evaluar el conocimiento de pediatras y residentes sobre factores de riesgo asociados al glaucoma cortisónico. Método: se trata de un estudio descriptivo, cuantitativo y prospectivo, realizado en noviembre de 2018 con médicos pediatras y residentes de pediatría actuantes en la ciudad Río de Janeiro, Brasil, que respondieron a un cuestionario con 12 preguntas sobre el nivel de conocimiento de los participantes en relación a los factores de riesgo para el glaucoma cortisónico. Las variables fueron presentadas por frecuencia absoluta y relativa, y por medida de tendencia central seguida de una medida de dispersión. Resultados: la mayoría de los participantes desconocen la relación entre el uso de corticosteroides y el desarrollo de glaucoma secundario, desconocen los factores de riesgo asociados al desarrollo de la referida enfermedad, y no encaminan a los pacientes sobre el uso de corticoides para acompañamiento con el oftalmólogo. Conclusión: se verificó la necesidad de crear campañas para informar a los médicos sobre la importancia de prescribir los corticosteroides con cautela, y cuando la prescripción sea necesaria. Se resalta también la importancia de la evaluación por profesional habilitado, especialmente buscando evitar el desarrollo del glaucoma cortisónico.(AU)