Pediatrician attitudes to exclusion of ill children from child-care centers in Israel: pressure on ambulatory practices.

BACKGROUND: The exclusion of ill children from child-care centers may be associated with high social, economic and medical costs. OBJECTIVE: To assess the opinions of pediatricians working in an outpatient setting in Israel on the exclusion/return of children in child-care centers. METHODS: A questionnaire on practices of exclusion/return of children in child-care centers, in general and according to specific signs and symptoms, was administered to a random computer-selected cross-sectional sample of 192 primary care community pediatricians in Israel. RESULTS: One hundred and seventy-three pediatricians completed the questionnaires, for a response rate of 90%; 147 were board-certified and 26 were not. About half the pediatricians felt pressured by parents requesting antibiotic therapy to accelerate the return of their sick child to the child-care center. The majority also believed their practice was overloaded by often unnecessary demands for medical notes by the child-care centers before children could return. More than half based their decision to exclude children on "common sense" and the remainder, on accepted guidelines. Except for scabies and lice, there were no significant correlations between the physicians' stipulation for a note on return of the child and the specific illness guidelines. CONCLUSIONS: This study shows that a high proportion of pediatricians based their exclusion practices on "common sense" and personal understanding instead of established guidelines, and that the guidelines did not affect their opinion on the duration of illness that warrant a note. Furthermore, half were subjected to parental pressure to employ inappropriate practices. These findings, combined with our earlier survey of child-care centers staff, indicate that better education of parents and day-care staff about ill child-care-center-exclusion policy in Israel would increase their common understanding with pediatricians.

Primary Care Physicians' Attitudes Toward Postpartum Depression: Is It Part of Their Job?

OBJECTIVES: This study surveyed Israeli primary care physicians' attitudes and practice regarding postpartum depression (PPD). METHODS: Participants included 224 pediatricians and family practitioners responding to an online survey (65% response rate). RESULTS: Almost all respondents (98.0%) considered it important that they be able to recognize the signs of PPD. Most (89.8%) noted that if they suspected PPD, they would become somewhat involved: clarifying, keeping attentive, consulting with colleagues, and/or referring the woman to another professional. Six respondents--only family practitioners--stated that they would treat the case themselves (P = .01). Family practitioners were significantly more willing to screen for PPD than were pediatricians (91.2% vs 64.6%; P < .0001). There were no differences between physicians by region or between males and females when comparing all respondents, as well as when comparing within medical specialty (P < .05). CONCLUSIONS: There is a clear difference between considering the importance of recognizing signs of PPD and acting on it. Family practitioners had more favorable attitudes than did pediatricians, however screening in pediatric facilities is considered by many to be optimal. Hopefully future directions for medical education and health policy for family practitioners and pediatricians, as well as obstetrician/gynecologists, will meet the challenge of early identification and treatment of PPD for the benefit of women, infants and families.

Parents' and medical personnel's beliefs about infant teething.

Many symptoms are attributed to teething. Little evidence exists to support these beliefs, despite their implications on clinical management. This study attempted to investigate parental and medical personnel's beliefs about teething. The study was conducted by means of a questionnaire, submitted to 55 pediatricians and 130 nurses. A parent survey was conducted simultaneously. We evaluated 462 questionnaires. An association of teeth eruption with infant morbidity was believed to exist by 76% of the responders, mostly by parents and nurses, and less so by physicians. Irritability, fever, and loose stools/diarrhea were believed to be the most common symptoms associated to teeth eruption. We conclude that almost all parents, the majority of nurses, and many physicians believe that teething is associated with the appearance of symptoms, most of which are minor and relate to discomfort rather than physical illness, but a substantial minority still ascribes potentially serious symptoms to teething.

The incidence of anemia in an Israeli population: a population analysis for anemia in 34,512 Israeli infants aged 9 to 18 months.

OBJECTIVES: The purpose of this work was to use the comprehensive computerized database of Clalit Health Services to analyze the prevalence and contributing factors of anemia among the population of Clalit Health Services-insured Israeli infants aged 9 to 18 months, characterized by ethnic sector. METHODS: This was a cross-sectional retrospective study for the year 2003 using the computerized database of Clalit Health Services for 34,512 infants aged 9 to 18 months insured by the Clalit Health Services sick fund. Children with abnormal white blood counts at the time of the hemoglobin test and with chronic diseases were excluded. The data were analyzed for age, infant hemoglobin level, ethnic origin, district distribution, type of clinic where the infant received treatment, the number of iron prescriptions dispensed to each child, and the mother's last hemoglobin level before giving birth. Anemia was defined as a hemoglobin level <105 g/L. RESULTS: The prevalence of anemia among Israeli infants is 15.5%. The prevalence is significantly higher in the non-Jewish population (22.5%) as compared with the Jewish population (10.5%). The lowest prevalence of anemia was found in pediatric health centers (10.7%). A significant correlation was found between the presence of anemia in infants and the presence of anemia found in their mothers. Infants with anemia used significantly less iron preparations. CONCLUSIONS: This study is one of the first studies to use a comprehensive computerized database to perform a population-based analysis of anemic infants. We found a considerable percentage of infants to be anemic and identified a specific population to be at high risk for anemia. We describe 2 factors that have the potential to be altered through intervention: improving compliance of iron intake and maternal anemia. Major national efforts should be made to minimize the prevalence of anemia, especially in the non-Jewish population, and to learn more about the causes of iron-deficiency anemia in this group. This study provides a base for an intervention study.