Anticipatory Guidance Research Articles

Changes in Pediatricians' Child Passenger Safety Counseling With Initiation of a Booster Seat Program.

Booster seats reduce injury in motor vehicle crashes, yet they are used less frequently than car seats and seat belts. Primary care providers are well positioned to educate and encourage families to use booster seats. We aimed to assess how a booster seat distribution program affected the documentation of restraint usage and anticipatory guidance at well-child visits at a pediatric primary care practice. We performed a retrospective chart review of patients aged 4 to 12 years from June to December in 2019 and 2020, representing before and after a booster seat program. The most frequently documented restraints in 2019 and 2020 were seat belts (51% vs 30%), booster seats (25% vs 27%), and not documented/unclear (17% vs 25%) (P < .001). The program significantly increased referrals for booster seats (P < .001). Despite significant differences in the proportion of children in each restraint category, overall booster seat use was similar between years.

Integrating machine learning predictions for perioperative risk management: Towards an empirical design of a flexible-standardized risk assessment tool

BackgroundSurgical patients are complex, vulnerable, and prone to postoperative complications that can potentially be mitigated with quality perioperative risk assessment and management. Several institutions have incorporated machine learning (ML) into their patient care to improve awareness and support clinician decision-making along the perioperative spectrum. Recent research suggests that ML risk prediction can support perioperative patient risk monitoring and management across several situations, including the operating room (OR) to intensive care unit (ICU) handoffs. ObjectivesOur study objectives were threefold: (1) evaluate whether ML-generated postoperative predictions are concordant with clinician-generated risk rankings for acute kidney injury, delirium, pneumonia, deep vein thrombosis, and pulmonary embolism, and establish their associated risk factors; (2) ascertain clinician end-user suggestions to improve adoption of ML-generated risks and their integration into the perioperative workflow; and (3) develop a user-friendly visualization format for a tool to display ML-generated risks and risk factors to support postoperative care planning, for example, within the context of OR-ICU handoffs. MethodsGraphical user interfaces for postoperative risk prediction models were assessed for end-user usability through cognitive walkthroughs and interviews with anesthesiologists, surgeons, certified registered nurse anesthetists, registered nurses, and critical care physicians. Thematic analysis relying on an explanation design framework was used to identify feedback and suggestions for improvement. Results17 clinicians participated in the evaluation. ML estimates of complication risks aligned with clinicians' independent rankings, and related displays were perceived as valuable for decision-making and care planning for postoperative care. During OR-ICU handoffs, the tool could speed up report preparation and remind clinicians to address patient-specific complications, thus providing more tailored care information. Suggestions for improvement centered on electronic tool delivery; methods to build trust in ML models; modifiable risks and risk mitigation strategies; and additional patient information based on individual preferences (e.g., surgical procedure). ConclusionsML estimates of postoperative complication risks can provide anticipatory guidance, potentially increasing the efficiency of care planning. We have offered an ML visualization framework for designing future ML-augmented tools and anticipate the development of tools that recommend specific actions to the user based on ML model output.Statement of Significance.•Problem: Implementation of machine-learning (ML) output within clinical workflows is not trivial.•What is already known: Barriers to ML implementation and appropriate use within clinical workflows include clinicians’ limited understanding of ML, wariness of ML output, and lack of ML output actionability.•What this paper adds: Qualitative end-user evaluation of postoperative risk predictions found high-levels of agreement between rankings of clinicians' manual risk rankings and ML-augmented risk estimates. The evaluation also highlighted design (functional and visual) enhancements for translational implementation of ML models within clinical workflows.

Orthopaedic Diagnoses in the Black Pediatric Population.

The Black pediatric population is one that has been historically underserved and continues to have unmet needs. Factors including lack of diversity in orthopaedic studies and in historical standards, such as bone age, may inadvertently lead to inferior care. There are certain conditions in this population for which the practicing orthopaedic surgeon should have a higher degree of suspicion, including slipped capital femoral epiphysis, Blount disease, and postaxial polydactyly. Systemic diseases with higher rates in this population have orthopaedic manifestations, including sickle cell disease, vitamin D deficiency, and obesity. Racial discrepancies in access to prenatal care can have orthopaedic consequences for babies, especially cerebral palsy and myelodysplasia. Racial discrepancy exists in evaluation for nonaccidental trauma. Increased awareness of these issues better prepares practitioners to provide equitable care.

Childhood-onset hereditary spastic paraplegia and its treatable mimics.

Early-onset forms of hereditary spastic paraplegia and inborn errors of metabolism that present with spastic diplegia are among the most common "mimics" of cerebral palsy. Early detection of these heterogenous genetic disorders can inform genetic counseling, anticipatory guidance, and improve outcomes, particularly where specific treatments exist. The diagnosis relies on clinical pattern recognition, biochemical testing, neuroimaging, and increasingly next-generation sequencing-based molecular testing. In this short review, we summarize the clinical and molecular understanding of: 1) childhood-onset and complex forms of hereditary spastic paraplegia (SPG5, SPG7, SPG11, SPG15, SPG35, SPG47, SPG48, SPG50, SPG51, SPG52) and, 2) the most common inborn errors of metabolism that present with phenotypes that resemble hereditary spastic paraplegia.

The important primary care role of neonatal nurse practitioners in the neonatal intensive care unit.

Neonatal nurse practitioners (NNPs) are recognized as acute care providers but are actually both acute and primary care providers via education and practice. Neonatal nurse practitioners provide primary care such as anticipatory guidance, care and follow-up of technologically dependent infants, and discharge planning. Numerous interventions and care in the neonatal intensive care unit (NICU) fall under the umbrella of health promotion, an aspect of primary care. In addition, NNPs must also be able to recognize, diagnose, and manage myriad common pediatric illnesses. There is a paucity of data to evaluate how NNP programs are meeting the National Association of Neonatal Nurses educational standards on this topic. A REDCap survey was sent to 31 NNP program directors, with a 100% response rate. All programs provide content addressing primary care management in their curriculum. National recognition of the primary care role, in addition to the acute care role that NNPs practice, should increase opportunities for clinical placement sites, employment opportunities, and grant funding. This article aims to demonstrate both the educational preparation and the delivery of primary care that NNPs provide in the NICU and other areas of practice.

Effects of an integrated mobile health lifestyle intervention among overweight and obese women planning for pregnancy in Singapore: protocol for the single-arm healthy early life moments in Singapore (HELMS) study

IntroductionChanges in social and lifestyle factors have led to increasing rates of metabolic and mental health problems. We hypothesise that a transformation of the current maternal and child health system...

USMLE Step 1 Pass/Fail is Here: Are Plastic Surgery Applicants Really Better Off?

As of January 26, 2022, the United States Medical Licensing Examination(USMLE) Step 1 score reporting will be changed from a numeric scoring system to pass/fail. Although the new scoring policy is expected to benefit medical students, there is concern that it will also amplify preexisting disadvantages and worsen disparities for students applying in the already-competitive plastic surgery match. Whether the reporting change will tangibly benefit applicants to plastic surgery has yet to be elucidated. A cross-sectional survey was distributed to medical students and graduates via social media platforms. Data were analyzed using Student t test and Chi-squared statistic, with an alpha level set at 0.05. Data collection and analysis was performed at Johns Hopkins University School of Medicine. This study included a sample of 120 American Medical Trainees (AMTs) and International Medical Trainees (IMTs) who are interested in plastic surgery. The plurality of respondents were against the new Step 1 score reporting (AMT: 40.7%; IMT: 44.3%), but differences existed between AMTs when compared to IMTs, especially regarding opinions about the reporting change on stress levels and competitiveness of highly competitive specialties. Regardless of training status, respondents felt that the pass/fail scoring system would increase their likelihood to engage with more research, dual apply, prioritize studying for Step 2 CK, and consider a dedicated research year. While a pass/fail reporting system for Step 1 may alleviate some stress for medical trainees, other issues arise that may perpetuate disparities and bias against students with little resources in the field of plastic surgery. Residency programs should offer anticipatory guidance regarding prioritization of aspects of application to ease this psychosocial and financial pressure, as well as help students reorganize their constrained time.

Firearm-Related Injuries and Deaths in Children and Youth: Injury Prevention and Harm Reduction.

Firearms are the leading cause of death in children and youth 0 to 24 years of age in the United States. They are also an important cause of injury with long-term physical and mental health consequences. A multipronged approach with layers of protection focused on harm reduction, which has been successful in decreasing motor vehicle-related injuries, is essential to decrease firearm injuries and deaths in children and youth. Interventions should be focused on the individual, household, community, and policy level. Strategies for harm reduction for pediatric firearm injuries include providing anticipatory guidance regarding the increased risk of firearm injuries and deaths with firearms in the home as well as the principles of safer firearm storage. In addition, lethal means counseling for patients and families with individuals at risk for self-harm and suicide is important. Community-level interventions include hospital and community-based violence intervention programs. The implementation of safety regulations for firearms as well as enacting legislation are also essential for firearm injury prevention. Increased funding for data infrastructure and research is also crucial to better understand risks and protective factors for firearm violence, which can then inform effective prevention interventions. To reverse this trend of increasing firearm violence, it is imperative for the wider community of clinicians, public health advocates, community stakeholders, researchers, funders, and policy makers to collaboratively address the growing public health crisis of firearm injuries in US youth.

Firearm-Related Injuries and Deaths in Children and Youth.

Firearms are the leading cause of death in children and youth 0 to 24 years of age in the United States. In 2020, firearms resulted in 10,197 deaths (fatality rate 9.91/100,000 youth 0-24 years old). Firearms are the leading mechanism of death in pediatric suicides and homicides. Increased access to firearms is associated with increased rates of firearm deaths. Substantial disparities in firearm injuries and deaths exist by age, gender, race, ethnicity, and sexual orientation and gender identity and for deaths related to legal intervention. Barriers to firearm access can decrease the risk to youth for firearm suicide, homicide, or unintentional shooting injury and death. Given the high lethality of firearms and the impulsivity associated with suicidal ideation, removing firearms from the home or securely storing them-referred to as lethal means restriction of firearms-is critical, especially for youth at risk for suicide. Primary care-, emergency department-, mental health-, hospital-, and community-based intervention programs can effectively screen and intervene for individuals at risk for harming themselves or others. The delivery of anticipatory guidance coupled with safety equipment provision improves firearm safer storage. Strong state-level firearm legislation is associated with decreased rates of firearm injuries and death. This includes legislation focused on comprehensive firearm licensing strategies and extreme risk protection order laws. A firm commitment to confront this public health crisis with a multipronged approach engaging all stakeholders, including individuals, families, clinicians, health systems, communities, public health advocates, firearm owners and nonowners, and policy makers, is essential to address the worsening firearm crisis facing US youth today.

CHEC-UP: A Digital Intervention to Reduce Disparities in Well-Child and Immunization Completion in Community Health

Objective&#x0D; Well-child visits and immunizations among children in the U.S. declined at the pandemic’s onset and vulnerable populations have been disproportionately affected. This pilot projects tested an innovative mechanism to use chatbots to engage caregivers in evidence-based preventive care for children. &#x0D; Design &#x0D; We used artificial intelligence (AI)-enabled chatbots to personalize messages and facilitate appointment scheduling over a five-month period. Chatbots introduced a novel way to connect vulnerable populations to care and challenged traditional convention of provider-patient engagement.&#x0D; Setting&#x0D; The pilot study was conducted at a Community Health Center in Chicago, Illinois that serves roughly 10,500 children, and 82% of patients are racial and/or ethnic minorities. &#x0D; Participants &#x0D; We targeted outreach to 200 English and Spanish-speaking families with children 0-17 years of age for proactive outreach using chatbots promoting well-child visit completion and up-to-date immunization status; moreover, a special emphasis was placed on the 0-2 age group as the first two years represent a critical time for primary prevention of vaccine-preventable diseases.&#x0D; InterventionsThe intervention focused on pre-visit engagement by launching an AI-enabled chatbot to deliver personalized messages and facilitate appointment scheduling via mobile devices. CHEC-UP also provided evidence-based anticipatory guidance prior to an appointment. Coaching in preparation for the visit with trusted information has the potential to educate, improve confidence and promote shared decisions between the parent and provider. Patient experience was measured via surveys deployed via the chatbot.&#x0D; Main Outcome Measures &amp; Results&#x0D; Chatbots facilitated a relative increase in well-child visits and immunizations by 27% in the intervention group. Well-child visits and immunizations in the intervention group increased 13% compared to the control group. Survey results and patient interviews indicated a high level of patient satisfaction using the chatbot. In addition to a favorable perception of the chatbots, patients also identified future use cases for chatbots.&#x0D; Conclusions Engaging patients with chatbots improved vaccination and well-child uptake. Patients were highly satisfied with chatbot engagement. By engaging patients and caregivers, chatbots present the potential to proactively engage patients in care and optimize vaccination uptake and realize one of societies’ greatest public health achievements: decreasing the spread of communicable diseases.

Effects of bothersome symptoms during the late reproductive stage and menopausal transition: observations from the Women Living Better Survey.

Bothersome symptoms during the late reproductive stage and menopausal transition sometimes interfere with women's activities of daily living and relationships, yet little is known about the specific effects of different groups of symptoms. Aims of these analyses were to examine the effects of bother related to 5 symptom groups on participant's assessment of 4 outcomes: interference with everyday activities, interference with relationships, "not feeling like myself," and self-ratings of health. Participants (N = 1,539 meeting eligibility and inclusion criteria) aged 35 to 60 years responded to the online Women Living Better Survey during March to August of 2020. In addition to rating 61 symptoms as bothersome on a scale from not at all bothered (0) to extremely bothered (6), they also indicated the degree to which their symptoms interfered with their activities and relationships indicating not at all (0) to a great deal (4). They indicated the extent to which they did not "feel like myself" choosing none of the time (0) to all of the time (4) and rated their health from poor (1) to excellent (5). Symptoms were grouped using results of principal components analysis. Five symptom groups with the highest bother ratings were analyzed for this report, including the following: brain fog, volatile mood, fatigue/pain, vasomotor symptoms (VMS)/sleep onset, and anxiety/vigilance symptoms. Two-stage hierarchical regression analysis was used to examine personal characteristics of the participants such as education, menopause-related factors, roles and stressors (stage 1), and effects of 5 symptom group bother ratings on interference with daily activities and relationships, "not feeling like myself," and health ratings (stage 2). Interference with daily activities was related to difficulty paying for basic items and bother associated with the brain fog, anxiety/vigilance, fatigue/pain, and VMS/sleep onset symptom groups. Interference with relationships was correlated with being in a committed relationship and bother related to all 5 symptom groups. "Not feeling like myself" was related to having completed less education, reporting greater overall stress, brain fog, anxiety/vigilance, volatile mood, and fatigue/pain symptoms. More positive health ratings were related to having completed more education, having responsibility for children or dependents, experiencing greater satisfaction with roles, and less fatigue/pain symptom bother. Bother related to all 5 symptom groups was associated with increased interference with relationships, but bother related to interference with daily activities was related to only 4 of the 5 symptom groups, but not volatile mood symptoms. The phrase "not feeling like myself" was related to more bothersome anxiety/vigilance, volatile mood, brain fog, and fatigue/pain symptoms. Of interest was that VMS/sleep symptoms, often attributed to the menopausal transition, were not related to either "not feeling like myself" or to self-ratings of health. Moreover, self-rated health was related only to fatigue/pain symptom bother. These findings suggest that the experience of symptoms typically attributed to a developmental event, in this case perimenopause, may be viewed as unrelated to one's health. Further clarification of which symptoms can be attributed to perimenopause rather than other factors, such as aging, will improve anticipatory guidance about perimenopause. Similarly, additional investigation of the meaning of the phrase "not feeling like myself" could help clarify why bothersome symptoms, such as mood, fatigue, and cognitive symptoms, but not vasomotor/insomnia symptoms, are associated with this descriptor. Setting accurate expectations about what is typical can influence anticipations, understanding the spectrum of experiences, and attributions of symptoms. Further investigation on these fronts will contribute to timely, accurate anticipatory guidance and strategic symptom management for patients and providers.

Two cases of splenic injuries in adolescent lacrosse players

Splenic injuries are the most common cause of death in the setting of abdominal trauma among athletes. Splenic injuries are difficult to diagnose as patients often present with non-localizing symptoms. There are limited reports of splenic lacerations due to the blunt impact from a lacrosse ball. We present two teenagers who presented to the Emergency Department (ED) with left-sided abdominal pain after being struck by a lacrosse ball in the left flank. Abdominal computed tomography scans revealed grade III and grade IV splenic lacerations, respectively. Understanding risk factors, associated symptoms, and return to play precautions is essential for diagnosis, management and anticipatory guidance in these patients.

Replacing community clinical hours with an antepartum simulation-based experience.

Community and population health is an essential part of pre-licensure nursing education. Securing community clinical sites for large cohorts of nursing students is challenging. Individual community sites in nursing specialty areas, such as women's health, limit the number of students, making it difficult to provide a consistent clinical experience for all students. The literature shows simulation is an effective alternative to traditional clinical hours. This article describes a pilot simulation-based antepartum experience in the community setting. This simulation-based experience replaced the clinical hours for a previous traditional clinical experience in the community setting, for which students were only able to observe and not interact. The objectives were to allow students to be engaged in communication, patient education, and anticipatory guidance with a live patient. Faculty at a large southeastern university created an antepartum simulation-based clinical experience focused on important elements of obstetrics and maternal health assessment utilizing standardized patients. Student responses from the post-simulation survey showed 96% strongly agreed they were more confident in communicating with clients. Faculty concluded this simulation-based experience is an effective alternative to traditional community clinical experiences in the antepartum setting.

Do children evaluated for maltreatment have higher subsequent emergency department and inpatient care utilization compared to a general pediatric sample?

BackgroundChild maltreatment leads to substantial adverse health outcomes, but little is known about acute health care utilization patterns after children are evaluated for a concern of maltreatment at a child abuse and neglect medical evaluation clinic. ObjectiveTo quantify the association of having a child maltreatment evaluation with subsequent acute health care utilization among children from birth to age three. Participants and settingChildren who received a maltreatment evaluation (N = 367) at a child abuse and neglect subspecialty clinic in an academic health system in the United States and the general pediatric population (N = 21,231). MethodsWe conducted a retrospective cohort study that compared acute health care utilization over 18 months between the two samples using data from electronic health records. Outcomes were time to first emergency department (ED) visit or inpatient hospitalization, maltreatment-related ED use or inpatient hospitalization, and ED use or inpatient hospitalization for ambulatory care sensitive conditions (ACSCs). Multilevel survival analyses were performed. ResultsChildren who received a maltreatment evaluation had an increased hazard for a subsequent ED visit or inpatient hospitalization (hazard ratio [HR]: 1.3, 95 % confidence interval [CI]: 1.1, 1.5) and a maltreatment-related visit (HR: 4.4, 95 % CI: 2.3, 8.2) relative to the general pediatric population. A maltreatment evaluation was not associated with a higher hazard of health care use for ACSCs (HR: 1.0, 95 % CI: 0.7, 1.3). ConclusionThis work can inform targeted anticipatory guidance to aid high-risk families in preventing future harm or minimizing complications from previous maltreatment.

Experiences With Prenatal Care Delivery Reported by Black Patients With Low Income and by Health Care Workers in the US

Black pregnant people with low income face inequities in health care access and outcomes in the US, yet their voices have been largely absent from redesigning prenatal care. To examine patients' and health care workers' experiences with prenatal care delivery in a largely low-income Black population to inform care innovations to improve care coordination, access, quality, and outcomes. For this qualitative study, human-centered design-informed interviews were conducted at prenatal care clinics with 19 low-income Black patients who were currently pregnant or up to 1 year post partum and 19 health care workers (eg, physicians, nurses, and community health workers) in Detroit, Michigan, between October 14, 2019, and February 7, 2020. Questions focused on 2 human-centered design phases: observation (understanding problems from the end user's perspective) and ideation (generating novel potential solutions). Questions targeted participants' experiences with the 3 goals of prenatal care: medical care, anticipatory guidance, and social support. An eclectic analytic strategy, including inductive thematic analysis and matrix coding, was used to identify promising strategies for prenatal care redesign. Preferences for prenatal care redesign. Nineteen Black patients (mean [SD] age, 28.4 [5.9] years; 19 [100%] female; and 17 [89.5%] with public insurance) and 17 of 19 health care workers (mean [SD] age, 47.9 [15.7] years; 15 female [88.2%]; and 13 [76.5%] Black) completed the surveys. A range of health care workers were included (eg, physicians, doulas, and social workers). Although all affirmed the 3 prenatal care goals, participants reported failures and potential solutions for each area of prenatal care delivery. Themes also emerged in 2 cross-cutting areas: practitioners and care infrastructure. Participants reported that, ideally, care structure would enable strong ongoing relationships between patients and practitioners. Practitioners would coordinate all prenatal services, not just medical care. Finally, care would be tailored to individual patients by using care navigators, flexible models, and colocation of services to reduce barriers. In this qualitative study of low-income, Black pregnant people in Detroit, Michigan, and the health care workers who care for them, prenatal care delivery failed to meet many patients' needs. Participants reported that an ideal care delivery model would include comprehensive, integrated services across the health care system, expanding beyond medical care to also include patients' social needs and preferences.

Is Pediatric Intensive Care Trauma-Informed? A Review of Principles and Evidence.

Pediatric critical illness and injury, along with the experience of recovering from critical illness are among the most potentially traumatic experiences for children and their families. Additionally, children often come to the Pediatric Intensive Care Unit (PICU) with pre-existing trauma that may sensitize them to PICU-related distress. Trauma-informed care (TIC) in the PICU, while under-examined, has the potential to enhance quality of care, mitigate trauma-related symptoms, encourage positive coping, and provide anticipatory guidance for the recovery process. This narrative review paper first describes the need for TIC in the PICU and then introduces the principles of TIC as outlined by the American Academy of Pediatrics: awareness, readiness, detection and assessment, management, and integration. Current clinical practices within PICU settings are reviewed according to each TIC principle. Discussion about opportunities for further development of TIC programs to improve patient care and advance knowledge is also included.

ANALYSIS OF VARIOUS INTERVENTIONS IN THE MANAGEMENT OF INFANTILE HEMANGIOMAS

Introduction: Infantile hemangiomas are the most common benign vascular tumors of infancy. The prevalence is around 3-10%. The various risk factors include female gender, prematurity, low birth weight, multiple pregnancies, advanced maternal age and in vitro fertilization. IH most commonly affect the head and neck region. This study aims to give an insight and highlight the evidence-based approach in the management of IH. To assess the occurrence, plan Aim: of management and the interventions in the management of hemangiomas occurring in children. This study used a retrospective observational m Method: ethod to assess and evaluate the various interventions employed in the management of infantile hemangiomas between July 2021 and February 2022. A total of 50 patients were Result: included in the study, 30 were females and 20 males. 15 lesions were surgically treated, 5 underwent laser ablation and remaining 30 were treated with beta blockers and corticosteroids. The primary outcome measures were clearance, a subjective measure of improvement, and adverse events. Secondary outcomes were other measures of resolution; aesthetic appearance; and requirement for surgical correction. The Outcome: treatment of IH depends on the following factors: Type of hemangioma, stage of the lesion, location and extent, number and distribution of the lesion, associated systemic involvement, presence or absence of ulceration and psychosocial distress of the parents or child. In general, any function threatening (ocular, ear, nasal tip, lip, large disguring facial lesion and genitalia involvement) or life-threatening hemangioma, need intervention. The remaining cases need only active non-intervention, like education about the natural course, treatment options and anticipatory guidance. Systemic corticosteroids are used for complicated hemangiomas, followed by non-selective beta-blockers, such as oral propranolol and topical timolol can be used for uncomplicated localized lesions.

The Collaborative Advocate: Psychiatrists' Role in Addressing Criminal Legal Involvement.

The Collaborative Advocate: Psychiatrists' Role in Addressing Criminal Legal Involvement.

Adolescent Athletes’ Perspectives on the Social Implications of Sport-Related Concussion

Purpose: Sport-related concussion can affect many domains of a patient’s health status. Social functioning is an important consideration, especially for adolescent athletes. Our purpose was to explore adolescent athletes’ social perspectives regarding sport and concussion. Methods: Using a qualitative study design we interviewed 12 interscholastic athletes who had sustained a sport-related concussion. The interviews focused on injury details, and explored the physical, psychosocial, emotional, and spiritual components of sport and health. Themes and categories were identified using the consensual qualitative research process by a three-person research team. A comprehensive codebook that captured the main themes and categories resulted. Results: Following concussion, participants discussed two primary themes: perceptions regarding the social aspects of sport and social perspectives regarding their concussion. Specific categories related to the social aspects of sport included: friendships and family and decision to participate based on peers. Specific categories regarding the social perspectives of the concussion included uncertainty of the diagnosis, perceptions of others regarding their injury, being ashamed of the concussion, parent and peer roles, and communication and expectation about their concussion. Conclusions: Participation in sport and removal from sport following a concussion have significant social implications for adolescent athletes. Specifically, the perceptions of peers, parents/guardians, and others regarding the injury can influence reporting of symptoms and recovery following concussion. Limited communication regarding recovery and expectations post-concussion may cause undue social pressures to return to activity prematurely. Providing a supportive environment in which patients can recover from concussion while engaging with peers and teammates is important. Anticipatory guidance, with education regarding the possible signs and symptoms, risk factors pre- and post-injury, and recovery expectations following a concussion are important to include in post-injury management and should be known to all stakeholders.

Psychosocial Issues Related to Newborn Screening: A Systematic Review and Synthesis.

Genomic advances have contributed to a proliferation of newborn screening (NBS) programs. Psychosocial consequences of NBS have been identified as risks to these public health initiatives. Following PRISMA guidelines, this systematic review synthesizes findings from 92 evidence-based, peer-reviewed research reports published from 2000 through 2020 regarding psychosocial issues associated with NBS. Results describe parents’ knowledge of and attitudes towards NBS, reactions to and understanding of positive NBS results, experiences of communication with health providers, decisions about carrier testing, and future pregnancies. Findings also explain the impact of positive NBS results on parent–child relationships, child development, informing children about carrier status, family burden, quality of life, and disparities. In conclusion, psychosocial consequences of receiving unexpected neonatal screening results and unsolicited genetic information remain significant risks to expansion of NBS. Findings suggest that risks may be mitigated by improved parent NBS education, effective communication, individualized genetic counseling, and anticipatory developmental guidance. Clinicians need to take extra measures to ensure equitable service delivery to marginalized subpopulations. Future investigations should be more inclusive of culturally and socioeconomically diverse families and conducted in low-resource countries. Providing these countries with adequate resources to develop NBS programs is an essential step towards achieving international health equity.