EUFOREUM Berlin 2023: Optimizing care for type 2 inflammatory diseases from clinic to AI: A pediatric focus.

The European Forum for Research and Education in Allergy and Airways diseases (EUFOREA) organized its bi-annual forum EUFOREUM in Berlin in November 2023. The aim of EUFOREUM 2023 was to highlight pediatric action plans for prevention and optimizing care for type 2 inflammatory conditions starting in childhood, with a focus on early-stage diagnosis, ensuring neither under- nor overdiagnosis, optimal care, and suggestions for improvement of care. EUFOREA is an international not-for-profit organization forming an alliance of all stakeholders dedicated to reducing the prevalence and burden of chronic respiratory diseases through the implementation of optimal patient care via educational, research, and advocacy activities. The inclusive and multidisciplinary approach of EUFOREA was reflected in the keynote lectures and faculty of the virtual EUFOREUM 2023 (www.euforea.eu/euforeum) coming from the pediatric, allergology, pulmonology, ENT, dermatology, primary health care fields and patients around the central theme of type 2 inflammation. As most type 2 inflammatory conditions may start in childhood or adolescence, and most children have type 2 inflammation when suffering from a respiratory or skin disease, the moment has come to raise the bar of ambitions of care, including prevention, remission and disease modification at an early stage. The current report provides a comprehensive overview of key statements by the faculty of the EUFOREUM 2023 and the ambitions of EUFOREA allowing all stakeholders in the respiratory field to be updated and ready to join forces in Europe and beyond.

Fragile X Syndrome: A Review for General Pediatricians.

Fragile X syndrome is the most commonly inherited form of intellectual disability. Identifying fragile X syndrome at a young age can be quite challenging because the classical physical features usually present in late childhood or early adolescence; therefore, it is important to consider genetic testing for all males with unexplained developmental delays, intellectual disability, and autism, females with developmental delays, intellectual disability or autism, and a family history of fragile X gene disorders. There is no specific treatment to manage fragile X syndrome. Still, a prompt referral for early intervention is essential to help maximize the child's learning potential, as well as a referral to child psychology if any behavioral concerns are present. It is of paramount importance for families with a history of fragile X syndrome to have access to genetic counseling as it can aid in future reproductive decisions and the risk of future recurrences of this condition. [Pediatr Ann. 2024;53(7):e269-e271.].

Applying a Trauma-Informed Lens to Challenging Adolescent Encounters: A Faculty Development Session for Pediatricians.

Introduction: Patient encounters perceived to be challenging are common and contribute to both suboptimal patient health outcomes and provider burnout. A trauma-informed care (TIC) approach to these encounters is critical, as many of the characteristics associated with challenging patient encounters can be linked to a history of trauma exposure. Methods: Our team created and delivered a 1-hour synchronous virtual session intended to bolster provider knowledge of TIC principles and their application to challenging adolescent encounters. Participants were all faculty and staff engaged in pediatric primary care at an urban academic center, including physicians, nurse practitioners, psychologists, and social workers. The content was rooted in adult learning principles and included didactic components anchored to case-based learning with facilitated group discussions and opportunities for reflection. We used paired pre- and postsession self-assessments of provider knowledge, confidence, and practice related to TIC using Likert-scale and free-text questions. Descriptive statistics and a paired t test were used to determine the impact of the session on these metrics. Results: In 24 paired surveys, there were statistically significant increases (p ≤ .001) in participant perceived knowledge, confidence, and practice, with 100% of participants having a statistically significant improvement in one or more of these domains. There were also strongly positive Likert-scale and free-text responses regarding content relevance and delivery. Discussion: We demonstrate that a brief session can create improvement in pediatric providers' perceived knowledge about the application of TIC principles to challenging adolescent encounters as well as confidence in their ability to put these into practice.

Trauma-informed care.

In recent years, trauma informed care has become a heavily researched topic; however, it has yet to achieve a universal standard in the field of pediatric medicine. One of the primary tenants of trauma informed care is a clear understanding of the pervasiveness and complexities of childhood trauma, and its intersection with a child and caregiver's physical wellness. A major component of trauma informed care is addressing the way medical providers may be exposed to vicarious trauma, secondary traumatic stress, and compassion fatigue. By taking proactive steps to educate medical providers on the effects of trauma, they are better equipped to assess a family's needs and provide enhanced quality of care for their patients and themselves.

Seizures, medical child abuse, and the pediatric neurologist.

Previously known as Munchausen syndrome by proxy, medical child abuse is a form of child maltreatment whereby the caregiver creates an environment in which medical care harms or threatens the wellbeing of a child. Approximately 40-50 % of medical child abuse cases involve neurological symptoms, with fabricated or induced seizures accounting for a significant proportion. Identifying fictitious seizures is often difficult even for the most experienced clinicians. Therefore, having a low threshold for clinical suspicion is essential in the timely diagnosis of medical child abuse. This article provides a review of the epidemiology, diagnosis, and management of medical child abuse when it involves seizures.

Pathway Programs That Support Students From Immigrant Backgrounds in Becoming Physicians.

Pathways programs are critical to promoting access and success for careers in healthcare for students from immigrant backgrounds. Three cases are presented that demonstrate the successful elements of pathways programs. Excellence in pediatrics requires the inclusion of talent from immigrant communities. Community capacity building and systems level change can be achieved through coliberatory practice of mutual action, investment, and benefit. Navigation, mentorship, and structural support for educational, social, and monetary capital are key components of pathways programs.

Immigrant and Refugee Health Curricula in US-Based Medical Training: A Scoping Review to Inform Integration Into Pediatric Residency Programs.

OBJECTIVE: Despite increases in the US foreign-born population, medical education opportunities in immigrant and refugee health (IRH) remain limited. We summarize findings for published IRH curricula and offer recommendations for integrating IRH into pediatric residency programs. METHODS: We performed a literature review of articles describing the design, implementation, or assessment of IRH curricula for US-based undergraduate and graduate medical trainees. RESULTS: The literature review identified 36 articles from 21 institutions describing 37 unique curricula. Three curricula included pediatric residency programs. Commonly taught topics included cultural humility, interpreter use, and immigration status as a social determinant of health. Immigrant-focused training experiences existed at continuity clinics, clinics for refugees or asylum seekers, and dedicated electives/rotations. Curricula were most frequently described as stand-alone electives/rotations. CONCLUSIONS: IRH curricula provide opportunities to develop skills in clinical care, advocacy, and community partnerships with immigrant populations. Pediatric residency programs should align the IRH curriculum with existing learning priorities, support and hire faculty with expertise in IRH, and partner with community organizations with expertise. Programs can also consider how to best support learners interested in careers focusing on immigrant populations. Further work is needed to establish competencies and validated tools measuring trainee satisfaction and clinical competency for IRH curricula.

Impact of the COVID-19 Pandemic on Inpatient Pediatric Medical Student Education in Hawai'i.

The COVID-19 pandemic has had many effects on medical student education, ranging from safety measures limiting patient exposure to changes in patient diagnoses encountered by medical students in their clerkship experience. This study aimed to identify the impact of the pandemic on the inpatient experiences of third- and fourth-year medical students by assessing patient volumes and diagnoses seen by students. Frequency and types of notes written by medical students on hospital-based pediatric rotations at Kapi'olani Medical Center for Women and Children as well as patient diagnoses and ages were compared between 2 time periods: pre-pandemic (July 2018-February 2020) and pandemic (May 2020-September 2021). On average, the number of patients seen by medical students was significantly reduced in the pandemic period from 112 patients/month to 88 patients/month (P=.041). The proportion of patients with bronchiolitis or pneumonia were also significantly reduced in the pandemic period (P<.001). Bronchiolitis was diagnosed in 1.3% of patients seen by medical students during the pandemic period, compared with 5.9% of patients pre-pandemic. Pneumonia was diagnosed in 1.0% of patients seen by medical students in the pandemic period compared with 4.6% pre-pandemic. There was no significant difference in patient age between the 2 groups (P=.092). During the first 18 months of the COVID-19 pandemic, medical students in this institution had a remarkably different inpatient experience from that of their predecessors. They saw fewer patients, and those patients had fewer common pediatric respiratory diseases. These decreases suggest these students may require supplemental education to compensate for these gaps in direct pediatric clinical experience.

Knowledge and beliefs of endocrine disruptors in pediatrics: all hands on deck!

Endocrine disruptors (ED) are ubiquitous pollutants, possibly implicated in chronic disease. Exposure of vulnerable populations; including neonates, infants and children; must therefore be limited. Informing parents is now a public health challenge. We conducted a quantitative cross-sectional study at the Lyon Mother and child Hospital. We used questionnaires to assess the beliefs and knowledge about ED of parents and pediatric healthcare professionals in the pediatric ward in Lyon, France. A total of 746 questionnaires were completed: 444 for professionals and 302 for parents. The majority of both populations had already heard of ED but only 10% of parents and 5% of professionals felt sufficiently informed. Professionals answered better than parents (73% vs. 60%). The main source of information was similar: media. Only 20% of professionals had read a scientific article about ED and 4% have followed a training. Environmental exposure and EDs is an increasing concern for parents but specific knowledge remains scare for parents and professionals. Specific training is needed.

Addressing the Paediatric Physiotherapy's Unmet Needs.

This viewpoint emphasises the vital role that paediatric physiotherapy plays in satisfying children's rehabilitation requirements, especially those of children with chronic illnesses and impairments. It highlights issues including inadequate education and a lack of personnel, underscoring the need for individualised care in a variety of paediatric settings. The letter promotes more knowledge, financing, and research to improve the quality and accessibility of paediatric physical therapy services offered worldwide. It urges medical practitioners and legislators to address these significantly unmet needs in order to improve developmental outcomes and assure children's optimal physical well-being through the prioritisation of early intervention and tailored therapy. Key Words: Paediatric physiotherapy, Rehabilitation, Physical therapy.

[The first translation on pediatrics: Er Ke Cuo Yao].

Er Ke Cuo Yao(The Pediatric Summary) is the first monograph on pediatrics of Western medicine translated and introduced in the late Qing Dynasty. It occupies an important position in the history of the development of modern pediatrics and modern Western medicine in China. Edited by American missionary Mary Hannah Fulton and translated by Chinese Western medicine scholar Yin Duanmo, the book consists of 2 volumes and 14 books, including general discussion of pediatrics, diagnosis of pediatric diseases, and discussion on teething, throat diseases, gastrointestinal diseases, worms, liver diseases, abdominal epimesis, and new infectious diseases, etc. covering the diagnosis, treatment, maintenance and other knowledge of Western medical pediatrics. The source of Er Ke Cuo Yao is not yet available, but it may be a synthesis of various materials, and the translation uses paraphrasing, transliteration, and traditional Chinese medicine terminology, and the language is easy to understand. Er Ke Cuo Yao reflects the level of development of pediatrics in Western medicine in the early modern period, makes up for the lack of pediatrics knowledge of traditional Chinese medicine, and plays an active role in the diagnosis and treatment of common pediatric diseases, epidemiological diseases, surgical diseases, and malnutrition prevention.