Anticipatory Guidance Research Articles

“They had the lunch lady coming up to assist”: The experiences of menarche and menstrual management for adolescents with physical disabilities

BackgroundMenarche is a pivotal time in an adolescent's life but can be experienced differently by those with physical disabilities. Parents typically serve as the primary educators and support for their daughters during this time. Little is known about the parent's perspective of their daughter's experience preparing for menarche and learning to manage menses. ObjectiveWe sought to understand the parent's perspective of the experience of their daughter with a physical disability around menarche and their preferences for health care provider support. MethodsIndividual semi-structured interviews were conducted with 21 parents of a daughter with a physical disability ages 7–26. Interviews were coded by 2 reviewers using Grounded Theory, with disagreements resolved by consensus. ResultsSix themes emerged regarding the parent's perception of the experiences, including 1) variation in emotional responses to menarche, 2) parent's perception of their daughter's experience with menses and menstrual symptoms, 3) cross-section of disability and menstrual management, 4) menstrual management at school, 5) parental knowledge correlating to daughter's preparation for menarche, and 6) desires for health care provider support. ConclusionsAll parents reported that their daughters faced challenges during menarche, ranging from emotional distress to dealing with the inaccessibility of hygiene products. Managing periods at schools was particularly burdensome. Parents who were better educated about what to expect were better able to prepare their daughters, but had difficulties finding informed, supportive providers. Health care providers should provide both anticipatory guidance and holistic, respectful, and equitable options for the management of menstrual symptoms.

The lived experience of reconstructing identity in response to genetic risk of frontotemporal degeneration and amyotrophic lateral sclerosis.

With the increasing availability of predictive genetic testing for adult-onset neurodegenerative conditions, it is imperative that we better understand the impact of learning one's risk status. Frontotemporal degeneration (FTD) is the second most prevalent cause of early-onset dementia. About one-third of patients have an identifiable genetic etiology, and some genetic variants that cause FTD can also cause amyotrophic lateral sclerosis (ALS). To understand individuals' risk perception and broader experience of living at risk, we completed semi-structured telephone interviews with 14 asymptomatic adults who tested positive for a variant known to cause risk for FTD and/or ALS. We conducted a thematic analysis, and within the core topic of identity, we derived three themes: conceptualization of FTD and ALS as a threat to identity, enduring uncertainty and dread, and varying centrality of risk status to identity. FTD and ALS risk raised fundamental issues for participants related to the essence of personhood, challenged them to confront Cartesian dualism (the philosophy of mind-body separation), and exposed how time, relationships, and social roles have affected their understanding of the nature of the self. Our findings provide important insight into how being at genetic risk shapes an individual's identity. We conclude that genetic counseling interventions that allow for identity exploration, anticipatory guidance, and uncertainty management should be utilized when supporting persons at risk.

Function in Cancer Patients: Disease and Clinical Determinants.

Patients with cancer often experience changes in function during and after treatment but it is not clear what cancer types, and associated clinical factors, affect function. This study evaluated patient-reported functional impairments between specific cancer types and risk factors related to disease status and non-cancer factors. A cross-sectional study evaluating 332 individuals referred to cancer rehabilitation clinics was performed at six U.S. hospitals. The PROMIS Cancer Function Brief 3D Profile was used to assess functional outcomes across the domains of physical function, fatigue, and social participation. Multivariable modeling showed an interaction between cancer type and cancer status on the physical function and social participation scales. Subset analyses in the active cancer group showed an effect by cancer type for physical function (p < 0.001) and social participation (p = 0.008), but no effect was found within the non-active cancer subset analyses. Brain, sarcoma, prostate, and lymphoma were the cancers associated with lower function when disease was active. Premorbid neurologic or musculoskeletal impairments were found to be predictors of lower physical function and social participation in those with non-active cancer; cancer type did not predict low function in patients with no evidence of disease. There was no differential effect of cancer type on fatigue, but increased fatigue was significantly associated with lower age (0.027), increased body mass index (p < 0.001), premorbid musculoskeletal impairment (p < 0.015), and active cancer status (p < 0.001). Anticipatory guidance and education on the common impairments observed with specific cancer types and during specific stages of cancer care may help improve/support patients and their caregivers as they receive impairment-driven cancer rehabilitation care.

Attention Challenges &amp; Symptom Manifestation Across Young Adult Roles for Undergraduates With Learning Attention Disorders: A Preliminary Analysis

Abstract Date Presented 04/21/2023 A qualitative examination is presented of experiences of LD and attention deficit hyperactivity disorder (ADHD) challenges and symptom manifestation among college students negotiating young adult daily tasks and social, work, and academic roles and contexts that may inform OT practice and anticipatory guidance. Primary Author and Speaker: Consuelo Kreider Additional Authors and Speakers: Anya Klumpp Contributing Authors: Sharon Medina

Functional Dementia Stages App for Hispanic Family Caregivers: Heuristic Evaluation and Usability Testing.

Hispanic family caregivers of persons with dementia are not getting the anticipatory guidance they need about how functional abilities will change as dementia progresses. Existing informational resources are overwhelming to navigate and written at a high reading level. Furthermore, professional assessment of functional abilities is not universally available. Innovative, tailored approaches are needed. Our aim was to develop and test a mobile application (app), the Interactive Functional Assessment Staging Navigator (I-FASTN), to support Hispanic family caregivers' assessment of care recipients' functional stage of dementia in either English or Spanish. We conducted heuristic evaluation with experts (N = 5) and usability testing with caregivers (N = 20). Chief usability problems were a confusing tutorial and difficulty finding the app's side menu. The app was well-received by caregivers, who indicated that the concise, illustrated content met their informational needs. However, analog alternatives are still needed by caregivers unaccustomed to using apps. [Journal of Gerontological Nursing, 49(7), 9-15.].

Dentists' Utilization of Caries Risk Assessment and Individualized Caries Prevention Methods in Pediatric Patients in Saudi Arabia.

The first step in any complete oral health care plan for a child is a thorough caries risk assessment (CRA). This study aimed to investigate whether the practice dentists in Saudi Arabia's Western province do CRA methods and offer Individualized Caries Prevention (ICP) to their pediatric patients. Dentists in active clinical practice in the Western province of Saudi Arabia were the participants of this cross-sectional survey. The participants in this study were chosen using a simple random sampling technique. A self-administered, structured questionnaire was used to gather participants' responses. A majority (88.2%) of the dentists agreed that it is very important to practice CRA on a regular basis among their pediatric patients. About 67% of dentists employed Individualized Caries Prevention methods. No statistically significant correlation was observed between ICP and CRA factors, indicating that interventions primarily focused on patients' financial affordability. Dentists should encourage parents/caregivers to establish a dental home concept at the earliest, which includes CRA, education, and anticipatory guidance on the prevention of oral diseases.

Psychosocial needs of pediatric cancer patients and their caregivers at end of treatment: Why psychosocial screening remains important.

The pediatric cancer Psychosocial Standards of Care calls for psychosocial screening across the cancer trajectory. The current study aims to describe pediatric cancer family needs at the end of treatment (EOT) and summarize feedback on a clinical EOT screening and education program. During a clinic visit, families attended an education session regarding general EOT considerations and caregivers and youth aged 11+ years completed questionnaires. Scores were coded for clinical significance based on cutoff scores per questionnaire, and clinical significance frequencies were calculated. Caregivers provided qualitative feedback on the EOT program via an open-ended prompt. Screening was completed by 151 families. Ninety-four patients (67.1%) endorsed risk by self- or proxy-report in at least one domain. Across all patient age groups, a symptom of neurocognitive functioning was the most frequently endorsed risk, including executive functioning, sustained focused, and thinking slower than others. For caregivers, 106 (74.1%) endorsed risk in at least one domain, with concerns for ability to manage their child's medical condition as the most frequent endorsement. Families were agreeable to an EOT program with many caregivers advocating for receiving this program earlier. Both patients and caregivers experienced clinically significant needs that require intervention at EOT. While patients are experiencing neurocognitive effects and distress, their caregivers are balancing management of their own distress with management of their child's needs during a transition to decreased support from the medical team. The findings affirm the need for systematic screening at EOT and anticipatory guidance for off treatment expectations.

Changing Degrees: Incorporating the Impacts of Climate Change on Health into Pediatric Residency Education and Practice.

The American Academy of Pediatrics (AAP) was the first major medical society to release a policy statement on the impacts of climate change on pediatric health. It is estimated that globally, children bear the burden of climate-induced disease. However, many undergraduate and graduate medical curricula do not cover this topic. This article builds on previous literature to propose a framework for such a curriculum as well as justify its relevance in light of current accreditation requirements. Some curricular topics include extreme heat and heat-related injury, degradations in air quality and pediatric respiratory disease, spread of vector-borne and diarrheal illness, and mental health effects. Lastly, it addresses clinical applications for this knowledge, including screening vulnerable patients, offering anticipatory guidance, and advocating for the medical benefits of planetary health.

Dental Hygienists’ Intentions to Provide Anticipatory Guidance Recommendations: Application of the Theory of Planned Behavior

Purpose: This study aimed to assess the relationship between the behavioral, normative, and control beliefs of dental hygienists (DHs) and their behavioral intention to provide anticipatory guidance (AG) to expecting parents and caregivers of infants and toddlers. Methods: A descriptive, cross-sectional survey design used convenience sampling strategies to recruit DHs (n=335) who provided oral health care to expecting parents and caregivers of children 0-5 years old. A survey was developed based on the Theory of Planned Behavior (TPB) and validated. Descriptive, correlation and regression analyses were conducted to assess the relationships among variables. Results: The survey completion rate was 72% (n=241). Strong relationships (p=.001) were shown between DHs’ behavioral, normative, and control beliefs and their intention to discuss AG with expecting parents and caregivers of infants and toddlers. The TPB model suggests normative (p&lt;.05) and control (p=.001) beliefs were strong predictors of intention. Control beliefs (p=.001) were the strongest predictor of intention for all TPB subscales. The results also indicated that DHs with bachelor’s degrees or higher demonstrated more positive normative (Md=73.00, p&lt;.001) and control beliefs (Md=94.00) than DHs with associate degrees. Conclusions: Although DHs are aware of AG for infants and toddlers, results demonstrated the TPB model might predict DHs’ intentions to provide AG based on normative and control beliefs. This information may serve as a baseline for future research exploring DHs’ anticipatory guidance behaviors toward caregivers of infants and toddlers.

Execution of anticipatory guidance and the knowledge and practice gap among caregivers in Southern Taiwan: A retrospective study

This study examined the practice rate of Anticipatory Guidance (AG) and the gap between knowledge and practice among caregivers. We retrospectively collected data from caregivers who brought their children for seven age-based well-child visits (birth to 7 years old) and seven corresponding AG checklists for practice (each ranged from 16 to 19 guidance items, 118 items in total) between 2015 and 2017. Practice rates of guidance items and their association with children's sex, age, residence, and body mass index were collected and analyzed. We enrolled 2310 caregivers (330 per well-child visit). Average practice rates of guidance items in the seven AG checklists were 77.6%-95.1%, generally without significant differences between urban/rural or male/female children. However, lower (<80%) rates were observed for 32 items, including dental check-ups (38.9%), use of fluoride toothpaste (44.6%), screen time (69.4%), and drinking less sugar-sweetened beverages (SSBs) (75.5%), with corresponding knowledge-to-practice gap rates of 55.5%, 47.9%, 30.3%, and 23.8%, respectively. "Drinking less SSBs" was the only item with a higher obesity rate in the non-achieved group versus the achieved group (16.7% vs. 7.4%, p=0.036; odds ratio: 3.509, 95% CI: 1.153-10.677, p=0.027). Caregivers in Taiwan practiced most AG recommendations. However, dental check-ups, fluoride toothpaste use, drinking less SSBs, and limiting screen time were less executed items. A higher obesity rate was found among 3-7-year-old children whose caregivers failed to practice the "Drink less SSBs" guidance. Strategies to overcome the gap between knowledge and practice are needed to improve these less-achieved guidance items.

Paediatrics and discomfort with death and dying.

Death and dying, while uncommon in day-to-day paediatrics practice, are becoming increasingly common occurrences as children with life-limiting illnesses are living longer. We reflect on our experiences with death and dying in our residency training and whether paediatrics, as a specialty, is uncomfortable with death. Paediatric trainees should be included in honest discussions about disease trajectories and participate in providing end-of-life care. Anticipatory guidance helps personalize care and can prevent unnecessary procedures or suffering that patients may experience. While trainees may not be present at the end-of-life for many patients, managing death and dying are important competencies for future paediatricians. Current paediatricians should reflect on their comfort with death and how this may impact their patient care.

Anticipated age of perimenopausal experiences, stress, satisfaction, and health and well-being: observations from the Women Living Better Survey.

People's expectations about the timing of developmental events, specifically the ages at which they will occur, are influenced by social and cultural contexts. When expected timing and lived experience are divergent, events such as menopause may be associated with greater stress or distress. We hypothesized that being "off-time," that is, experiencing perimenopause-related menstrual cycle changes or symptoms in a timeframe before a person expects them, would lead to worse ratings on measures of stress, satisfaction, and health. Participants responded to the online Women Living Better Survey during March to August 2020; 1,262 met the eligibility criteria for inclusion in hypothesis testing. Being "off-time" referred to experiencing changes related to perimenopause at a younger age than that at which participants anticipated experiencing such changes. Using a one-way analysis of variance (ANOVA), we examined differences in being "off-time" versus "on-time" on seven participant-rated measures: stress (overall and health-related stress), satisfaction with life roles and activities, and well-being and health ratings (interference with daily activities, interference with relationships, "not feeling like myself," and perceived health). Using 2-way ANOVA, we then tested hypothesized differences between being "off-time" and on-time and experiencing perimenopause-related menstrual cycle changes, vasomotor/sleep symptoms, or volatile mood symptoms on the same seven measures. Those who were "off-time" versus "on-time" reported significantly poorer health ratings in a one-way ANOVA. Experiencing more noticeable perimenopause-related menstrual cycle changes was significantly related to greater health stress, overall stress, satisfaction with life roles and activities, interference with daily activities, interference with relationships, and "not feeling like myself" (all P < 0.05), but not to health ratings. Experiencing more bothersome vasomotor symptoms was significantly related to health stress, overall stress, interference with daily activities, interference with relationships, and "not feeling like myself" more of the time and to poorer perceived health (all P < 0.05). There were no significant interaction effects of being "off-time" and experiencing perimenopause-related menstrual cycle changes or vasomotor symptoms. In contrast, having more bothersome volatile mood symptoms significantly affected health stress, overall stress, satisfaction with life roles and activities, interference with daily activities, interference with relationships, "not feeling like myself" more of the time, and perceived health. Finally, there was a significant interaction effect of being "off-time" and volatile mood symptoms on health stress, satisfaction with life roles and activities, and perceived health (all P < 0.05). Being "off-time" alone had little effect on studied measures with the exception of poorer perceived health. Experiencing more noticeable perimenopause-related menstrual cycle changes or having more bothersome vasomotor symptoms influenced several measures, but there were no interactive effects with being "off-time." In contrast, those who were "off-time" and experiencing more bothersome volatile mood symptoms reported greater health stress, lower satisfaction with life roles and activities, and poorer perceived health. These interactive effects of being "off-time" and experiencing volatile mood suggest a need for greater attention to the link between volatile mood and perimenopause. Furthermore, anticipatory guidance for those on the path to menopause should include the possibility of volatile mood symptoms.

A Multi-Hospital Survey of Current Practices for Supporting Recovery From Sepsis.

Electronic survey assessing the use of best practices for recovery from COVID-related and non-COVID-related sepsis. Questions included four-point Likert responses of "never" to "always/nearly always." Twenty-six veterans affairs hospitals with the highest (n = 13) and lowest (n = 13) risk-adjusted 90-day sepsis survival. Inpatient and outpatient clinician leaders. None. For each domain, we calculated the proportion of "always/nearly always" responses and mean Likert scores. We assessed for differences by hospital survival, COVID versus non-COVID sepsis, and sepsis case volume. Across eight domains of care, the proportion "always/nearly always" responses ranged from: 80.7% (social support) and 69.8% (medication management) to 22.5% (physical recovery and adaptation) and 0.0% (emotional support). Higher-survival hospitals more often performed screening for new symptoms/limitations (49.2% vs 35.1% "always/nearly always," p = 0.02) compared with lower-survival hospitals. There was no difference in "always/nearly always" responses for COVID-related versus non-COVID-related sepsis, but small differences in mean Likert score in four domains: care coordination (3.34 vs 3.48, p = 0.01), medication management (3.59 vs 3.65, p = 0.04), screening for new symptoms/limitations (3.13 vs 3.20, p = 0.02), and anticipatory guidance and education (2.97 vs 2.84, p < 0.001). Lower case volume hospitals more often performed care coordination (72.7% vs 43.8% "always/nearly always," p = 0.02), screening for new symptoms/limitations (60.6% vs 35.8%, p < 0.001), and social support (100% vs 74.2%, p = 0.01). Our findings show variable adoption of practices for sepsis recovery. Future work is needed to understand why some practice domains are employed more frequently than others, and how to facilitate practice implementation, particularly within rarely adopted domains such as emotional support.

Pearls of wisdom: Updated skill-specific parenting strategies in the first 6 years.

This article provides knowledge translation on up-to-date parenting strategies (pearls of wisdom). These pearls support the development of specific skills in children from birth through 5 years of age. Paediatricians have indicated that they feel inadequately trained in providing parenting guidance. This article could be used by family physicians, community health nurses, nurse practitioners, and paediatricians as an office reference when providing anticipatory parenting guidance and when there are parent or clinician concerns that relate to various developmental stages. Included are general tips for guiding parents and pearls that support self-regulation, attachment, perspective taking, and developing the child's sense of self. The present review links pearls to specific reference sources in the literature which cite developmental standards and advice. Evidence-based parenting programs are cited for children with more complex presentations due to developmental, regulatory, or behavioural disorders, temperament individual differences, or limited parenting support. Website links for parents are recommended, and Parenting Pearls handouts provided, to solidify understanding and follow through.

Call for a More Specific Diagnosis of Infant of a Diabetic Mother to Optimize Neonatal Care

Hyperglycemia is the diagnostic feature of diabetes mellitus (DM), and during pregnancy, hyperglycemia has numerous serious implications for organogenesis and fetal growth. Each type of DM has different neonatal implications based on pathogenesis, length of disease, and comorbidities. Currently, limited attention is given to the woman’s type of DM when evaluating risks for neonates. The diagnosis of infant of a diabetic mother is not sufficient because of the varying pathophysiology of diabetes classifications and associated neonatal outcomes. By expanding the diagnosis to include the woman’s classification and glucose control, maternity and neonatal care providers could develop plans of care based on potential neonatal outcomes, including anticipatory guidance for families. In this commentary, we propose a more specific diagnosis, rather than infant of a diabetic mother, to better serve these infants.

Associations of frailty with overall survival (OS) and functional decline among older adults with non–small-cell lung cancer (NSCLC) receiving chemotherapy, immunotherapy, and/or targeted therapy.

12040 Background: Among older adults with cancer receiving chemotherapy, frailty indices can predict poor outcomes including survival and toxicity. Given the increasing use of immunotherapy and targeted therapy to treat NSCLC, we assessed the prognostic importance of frailty among older adults with NSCLC receiving systemic therapy. Methods: This multi-site prospective cohort study enrolled adults age ≥65 with advanced NSCLC starting chemotherapy, immunotherapy, and/or targeted therapy with non-curative intent. Patients completed geriatric assessments pretreatment and at 1, 2, 4, and 6 months. We constructed a 47-item deficit-accumulation frailty index including pretreatment demographic, geriatric assessment, and clinical factors using established methodology. Frailty scores ranged from 0 (no frailty deficits) to 1 (all frailty deficits present). We categorized patients as robust ( &lt; 0.2), pre-frail (0.2-0.34), or frail (≥0.35). The primary outcome was OS. Secondary outcomes included treatment-related grade ≥3 adverse events (AE), unplanned hospitalization, and functional decline in instrumental activities of daily living (IADL). We conducted a Kaplan-Meier survival analysis to estimate OS by frailty group and Cox proportional hazards models adjusting for treatment type. We used logistic regression models to evaluate the association of frailty with secondary outcomes adjusting for treatment type. Results: Among 149 patients, median age was 73 (range 65-94). During the study, 32% received targeted therapy, 29% immunotherapy, 27% chemoimmunotherapy, and 12% chemotherapy. Overall 43% of patients were robust, 38% pre-frail, and 19% frail. Frailty was associated with Asian race, lower education, Medicaid insurance, and no prior NSCLC surgery. Notably, frailty was not associated with age or treatment type. Median OS was 18.7 months overall: not reached for robust patients, 8.9 months for pre-frail, and 5.6 months for frail patients. Adjusting for treatment type, pre-frail (HR 2.11, 95% CI 1.24-3.60; p = 0.006) and frail (HR 2.86, 95% CI 1.52-5.39; p = 0.001) patients had worse OS compared to robust patients. During treatment, 29% developed a grade ≥3 AE, 31% had an unplanned hospitalization, and 41% developed IADL decline. Pre-frail/frail patients were more likely to develop IADL decline (HR 2.18, 95% CI 1.02-4.68; p = 0.04) than robust patients, but there were no differences in toxicity or hospitalization. Conclusions: Frailty is prognostic for OS among older adults with advanced NSCLC receiving systemic therapy across treatment types and predicted IADL decline. Frailty assessment before initiation of systemic therapy may help identify older adults with advanced NSCLC at higher risk of poor outcomes to inform decision making, individualize anticipatory guidance, and optimize supportive care.

0483 Stakeholder Engagement Studios to Explore the Journey to Diagnosis of OSA Informed by Primary Care Providers and Patients

Abstract Introduction Barriers to obstructive sleep apnea (OSA) diagnosis include operational misalignments and miscommunications among patients, providers, industry, insurers, and the healthcare system. To explore this, we engaged stakeholders to examine determinants of OSA diagnosis in primary care to optimize trial planning. Methods We conducted two, separate, virtual, 1-hour stakeholder engagement studio sessions with Penn Medicine Primary Care Providers (n=6) and patients referred for OSA diagnostics within prior year (n=3). Facilitation guides were used to elicit barriers/facilitators to reaching diagnosis. Sessions were facilitated by a sleep physician and advanced practice sleep nurse with two note-takers in attendance. Rapid matrix analysis approach identified consistent themes within diagnosis barrier and facilitator categories. Themes were categorized by Safety Engineering Initiative for Patient Safety (SEIPS) work system domains: people (P), environment (E), tools (T), and tasks (T), PETT. Results Fourteen facilitators (2P, 3E, 3T, 6T) and 15 barriers (2P, 4E, 3T, 6T) were identified for “getting to OSA diagnosis.” Provider-level barriers include: hesitancy to provide anticipatory guidance to patients due to ambiguous workflows after referral, excessive referral order options, no access to templated patient instructions or quality education resources, confusing order panels and use of electronic health record (EHR) workarounds, and fragmented communication. Patient-level barriers include: timeliness of communication and care, sleep health unawareness, low technology literacy for EHR messaging, financial considerations, and insufficient follow-up from healthcare team. Provider facilitators include: classic OSA presentation, diagnosis decision aids, patient education resources, easy to find results in EHR, and low threshold to order referral due to knowledge about sleep. Patient facilitators include: trusted primary care relationship, choice of visit type (telehealth vs. in-person) and communication mode (phone call vs. text vs. EHR portal), active outreach/engagement by healthcare team, and access to educational materials. Conclusion Repeated studios, including stakeholders from varied sites, will further refine determinants with more saturation and validity. Engaging with stakeholders is supporting the design of a contextually relevant, end-user valued study to address undiagnosed OSA. Given the estimated high prevalence of undiagnosed OSA and the multiple stakeholders that contribute to the diagnostic process and experience, research-driven solutions will be impactful and better optimized with multi-level partnered research. Support (if any) K12HS026372

Screen time and preschool children: Promoting health and development in a digital world.

COVID-19 transformed the family media environment and spurred research on the effects of screen media exposure and use on young children. This update of a 2017 CPS statement re-examines the potential benefits and risks of screen media in children younger than 5 years, with focus on developmental, psychosocial, and physical health. Four evidence-based principles-minimizing, mitigating, mindfully using, and modelling healthy use of screens-continue to guide children's early experience with a rapidly changing media landscape. Knowing how young children learn and develop informs best practice for health care providers and early years professionals (e.g., early childhood educators, child care providers). Anticipatory guidance should now include child and family screen use in (and beyond) pandemic conditions.

49 Post-Injury Trajectory of Body Mass Index Among Burn Survivors

Abstract Introduction Hypermetabolism following a burn injury causes perturbations of key cardiopulmonary and cellular functions which often persist long-term. Patients are advised to increase caloric intake to address this hypermetabolic state. However, potential weight change implications from such blunt strategies are not well studied. We aimed to 1) determine factors associated with weight change from discharge and 2) understand their relationship to other physical and psychosocial measures over time. By doing so, more tailored approaches to healthy weight management could be devised. Methods Adult participants that were enrolled in the Burn Model System (BMS) National Database after 2015 were included in the analysis. Weight was collected and BMI calculated during admission and at 0.5, 1, 2, and 5 year follow-ups. Mixed models included repeated measures controlling for correlated error of the outcomes and were used to assess the association of weight change with demographic, injury factors and psychosocial measures over time. Results A total of 698 individuals were included in the analysis. Median age was 48 years (IQR 33, 59), 218 participants were female (31.2%), median TBSA injured was 10% (IQR 3, 25), and 388 sustained flame injury (55.6%). Median BMI was 26.75 kg/m2 (IQR 23.67, 31.05). During follow-up, 446 participants (64%) had a median weight gain from admission to last follow-up of 2kg (IQR -2, 6.3). There were significant differences in weight trajectory between BMS centers (p=0.0003), which was included in subsequent models. Sex, marital status, and race were not associated with weight change. Increases in burn size (p&amp;lt; 0.0001) and number of months working after injury (p=0.03) were associated with greater weight, while older age at time of injury (p&amp;lt; 0.0001) was associated weight loss. Greater weight gain was associated with higher PROMIS-29 Physical Function (p=0.002) and Neuro-QOL (p=0.03) scores (meaning better) after one year. PROMIS-29 Sleep Disturbance score was associated with weight change only between years 2-5 of follow-up (p=0.029), with higher sleep disturbance score associated with lower BMI. Conclusions Most people living with burn injury experienced a modest weight gain after injury. Weight trajectory was impacted by several demographic factors including age, burn size, and amount time spent working, as well as physical and psychosocial measures (PROMIS-29 Physical Function, Neuro-QOL). Applicability of Research to Practice These factors can be used to inform anticipatory guidance, diet recommendations, and exercise programs for people with burn injury. The impact of tracking weight and health goals with patients in the outpatient settings should be more closely examined.

Anticipatory Guidance through Online Motivational Interviewing for Mothers on Early Childhood Caries among Young Children of Age 9-24 Months amidst Pandemics: A Nonrandomized Clinical Trial.

A total of 222 mothers with 9-24 months old children were selected and added to the e-groups. The allocated mothers were given a pretest questionnaire and collected back with a photo of their child's oral health, and anticipatory guidance and in-depth interviewing were given to them. Follow-up is done in 2, 4, and 6 months. Awareness is evaluated by pre- and posttest questionnaires. Reversal of the white spot is evaluated through indices, and progression is noted. The data was analyzed using Statistical Package for the Social Sciences 13. Pretest and postquestionnaire analysis were done using the Chi-squared test. The test shows the marked raise in knowledge, attitude, and practice of mothers on their children after postintervention, which was given through motivational interviewing (MI). In summary, the MI intervention appeared to improve maternal knowledge but had no effect on oral health behaviors or on the progression of early childhood caries (ECC). Aravind A, Sathyaprasad S, Ilyas I. Anticipatory Guidance through Online Motivational Interviewing for Mothers on Early Childhood Caries among Young Children of Age 9-24 Months amidst Pandemics: A Nonrandomized Clinical Trial. Int J Clin Pediatr Dent 2023;16(2):227-236.