Anticipatory Guidance Research Articles

Experiences of Informal Caregivers Caring for Individuals With Chronic Schizophrenia in Asia: A Systematic Review and Meta-Synthesis.

In Asia, many caregivers are culturally obliged to assume the role of taking care of individuals experiencing chronic schizophrenia, even as they grapple with stigma and compassion fatigue. Despite the significance of this phenomenon, the collective experiences of Asian caregivers remain poorly understood. To synthesise qualitative evidence on the experiences of informal caregivers when caring for individuals with chronic schizophrenia in Asia. A search was conducted on seven databases for studies published between 2013 and 2023. The included studies were appraised using the Critical Appraisal Skills Program tool. Data extraction was based on the Joanna Briggs Institute (JBI) Qualitative Extraction Form. The data synthesis was based on the framework by Sandelowski and Barroso. Our review included the experiences of 1345 informal caregivers from 57 included studies. The analysis yielded the overarching theme of 'Navigating Challenges, Forging Resilience'. Three themes were identified: (i) challenges in caregiving, (ii) lack of support and (iii) coping and resilience. Our findings highlighted the Asian caregivers' stressors, particularly cultural and traditional factors, a facet often overlooked in the literature. Mental healthcare practitioners must provide caregivers with comprehensive information. Anticipatory guidance is essential during the initial stages of the diagnosis. To negate geographical limitations, caregiver-training sessions can be pre-recorded and posted to online platforms. Finally, cultural and spiritual beliefs can be integrated into the treatment plans for individuals with schizophrenia in the community. Within the institutional setting, mental healthcare practitioners are encouraged to provide caregivers with comprehensible information or training in person and through written or online platforms, which can transcend geographical limitations. Anticipatory guidance is essential, especially during the initial stages of the diagnosis, when confusion and uncertainties are prevalent. Periodic home visits by mental healthcare practitioners can help ease caregivers' concerns and enhance their caregiving confidence. Finally, cultural and spiritual beliefs should be integrated into the treatment plans for individuals with schizophrenia in the community as it promotes cultural acceptability, encourages referrals to appropriate institutions and reduces the stigma of mental healthcare.

46 Micronutrient deficiencies in children and youth with autism spectrum disorder: Findings from a national surveillance study

Abstract Background Children and youth with autism spectrum disorder (ASD) may be at risk of micronutrient deficiencies secondary to feeding problems such as limited dietary repertoire and high-frequency single food intake. The epidemiology of micronutrient deficiencies in the paediatric ASD population has not been studied. Objectives To determine minimum incidence, clinical characteristics, and health care utilization for four micronutrient deficiencies in children and youth with ASD in Canada: (1) vitamin A deficiency/xerophthalmia, (2) scurvy, (3) severe, symptomatic vitamin D deficiency, and (4) severe iron-deficiency anemia. Design/Methods We conducted a study via the Canadian Paediatric Surveillance Program, an active, population-based surveillance platform, between January 2020 and December 2022. More than 2,500 paediatricians and paediatric subspecialists were asked, monthly, to report cases of children and youth <18 years of age with ASD and one or more of the micronutrient deficiencies under surveillance. Case information was obtained via a detailed clinical questionnaire. Descriptive statistics were used to summarize the data. For average yearly minimum incidence estimates, we used case counts over the 3 year surveillance period, 2021 census data and recent ASD prevalence estimates (2% of children/youth aged 1 to 17 years living in private dwellings in Canada). Results Twenty-seven children and youth met the case definition (most male; median age 7.7 years, range 1.8–14.9 years). Multiple deficiencies were diagnosed concurrently in 9/27 (33%). Minimum incidence, per 100,000 children and youth with ASD per year, was 5.1 for scurvy (17 diagnoses); 3.0 for severe iron deficiency anemia (10 diagnoses); 2.1 for severe, symptomatic vitamin D deficiency (7 diagnoses); and <1 for vitamin A deficiency/xerophthalmia (<5 diagnoses). Restricted diet/limited food repertoire, attributed to the patient, was universal (27/27). Number of different foods in the patient’s diet was <10 in nearly all (20/23, 87%). Most patients were non-verbal (19/27, 70%) and of normal weight (18/26, 69%). Two-thirds (18/27, 67%) were admitted to hospital (median duration 8 days, range 3–32 days). One-third (9/27, 33%) underwent an invasive procedure as part of their diagnostic workup. Conclusion This surveillance study represents the first population-level examination of the epidemiology of micronutrient deficiencies in children and youth with ASD. Results suggest that micronutrient deficiencies in ASD are rare but clinically important, leading not infrequently to hospital admission and invasive investigations. Clinical characteristics of cases should inform anticipatory guidance and prevention efforts tailored to the paediatric ASD population.

Content Analysis of Brief Telephonic Conversation with Parents of Children with Cleft Lip and Palate During Sustained Anticipatory Guidance Sessions.

Cleft lip and palate (CLP) represents complex congenital anomalies that necessitate a comprehensive approach to care, involving multiple healthcare disciplines. The primary aim of the study is to explore the content of periodic telephone support calls between parents/caregivers of children with CLP and pediatric dentist during sustained anticipatory guidance. The qualitative analysis was conducted with the available telephonic recordings that was obtained from the STOP database. 40 recordings of 8 children were used for this study. The recorded interviews were translated and transcribed verbatim and analysed using the thematic content analysis method. The four major themes that were addressed by the dentist were the general health of the baby, oral health and development, surgery-related concerns and emotional support. It was also observed that the parents demonstrated a positive shift in oral health related behaviour significantly improving their child's oral hygiene practices. The telephonic support calls offer valuable insights into the concerns and topics the parents of children with CLP are eager to discuss. These calls not only address general concerns, receiving emotional support from the professionals, demonstrate the health related behavior shift that takes place during SAG and reassures parents of their support.

Supplementing provider counseling with an educational video prior to scheduled induction of labor

BackgroundInduction of labor (IOL) is common with one in four labors being induced in the United States (US). IOL has been associated with lower birth satisfaction. Video education can address gaps in education and promote anticipatory guidance. Prior studies in obstetrics have focused on randomized designs in English-speaking patients, leaving opportunities to explore how these tools perform in a pragmatic fashion with diverse patient populations. Our objective was to evaluate the effects of a video education tool on patient satisfaction and knowledge of IOL experience in English and Spanish-speaking patients scheduled for IOL at a tertiary care hospital.MethodsThis was a single site pragmatic implementation of a quality improvement measure at an academic hospital. A bilingual survey was developed to evaluate the impact of an educational video on birth satisfaction and knowledge of IOL procedures. The video is freely available in English and Spanish. Baseline postpartum surveys were collected from June to July 2021. The video was subsequently recommended by providers when scheduling IOLs. Post-intervention surveys were collected from September to November 2021 after an implementation period. Groups were compared using t-tests for satisfaction scores and chi-square analyses for categorical variables.ResultsThirty-two participants completed the baseline survey and 72 completed the post-implementation survey with response rates of 88.9% and 91.1%, respectively. There were no statistically significant changes between mean total satisfaction scores (26.9 vs 28.0 out of 40.0, p = 0.290). 61 participants were English speaking (58%) and 43 Spanish (42%). Thirty (42%) patients reported watching the video.Correct identification of amniotomy use improved in the post-intervention group (p = 0.002). No changes were seen in anticipated duration of labor nor in whether patients would choose to be induced again.ConclusionsRecommendation of video education before scheduled IOL was associated with little improvement in knowledge about IOL, but no significant improvement in patient satisfaction. While video education has improved these measures in randomized trials, our study demonstrated that real-world implementation and patient uptake may be initially difficult. This study may help providers emphasize direct education and counseling and promote optimal implementation of innovative educational media.

Breast Milk Feeding for Infants Who Required Major Surgery

ObjectiveTo identify barriers or facilitators that influenced mothers to provide mother’s own milk (MOM) for 6 months to their infants who were hospitalized in the NICU after major surgery. DesignDescriptive qualitative. SettingAn 80-bed, Level 4 NICU of a regional pediatric hospital in the western United States. ParticipantsFourteen mothers who provided MOM for their infants who required surgery within 1 week of age. MethodsWe conducted in-person interviews upon admission and discharge of the infant, phone interviews 1 and 2 weeks after discharge, and phone interviews monthly for 6 months or until discontinuance of the provision of MOM. We analyzed interviews using the Brooks thematic template analysis method. ResultsEleven infants received exclusive MOM at discharge, and nine infants remained on exclusive MOM at 6 months. We generated four principal themes from the participants’ comments: Value of Breast Milk, Challenges of Providing MOM, Emotional Fluctuation, and Coping With Reality of Circumstances. ConclusionInternalizing the value of MOM, family support, and coping with barriers were key factors that influenced participants to provide MOM for at least 4 months. Findings of this study suggest that prenatal education with anticipatory guidance and lactation support in the NICU can help mothers achieve the goal of extended provision of MOM to infants with serious conditions that require surgery. Education and support may be especially helpful for young, first-time mothers.

Abortion.

Induced abortion is safe, is common, and reduces pregnancy-related maternal morbidity and mortality. Internal medicine physicians are uniquely positioned to counsel patients on their pregnancy options, assess medical risks of pregnancy in the context of comorbidities, refer for abortion care when the patient desires it, or provide abortion care themselves. Clinicians can also provide anticipatory guidance about what patients should expect if they seek abortion care.

7341 Establishing a Multidisciplinary Care Program for patients with Klinefelter Syndrome and other Aneuploidy X and Y Variations

Abstract Disclosure: C.J. Romero: None. N.R. Malhotra: None. A. Norris-Brilliant: None. C. Mintz: None. Objectives: Klinefelter syndrome (KS) is one of the most common genetic aneuploidies denoted by a XXY karyotype and affects up to 1 in 600 patients. Most patients are not diagnosed until adolescent years or adulthood. KS is one of the leading causes of male infertility and testosterone insufficiency. KS is also associated with developmental delays, particularly speech and language delay. Advances in genetics screenings has led to early identification of KS and other aneuploidy X and Y variations, access to neurodevelopmental screening and fertility preservation resources during adolescence and young adulthood. We believe a multidisciplinary program for KS can provide the necessary resources for patients and families at any age from infancy to young adulthood. Methods: A group of faculty from the divisions of pediatric endocrinology, genetics, urology and psychiatry assembled in 2023 to establish a multidisciplinary clinic (MDC) to provide comprehensive care to patients/parents; this ranged from prenatal diagnosis to young adulthood. Two major challenges of care are access to neuro-psychological evaluations and fertility preservation options. Testosterone supplementation requires appropriate referral to endocrinology and timing of treatment remains controversial. Our goals include: expertise guidance and planning after prenatal diagnosis or later in age; access to cost effective neuro-psychological testing during early childhood years; urological consultation beginning in early puberty to educate and prepare patients for choices of surgical and non-surgical options of fertility preservation. Results: Our current center cares for 12 patents ranging from ages 3 months to 21 years. Of this cohort, 3 (25%) of the patients had initial consultations with the parents during pregnancy. 7 (58%) of the patients were of pubertal age that one would consider testosterone replacement, but only 3 (43%) were taking testosterone. Only 1 patient of school age reported neuro-psychological evaluation that was completed at a different institution. No patients received testosterone supplementation during year one of life. Conclusions: A multidisciplinary team can offer simultaneous assessment, anticipatory guidance and management for KS patients and their families. It is a comprehensive resource to our community. Prenatal genetic screenings bring awareness to this diagnosis and therefore timely education toward understanding the lifelong management of KS. Identifying developmental delays early in childhood will help with scholastic success. Monitoring of pubertal development will ensure appropriate pubertal progression in addition to education and management of fertility preservation. Undoubtedly future urological advances will assist patients more effectively. We believe our model provides the access to resources that allow our patients and family to successfully thrive. Presentation: 6/2/2024

The effects of the COVID-19 pandemic on pediatric dog bite injuries

Background/objectiveShortly after the onset of the COVID Pandemic, when many schools and outside activities were suspended, dog adoption rates increased. It is unknown if increased dog adoption rates along with stay-at-home orders resulted in changes to pediatric dog bite injuries. The objective of this study was to examine the incidence and characteristics of dog bites in children seen in a pediatric emergency department (PED) during the pandemic compared to before.MethodsA retrospective review of children evaluated in the PED of a level 1 pediatric trauma center and its satellite PED from March 2018 through February 2022 who had a discharge diagnosis of dog bite (ICD-10 W54.0XXA) was conducted. Pre-pandemic cases, March 2018 through February 2020, were compared to those that occurred during the pandemic, March 2020 through February 2022.ResultsThere were 2,222 patients included in the study. Compared to pre-pandemic cases, the incidence for the first 12 months of the pandemic was 1.5 times higher than the pre-pandemic 12-month periods but returned closer to the pre-pandemic rates during the second 12 months of the pandemic. More patients were admitted during the pandemic (6.1% vs. 3.7%, p < 0.05). Facial and multiple injuries occurred more frequently during the pandemic (face 35.9% vs. 33.5%: multiple 18.5% vs. 15.6% p < 0.05).ConclusionsThere was a higher incidence of PED visits, higher admission rates, and an increase in multiple body part and facial injuries in children with dog bite injuries during the COVID pandemic compared to pre-pandemic. Pediatric providers should emphasize safe dog interactions with anticipatory guidance.

NEUROCOGNITIVE EVALUATION OF PATIENTS WITH DIGEORGE SYNDROME

BackgroundDiGeorge syndrome (DGS), the most common microdeletion syndrome, affects multiple organs, including the heart, the nervous system, and the immune system. In this study, we aimed to evaluate the clinical, laboratory, brain MRI, and neurocognitive findings of our patients with DGS. MethodsClinical and laboratory data of fifty-two patients with DGS between June 2000- March 2022 were evaluated retrospectively. Brain MRI and neuropsychological tests were performed to assess the neurocognitive status of the patients. ResultsFifty-two patients (28 males and 24 females) were included in our study. Fifteen of them died during the follow-up. All 37 patients who are alive had partial DGS. The median age of patients was ten years and seven months, and the median age at diagnosis was five years and four months. Bilateral conduction deceleration in the anterior visual pathways in 6 (20%) of 30 patients was determined by the VEP (Visual Evoked Potentials). The auditory brainstem evoked potential test (BAEP) showed sensorineural hearing loss in 11 out of 30 (36.6%) patients. Brain MRI disclosed brain parenchymal abnormalities in 18 out of 25 (72%) patients. Impairments in executive functions, expressive language, and verbal memory were noted in 18 patients who were neuropsychologically assessed. ConclusionIt is important to keep in mind that patients with DiGeorge syndrome may be accompanied by neurocognitive findings. Awareness of the potential for underlying psychiatric and neurodevelopment disorders is key to anticipatory guidance, optimization of therapies, and maximizing life quality.

Permanent tooth avulsions: A retrospective analysis of the demographics and aetiology of cases at a tertiary hospital in Sydney, Australia

AbstractThis retrospective analysis reviewed the demographics of patients sustaining dental avulsion injuries at a tertiary dental hospital in Sydney, Australia. Data were extracted from dental records of patients who presented with avulsed permanent anterior teeth and were treated between 1 January 2001 and 30 June 2021. Demographic, clinical and radiographic data from 91 patients with 117 avulsed permanent anterior teeth were available for analysis. The median age of the patients was 12 years (IQR 9.0–17.0). Males accounted for 68.4% of avulsion injuries. Non‐organised sports were the most common cause of injury (42.7%). Maxillary central incisors were the most frequently avulsed tooth (83.3%). Peak prevalence of injuries occurred on the weekend. The findings from this study may reflect regional factors such as climate and participation in sport. Anticipatory guidance should be provided to patients at elevated risk of dental avulsion.

Developmental Milestones for Children With Down Syndrome.

The American Academy of Pediatrics recommends that children and adolescents with Down syndrome receive anticipatory guidance regarding development and behavior. However, few tools provide specific guidance on developmental norms for children with Down syndrome. Our objective was to estimate age ranges at which children and adolescents with Down syndrome achieve developmental milestones to facilitate developmental screening by pediatric practitioners. We used standardized questionnaires to obtain information from clinicians and caregivers of children with Down syndrome who received care at the Boston Children's Hospital Down Syndrome Program between March 2018 and March 2023. Data included information from 2599 visits for 842 individuals with Down syndrome ages 2 months to 24 years. We used mixed-effects logistic regressions to predict the probability of achieving 25 specific developmental milestones with 15%, 30%, 45%, 60%, 75%, and 90% probability as a function of age. We further stratified results by individuals' sex. We present age norms for our study's population of people with Down syndrome for key milestones in academic, adaptive, language, and motor domains by calculating the ages at which milestone achievement was 75% probable. We then compare these norms to published norms for the general population. This study provides clinicians and families with age-based norms for achievement of key developmental milestones for children and adolescents with Down syndrome.

Factors Associated with Older People's Anxiety Symptom Positioning after COVID-19: Cross-Sectional Findings from a Canadian Sample.

This study sheds light on the personal characteristics of older Canadians self-identifying as severely anxious and the coping strategies that they gravitated to mitigate their anxiety. Our studied sample consisted of 606 Canadians aged 60 and above who took part in an e-survey across all 10 of Canada's provinces, launched in July 2022, when social distancing was lifted across the country. Participants completed a personal characteristics questionnaire, the Geriatric Anxiety Scale or GAS-10, and a checklist of everyday coping strategies for mitigating anxiety. A seemingly greater number of severely anxious Canadians were born female, self-identified as a cisgender woman, and were in their 60s and in poor to fair health. A univariate logistic regression analysis revealed that all such personal characteristics were associated with statistically significantly greater odds of experiencing severe anxiety. In our multivariate logistic regression analysis, no significant differences were observed between the sexes (AOR = 0.590, p = 0.404), and non-binary and cisgender men (AOR = 0.689, p = 0.441) and women (AOR = 0.657, p = 0.397). Nor were there statistically significant differences in the odds of experiencing severe anxiety for those living with versus without a life partner and chronic illnesses. Older Canadians experiencing severe anxiety were far more likely to normalize their fear and anxiety (AOR = 4.76, p < 0.001), challenge their worries (AOR = 5.21, p < 0.001), and to relax or meditate (AOR = 2.36, p = < 0.001). They were less inclined to decrease other sources of stress in their lives, to stay active, and to get enough sleep. We offer anticipatory guidance for mental health program planners and practitioners, and fruitful avenues of inquiry for researchers.

Clinician actions in response to Adverse Childhood Experience (ACE) screening

Background and ObjectiveAdverse Childhood Experiences(ACEs) have a powerful influence on mental health, physical health, and life expectancy. Screening for ACEs and the clinician response to ACEs are critical to addressing the health and well-being of children; however, little is known about the actions clinicians take in response to ACE screening. Therefore, we aimed to examine clinician responses to ACE screening at five California pediatric clinics in a large public health care system. MethodsPatient demographics, indicators of social and behavioral determinants of health (e.g., housing insecurity), the number of ACEs endorsed on a screening instrument, and the actions clinicians took in response to each ACE screen were collected. Data was collected from May to October 2021. These data were used to examine the association between number of ACEs reported and clinician response, controlling for patient demographics and their social and behavioral determinants of health using multiple logistic regression. ResultsFive participating pediatric clinics conducted 2,652 ACE screens in six-months. Clinicians documented an action twice as often when ACEs were present, after controlling for patient demographics and their social and behavioral determinants of health (odds ratio(OR) = 2.2, 95 % confidence interval(CI): 1.5–3.3, p-value < 0.0001). Clinicians were three times more likely to record referrals to mental health clinicians, social workers, and community organizations relative to anticipatory guidance when the number of ACEs increased from one to three to four or more (OR=3.2, 95 %CI: 1.6–6.5, p < 0.0001). ConclusionFindings provide early information that ACE screening results are associated with patient care.

From Striving to Thriving: Mitigating Anti-Black Family Racism to Maximize Health Outcomes in Black Children

Certain inequities and injustices represent long-standing, recurring challenges that disproportionately affect many Black communities in the United States. Despite decades of efforts to eliminate these problems and improve outcomes in health, housing, education, and employment, a significant number of Black families are still “surviving” and not “thriving.” The effects of historical and ongoing discriminatory policies continue to increase risk for adverse outcomes among Black people and their families. These systemic conditions also help perpetuate negative myths and stereotypes associated with the Black family unit, and particularly, Black fathers. In striving to achieve equitable child health outcomes, it is vital for health care professionals to comprehend the tangible traumas that result from experiencing racism. This specific type of harm also acts as a driver for manifestation of developmental, physical, behavioral, and mental health issues in Black children. This review highlights the intersecting dynamics of structural racism, Black family units, and adverse outcomes on child health, development, and behavior. Health care professionals seeking to provide culturally attuned and appropriate anticipatory guidance need to address the effects of racism on social-emotional, language, and cognitive development in children. This includes centering Black family perspectives and advocating for antiracist programs and policies that protect Black children, such as increased support of Black children with special education needs, more equitable funding for neighborhoods where Black families reside, and meaningful efforts to reform criminal justice system practices that unfairly target Black men. By actively mitigating anti-Black racism, Black children and families can shift from surviving to thriving.

Unusual Maternal and Fetal Findings With Cell-Free DNA Screening.

With advances in prenatal cell-free DNA (cfDNA) technology, the information available with cfDNA continues to expand beyond the common fetal aneuploidies such as trisomies 21, 18, and 13. Due to the admixture of maternal and fetal/placental DNA, prenatal cfDNA remains a screening test with the possibility of false-positive and false-negative results. This review aims to summarize unusual incidental maternal and fetal genomic abnormalities detectable by cfDNA and to provide anticipatory guidance regarding management. Of 140 articles identified with keywords such as "incidental" and "discordant" cfDNA, 55 original research articles, review articles, case series, and societal guidelines were reviewed. Prenatal cfDNA may incidentally identify a spectrum of maternal genomic abnormalities such as malignancy, mosaicism, and copy number variants. When discordant with fetal diagnosis, these cases require additional investigation with maternal genetic testing and follow-up evaluation. Such incidental fetal/placental abnormalities may include rare autosomal trisomies, uniparental disomy, and triploidy. Further evaluation of fetal/placental abnormalities can be pursued with a combination of ultrasound and prenatal diagnosis with chorionic villous sampling and/or amniocentesis. Societal guidelines do not currently recommend cfDNA screening for rare autosomal trisomies, microdeletions, or copy number variants, and some experts suggest that sex chromosome screening should be opted in after counseling. Knowledge about possible incidental findings with prenatal cfDNA is needed to inform pretest and posttest counseling with appropriate follow-up evaluation. As cfDNA technology has advanced to include genome-wide findings, it is important for clinicians, genetic counselors, and societal guidelines to acknowledge the spectrum of possible results outside of the traditional and sex chromosome aneuploidies.

Comparison of medication abortion outcomes at less than and greater than 6 weeks gestation

ObjectivesTo compare outcomes and characteristics of two cohorts of patients: those receiving medication abortion (MAB) at ≤42 days gestation and those at 43-56 days gestation. Study DesignWe conducted a retrospective cohort study to compare characteristics and outcomes of all 142 patients accessing MAB at ≤42 days versus 200 patients at 43-56 days in 2022. We sought to detect a 7% difference in MAB success with 80% power and an alpha of 0.05. We compared follow-up responses and unscheduled contacts with the healthcare system. ResultsAbortion success rates were similar between the ≤42 day and 43-56 day groups (94.3% vs 97%, p=0.226). Those ≤42 days had a higher frequency of unscheduled office visits (13% vs 6%, p=0.01) but no difference in phone calls or emergency room visits. More patients with successful MAB in the ≤42 days group answered that bleeding (11.7% vs 1.9%, p=0.006) and cramping (10.5% vs 2.9%, p=0.035) were not heavier or worse than a period, and that they did not have pregnancy symptoms prior to the abortion (15.8% vs 6.0%, p=0.034).Patients ≤42 days gestation less often had a pre-treatment ultrasound (48% vs 64%, p=0.004). Patients without prior ultrasound more often needed uterine aspiration to complete the abortion (6.8% vs 2%, p=0.027). ConclusionsPatients undergoing MAB at ≤42 days have similar success rates but more unscheduled office visits, and more ambiguous symptoms when using standardized questions for evaluating abortion success. Clinicians should consider adapting their anticipatory guidance and counseling for this population. ImplicationsAccess to very early abortion is increasingly relevant as legal restrictions on abortion increase. Earlier gestations may have different responses to standard follow-up questions despite a successful MAB and may have more interactions with the healthcare system.

Integrating firearm storage and safety devices into health care.

Millions of US children and adolescents live in homes with loaded firearms, with only half of these homes securing their guns. Firearm-related deaths among youth have doubled over the past decade, making firearms the leading cause of death for children and adolescents in the United States. The recent advisory by the US Surgeon General, identifying firearm violence as a public health crisis, underscores the urgent need for responsible firearm ownership, including safe firearm storage. However, the healthcare community currently lacks durable medical equipment (DME) codes for firearm storage devices, limiting the ability of healthcare providers to support responsible gun ownership. We propose the establishment of DME codes for firearm storage and safety devices, which would facilitate insurance coverage of these vital prevention measures. Durable medical equipment codes would empower physicians and other healthcare providers to integrate anticipatory guidance and lethal means counseling of firearm safety into routine care and support hospital- and community-based efforts to prevent firearm-related injuries and deaths among children and adolescents.

Health Care Leaders' Experience with a Multi-Level Intervention to Reduce Hypertension Disparities: A Qualitative Analysis.

With health equity growing as a priority within health care, health systems must transform that calling into action within their social, economic, and political environments. The current literature has not compared how different organizations manage the same health disparities intervention. This qualitative study aims to illustrate how different organizations navigated the implementation and sustainability of a hypertension disparities intervention by comparing experiences across Federally Qualified Health Centers (FQHCs), a private health system, and other non-clinical partnering organizations. As a study within a randomized controlled trial designed to reduce disparities in hypertension care, we conducted interviews with health care leaders before and after participation in the trial's multi-level intervention. Before participation, we interviewed five health care leaders representing five health systems. Following the intervention, we interviewed 14 leaders representing the five health systems and two partnering organizations. Discussions focused on intervention implementation and plans for sustainability. The primary considerations in implementation were appropriate staffing and multi-level organizational buy-in. When discussing long-term planning, health systems prioritized the structure of a stepped-care protocol incorporating community health workers (CHWs) and case managers. The sustainability of the CHW intervention at FQHCs was dependent on funding, whereas a private, non-FQHC physician practice network focused on expanding current resources for more patients. These findings serve as anticipatory guidance for organizations aiming to reduce hypertension disparities and provide support for policies that financially assist these interventions. Further investigation is warranted on the organizational factors that may influence the degree of success in eliminating health care disparities.

Application of principles learned in a prevention-focused pediatric dental residency curriculum to professional practice.

This study examined whether pediatric dentists who participated in a pediatric dental residency program focusing on disease prevention and management training and screening for social determinants of health (SDOH) were applying these principles to their professional practice upon graduation. Using a cross-sectional study design, a one-time-only online survey was disseminated to 75 pediatric dentists who graduated from the University of California, Los Angeles's training program between 2012 and 2022. The 21-item survey included questions on demographics, patient population characteristics, and application of preventive dentistry and SDOH to their professional practice. Descriptive statistics and bivariate analyses were used to assess survey items. The survey response rate was 64%. Over two-thirds (67%) of alumni reported accepting Medicaid, 34% saw patients in a medically underserved area and all reported seeing children with special needs in their practice. Strategies used to address SDOH in their practice included providing anticipatory guidance (98%) and educating families on oral disease prevention and screening for SDOH (96%). Alumni accepting patients with Medicaid/public health insurance were more likely to address SDOH in their practice, such as assisting patients with filling out Medicaid paperwork (p<0.05), conducting outreach to underserved communities (p<0.05), and using interpreters in their practice (p<0.01) in comparison with alumni not accepting patients with Medicaid/public health insurance. This study demonstrated that a pediatric dental residency program may be successful in training residents to educate children, families, and special needs patients on disease prevention and management in an ethical and culturally sensitive manner and screen for SDOH during patient visits.

A Paradigm Shift: Implications for Social Worker Provision of LGBTQI+ Information and Support in Human Milk Feeding

Human milk feeding has generally been described using a heteronormative and cisnormative paradigm focusing on a mother and child dyad with the child nursing at the mother's breast and the father in a supportive role. However, there has been a paradigm shift that has emerged from the LGBTQI+ community that recognizes dynamic gender identities, gender roles, sexual orientations, and diverse family structures. Social workers can best provide support to people with dynamic and diverse gender roles and a variety of family structures. The purpose of this paper is to provide an overview of social work best practices, including de-sexed and gender-inclusive language, gender-affirming, and trauma-informed care in supporting lactation and infant feeding for LGBTQI+ families. This paper acknowledges and describes terminology that promotes equity and inclusivity in human milk feeding and provides examples of information and anticipatory guidance that social workers can use to protect, promote, and support human milk feeding in the LGBTQI+ community.