Family Pediatricians Research Articles

Telemedicine and time management in primary care.

Information and communication technologies (ICTs) can enable workers to structure work in novel ways, allow for better time management, and increase work scheduling autonomy. Time management and work scheduling are important factors in the field of clinical practice in primary care. Time limits on consultation are a key constraint on the delivery of good care since the length of patient-physician consultation impacts its quality. This research aimed to examine the experiences of primary care physicians (PCPs) when using telemedicine technologies (TTs), a type of ICT, in their communication with patients. During 2023 in-depth interviews were conducted with 20 Israeli PCPs: family physicians and pediatricians. Perception and management of time emerged as a focal subject in the interviews. The PCPs interviewed described several effects of TTs on time management in primary care. They portrayed TTs as saving time for patients and having a mixed effect on the healthcare organization: both saving and wasting their work time. TTs were described as impacting their time management in the context of work-life balance, allowing them to manage their time during and between appointments. For PCPs, TTs can be beneficial for managing time in the clinic, which can contribute to better healthcare. This article, concerning TTs as a type of ICT, contributes to the existing literature which suggests that ICTs can allow for better time management and increase work scheduling autonomy. It also presents several recommendations for better implementation of TTs in healthcare organizations.

Telemedicine and patient-centered care: The perspective of primary-care physicians.

Patient-centered care (PCC) has become a central aim for healthcare systems worldwide due to recognition of its advantages. The growing use of telemedicine technologies (TT) raises concerns of diminishing interpersonal contact, especially in primary care, and questions the appropriate way of implementing PCC. This article aims to explore primary-care physicians' (PCP) experiences of PCC when using TT. During 2023 in-depth interviews were conducted with 20 Israeli PCP: family physicians and pediatricians. The PCP described their experiences of using TT in their communication with patients as including some characteristics of PCC but not others. They related to TT as a means of forming relationships and communicating with patients, highlighting its individualistic focus and describing it as a way of coordinating care. When describing the use of TT in their communication with patients, they barely related to empathy and respect for the patient, to their own involvement in the treatment, to shared decision-making, or to a holistic focus on the patient. The absence of interpersonal qualities and soft skills communication from the physicians' TT experience seems to erode their personal well-being and professional satisfaction and may even lead to burnout. We therefore recommend instructing PCP to better integrate PCC into their TT communication with patients since it contributes to the quality of healthcare and is significant for the well-being of both patients and physicians.

I disturbi specifici di apprendimento (DSA)

The article aims to provide a cognitive tool that helps the family paediatrician to manage children with DSA through an increasingly aware way, so that the principle of universal right to education is best realized. The Italian Law no. 170 attributes the task of suspecting the presence of a DSA to schools of all levels (starting from nursery schools), but the paediatrician can also have the opportunity to participate in this "filter" activity by using suggestions from the child neuropsychiatrist during health assessments. For this reason, the risk factors and indicators correlated with the presence of the disorder are illustrated. The brief excursus on the validated tools for DSA screening allows the paediatrician to interpret their meaning better and, in particular cases, to use them directly. The article then clarifies how and by whom the diagnosis and subsequent certification must be made so as to implement didactic and educational interventions. Finally, the methods of training interventions addressed to all the teaching staff and the possible social and educational protections are illustrated.

A population database analysis to estimate the varicella vaccine effectiveness in children < 14 years in a high vaccination coverage area from 2004 to 2022

IntroductionIn the Veneto Region of Italy, universal varicella vaccination (VV) started in 2007 with a two-dose schedule at 12–15 months and 5–6 years of age achieving 90 % coverage in 2019. The study aimed at evaluating the vaccine effectiveness (VE) in children using a primary-care database MethodsThis retrospective analysis used Pedianet, a comprehensive database of 73 family paediatricians in the Veneto Region. Incidence rates (IR) of varicella were evaluated in children aged <14 years enrolled since birth, between January 2004 to April 2022. Cases were classified as breakthrough if happening beyond 42 days post-VV. Complications and prescription were evaluated. Subject were followed up from 2004 or the enrollment date, until the end of assistance/study or the first or second VV dose. Kaplan-Meier curves and log-rank tests were used to compare the varicella incidence by vaccination status. Hazard ratios of varicella infection, adjusted (aHRs) for sex, vaccinal status, age group, prematurity and socioeconomic status were estimated with Cox's regression. VE for one and two VV doses was defined as 1-aHR*. Results36,498 children, followed for 233,508 person-years from 2004 to 2022 experienced 1006 cases of varicella (13 complicated and 35 breakthrough). Younger children had a higher risk of experiencing varicella compared to children aged >7 years, irrespective of their vaccination status. Indeed, the IR increased from 5.5 to 19.5 × 1000 person-years and from 1.1 to 5.4 × 1000 person-years in unvaccinated and vaccinated children aged <12 months versus those aged 5–6 years, respectively. Varicella VE was 83.4 % and 94.7 % in those vaccinated with one and two doses. After six years, the cumulative probability of experiencing varicella was 10.7 % for unvaccinated subjects, and 2.5 % and 0.4 % for those vaccinated with one and two-doses (log-rank test, p < 0.001). ConclusionsTwo-dose schedule VV is effective in drastically reduce varicella episodes. Breakthrough varicella episodes remain rare events.

Clinician Willingness to Prescribe Medications for Opioid Use Disorder to Adolescents in Indiana.

Prescribing medications for opioid use disorders (MOUD), including buprenorphine, naltrexone, and methadone, to adolescents remains an underused evidence-based strategy for reducing harms associated with opioid use. To identify potential associations between clinician- and community-level characteristics regarding clinicians' self-reported willingness to prescribe MOUD to adolescents. This cross-sectional study included a phone survey of Indiana clinicians and spatial analysis of community-level characteristics. Clinicians were eligible for inclusion in analyses if actively providing health care and listed on the Buprenorphine Practitioner Locator website, a publicly available national registry of clinicians possessing a waiver to legally prescribe buprenorphine (ie, waivered clinicians). Community-level characteristics, including total population, rurality or urbanicity, percentage with incomes below the federal poverty line, and racial or ethnic makeup. Clinicians were asked about their willingness to prescribe MOUD to adolescents younger than 18 years if clinically indicated. Responses were recorded as no, yes, or yes with conditions. Among the 871 clinicians listed on the website as of July 2022, 832 were eligible for inclusion and contacted by phone. Among waivered clinicians, 759 (91.2%) reported being unwilling to prescribe MOUD to adolescents, 73 clinicians (8.8%) reported willingness to prescribe MOUD to adolescents, and only 24 (2.9%) would do so without conditions. A multivariable logistic regression model including spatially lagged community-level variables showed that, among areas with waivered clinicians, clinicians practicing in more populated areas were significantly less likely to prescribe to adolescents (β = 0.65; 95% CI, 0.49-0.87; P = .003). Similarly, those in more rural areas were significantly more likely to prescribe to adolescents (β = 1.27; 95% CI, 1.02-1.58; P = .03). Variation in clinician willingness to prescribe was not explained by other community-level characteristics. Among all waivered clinicians, advanced practice clinicians were less likely than physicians to report willingness to prescribe (β = 0.58; 95% CI, 0.35-0.97; P = .04), as were physicians without any specialty training relevant to MOUD prescribing when compared with family medicine clinicians (β = 0.40; 95% CI, 0.18-0.89; P = .03). A small subgroup of waivered clinicians had training in pediatrics (13 clinicians [1.6%]), and none were willing to prescribe MOUD to adolescents. From this cross-sectional study, it appears that Indiana adolescents continued to face gaps in access to MOUD treatment, despite its well-established efficacy. Programs that support primary care practitioners, including family medicine clinicians and pediatricians, in safe and appropriate use of MOUD in adolescents may bridge these gaps.

The priority of organizational improvement of preventive vector in the system of intersectoral interaction for the preservation of children’s eye health

Background. The relevance of the study is due to a need to apply a comprehensive differentiated approach to the organization of preventive diagnostic examinations and monitoring the formation of visual functions in children of various ages in the difficult conditions of hostilities on the territory of our country. Children’s health remains a strategic task for the formation of Ukraine’s defense capabilities in the future. Full vision is necessary for the formation of a physically healthy and socially adapted personality, good quality of life, learning, working capacity, both in childhood and in working age. In difficult domestic conditions and taking into account the forecast calculations of international experts, which testify to the formed trends towards the growth of ophthalmic pathology, the research on the implementation of modern organizational approaches to the formation of healthy visual functions from childhood is gaining relevance. The purpose of the study was to justify the use of systemic measures of intersectoral interaction to preserve the eye health of children. Materials and methods. The materials for the study were the results of a sociological survey of doctors who provide medical and preventive care to children at outpatient and polyclinic basis (a total of 504 questionnaires were analyzed). The procedure of filling out the questionnaires required anonymity and the prior voluntary verbal consent of the doctors to participate in the study. The research methods were sociological survey, analytical synthetic, content analysis, systemic approach and systemic analysis, medical statistical (calculation of representativeness and reliability of sociological research results). Results. The need for justified organizational improvement in the preventive approach to preserving visual functions in children has been pro­ven. The algorithm of preventive intervention, based on organizational, diagnostic, treatment and preventive measures, is primarily focused on the cooperation of family doctors, family pediatricians, pediatric ophthalmologists and secondary medical staff of medical and educational institutions when introducing modern regular medical and preventive technologies, identifying risk factors and conducting effective supervision of the formation of visual functions in children of various ages, will contribute to the early detection of possible vision disorders for the timely implementation of the necessary treatment and preventive measures. Most interviewed doctors of the outpatient polyclinic level expressed the feasibility of introducing regular systemic supervision of visual functions in preschool and school-age children in the context of implementing state preventive programs to preserve vision from childhood in Ukraine. Conclusions. The medical and social importance of preserving eye health from childhood requires organizational improvement of a preventive approach whose introduction will contribute to the early detection of risk factors, early signs and manifestations, the implementation of the necessary medical and preventive measures, timely diagnosis, correction and treatment of diseases of the eye and its accessory parts in children. The obtained results open the prospect of establishing systemic intersectoral interaction in the planning and implementation of measures of comprehensive programs to prevent the development of ophthalmic pathology among children of various ages.

Group A Streptococcus infections in children and adolescents in the post-COVID-19 era: a regional Italian survey

BackgroundDespite the worldwide increasing incidence of Group A Streptococcus (GAS) infections reported since December 2022, data on noninvasive GAS (nGAS) infections in the post COVID-19 era are limited. By a self-reported survey performed in an outpatient setting, we investigated the number and clinical features of GAS infections, the diagnostic work-up and the type of treatment utilized. In addition, the rate of influenza vaccination was evaluated.MethodsIn June 2023 family pediatricians involved in the study sent the survey to parents of patients aged 0–16 years. The survey included questions on GAS infections that occurred from January 1 to May 31, 2023.ResultsAmong 3580 children, 20.3% had a GAS infection (0,8% < 1 year, 16,4% 1–3 years, 42,3% 3–6 years, 26,5% 6–9 years, 11,4%, 9–12 years, and 2,6% 12–16 years). Symptoms reported were sore throat (76.9%), fever (75.2%), tonsillar exudate (25.2%), lymphadenopathy (21.8%), and scarlet fever (14.7%). A single patient was hospitalized due to GAS meningitis.Twenty four percent of children had more than one GAS infection. In this group, frequencies of symptoms reported in the first and in the following infection were similar, except for fever and scarlet fever which were less frequent during relapses. GAS was identified by rapid antigen detection test in 81.0% of children. Eighty-nine per cent of children were treated with antibiotics, mostly amoxicillin/clavulanate (40.4%) and amoxicillin (39.4%). Thirty four percent of children received influenza vaccine. No difference was observed among immunized and not immunized regarding the number and characteristics of GAS infection. ConclusionsWe reported a certain prevalence of nGAS infections in children, mainly those aged 3–6 years age, who were mostly characterized by a low score of symptoms, and in most of the cases diagnosed and treated using a microbiological test as confirmatory tool.In this new clinical setting, a national study would be useful to reach more significant data for the definition of a correct diagnosis and clinical management of nGAS infections in children. Moreover, it is important to improve flu vaccination campaign and coverage to protect children from coinfections that could worsen the disease and misdiagnose the etiology of pharyngitis.

Oropharyngeal candidiasis — interdisciplinary aspects of childhood medicine

Scientific research in recent years has increased the interest of clinicians in the role of microorganisms in maintai­ning health and the occurrence of diseases. In most cases, fungal lesions of the oral mucosa are a manifestation of numerous somatic diseases and the results of their treatment and contri­bute to complications. To write this article, the information was searched ­using the databases Scopus, Web of Science, Med Zine, Pub Med, Google Scholar, the new version of the International Classification of Diseases (ICD-11) and the Standards of Care “Rational use of antibacterial and antifungal drugs for therapeutic and prophylactic purposes” (2023) were taken into account. The review presents data from the world literature on the role of fungal infection in the development of oropharyngeal candidiasis in children, current perspectives on the mechanism of its formation, clinical manifestations and diagnosis. A comparative characterization of the recommendations of national and foreign guidelines and a generalization of retrospective analyzes on the feasibility of prescribing systemic antifungal drugs for candidal lesions of the oral mucosa and possible methods of correction for mycoecological disorders in children are given. In the context of the presented problem, an integrated approach of a primary care physician, dentist and pediatrician to the diagnosis and treatment of oropharyngeal candidiasis in children is recommended. Timely diagnosis of oropharyngeal candidiasis in children, individual selection of antifungal drugs, synbiotics and multicomponent agents based on probiotics should be a priority area of joint work of general practitioners — family physicians, pediatricians and dentists.

Follow-up and monitoring programme in children identified in early-stage type 1 diabetes during screening in the general population of Italy.

To provide guidance for follow-up and monitoring of children and adolescents identified as positive to islet autoantibodies (IA) in the general population screening for type 1 diabetes (T1D) in Italy. Detection of IA helps to diagnose pre-symptomatic T1D, prevent diabetic ketoacidosis (DKA) and identify persons for new therapies to delay symptomatic diabetes. Italy recently became the first country to approve by law a general autoantibody screening program for T1D and celiac disease in all children and adolescents (age 1-17yr). A pilot study is currently underway in four Italian regions addressing feasibility issues to be used in the scale up to nationwide screening. Meanwhile, a group of experts developed guidance recommendations for follow-up and monitoring of identified IA positive persons. Ten key components have been identified: establishment of a registry for children and adolescents at risk; close collaboration with the national network of family paediatricians; creation of T1D centers with expertise in follow-up and monitoring; educational measures; assurance of solid IA tests; identification of appropriate metabolic tests; feed-back feasibility and acceptability questionnaires; potential access to available therapeutic interventions; valuable outcome measures including DKA incidence; costs monitoring. Distinctive features of this program include single (in addition to multiple) IA antibody-positive persons in follow-up and the use of CGM to assess risk progression, rather than the cumbersome OGTT. It is expected that the proposed follow-up and monitoring program will be effective, affordable and acceptable to children and families identified in general T1D screening in Italy.

Comparison of Physicians' Attitudes and Practice Regarding Vaccination during Pregnancy in Turkey.

This study aimed to investigate the knowledge, attitudes, and behaviors of family physicians (FPs), pediatricians (PPs), and obstetricians and gynecologists (OGs) regarding vaccine administration during pregnancy in Turkey as factors that contribute to decision-making. The survey was distributed among FPs, OGs, and PPs, and participants were asked to rate their knowledge on specific topics using a five-point scale ranging from "Not Effective" to "Effective". The tetanus and diphtheria (Td) vaccine was highly recommended by 94.9% of physicians and considered very effective. Among the physicians surveyed, 80% of PPs and 66.0% of OGs were aware of the disease burden of pertussis. We also found that 74.5% of FPs and 77.2% of PPs believed they needed more information about vaccination during pregnancy. All physicians surveyed agreed or strongly agreed that explaining the disease risks and benefits of vaccination increases the vaccine acceptance rate. The results of this survey study indicate that the knowledge and awareness of physicians need to be improved to increase vaccination rates during pregnancy in Turkey, and it is essential to incorporate influenza and tetanus, diphtheria, and pertussis (TdaP) vaccines into the standard maternal immunization schedule for newborns.

Physicians’ perspectives on COVID-19 vaccinations for children: a qualitative exploration in Ontario, Canada

ObjectivesParents’ decisions to vaccinate their children against COVID-19 are complex and often informed by discussions with primary care physicians. However, little is known about physicians’ perspectives on COVID-19 vaccinations for...

Increased adherence to influenza vaccination among Palermo family pediatricians: a study on safety and compliance of qLAIV vaccination

BackgroundInfluenza represents a serious public health threat, especially for the management of severe cases and complications of the disease, requiring the implementation of control measures. We aimed to assess the acceptance and impact of qLAIV vaccination among a representative sample of family paediatricians (FPs) operating in Palermo Local Health Authority (LHA). To this end we evaluated vaccination coverage rates, comparing it with that observed in Sicilian context, while actively monitoring possible adverse reactions and their severity.MethodsAn observational descriptive non-controlled study was conducted in two phases, from September 2022 to June 2023. The first phase involved a formative and educational intervention with a pre-intervention questionnaire to assess the knowledge and attitudes of FPs on paediatric influenza vaccination. The second phase consisted of an active surveillance on qLAIV safety and acceptance among the paediatric population assisted by the participating FPs, from October 2022 to April 2023. Frequencies, chi-squared tests, and comparisons statistics were performed using Stata/MP 14.1.ResultsThe overall coverage rate among the paediatric population involved in the intervention was 13.2%, with an I.M./qLAIV ratio of vaccine administered of 1/4.25. This coverage rate was significantly higher (p-value <0.001) when compared to the average values reported in the population under the Palermo Local Health Authority (LHA) (6.7%) and in the entire Sicily (5.9%). Adverse events in the qLAIV group were mild, with only 3.3% experiencing them, primarily presenting as a feverish rise (3.2%). No severe adverse reaction was reported.ConclusionsThe educational intervention significantly raised paediatric influenza vaccination rates among the participating FPs, and in general improved influenza vaccination coverage rates in the Palermo’s LHU. Minimal, non-serious adverse events underscored the vaccine’s safety. Training sessions ensured paediatricians stayed informed, enabling them to provide comprehensive information to parents for secure and informed vaccination decisions in their practices.

Knowing, recognizing, and preventing shaken baby syndrome: The role of primary care pediatrician

The Shaken Baby Syndrome (SBS) is the result of a severe form of physical abuse inflicted on children under the age of 2, mostly by parents or other caregivers, to quiet their inconsolable crying. The violent shaking of the child results in devastating consequences up to death or can lead to serious neurological sequelae and/or compromise of their neurodevelopment. The clinical diagnosis of SBS is not always easy and immediate, especially in cases where the picture presents with subtle signs and symptoms not directly attributable to abuse: it is therefore fundamental that the family pediatrician is aware of this nosological entity, suspects it in the presence of certain risk factors, always considers it in the differential diagnosis like any other pathology, and above all prevents it through sensitization and education of parents and other caregivers to adequately manage their child's crying. This article aims to emphasize the role of primary care pediatricians in knowing, recognizing, and preventing the shaken baby syndrome.

Early Detection of 5 Neurodevelopmental Disorders of Children and Prevention of Postnatal Depression With a Mobile Health App: Observational Cross-Sectional Study.

Delay in the diagnosis of neurodevelopmental disorders (NDDs) in toddlers and postnatal depression (PND) is a major public health issue. In both cases, early intervention is crucial but too rarely implemented in practice. Our goal was to determine if a dedicated mobile app can improve screening of 5 NDDs (autism spectrum disorder [ASD], language delay, dyspraxia, dyslexia, and attention-deficit/hyperactivity disorder [ADHD]) and reduce PND incidence. We performed an observational, cross-sectional, data-based study in a population of young parents in France with at least 1 child aged <10 years at the time of inclusion and regularly using Malo, an "all-in-one" multidomain digital health record electronic patient-reported outcome (PRO) app for smartphones. We included the first 50,000 users matching the criteria and agreeing to participate between May 1, 2022, and February 8, 2024. Parents received periodic questionnaires assessing skills in neurodevelopment domains via the app. Mothers accessed a support program to prevent PND and were requested to answer regular PND questionnaires. When any PROs matched predefined criteria, an in-app recommendation was sent to book an appointment with a family physician or pediatrician. The main outcomes were the median age of the infant at the time of notification for possible NDD and the incidence of PND detection after childbirth. One secondary outcome was the relevance of the NDD notification by consultation as assessed by health professionals. Among 55,618 children median age 4 months (IQR 9), 439 (0.8%) had at least 1 disorder for which consultation was critically necessary. The median ages of notification for probable ASD, language delay, dyspraxia, dyslexia, and ADHD were 32.5 (IQR 12.8), 16 (IQR 13), 36 (IQR 22.5), 80 (IQR 5), and 61 (IQR 15.5) months, respectively. The rate of probable ADHD, ASD, dyslexia, language delay, and dyspraxia in the population of children of the age included between the detection limits of each alert was 1.48%, 0.21%, 1.52%, 0.91%, and 0.37%, respectively. Sensitivity of alert notifications for suspected NDDs as assessed by the physicians was 78.6% and specificity was 98.2%. Among 8243 mothers who completed a PND questionnaire, highly probable PND was detected in 938 (11.4%), corresponding to a reduction of -31% versus our previous study without a support program. Suspected PND was detected a median 96 days (IQR 86) after childbirth. Among 130 users who filled in the satisfaction survey, 99.2% (129/130) found the app easy to use and 70% (91/130) reported that the app improved follow-up of their child. The app was rated 4.8/5 on Apple's App Store. Algorithm-based early alerts suggesting NDDs were highly specific with good sensitivity as assessed by real-life practitioners. Early detection of 5 NDDs and PNDs was efficient and led to a possible 31% reduction in PND incidence. ClinicalTrials.gov NCT06301087; https://www.clinicaltrials.gov/study/NCT06301087.

Pharmacological management of attention-deficit/hyperactivity disorders (ADHD) by generalists and specialists in Germany: a secondary data analysis

Attention-deficit/hyperactivity disorder (ADHD) is one of the most common mental health disorders among children, and it is rapidly surging among adults as well. The aim of this study was to investigate the role of community neurologists and psychiatrists as well as general practitioners and paediatricians in prescribing ADHD medications in Germany and whether their role has changed over the 10-year period from 2008 and 2018. In this secondary analysis of anonymized prescribing data, we calculated the absolute and relative frequencies of ADHD prescriptions by neurologists and psychiatrists, summarized as specialists, and family physicians and paediatricians, summarized as generalists, and how it has changed during the years 2008 to 2018. A total of 620 practices delivered data on 77,504 patients diagnosed with ADHD, 38% (29,396/77,504) of them had received a prescription for ADHD medicine at least once in the study period. Over time, we observed a shift from generalists to specialists. While 59% of patients received their prescription from a generalist and 41% from a specialist in 2008, there was reverse in the ratio in 2018: only 37% received their medication from a generalist and the vast majority (63%) from a specialist. This trend was particularly evident among adults: 58% of them received their ADHD medication from a specialist in 2008, but 80% in 2018. The proportion of children and adolescents who received their prescriptions from a specialist rose from 38% to 51% over the same period. There is a shift in drug prescription away from generalists to specialists, without any discussion of advantages or disadvantages so far. However, this would be desirable, not least because specialists alone may not have sufficient resources to care for all ADHD patients.

Pediatric ultrasound practice in Italy: an exploratory survey

BackgroundThe aim of this exploratory survey is to describe the current state of US (ultrasound) technique across different pediatric settings nationwide.MethodsA questionnaire was emailed to all members of the Italian Society of Pediatrics, including pediatric residents. The survey was open from December 2021 to March 2022.ResultsThere were 1098 respondents. Seven hundred and seven pediatricians (84.1%) reported any use of US, while 51 (44.3%) residents denied it. The majority of participants (n = 956, 87.1%) reported to have a US machine available within the department, mostly cart-based (n = 516, 66.9%) and provided from 1 to 5 years prior to the survey (n = 330, 42.8%). Lung and neonatal cerebral regions were the most frequently scanned (n = 289, 18.7% and n = 218, 14.1%, respectively). The suspicion of pneumonia or respiratory distress represented the main reasons for performing US in emergency room (n = 390, 78% and n = 330, 66%, respectively). The majority of family pediatricians reported to scan lung and kidney/urinary tract regions (n = 30, 16.9%, and n = 23,12.9%, respectively). Regarding US training, the majority of respondents (n = 358, 34.6%) declared an experience-based education, with a deficient certification enabling the use of US in 71.6% (n = 552) of cases. The most common barriers included the lack of a well-defined training program (n = 627, 57.1%), unavailability of the US machine (n = 196, 17.9%) and legal responsibility concern (n = 175, 15.9%).ConclusionsDespite the growing interest on pediatric US nationally, significant barriers still limit widespread adoption. These obstacles may be addressed through the dissemination of a specific US education plan and providing additional resources.

Association Between Early-Life Exposure to Antibiotics and Development of Child Obesity: Population-Based Study in Italy.

Childhood obesity is a significant public health problem representing the most severe challenge in the world. Antibiotic exposure in early life has been identified as a potential factor that can disrupt the development of the gut microbiome, which may have implications for obesity. This study aims to evaluate the risk of developing obesity among children exposed to antibiotics early in life. An Italian retrospective pediatric population-based cohort study of children born between 2004 and 2018 was adopted using the Pedianet database. Children were required to be born at term, with normal weight, and without genetic diseases or congenital anomalies. We assessed the timing of the first antibiotic prescription from birth to 6, 12, and 24 months of life and the dose-response relationship via the number of antibiotic prescriptions recorded in the first year of life (none, 1, 2, and ≥3 prescriptions). Obesity was defined as a BMI z score >3 for children aged ≤5 years and >2 for children aged >5 years, using the World Health Organization growth references. The obese incidence rate (IR) × 100 person-years and the relative 95% CI were computed using infant sex, area of residence, preschool and school age, and area deprivation index, which are the covariates of interest. A mixed-effect Cox proportional hazards model was used to estimate the hazard ratio and 95% CI for the association between antibiotic exposure in early life and child obesity between 24 months and 14 years of age, considering the family pediatricians as a random factor. Several subgroup and sensitivity analyses were performed to assess the robustness of our results. Among 121,540 children identified, 54,698 were prescribed at least an antibiotic within the first year of life and 26,990 were classified as obese during follow-up with an incidence rate of 4.05 cases (95% CI 4.01-4.10) × 100 person-year. The risk of obesity remained consistent across different timings of antibiotic prescriptions at 6 months, 1 year, and 2 years (fully adjusted hazard ratio [aHR] 1.07, 95% CI 1.04-1.10; aHR 1.06, 95% CI 1.03-1.09; and aHR 1.07, 95% CI 1.04-1.10, respectively). Increasing the number of antibiotic exposures increases the risk of obesity significantly (P trend<.001). The individual-specific age analysis showed that starting antibiotic therapy very early (between 0 and 5 months) had the greatest impact (aHR 1.12, 95% CI 1.08-1.17) on childhood obesity with respect to what was observed among those who were first prescribed antibiotics after the fifth month of life. These results were consistent across subgroup and sensitivity analyses. The results from this large population-based study support the association between early exposure to antibiotics and an increased risk of childhood obesity. This association becomes progressively stronger with both increasing numbers of antibiotic prescriptions and younger age at the time of the first prescription.

Quadrivalent Live-Attenuated Influenza Vaccine in Milan preschools: an Italian experience of school-located flu vaccination within the 2022–2023 season

BackgroundIn Italy, since the 2020–2021 flu season, the flu vaccine recommendation was extended to all children aged 6 months to 6 years and quadrivalent Live-Attenuated Influenza Vaccine (qLAIV) was introduced. Since school-aged children are important carriers of annual influenza epidemics, a school-based influenza vaccination program may potentially increase vaccine uptake. Recent studies, conducted in the UK and the US, show that school-based vaccination can reach higher percentage of paediatric vaccination coverage compared to children vaccinated in other settings.MethodsDuring 2022–2023 flu season in 9 preschools located in Milan healthcare personnel vaccinated children with qLAIV at the end of a school day. A Google Form questionnaire was administered to preschoolers’ parents of all preschools within the Municipality of Milan.ResultsIn the preschools engaged in the vaccination program, 233 out of 1939 children were vaccinated (12%). Among these, 61 (26.2%) had never been vaccinated for influenza before. Vaccination coverage was 11.5% for Italian children and 14.3% for children coming from an immigrant background.We collected 3659 questionnaire responses, divided according to study participation status (371 from preschools that participated in the vaccination program and 3288 from other preschools in Milan). 57% of the families who answered to the questionnaire vaccinated their children for flu. qLAIV accounted for 85.6% of vaccinations. We observed a statistically significant difference in the percentage of vaccinated children between those attending a school participating in the project (67.9%) and children attending other schools (56%) (p < 0.001). Vaccination was administered by family pediatricians (48.9%), in vaccination centers (34.8%), in vaccine hubs (11.3%), in schools (2.6%), by private pediatricians (1.6%) and in other settings (0.7%). Focusing on the responses from families whose children attend schools participating in the vaccination program, 21.8% stated that the vaccination was provided in school.ConclusionAccording to our experience, in Italy, at the moment, only the cooperation between health providers and alternative settings, including schools, may expand flu vaccination coverage. In particular, schools are to be considered a place to inform and reach out to families, useful to increase vaccination coverage.

Parental practices that influence children's development: how often are they implemented and by whom-results from the NASCITA birth cohort study.

This study aims to assess how commonly 15 parental practices, known to have positive effects on child and adult health, are carried out by families in Italy, if they are related, and which characteristics are associated with implementation. Children participating in the NASCITA Cohort, a prospective study in which family pediatricians in Italy collect data on children and their families, were included if they had sufficient data. Data on practice implementation, socio-demographic characteristics, and interrelatedness between practices were analyzed. In all, 3337 children were included. Their mothers had an average age at birth of 33years (range 17-52) and medium-high levels of education (86% of mothers) and employment (72%). No smoking or alcohol in pregnancy, supine infant sleeping position, and tummy time were the most commonly implemented practices (by over 85% of mothers, each), while the least common was exclusive breastfeeding at 6months (28%). Parental practices are related and several socio-demographic characteristics influence their implementation, with mother's educational level and geographic area of residence influencing most of the practices (each influencing 12 of 15 practices). Low educational level (OR 0.34; 95% CI 0.26-0.44), being born abroad (OR 0.43; 95% CI 0.34-0.56), and residing in the South (OR 0.49; 95% CI 0.41-0.58) most reduce the probability of implementing numerous supportive practices (all three P < 0.001). Conclusion:Socio-demographic factors contribute significantly to carrying out supportive practices. Future interventions should address the identified inequalities, prioritizing families most in need. Direct involvement of pediatricians is warranted given their favorable position for promoting positive behaviors. What is Known: • Several parental actions in the early life of a child are known to have positive effects on later child health and development. • While folic acid supplementation and exclusive breastfeeding have been promoted for years, other supporting actions are less well-known. What is New: • Rates of parental adherence to the different supportive actions varied greatly and actionswere often scantly adopted. • Socio-demographic characteristics influenced adherence, with young, unemployed mothers with low educational levels, living in the South, or who were born abroad adhering significantly less.

Epidemiology of Paediatric Italian Food Allergy: Results of the EPIFA study

BackgroundUpdated epidemiological data are important for defining effective public health strategies for paediatric food allergy (FA). ObjectiveThe Epidemiology of Paediatric Italian Food Allergy(EPIFA) study was designed to investigate the epidemiology of paediatric FA in one of the most populated Italian region. MethodsRetrospective cohort study performed in collaboration with family paediatricians(FPs) aimed at the investigation of epidemiology of Italian paediatric FA in the years 2009-2021. FPs of the Campania Region were invited to use the Google Forms platform for the online compilation of the data forms. Data forms were reviewed by experienced paediatric allergists at the coordinating centre. ResultsA total population of 105.151 subjects (aged 0-14 years) was screened during the study period. Data from 752 FA patients were evaluated. A progressive increase in FA incidence and prevalence was observed from 2009 to 2021 with a relative increase up to 34% and 113.6%, respectively at the end of study period. The relative increase in FA prevalence was higher in the 0-3 years old age group in the same study period (+120.8%). The most frequent allergens were cow’s milk, hen’s egg, and nuts. ConclusionThe results of the EPIFA study showed an increase in paediatric FA incidence and prevalence from 2009 to 2021 in Italy. These results underline the necessity of new effective strategies for the prevention and management of these conditions.