Parental Instruction Research Articles

El efecto de los videojuegos en variables sociales, psicológicas y fisiológicas en niños y adolescentes (The effect of playing videogames on social, psychological and physiological variables in children and adolescents)

El propósito de este trabajo será presentar evidencia científica acerca de los efectos del uso de los videojuegos en aspectos de la vida social de niños y adolescentes, así como posibles efectos psicológicos y fisiológicos generales. Se ha realizado una revisión de la literatura en bases de datos pertinentes y se han seleccionado investigaciones experimentales y meta analíticas de las cuales se extrajo información acerca de los efectos positivos y negativos de los videojuegos en niños y adolescentes. Se ha encontrado que la industria de los videojuegos es multimillonaria, y a pesar de que los videojuegos son populares en todo el mundo, la investigación científica sistemática es escasa y a veces, contradictoria. En algunos estudios se asocia el exceso de juego con efectos sociales y psicológicos negativos, como el aislamiento y la agresividad; mientras que en otros se asocia con el aprendizaje y reaprendizaje motor y la tenacidad para enfrentar situaciones de la vida real. En cuanto a efectos fisiológicos se ha encontrado que los juegos de video de naturaleza activa pueden ser promotores de un mayor gasto energético que los videojuegos de naturaleza pasiva; por lo que con una guía adecuada, podrían considerarse benéficos para combatir la epidemia global del sedentarismo y la obesidad. Se piensa que los juegos de video y todo lo relacionado con una pantalla serán parte de la vida de la población en el futuro, por lo que se deben realizar estudios sistemáticos para determinar los efectos de esta exposición a largo plazo. Palabra clave: videojuegos, sedentarismo, agresividad, atención, gasto energético.Abstract: The purpose of this manuscript will be to present scientific evidence regarding the effects of videogame playing on different aspects of the social life of children and adolescents, as well as the general potential psychological and physiological effects. A literature review from relevant databases has been performed, and experimental and meta-analytical studies have been scrutinized for positive and negative effects of videogames in children and adolescents. In general, it has been found that there is a billionaire videogame industry and yet, despite the worldwide popularity of videogames, research is still scarce and sometimes contradictory. Some research suggests a correlation between excess time video gaming on negative social and psychological aspects such as isolation and aggressive behavior; while other research suggests a positive association with motor learning, motor re-training and resilience. As far as physiological effects it has been reported that active videogames might promote higher energy expenditure than passive videogames; therefore, given an adequate parental instruction might provide videogames beneficial properties to combat the global epidemic of sedentary behavior and obesity. Videogames and everything related «to be» in front of a screen will be common to future generations, and therefore more systematic studies are required to determine the long-term exposure effects to these devices.Key words: videogames, sedentary behavior, aggressive behavior, attention, energy expenditure.

Infants learn baby signs from video.

There is little evidence that infants learn from infant-oriented educational videos and television programming. This 4-week longitudinal experiment investigated 15-month-olds' (N=92) ability to learn American Sign Language signs (e.g., patting head for hat) from at-home viewing of instructional video, either with or without parent support, compared to traditional parent instruction and a no-exposure control condition. Forced-choice, elicited production, and parent report measures indicate learning across all three exposure conditions, with a trend toward more robust learning in the parent support conditions, regardless of medium. There were no differences between experimental and control conditions in the acquisition of corresponding verbal labels. This constitutes the first experimental evidence of infants' ability to learn expressive communication from commercially available educational videos.

Community translation of the Math Interactive Learning Experience Program for children with FASD

The Math Interactive Learning Experience (MILE), a program designed to address academic and behavioral problems found in children with Fetal Alcohol Spectrum Disorders (FASD), was found to be effective in a randomized clinical trials with results that persisted at a 6-month follow-up. The current study evaluated the effectiveness of a community translation, in partnership with several community sites in the metropolitan Atlanta area. A total of 60 participants were randomly assigned to one of the three treatment groups: the MILE program administered at a specialty care center (Center MILE) or in the community (Community MILE), or to parent math instruction only (Parent Instruction). This study evaluated instructor satisfaction with the training program, knowledge related to FASD and the MILE program, adherence to the MILE teaching methodology, participant math outcomes, and parents’ satisfaction with their treatment experience. Instructors reported a high degree of satisfaction with the overall training and mean site fidelity ratings were positively correlated with change in math performance. Those in the MILE intervention groups demonstrated more positive gains in math skills than those in the Parent Instruction group but did not differ from each other. Parents in the Parent Instruction group reported less satisfaction with their intervention than those assigned to the Center MILE group but satisfaction ratings did not differ between those in the MILE intervention groups. These results indicate that the community translation and the MILE instructor training program developed as part of this process were well-received and effective in producing positive treatment outcomes.

Erratum to: Serving the New Class: The Dynamics of Educational Transitions for Romanian Adults Born Before 1985 During Communism and Afterwards

The present article aims to investigate the dynamics of access to the upper secondary and tertiary levels of the educational career of several cohorts of Romanian adults born before 1985 by analyzing the expansion of educational levels and the dynamics of the inequalities in probabilities of access to these levels in Romania by applying the logistic response model to explain the variations in probabilities of realizing the transition to the vocational and the baccalaureate level in the upper secondary and to the higher education in the case of almost 5,000 Romanian citizens surveyed in 2010. The main result of the study is that, contrary to what is suggested by gross enrollment figures, throughout de decades of communism net access to education improved only in case of the vocational upper secondary school while the academic track just kept in pace with the evolution of the distribution of instruction of parents. In other words, the data provides strong support for the thesis of the ‘new class’, that states that the class of persons holding secondary level degrees, not Communist Party members especially, demanded a dramatic expansion of the academic high schools in order to preserve their educational status throughout the generation of their children and explain thus the expansion of academic track of the upper secondary in absolute figures although without improvements of access opportunities.

Discharge instructions for parents in the context of pediatric emergency care: a narrative review

Discharge instructions for parents in the context of pediatric emergency care: a narrative review

An adapted education program to increase adherence to the dietary guidelines for Americans: a feasibility study (807.1)

The National Institutes of Health (NIH) We Can! (Ways to Enhance Children's Activity & Nutrition) was culturally tailored in order to increase adherence to the Dietary Guidelines for Americans, as the vehicle for preventing childhood overweight and obesity in Louisiana families.We Can! Louisiana is an educational program aimed at promoting adherence to the healthful food and physical activity recommendations set forth in the U.S. Dietary Guidelines for Americans and the resulting effect on reducing weight gain and the risk factors for obesity‐related chronic disease in parents and children in rural Louisiana communities.The education program designed with input from representatives of the target population including time and location of classes and selection of the healthy lifestyle promoter from the community, included topics gathered from the focus groups that were historical, social, cultural, and environmental in nature that influence health behavior of the target population. The We Can! Louisiana weekly parent sessions included food preparation instructions, physical activity and a period for participants to discuss progress and challenges in following recommended child feeding principles, and developing self‐efficacy and social support in meeting the U.S. Dietary Guidelines for Americans recommendations. A gardening component was included to encourage adoption of the U.S Dietary Guidelines for Americans. The biweekly sessions were held with the children to reinforce the parental instructions. Parents and children demonstrated sustained interest in weekly nutrition and physical activities and offered suggestions for making the program interesting.Grant Funding Source: USDA/ARS project #58‐6251‐8‐041

Seven practical principles for improving patient education: Evidence-based ideas from cognition science.

An important role of the paediatrician is that of a teacher - every clinician is an educator to patients and their families. This education, however, often occurs under difficult or time-pressured learning conditions. The authors present principles derived from three basic theories of human cognition that may help to guide clinicians' instruction of parents and patients. Cognitive load theory holds that an individual's capacity to process information is finite. By controlling information flow rate, decreasing reliance on working memory and removing extraneous cognitive load, learning is improved. Dual code theory suggests that humans have separate cognitive 'channels' for text/audio information versus visual information. By constructing educational messages that take advantage of both channels simultaneously, information uptake may be improved. Multimedia theory is based on the notion that there is an optimal blend of media to accomplish a given learning objective. The authors suggest seven practical strategies that clinicians may use to improve patient education.

Antecedents of different qualities of home-based parental involvement: Findings from a cross-cultural study in Germany and Thailand

Abstract The purposes of the present study were to identify factors that explain differences in the quality of home-based parental instruction (PI) and to explore the role of culture by analyzing antecedents of PI in two rather individualistic (Germany) versus collectivistic (Thailand) societies. SEM-analyses based on data from 288 German parent–child dyads and 494 dyads from Thailand were conducted in order to investigate, whether variables derived from a modified and extended version of the model of Hoover-Dempsey and Sandler (2005) can be assessed reliably and validly in both samples and possess comparable predictive power. Overall, the results suggest that the newly developed instruments are applicable in both cultures. Nevertheless, it seems that motivational beliefs, role conceptions, and interpersonal conditions may affect PI in a somewhat different way depending on culture.

Commentary to ‘Emergency room visits and readmissions after pediatric urologic surgery’

Preventability of early readmissions at a children’s hospital. Pediatrics 2013;131:e171. [4] Readmissions Reduction Program. Available from: http://cms. gov/Medicare/Medicare-Fee-for-Service-Payment/ AcuteInpatientPPS/Readmissions-Reduction-Program.html/. [accessed 26.07.13]. [5] Kocher RP, Adashi EY. Hospital readmissions and the Affordable Care Act: paying for coordinated quality care. J Am Med Assoc 2011;306:1794. [6] Dougherty D, Schiff J, Mangione-Smith R. The Children’s Health Insurance Program Reauthorization Act quality measures initiatives: moving forward to improve measurement, care, and child and adolescent outcomes. Acad Pediatr 2011; 11(Suppl.):S1. [7] Berry JG, Toomey SL, Zaslavsky AM, Jha AK, Nakamura MM, Klein DJ, et al. Pediatric readmission prevalence and variability across hospitals. J Am Med Assoc 2013;309: 372e80. [8] Yakoubi R, Lemdani M, Monja M, Viller A, Koeng P. Is there a role for a-blockers in ureteral stent related symptoms? A systematic review and meta-analysis. J Urol 2011; 186:928. [9] Nelson CP, Rosoklija I, Grant R, Retik AB. Development and implementation of a photographic atlas for parental instruction and guidance after outpatient penile surgery. J Pediatr Urol 2012;8:521. [10] Kangovi S, Grande D. Hospital readmissions: not just a measure of quality. J Am Med Assoc 2011;306:1796. [11] Cassedy A, Fairbrother G, Newacheck PW. The impact of insurance instability on children’s access, utilization, and satisfaction with healthcare. Ambul Pediatr 2008;8:321. [12] Zickafoose JS, Gebremariam A, Clark SJ, Davis MM. Medical home disparities between children with public and private insurance. Acad Pediatr 2011;11:305. [13] Srivastava R, Keren R. Pediatric readmissions a hospital quality measure. J Am Med Assoc 2013;309:396. [14] Kogon B, Jain A, Oster M, Woodall K, Kanter K, Kirschbaum P. Risk factors associated with readmission after pediatric cardiothoracic surgery. Ann Thorac Surg 2012;94:865. [15] Reynolds M, Lautz TB. Context and significance of emergency department visits and readmissions after pediatric appendectomy. J Pediatr Surg 2011;46:1918. [16] Joynt KE, Jha AK. Characteristics of hospitals receiving penalties under the Hospital Readmissions Reduction Program. J Am Med Assoc 2013;309:342.

Evaluating the effect of an asthma self-management intervention for rural families

Objective: To present outcomes of an asthma self-management educational intervention delivered to children (grades 2–5) at school and to parents in a home visit. Methods: The intervention effectiveness was tested in a 12-month longitudinal study with randomization by elementary schools into treatment and attention-control groups with 183 children who had a diagnosis of asthma. Data were collected at four time points. Change over time was examined with linear mixed models. Results: Quality of life (QOL), hospitalizations, and emergency department visits improved significantly for all the children. African American and Mexican American children had worse asthma-related QOL than did White children. Asthma management behaviors, asthma self-efficacy, and coping likewise improved with girls improving significantly more than the boys. Significant improvements in inhaler skill and asthma severity were seen in the treatment group children when compared to the control group. Treatment group parents showed significant improvements in home asthma management and self-efficacy. Conclusions: The improvement in inhaler skill is an important finding for practitioners as this is a behavior that can be addressed in the clinical setting. The reduction in the treatment group’s asthma severity scores may reflect the improvement in medication delivery as their inhaler skill improved. The differential improvement between boys and girls points to the need for testing other formats in asthma education that can address different learning styles. The individualized parent asthma education enabled the intervener to incorporate neighborhood and home environmental information thereby allowing for tailoring of parental instruction.

Neonatal Opiate Withdrawal and Rooming-In: A Retrospective Analysis of a Single Center Experience

To evaluate our treatment of neonatal abstinence syndrome (NAS), our experience with rooming-in of opiate-dependent mothers and to examine the influence of rooming-in on short term outcome of infants exposed to opiates in utero. Retrospective analysis of maternal and perinatal data of newborn infants with NAS treated between 2004 and 2011 in a level 3 academic children's hospital in a German metropolis. Therapy of NAS and duration of therapy, length of hospital stay and costs were considered in particular. Data of 77 newborns with NAS were analysed. 84.6% of infants were treated with tincture of opium (79.2% rooming-in, 88.7% no rooming-in). Infants with rooming-in (n=24) had a 17% shorter median duration of therapy [27.0 d (IQR 24.0-38.5), no rooming-in (n=53) 32.5 d (IQR 25.0-54.5)] and shorter median length of hospital stay [33.0 d (IQR 28.0-48.0), no rooming-in 41.5 d (IQR 30.3-54.5)]. Demographic data was comparable between newborns and mothers with or without rooming-in. Costs were median 13 457 € (IQR 8 967-17 494)/patient [rooming-in: 9 547 € (IQR 7 024-16 135), no rooming-in: 14 486 € (IQR 9 479-19 352)]. Rooming-in in NAS should be encouraged to shorten duration of therapy and length of hospital stay and thereby reduce costs. No major problems arose in the care of the infants with NAS when parents stayed with their infants but close monitoring of the newborn and strict instruction of parents are required.

Parenting support: Another gender-related policy illusion in Europe?

Using developments in England as the baseline case study, this article critically examines the ‘turn to parenting’, as constituted by the emergence of parenting as a way of conceiving of the role of parent and the putting in place of a set of services for parental instruction and education. The view of parent generalised by these developments is akin to the idea of ‘parenter’ — a genderless someone who puts into practice a set of instrumental behaviours in relation to child-rearing that are beyond gender specificity or social setting. When the measures are examined they are shown to be not gender neutral but gender blind. I suggest that gender blindness is traceable to some of the philosophical influences behind the interventions. It also fits with the instrumental views inherent in policy today, in relation not only to children's development but also the roles of women and men in contemporary economy and society. There is also the fact that a key intent of some of the provisions is to exercise control over the parenting-related behaviours of the poorer sections of the population and women are potentially the best means of achieving this.

A Transactional Model of Parental Involvement and Children's Achievement from Early Childhood through Adolescence

SYNOPSIS Objective. In a longitudinal study, researchers examined the transactional relations between two types of parental home involvement, academic instruction and academic socialization, and children's reading achievement from early childhood through adolescence. Academic instruction involves one-on-one interactions between parent and child that target the development of specific academic skills, and academic socialization involves parents' promotion of academic values, beliefs, and expectations. Design. The sample was based on an ongoing long-term longitudinal study, and included 122 children (approximately equal in gender) and their families. This study included data collected from ages 3 to 17 years, employing a variety of direct and indirect assessments Results. Findings showed that the two types of parental home involvement are distinct, related, and highly stable from early childhood through adolescence, and both types of parental home involvement show transactional relations with children's reading achievement over time. Conclusion. This study contributes to the literature by elucidating the stability of parental academic instruction and socialization, as well as their transactional relations with children's achievement within a single integrated model from early childhood through adolescence.

Down Syndrome: what do pregnant women know about their individual risk? A prospective trial

Down Syndrome is the most common chromosomal abnormality causing intellectual disability in western countries. The incidence relates directly to maternal age. Mothers have to face two risks when prenatal diagnosis is concerned: the probability of a congenital aneuploidy in their fetus, on the one hand, and the procedure-related risk of an invasive prenatal intervention, on the other hand. Women need precise information to deal with these risks. The aim of the study was to evaluate women's knowledge about the individual risk of their fetus being affected by Down Syndrome. A structured questionnaire was distributed among all pregnant women who visited the prenatal care unit at Munich University Hospital, Campus Großhadern. Data evaluation was performed using Microsoft Excel 2003 and SPSS 12.0 for Windows. Statistical analysis was achieved by applying the Student t test, with statistical significance defined as p < 0.05. The data of 237 out of 246 women (96 %) were analyzed. The median gestational age of the study group was 20 (5/7) weeks of gestation [range 5 (1/7)-38 (4/7)]. The median maternal age was 32 years (range 20-41). The collective consisted of 52 % nulliparous, 34 % primiparous and 14 % multiparous women. Their educational history varied with 57 % women who attended high school and 43 % secondary school. Seventy-eight percent (185/237) of these mothers were aware of the fact that a risk of fetal aneuploidy exists, but 22 % (51/237) had never even considered this as an individual risk in their fetus. Most study participants (84 %, 155/185) realized the risk of fetal aneuploidy before conception or at least in early pregnancy. Only 5 % (10/185) of women within late pregnancy considered a chromosomal abnormality as a forthcoming risk for the first time as late as in the second or third trimester. Overall, the women estimated the risk of Down Syndrome being present in their fetus in a ratio of 1:33 (range 1-9,000:10,000); 67 % overestimated the risk and 23 % underrated their individual risk by at least a factor of 2. Only 10 % of the women had a realistic idea (within double standard deviation) of their age-dependent specific risk (p < 0.001). The patient's self-risk assessment was influenced by factors such as personal experience (69 %), counseling by health-care professionals (19 %) or information from different media (19 %). The mother's self-risk assessment was independent of maternal age, education parity or gestational age. Information transfer to patients concerning prenatal medicine is only successful to a certain extent, as pregnant women substantially overrate the risk of congenital handicaps in their fetuses. The need for a more comprehensive instruction of parents is not limited to particular subgroups. Health-care professionals and media are called upon to compensate for the apparent information deficits in parents and improve the public awareness of Down Syndrome.

In vitro and in vivo consequences of variant medium-chain acyl-CoA dehydrogenase genotypes

BackgroundMedium-chain acyl-CoA dehydrogenase (MCAD) deficiency is the most common inherited disorder of the mitochondrial fatty acid oxidation, caused by mutations in the ACADM gene. Since the introduction of neonatal screening for MCAD deficiency, a subgroup of newborns have been identified with variant ACADM genotypes that had never been identified before in clinically ascertained patients. In vitro residual MCAD enzyme activity has been found to facilitate risk-stratification. In this study we integrated results of in vitro (residual MCAD enzyme activities) and in vivo (clinical fasting tolerance tests, and phenylpropionic acid loading tests) tests in this subgroup of newborns, defining the consequences of variant ACADM genotypes.MethodsEnzyme analyses were performed in leukocytes with: hexanoyl-CoA (C6-CoA) +/− butyryl-CoA (C4-CoA), and phenylpropionyl-CoA (PP-CoA). In vitro studies were performed in 9 subjects with variant ACADM genotypes, in vivo functional tests in 6 of these subjects.ResultsEnzyme analyses with C6-CoA, C6-CoA + C4-CoA, and PP-CoA identified significantly higher residual MCAD enzyme activities in subjects with variant ACADM genotypes when compared to patients with classical ACADM genotypes.After prolonged fasting (range 15–18.5 hours) no hypoglycaemia was observed. Increasing concentrations of free fatty acids indicated lipolysis, and ketone body concentrations were sufficient for blood glucose concentrations in 5 out of 6 subjects. Phenylpropionic acid loading clearly demonstrated in vivo residual MCAD enzyme activity in all studied subjects.ConclusionsSubjects with variant ACADM genotypes and residual MCAD enzyme activities >10% display residual MCAD enzyme activities in vitro and in vivo. Our findings support the hypothesis that the guidelines on maximal duration of fasting might be abandoned in subjects with residual MCAD enzyme activities >10% under normal conditions. An emergency regimen and parental instructions remain necessary in all subjects with MCAD deficiency, regardless of residual MCAD enzyme activity.

Loan Performance among Low-Income Households: Does Prior Parental Teaching of Money Management Matter?

Financial literacy and financial education play a central role in asset accumulation, shaping individuals' attitudes, behaviors, and decisions in ways that, ultimately, affect their financial and social well-being. The acquisition of financial skills begins with parental teaching and role modeling, which provides children with their first exposure to concepts of saving and money management. Because such parental instruction is crucial to children's later financial outcomes, children whose parents lack basic financial literacy may be further disadvantaged by the absence of financial instruction at home. This study uses a sample of low- and moderate-income homeowners to test the hypothesis that parental teaching of money management influences children's asset-building outcomes in adulthood. The empirical analysis examines the likelihood of delinquency and default among low- and moderate-income homeowners with mortgages purchased through the Community Advantage Program. The results are consistent with a long-term impact of parental teaching on children's later asset outcomes: greater parental teaching is found to be associated with reduced loan delinquency and foreclosure. Implications for intervention programs to close the financial literacy gap are discussed.

Communication Takes Two

Communication Takes Two

버츄 프로젝트에 근거한 부모-자녀간 의사소통능력향상 프로그램의 효과 연구: S시 어머니를 중심으로

This study has developed on Virtues Project program, which enhances parent communication abilities. The purpose of this study is to verify the improvement on parent communication skills after taking a program. To obtain effective children educational direction, we have offered assistance to the parents that understanding the importance of the parental instruction, improvement of the relationship between parents and children. To enhance the parent communication ability, this program is consisted of five virtue strategies, structured activity programs and various self-examination for attending parents to the program rather than listening the lecture. This program is consists of six session with two hours each session for six weeks. I have studied 26 subjects and they were divided into experiment group and control group. According to this study, this program works on improving parent communication skills. Namely, experiment group showed significant enhancement of communication abilities compared to that of control group.

Risk stratification by residual enzyme activity after newborn screening for medium-chain acyl-CoA dehyrogenase deficiency: data from a cohort study

BackgroundSince the introduction of medium-chain acyl coenzyme A dehydrogenase (MCAD) deficiency in population newborn bloodspot screening (NBS) programs, subjects have been identified with variant ACADM (gene encoding MCAD enzyme) genotypes that have never been identified in clinically ascertained patients. It could be hypothesised that residual MCAD enzyme activity can contribute in risk stratification of subjects with variant ACADM genotypes.MethodsWe performed a retrospective cohort study of all patients identified upon population NBS for MCAD deficiency in the Netherlands between 2007–2010. Clinical, molecular, and enzymatic data were integrated.ResultsEighty-four patients from 76 families were identified. Twenty-two percent of the subjects had a variant ACADM genotype. In patients with classical ACADM genotypes, residual MCAD enzyme activity was significantly lower (median 0%, range 0-8%) when compared to subjects with variant ACADM genotypes (range 0-63%; 4 cases with 0%, remainder 20-63%). Patients with (fatal) neonatal presentations before diagnosis displayed residual MCAD enzyme activities <1%. After diagnosis and initiation of treatment, residual MCAD enzyme activities <10% were associated with an increased risk of hypoglycaemia and carnitine supplementation. The prevalence of MCAD deficiency upon screening was 1/8,750 (95% CI 1/7,210–1/11,130).ConclusionsDetermination of residual MCAD enzyme activity improves our understanding of variant ACADM genotypes and may contribute to risk stratification. Subjects with variant ACADM genotypes and residual MCAD enzyme activities <10% should be considered to have the same risks as patients with classical ACADM genotypes. Parental instructions and an emergency regimen will remain principles of the treatment in any type of MCAD deficiency, as the effect of intercurrent illness on residual MCAD enzyme activity remains uncertain. There are, however, arguments in favour of abandoning the general advice to avoid prolonged fasting in subjects with variant ACADM genotypes and >10% residual MCAD enzyme activity.

Development and implementation of a photographic atlas for parental instruction and guidance after outpatient penile surgery

ObjectiveTo develop and evaluate a visual tool to assist parents in assessing healing after surgical circumcision or revision circumcision (SCRC). MethodsAmong children undergoing SCRC, photographs were taken on postoperative days 0-1-2-3-5-7-10-14-21, and compiled into an atlas. Atlas utility was assessed during two 1-month periods. During the first period (M1) families received routine postoperative instructions only; during the second period (M2), families received the atlas in addition to routine instructions. Families were surveyed by phone and calls/contacts were tracked. Results33 families (among 83 SCRCs) were surveyed during M1, vs 39 families (among 77 SCRCs) during M2 (p = 0.17). Nearly all reported the atlas helpful (59% very helpful, 27% moderately helpful, 9% somewhat helpful). All but one family used the atlas. There was a trend toward families receiving the atlas being more comfortable (64% vs 82% very comfortable, p = 0.12). Survey scores were similar between M1 and M2 for total score, satisfaction, and the number whose expectations were met (58% vs 55%, p = 0.21). Phone contacts decreased between M1 and M2, both in absolute number (M1 = 24 calls vs M2 = 12 calls), and as a proportion of total cases performed (29% vs 16%, p = 0.04). ConclusionsThe circumcision atlas was well received by families and was associated with a significant decrease in post-surgical telephone calls. The atlas has been put into routine clinical use with excellent response.