Pediatric Appointments Research Articles

The acceptability and feasibility of using a 3D body size scale to initiate conversations about weight in toddlerhood: a mixed-methods study.

Health Care Professionals struggle to initiate conversations about overweight in toddlerhood. A novel 3D body size scale (3D BSS) may facilitate engagement with this topic during pediatric appointments. To explore barriers and facilitators to using the 3D BSS through a mixed-methods design. For the qualitative phase, parents of toddlers (n = 38) participated in semi-structured interviews introducing the 3D BSS of 4-5-year-old children. For the quantitative phase, pre- and post-interview questionnaires were administered to ascertain the acceptability of the 3D BSS. Parents rated the 3D BSS as "very" (n = 20, 52.6%) to "moderately" (n = 12, 31.6%) acceptable. Thematic analysis revealed four barriers to acceptability: i) the sensitive nature of child weight, ii) the belief that weight does not determine health, iii) the visual normalisation of overweight and iv) the need to account for individual variation in growth patterns. However, these barriers could be overcome through three facilitators: i) the provision of expert guidance ii) the value of simple tools, and iii) tailoring conversations to familial needs. Parents considered the 3D BSS an acceptable visual resource to discuss child weight during routine appointments. However, the acceptability of the tool was conditional on a sensitive, collaborative, and tailored delivery approach.

Hemoglobin A1c, Physical Activity, And Sport Participation Among Children With Type 1 Diabetes

Children with type 1 diabetes (T1D) should engage in a minimum of 60 minutes of moderate- to vigorous-intensity physical activity (PA) daily, the same as children without T1D; however, care must be taken to prevent or address hypoglycemia or hyperglycemia during and after PA. PURPOSE: The purpose of this study was to determine if PA or sport participation predicted hemoglobin A1c (HbA1c) in children with T1D. METHODS: This study was conducted within a nationally certified pediatric diabetes care and academic medical center. Patients 7 to 17 years old with T1D presenting for their regularly scheduled pediatric endocrinology appointment were invited to complete a physical activity and sport participation electronic survey. Data were linked to their medical records for age, T1D diagnosis duration, ethnicity, race, gender, insurance type, body mass index (BMI), continuous glucose monitor (CGM) and insulin pump usage, and the primary outcome variable HbA1c. RESULTS: Participants consisted of 73 females (47.7%) and 80 males (52.3%), 12.97 ± 2.82 years old, with an average HbA1c of 8.78 ± 1.87. They were physically active for 60 minutes or more 3.48 ± 1.95 days per week with only 7.9% (n = 12) meeting the recommendation of daily PA, yet almost two-thirds played sports within the past year (n = 98, 64.1%). A multiple linear regression model indicated that although HbA1c decreased by .175 for each day a child engaged in PA and decreased .121 for every sport team a child played only the number of days active per week was a significant predictor of better HbA1c (p < .05). CONCLUSION: Since the number of days active per week was a significant predictor of better HbA1c, it behooves diabetes care teams to encourage PA in addition to sport participation alone. Further investigation should address socioecological barriers to PA and sport participation. This study was made possible by support from the Christensen Family, Children’s Hospital Foundation, and University of Louisville Foundation.

Dietary intake quality and associated factors in one year-old children seen by primary healthcare services.

The purpose of this paper was to analyze the food intake quality in one year-old children seen by a primary healthcare (PHC) service. This is a cross-sectional studied nested within a child oral health cohort study which collected data regarding children born in 2013 and monitored in Porto Alegre for two years. We applied a questionnaire on maternal variables and frequency of pediatric appointments, weight and height measurements, and children's food intake. To that end, a score was generated based on the points assigned according to SISVAN (meaning 'food and nutrition monitoring system,' run by the Brazilian Ministry of Health). A multivariate model was calculated using Poisson regression with robust variance. The sample comprised 249 children. We found 30.5% (76) of poor/regular dietary quality, which in the multivariate model was associated to the guardian's educational background, considering up to incomplete high school (PR = 2.14, CI95% = 1.03-4.44) and complete high school (PR = 1.70, CI95% = 0.81-3.54), as well as their failure to see a dentist (PR = 2.54, CI95% = 1.33-4.84) or having seen one before the age of four months (PR = 1.94, CI95% = 1.01-3.72). It is our conclusion that failing to see a dentist within the first year of life and lower maternal schooling negatively impact on children's dietary quality.

Parent-perceived barriers to child weight management: Measure validation in a clinical sample.

Although families face many barriers to obtaining and maintaining a healthy weight status for children, there remains a lack of psychometrically sound tools to assess perceived barriers. The Barriers to Child Weight Management (BCWM) scale quantitatively assesses parents' perceptions of barriers to engaging in positive weight-related behaviors but has not been validated within a clinical sample. The present study sought to validate the BCWM scale among parents of children presenting to a tertiary pediatric weight management clinic. Participants included 258 parents of children aged 6-18 years presenting to a tertiary care behavioral weight management program. Parents completed the BCWM prior to the initial clinic visit. Confirmatory factor analysis was conducted to test the previously identified 4-factor structure within a clinical sample. Overall model fit was good with the addition of 2 theoretically appropriate model respecifications, χ2(144) = 278.60, p < .001, comparative fit index = .90, root mean square error of approximation = .05, standardized root mean square residual = .06. The BCWM is a promising tool to assess parental perceptions of barriers to healthy weight-related behaviors among youth presenting for clinical weight management intervention. Incorporation of this measure into pediatric weight-management appointments may aid in quickly identifying points of intervention. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Research on Digital Information System Construction and Intelligent Management of Clinical Pediatric Nursing in Hospital

The paper uses the prototype method and modular design idea to modularize the pediatric nursing information management system, program with Visual FoxPro5.0, and test the clinical pediatric nursing information system. The system optimizes the pediatric nursing process, improves the efficiency of medical staff, and greatly reduces the problems of medical records loss, errors, and supervision. After the pediatrics run this information management system, the leaders can grasp the indicators of the quantity, quality, efficiency, efficiency and management of each group, which is conducive to strengthening the management of pediatrics and guiding the healthy development of pediatrics. Through the assessment and evaluation of individuals engaged in medical work, grasp the objective data of medical staff's business ability, work performance, medical ethics, job qualifications. Provide a reliable basis for pediatric appointment, training, promotion, and distribution.

Impacting child health outcomes in congenital heart disease: Cluster randomized controlled trial protocol of in-clinic physical activity counselling

BackgroundMost (>90%) children with congenital health defects are not active enough for optimal health. Proactively promoting physical activity during every clinic visit is recommended, but rarely implemented due to a lack of appropriate resources. MethodsThis cluster randomized controlled trial will implement an evidence-based, multi-faceted physical activity intervention. All eligible patients at small (London, ON), medium (Ottawa, ON) and large (Edmonton, AB) pediatric cardiac clinics will be approached, with randomization to intervention/control by clinic and week. Intervention patients will be counselled with 5 key physical activity messages, have questions about physical activity answered, and have access to a custom web site with personalized activity suggestions and support from a Registered Kinesiologist. The primary outcome is daily physical activity (number of steps, minutes of moderate-to-vigorous activity) assessed via pedometer one week per month for 6-months. Standardized questionnaires assess activity motivation and quality of life at baseline and end of study. Healthcare outcomes will be clinic visit time and contacts for physical activity concerns. Repeated measures ANCOVA will compare control/intervention pedometer outcomes, adjusting for covariates (alpha=0.05). ConclusionsThis trial aims to determine whether providing resources and protocols enables clinicians to counsel about physical activity as part of every pediatric cardiology appointment. Evaluations of healthcare system impact and intervention delivery in small, medium and large clinics will assess applicability for implementation in all pediatric cardiac clinics. The impact on physical activity motivation and participation will evaluate the effectiveness of this standardized approach for increasing physical activity in children with congenital heart defects.

Predicting no-shows in paediatric orthopaedic clinics

BackgroundClinic ‘no shows’ (NS) can be a burden on the healthcare system, and efforts to minimise them can reduce lost revenue and improve patient care. Leveraging a large data set...

'Getting to clinic study': A mixed methods study of families who fail to attend hospital outpatient clinics.

Non-attendance rates at paediatric hospital outpatient clinics are high; however, parent-reported reasons for non-attendance are poorly understood. We aimed to identify: (i) modifiable system and parent factors that prevent parents from attending paediatric outpatient clinic appointments with their child; and (ii) parent views on changes that could be made to reduce non-attendance. Interviews were conducted with a random sample of parents of children aged 0-18 years who did not attend scheduled new or review outpatient clinic appointments at a metro, tertiary children's hospital in Melbourne, between 1 May and 31 July 2017. Families were excluded if the principal investigator had previously cared for the child in clinic. A total of 50 parents completed an interview. Common factors related to non-attendance were reported as not receiving an appointment letter (n = 13, 26%) or text reminder (n = 16, 32%); and difficulties making changes to scheduled appointments (n = 11, 22%). Parents suggested a number of ways hospitals could reduce non-attendance, including flexible clinic times, reduced waiting periods, cheaper parking, consistent text reminders of upcoming appointment and, overwhelmingly, the ability to reschedule via text, removing the need to telephone the hospital. The principal reasons families struggle to attend appointments is being unaware of appointments, not receiving letters or text reminders. The lack of correct contact details held by the hospital's electronic medical record suggest systems errors in communication are impacting attendance rates of children in the clinics, and that addressing these internal issues may increase clinic attendance rates.

An Interactive Parent-Targeted Text Messaging Intervention to Improve Oral Health in Children Attending Urban Pediatric Clinics: Feasibility Randomized Controlled Trial.

BackgroundEffective preventive treatments for dental decay exist, but caries experience among preschoolers has not changed, with marked disparities in untreated decay. Despite near-universal use of SMS text messaging, there are no studies using text messages to improve the oral health of vulnerable children.ObjectiveThis randomized controlled feasibility trial aimed to test the effects of oral health text messages (OHT) versus a control (child wellness text messages or CWT). OHT was hypothesized to outperform CWT on improving pediatric oral health behaviors and parent attitudes.MethodsParents with a child aged <7 years were recruited at urban clinics during pediatric appointments (79% [41/52] below poverty line; 66% [36/55] black) and randomized to OHT (text messages on brushing, dental visits, bottle and sippy cups, healthy eating and sugary beverages, and fluoride) or CWT (text messages on reading, safety, physical activity and development, secondhand smoke, and stress) groups. Automated text messages based on Social Cognitive Theory were sent twice each day for 8-weeks. Groups were equivalent on the basis of the number of text messages sent, personalization, interactivity, and opportunity to earn electronic badges and unlock animated characters. Assessments were conducted at baseline and 8 weeks later. Data were analyzed with linear mixed–effects models.ResultsA total of 55 participants were randomized (28 OHT and 27 CWT). Only one participant dropped out during the text message program and 47 (24 OHT and 23 CWT) completed follow up surveys. Response rates exceeded 68.78% (1040/1512) and overall program satisfaction was high (OHT mean 6.3; CWT mean 6.2; 1-7 scale range). Of the OHT group participants, 84% (21/25) would recommend the program to others. Overall program likeability scores were high (OHT mean 5.90; CWT mean 6.0; 1-7 scale range). Participants reported high perceived impact of the OHT program on brushing their child’s teeth, motivation to address their child's oral health, and knowledge of their child's oral health needs (mean 4.7, 4.6, and 4.6, respectively; 1-5 scale range). At follow up, compared with CWT, OHT group participants were more likely to brush their children’s teeth twice per day (odds ratio [OR] 1.37, 95% CI 0.28-6.50) and demonstrated improved attitudes regarding the use of fluoride (OR 3.82, 95% CI 0.9-16.8) and toward getting regular dental checkups for their child (OR 4.68, 95% CI 0.24-91.4). There were modest, but not significant, changes in motivation (F1,53=0.60; P=.45) and self–efficacy (F1,53=0.24; P=.63) to engage in oral health behaviors, favoring OHT (d=0.28 and d=0.16 for motivation and self–efficacy, respectively).ConclusionsThe OHT program demonstrated feasibility was well utilized and appealing to the target population and showed promise for efficacy.

Pediatric vaccination appointment scheduling: experience from an Italian clinic

Abstract Issue/problem Since 2012 pediatric vaccination coverages in Italy have been decreasing. Negative trends have been recorded especially for hexavalent and MMR vaccines. In mid-2017 the Italian government passed an act making ten vaccines compulsory. Most recent data show the act is working, however other aspects of the process should be improved. Description of the problem Parents are invited to bring their children to the clinic through letters or telephone calls. Vaccination appointments are scheduled during weekdays, either in the morning, the afternoon, or both. Each session is carried out by a physician and a nurse, with a new patient scheduled every ten minutes. Appointments and vaccinations are registered on the vaccine-specific electronic health record (SISPC). Results In March 2019, the vaccination clinic worked 21 days for a total of 29 sessions. 823 appointments were available, 797 of them (96.8%) had a patient scheduled before the session started. 547 (68.6%) attended the vaccination appointment, 98.4% of them were vaccinated (538, 67.5% of the total patients scheduled). Among those who did not attend the scheduled appointment, only 108 (43.2%) agreed to reschedule. Eventually, only 58.3% of these patients attended the rescheduled appointment. No statistically significant differences among those who attended and those who did not attend the appointment were found among the variables retrieved from SISPC: day, time, vaccination planned (type, and if mandatory or not), sex, age. Lessons A third of available vaccination appointments in our clinic were lost. Despite the ease through which patients can reschedule an appointment, many choose not to and left their appointments unattended. Although missing a vaccination appointment can be appropriate - e.g. when the child is sick - and great effort should be put to achieve the goal of improving coverages, policymakers should also consider provisions to discourage such behaviors for a better use of resources. Key messages A third of available vaccination appointments in our clinic were lost in a month. Keeping in mind the goal of improving coverages, policymakers should aim for the best possible use of resources.

Parents’ questions to clinicians within paediatric hearing habilitation appointments for children with hearing impairment

ObjectiveTo examine parents’ questions to clinicians and how clinicians respond in paediatric hearing healthcare appointments with children with hearing loss. MethodsThe data consisted of 48 video-recorded hearing habilitation appointments. Participants included 22 clinicians, 41 children, and 48 parents/carers. Data were analysed using conversation analysis. ResultsA total of 89 questions from parents were directed to the clinicians in the appointments. Parents’ questions were mostly designed as polar (yes/no) questions. The questions covered several action and topical agendas, and in most instances functioned as something other than merely soliciting information. The most prominent action agenda of parents’ questions involved questions that displayed parental concern. These questions sought reassurance as well as information from the clinician. ConclusionWhile parents in this study did not ask a large number of questions during the appointments their questions performed important functions. Parents’ questions cannot be assumed to be only about seeking information. Often parents’ questions are in pursuit of reassurance from the clinician about their child’s progress. Practice ImplicationsClinicians may need to provide encouragement to parents to ask questions during appointments. As part of delivering family-centred care, clinicians need to be aware that their responses may need to go beyond information provision.

Wait times, health care touchpoints, and nonattendance in an academic pediatric dermatology clinic.

Timely access to pediatric dermatology care remains a challenge. While awaiting appointments, many patients and families utilize so-called health care touchpoints outside of the dermatology clinic such as primary care or emergency department visits to address dermatologic concerns. Long waiting periods also factor into nonattendance rates at pediatric dermatology appointments. This observational retrospective study investigated wait times, relevant health care touchpoints, and factors related to nonattendance at a pediatric dermatology clinic. We reviewed demographic, health care touchpoint, and nonattendance data for patients referred by a primary care affiliate to the Children's Hospital of Philadelphia (CHOP) pediatric dermatology clinic from February 2016 to May 2017. Descriptive statistics were used to identify trends among analyzed variables. We reviewed 250 patient records. The average number of touchpoints per patient was 0.56, and factors that significantly correlated with increased numbers of touchpoints included younger patient age and longer wait time while payer, primary diagnosis, and time of year were not associated. The nonattendance rate was 26%, and factors significantly associated with increased nonattendance rate included longer wait times and winter and spring appointments. Long wait times impact numbers of touchpoints and appointment attendance rate when referring to pediatric dermatology. A platform such as teledermatology may represent an opportunity to improve access to care by allowing for earlier input from the pediatric dermatologist.

1308-P: Improved Transition in Young Adults with Diabetes: A Pragmatic Clinical Trial

Background: The transition from pediatric to adult diabetes care is a vulnerable period for youth with diabetes. During transition, youth with diabetes are at high risk for loss to follow-up, worsening glycemic control, and increased hospitalizations. Objective: Our objective was to assess the effect of a technology enhanced transition coordinator on loss to follow-up in youth with diabetes transitioning from pediatric to adult diabetes care. Methods: This open label, pre-post pragmatic clinical trial, assessed the effect of a technology enhanced transition coordinator in transitioning young adults with diabetes from pediatric to adult diabetes care. Our primary outcome was the rate of loss to follow-up defined as no outpatient diabetes appointments in the one year following transfer. The usual care (control) cohort were youth with diabetes who received usual care (i.e., transition preparation during pediatric diabetes appointments prior to transfer). The intervention cohort received the usual care and had a transition coordinator who assisted them through the transition period with regular, per protocol contact, by texting, emailing, Twitter®, and/or postings on a private Facebook® page. Results: Baseline average hemoglobin A1c was not different between the intervention cohort [number (n) = 101, 47.5% females] versus the usual care cohort (n= 209, 49.3% female) [8.9 ± 2.0 standard deviation (SD) versus 9.1 ± 2.4 SD, p=0.28] in the year prior to transfer. In the year following transfer, 49.3% of young adults in the usual care cohort versus 11.8% of young adults in the intervention group did not attend any outpatient diabetes appointments (p&amp;lt; 0.01) in the year following transfer. Conclusions: Our technology enhanced transition coordinator intervention was successful in reducing loss to follow-up in transitioning young adults with diabetes. Importantly, this program used simple readily accessible technologies which increases the transferability and sustainability of this intervention. Disclosure S. Butalia: None. A. McGuire: None. S. Crawford: None. D. Dyjur: None. J. Mercer: None. D. Pacaud: Other Relationship; Self; Novo Nordisk A/S, Sandoz, TOLMAR. Funding Lawson Foundation

Impact of a transition program with navigator on loss to follow-up, medication adherence, and appointment attendance in hemoglobinopathies.

Transition from pediatric to adult care is a period of high risk for loss to follow-up, morbidity, and mortality in adolescents and young adults (AYA) with hemoglobinopathies. The purpose of this study was to determine whether a transition program with transition navigator (TN) reduced loss to follow-up and hospitalizations and improved medication adherence and appointment attendance compared with an unstructured transfer. A retrospective observational study compared all AYA with hemoglobinopathies who turned 18 one year prior to (n=51) and one year after (n=61) the initiation of the transition program. Data from one year prior to last pediatric appointment and one year following first adult appointment were collected from each patient. The transition program with TN reduced loss to follow-up from 29% to 7% (P=0.034). A greater proportion of patients in the transition cohort maintained or improved adherence to hydroxyurea or iron chelation to ≥4 days/week; exposure to the program was independently associated with such improvement (P=0.047). A trend toward improvement or maintenance of ≥90% attendance to appointments was observed (P=0.096). Frequency of hospitalization was not significantly different between the two cohorts (P=0.985). A transition program with TN significantly reduced loss to follow-up, and significantly improved and maintained fair to good medication adherence. Further analysis of economic benefit and patient satisfaction will be conducted.

Parent perceptions of restrictive feeding on the relationship between youth BMI z-score and weight control behavior use in African American youth: A mediational study

BackgroundChildren with higher body weights engage in more healthy weight control behaviors (HWCBs) and unhealthy weight control behaviors (UWCBs) compared to healthy weight peers. Parent restrictive feeding (parental attempts to limit what and how much children eat in an effort to manage youth weight) has also been associated with youth weight. However, there is limited research on parental feeding practices among non-Caucasian samples, despite evidence that parental feeding may function differently across races. Therefore, the current study aimed to examine the mediating role of parent restrictive feeding on the relationship between youth body mass index (BMI) z-score and youth use of HWCBs and UWCBs among African American youth. MethodsMeasures were completed by youth (ages 10–13 years) and their parents at a pediatric primary-care appointment. Youth completed a weight control behavior questionnaire asking youth to answer whether or not they have engaged in specific behaviors to lose weight. Parents completed a questionnaire on parent-feeding practices. Youth height and weight were obtained from their medical records. ResultsMediation models revealed parent restrictive feeding significantly mediated the relationship between youth BMI z-score and HWCB use, but not between youth BMI z-score and UWCB use. ConclusionResults from the current study suggest parent restrictive feeding in African American populations may encourage health promoting youth weight management behaviors. Additional research is warranted to investigate how cultural factors may impact the relationships between parent restrictive feeding practices and youth weight control behaviors as there may be important clinical implications when working with diverse populations.

The House of the Little Tooth Diniz: An Oral Health Educational Project

&lt;p class="Standard"&gt;&lt;strong&gt;&lt;/strong&gt;&lt;em&gt;Dental caries is currently one of the major public health problems, given its high incidence among 6-12-year-old children. This age group of children is considered a priority group, due to the transitional period of the replacement of deciduous teeth. This article intends to present a ludic-pedagogical instrument for oral health education, targeted at these children, based on the learning of problems related to oral health through a story narrative and associated pictograms. By means of a health education manual with several pictorial representations of dentistry clinical acts, we intended to imagetically reinforce the therapeutic adherence of children to Paediatric Dentistry as well as oral health prevention care, which are considered determinant factors for oral health success amongst children. The choice of a handbook format for this purpose was considered a health education pedagogical strategy with added value to the Paediatric Dentistry appointment setting, granting patients an active and leading role in their therapeutic path. The handbook can also be of use to younger children, through parental storytelling, establishing a dyadic communication between parents, educators and professionals.&lt;/em&gt;&lt;/p&gt;

The role of observation within a project aiming at facilitating the transition of young patients with juvenile diabetes from paediatric to adults’ services

ABSTRACTIn recent years, the spread of juvenile diabetes has increased exponentially causing major psychological, economic and social costs and raising concern among health professionals and policy makers in relation to supporting these children and adolescent patients. The patients’ transition from Paediatric to Adult services is a critical moment with a high percentage of treatment drop-outs. This has been the focus of research carried out by a team of paediatricians, adult diabetologists, and child and adolescent psychotherapists in the Medical School of a large Italian city. This paper focuses on the role of psychoanalytical observation applied in work discussion seminars with the staff of Paediatric and Adult services in the hospital. The observations were conducted in the joint outpatient clinic, a new Service introduced experimentally to facilitate the transfer from Paediatric to Adult Dibetology Clinics. The seminars included the diabetologist for the last paediatric medical appointment and a paediatrician for the first young adult appointment. The paper discusses the methodology and the data gathered, focussing on the dynamics between the two doctors in the joint outpatient clinic, and on the impact of the social defences, which initially interfered with the joint work.

Parental Expressed Concerns about Silver Diamine Fluoride (SDF) Treatment.

Background: The staining associated with its caries arrest may be a deterrent for the use of Silver Diamine Fluoride (SDF). This study aims to elucidate the concerns that inform parents' perceptions and acceptance of SDF as a treatment option for their child. Study Design: We analyzed qualitative data obtained through an investigation in which parents attending a pediatric dental appointment participated in a survey, which included an open-ended question to evaluate their opinions about SDF staining. Thematic analysis of the comments, offered by the subsample of participants who replied to this question (n=43), yielded insights about perception of SDF therapy. Results: Most parents who provided comments were mothers (83.7%), college graduates (72.1%), primarily white (48.8%) or Hispanic (27.9%). Six themes emerged from the thematic analysis of the parents' responses: Esthetic Concerns, Psychosocial Concerns, SDF Treatment Process, Risks and Side Effects, Situational Benefits, and Dental Treatment Process. While many of the parents' comments are related to appearance, other topics that merit consideration when discussing SDF treatment were mentioned. Conclusions: Although parents are concerned about the esthetic impact of SDF, they understand the risks of alternative treatments and welcome information that will allow them to make an informed decision. Location of the cavities and visibility of the staining appear to heavily influence the decision to accept or reject this therapy.

Oral health beliefs and oral hygiene behaviours among parents of urban Alaska Native children

ABSTRACT American Indian/Alaska Native (AI/AN) children have a prevalence rate of early childhood caries 5 times that of the overall US population. Oral hygiene and oral health beliefs have not been described among AI/AN parents. This study explored constructs of the health belief model informing oral health beliefs and oral hygiene behaviours of parents of AI/AN children ages 0-6 years. The study aimed to determine the toothbrushing behaviour in parents of AI/AN childrenand the relationship between parent oral health beliefs and toothbrushing frequency. A cross-sectional survey which included the Oral Hygiene Scale, Oral Health Belief Questionnaire and the Early Childhood Oral Health Impact Scale was administered to a convenience sample of parents of AI/AN children 71 months or younger attending outpatient paediatric primary care appointments (N=100). Analyses were conducted to determine parent toothbrushing and the relationship between parent health beliefs and child toothbrushing. The odds of regular child toothbrushing were 49.10 times higher when the parent brushed their own teeth regularly (confidence interval (CI)=11.46–188.14; p<0.001). Parental toothbrushing had a strong positive association with the belief that oral health is as important as physical health. This research endorses parent-focused toothbrushing interventions to reduce AI/AN early childhood caries rates.

Impact of trainees on patient appointment time in a pediatric ophthalmology clinic

Academic pediatric ophthalmologists face special challenges in clinical efficiency as they balance providing medical care with educating medical trainees. However, few studies have explored the relationshiP between medical education and clinical efficiency. To address this gap, this study examines the effect of presence of medical trainees on pediatric ophthalmology patient appointment times.