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Artigo em Inglês | MEDLINE | ID: mdl-28057447


Among pediatricians, perceived knowledge of efficacy, tolerability, dosing, and side effects of antidepressants represent significant sources of variability in the use of these medications in youth with depressive and anxiety disorders. Importantly, the qualitative factors that relate to varying levels of comfort with antidepressants and willingness to prescribe are poorly understood. Using a mixed-methods approach, in-depth interviews were conducted with community-based and academic medical center-based pediatricians (N = 14). Interviews were audio recorded and iteratively coded; themes were then generated using inductive thematic analysis. The relationship between demographic factors, knowledge of antidepressants, dosing, and side effects, as well as prescribing likelihood scores for depressive disorders, anxiety disorders or co-morbid anxiety and depressive disorders, were evaluated using mixed models. Pediatricians reported antidepressants to be effective and well-tolerated. However, the likelihood of individual physicians initiating an antidepressant was significantly lower for anxiety disorders relative to depressive disorders with similar functional impairment. Pediatricians considered symptom severity/functional impairment, age and the availability of psychotherapy as they considered prescribing antidepressants to individual patients. Antidepressant choice was related to the physician׳s perceived knowledge and comfort with a particular antidepressant, financial factors, and the disorder-specific evidence base for that particular medication and consultation with mental health practitioners. Pediatricians noted similar efficacy and tolerability profiles for antidepressants in youth with depressive disorders and anxiety disorders, but tended to utilize "therapy first" approaches for anxiety disorders relative to depressive disorders. Parental and family factors that influenced prescribing of antidepressants by pediatricians included parental ambivalence, family-related dysfunction and impairment secondary to the child׳s psychopathology as well as the child׳s psychosocial milieu. Pediatricians consider patient- and family-specific challenges when choosing prescribing antidepressant medications and are, in general, less likely to prescribe antidepressants for youth with anxiety disorders compared to youth with depressive disorders. The lower likelihood of prescribing antidepressants for anxious youth is not related to perception of the efficacy or tolerability, but rather to a perception that anxiety disorders are less impairing and more appropriately managed with psychotherapy.

Antidepressivos/uso terapêutico , Transtornos de Ansiedade/tratamento farmacológico , Atitude do Pessoal de Saúde , Transtorno Depressivo/tratamento farmacológico , Padrões de Prática Médica/estatística & dados numéricos , Adolescente , Adulto , Idoso , Antidepressivos/efeitos adversos , Competência Clínica , Tomada de Decisão Clínica , Prescrições de Medicamentos/estatística & dados numéricos , Uso de Medicamentos/estatística & dados numéricos , Feminino , Pesquisa sobre Serviços de Saúde/métodos , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Pediatras/psicologia , Projetos Piloto , Estados Unidos
Clin Pediatr (Phila) ; 56(8): 752-758, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-27872358


Childhood obesity rates appear to be leveling off. Studies not looking at severe obesity may be masking a rightward shift in the distribution of body mass indexes. Our objective was to provide current prevalence rates and examine trends in overweight, obesity, class 2 obesity, and class 3 obesity for youth in Cincinnati, Ohio. We performed a retrospective chart review of children 2 to 18 years old seen at Cincinnati Children's Hospital Medical Center between July 1, 2011, and June 30, 2014. Data from 217 037 BMIs were obtained; 35.2% of children were found to have an elevated BMI. Prevalence rates were highest in older, Hispanic, and Medicaid-insured children. The only significant trend over the 3-year period was a downward shift in class 3 obesity ( P = .02), contrary to national findings. Further studies assessing which clinical/community efforts have led to this downward trend will be essential to target future resources and facilitate continued progress.

Obesidade Mórbida/epidemiologia , Obesidade Pediátrica/epidemiologia , Adolescente , Índice de Massa Corporal , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Ohio/epidemiologia , Prevalência
Pediatr Emerg Care ; 26(1): 36-8, 2010 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-20065828


Modern air-powered pellet guns are capable of propelling their projectiles at velocities of 250 to 930 ft/s depending on their propulsion system-rivaling traditional small caliber firearms in the potential for serious soft tissue injuries. Management decisions regarding thoracic/cardiac pellet gun injuries must be based on the presentation and stability of the patient and the location of the retained pellet. We present a report of the nonsurgical management of an 8-year-old girl with a retained pericardial pellet and small stable effusion.

Acetaminofen/uso terapêutico , Analgésicos não Entorpecentes/uso terapêutico , Anti-Inflamatórios/uso terapêutico , Traumatismos Cardíacos/terapia , Monitorização Fisiológica/métodos , Ferimentos por Arma de Fogo/terapia , Criança , Ecocardiografia , Eletrocardiografia , Feminino , Seguimentos , Traumatismos Cardíacos/diagnóstico , Humanos , Radiografia Torácica , Tomografia Computadorizada por Raios X , Índices de Gravidade do Trauma , Ferimentos por Arma de Fogo/diagnóstico