Pediatric Knowledge Research Articles

Abnormalities in enamel structure and their association with systemic diseases and syndromes

Etiology of abnormalities in tooth structure has been subject of numerous studies but still has not been fully understood. Heredity is an established etiological factor for many types of structural anomalies of the teeth. Factors that cause changes in enamel structure may be genetic, immunologic and teratogenic or systemic diseases. Genetic changes may include individual genes, micro deletions or chromosomal defects. Systemic diseases can be associated with anomalies of tooth structure and diversity of clinical picture requires a multidisciplinary approach to the therapy. Amelogenesis imperfecta (AI) represents a large group of structural abnormalities of the teeth. AI can exist independently or as a part of large number of syndromes and systemic diseases. Knowledge of clinical presentation, etiology, pathogenesis of structural anomalies of the teeth and their association with certain systemic diseases is of great importance to everyday dental practice in terms of prevention, prognosis and therapy. Also, it is necessary to expand basic knowledge of pediatricians in regards to the clinical picture of anomalies in tooth structure and their possible association with a wide range of systemic diseases and syndromes, in order to provide comprehensive clinical treatment. Therefore, the aim of this study was to present etiopathogenesis and classification and to describe the most important abnormalities of enamel structure and their association with systemic diseases and syndromes.

Severe osteogenesis imperfecta: case report.

The authors present a case of Osteogenesis Imperfecta, emphasizing the clinical and epidemiological characteristics, forms of classification and treatment of the disease. This is an important case not only to the knowledge of pediatricians and orthopedists, but also for other professionals involved with the problem. This article has been jointly described by the Departments of Pediatrics and Neonatology of the Girassol Clinic in Luanda Capital of the Republic of Angola, Africa.

1456 A Survey of Paediatricians Practices and Knowledge About Pneumococcal Vaccines in High Risk Children Before the Era of Universal Immunisation

Aims and Background: We aimed to assess the knowledge and practice of paediatricians in the Trent region of England about the Chief Medical Officer's (CMO) recommendations for the pneumococcal vaccines (PV) to high-risk children before the introduction of the vaccine into the routine universal immunisation programme in Sept 2006. Methods and Design: A total of 68 self-administered questionnaires were returned from a total of 100 posted out to paediatricians in the Trent region. Results: 89% of the paediatricians were aware of the CMO's recommendations of pneumococcal and influenza vaccines to high risk children. The most correctly identified high risk groups for PV were children with asplenia / splenic dysfunction (71%), chronic lung disease (69%), previous invasive pneumococcal disease (65%), congenital heart disease (63%), neuromuscular diseases (59%), nephrotic syndrome (57%), cystic fibrosis (54%) and chronic heart failure (54%). Table 1 The least correctly identified high-risk groups were children previously admitted for asthma or a lower respiratory tract disease (9% each), cirrhosis (28%), patients with CSF shunts (31%), following renal transplant (37%), on chemotherapy or steroids (38%) and chronic liver diseases (38%). Conclusion: Most paediatricians were aware of the CMO's recommendations on pneumococcal vaccines for high-risk children. This knowledge however was poorly translated into correct advice given to patients. The introduction of PV into the universal immunisation schedule would enable all the high-risk children to be optimally protected and not subjected to the unreliable knowledge of their busy paediatricians and ”postcode lottery” effect.

Preventive Oral Health Care in Early Childhood: Knowledge, Confidence, and Practices of Pediatricians and Family Physicians in Florida

To examine the relationships among pediatricians' and family physicians' oral health training, knowledge, confidence, and practice patterns. A survey of physicians identified through the membership databases of the Florida Academy of Family Physicians and the Florida Pediatric Society was conducted in 2008. Responses of pediatricians and family physicians were compared through bivariate and multivariate analyses. Although training was not directly associated with performing recommended practices, there were positive associations between training and confidence and between confidence and performing recommended practices (P <.05). Pediatricians were more likely than family physicians to answer fluoride-related knowledge questions correctly and reported greater confidence (P <.05). Less than 20% of the respondents reported counseling parents about bringing their child to the dentist before age 1 year or inquiring about the parents' dental health. Oral health training appears to promote confidence in performing recommended oral health practices. Differences in fluoride knowledge by provider type suggest that fluoride guidance has been disseminated more effectively among pediatricians than among family physicians. Educational content of oral health training programs should place increased emphasis on current fluoride guidance, early dental visits, and assessing parents' oral health. Instructional methods should address physicians' confidence, particularly among family physicians.

Pflanzliche Arzneimittel für Kinder – Verbesserung der Datenlage

HERBAL MEDICINAL PRODUCTS FOR PAEDIATRIC USE: IMPROVING THE DATA BASECurrently there is scarcity of clinical data on herbal medicinal products for paediatric use. Due to this research gap and on the basis of HMPC’s (EMEA) evaluation, no herbal medicinal products for the age cohort 0-4 years could be made available in the foreseeable future. The objective of this article is to highlight possibilities of integrating the experience and knowledge of general practitioners and paediatricians in the application of herbal medicinal products as well as their structural sampling and processing. The author discusses the merits and shortcomings of observational and controlled retrospective studies and recommends the latter.

Desconhecimento da diretriz de prevenção da aterosclerose na infância e adolescência por pediatras em São Paulo

To report the extent of knowledge of pediatricians in São Paulo concerning the Guidelines. At pediatric events or hospitals, pediatricians were given a questionnaire about the time of training, work, dedication in the area of pediatrics, and academic performance for reply to multiple choice questions with information drawn from the Guidelines. The Chi -square and the Chi -square of linear trend tests were chosen for statistical calculations. Among 370 pediatricians surveyed, 65.7% had no previous knowledge of the Guidelines. The cut-off for the hits was > or = 70% (> or = 5 correct replies). Only 136 pediatricians (36.7%) reached the cut-off and no gender differences were found in knowledge (p = 0.25). Among 187 professionals involved in academic activities, 45 (24%) hit the cut-off and about 183 participants from non-academic activities, 23 (12.7%) reached > or = 5 hit points (p <0.001). Pediatricians in the public sector had better knowledge about preventive measures for atherosclerosis risk factors (46.1%, p = 0.01). Awareness of the Guidelines was independent from training time. The majority of pediatricians in the city of São Paulo were not familiar with the Guidelines for Prevention of Atherosclerosis in Childhood and Adolescence and individual strategies were rarely found. Medical education and adequate disclosure of the Guidelines are necessary for active control of populational risk factors.

Strengthening the Paediatricians Project 2: The effectiveness of a workshop to address the Priority Mental Health Disorders of adolescence in low-health related human resource countries

BackgroundPaediatricians can be empowered to address the Priority Mental Health Disorders at primary care level. To evaluate the effectiveness of a collaborative workshop in enhancing the adolescent psychiatry knowledge among paediatricians.MethodsA 3-day, 27-hours workshop was held for paediatricians from different regions of India under the auspices of the National Adolescent Paediatric Task Force of the Indian Academy of Paediatrics. A 5-item pretest-posttest questionnaire was developed and administered at the beginning and end of the workshop to evaluate the participants' knowledge acquisition in adolescent psychiatry. Bivariate and multivariate analyses were performed on an intention-to-participate basis.ResultsForty-eight paediatricians completed the questionnaire. There was significant enhancement of the knowledge in understanding the phenomenology, identifying the psychopathology, diagnosing common mental disorder and selecting the psychotropic medication in the bivariate analysis. When the possible confounders of level of training in paediatrics and number of years spent as paediatrician were controlled, in addition to the above areas of adolescent psychiatry, the diagnostic ability involving multiple psychological concepts also gained significance. However, both in the bivariate and multivariate analyses, the ability to refer to appropriate psychotherapy remained unchanged after the workshop.ConclusionsThis workshop was effective in enhancing the adolescent psychiatry knowledge of paediatricians. Such workshops could strengthen paediatricians in addressing the priority mental health disorders at the primary-care level in countries with low-human resource for health as advocated by the World Health Organization. However, it remains to be seen if this acquisition of adolescent psychiatry knowledge results in enhancing their adolescent psychiatry practice.

Sospecha de maltrato infantil en urgencias pediátricas

Objective To describe the epidemiology of child abuse in an emergency department of a tertiary paediatric hospital. Methods Descriptive and retrospective study from January 2008 to January 2006 including patients less than sixteen years of age who were suspected of being abused during the examination in the emergency department. Results Child maltreatment was 0.07% of all paediatric emergencies (45% physical abuse, 35% sexual abuse and 20% neglect). Mean age of 6 years old, with no gender differences. 86% were suspected of maltreatment. An adult living with the child was suspected in 67% of cases. Social and judicial procedures were activated. A total of 24 children were admitted, 14 under medical criteria and the rest in order to protect the child; 2 had serious neurological consequences and one died. Eight patients were discharged to social service care centres. Conclusions We believe it is necessary to improve the pediatrician's knowledge of child abuse and to create specialized units.

Pediatricians’ Knowledge of and Attitudes Toward Fragile X Syndrome Screening

Fragile X syndrome (FXS) screening exemplifies the challenges of screening for rare genetic conditions, including the potential to detect carriers and the lack of evidence regarding the benefit of early intervention. The aim of this study was to evaluate knowledge, experience, and attitudes of pediatricians toward FXS screening, either as part of newborn screening or at the 12-month well-child visit. Responses to survey mailings to 400 general pediatricians were analyzed. The response rate was 47%. Although most (98%) reported knowing that FXS causes intellectual disability, only half (53%) knew that females could be affected and 28% knew that carriers can have health problems as adults. Only 39% reported knowing enough about FXS to discuss the condition with the family of a child who might have the condition. Most respondents (78%) believed that newborn screening for FXS would be beneficial for children and families. About half (55%) believed that parents should be offered FXS screening as part of well-child care. Few (8%) reported that they would not support FXS newborn screening or screening during well-child care because of carrier detection. Among respondents there is good support for FXS newborn screening and some support for FXS screening as part of well-child care. Prior to implementing screening, efforts are needed to educate pediatricians and assess their ability to inform parents about the implications of testing and provide care after the identification of FXS or carriers. These activities can serve as a model for how to introduce other genomic tests into the primary care setting.

Pediatrician attitudes, knowledge, and practice behavior regarding teen driving safety

Problem Each year about 4,000 teens ages 16-19 die on U.S. roads. Injury prevention counseling is recommended as a valuable and cost-effective part of routine health supervision. This study describes pediatrician knowledge and practice regarding teen driving safety. Methods A 31-item self-administered survey was mailed to pediatricians. Results 160 of 392 pediatricians (41%) completed the survey. During a health supervision visit 93% of pediatricians reported discussing seat belt use, 89% impaired driving, 54% teen licensing laws, and 16% parent teen contract. Half reported having a teen in their practice killed in a crash. Conclusions A majority surveyed report discussing and counseling teens on first wave teen driver safety issues (seat belts, alcohol use), but most do not discuss graduated driver licensing laws or related issues. Impact on Industry: Broadly adopted, this inexpensive counseling approach, could lead to reductions in teen motorvehicle crash injuries.

Knowledge of Flemish paediatricians about children's oral health – results of a survey

To examine the knowledge paediatricians have about oral health in children. A questionnaire on oral health knowledge was mailed to all members of the Flemish Paediatric Association representing 350 out of 676 Flemish paediatricians. Questions concerned timing of the first dental visit, effects of thumb sucking, fluoride supplements, trauma, fluorosis, mutans streptococci and caries, prevention of dental caries, nursing bottle caries and use of sealants. Two hundred seventy-six questionnaires (79%) were returned. Of the respondents, 71% said they have had some training on dental topics, and most rely on information brochures to be informed on dental subjects. Parents frequently questioned paediatricians about dental eruption. Paediatricians stated that the first dental visit should be scheduled at the age of 3. Eighty-three percent of the paediatricians stated that thumb sucking was harmful to dentition; 7% regularly prescribed fluoride supplements. Knowledge about fluorosis was moderate. Paediatricians judged community water fluoridation and tooth brushing after consuming erosive drinks as effective. The efficacy of dairy products was underrated. Seventy-three percent of the paediatricians were aware of nursing bottle caries, whereas only 39% were familiar with fissure sealing. Initiatives are needed to improve knowledge about oral health of physicians involved in preventive health care of children.

Primary Immunodeficiency Disorders: Survey of Pediatricians in Kuwait

Early diagnosis of primary immunodeficiency disorders (PID) is critical so life saving interventions can be implemented to avoid significant morbidity and mortality. Unfortunately, they are frequently misdiagnosed, which results into significant delay in diagnosis. This study aimed to determine the knowledge and practice of pediatricians in Kuwait about PID. A 66-item self-administered questionnaire was designed and distributed to the pediatricians working at all six governmental hospitals to measure their knowledge and practice about PID. A total of 244 pediatricians (78.4%; 143 males and 101 females) participated in the study. The mean age of participants was 40 years, and the mean number of years working in pediatrics was 13 years. The mean overall score was 59.6%, whereas the mean score in clinical presentation section was 63%, in associated diseases and syndromes section 58%, and in laboratory investigations section 51%. Only 26% of the participants answered correctly at least 2/3 of the questions (67% of the questions). This survey demonstrates that there is universal deficiency in both the knowledge and practice of pediatricians in the field of PID. Implementation of strategies to improve the awareness of pediatricians about PID is critical so early therapeutic interventions can be done to improve the health and prevent morbidity and mortality.

Aconselhamento em alimentação infantil: um estudo de intervenção

To evaluate the effectiveness of an integrated infant and young child feeding counseling course for transforming the knowledge, attitudes and practices of pediatricians and nutritionists working for the municipal health system of São Paulo, Brazil.A randomized intervention study enrolling 29 professionals in the intervention group and 27 in the control group. Interviewers were trained in advance to collect data on the professionals working at health centers, before and 2 months after the intervention. Three research instruments were used, the first was to assess the profile of each professional, the second assessed their knowledge and the third was a clinical observation protocol. Analysis was performed using the Kruskal-Wallis test for independent samples and the Tukey method.The results for the knowledge questionnaire showed improvements in the intervention group (p < 0.001) for the whole questionnaire and for questions on breastfeeding (p = 0.004); HIV and infant and young child feeding (p = 0.049); complementary feeding (p = 0.012); and counseling in infant and young child feeding (p = 0.004). In terms of performance, it was observed that the intervention group had significantly improved their dietary anamnesis after the intervention (p < 0.001).This course effectively promoted an increase in knowledge and improvements in dietary anamnesis performance, but the same was not true of counseling skills.

Infant and young child feeding counseling: an intervention study

To evaluate the effectiveness of an integrated infant and young child feeding counseling course for transforming the knowledge, attitudes and practices of pediatricians and nutritionists working for the municipal health system of São Paulo, Brazil. A randomized intervention study enrolling 29 professionals in the intervention group and 27 in the control group. Interviewers were trained in advance to collect data on the professionals working at health centers, before and 2 months after the intervention. Three research instruments were used, the first was to assess the profile of each professional, the second assessed their knowledge and the third was a clinical observation protocol. Analysis was performed using the Kruskal-Wallis test for independent samples and the Tukey method. The results for the knowledge questionnaire showed improvements in the intervention group (p < 0.001) for the whole questionnaire and for questions on breastfeeding (p = 0.004); HIV and infant and young child feeding (p = 0.049); complementary feeding (p = 0.012); and counseling in infant and young child feeding (p = 0.004). In terms of performance, it was observed that the intervention group had significantly improved their dietary anamnesis after the intervention (p < 0.001). This course effectively promoted an increase in knowledge and improvements in dietary anamnesis performance, but the same was not true of counseling skills.

O conhecimento de pediatras sobre alergia alimentar: estudo piloto

OBJETIVO: Avaliar o conhecimento de pediatras sobre alergia alimentar. MÉTODOS: Dados obtidos de questionário padronizado, postado e respondido por pediatras filiados à Sociedade Brasileira de Pediatria (SBP). Digitação dos dados em planilha Excel e análise de freqüência de respostas afirmativas em porcentagem. RESULTADOS: Foram analisados 895 questionários preenchidos por pediatras de todo o país, com predomínio da região Sudeste (61,6%). Segundo os pediatras entrevistados, as manifestações diagnósticas de alergia alimentar são: respiratórias, cutâneas e sistêmicas, em iguais proporções. Ainda segundo estes pediatras, leite de vaca (98,9%), clara de ovo (58,7%) e amendoim (50,9%) são os principais alimentos associados a essas manifestações. Embora 74,8% dos respondedores tivessem identificados os corantes e aditivos alimentares como responsáveis pela alergia alimentar, apenas 19,4% conheciam o código de identificação da tartrazina. CONCLUSÕES: Os dados apresentados reforçam a necessidade de ampliação dos conhecimentos dos profissionais de saúde sobre o diagnóstico e tratamento da alergia alimentar, com o objetivo de garantir o uso de critérios diagnósticos e terapêuticos mais adequados.

Physician Recommendations Regarding SIDS Risk Reduction: A National Survey of Pediatricians and Family Physicians

Sudden infant death syndrome (SIDS) is a leading cause of death among infants. Recently, new SIDS risk factors have emerged. To determine knowledge and recommendations of pediatricians and family physicians regarding SIDS-relevant practices. Cross-sectional survey of 3005 pediatricians and family physicians. Of the 783 respondents, pediatricians comprised 64% and females 52%; 78% recognized supine as the recommended sleep position; 69% recommended supine. Almost all physicians recommended a firm mattress, 82% recommended a crib or bassinet, and 42% recommended a separate room for infants; 63% had no preference about or did not recommend restricting pacifier use. Pediatricians were more likely to discuss infant sleep position and room sharing at every well-child visit. Knowledge about recommended infant sleep position is relatively high, but there are gaps in physician knowledge regarding safe sleep recommendations. Greater dissemination of information is required, and barriers to implementation need to be identified and addressed.

Continuous medical education (CME): Do we need CME for paediatric environmental medicine in Europe?

The knowledge about the influence of environmental hazards on children's health is increasing enormously. European Ministers of Health and Environment, like many other stakeholders, identified the environmental hazards in Europe for the health of children as so serious, that they called for a “Children's Environment and Health Action Plan for Europe (CEHAPE)” approved in June 2004. The knowledge of paediatricians and other health care providers on children's health and environment in Europe is insufficient, due to the lack of training in environmental medicine for medical students, clinical trainees and postgraduates. Only continuous medical education in environmental medicine can help to fill this gap of knowledge and is thereby urgently needed. The World Health Organization developed a training package for health care providers for children's health and environment, containing excellent material for paediatric training events. The International Network on Children's Health, Environment and Safety (INCHES) developed additional training material for paediatricians within the Children's Health, Environment and Safety Training (CHEST) project. The German Network Children's Health and Environment offers training for paediatric doctors’ assistants in primary prevention. To improve knowledge about children's health and environment at all levels in paediatric settings, greater efforts of national institutions, paediatric associations and other institutions are necessary. It is time to strengthen existing structures and to introduce, where necessary, new structures for training in environmental medicine.

Quality of pediatricians' knowledge and outpatient diagnosis of childhood asthma

This article has analyzed a relationship between quality of theoretical knowledge of pediatricians at outpatient clinics and asthma diagnosis. Questionnaires revealed insufficient theoretical knowledge on current therapeutic and diagnostic approaches for asthma which depended on length of time after last postgraduate education course. The late diagnosis of asthma in childhood outpatient clinics was made in 95.7 %. A mean delay in diagnosis was 4 years and the more the knowledge was worse. The late diagnosis of asthma was proven to be related to more severe course of the disease and wider sensitization spectrum. The more informative and available in primary care predictors of asthma onset were defined. A diagnostic table has been created which contains the most informative criteria of asthma and allows a quantitative prognosis of the disease in children with recurrent respiratory syndrome.

Pediatrician knowledge and attitudes regarding human papillomavirus disease and its prevention

Between 1 September and 8 October 2006, we used a self-administered, anonymous questionnaire in order to evaluate knowledge and attitudes regarding HPV disease and its prevention in a nationally representative sample of Italian pediatricians. Three hundred and eleven of the 400 enrolled physicians (175 primary care pediatricians, 160 hospital pediatricians and 65 residents in pediatrics) returned completed surveys (227 females; mean age+/-standard deviation, 45.3+/-11.61 years). The results showed a lack of knowledge concerning HPV disease and its prevention, with marginal differences between the subgroups, even though the majority would recommend HPV vaccination. These findings highlight an urgent need to improve pediatrician information in order to ensure the optimal implementation of HPV vaccination, and the adequate acceptability of HPV vaccines to adolescents and their parents.

Conhecimento de pediatras e nutricionistas sobre o tratamento da alergia ao leite de vaca no lactente

OBJETIVO: Avaliar o conhecimento de pediatras e nutricionistas sobre a dieta de exclusão do leite de vaca e seus derivados, com ênfase em questões relacionadas à nutrição da criança. MÉTODOS: Estudo transversal descritivo, do qual participaram pediatras (n=53) e nutricionistas (n=29), vinculados a hospitais públicos do Município de São Paulo, no ano de 2005. Os dados foram coletados por questionário auto-administrado. RESULTADOS: A idade dos profissionais variou de 21 a 50 anos. Quanto ao tempo de graduação, 41,2% eram formados a menos de cinco anos e 91,6% possuíam especialização, mestrado e/ou doutorado. A maioria (97,5%) afirmou avaliar a dieta de crianças submetidas à exclusão do leite de vaca, entretanto, somente 48% o faziam de forma mais detalhadas, incluindo o cálculo da ingestão alimentar. Apenas 38,7% comparam a ingestão alimentar da criança com algum padrão de recomendação. A recomendação diária da ingestão de cálcio para crianças com até 36 meses foi corretamente assinalada por 22% dos pediatras e 60,7% dos nutricionistas (p=0,001). Produtos não adequados como substitutos do leite de vaca seriam recomendados por 66% dos pediatras e 48,3% dos nutricionistas. Com relação à leitura de rótulos de produtos industrializados, 81,6% dos pediatras e 96,4% dos nutricionistas orientam os pais a ler todos os termos que indicam a presença das proteínas do leite de vaca. CONCLUSÕES: Os pediatras e nutricionista demonstraram erro conceitual no que se refere às principais recomendações terapêuticas na alergia às proteínas do leite de vaca.