Proportion Of Pediatricians Research Articles

Assessing vaccine hesitancy among healthcare providers in Brazil: the influence of vaccine status and professional experience

ObjectiveAssess the occurrence of vaccine hesitancy among pediatricians and their patients and identify potential predictors to mitigate hesitancy among them. MethodsThe study is a cross-sectional survey using an online questionnaire sent to pediatricians affiliated with the Brazilian Society of Pediatrics. The data was analyzed using statistical methods such as exploratory factor analysis, principal component analysis, correspondence analysis, and generalized linear mixed models. ResultsA total of 982 respondents, with a majority being females (77.4%), participated in the research. Among them, the proportion of pediatricians with complete vaccine status was 41.14%, while 90.6% had undergone medical residency. Furthermore, 9.3% worked in public healthcare settings, 30.4% in private settings, and 60.3% in mixed healthcare settings. The analysis revealed a significant association between vaccine status and pediatricians’ misconceptions about COVID-19 vaccines, with those having complete vaccine status showing lower misconceptions (mean difference of -0.15, p = 0.010). Moreover, pediatricians with medical residency experience exhibited fewer misconceptions about COVID-19 vaccines (mean difference of -0.33, p = 0.002). Additionally, correspondence analysis unveiled the presence of two distinct profiles among pediatricians, showcasing variations in vaccine education, professional experience, and vaccine confidence perceptions. ConclusionThe study highlights the influence of vaccine status and medical residency experience on pediatricians’ attitudes and misconceptions about vaccines, emphasizing the need for targeted educational interventions to promote vaccine confidence and combat hesitancy within the healthcare provider community.

Evaluation of pediatricians' awareness about anaphylaxis.

Anaphylaxis is a severe hypersensitivity reaction with a rapid onset and is potentially life-threatening if not treated promptly. This study aimed to determine the level of knowledge of pediatricians in Turkey in recognizing and treating the clinical symptoms of anaphylaxis, compare the previous studies conducted in Turkey chronologically, and show the current trends on awareness of anaphylaxis in developed and developing countries in the world. Pediatric residents and specialists from all over Turkey were included in the study. A questionnaire was prepared by compiling the current literature. Questions were sent to pediatricians via online applications. Statistical tests were used to analyze the data. A total of 524 pediatricians participated in the study. All participants accepted that anaphylaxis was a life-threatening condition. Almost all suggested epinephrine as the primary drug used in anaphylaxis. The proportion of pediatricians who knew the appropriate dose, route of administration, and place of administration of epinephrine was 82.8%, 88.9%, and 89.7%, respectively. The rate of pediatricians who recognized the clinical features of anaphylaxis was over 90%. The proportion of pediatricians who knew the epinephrine auto-injector and dose was 74.4% and 53.1%, respectively. Pediatricians with less than 10 years of experience and those working in public hospitals had better knowledge about atypical symptoms of anaphylaxis. Although there are still inadequacies in identifying atypical symptoms and treating anaphylaxis, our study revealed that the level of awareness of anaphylaxis had shown an increasing trend in Turkey over time. On the other hand, the knowledge on diagnosing and treating anaphylaxis still needs to be improved, especially for physicians working in rural areas of developing countries.

Top 100-Cited Articles in Tinnitus: A Bibliometric Analysis

Neonatal hyperbilirubinemia is a widespread and significant clinical condition amongst neonates worldwide Methods: A specially designed questionnaire was distributed to a random sample of 200 pediatricians working in the main childhood hospitals in Sana'a. Results: The pediatricians involved in the study stated high use (61.8%) of the cephalo-caudal progression as a method to evaluate jaundice in the newborn. Less proportion of pediatricians tested total serum bilirubin levels in jaundiced neonates ahead of their discharge from the hospital as compared to jaundiced neonates examined at the post-discharge visit (73.9% vs. 83.4%). The majority of pediatricians did not believe neonatal jaundice noted after discharge and gestational ages 37–38 weeks as being risk factor for the development of acute bilirubin encephalopathy. A considerable number of our pediatricians initiated phototherapy as well as exchange transfusion at lower levels of serum bilirubin than the recommended by the AAP guidelines at age of 24-48 hr, (66.7% and 57.6% respectively). Conclusion: although Yemeni pediatricians in the study were liable to start up phototherapy and exchange blood transfusion at points lesser than those recommended, the study revealed an overall consistency of their practice with hyperbilirubinemia treatment guidelines of the American Academy of Pediatrics, 2004.

Use of Immunization Information Systems in Primary Care.

Immunization information systems (IISs) are highly effective for increasing vaccination rates but information about how primary care physicians use them is limited. Pediatricians, family physicians (FPs), and general internists (GIMs) were surveyed by e-mail and mail from January 2015 to April 2015 from all states with an existing IIS. Providers were recruited to be representative of national provider organization memberships. Multivariable log binomial regression examined factors associated with IIS use (October 2015-April 2016). Response rates among pediatricians, FPs, and GIMs, respectively, were 75% (325/435), 68% (310/459), and 63% (272/431). A proportion of pediatricians (5%), FPs (14%), and GIMs (48%) did not know there was a state/local IIS; 81%, 72%, and 27% reported using an IIS (p<0.0001). Among those who used IISs, 64% of pediatricians, 61% of FPs, and 22% of GIMs thought the IIS could tell them a patient's immunization needs; 22%, 29%, and 51% did not know. The most frequently reported major barriers to use included the IIS not updating the electronic medical record (29%, 28%, 35%) and lack of ability to submit data electronically (22%, 27%, 31%). Factors associated with lower IIS use included FP (adjusted risk ratio=0.85; 95% CI=0.75, 0.97) or GIM (adjusted risk ratio=0.33; 95% CI=0.25, 0.42) versus pediatric specialty and older versus younger provider age (adjusted risk ratio=0.96; 95 CI%=0.94, 0.98). There are substantial gaps in knowledge of IIS capabilities, especially among GIMs; barriers to interoperability between IISs and electronic medical records affect all specialties. Closing these gaps may increase use of proven IIS functions including decision support and reminder/recall.

Pediatricians’ Self-Reported Role in Treating Children and Adolescents With Major Depressive Disorder

Major depressive disorder (MDD) is a serious US public health problem for children and adolescents. This study explored pediatricians' self-reported role in treating children and adolescents with DSM-IV-TR MDD after the 2004 US Food and Drug Administration black-box warning. A national random sample of pediatricians (N = 2,000) was surveyed from the beginning of November 2007 through the end of January 2008, with a usable response rate of 22.7% (408 of 1,800 deliverable surveys). Descriptive statistics and χ(2) tests were used to analyze the data on treatment versus referral of children and adolescents with MDD and on the proportion of pediatricians in 4 geographic regions who treat children and adolescents with MDD. The majority of the pediatricians (60.0%, 245 of 408) do not treat either children or adolescents with MDD. Fewer than one-third of the pediatricians (28.2%, 115) reported treating both children and adolescents. The majority of the pediatricians (83.6%, 341) reported referring both children and adolescents to psychiatrists for treatment. The χ(2) tests indicate that the proportion of pediatricians who treat children (P = .088) and adolescents (P = .259) does not vary significantly according to the 4 geographic regions analyzed (Northeast, South, Midwest, and West). On the basis of self-report, the majority of US pediatricians do not treat children and adolescents with MDD but instead refer these patients to psychiatrists. In light of the current shortage of child and adolescent psychiatrists in the United States, referral to these specialists may be problematic.

A study of the pediatric workforce

Linda Althouse and Jim Stockman from the American Board of Pediatrics (ABP) recently completed an update of pediatric workforce data that is analyzed on a regular basis by the ABP. In the past, these studies have been published as a series of reports for general pediatrics and each of the 13 subspecialties. This time, all the workforce data are being published in one Commentary. The ABP has the best data on this topic, and they combine data from three different sources to create a very comprehensive data set. The results are interesting and indicate that there is probably no immediate crisis in the offing, but we will need to monitor the balance between general pediatrics and pediatric subspecialty careers, as well as the distribution of pediatricians from a geographical point of view. In addition, there is information about the increase in proportion of pediatricians that plan to work part-time and the percentage of pediatricians who may start to enter retirement. Article page 1036▶ The Pediatric Workforce: An Update on General Pediatrics and Pediatric Subspecialties Workforce Data from the American Board of PediatricsThe Journal of PediatricsVol. 159Issue 6PreviewFor several decades, the American Board of Pediatrics (ABP) has assimilated workforce data using questionnaires administered in association with its various examinations and through a tracking system that provides an annual update of residents and fellows in training. These data provide critical information regarding trainees and practitioners in pediatrics and the overall workforce landscape. In 2006, The Journal published a series of workforce reports for general pediatrics and the 13 subspecialties for which the ABP currently administered examinations. Full-Text PDF

Patient Factors Used by Pediatricians to Assign Asthma Treatment

Although asthma is often inappropriately treated in children, little is known about what information pediatricians use to adjust asthma therapy. The purpose of this work was to assess the importance of various dimensions of patient asthma status as the basis of pediatrician treatment decisions. We conducted a cross-sectional, random-sample survey, between November 2005 and May 2006, of 500 members of the American Academy of Pediatrics using standardized case vignettes. Vignettes varied in regard to (1) acute health care use (hospitalized 6 months ago), (2) bother (parent bothered by the child's asthma status), (3) control (frequency of symptoms and albuterol use), (4) direction (qualitative change in symptoms), and (5) wheezing during physical examination. Our primary outcome was the proportion of pediatricians who would adjust treatment in the presence or absence of these 5 factors. Physicians used multiple dimensions of asthma status other than symptoms to determine treatment. Pediatricians were significantly more likely to increase treatment for a recently hospitalized patient (45% vs 18%), a bothered parent (67% vs 18%), poorly controlled symptoms (4-5 times per week; 100% vs 18%), or if there was wheezing on examination (45% vs 18%) compared with patients who only had well-controlled symptoms. Pediatricians were significantly less likely to decrease treatment for a child with well-controlled symptoms and recent hospitalization (28%), parents who reported being bothered (43%), or a child whose symptoms had worsened since the last doctor visit (10%) compared with children with well-controlled symptoms alone. Pediatricians treat asthma on the basis of multiple dimensions of asthma status, including hospitalization, bother, symptom frequency, direction, and wheezing but use these factors differently to increase and decrease treatment. Tools that systematically assess multiple dimensions of asthma may be useful to help further improve pediatric asthma care.

Intentional Injury Management and Prevention in Pediatric Practice: Results From 1998 and 2003 American Academy of Pediatrics Periodic Surveys

Intentional injuries are significant causes of pediatric morbidity and mortality in the United States. A 1998 American Academy of Pediatrics (AAP) survey identified child abuse, domestic violence, and community violence as concerns for pediatricians, although the majority of pediatricians also reported feeling unprepared to manage these issues. A second AAP survey in 2003 analyzed trends in pediatrician experience and attitudes related to these issues. Surveys were sent to national random samples of AAP members in 1998 (n = 1629) and 2003 (n = 1603); response rates were 62% and 53%, respectively. Surveys measured pediatrician experience in the past 12 months in managing injuries caused by child abuse, domestic violence, and community violence. Attitudes regarding available resources and adequacy of training about intentional injury management were also collected. Trends between surveys were analyzed using chi2 analysis. The proportion of pediatricians who reported treatment of intentional injuries increased between surveys. The percentage of pediatricians who indicated that screening for domestic violence and community violence risk should be included in routine health visits increased from 66% to 72% and 71% to 77%, respectively. Confidence in ability to identify and manage injuries that were caused by domestic violence and community violence increased but remained low, whereas the proportion of pediatricians who expressed confidence in ability to identify child abuse decreased (65% vs 60%). Despite overall improvement in acceptance of intentional injury prevention in routine care as well as confidence in intentional injury management, pediatrician confidence to identify and manage intentional injuries remains low.

Gun Ownership and Counseling of Alabama Pediatricians

To examine the personal behavior of primary care pediatricians in Alabama with respect to a gun control policy. The American Academy of Pediatrics supports removal of handguns from homes, safe gun storage in homes with guns, and counseling patients about gun safety practices. Survey. Primary care pediatricians. Population-based sample. None. The proportion of pediatricians who were gun and handgun owners was examined. In addition, the safety behaviors and counseling practices reported by pediatricians were examined. The response rate for pediatricians was 67%. Fifty percent of pediatricians reported owning a gun. Thirty-four percent of pediatricians had a handgun in their household. Eleven percent of pediatricians had unsafe gun practices, where unsafe was defined as having a loaded gun in the home or car at least some of the time. The most common reason for owning a handgun or having a loaded gun in the home or car was personal protection. Only a third (33%) of pediatricians routinely counseled their patients about gun safety. Long gun owners were less likely to counsel patients about bike helmet safety and were less likely to use car seats and bike helmets for their own children. A large proportion of Alabama pediatricians are gun owners, but most store weapons safely. Although long gun owners were less likely to use car seats or bike helmets and less likely to counsel patients regarding bike helmet use, no effect of gun ownership on counseling about gun safety was identified.

Factors Associated With Pediatricians' Participation in Medicaid in North Carolina

To describe the relative importance of factors influencing pediatricians' participation in Medicaid in North Carolina. Questionnaire survey. Nonacademic primary care pediatricians in direct patient care at least 50% of the time; 332 (85%) of the 389 eligible pediatricians responded. Proportion of pediatricians who restricted Medicaid patients' access to their practices. The association between restricting access and the following factors was assessed: Medicaid reimbursement, pediatricians' demographic characteristics, knowledge of the Medicaid program, attitudes toward Medicaid patients and the Medicaid program, and beliefs about whether other physicians were available to care for Medicaid patients. Twenty-nine percent of pediatricians restricted Medicaid patients' access to their practices. The proportion of pediatricians restricting access was 62% in cities, 13% in medium-sized towns, and 12% in small towns (P less than .001), but the proportion of pediatricians in cities who restricted access varied from 87% to 22%. Pediatricians who received a higher proportion of their usual fee were less likely to restrict Medicaid patients' access. The relationship between Medicaid payment and restricted access was substantially weakened after controlling for the following factors: (1) the size of the community, (2) pediatricians' attitudes toward Medicaid payment, (3) their perceptions that they were too busy to care for Medicaid patients, and (4) whether there were other resources for the care of Medicaid patients. At comparable levels of payment, rural pediatricians were about six times less likely than urban pediatricians to restrict access. Pediatricians who knew less about Medicaid reimbursement also restricted access more often. Whether or not they restricted access to new Medicaid patients, pediatricians provided acute, preventive, hospital, and emergency care to the Medicaid patients who were already in their practices. Existing resources for the care of Medicaid patients, pediatricians' economic dependence on Medicaid, and the local norms of practice may be important factors in pediatricians' decision to participate in Medicaid. Increasing reimbursement will have only modest effects on Medicaid participation. Strategies to improve participation should also address pediatricians' knowledge of the Medicaid program and enlist the support of community physicians.

Preparedness of Practicing Pediatricians to Manage Emergencies

To determine pediatrician preparedness to manage emergencies, a nationally representative random sample of 1000 non-hospital-based pediatricians was surveyed about (1) types of emergencies encountered and methods of transport to an emergency facility, (2) availability and use of equipment and medications in the office, and (3) determinants of pediatrician confidence in managing emergencies. The proportion of pediatricians who had encountered specific emergencies ranged from 86% for meningitis to 22% for cardiopulmonary arrest. The majority transported acutely ill children to an emergency department by ambulance. Availability of individual pieces of equipment and medications in offices ranged from 97% for epinephrine 1:1000 to 11% for bone marrow needles for intraosseous access. Combination of equipment available to manage particular emergencies ranged from 61% for severe dehydration to 11% for cardiopulmonary arrest. The equipment available in a pediatrician's office was significantly related to the type of primary work setting. Pediatrician confidence in managing the initial stabilization of emergencies ranged from 58% for seizures to 25% for epiglottitis. Confidence was related significantly to year residency was completed, Advanced Cardiac or Advanced Pediatric Life Support training, work setting, and the availability of equipment in the office. Continuing education regarding initial office management of and equipment for common emergencies should improve the pediatrician's confidence and competence in this area.

THE PEDIATRICIAN AS CONSULTANT IN A GENERAL PRACTICE AREA

As long as births on this continent increase faster than the proportionate output of medical graduates, there will never be a sufficient number of trained pediatricians, "comprehensive" or otherwise, to attend the entire childhood population—even if this situation were ideal, and there are arguments against it being so—unless, of course, the proportion of pediatricians among total practitioners increases tremendously, which is improbable. The pediatrician-to-child population ratio is estimated to be 1 to 7000.1 In 1957, the United States had approximately one Board Certified pediatrician for every 40 physicians of all categories, and there appears to be no breaking of ranks by the generalists. The more comprehensively a pediatrician practices (that is, with close supervision of the child and extensive counselling of the family) the fewer patients will he be able to see and the more expensive will his services become. (It could be that this mode of pediatric candidate, as others have suggested.) Thus for practical reasons of availability and economy the less trained general practitioner must continue to assume the greatest share of the work, and he would still turn to the specialist pediatrician for particular help, as seems to be indicated from the foregoing presentation. If improved quality of child care is the aim of medical educators, then that emphasis should be placed as much on the training of the general practitioner as on that of the pediatrician,7 and the latter should look more to the field of consultation for his contribution to the nation's health. The author readily admits that his way of practice is not without shortcomings and difficulties, part of which derive from the fact that he holds a minority view among his peers. Some of the problems can be surmised from between the lines of the material presented, but they need not be dwelt upon because they do not detract from the main theses of the study. A specialist with referrals justifies his status; without them his valuable knowledge and skills tend to rust from disuse. That the pediatrician consultant must minimize the scope of his counselling work need not mean that he stands unconcerned about general well-being of children and other pertinent issues; in such matters he can and should participate at the voluntary community level and thus play his distinctive part on the wider scene. By interposing himself between the grass roots and the ivory towers he becomes a key link in the chain of medical services to the child, and at the same time he assures himself of a satisfying professional existence.