Pediatric Outpatient Clinic Research Articles

Increasing Screening for Sexually Transmitted Infections Among Adolescents and Young Adults Diagnosed With Sickle Cell Disease: A Quality Improvement Project

BackgroundSexually transmitted infections affect 20 million adolescents and young adults in the United States annually. Local ProblemIn a pediatric outpatient sickle cell disease clinic, in southeastern, US, 16% (43/272) of patients aged 16-24 had a documented sexual health history and 12% (4/77) completed STI screenings. The clinic's aim was to increase sexual health assessment, STI screenings, diagnosis, and treatment. Methods/InterventionUsing process redesign, a standardized sexual health and STI screening process at routine visits was implemented to increase completion of sexual health histories and STI screening. ResultsSexual health history collection rates increased from 16% (43/272) pre- to 92% (107/116) post-intervention. The rate of STI testing offered increased from 12% (5/43) pre- to 100% (116/116) post-intervention. The STI testing rates increased 22.5 % from 40% (2/5) pre- to 49% (20/41) post-intervention. ConclusionsEvidence-based standardized interventions can successfully be used to assist in sexual health documentation and STI screening.

A recipe for health: A descriptive qualitative study examining paternal influence and the establishment of children's healthy eating habits in Singapore.

This study aimed to explore Singaporean fathers' perceived influence over their children's eating habits. A descriptive qualitative study design was used. Convenience sampling was used to recruit fathers of children aged 3-21 years old from a general paediatric outpatient clinic in a tertiary public hospital. Data were collected from September 2023 to January 2024. Fifteen fathers were interviewed until data saturation. A semi-structured interview guide was used to conduct virtual interviews and thematic analysis was used for data analysis. Three themes and nine subthemes were identified. The three themes were: (1) laying a good foundation, (2) circumstances shaping perspectives, and (3) agents of future behavioural change. Fathers perceived themselves as influencing their children's eating habits by laying a good foundation and that their perspectives were influenced by their circumstances such as lack of time and gender roles. Fathers identified elements that could initiate their future behaviour change to better influence their children's eating habits. These findings provide nuanced insights into paternal perceptions, for the future development of father-specific interventions to enhance their influence in promoting good eating habits among their children. Healthcare professionals can encourage paternal involvement through providing health education on healthy nutrition for their children to both mothers and fathers in the clinical setting. Healthcare professionals can also organize hands-on events that teach about food exploration and nutrition for fathers to take part in with their children.

P-1438. Health-Related Social Needs and Guardian Adversity in Outpatient Pediatric Infectious Diseases

Abstract Background Infectious Diseases (ID) outpatient settings do not routinely screen for psychosocial needs of patients and families that may exacerbate infectious processes or challenge traditional treatment. We assessed the prevalence of health-related social needs (HRSN), guardian adverse childhood experiences (ACEs), and neighborhood-level socioeconomic deprivation in two pediatric outpatient ID clinics. Methods Using a cross-sectional study design, we approached English- and Spanish-speaking guardians of outpatient ID patients at two campuses. Guardians completed a HRSN screen (evaluating food/housing insecurity, transportation access, and mental health concerns) and the 10-question ACEs questionnaire (evaluating traumatic childhood experiences of guardians). Responses were entered into REDCap. We geocoded street addresses to identify census tract-level socioeconomic deprivation index (SDI) scores, with higher scores indicating more deprivation. We quantified individual HRSN items, total ACE scores, and SDI measures. We extracted clinical/demographic information from patient charts. Descriptive analyses were pursued. ANOVA analyses explored associations with psychosocial needs and SDI scores.Figure 1.Association of SDI score and Food Insecurity Over the Past 12 Months. Results To date, 221 caregivers have been surveyed, and results are described in Table 1. Most children identified as White, non-Hispanic, and English-speaking. Many families reported any food insecurity (15%), regular caregiver depressive symptoms (20%), and recent anxiety (70%). Four percent lived in an unsteady place, and 5% had transportation issues that affected access to medical care. Firearms were present in 35% of homes. Nineteen percent of guardians had high ACEs (≥4). The mean SDI score was 0.32 (range 0.11-0.71), similar to our institution’s primary service area. Higher SDI scores were associated with more food insecurity over the past 12 months (Figure 1, p< 0.001) and the past week (Figure 2, p=0.01).Figure 2.Association of SDI Score and Food Insecurity Over the Past Week. Conclusion Guardians of children receiving ID outpatient care reported HRSNs and ACEs. SDI score may be a useful adjuvant to screening to identify more efficiently those at risk for challenges like food insecurity. Outpatient ID settings can identify and help mitigate these concerns in clinical encounters. Disclosures Elizabeth P. Schlaudecker, MD, MPH, Pfizer: Grant/Research Support|Sanofi Pasteur: Advisor/Consultant

Behavioural Changes of Late Talkers During the Covid-19 Pandemic, One Year Follow-Up From a Community Sample.

Global threats to child health and well-being, compounded by the COVID-19 pandemic, have put child development at grave risk. This study aimed to observe the behavioural changes of children with isolated language delays from a paediatric outpatient clinic as a community sample during the pandemic with a 1-year follow-up. Patients admitted to the paediatrics outpatient clinic due to isolated language delays were included in the study. The Ages and Stages Questionnaire and Child Behaviour Checklist-1½-5 were implemented at baseline and 1 year later. All families were provided with information on developmental supportive strategies and called at 3-month intervals for follow-up. Eighty-three children were initially included in this prospective study and completed with a 66.3% retention rate after 1 year. The mean initial age of the children was 30 ± 5.1 months. Internalising behaviour problems were high enough for concern at the baseline and all behavioural problem scores decreased after 1 year (p < 0.001). The initial proportion of children with borderline or clinical internalising problems also decreased from 69.1% to 5.5% after 1 year, and most children had normal language development. Late talkers experienced some behavioural problems during the pandemic, and the language and behaviour outcomes of these children who attended the paediatric clinic were better after the 1-year follow-up, even during the COVID-19 pandemic. The management of language delays in young children in crisis should include providing families with developmental support strategies consistently through the paediatric healthcare system to optimise child developmental and behavioural functioning.

The relationship among heart health attitudes, socioeconomic factors, and HbA1c levels in adolescents with type 1 diabetes

Background Type 1 Diabetes is important chronic health problem that incidence increasing between the ages of 4–6 and 10–15, has multi-dimensional etiological factors. Cardiovascular diseases may develop due to diabetes and cause significant morbidity and mortality. Diabetes cause deterioration of vascular structure, and sudden onset of heart disease through various pathophysiological mechanisms. Controlling factors, especially diabetes management, is very important in preventing cardiovascular diseases. Objective The study aimed to investigate the relationship between heart health attitudes, socioeconomic factors, and HbA1c levels in adolescents with Type 1 Diabetes. Methods The study included 10–15-year-old adolescents with Type 1 Diabetes treated in pediatric endocrinology outpatient clinic provided they met the inclusion and exclusion criteria. Adolescents’ heart health attitudes were evaluated with the cardiovascular health promotion attitude scale for children. HbA1c levels and socioeconomic characteristics of the adolescents were recorded. Results The independent predictors of the group with favorable heart health attitudes were exercise duration, meal frequency, low economic status, and HbA1c levels. HbA1c levels were positively associated with nutrition, exercise, sedentary life, and smoking subscale scores as well as total scale scores. However, it was not associated with the scores of self-love and stress subscales. Low self-love and stress subscale scores were independent predictors of low economic status and explain why low economic status is a predictor of favorable heart health attitudes. Conclusions The cardiovascular health promotion attitude scale scores are associated with HbA1c levels, which is a predictor of increased cardiovascular diseases. This predictive ability of the scale makes its use meaningful.

ASSESSMENT OF BODY COMPOSITIONS BY FOOT-TO-FOOT BIOELECTRIC IMPEDANCE AMONG CHILDREN WITH NEUROLOGICAL MANIFESTATIONS

OBJECTIVE: In clinical practice, the use of foot-foot bioelectrical impedance analysis (BIA) in the assessment of body composition continues to increase. Its preference is primarily defined by its portability, simplicity, speed, and reliability. The present study aimed to evaluate body composition by BIA among children with neurological manifestations. MATERIAL AND METHODS: Anthropometric measurements and body composition of 406 children attending the pediatric neurology outpatient clinic were analyzed, and the gender and groups were compared based on the diagnosis. RESULTS: Boys manifested lower values of weight, percentage body fat (%BF), fat percentile, fat mass, and Body mass index (BMI) but higher values of percentage total body water (%TBW) than girls [weight (p = 0.015), %BF (p&amp;lt;0.001), fat percentile (p = 0.001), fat mass (p&amp;lt;0.001), BMI (p = 0.006), and %TBW (p&amp;lt;0.001)]. Significant differences were determined among the groups except for weight standard deviation score (SDS) and height SDS (p&amp;lt;0.001). CONCLUSIONS: Based on body composition evaluation by foot-to-foot BIA, We may suggest that each neurological subgroup within the pediatric population demonstrates a distinct body composition. Therefore, evaluation of body composition will contribute to obtaining information about nutritional/hydration status..

Knowledge and management practices of infantile colic among mothers attending the paediatric outpatient clinic in port Harcourt, Nigeria

Background: Infantile colic is a functional gastrointestinal disorder not explained by organic or biochemical abnormalities. The aim of the study was to assess the knowledge and practice of infantile colic management among mothers in Southern Nigeria. Methods: It was a cross-sectional study carried out over one-year period using interviewer-administered questionnaires. Results: Of 327 mothers recruited, most were of age group 28-37 years 204 (62.4%), had tertiary level of education 226 (69.1%), with parity of two 214 (65.4%) and were presently nursing infants of 1-12 months of age 227 (69.4%). Majority 259 (79.2%) lived in urban areas and belonged to the upper socioeconomic class 163 (49.8%). Most mothers 249 (76.1%) had heard of infantile colic majorly from parents/relatives/in-laws (29.1%). Majority of them said colic was a physiologic process 201 (82.0%) while 142 (58.0%), due to gas in the intestines. Incorrect knowledge of features of colic included vomiting, passage of green-coloured stools and fever. Most mothers had good knowledge of infantile colic (44.3%) and this was significantly associated with higher level of education and socioeconomic class. Most children 206 (63.0%) brought to the clinic had had infantile colic which started mostly at 0-4 months 223 (68.2%) and resolved by 3-5 months of age 171 (52.3%). The most common treatment practices were the use of nospamin (38.1%) and grippe water (33.5%), prescribed mostly by healthcare workers (27.3%) and purchased from chemist shops (71.8%). Conclusion: There was good knowledge of infantile colic among mothers in the study. However, there is still need to increase public enlightenment on the benign and self-limiting nature of infantile colic.

Predictors of early childhood insomnia according to parent-rated degree of severity.

This study aimed to investigate child and maternal-related predictors of Early Childhood Insomnia (ECI) based on a parent-rated severity in a convenience sample of mother-infant dyads with ECI. We conducted a single-center, cross-sectional prospective study involving infants aged 6-36 months who attended the Pediatric Behavioral Sleep Outpatient Clinic at Marmara University Hospital, Istanbul, over 5 years for ECI. Infant sleep was evaluated by Brief Infant Sleep Questionnaire. Beck Depression and Anxiety Inventories were used to assess maternal depression and anxiety. Predictive factors for parent perceived ECI severity were examined by logistic regression models. Among 759 registered mother-child dyads, the mean age of the children at diagnosis was 15.5±7.5 months, and 56.7% were male. Overall, 76.5% of the mothers rated their child's sleep to be a serious problem. The odds of parent-reported serious sleep problems were increased in children who woke up often and spent longer in wakefulness. The strongest predictor of ECI severity was maternal sleep deprivation and having a former colicky infant. In addition, mothers scoring higher on maternal anxiety symptoms were more likely to rate their children's sleep as serious than women with lower anxiety scores. This study further underscored that heightened maternal sleep deprivation, elevated maternal anxiety symptoms, and previous exposure to a colicky infant were significant predictors of the perceived severity of ECI. Future research should explore interventions aimed at improving maternal well-being and infant sleep patterns to potentially mitigate the severity of ECI and its impact on family dynamics.

Translation and Adaptation of the SCOFF Questionnaire to the Greek Language (G-SCOFF) Using a Tertiary-Setting Adolescent Sample.

Feeding and eating disorders (FEDs) constitute an important mental health problem today, especially among youngsters. The Sick, Control, One, Fat, Food (SCOFF) questionnaire was developed 25 years ago and remains the most frequently applied screening tool for FEDs among adults and youngsters. The aim of the present study was to translate and adapt the SCOFF questionnaire to the Greek language, using a tertiary-setting adolescent sample. A total of 167 adolescents (86 boys, 81 girls) admitted to the pediatric outpatient clinics of the Georgios Gennimatas and Hippokration General hospitals completed the SCOFF questionnaire. Anthropometric indices were measured and dietary intake was recorded. A total of 74 adolescents (44.3% of the sample) were classified as engaging in disordered eating behaviors and as possible patients with FEDs based on the SCOFF questionnaire. No differences were noted in the dietary intake between adolescents who screened positive and those who screened negative for FEDs. The body mass index z-score and obesity status were greater among children screening positive for FEDs compared to those screening negative (p < 0.01). One patient who was later diagnosed with anorexia nervosa was detected as a possible FED case by the questionnaire. The present study revealed that more than two out of five adolescents attending a pediatric clinic exhibited disordered eating behavior. The use of the G-SCOFF questionnaire is feasible and effective for FED triage in the Greek tertiary pediatric setting.

Corrigendum: Diagnostic Approach to Children with Unexplained Global Developmental Delay in Pediatric Neurology Outpatient Clinic.

Corrigendum: Diagnostic Approach to Children with Unexplained Global Developmental Delay in Pediatric Neurology Outpatient Clinic.

Feasibility of home blood pressure screening in the paediatric outpatient clinic setting

ObjectiveThe aim of this study was to evaluate the acceptability and feasibility of home-based blood pressure (BP) screening in a group of paediatric patients with known elevated risk of developing...

Effect of Surfactant Protein B and D Genes Polymorphisms on Frequency and Severity of Acute Bronchiolitis

Background and aim: Acute bronchiolitis (AB) is the most common cause of hospitalization in infants. Varying bronchiolitis presentations in patients with similar demographic characteristics suggest genetic causes of individual differences. Materials and Methods: The study included 106 infants diagnosed with AB and 107 healthy infants recruited from a pediatric outpatient clinic. Genotyping was conducted for intron 4 and C/A–18 in the SP-B gene, along with SP-D/160 (Ala160Thr) and SP-D/270 (Ser270Thr) polymorphisms in the SP-D gene. Results: The SP-B intron 4 invariant polymorphisms of ins/ins and ins/del were 93.40% and 4.72% in the AB group and 84.11% and 15.89% in the control group, respectively (p = 0.012). Frequency of polymorphism in the SP-D/270 (Ser270Thr) gene for Ser/Ser and Ser/Thr was 60% and 39.05% in the AB group and 79.44% and 18.69% in the control group, respectively (p = 0.004). The frequencies of Ser and Thr alleles were 79.90% and 20.10% in the AB group and 88.79% and 11.21% in the control group, respectively (p = 0.012). There was no observed correlation between the SP-B intron 4 and C/A-1, as well as the SP-D Ser270Thr and Ala160Thr polymorphisms, with the severity of AB (p &gt; 0.05). Conclusion: SP-B gene polymorphisms were identified as risk factors for AB, while SP-D polymorphisms appeared to play a protective role. However, these polymorphisms were not linked to AB severity. Early identification of children at risk could enable close monitoring and preventive care.

Characteristics of pediatric patients with chronic cough: data from a pediatric immunology and allergy outpatient clinic

Aims: Chronic cough is a common complaint in childhood. A differential diagnosis is very important in children with a chronic cough. We aimed to investigate the etiology and underlying risk factors of chronic cough in children. Methods: Patients aged 1-18 years who were referred to Sincan Training and Research Hospital Pediatric Immunology and Allergy Outpatient Clinic were included. Demographic, clinical and laboratory features of patients were recorded. Results: The study included 403 children with a median age of 8 years (IQR 6-12) (53% males). 30% of patients had allergic rhinitis (AR), 4.7% of patients had atopic dermatitis (AD), and 2% patients had food allergy (FA) history. 78(19.3%) patients also complained of dyspnea and 9 (2.2%) patients had a diagnosis of cardiovascular disease. 245 (60.8%) asthma-wheezy infant, 107 (26.6%) post-infectious cough, 36 (9%) postnasal drip syndrome, 9 (2.2%) gastroesophageal reflux and 6 (1.5%) psychogenic cough were detected in the whole group. The number of patients with accompanying dyspnea 76 (28.5%) and familial history of atopy 113 (42.3%) were higher in the asthma-wheezy infant group than others group (p

The prevalence of obesity in children with CHD: what has changed over the past decade in Southwestern Ontario?

To assess the prevalence of obesity and investigate any changes in body mass index in children with CHD compared to age-matched healthy controls, in Southwestern Ontario. The body mass index z-scores of 1259 children (aged 2-18) with CHD were compared with 2037 healthy controls. The body mass index z-scores of children who presented to our paediatric cardiology outpatient clinic from 2018 to 2021 were compared with previously collected data from 2008 to 2010. A longitudinal analysis of patients with data in both cohorts was also completed. In total, 21.4% of patients with CHD and 26.6% of healthy controls were found to be overweight or obese (p < 0.001). The 2018-2021 cohort of CHD patients and controls had significantly higher body mass index z-scores compared to the 2008-2010 cohort (p < 0.001). Longitudinal analysis showed that body mass index z-scores significantly increased over time for CHD patients with data in both cohorts (2018-2021: M = 0.59, SD = 1.26; 2008-2010: M = -0.04, SD = 1.05; p < 0.001). The prevalence of obesity in all children, irrespective of CHD, is rising. The coexistence of obesity and CHD may pose additional cardiovascular risks and complications.

The parent-doctor-child triangle: a structural equation modeling-based study in pediatric outpatient clinics in Indonesia.

Parental satisfaction is essential for evaluating pediatric care quality and influences healthcare practices and performance. Pediatric patients frequently experience anxiety, affecting their and their parents' satisfaction. Nurses play a key role in reducing anxiety and improving care interactions. Meeting parents' expectations shapes long-term outcomes and impacts the hospital's reputation. While instruments such as the Child ZAP (Zufriedenheit in der Arztpraxis) provide comprehensive measures of satisfaction, their use in Indonesia has not been explored. This study aimed to validate the Child ZAP and offer insights to improve pediatric care quality in Indonesia. A cross-sectional study was conducted with 139 mothers whose children were older than 5 years and received treatment at private hospitals. Structured questionnaires were analyzed using partial least squared-structural equation modeling in SmartPLS 4, and a disjoint two-stage method was used to test dimensionality. All hypotheses were significant (p<.05), demonstrating strong support. All Child ZAP dimensions, treated as lower-order constructs, effectively measured parents' satisfaction as a higher-order construct. Overall parental satisfaction significantly influenced behavioral intention and mediated its relationship with Child ZAP. The mother's and the child's age served as moderating factors. The research model exhibited strong predictive power, underscoring pediatric nurses' pivotal role in improving communication among parents, physicians, and children to ensure quality care. The Child ZAP instrument effectively evaluates parental satisfaction by examining how children interact and communicate with medical staff. It assesses doctors' engagement with children and their communication skills, highlighting nurses' essential role in providing family-centered pediatric care.

Evaluation of the Relation between Insulin- Like Growth Factor 2 and Ventricular Septal Defect in Outpatient Pediatric Cardiology Clinic Patients of Suez Canal University Hospitals: Review Article

Evaluation of the Relation between Insulin- Like Growth Factor 2 and Ventricular Septal Defect in Outpatient Pediatric Cardiology Clinic Patients of Suez Canal University Hospitals: Review Article

HPV vaccination knowledge, attitude, and practices among physicians in a teaching hospital, Karachi

ABSTRACT Context: Cervical cancer is a global public health problem. It is the fourth most common cancer in women globally. Human papillomavirus (HPV) vaccine has reduced the incidence of HPV-related illness in the past decade. However, for the vaccination programs to be successful, recommendation by the primary care physicians is essential. Aims: The aim of this study was to evaluate the knowledge, attitude, practices, and barriers toward HPV vaccination among physicians practicing at a teaching hospital in Karachi, Pakistan. Settings and Design: This is a cross-sectional study carried out with a sample size of 165 among doctors practicing in Family medicine, Internal medicine, Pediatrics, and Gynecology outpatient clinics at a teaching hospital. Methods and Material: Physicians were approached in outpatient clinics, and a pilot-tested coded questionnaire was filled by them. Statistical Analysis Used: Data were analyzed using SPSS version 19. Results: Results show 22.4% males and 77.6% females participated in the study. 20% were internists, 35.2% were family physicians, 18.8% were pediatricians, and 26.1% were gynecologists. In terms of knowledge, 67.2% physicians showed good knowledge. In terms of attitude, it was found that 90.9% of physicians showed positive attitude toward prescribing HPV vaccine. However, only 37.5% physicians prescribed HPV vaccine to patients. Cost of vaccine, time constraints, and lack of knowledge among female patients were recognized as the most common barriers against prescribing the vaccine. Conclusions: From these results, we can infer that overall practices of our physicians are lacking, with respect to prescribing the HPV vaccine. Positive attitude should be taken as an advantage, and overcoming the barriers should be considered as the next step for improvement of our practice.

Ovarian function in adolescents and young adults undergoing cancer treatment: biochemical and ultrasound marker analysis.

Gonadal dysfunction is a major late complication after cancer diagnosis and treatment. We aimed to study the prevalence of premature ovarian insufficiency (POI) and the potential reduction of ovarian reserve in a cohort of adolescent and young adult (AYA) patients undergoing cancer treatments, evaluating ovarian function and reserve markers. We also aimed to analyze how these markers are related to each other and to treatment-related risk factors. We performed a retrospective study, including all female AYA patients undergoing cancer treatment during childhood or adolescence who visited our pediatric gynecology outpatient clinic between January 1, 2018, and August 30, 2023. Serum levels of anti-Mullerian hormone (AMH) and follicle-stimulating hormone (FSH), antral follicle count (AFC) and mean ovarian volume were evaluated. The correlations between these markers and how their alterations are related to treatment-related risk factors were analyzed. The prevalence of POI in 95 patients was 18.9 %. A significant positive correlation was observed between AMH levels and both AFC and ovarian volume. AMH was the most reliable serum marker for ovarian function in terms of POI. Independent risk factors for ovarian dysfunction in relation to all the markers analyzed were hematopoietic stem cell transplantation (HSCT) and high doses of alkylating agents (≥6000 mg/m2). Gonadal dysfunction and infertility are quite common in AYA patients undergoing cancer treatment. High-dose alkylating agents and HSCT are the independent risk factors. AMH and FSH values, AFC and mean ovarian volume provide different but consistent information for closely monitoring patients after cancer treatment.

Randomised feasibility study of an intestinal adsorbent in acute diarrhoea in The Gambia

BackgroundDiarrhoea remains a leading cause of death in children. An intestinal adsorbent may reduce diarrhoea duration and severity.MethodsRandomised controlled feasibility trial with two phases: phase 1 (0–4 hours and double-blind)...

Evaluation of long-term pulmonary functions after COVID-19 infection in children: a longitudinal observational cohort study.

We aimed to present the changes that may occur in pulmonary functions in children who experienced more severe coronavirus disease 2019 (COVID-19) during long-term follow-up. A prospective longitudinal observational cohort study was conducted with 34 pediatric patients (7-18 years) who were hospitalized with COVID-19 infection (moderate n = 25, severe n = 9), and followed up at our Pediatric Infection Outpatient Clinic for approximately two years. Pulmonary function tests (PFTs) were performed using spirometry. Data from the hospitalization period revealed no significant differences between the severity groups in terms of demographic, clinical, laboratory, radiological, treatment, and outcome (p > 0.05). The median time interval between COVID-19 infection and PFTs was 15 months (range 11-29 months), and there was no significant difference between severity groups (p = 0.878). Eight patients (24%) had abnormal pulmonary functions; among them, seven had an obstructive pattern (21%) and one had a restrictive pattern (3%). The severity groups had no statistical difference in pulmonary functions (p = 0.105). While forced expiratory volume in 1 second (FEV1) %, FEV1/forced vital capacity (FVC)%, and forced expiratory flow during the middle half of FVC (FEF25-75%) ratios were lower in the severe patient group, Z-scores were similar. Among the patients continuing polyclinic follow-up, 41% had persistent respiratory symptoms before PFTs. No differences were observed in PFTs when compared based on the presence of symptoms (p > 0.05). We observed no significant long-term differences in pulmonary function between moderate and severe COVID-19 cases in children.