Pediatric Appointments Research Articles

02 Youth perspectives on virtual healthcare appointments in Nova Scotia – a qualitative study

Abstract Background With the onset of the COVID-19 pandemic, public safety measures required healthcare providers to look for alternative ways of delivering care in a safe and timely fashion. This led to an escalated use of virtual appointments to continue to provide patient care. For future decision-making regarding virtual care in our community, we must consider the youth perspective to ensure our healthcare delivery meets the needs of this patient population. Objectives Our study aims to determine the perspectives of local youth patients on their experience with virtual and in-person paediatric clinic appointments. Design/Methods Participants were recruited from general and subspecialty paediatrics clinics at the IWK Health Centre, in Nova Scotia, Canada. Eligibility criteria included attending both a virtual and in-person appointment from 2019-2022. Participants completed a semi-structured interview and provided their perspective on comfort level, accessibility, participation, and general preferences between virtual and in-person clinics. Transcribed data was analyzed using thematic analysis with both inductive and deductive approaches to identify themes. Results 12 participants aged 14-18 provided interviews. Participants represented clinical areas of general paediatrics, rheumatology, diabetes clinic and gender clinic. Virtual appointments were preferred for convenience, flexibility, and efficiency during shorter conversations. In-person appointments were preferred for physical concerns, communication and relationship building. Some youth appreciated talking face-to-face for the ease of communication, feeling able to “get the point across” in this setting. The value of the in-person connection with their healthcare team was expressed by some youth, and building this relationship held importance. When appointments provided education, youth preferred for that information to be delivered in-person. Participants overall felt more comfortable during virtual appointments, and participation levels varied based on the individual and not based on an appointment being virtual versus in-person. Accessibility issues were predominantly associated with in-person appointments, with barriers including access to transportation, time spent attending appointment, and the cost of travelling to a tertiary care centre. Conclusion Youth patients have unique and individual preferences for virtual versus in-person appointments. This study provided insight into situations when each appointment type should be considered and emphasizes the importance of including the youth in the decision-making process around appointment scheduling when possible.

A meta-analysis and systematic review of the use of transition tools for patients transitioning from paediatric to adult rheumatology services

Abstract Objectives Transition from paediatric to adult care can be challenging, but transition tools are designed to increase successful rates of transfer. We aimed to conduct a meta-analysis and systematic review into the use of transition tools on transfer of care from paediatric to adult services for rheumatology patients. Methods An extensive literature search was conducted using Medline, PubMed and Embase. 12 papers were included in a systematic review and 8 papers in the meta-analysis looking at use of transition tools on successful follow up in adult clinics. Results The meta-analysis showed 86.6% (95% CI: 53.3–80.6%) of patients who used a transition tool attended an adult outpatient clinic within 1 year of their last paediatric appointment, compared with 67.7% (95% CI: 56.7–99.7%) of patients who successfully transferred without a transition tool. Conclusions The systematic review demonstrated several unique transition tools with local success but no dominant method. This paper demonstrated a general positive influence of transition tools on successful transfer, but more research is needed to strengthen the association.

Impact of asthma and allergic rhinitis control on sleep disordered breathing in pediatrics

AimThe aim of our study is to assess the quality of sleep in children with asthma and/or allergic rhinitis, as well as the impact of the control of allergic respiratory diseases on sleep disturbances. Materials and methodsIt is an observational cross-sectional study on children attending pediatric allergy appointments at a portuguese tertiary hospital (G1), and compared to a control population (G2). The asthma and rhinitis control was determined using the Control of Allergic Rhinitis and Asthma Test (CARAT/CARATKids) questionnaires. Sleep was evaluated using the Pediatric Sleep Questionnaire (PSQ). G1 included 61 patients and G2 included 100 children. ResultsAbout a third of the children in the study group had sleep-related breathing disorders (SDB), compared to 9 % on the control group (p-value <0.05). There was a significant positive correlation between uncontrolled asthma and allergic rhinitis, and SDB (p-value <0.05). ConclusionSDB is more prevalent among children with asthma and/or allergic rhinitis. The absence of control of the allergic respiratory diseases has a negative impact on sleep. We recommend large cross-sectional studies to better comprehend the exact relationship between the two conditions, as well as the use of objective diagnostic tools. We believe it is essential to implement early screening for sleep disorders in children with allergic respiratory diseases, through validated questionnaires.

Transition readiness assessment in Portuguese adolescents and young adults with pediatric-onset rheumatic diseases: a single-center study.

In this study, we aimed to assess the transition readiness levels amongst patients with childhood-onset rheumatic diseases. Additionally, we sought to identify and analyze predictive factors associated with better transition readiness skills in adolescent and young adult (AYAs) patients. This is a monocentric cross-sectional study that includes patients between 14 and 26 years of age who attended outpatient pediatric and young adult rheumatology appointments between October and December of 2023 and that were diagnosed with an immune-mediated rheumatic disease before reaching 18 years of age, with at least 1 year of disease duration. Patients were presented with a questionnaire that contained demographic and clinical questions, TRACS (Questionário de Preparação da Transição para a Autonomia nos Cuidados de Saúde) questionnaire - a validated Portuguese version of the Transition Readiness Assessment Questionnaire (TRAQ), and Hospital Anxiety and Depression Scale (HADS) questionnaire. Data was analyzed to assess the significant associations between the different variables and transition readiness outcome measured by the TRACS. Descriptive statistics, statistical comparisons and logistic regression analysis were performed. A total of 69 patients with a median age of 20 [17.5-22.5] were included in this study. The median TRACS score was 4.41 [4.09-4.74]. Significantly higher TRACS scores were observed in patients who were female, 18 years of age or older, had a higher level of education, were employed, had active disease or that belonged to middle-class (when compared to patients belonging to upper- middle class). The logistic regression analysis demonstrated that being a female or having an educational status equal to 12th grade or superior emerged as predictors of higher transition readiness levels. Our study identified female sex and higher level of education as predictors of increased transition readiness levels. Therefore, healthcare providers should consider these variables when assessing patients for transition readiness and focus on improving transition process, especially in male and less educated AYAs.

Effectiveness of text message reminders on paediatric appointment adherence: a systematic review and meta-analysis.

Attending health appointments is important for the paediatric population, as it allows for earlier detection of health issues and subsequent necessary treatments. It also ensures timely immunisations while also allowing patients or their parents to raise health concerns. Hence, it is crucial to take steps to ensure that such medical appointments are attended.To evaluate the effectiveness of text message reminders (TMRs) in improving paediatric patients' adherence to their appointments.A systematic review and meta-analysis were conducted. The search spanned across eight online databases from their inception dates to January 2024. The random-effects model was utilised to conduct the meta-analysis, where risk ratio was used as the effect measure. Subgroup analyses were conducted for age, number of TMRs sent, and type of appointments attended.In total, 13 studies were included. Compared to standard care (involving non-text message reminders or no reminders), TMRs were significantly more effective in improving appointment attendance among the paediatric population. Significant subgroup differences were found in the type of appointments attended, where TMRs were more effective for medical appointments compared to vaccination appointments. No differences in adherence to appointments were found across age groups or the number of TMRs sent. Conclusion: Sending TMRs can be a potentially cost-effective way to improve the attendance rate of paediatric medical appointments, given the ease of implementation and the extensive mobile phone usage globally. Future studies should compare TMRs to other modes of automated reminders such as telephone messages or emails, to identify the most optimal method of delivery. Trial registration: PROSPERO (CRD42023464893).

Predictors of No-Show Status: An Analysis of Pediatric Ophthalmology Patients at an Academic Ophthalmology Department in the United States.

To identify pediatric patient and appointment characteristics associated with no-show status at a tertiary care pediatric ophthalmology clinic within a U.S. academic ophthalmology department. A cross-sectional retrospective chart review was performed for all pediatric patients with a scheduled ophthalmology appointment at the Penn State Eye Center between April 1, 2022 and March 31, 2023. A multivariate logistic regression analysis assessed associations between appointment nonattendance and patient characteristics. Of 8,083 scheduled visits, 1,445 (17.9%) were no-shows. Factors associated with no-show status included appointment type (new vs return odds ratio [OR]: 1.43, 95% CI: 1.26 to 1.63, P < .001); lower median household income (< $41,374 vs > $68,957 OR: 1.89, 95% CI: 1.40 to 2.55, P < .001; $41,374 to $68,957 vs > $68,957 OR: 1.27, 95% CI: 1.12 to 1.44, P < .001); non-private insurance (self-pay vs private: OR: 5.65, 95% CI: 3.87 to 8.24, P < .001, Medicaid vs private: OR: 2.17, 95% CI: 2.32 to 3.16, P < .001); commute distance 10 to 30 miles vs < 5 miles (OR: 1.49, 95% CI: 1.11 to 1.99, P = .008); race: unavailable vs White (OR: 2.18, 95% CI: 1.66 to 2.85, P < .001), Black vs White (OR: 1.86, 95% CI:1.53 to 2.27, P < .001), Other vs White (OR: 1.47, 95% CI: 1.27 to 1.70, P < .001); ethnicity: Hispanic vs non-Hispanic (OR: 1.92, 95% CI: 1.62 to 2.27, P < .001); and language preference: Spanish vs English (OR: 1.86, 95% CI: 1.49 to 2.32, P < .001), Nepali vs English (OR: 1.60, 95% CI: 1.06 to 2.43, P = .027), other vs English (OR: 1.83, 95% CI: 1.35 to 2.49, P < .001). Appointment reminders (phone call, P = .013); text message, P < .001; other, P = .013) all resulted in a greater propensity to show, but email communication alone did not (P = .674). Certain patient and appointment characteristics that are linked to a higher rate of no-show status can inform targeted initiatives to improve health care outcomes, resource utilization, and clinical efficiency in the pediatric ophthalmology community. [J Pediatr Ophthalmol Strabismus. 20XX;X(XX):XXX-XXX.].

Feasibility of caregiver diabetes distress screening in routine clinical care of youth with type 1 diabetes.

Caregiver diabetes distress (DD) consists of feeling overwhelmed, sad, and/or concerned; one-third of parents of youth with type 1 diabetes (T1D) report severe distress up to 4 years after T1D diagnosis. PAID-PR (Problem Areas in Diabetes Survey-Parent Revised) assesses DD primarily in research settings; however, less is known about its clinical utility. We aimed to identify the feasibility of implementing PAID-PR screening at a diverse, academic US paediatric diabetes center during routine clinic follow-up visits through quality improvement methodologies. The PAID-PR was intended to be offered in English to caregivers at all paediatric T1D appointments, by the front desk during appointment check-in, or through REDCap prior to telehealth appointments or at local sites to all eligible caregivers. Adult psychosocial resources were provided to all, regardless of score. Forms were scored after appointments; scores ≥80 were referred to Diabetes Psychology providers for follow-up. A total of 391 caregivers completed the PAID-PR, though only half of eligible caregivers received it in person. Response rates were highest in person (90%), compared to REDCap (25%). In total, 27% (n = 107) scored ≥56 (DD). Of those with DD, 21% (n = 23) scored ≥80 and were referred to psychology. Demographics are reported in Table1. PAID-PR score was positively correlated to A1c (p = 0.038) and inversely to child age (p = 0.014). Clinic caregiver DD screening was implemented with higher response rates in person; however, expanding in-person screening to all eligible caregivers is necessary. Furthermore, since the PAID-PR was in English, some caregivers with DD were likely missed. Future directions include screening in additional languages.

Identifying barriers to pediatric dental appointments: insights from a study at Prince Faisal bin Al-Hussein Hospital.

Ensuring good oral health is crucial for overall well-being. Missed appointments can negatively impact the quality of care and oral health outcomes, making it essential to identify the factors contributing to non-attendance. This study aimed to identify the factors associated with non-attendance at a pediatric dental clinic. The study used a cross-sectional design, which included a random sample (n = 265) of eligible pediatric patients under 12 years old, with data collected through questionnaires completed by their parents. Data were collected over 3 months, from November 2023 to January 2024, and analyzed using descriptive statistics and a chi-square test, with a confidence level of 95%. Results indicated that 76% of patients were school-age children, and 44% of children had missed their appointments. The critical barriers to attendance mentioned by parents were social and family commitments (15.2%), forgetfulness (11.2%), illness (8.6%), school commitments (6.9%), and fear of dental treatment (3.5%). The administrative barriers were due to staff miscommunications (10.3%), while non-attendance for unspecified reasons was 11.2%. Finally, the relationship between age, gender, and type of transportation with missed appointments was statistically significant (P < 0.05). This study highlights the significant rate of missed appointments and the factors contributing to non-attendance at pediatric dental clinics.

AYURVEDIC PERSPECTIVES ON MANAGING PAMA KUSHTHA (SCABIES) IN CHILDREN: A COMPREHENSIVE REVIEW

Skin diseases are considered a serious health problem in children because they cause discomfort and considerable morbidity. Dermatological disorders account for nearly one-third of all paediatric outpatient appointments. Scabies is a frequent skin infestation caused by tiny mites known as "Sarcoptes scabiei." It is very contagious and typically spreads through skin-to-skin contact with someone who is already afflicted. Almost all skin problems in Ayurveda are explained by the wide term "Kushtha." Pama can be correlated with scabies, which is one type of Kshudra Kushtha as described in the classics. Because it is highly contagious, it spreads swiftly in crowded environments. The scabies rash can lead to cellulitis, folliculitis, boils, and impetigo. It was discovered that "Pama" Vyadhi It has been found that "Pama" vyadhi is one of the most prevalent diseases seen at lower socioeconomic levels and occurs in unsanitary individuals. This paper explored Pama disease diagnosis and therapy using in Ayurveda.

Audiology-led model provides efficient and effective access to grommet surgery

ABSTRACT Children with otitis media who are referred to paediatric otorhinolaryngology (ORL) departments often experience significant delays in treatment. Alternate models of care utilising audiologists with extended scopes of practice can potentially improve outcomes in services experiencing difficulties with high demand and insufficient ORL capacity. An Advanced Audiology Practitioner (AAP) service was implemented in Counties Manukau to combat known long wait times for children with otitis media. This study aimed to retrospectively evaluate the clinical and service outcomes of the 165 children referred to the AAP service during the initial 3 month period of operation. Engagement with the AAP service was high, with a 96% attendance rate at the first appointment. The proportion of children waiting longer than recommended (>120 days) for paediatric ORL appointments was reduced by 33%, and the average wait time for children seen in the AAP service was reduced from 196 to 14 days. The AAP model provided an efficient and effective clinical service, with 55% of children seen in a single visit and 91% of waitlisted children having middle ear effusion on myringotomy. In conclusion, the AAP model improves access to ORL treatment, particularly for children at risk for otitis media and associated hearing loss.

Quality Improvement Initiative Enhances Outpatient Pediatric Pulmonology Follow-up for Premature Infants with Bronchopulmonary Dysplasia

Introduction: Bronchopulmonary dysplasia (BPD) is a chronic lung disorder affecting many premature infants. Infants with BPD have higher hospital readmission rates due to respiratory-related morbidity. We aimed to increase the rates of outpatient pulmonary follow-up and attendance of premature babies with moderate and severe BPD to above 85% within 6 months. Methods: We conducted a quality improvement project at Yale New Haven Children’s Hospital. Key interventions included developing a BPD clinical pathway integrated into the electronic medical record to assist providers in correctly classifying BPD severity, assigning the appropriate International Classification of Diseases, 10th Revision code (P27.1), and providing standardized treatment options. The outcome measures included correct diagnosis and classification of BPD, the percentage of patients with BPD scheduled for pediatric pulmonology appointments within 45 days, and the percentage attending those appointments. Results: There were 226 patients in our study, including 85 in the baseline period. Correct diagnosis of BPD increased from 49% to 95%, the percentage of scheduled appointments increased from 71.9% to 100%, and the percentage of appointments attended increased from 55.6% to 87.1%. Conclusions: Our quality improvement initiative improved the accuracy of diagnosis, severity classification, and outpatient pulmonary follow-up of children with moderate and severe BPD.

Screening for Food Insecurity in a Pediatric Diabetes Program: Provider and Parent/Guardian Perspectives.

Food insecurity (FI) is associated with poor health outcomes in children, and studies have shown higher FI among children with diabetes mellitus. This study assessed provider (N = 22, 35.5% response rate) and parent/guardian (N = 207, 14.6% response rate) perspectives toward FI screening in a pediatric diabetes program. Among 22 providers, most "rarely" (54.5%) or "never" (27.3%) screened for FI although all felt that screening was at least "slightly important." Barriers included lack of time (63.6%), not remembering to screen (59.1%), lack of knowledge about how to address positive screens (45.5%), and being unsure how to screen (40.9%). Among 186 parent/guardians, only 24.1% had been asked about FI at a pediatric medical appointment, but only 8.6% disliked the idea of being asked by a medical provider at endocrinology visits. To be effective and sustainable, FI screening must fit within the visit flow, and providers need education on how to address positive screens.

Basics of formation and correction of dental anxiety

The foundations of negative experiences of dental treatment and clinical observation are laid in childhood, and the patient’s further attitude towards dental procedures depends on how the child’s first acquaintance with a dentist goes. Anxiety, tension and fear of upcoming pain can lead to the development of varying degrees of dental phobia. Children's fears do notallow for complete and timely treatment, which requires the development of measures to correct them. Aim. Develop a technique for reducing anxiety in patients with dental anxiety at a pediatric dental appointment. Materials and methods. The study involved 90 children aged 6-15 years. They were divided into groups depending on the strength of the nervous system. In each group, the level of dental anxiety was determined and methods were used to reduce it, which included: motivational interviewing, art therapy, adaptation using hardware technologies. Results. After carrying out adaptation techniques for children, a decrease in dental anxiety was observed in each group of subjects. The technique was most effective in the group of children with a strong nervous system. Conclusions. This developed complex of psychological support for patients at a pediatric dental appointment (procedures promoting relaxation, distraction, perceived control) reduces the level of dental anxiety and improves the indicators of vegetative support.

Pregnancy- and parenting-related barriers to receiving medication for opioid use disorder: A multi-paneled qualitative study of women in treatment, women who terminated treatment, and the professionals who serve them.

Women face unique barriers when seeking treatment for substance use disorders, often related to pregnancy and parenting. This study adds to the extant literature by elucidating the pregnancy- and parenting-related barriers women face when initiating or continuing medication for opioid use disorder, specifically. This study is based on qualitative semi-structured interviews. Three subgroups participated in semi-structured interviews regarding their experiences (N = 42): women with current or past opioid use disorders who have used or were presently using medication for opioid use disorder, professionals working in substance use disorder treatment programs, and criminal justice professionals. Three parenting-related subthemes were identified: (1) insufficient access to childcare to navigate appointments and meetings, (2) fear of losing custody of, or access to, one's children, and (3) prioritizing one's children's needs before one's own. Three subthemes were identified with regard to pregnancy as a barrier: (1) hesitancy among physicians to prescribe medication for opioid use disorder for pregnant patients, (2) limited access to resources in rural areas, and (3) difficulty navigating a complex, decentralized health system. Systemic changes are needed to reduce pregnant and parenting women's barriers to seeking medication for opioid use disorder. These include improved childcare support at both in-patient and outpatient treatment programs, which would assuage women's barriers related to childcare, as well as their fears of losing access to their children if they spend time away from their children for treatment. An additional systemic improvement that may reduce barriers for these women is access to comprehensive, integrated care for their prenatal care, postpartum care, pediatric appointments, and appropriate substance use disorder treatment.

Telehealth Use and Access to Neurology Outpatient Clinical Services for Children: An Observational Cohort Study.

Access to neurology services is important for children's well-being. We sought to evaluate the effects of telehealth on pedi-atric neurology appointment outcomes for children. Using electronic health record (EHR) data, information about children with pediatric neurology appointments in a tertiary care children's hospital in North Carolina was collected. Appointment outcomes (completion, cancellation, and no-show rates) were calculated for children who had a neurology appointment scheduled both in the pre-pandemic (March 10, 2019, to March 9, 2020) and pandemic (March 10, 2020, to March 9, 2021) periods. "Telehealth user" was a child who had at least one telehealth appointment scheduled between March 10, 2020, and March 9, 2021. In bivariate and multivariate analyses, we compared appointment outcomes for telehealth users and non-users. EHR data were limited to a single institution and could have missed children's clinical encounters elsewhere. Since this study used secondary data that were not collected for research purposes, it is possible that there were unmeasured confounders. Because of the observational nature of the study, the association between telehealth use and appointment outcomes does not indicate causation. A total of 2110 children had 11,194 pediatric neurology appointments scheduled. Telehealth users compared with non-users were more likely to be White, non-Hispanic, have private insurance, and live farther from the children's hospital. There was a statistically sig-nificant decrease in completion (66% versus 57%) and increase in cancellation (27% versus 33%) and no-show (7% versus 10%) rates in the pandemic when compared to the pre-pandemic period. In the pre-pandemic period, telehealth user and non-user groups had similar cancellation and no-show rates. In the pandemic period, there was a statistically significant decrease in cancellation and no-show rates in the telehealth user group when compared to the non-user group. Pediatric neurology outpatient clinic visits decreased substantially during the pandemic. Telehealth mitigated these problems. Children belonging to a minority race/ethnicity are less likely to use telehealth, increasing their risk of poor access to neurology services.

Factors Associated with No-Show Rates in a Pediatric Audiology Clinic.

To evaluate factors associated with no-show rates in a pediatric audiology clinic. Retrospective review. Tertiary referral center. All pediatric patients younger than 18 years whose parents/guardians scheduled an appointment at a tertiary Audiology Clinic between June 1, 2015, and July 1, 2017. Data included whether the patient came to their appointment, patient age, sex, race, insurance type, appointment type, location, season of appointment, and day of the week of the appointment. Of the 7,784 pediatric appointments scheduled with audiology, the overall no-show rate was 24.3% (n = 1893). Lower age was significantly associated with no-shows ( p = 0.0003). Black/African American children were more likely to no-show compared with White/Caucasians ( p = 0.0001). Compared with self-pay/military/other insurance, those with Medicaid were more likely to no-show ( p = 0.0001). The highest rate of no-shows occurred during summer (27%). On multivariate analysis, younger age, Black/African American race, and Medicaid insurance were associated with increased no-show rates. A variety of factors influence no-show rates in a pediatric audiology setting. No-shows can affect treatment quality and affect overall hearing outcomes. Further investigation is necessary to assess barriers to appointment adherence and to develop interventions to improve adherence and care.

E22 Experiences among parents caring for children with juvenile idiopathic arthritis at a tertiary referral hospital in Kenya

Abstract Background Juvenile idiopathic arthritis (JIA) is a highly morbid disease associated with significant rates of preventable permanent damage. The burden and distribution of JIA in African countries vary compared with data across the globe. High-income countries have shown a higher prevalence of JIA compared with low-income countries. Recent studies done in Zambia and Nigeria demonstrated contrasting results in the distributions of the subtypes of JIA within the African continent and those seen in Western countries. Most of these studies were quantitative in nature, looking at health related quality of life within this cohort of patients. Studies done looking at the parental experiences in caring for children for JIA have been reported in high income countries. No studies have been reported within our region to assess the impact of JIA has on parents/guardians caring for children suffering from JIA. Studies from high income countries have shown negative impacts on the social, emotional and financial well-being of guardians caring for children with JIA. We aim to look at impact JIA has on guardians caring for children affected within our context. A few studies in high income countries reported that parental experiences and perceptions play a big role in the long term wellbeing of the child. It still remains unknown the impact JIA might have within our population. Methods This will be a phenomenological type of qualitative study design. 18 potential participants (below 16 years) with a confirmed diagnosis of JIA will be purposively selected from the Kenya pediatric rheumatology registry database (KAPRI). Guardians of patients who meet the inclusion criteria will be scheduled for an introductory meeting on specific days of the week in line with their pediatric rheumatology appointment and in the presence of the primary investigator and the rheumatology consultant. Parental experiences will have been conceptualized using four major indicators: social experience, financial experiences, psychological experience, and medical and treatment-related experiences which impact their overall quality of life. These four concepts have been operationalized using various indicators which were retrieved from literature. The interview guide questionnaire was informed by the conceptual framework which was developed from extensive literature review findings on lived experiences of patients with various health conditions. The concepts in the framework will also serve as the pre-determined themes guiding the deductive thematic data analysis. We shall carry out a deductive thematic data analysis. Hence pre-determined themes extracted from the conceptual framework which was developed from extensive literature review findings on lived experiences of patients will be used in analyzing the data. At the same time, any other new emerging themes will be considered. The transcribed data will be analyzed using the Max for Qualitative Data Analysis (MAXQDA) software program version 2022. Results This project is in its preliminary data collection phase and enrolment of participants is ongoing at the Aga khan University Hospital Nairobi after approval by the Institutional Scientific and Ethical Review Committee (ISERC). Conclusions The results in this study will open avenues for further bigger studies to help promote patient centered care. The results in this study will depict the impact of JIA within our context, as studies done outside of Africa cannot be extrapolated because of the differences in social, economic, and cultural standards and capabilities of practice. Currently, the paucity of data from Africa makes it difficult to predict the burden and impact that JIA pauses on families. This study being a qualitative design, will give an in-depth view on the impact the disease has on the families compared with quantitative studies looking at the quality of life which scarce and despite their values, have limitations such as the inability to include social and cultural aspects and emotional aspects of children's lives and their families and the meaning of life.

Radiographic evaluation of the prevalence of dental anomalies of number

Objectives: This study aims to determine the prevalence of tooth agenesis and supernumerary teeth and characterize both anomalies in a Portuguese pediatric population. Methods: Clinical records of patients attending Pediatric Dentistry appointments in the Faculty of Dental Medicine of the University of Porto were consulted. Appointments from September 2020 to December 2021 were analyzed. For each patient, sex and age were recorded, along with any relevant data in their clinical history. Statistical analysis of the results was conducted using chi-square tests with a significance level of 0.05. The sample included 144 patients. Results: This study found a prevalence for tooth agenesis of 20.83% (11.81% excluding the third molars) and a prevalence for supernumerary teeth of 1.39%. The prevalence of agenesis was 26.1% for males and 16% for females. No association was established in this regard (p&gt;0.05). The most affected teeth were the third molars, followed by the second premolars. The mandible had 52.63% of agenesis cases, but no association was found (p&gt;0.05). Two cases of supernumerary teeth were found, both in male patients and in the second quadrant. No differences were inferred regarding sex (p&gt;0.05). Conclusions: The results of this study contributed to the existing data regarding the prevalence of dental anomalies of number within a Portuguese population.

Ingrown toenail – an update of knowledge and a proposal of a novel treatment approach

Ingrown toenail is one of the most common foot health problems, which is the reason for frequent paediatric, surgical, family medicine and podology appointments. The problem most often affects schoolchildren and young adults, with incorrect hygiene habits and improper care typically considered its causes. The disorder is usually managed in a surgical clinic, with a wedge-shaped undercutting of the nail plate or, in advanced cases, total nail avulsion, being the most common treatment approaches. However, these techniques are characterised by poor efficacy and high recurrence rates, and often lead to further complications, as well as permanent deformations of the nail plate. Therefore, we propose an alternative approach to the problem of ingrown toenails and present a causative surgical method. This technique consists in soft tissue plasty to reduce the prominence of nail folds followed by adaptation of healthy tissues with the use of skin sutures to the shape and dimensions of the nail plate. Since the procedure is performed under local anaesthesia, the treatment can be performed in an outpatient setting. Nail fold plasty allows for effective and permanent resolution of ingrown toenail symptoms, however, it requires strict compliance with postoperative recommendations, which mainly focus on proper care. The lack of interference in the structure of the nail matrix and plate minimises the risk of complications, permanent deformations of the nail apparatus and allows for maintaining the full width of the nail plate.

Predictors of Patient-Related Cancellations and No-Shows for Pediatric Orthopaedics and Sports Medicine Appointments Are Condition Specific

Background: Visit cancellations have detrimental effects on patient health and reduce clinic productivity. We sought to understand the factors that influence cancellation rates across the major subspecialties in pediatric orthopaedics and sports medicine (OSM).Methods: In-person OSM visits from a high-volume multi-site academic pediatric hospital (01/01/2019-02/28/2020) were used to study the effect of patient demographics, distance to clinic, insurance type, visit type (new vs. follow-up) on visit cancellation (canceled by patient and no-shows). When available, chief complaint was used to categorize visits into major subspecialties: cerebral palsy, foot and ankle, hip, knee, other lower extremity, spine, and upper extremity. Logistic regression was used to identify contributors to the visit cancellations in a multivariate model.Results: 424,397 visits (15.9% canceled) were included in the analysis. Based on the multivariate analysis, being non-white (OR=1.139), Hispanic (OR=1.133), older age (OR=1.007), female (OR=1.046), living farther from clinic (OR=1.002), and having public insurance (OR=1.163) were associated with higher cancellations, whereas median household income (OR=0.994, per $10,000) and new visit (OR=0.969) were associated with lower cancellations (P<0.04). 241,305 visits were categorized into subspecialties. The effects of studied patient-related factors and visit types on cancellations were highly variable across subspecialties. When significant, having public insurance and living farther from the clinic were consistently associated with higher rates of cancellations, while being a non-English speaker and having a new visit were associated with lower rates of cancellation. The remaining factors showed variable effects.Conclusion: Disparities exist in patient-related visit cancellations in pediatric and young-adult OSM with different patterns across major OSM subspecialties. These findings highlight the importance of looking at these specific orthopedic conditions separately to develop more effective strategies to improve patient compliance and efficiently utilize healthcare resources.Level of Evidence: Level IIIKey Concepts•Across all pediatric and young-adult OSM visits, being non-white, Hispanic, female, living farther from clinic, and having public insurance were associated with higher odds of cancellation.•While disparities exist in patient-related visit OSM care, the factors that influence cancellation in specific subspecialties are varied and complex.•Further research that looks at specific orthopedic conditions separately will improve efficiency and effectiveness of care and increasing patient compliance.