MACCABI-RED, community emergency care at the press of a button: a descriptive study.

BACKGROUND: Maccabi-RED is a new service developed in Israel that allows primary care staff to direct urgent cases to specialists in the community for evaluation in their local clinics on the same day as an alternative to an emergency department (ED) visit. A primary care physician or a nurse can activate the service, and all nearby specialists receive "a call" and can decide if they are willing to accept it, thus allowing the patient to avoid an unnecessary visit to the ED. AIM: To quantify and characterize the medical care provided by this service in a large national healthcare system. DESIGN AND SETTING: Multicenter, community-based, retrospective cohort study. METHODS: All Maccabi-RED visits recorded between September 2021 and August 2022 were included. Patient characteristics were compared to national demographics. Descriptive statistics were used to present data regarding recorded diagnoses, treating physicians, treatments or referrals provided, and subsequent emergency department admissions or hospitalizations. RESULTS: 31831 visits were recorded. Most frequent diagnoses were musculoskeletal pain (12.1%), otitis or otalgia (7.8%), contusions (7.6%), fractures (7.1%), foreign body (6.7%), pregnancy-related symptoms (6.3%), and upper-respiratory or unspecified viral infection (6.3%). The most common treatments reported were foreign body removal (5%) and cast application (3.5%). Only 7.8% of visits resulted in emergency department admission within seven days (any cause). The average time from patient request to physician treatment was 91 min. CONCLUSIONS: Maccabi-RED is being widely used by patients nationwide. Additional studies are needed to investigate whether Maccabi-RED reduces emergency department visits and costs.

Deep learning-based automated bone age estimation for Saudi patients on hand radiograph images: a retrospective study.

PURPOSE: In pediatric medicine, precise estimation of bone age is essential for skeletal maturity evaluation, growth disorder diagnosis, and therapeutic intervention planning. Conventional techniques for determining bone age depend on radiologists' subjective judgments, which may lead to non-negligible differences in the estimated bone age. This study proposes a deep learning-based model utilizing a fully connected convolutional neural network(CNN) to predict bone age from left-hand radiographs. METHODS: The data set used in this study, consisting of 473 patients, was retrospectively retrieved from the PACS (Picture Achieving and Communication System) of a single institution. We developed a fully connected CNN consisting of four convolutional blocks, three fully connected layers, and a single neuron as output. The model was trained and validated on 80% of the data using the mean-squared error as a cost function to minimize the difference between the predicted and reference bone age values through the Adam optimization algorithm. Data augmentation was applied to the training and validation sets yielded in doubling the data samples. The performance of the trained model was evaluated on a test data set (20%) using various metrics including, the mean absolute error (MAE), median absolute error (MedAE), root-mean-squared error (RMSE), and mean absolute percentage error (MAPE). The code of the developed model for predicting the bone age in this study is available publicly on GitHub at https://github.com/afiosman/deep-learning-based-bone-age-estimation . RESULTS: Experimental results demonstrate the sound capabilities of our model in predicting the bone age on the left-hand radiographs as in the majority of the cases, the predicted bone ages and reference bone ages are nearly close to each other with a calculated MAE of 2.3 [1.9, 2.7; 0.95 confidence level] years, MedAE of 2.1 years, RMAE of 3.0 [1.5, 4.5; 0.95 confidence level] years, and MAPE of 0.29 (29%) on the test data set. CONCLUSION: These findings highlight the usability of estimating the bone age from left-hand radiographs, helping radiologists to verify their own results considering the margin of error on the model. The performance of our proposed model could be improved with additional refining and validation.

School Medical Service: Strategies to Promote Psycho-Physiological Well-Being.

Schools represent the ideal setting for educating children about the acquisition of active lifestyles seen not only from a health point of view but also from psycho-pedagogical and social perspectives. Based on evidence from scientific literature, there is a need to include physical activity in school routines, especially in primary schools, where the habits learned by children stay with them in their later years and adulthood. With the support of the school medicine service, schools become a favorable context for planning health education sessions aimed at students, with particular reference to prevention. Within teaching, it is necessary to consider the motor area as a fundamental tool for acquiring correct lifestyles, facilitating cognitive development, inclusiveness, and psycho-emotional and socio-relational factors. Schools can play a fundamental role, becoming the key to promoting physical activity at different times of the day, such as during class hours (with active breaks), during breaks, before and after lessons, and by integrating movement into teaching. This review is the result of an in-depth overview of the available literature on the relationship of schools with health and health promotion from a preventive perspective, with awareness of how the issue is being approached and the need for further future reflections that will go hand in hand with the coming changes.

Mucoadhesive Budesonide Solution for the Treatment of Pediatric Eosinophilic Esophagitis.

Eosinophilic Esophagitis is an antigen-mediated inflammatory disease characterized by thickening of the esophageal wall, leading to dysphagia, vomiting, reflux, and abdominal pain. This disease can be treated with a therapeutic approach ranging from diet to pharmacological therapy. Jorveza® (budesonide) and Dupixent® (dupilumab) are treatments for Eosinophilic Esophagitis approved by the European Medicines Agency in adults but not in children. Budesonide-based extemporaneous oral liquid suspensions could be prepared for pediatric use. The main limit of this formulation is that budesonide needs a longer residence time on the esophageal mucosa to solubilize and diffuse in it to exert its local anti-inflammatory effect. Herein, we propose the development of an extemporaneous mucoadhesive oral budesonide solution for the pediatric population. A liquid vehicle containing hydroxypropyl-beta-cyclodextrin as a complexing agent and carboxymethylcellulose sodium as a mucoadhesive excipient was used to prepare budesonide-based formulations. A stable solution at a concentration of 0.7 mg/mL was successfully prepared and characterized. The formulation showed rheological and mucoadhesive properties suitable for an Eosinophilic Esophagitis local prolonged treatment. In this way, pharmacists can prepare stable budesonide-based mucoadhesive solutions, providing both patients and physicians with a new therapeutic option for Eosinophilic Esophagitis pediatric treatment.

Prevalence of SARS-CoV-2 in newborns born to SARS-CoV-2-positive mothers at 2 weeks of life.

Introduction: Limited evidence exists on management recommendations for neonates born to SARS-CoV-2-positive mothers. This study looked at transmission risk of neonates presenting for primary care in a large regional health system within New York during the early months of the COVID-19 pandemic. Methods: This was a prospective, observational study of newborns born to SARS-CoV-2-positive mothers presenting at any of the 19 Northwell Health-Cohen Children's Medical Center primary care practices who underwent another oropharyngeal/nasopharyngeal swab for detection of SARS-CoV-2 by day of life (DOL) 14. Results: Among 293 newborns born to SARS-CoV-2-positive mothers who were negative at birth, 222 were retested at DOL 14, corresponding to times with different predominant strains. Of these, seven tested positive but had no symptoms. Conclusion: The overall low transmission rates and absence of symptomatic infection support the safety of direct breastfeeding after hospital discharge with appropriate hand and breast hygiene.

Updates for Reptile Pediatric Medicine.

The health of hatchling, juvenile, and young adult reptiles continues to be plagued by historic nutritional deficiencies, old and emerging infectious diseases, and more recent phenotype-selective congenital abnormalities that impact welfare. Knowledge of mating seasonality, average egg counts, gestation times, and age and/or size for sexual maturity is necessary to help guide best practices for care of pediatric reptiles. Calcium, vitamin D3, and ultraviolet B (UVB) lighting recommendations vary in effectiveness amongst different species and can change with age. Phenotype-selective color patterns for spider ball pythons and scalation pattern for bearded dragons have resulted in vestibular disease, and increased evaporative water loss, respectively. Salmonellosis remains the most reported zoonotic disease for captive reptiles in the United States, despite improvements in client education and improvements in captive reptile husbandry.

What Is the Aim of PEDIATRIC "Gender-Affirming" Care?

The original "Dutch Protocol"-the treatment model comprised of puberty blockers, cross-sex hormones, and surgery-was intended to improve the mental and physical health of pediatric patients experiencing distress over their sexed bodies. Consequently, both researchers and clinicians have couched eligibility for treatment and measures of treatment efficacy in terms of the interventions' effects on outcomes such as gender dysphoria, depression, anxiety, and suicide. However, recent systematic reviews have concluded that the scientific evidence supporting these interventions is uncertain, leading to significant international differences in what treatments are offered to youth. Against this backdrop, a different argumentative approach has emerged in support of gender-affirming care. This approach appeals not to reductions in patient morbidity or mortality but to patient autonomy, where medical intervention is pursued as a means to the satisfaction of a patient's "embodiment goals." In this article, I raise objections to autonomy-based justifications for pediatric gender-affirming care, concluding that these arguments misunderstand the place of autonomy in clinical decision-making and, consequently, put patients at risk of medical harm.

From Clinic to Computer and Back Again: Practical Considerations When Designing and Implementing Machine Learning Solutions for Pediatrics.

Purpose of review: Machine learning (ML), a branch of artificial intelligence, is influencing all fields in medicine, with an abundance of work describing its application to adult practice. ML in pediatrics is distinctly unique with clinical, technical, and ethical nuances limiting the direct translation of ML tools developed for adults to pediatric populations. To our knowledge, no work has yet focused on outlining the unique considerations that need to be taken into account when designing and implementing ML in pediatrics. Recent findings: The nature of varying developmental stages and the prominence of family-centered care lead to vastly different data-generating processes in pediatrics. Data heterogeneity and a lack of high-quality pediatric databases further complicate ML research. In order to address some of these nuances, we provide a common pipeline for clinicians and computer scientists to use as a foundation for structuring ML projects, and a framework for the translation of a developed model into clinical practice in pediatrics. Throughout these pathways, we also highlight ethical and legal considerations that must be taken into account when working with pediatric populations and data. Summary: Here, we describe a comprehensive outline of special considerations required of ML in pediatrics from project ideation to implementation. We hope this review can serve as a high-level guideline for ML scientists and clinicians alike to identify applications in the pediatric setting, generate effective ML solutions, and subsequently deliver them to patients, families, and providers.

La evaluación del desarrollo psicológico en los dispensarios de lactantes de Buenos Aires: medicina y psicología en la Argentina, 1935-1942 / The evaluation of psychological development in the dispensarios de lactantes (infant and toddler clinics) in Buenos Aires: medicine and psychology in Argentina, 1935-1942

El trabajo indaga el uso médico de las técnicas de evaluación psicológica en dispensarios de lactantes de Buenos Aires en el marco de los estudios históricos de la psicología en la Argentina. Analiza el ámbito institucional para elucidar el entramado de discursos en el que cabe situar el interés por el control del desarrollo psicológico. Estudia las pruebas utilizadas, las características de la aplicación y los resultados más significativos. Explora las vicisitudes del campo profesional, a la luz de las cuales el recurso a la psicología habría sido útil para consolidar la legitimación del saber médico. Advierte una divergencia entre este uso médico de la psicología y la producción y circulación de conocimiento psicológico en los ámbitos académico y educativo.(AU)

This article explores the medical use of techniques for psychological evaluation in the dispensarios de lactantes (infant and toddler clinics) in Buenos Aires within the framework of historical studies of psychology in Argentina. It analyzes the institutional environment in order to shed light on the framework of discourses within which the interest in controlling psychological development may be situated. It studies the tests used, the characteristics of application and the most significant results. It explores the vicissitudes of the professional field, in the light of which psychology was useful for consolidating the legitimacy of medical knowledge. It points out a divergence between this medical use of psychology and the production and circulation of psychological knowledge in academic and educational environments.(AU)

La evaluación del desarrollo psicológico en los dispensarios de lactantes de Buenos Aires: medicina y psicología en la Argentina, 1935-1942 / The evaluation of psychological development in the dispensarios de lactantes (infant and toddler clinics) in Buenos Aires: medicine and psychology in Argentina, 1935-1942

Resumen El trabajo indaga el uso médico de las técnicas de evaluación psicológica en dispensarios de lactantes de Buenos Aires en el marco de los estudios históricos de la psicología en la Argentina. Analiza el ámbito institucional para elucidar el entramado de discursos en el que cabe situar el interés por el control del desarrollo psicológico. Estudia las pruebas utilizadas, las características de la aplicación y los resultados más significativos. Explora las vicisitudes del campo profesional, a la luz de las cuales el recurso a la psicología habría sido útil para consolidar la legitimación del saber médico. Advierte una divergencia entre este uso médico de la psicología y la producción y circulación de conocimiento psicológico en los ámbitos académico y educativo.

Abstract This article explores the medical use of techniques for psychological evaluation in the dispensarios de lactantes (infant and toddler clinics) in Buenos Aires within the framework of historical studies of psychology in Argentina. It analyzes the institutional environment in order to shed light on the framework of discourses within which the interest in controlling psychological development may be situated. It studies the tests used, the characteristics of application and the most significant results. It explores the vicissitudes of the professional field, in the light of which psychology was useful for consolidating the legitimacy of medical knowledge. It points out a divergence between this medical use of psychology and the production and circulation of psychological knowledge in academic and educational environments.

Pediatric medicines and their relationship to dental caries / Medicamentos infantis e sua relação com cárie dentária

The aim of this study was to evaluate mothers' knowledge about the cariogenic potential of pediatric medicines. A total of 111 mothers were interviewed using a standardized form containing 15 questions relating to the association of pediatric drug use with dental caries and oral hygiene care. Descriptive and inferential statistics (Chi-square test and Fisher's exact) were used at a significance of 5 percent. Most of the mothers were aged 40 years or under (77.4 percent), high school educated (30.6 percent) and not working (50.5 percent). The association between medication use and dental caries or defects in teeth structure was mentioned by 35 (43.2 percent) mothers, 33 of whom (40.7 percent) cited this was due to the presence of sugar in the formulations. Only 32 mothers (28.8 percent) performed oral hygiene for the child after drugs ingestion, although 81.1 percent (n = 90) had never received guidance on the importance of this practice. The type of occupation and maternal education level were not significant in these issues (p> 0.05). Pediatric medicines can create problems for the teeth and a high percentage of mothers are unable to establish a clear cause and effect relationship with this association. Therefore, the pharmaceutical industry needs to be more aware of this and should prepare pediatric medicines without the presence of sucrose.

O objetivo do estudo foi verificar o conhecimento materno sobre o potencial cariogênico de medicamentos infantis. Foram entrevistadas 111 mães por meio de formulário padronizado contendo 15 perguntas relativas à associação do uso de fármacos pediátricos com a cárie dentária e aos cuidados com a higiene bucal. Foi usada a estatística descritiva e inferencial (Qui-quadrado de Pearson e exato de Fischer), com significância de 5 por cento. A maioria das mães tinha até 40 anos (77,4 por cento), ensino médio (30,6 por cento) e não trabalhava (50,5 por cento). A associação entre uso de medicamentos e cárie dental ou defeitos na estrutura dos dentes foi apontada por 35 (43,2 por cento) mães, das quais 33 (40,7 por cento) devido à presença de açúcar nas formulações. Apenas 32 (28,8 por cento) realizavam a higienização bucal da criança após a ingestão de medicamentos; 81,1 por cento (n=90) nunca receberam orientações quanto à importância desta prática. O tipo de ocupação e o grau de escolaridade materno não foram significativos nestas questões (p>0,05). Os medicamentos pediátricos podem trazer problemas para os dentes e alto percentual de mães não consegue estabelecer claramente a relação de causa e efeito existente em tal associação, portanto, é necessária maior conscientização das indústrias farmacêuticas para elaboração de medicamentos pediátricos sem a presença de sacarose.