Child Health Needs and the Pediatric Endocrinology Workforce: 2020-2040.

The pediatric endocrinology (PE) workforce in the United States is struggling to sustain an adequate, let alone optimal, workforce capacity. This article, one of a series of articles in a supplement to Pediatrics, focuses on the pediatric subspecialty workforce and furthers previous evaluations of the US PE workforce to model the current and future clinical PE workforce and its geographic distribution. The article first discusses the children presenting to PE care teams, reviews the current state of the PE subspecialty workforce, and presents projected headcount and clinical workforce equivalents at the national, census region, and census division level on the basis of a subspecialty workforce supply model through 2040. It concludes by discussing the educational and training, clinical practice, policy, and future workforce research implications of the data presented. Data presented in this article are available from the American Board of Pediatrics, the National Resident Matching Program, and the subspecialty workforce supply model. Aging, part-time appointments, and unbalanced geographic distribution of providers diminish the PE workforce capacity. In addition, limited exposure, financial concerns, and lifestyle perceptions may impact trainees. Additional workforce challenges are the subspecialty's increasingly complex cases and breadth of conditions treated, reliance on international medical graduates to fill fellowship slots, and high relative proportion of research careers. The recent limitations on pediatric endocrinologists providing gender-affirming care may also impact the geographic distribution of the subspecialty's workforce. Deliberate actions need to be taken now to continue serving the needs of children.

Eight Domains of Pediatrician Wellness: A Stakeholder Informed Model.

BACKGROUND: Physician wellness is important to health care systems and quality patient care. There has been limited research clarifying the physician wellness construct. We aimed to develop a stakeholder-informed model of pediatrician wellness. METHODS: We performed a group concept mapping (GCM) study to create a model of pediatrician wellness. We followed the four main steps of GCM and recruited pediatricians at multiple sites and on social media. During brainstorming, pediatricians individually responded to a prompt to generate ideas describing the concept of pediatrician wellness. Second, pediatricians sorted the list of brainstormed ideas into conceptually similar groups and rated them on importance. Sorted data were analyzed to create maps showing each idea as a point, with lines around groups of points to create clusters of wellness. Mean importance scores for each cluster were calculated and compared using pattern match. RESULTS: Pediatricians in this study identified eight clusters of wellness: 1) Experiencing belonging and support at work, 2) Alignment in my purpose, my work, and my legacy, 3) Feelings of confidence and fulfillment at work, 4) Skills and mindset for emotional well-being, 5) Harmony in personal, professional, and community life, 6) Time and resources to support holistic sense of self, 7) Work boundaries and flexibility, and 8) Organizational culture of inclusion and trust. There were no significant differences in mean cluster rating score; the highest rated cluster was Harmony in personal, professional and community life (3.62). CONCLUSION: Pediatricians identified eight domains of wellness, spanning professional and personal life, work, and individual factors.

Vaccine hesitancy among physicians: a qualitative study with general practitioners and paediatricians in Austria and Germany.

OBJECTIVE: This study aims to understand reasons for vaccine hesitancy (VH) among general practioners (GPs) and paediatricians. We aim to analyse how and when the healthcare workers (HCWs) developed vaccine-hesitant views and how they transfer these to patients. DESIGN AND SETTING: Semistructured interviews with vaccine-hesitant GPs and paediatricians were conducted in Austria and Germany using an explorative qualitative research design. PARTICIPANTS: We contacted 41 physicians through letters and emails and 10 agreed to participate, five were male and five female. DATA COLLECTION AND ANALYSIS: Ten interviews were recorded, transcribed verbatim and anonymised. The material was analysed inductively following a grounded theory approach with open coding using the software atlas.ti. RESULTS: Key themes that were identified were education and career path, understanding of medicine and medical profession, experiences with vaccines, doctor-patient interactions and continuous education activities and the link to VH. GPs and paediatricians' vaccine-hesitant attitudes developed during their medical training and, in particular, during extracurricular training in homeopathy, which most of the participants completed. Most participants work in private practices rather than with contracts with social insurance because they are not satisfied with the health system. Furthermore, they are critical of biomedicine. Most of the interview partners do not consider themselves antivaccination, but are sceptical towards vaccines and especially point out the side effects. Most do not vaccinate in their practices and some do only occasionally. Their vaccine-hesitant views are often fostered through respective online communities of vaccine-hesitant HCWs. CONCLUSIONS: More studies on a connection between complementary medicine and vaccine-hesitant views of HCWs are needed. Education about vaccines and infectious diseases among healthworkers must increase especially tailored towards the use of internet and social media. Physicians should be made aware that through time and empathy towards their patients they could have a positive impact on undecided patients and parents regarding vaccine decisions.

Overcoming refusal of treatment in pediatric cancer without legal involvement: A descriptive case series from interviews with pediatric oncologists.

To describe strategies that pediatric oncologists utilize to persuade families to initiate or continue chemotherapy after refusing treatment, we examined transcripts from interviews of oncologists with relevant experience. We identified three cases in which the pediatric oncologists' approaches led to voluntary acceptance of recommended treatment without legal intervention. Strategies used include direct communication with alternative medicine providers, time-limited trial of alternative therapy, and praying with the family. While we cannot conclude whether these approaches could be generalized to other cases, they offer ideas for pediatric oncologists to consider when facing the decision to seek judicial involvement or discontinue persuasive efforts.

Gender-Affirming Care in Children.

Cast into the spotlight because of recent legislative actions, gender-affirming care is a hot topic of discussion across the country when it comes to pediatric health care. And yet there is a great deal of misinformation being perpetuated about gender-affirming care that may be harmful to youth who identify as transgender and gender diverse (TGD). In addition, TGD youth continue to be an underserved and marginalized group that receive disparate health care at baseline. It is our role as pediatricians to understand the current landscape of evidence and guidance available to promote the health of TGD youth while reducing discrimination through education, nonjudgmental holistic treatment, and advocacy at local and national levels. [Pediatr Ann. 2023;52(5):e160-e163.].

Psychosocial supports within pediatric nephrology practices: A pediatric nephrology research consortium survey.

BACKGROUND: The landscape of available psychosocial services within pediatric nephrology care is poorly characterized. However, the effects of kidney disease on emotional health and health-related quality of life are well documented, as is the impact of social determinants of health on kidney disease outcomes. The objectives of this study were to assess pediatric nephrologists' perceptions of available psychosocial services and to elucidate inequities in access to psychosocial care. METHODS: A web-based survey was distributed to members of the Pediatric Nephrology Research Consortium (PNRC). Quantitative analyses were performed. RESULTS: We received responses from 49 of the 90 PNRC centers. With regards to dedicated services, social work was most commonly available (45.5-100%), followed by pediatric psychology (0-57.1%) and neuropsychology (0-14.3%), with no centers having embedded psychiatry. Availability of psychosocial providers was positively associated with nephrology division size, such that as center size increased, access to various psychosocial providers increased. Notably, the majority of respondents indicated that perceived need for psychosocial support exceeds that which is currently available, even at centers with higher levels of current support. CONCLUSIONS: Within the US, there is wide variability in the availability of psychosocial services within pediatric nephrology centers despite a well-documented necessity for the provision of holistic care. Much work remains to better understand the variation in funding for psychosocial services and in utilization of psychosocial professionals in the pediatric nephrology clinic, and to inform key best practices for addressing the psychosocial needs of patients with kidney disease.

Pediatricians' role in healthcare for Latino autistic children: Shared decision-making versus "You've got to do everything on your own".

LAY ABSTRACT: Latino parents may choose to use complementary health approaches, such as vitamins, supplements, and special diets, for their autistic children. However, they might not tell their pediatrician about their complementary health approach use if they worry that the pediatrician will disapprove or judge them. This fear, along with pediatricians' lack of autism knowledge, creates barriers to "shared decision-making" between parents and pediatricians. Shared decision-making is a process where families and healthcare providers collaborate and exchange information in order to come to an agreement about treatment options. In our qualitative study with 12 bilingual Latino families of autistic children, we interviewed and observed families to learn about their experiences with both conventional healthcare (their pediatrician) and complementary health approaches. Our study results describe the parents' different pathways to an autism assessment, a process that is sometimes called the "diagnostic odyssey." The parents reported that conventional healthcare met their needs for their child's physical health but not for their child's developmental challenges. The parents who used complementary health approaches for their autistic children were more frustrated about a lack of autism information from pediatricians than those who did not use complementary health approaches. Finally, we describe two examples of successful shared decision-making between parents and pediatricians. We conclude that pediatricians who are able to talk about complementary health approaches with Latino families may help to facilitate shared decision-making and reduce healthcare disparities for Latino autistic children.

Practical Aspects of ASD Management-What Pediatricians Should Know.

The increasing prevalence of autism spectrum disorder (ASD) warrants higher levels of clinical attention to optimally manage children with ASD. There is mounting evidence that early intervention programs can help improve developmental functioning, maladaptive behaviors, and core ASD symptoms. The most thoroughly investigated and evidence-based therapies have been developmental, behavioral, and educational interventions mediated by either professionals or parents. Other commonly available interventions include speech and language therapy, occupational therapy, and social skills training. Pharmacological interventions, where needed, are used as an adjunct to treat severe problem behaviors and manage medical and psychiatric comorbidities. Complementary or alternative medicine (CAM) approaches have not proven to be of any benefit, and some of them may be harmful to the child. As the child's first point of contact, the pediatrician is well-positioned to effectively guide the families to therapies that are evidence-based and safe and also collaborate with various specialists to provide seamless, coordinated care for these children so as to improve their developmental outcomes and social functioning.

Percepções de familiares sobre uma rede de cuidados de saúde mental infantojuvenil / Family perceptions about a children's mental health network / Percepciones familiares sobre una red de atención de salud mental infantojuvenil

Este artigo pretende conhecer como a rede de cuidados em saúde tem se operacionalizado a partir da percepção de familiares de crianças com demanda de cuidado em saúde mental (SM). Foram realizados dois grupos focais, um com familiares da Atenção Básica (AB) e outro com familiares do Centro de Atenção Psicossocial Infantojuvenil (CAPSij), totalizando 15 participantes. Seguiu-se com a análise lexical do tipo classificação hierárquica descendente, com o auxílio do software R Interface, a fim de análises multidimensionais de textos e questionários (IRaMuTeQ), resultando em cinco classes: A Pílula Mágica; Forças e Fraquezas dos serviços; Procurando por ajuda; Aceitando o diagnóstico da criança e Onde procurei ajuda. Os resultados apontam para dificuldades presentes na AB em identificar e manejar situações de Saúde Mental Infantojuvenil (SMIJ), por meio de uma lógica ainda medicalizante. Ressalta-se que a escola é apresentada como lugar de destaque na produção da demanda por cuidado e a família ainda é pouco convocada à construção das ações. Conclui-se, então, que avanços ainda são necessários para operacionalização de um cuidado pautado nas diretrizes da política de SMIJ.(AU)

This article aims to know how the healthcare network has been operationalized from the perception of family members of children with demand for mental health care (MH). Two focus groups were held, one with family members from Primary Care (PC) and the other with family members from the Child Psychosocial Care Center (CAPSij), totaling 15 participants. A lexical analysis of the descending hierarchical classification type was performed with the help of the software R Interface for multidimensional analyzes of texts and questionnaires (IRAMUTEQ), resulting in five classes: The Magic Pill; Strengths and Weaknesses of services; Looking for help; Accepting the child's diagnosis; and Where did I look for help. The results point to difficulties present in PC in identifying and managing situations of mental health in children and adolescents (MHCA), with a medicalization logic. Note that the school is presented as a prominent place in producing the demand for care, and the family is still not very much involved in the actions. It is, thus, concluded that advances are still needed for operationalization of care guided by MHCA policy guidelines.(AU)

Este artículo tuvo por objetivo conocer cómo opera una red asistencial a partir de la percepción de familiares de niños con demanda de atención en salud mental (SM). Se realizaron dos grupos focales, uno con familiares de Atención Primaria (AP) y otro con familiares del Centro de Atención Psicosocial Infantojuvenil (CAPSij), totalizando 15 participantes. Se realizó análisis léxico del tipo clasificación jerárquica descendente con la ayuda del software Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires (IRAMUTEQ), lo que resultó en cinco clases: "La píldora mágica"; "Fortalezas y debilidades de los servicios"; "En busca de ayuda"; "Aceptar el diagnóstico del niño" y "¿Dónde busqué ayuda?". Los resultados apuntan las dificultades presentes en AP para identificar y manejar situaciones de salud mental infantojuvenil (SMIJ) mediante una lógica aún medicalizante. La escuela tiene un lugar destacado en la producción de la demanda de cuidados y la familia aún no está muy involucrada en la construcción de acciones. Se concluye que se necesitan avances para ofertar una atención guiada por lineamientos de la política del SMIJ.(AU)

El rol del pediatra en la prevención de la fecundidad adolescente / The role of the pediatrician in the prevention of adolescent fertility

La fecundidad adolescente en Cuba es elevada y muestra resistencia a su reducción en los últimos años a pesar de las acciones realizadas. Para promover una sexualidad responsable en los adolescentes, se requiere de un diferente y particular accionar de los pediatras. El objetivo de esta colaboración es aportar elementos que sensibilicen e involucren a los pediatras cubanos para que ofrezcan orientación a los adolescentes sobre el ejercicio de una sexualidad plena, libre y responsable, que contribuya a la reducción de la fecundidad y al cuidado integral de la salud sexual y reproductiva. El método utilizado fue la revisión de las legislaciones vigentes y las recomendaciones de varias sociedades internacionales de pediatría, respecto a la función e importancia de la especialidad en la prevención del embarazo adolescente. Se destacan las ventajas del pediatra para la prevención de la fecundidad adolescente, se explican las habilidades que deben adquirir para informar y orientar a los adolescentes, se analizan las barreras que debe favorecer el acceso del adolescente a la prevención de la fecundidad y se exponen las recomendaciones específicas para su actuación Se concluye que los pediatras cubanos pueden contribuir a la reducción de la fecundidad y mejorar el cuidado integral de la salud sexual y reproductiva de los adolescentes(AU)

Adolescent fertility in Cuba is high and shows resistance to its reduction in recent years despite the actions taken. To promote responsible sexuality in adolescents, a different and particular action of pediatricians is required. The objective of this collaboration is to provide elements that sensitize and involve Cuban pediatricians to offer guidance to adolescents on the exercise of a full, free and responsible sexuality, which contributes to the reduction of fertility and comprehensive care of sexual and reproductive health. The method used was the review of current legislation and the recommendations of several international pediatric societies, regarding the role and importance of the specialty in the prevention of adolescent pregnancy. The advantages of the pediatrician for the prevention of adolescent fertility are highlighted, the skills they must acquire to inform and guide adolescents are explained, the barriers that the pediatrician must face to favor the access of adolescents to prevent fertility are analyzed, and the specific recommendations for the action of the pediatrician in the prevention of adolescent fertility are exposed. It is concluded that Cuban pediatricians can contribute to the reduction of fertility and improve the comprehensive care of sexual and reproductive health of adolescents(AU)

Role of Pediatricians, Pediatric Associations, and Academic Departments in Ensuring Optimal Early Childhood Development Globally: Position Paper of the International Pediatric Association.

ABSTRACT: Early childhood (birth-8 years), particularly the first 3 years, is the most critical time in development because of the highly sensitive developing brain. Providing appropriate developmental care (i.e., nurturing care, as defined by the World Health Organization [WHO]) during early childhood is key to ensuring a child's holistic development. Pediatricians are expected to play a critical role in supporting early childhood development (ECD) through providing developmental services such as developmental monitoring, anticipatory guidance, screening, and referral to medical and/or community-based services when delay is identified. Pediatricians are also expected to serve as advocates within their clinics and communities for improved delivery of ECD services, such as advocating for increasing funding for ECD initiatives, increasing insurance coverage of ECD services, and working to increase other pediatricians' awareness of the principles of ECD and how to deliver developmental services. However, this does not always occur. Typically, pediatricians' training and practice emphasizes treating disease rather than enhancing ECD. Pediatricians are further hindered by a lack of uniformity across nations in guidelines for developmental monitoring and screening. In this article, we present the vision of the International Pediatric Association (IPA) of the roles that pediatricians, academic departments, medical training programs, and pediatric associations should fulfill to help support ECD, including raising ECD to higher levels of priority in routine pediatric care. First, we present the challenges that face these goals in supporting ECD. We then propose, with supportive literature, strategies and resources to overcome these challenges in collaboration with local and international stakeholders, including the IPA, the WHO, UNICEF, and the World Bank.

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.

Utilización de medicinas tradicionales en la población que asiste a un hospital pediátrico de la Ciudad Autónoma de Buenos Aires / Use of traditional medicine in the population attending a children's hospital in the City of Buenos Aires

Introducción. Existen estudios que dan cuenta del uso extendido de la medicina tradicional (MT) en diversos países. La formación del pediatra es escasa en este campo. Objetivo. Describir las características de la MT utilizada por los pacientes de un hospital pediátrico de la Ciudad Autónoma de Buenos Aires. Población y métodos. Diseño cualitativo, basado en la teoría fundada. Entrevista a cuidadores de niños de 0 a 11 años. Resultados. Se entrevistaron 30 personas de diferentes colectividades, la gran mayoría mujeres amas de casa. Casi la totalidad refirió haber utilizado la MT. La fuente de recomendación más utilizada fue la familia. En general, el uso de la MT precede a la consulta a un médico del sistema de salud. Se acude a la MT por entidades definidas por la medicina convencional, pero también por otras propias, como pata de cabra, ojeo y empacho. Las prácticas terapéuticas incluyen la administración de preparados a base de plantas, infusiones, caldos, como también rituales conducidos por curanderos. Todos los usuarios refirieron una valoración positiva de la MT. Una gran parte de los entrevistados consideró importante que el médico conozca y pregunte sobre ella. Todos refirieron que su uso no fue abordado en consultas previas. Conclusiones. La MT se extiende como conocimiento y/o práctica en toda la población estudiada y forma parte de su vida cotidiana. Los métodos utilizados son muy diversos, así como las situaciones para las que se utiliza; las principales causas son de origen gastrointestinal y respiratoria. No es abordada en la consulta pediátrica, pero sus usuarios desearían que lo fuera.

Introduction. Several studies have reported on the widespread use of traditional medicine (TM) in different countries. Pediatricians receive scarce training in this field. Objective. To describe the characteristics of TM used by patients attending a children's hospital in the City of Buenos Aires. Population and methods. Qualitative design based on grounded theory. Interview with caregivers of children aged 0-11 years. Results. Thirty people from different communities were interviewed, mostly homemakers. Almost all referred having used TM. The most common source of recommendation was the family. In general, TM use precedes the visit to a physician in the health system. TM is used to manage conditions defined by conventional medicine, but also to treat folk illnesses such as Simeon's disease, evil eye, and indigestion. Therapeutic practices include plant-based preparations, infusions, broths, as well as other rituals performed by folk healers. All users had a positive opinion about TM. Most interviewees considered that physicians should know and ask about TM. All participants referred that its use had not been addressed in prior visits. Conclusions. TM spreads as knowledge and/ or practice across the studied population and is part of everyday life. TM methods vary greatly, as well as the conditions for which it is used; the main reasons for use included gastrointestinal and respiratory conditions. It is not addressed in pediatric visits, but users wish it was.

Use of traditional medicine in the population attending a children's hospital in the City of Buenos Aires. / Utilización de medicinas tradicionales en la población que asiste a un hospital pediátrico de la Ciudad Autónoma de Buenos Aires.

INTRODUCTION: Several studies have reported on the widespread use of traditional medicine (TM) in different countries. Pediatricians receive scarce training in this field. OBJECTIVE: To describe the characteristics of TM used by patients attending a children's hospital in the City of Buenos Aires. POPULATION AND METHODS: Qualitative design based on grounded theory. Interview with caregivers of children aged 0-11 years. RESULTS: Thirty people from different communities were interviewed, mostly homemakers. Almost all referred having used TM. The most common source of recommendation was the family. In general, TM use precedes the visit to a physician in the health system. TM is used to manage conditions defined by conventional medicine, but also to treat folk illnesses such as Simeon's disease, evil eye, and indigestion. Therapeutic practices include plant-based preparations, infusions, broths, as well as other rituals performed by folk healers. All users had a positive opinion about TM. Most interviewees considered that physicians should know and ask about TM. All participants referred that its use had not been addressed in prior visits. CONCLUSIONS: TM spreads as knowledge and/ or practice across the studied population and is part of everyday life. TM methods vary greatly, as well as the conditions for which it is used; the main reasons for use included gastrointestinal and respiratory conditions. It is not addressed in pediatric visits, but users wish it was.

uso extendido de la medicina tradicional (MT) en diversos países. La formación del pediatra es escasa en este campo. OBJETIVO: Describir las características de la MT utilizada por los pacientes de un hospital pediátrico de la Ciudad Autónoma de Buenos Aires. Población y métodos. Diseño cualitativo, basado en la teoría fundada. Entrevista a cuidadores de niños de 0 a 11 años. RESULTADOS: Se entrevistaron 30 personas de diferentes colectividades, la gran mayoría mujeres amas de casa. Casi la totalidad refirió haber utilizado la MT. La fuente de recomendación más utilizada fue la familia. En general, el uso de la MT precede a la consulta a un médico del sistema de salud. Se acude a la MT por entidades definidas por la medicina convencional, pero también por otras propias, como pata de cabra, ojeo y empacho. Las prácticas terapéuticas incluyen la administración de preparados a base de plantas, infusiones, caldos, como también rituales conducidos por curanderos. Todos los usuarios refirieron una valoración positiva de la MT. Una gran parte de los entrevistados consideró importante que el médico conozca y pregunte sobre ella. Todos refirieron que su uso no fue abordado en consultas previas. CONCLUSIONES: La MT se extiende como conocimiento y/o práctica en toda la población estudiada y forma parte de su vida cotidiana. Los métodos utilizados son muy diversos, así como las situaciones para las que se utiliza; las principales causas son de origen gastrointestinal y respiratoria. No es abordada en la consulta pediátrica, pero sus usuarios desearían que lo fuera.

Clinical outcomes and cost-effectiveness of large-scale midwifery-led, paediatrician-overseen home phototherapy and neonatal jaundice surveillance: A retrospective cohort study.

AIM: To evaluate a large midwifery-led, paediatrician-overseen home jaundice surveillance and home phototherapy (HPT) programme. METHODS: We conducted a retrospective cohort study over 2019. Included were all infants with birth gestation ≥35 weeks, discharged at 4-96 h and receiving care from midwifery-at-home (a 12-h daily, 365-days hospital-based outreach service, supported by hospital paediatricians). Phototherapy was delivered via BiliSoft blanket with treatment thresholds determined by standard nomograms. The main outcomes of interest were unplanned readmissions, and cost-effectiveness based on hospital finance department actual costs. Also examined were parental compliance, device issues and safety. RESULTS: During 2019, 4308 infants received home jaundice surveillance with 86% hospital-discharged before 72 h, 82% exclusively breastfed and 69% having overseas-born mothers. Four hundred infants received HPT, comprising 101 continuing from inpatient phototherapy (IPT), 56 rebounding after IPT, and 243 home-diagnosed as needing phototherapy and triaged to HPT. Only 1 of 400 (0.25%) HPT infants required readmission. Additionally, there were 80 home-diagnosed jaundiced infants triaged to immediate readmission for IPT. Maximal serum bilirubin was 454 µmol/L. No exchange transfusion, encephalopathy or HPT-device problems occurred. An early 2019 bilirubin analyser upgrade resulted in higher bilirubin readings and some unintended subthreshold phototherapy. Supported by midwives, most parents managed HPT with ease. HPT cost $640/day compared to $2100/day for infant IPT readmission and $1000/day for a longer birth-admission stay. Up to 2 weeks' midwifery-at-home care for the whole cohort cost $2 m less than a 2-day longer birth-admission stay. CONCLUSION: Large-scale, midwifery-led, paediatrician-overseen jaundice surveillance and HPT can achieve very low unplanned readmission rates and be cost-effective.

Results of a national survey on knowledge and use of complementary and alternative medicine by paediatricians.

INTRODUCTION: The use of certain Complementary and Alternative Medicines (CAM) in children has been documented in Spain. The main aim of this study is to estimate the knowledge, recommendations, and use of CAM by Spanish paediatricians. MATERIAL AND METHODS: A national study was conducted from June to July 2020 using an online questionnaire. Two e-mails were sent to paediatricians who were members of the Spanish Association of Paediatrics (AEP). RESULTS: Out of 1414 responses received, acupuncture was considered as a science by 31.8%. Homeopathy was recommended to parents by 28.1%. CAM was used by 21.3% of physicians, at least once, to improve their own health. Only 3.8% had ever replaced a conventional treatment with CAM. The following variables were associated with a greater disposition to prescribe homeopathy: female, age over 45 years old, paediatricians working in Primary Care, and paediatricians working in private healthcare. CONCLUSIONS: This AEP Committee on Medicines questionnaire provides new data that should be considered alarming and should ask for a serious thinking on the use of CAM in Spain. Some paediatricians are recommending parents to give treatments not supported by scientific evidence to their children. This practice could be potentially harmful, especially when conventional treatment is being replaced.

Design and Assessment of a Mobile Health Care Solution for the Military Pediatrician: The DHA Pediatrics App.

INTRODUCTION: Mobile health technology design and use by patients and clinicians have rapidly evolved in the past 20 years. Nevertheless, the technology has remained in silos of practices, patients, and individual institutions. Uptake across integrated health systems has lagged. MATERIALS AND METHODS: In 2015, the authors designed a mobile health application (App) aimed at augmenting the capabilities of clinicians who care for children within the Military Health System (MHS). This App incorporated a curated, system-based collection of Clinical Practice Guidelines, access to emergency resuscitation cards, call buttons for local market subspecialty and inpatient teams, links to residency academic calendars, and other web-based resources. Over the next 5 years, three Plan-Do-Study-Act cycles facilitated multiple enhancements for the App which eventually transitioned from the Android/iOS stores to a web browser. The "People At the Centre of Mobile Application Development" tool which has validity evidence captured user experience. The team assessed the App's global effectiveness using Google Analytics. A speed test measured time saved and accuracy of task completion for clinicians using the App compared to non-users. Finally, MHS medical librarians critiqued the App using a questionnaire with validity evidence. The Walter Reed National Military Medical Center Institutional Review Board reviewed the study and deemed it exempt. RESULTS: Clinician respondents (n = 68 complete responses across six MTFs, 51% graduate medical trainees representing a 7.4% response rate of active duty pediatrician forces) perceived the App to have appropriate qualities of efficiency, effectiveness, learnability, memorability, errors, satisfaction, and cognitive properties following App use in clinical practice. Google Analytics demonstrated more than 1,000 unique users on the App from May 1, 2020 to January 20, 2021. There were 746 instances (26% of all sessions) when a user navigated between more than one military treatment facility. App users were faster and more accurate at task completion during a digital scavenger hunt. Medical librarians measured the App to have acceptable usefulness, accuracy, authority, objectivity, timeliness, functionality, design, security, and value. CONCLUSIONS: The App appears to be an effective tool to extend a clinician's capabilities and inter-professional communication between world-wide users and six MHS markets. This App was designed-and used-for a large health care network across a wide geographic footprint. Next steps are establishing an enduring chain of App champions for continued updates and sharing the App's code with other military medical disciplines and interested civilian centers.

Development and Assessment of an Abbreviated Acupuncture Curriculum for Pediatricians.

OBJECTIVE: Acupuncture has been shown to improve pain and other health outcomes in children and is well tolerated. However, use of acupuncture by pediatric medical providers is rare, in part due to the cost and time associated with formal training. We aimed to develop an abbreviated acupuncture curriculum and assess its impact and acceptability with academic pediatricians. METHODS: In this pilot study, pediatricians received instruction in 2 acupuncture protocols for treating acute and chronic pain (Battlefield Acupuncture and Four Gates) during a 10-hour course developed by board-certified medical acupuncturists. Learning methods included an online module with videos and articles, 2 live workshops, and additional home practice. Participants completed a skills-based exam and pre- and post-tests measuring knowledge and attitudes about acupuncture treatment. RESULTS: Forty-five physicians (divided among 3 cohorts) began the acupuncture training course, and 38 (84.4%) completed all components. The course significantly increased participants' perceived efficacy of acupuncture for acute and chronic pain. Participants showed significant improvement in acupuncture knowledge. All participants agreed that the course would influence their current medical practice, and all participants felt confident utilizing basic acupuncture. Additionally, all participants indicated that they would recommend the abbreviated acupuncture curriculum to a colleague. CONCLUSIONS: Pediatricians became proficient in 2 acupuncture protocols with a 10-hour curriculum and found the format and content highly acceptable. Future plans include studying acupuncture implementation and expanding the course to other departments and institutions.

Compassion fatigue, burnout, and compassion satisfaction in pediatric subspecialists during the SARS-CoV-2 pandemic.

BACKGROUND: The aim of this study was to explore factors contributing to compassion fatigue (CF), burnout (BO), and compassion satisfaction (CS) during the severe acute respiratory syndrome coronavirus-2 pandemic in pediatric subspecialists. METHODS: The Compassion Fatigue and Satisfaction Self-Test (CFST) and a questionnaire of personal/professional characteristics were distributed electronically to pediatric subspecialists. RESULTS: There were no significant differences in pre- and early-pandemic CF, BO, and CS scores. Nearly 40% of respondents felt their contributions to the pandemic were not valued by their institutions. Higher CF scores were significantly associated with: higher BO score; "I have put myself at increased risk through my work"; working in one's specialty >50% of time; distress about mental health and/or future uncertainty. Higher BO scores were significantly associated with: higher CF score; "Self-care is not a priority"; emotional depletion. Higher CS scores were significantly associated with: "My institution values my contribution to the COVID-19 crisis"; workplace debriefs; pet therapy. CONCLUSIONS: The pandemic has only increased the need for physicians to receive social/emotional support from their institution and to feel their workplace contributions are valued. Successful pre-pandemic workplace interventions may not adequately support physicians during the pandemic. Further study is needed to identify supports that best counter the pandemic's unprecedented challenges. IMPACT: The sentiment "My institution has valued my contribution to the Covid-19 crisis" was the only significant factor associated with lower BO scores and was also associated with higher CS scores in pediatric subspecialists. This study is the first comparison of pre- and early-pandemic CF, BO, and CS scores in a national cohort of pediatric subspecialists. When considering interventions to promote CS and mitigate CF and BO for pediatric subspecialists during and after the pandemic, institutional leadership must offer wellness programming focused on social/emotional supports and prioritize a culture that explicitly recognizes and values every physician's contributions.