Pediatric Health Care Professionals Research Articles

Survey highlights the need for specific interventions to reduce frequent conflicts between healthcare professionals providing paediatric end-of-life care.

This study explored how paediatric healthcare professionals experienced and coped with end-of-life conflicts and identified how to improve coping strategies. A questionnaire was distributed to all 2300 professionals at a paediatric university hospital, covering the frequency of end-of-life conflicts, participants, contributing factors, resolution strategies, outcomes and the usefulness of specific institutional coping strategies. Of the 946 professionals (41%) who responded, 466 had witnessed or participated in paediatric end-of-life discussions: 73% said these had led to conflict, more frequently between professionals (58%) than between professionals and parents (33%). Frequent factors included professionals' rotations, unprepared parents, emotional load, unrealistic parental expectations, differences in values and beliefs, parents' fear of hastening death, precipitated situations and uncertain prognosis. Discussions with patients and parents and between professionals were the most frequently used coping strategies. Conflicts were frequently resolved by the time of death. Professionals mainly supported designating one principal physician and nurse for each patient, two-step interdisciplinary meetings - between professionals then with parents - postdeath ethics meetings, bereavement follow-up protocols and early consultations with paediatric palliative care and clinical ethics services. End-of-life conflicts were frequent and predominantly occurred between healthcare professionals. Specific interventions could target most of the contributing factors.

Gross Motor Function Classification System in patients with cerebral palsy: interobserver reliability between parents and orthopaedic specialists

Background: The widely used Gross Motor Function Classification System (GMFCS) was designed to improve understanding and subsequent treatment of children with cerebral palsy. Previous studies investigating reliability between physician and family report of GMFCS have focused on limited age groups or mobility levels. The current study aims to investigate the GMFCS agreement between pediatric orthopaedic healthcare professionals (HCP) and families across all age groups for children with cerebral palsy. Methods: A total of 124 participants completed this prospective study at an orthopaedic children’s hospital. The HCP and family classified the mobility level of each child with cerebral palsy using the GMFCS. Each group was blinded to the other’s assessment of the child. Agreement reliability in GMFCS assessment between parents of children with cerebral palsy and HCP was determined. Results: The interclass correlation coefficient between parents and HCP was 0.92. There was agreement between HCP and parents in 69% of the children evaluated. These findings are similar to results of previous studies. Of those in which there was disagreement, 97% differed by one GMFCS level. In those that differed, the parents provided a lower functional level in 54%, in contrast to previous studies that reported much higher percentages. Conclusions: These findings add to the reliability of the GMFCS being used as a tool for effective communication between HCP and parents of those children with cerebral palsy across all age groups. This reliability can assist with the development of goals and expectations for that child.

Personalized Web-Based Advice in Combination With Well-Child Visits to Prevent Overweight in Young Children: Cluster Randomized Controlled Trial.

BackgroundOverweight is a major health issue, and parent-targeted interventions to promote healthy development in children are needed.ObjectiveThe study aimed to evaluate E-health4Uth Healthy Toddler, an intervention that educates parents of children aged 18 to 24 months regarding health-related behaviors, as compared with usual care. The effect of this intervention on the following primary outcomes was evaluated when the children were 36 months of age: health-related behaviors (breakfast daily, activity and outside play, sweetened beverage consumption, television (TV) viewing and computer time), body mass index (BMI), and the prevalence of overweight and obesity.MethodsThe BeeBOFT (acronym for breastfeeding, breakfast daily, outside playing, few sweet drinks, less TV viewing) study is a cluster randomized controlled trial involving 51 Youth Health Care (YHC) teams. In total, 1094 parents participated in the control group, and 1008 parents participated in the E-health4Uth Healthy Toddler intervention group. The intervention consisted of Web-based personalized advice given to parents who completed an eHealth module and discussion of the advice during a regular well-child visit. In this study the eHealth module was offered to parents before two regular well-child visits at 18 and 24 months of age. During the well-child visits, the parents’ personalized advice was combined with face-to-face counseling provided by the YHC professional. Parents in the control group received usual care, consisting of the regular well-child visits during which general information on child health-related behavior was provided to parents. Parents completed questionnaires regarding family characteristics and health-related behaviors when the child was 1 month (inclusion), 6 months, 14 months, and 36 months (follow-up) of age. The child’s height and weight were measured by trained health care professionals from birth through 36 months of age at fixed time points. Multilevel linear and logistic regression models were used to evaluate the primary outcomes at 36 months of age.ResultsAt 36 months, we observed no differences between health-related behaviors of children, BMI or the percentage of children having overweight or obesity in the control and intervention group (P>.05). An analysis of the intervention effect revealed that boys benefited from eating breakfast daily, non-Dutch children spent more time being active or playing outdoors, children of low-educated parents and of overweight and obese mothers spent less time watching TV or using the computer, and children of normal weight mothers drank less sweetened beverages (P<.05) compared with the control group.ConclusionsThe E-health4Uth Healthy Toddler intervention resulted in small improvements in health-related behaviors among subgroups but had no significant effects with respect to the children’s BMI. We conclude that the E-health4Uth Healthy Toddler intervention may be useful for pediatric health care professionals in terms of providing parents with personalized information regarding their child’s health-related behaviors.Trial RegistrationNetherlands Trial Register: NTR1831; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=1831 (Archived by WebCite at http://www.webcitation.org/6mm5YFOB0)

An online ASD learning module for pediatric health care professionals

PurposeYouth with autism spectrum disorder (ASD) often have co-occurring health care needs and are likely to come into contact with several health care professionals over their lives. At the hospital, youth with ASD may require specialized supports to optimize health care experiences and for medical services to be delivered safely. At present, there is a limited understanding of how to best support this patient population. The purpose of this paper is to develop, implement, and evaluate an online training module for hospital staff about ASD.Design/methodology/approachTo evaluate participants’ perceived utility of the learning tool, a post-module survey was administered.FindingsIn all, 102 health care professionals and other hospital staff completed the training and evaluation measure. Majority of participants had prior ASD-focused education (66 percent) and had experience working with at least 20 youths with ASD (57 percent). Majority of participants (88 percent) perceived the information from the module to be helpful in their daily work and reported that they learned something new (63 percent). Participants were interested in receiving additional ASD online module training opportunities on topics including: hands-on behavior management strategies, in-hospital resources, guidance on treatment adherence, and ASD training geared specifically to protection services staff.Originality/valueThe results from this evaluation have important practice implications for hospital staff working with patients with ASD and their families. Evidence-based strategies were easily accessible for staff and the module can be feasibly built upon and expanded as well as disseminated beyond the current hospital setting.

Clinician Response to Child Abuse Presentations in the Vietnamese Hospital Emergency Setting.

Ongoing fiscal stability has enabled the National Assembly in Vietnam to turn its attention to improving the health and well-being of women and children. Training pediatric health care professionals in the recognition and response to child abuse presentations in the emergency setting has the potential to improve outcomes for the disproportionate number of vulnerable children presenting to the emergency setting with nonaccidental injuries. This study explored the training needs and expectations of the staff preparing to undertake such a clinical training program. This qualitative study is based on semistructured interviews with 16 clinicians from the emergency setting of a leading pediatric hospital in Vietnam. Interview questions focused on current practice in recognizing and responding to child abuse and neglect presentations, the level of training and experience of participants, and subjective reports of confidence in recognizing abuse. Interviews were conducted in English and Vietnamese, with check-translation of transcripts performed by an independent translator. A culture of collegiality and innovative workplace practices was revealed. Analysis revealed two overarching themes that were related to the need for evidence, forensic analysis, respecting families, and consultation. Despite participant confidence in recognizing and reporting child abuse and neglect presentations, knowledge deficits were found. This article presents a critical analysis of the context within which the first evidence-based clinical training program of its kind in Vietnam was developed and implemented in a pediatric children's hospital. Clinicians felt a strong moral obligation to protect children from further harm, however encountered a number of barriers inhibiting this process. Findings significantly shaped the Safe Children Vietnam training program and will also contribute to the development of protocols and improvement of community support services at the study site.

P038: Does the pediatric emergency department have a role in pediatric palliative care?

Introduction: Very little is known regarding the emergency department’s (ED) role in the care of paediatric patients with complex chronic and life-limiting illnesses. In fact, the provision of paediatric palliative care (PPC) in the paediatric ED has, of yet, never been explored. This study aims to explore pediatric emergency medicine healthcare professionals’ perspectives regarding their role in PPC and to compare these to other health care professionals’ understandings of the ED’s role in PPC. Methods: Interdisciplinary semi-structured focus groups were held with healthcare providers from pediatric emergency medicine, pediatric palliative care, pediatric complex care and pediatric intensive care. Exploratory open-ended questions introduced naturally occurring discussions and interactions. Data was transcribed in full and analysed using NVivo© software. Data analysis was performed by thematic analysis and theoretical sampling. Results: From January to October 2016, 58 participants were interviewed; most were female nurses and physicians. ED providers seek to maintain continuity of care and uphold pre-established wishes throughout PPC patients’ ED visits by listening and supporting the patient and family, evaluating the clinical situation, communicating with primary care teams and organising rapid admissions to wards. Some ED providers recognized having no choice to provide palliative care approach under certain circumstances despite thinking it might not be part of their culture and role. Each interdisciplinary team demonstrated particular values and cultures, influencing their understandings of the ED’s role in PPC; continuity of care is complicated by these distinct philosophies. Limitations to providing PPC in the ED are related to unsuitable physical environments, lack of uninterrupted time, efficiency expectations, unknown patients, provider lack of knowledge and moral distress. Solutions were directed at improving communication between teams and humanizing care to develop a sensibility to quality PPC in the ED. Conclusion: Although the perspective of pediatric ED’s role in caring for PPC patients is heterogeneous, several barriers to providing high quality emergency PPC can be overcome. Future studies will explore the experiences of PPC families presenting to the ED.

Practices and awareness of the paediatricians regarding syrups and sugar free medicines in Chennai City

IntroductionPaediatricians and paediatric health care professionals should develop the knowledge base to perform oral health risk assessments on all patients beginning at 6 months of age Dentist are not the only health professionals to see children at high risk for tooth decay. Paediatricians have a key role in helping young patients before tooth decay becomes a reality. Aim1. To assess Practices of the paediatricians regarding syrups and sugar free medicines in Chennai City. 2. To assess Awareness of the paediatricians regarding syrups and sugar free medicines in Chennai City. Materials and MethodsThe study consisted of 65 males and 45 females which totally comprised of 110 study subjects. The subjects were of age ranging between 28 and above 57 years old. The source of data was primary and was obtained through a questionnaire survey. The resulting data was coded and statistical analysis was done using SPSS (Statistical Package for Social Sciences) version 17.0 software, Chi-square test was applied to compare the percentages and the level of significance was set at 0.05. ResultsThough there was a difference in responses given by Paediatricians regarding their practices and awareness on syrups and sugar free medicines according to year of practices there was no marked difference noted between them. ConclusionIn the present study, most paediatricians recognize that paediatric medicines can cause teeth problems, a high percentage are able to establish a relationship with the dental caries. Paediatric formulations without added sugar should be available to those responsible, and professionals could provide better and more intensive teaching on the proper oral hygiene care after use of these medicines.

Pediatric and neonatal transport in Spain, Portugal and Latin America

ObjectiveTo study the organization of inter-hospital transport of pediatric and neonatal patients in Spain, Portugal and Latin America. DesignAn observational study was performed. An on-line survey was sent by email including questions about characteristics of national, regional and local health transport systems, vehicles, material, and composition of the transport team and their training. SettingHospital pediatric healthcare professionals treating children in Spain, Portugal and Latin America. ResultsA total of 117 surveys from 15 countries were analyzed. Of them, 55 (47%) come from 15 regions of Spain and the rest from Portugal and 13 Latin American countries. The inter-hospital transport of pediatric patients is unified only in the Spanish regions of Baleares and Cataluña and in Portugal. Chile has a mixed unified transport system for pediatric and adult patients. Only 51.4% of responders have an educational program for the transport personnel, and only in 36.4% of them the educational program is specific for pediatric patients. In Spain and Portugal the transport is executed mostly by public entities, while in Latin America public and private systems coexist. Specific pediatric equipment is more frequent in the transport teams in the Iberian Peninsula than in Latin American teams. The specific pediatric transport training is less frequent for teams in Latin America than on Spain and Portugal. ConclusionsThere is a great variation in the organization of children transport in each country and region. Most of countries and cities do not have unified and specific teams of pediatric transport, with pediatric qualified personnel and specific material.

Preparing Pediatric Healthcare Professionals for End-of-Life Care Discussions: An Exploratory Study.

Preparedness to initiate end-of-life (EoL) discussions is a confronting and daunting task for all healthcare professionals. We conducted a group interview to explore healthcare professionals' experiences of preparing for EoL discussions with the patient and their family in a pediatric context. To identify what pediatric healthcare professionals consider important when preparing for an EoL discussion. A qualitative design using a group interview. Two open-ended questions were asked: (1) How could preparedness to initiate EoL care discussions between healthcare professionals and the patient and family be enhanced? (2) What education resources/strategies could be developed to support preparation for EoL care discussions? Healthcare professionals, including medical, nursing, and allied health professionals working in pediatric palliative care settings across Queensland, Australia. These settings included major tertiary hospitals, general practice, community, and nongovernment organizations. A convenience sample of 36 healthcare professionals consented to participate in the study. An analysis of the data identified seven themes that had relevance for preparing for an EoL discussion: communication, healthcare professional perspectives, interdisciplinary team role, patient and family perspectives, practical issues, addressing mistakes, and healthcare professional education. Pediatric healthcare professionals confirmed that gaps exist in preparing for an EoL discussion. The findings support a need for further research in two areas. First, a systematic review of interdisciplinary resources that are available to support healthcare professionals in preparing for EoL discussions is recommended. Second, evidence-based interdisciplinary interventions to support pediatric EoL discussions need to be developed and evaluated.

Fertility Preservation Care for Children and Adolescents with Cancer: An Inquiry to Quantify Professionals' Barriers.

There is a growing interest in fertility preservation as emerging research is highlighting the prevalence of infertility among young cancer survivors and its negative impact on quality of life. Previous qualitative research has identified barriers of fertility preservation care among professionals. The aim of this study was to assess the prevalence of these barriers among pediatric and adolescent oncology healthcare professionals and evaluate factors that influence them. Based on previously identified barriers and experts' input, a questionnaire was developed and sent to 88 professionals drawn from the multidisciplinary pediatric and adolescent oncology team of a large Principal Treatment Centre. Multivariate analysis was performed to evaluate which factors influence professional adherence to fertility preservation care. In total, 48 (55%) professionals responded and were included in the analysis. All pediatric and adolescent oncology healthcare professionals reported at least one barrier to fertility preservation care. Even though some interdisciplinary differences were observed, the most frequently endorsed barriers were focusing on patients' characteristics (age, health status, urgency of cancer treatment, and lack of interest in fertility issues). The least frequently endorsed barriers were related to organizational aspects (availability of fertility specialists, time constrains, and ability to raise fertility issues). Nurses and allied healthcare professionals endorsed knowledge or policy gaps as barriers to a greater degree than medical doctors. Results suggest that educational support provision, especially for nurses and allied healthcare professionals, and strengthening interdisciplinary collaborations could help overcome observed barriers and facilitate fertility discussions with pediatric and young cancer patients.

In-hospital capacity-building in research and management for pediatric professionals.

We describe an educational strategy aimed at capacity-building of hospital health care professionals in research and management initiated at a pediatric hospital in 2006, and the results obtained eight years after its implementation. Research and Management in Pediatrics (GIP) is an annual 250-hour course combining meetings and off-site assignments delivered through the Hospital's on-line campus. It provides students with practical tools for research (epidemiology, methodology, bibliographic search, evidencebased medicine, biostatistics) and management (strategic planning, management programs, health services research, quality improvement, health economics). Assessment methods included integrative exercises, a final evaluation, and a group research or management project. Results obtained over the 2006-2013 period were highly satisfactory. An intensive training program on research and management is a useful strategy for in-hospital capacity-building of pediatric health care professionals in basic tools for research activities, critical reading of biomedical literature and rational management of pediatric health services.

Diagnosis and management of allergic conjunctivitis in pediatric patients.

Allergic conjunctivitis (AC), although one of the most common ocular disorders in pediatric patients, is frequently overlooked, misdiagnosed, and undertreated in children. To guide pediatric health care professionals in the optimal diagnosis and management of AC in pediatric patients. To identify any existing best practice guidelines for the diagnosis and treatment of AC in pediatric patients, a review of the literature published between 2004 and January 2015 was conducted. Diagnosis and treatment algorithms and guidelines for pediatric patient referrals were then developed. A literature search to identify best practice guidelines for the treatment of AC in pediatric patients failed to return any relevant articles, which highlighted the need for best practice recommendations. Based on publications on adult AC and clinical experience, this review provides step-by-step guidance for pediatric health care professionals, including recognizing clinical features of AC, establishing a comprehensive medical history, and performing a thorough physical examination to ensure a correct diagnosis and the optimal treatment or referral to an eye care specialist or allergist when required. In addition to established drug treatments, the role of subcutaneous and sublingual immunotherapy is discussed to inform pediatric health care professionals about alternative treatment options for patients who do not tolerate pharmacotherapy or who do not respond sufficiently. The diagnostic and treatment algorithms and guidelines provided in this review help address the current literature and educational gap and may lead to improvements in diagnosis and management of pediatric AC.

The Journal celebrates 85 years

The first issue of The Journal of Pediatrics rolled off the presses in 1932 as the first official publication of the American Academy of Pediatrics (AAP; J Pediatr 1982;101:1-4). However, in 1948, the AAP introduced Pediatrics, and The Journal of Pediatrics became an independent, nonsociety journal—a status it has held ever since. Being a proprietary journal means that we do not have a built-in subscriber base, so we never take for granted the continued support of our authors, reviewers, and readers. Prompted by an unsolicited report submitted by Hellems et al reflecting on the first 75 years of The Journal (J Pediatr 2009;155:16-20.e1), we published two editorials providing a behind-the-scenes look from the perspective of the editor and the publisher (J Pediatr 2009;155:3-5 and 6-7). After 85 years, The Journal has continued to follow our mission: “Through a rigorous process of evaluation and peer review, The Journal of Pediatrics strives to publish pediatric research of the highest value for a diverse audience of pediatric healthcare professionals” (http://www.jpeds.com/content/aims). Although some aspects of publishing have changed (eg, mobile apps, online innovations, clinical trials registration), our foundation remains strong and we appreciate your support. Over the years, we have received and published countless articles “to inform immediate care decisions, deepen knowledge, and advance further scientific discovery to improve the quality of care and the health of infants, children, and adolescents” (http://www.jpeds.com/content/aims). To provide just a sampling of high impact clinical practice articles that have been published in The Journal over the past 85 years, throughout the year we will highlight a number of articles. Please follow us on Twitter (https://twitter.com/jpediatr) to rediscover these important articles, joining the conversation by tweeting your thoughts, reminiscences, and comments regarding articles that have been useful or meaningful to you, your practice, and your research. Cheers to another 85+ years!

Sex and Racial/Ethnic Differences in Positive Outcomes in Delinquent Youth After Detention

ImportanceLongitudinal studies of delinquent youth have focused on criminal recidivism, not on psychosocial outcomes in adulthood. This omission is critical because after detention most youth return to the community, where they become the responsibility of pediatric health care professionals.ObjectiveTo investigate 8 positive outcomes among delinquent youth 5 and 12 years after detention, focusing on sex and racial/ethnic differences.Design, Setting, and ParticipantsIn the Northwestern Juvenile Project, a longitudinal US study of long-term outcomes of delinquent youth after detention, participants were interviewed in detention between November 20, 1995, and June 14, 1998, and reinterviewed up to 9 times during the 12-year study period, through May 12, 2011. Data analysis was conducted between November 18, 2013, and July 25, 2016.ExposuresJuvenile detention.Main Outcomes and MeasuresAchievement of positive outcomes in 8 domains: educational attainment, residential independence, gainful activity, desistance from criminal activity, mental health, abstaining from substance abuse, interpersonal functioning, and parenting responsibility. Outcomes were assessed with widely used measures supplemented by correctional records.ResultsThe study included 1829 youth at baseline (1172 males and 657 females; mean [SD] age, 14.9 [1.4] years). At the end of the study, 1520 (83.1%) of the original sample remained (944 males and 576 females; mean [SD] age, 27.6 [1.4] years). Twelve years after detention, females were more likely than males to have positive outcomes for gainful activity (odds ratio [OR], 2.53; 95% CI, 1.86-3.44), desistance from criminal activity (OR, 5.89; 95% CI, 4.38-7.92), residential independence (OR, 3.41; 95% CI, 2.57-4.52), parenting responsibility (OR, 18.65; 95% CI, 12.29-28.30), and mental health (OR, 1.48; 95% CI, 1.13-1.92). Twelve years after detention, only 21.9% of males and 54.7% of females had achieved more than half of the outcomes. As youth aged, the number of positive outcomes increased only modestly (mean increase for males, 0.37; 95% CI, 0.13-0.62; for females, 0.29; 95% CI, 0.13-0.45). Among males, non-Hispanic white individuals were significantly more likely to achieve most positive outcomes compared with minorities, but less likely to abstain from substance abuse. For example, 12 years after detention, non-Hispanic white males had nearly 3 times the odds of educational attainment compared with African American (OR, 2.82; 95% CI, 1.77-4.50) and Hispanic males (OR, 2.91; 95% CI, 1.75-4.82), and 2 to 5 times the odds of gainful activity compared with African American (OR, 5.17; 95% CI, 3.16-8.45) and Hispanic males (OR, 2.58; 95% CI, 1.56-4.26). Latent class analysis shows that African American males fared the worst, with lives characterized by incarceration, criminal activity, and few positive outcomes.Conclusions and RelevanceOur findings highlight racial/ethnic disparities among youth in achieving positive outcomes after detention. To improve outcomes, pediatric health care professionals should recognize the importance of psychosocial health, partner with on-site psychosocial services in their practices, and facilitate access to services in the community.

Publishing Trends in the Field of Pediatric Emergency Medicine From 2004 to 2013.

To identify publishing trends within the field of pediatric emergency medicine between 2004 and 2013. We conducted a MEDLINE search of pediatric emergency medicine articles, filtered by clinical trial, published between 2004 and 2013 in ten journals from the fields of pediatrics, emergency medicine, general medicine, and pediatric emergency medicine. Each article was classified by journal type, study design, results (positive or negative/equivocal), age/type of subjects, and major topic (based on the objective of the study). Articles were stratified by publication period (2004-2008 or 2009-2013) to analyze trends. A total of 464 articles were analyzed. The majority of articles were described as randomized-controlled trials (47%) with negative/equivocal findings (70%). The most common major topics were pain management, asthma, sedation, bronchiolitis, resuscitation, simulation, and ultrasound. Over time, the percentage of articles published in pediatrics and pediatric emergency medicine journals increased (P = 0.0499) and the percentage for all study designs increased except for randomized controlled trials (P = 0.0089). There were no differences between the 2 publication periods when stratified by results, age/type of subjects, and major topic. By identifying these trends, we hope to encourage researchers to perform studies in the field of pediatric emergency medicine where deficiencies lie and to guide pediatric health care professionals to where published, evidence-based studies can be found in the medical literature.

Understanding Zika virus.

This article describes what pediatric healthcare professionals should know about Zika virus (ZIKV). ZIKV is classified as an arthropod-borne, single-stranded RNA virus of the Flaviviridae family and genus Flavivirus. ZIKV is not new. The virus was first discovered almost 70 years ago in Uganda. The first isolate of the virus was found in rhesus monkeys in the Zika Forrest, hence the nomenclature. The primary route of ZIKV transmission to humans is through the bite of an infected Aedes species mosquito-primarily Aedes aegypti. When the mosquito bites individuals infected with the virus, mosquitos then become the vector of transmitting the infection to others. Women can also pass ZIKV to their fetus during pregnancy and at the time of delivery. ZIKV can also be transmitted through sexual activity from an individual who is infected with the virus to his or her partners. It is estimated that approximately 18% of individuals infected with ZIKV will go on to develop symptoms. When symptoms develop, it is usually within 3-12 days, although this may vary. Most often, symptoms are mild and self-limited. The most common symptoms are fever, arthralgia, maculopapular rash, and conjunctivitis lasting up to seven days. Less frequent symptoms include headache, vertigo, myalgia, vomiting, and diarrhea. At present, there is no vaccine available to prevent ZIKV and no specific antiviral treatment. Supportive care consisting of rest, hydration, analgesics, antihistamines, and antipyretics is recommended as needed. Given that there is no vaccine or treatment for ZIKV, considerable efforts must be focused on prevention. One of the most effective ways of preventing ZIKV infection is through avoiding mosquito bites, especially when traveling to or residing in areas where transmission is present. Precautions should include wearing appropriate attire with the objective of having as little skin exposed as possible, use of screens for windows and doors, and use of insect repellent. What is known about ZIKV changes continually. An infectious threat that was relatively obscure just a few months ago has now become a topic of heightened interest worldwide. Pediatric healthcare professionals must remain cognizant of evolving developments and emerging new evidence.

Auditory Brain Development in Children with Hearing Loss – Part Two

Auditory Brain Development in Children with Hearing Loss – Part Two

Auditory Brain Development in Children With Hearing Loss – Part One

Auditory Brain Development in Children With Hearing Loss – Part One

Transporte pediátrico y neonatal en España, Portugal y Latinoamérica

ObjectiveTo study the organization of inter-hospital transport of pediatric and neonatal patients in Spain, Portugal and Latin America. DesignAn observational study was performed. An on-line survey was sent by email including questions about characteristics of national, regional and local health transport systems, vehicles, material, and composition of the transport team and their training. SettingHospital pediatric healthcare professionals treating children in Spain, Portugal and Latin America ResultsA total of 117 surveys from 15 countries were analyzed. Of them, 55 (47%) come from 15 regions of Spain and the rest from Portugal and 13 Latin American countries. The inter-hospital transport of pediatric patients is unified only in the Spanish regions of Baleares and Cataluña and in Portugal. Chile has a mixed unified transport system for pediatric and adult patients. Only 51.4% of responders have an educational program for the transport personnel, and only in 36.4% of them the educational program is specific for pediatric patients. In Spain and Portugal the transport is executed mostly by public entities, while in Latin America public and private systems coexist. Specific pediatric equipment is more frequent in the transport teams in the Iberian Peninsula than in Latin American teams. The specific pediatric transport training is less frequent for teams in Latin America than on Spain and Portugal. ConclusionsThere is a great variation in the organization of children transport in each country and region. Most of countries and cities do not have unified and specific teams of pediatric transport, with pediatric qualified personnel and specific material.

Interventions by Health Care Professionals Who Provide Routine Child Health Care to Reduce Tobacco Smoke Exposure in Children: A Review and Meta-analysis.

Reducing child exposure to tobacco smoke is a public health priority. Guidelines recommend that health care professionals in child health settings should address tobacco smoke exposure (TSE) in children. To determine the effectiveness of interventions delivered by health care professionals who provide routine child health care in reducing TSE in children. A secondary analysis of 57 trials included in a 2014 Cochrane review and a subsequent extended search was performed. Controlled trials (published through June 2015) of interventions that focused on reducing child TSE, with no restrictions placed on who delivered the interventions, were identified. Secondary data extraction was performed in August 2015. Controlled trials of routine child health care delivered by health care professionals (physicians, nurses, medical assistants, health educators, and dieticians) that addressed the outcomes of interest (TSE reduction in children and parental smoking behaviors) were eligible for inclusion in this review and meta-analysis. Study details and quality characteristics were independently extracted by 2 authors. If outcome measures were sufficiently similar, meta-analysis was performed using the random-effects model by DerSimonian and Laird. Otherwise, the results were described narratively. The primary outcome measure was reduction in child TSE. Secondary outcomes of interest were parental smoking cessation, parental smoking reduction, and maternal postpartum smoking relapse prevention. Sixteen studies met the selection criteria. Narrative analysis of the 6 trials that measured child TSE indicated no intervention effects relative to comparison groups. Similarly, meta-analysis of 9 trials that measured parental smoking cessation demonstrated no overall intervention effect (n = 6399) (risk ratio 1.05; 95% CI, 0.74-1.50; P = .78). Meta-analysis of the 3 trials that measured maternal postpartum smoking relapse prevention demonstrated a significant overall intervention effect (n = 1293) (risk ratio 1.53; 95% CI, 1.10-2.14; P = .01). High levels of study heterogeneity likely resulted from variability in outcome measures, length of follow up, intervention strategies, and unknown intervention fidelity. Interventions delivered by health care professionals who provide routine child health care may be effective in preventing maternal smoking relapse. Further research is required to improve the effectiveness of such interventions in reducing child TSE and increasing parental smoking cessation. The findings of this meta-analysis have policy and practice implications relating to interventions by routine pediatric health care professionals that aim to reduce child exposure to tobacco smoke.