Young Pediatricians Research Articles

Professional, educational and psychosocial impacts of the COVID-19 pandemic on pediatricians

ABSTRACT Objectives COVID-19 infection is not limited to medical aspects, but may have significant negative impacts on education, tourism, the economy as well as sociocultural, ethical, and legal aspects. We aimed to assess the multidimensional impact of the COVID-19 pandemic on pediatricians by examining their COVID-19 infection, domestic life and quarantine, as well as work patterns, educational activities, and psychosocial impact. Methods An online survey consisted of seven sections and 68 questions was prepared through ‘Google Forms.’ The survey was sent via e-mail to physicians who are members of the National Pediatric Association of Turkey. Results The pandemic has affected pediatricians working in our country in a multifaceted aspect. They experienced significant anxiety/depression/stress, 8% of them felt it at a pathological level and were receiving treatment, and women and young pediatricians were more vulnerable to the pandemic. The more adequately informed about the disease, the more prepared for COVID-19 and lower levels of psychological distress, which emphasizes the importance of education and institutional continuing support. Our study showed that academic education was seriously disrupted and the satisfaction rate with virtual education was low. Conclusion Although COVID-19 has less impact today, it has taught us that it is necessary to be ready for new pandemics in the future. The required measures should be taken urgently and effectively healthcare professionals should follow a rational and applicable disaster plan.

Trajectories of a doctor's professional development: a narrative interview. Part 1

BACKGROUND: Medical education is one of the most prestigious and in demand at the present stage, which, first of all, is reflected in the high competition rates for admission to a medical university. At the same time, the digital development of the Institute of Medicine determines the increasing academic load and the need to expand the range of disciplines studied at a medical university. AIM: To study of the trajectories of professional development of a young doctor in the Russian healthcare system in modern conditions. METHODS: The study of the trajectories of professional development of young doctors was carried out by the method of narrative interview (n=52) in September–December 2022 on the basis of the Institute of Social Sciences of Sechenov University. The study involved young internists (n=11), pediatricians (n=11), obstetricians and gynecologists (n=10), dentists (n=10), surgeons (n=10). RESULTS: The analysis of the array of narratives allowed us to identify three key semantic and semantic data blocks (including seven subgroups), which served as the empirical basis of the standard narrative plot: the pre-university stage ["playing the profession" (3–7 years), "premonition" of professional choice (8–11 years), professional self-determination or the formation of professional intentions (12–17 years)]; university stage [obtaining medical education as the "foundation" of professional socialization (1–2 years), determining the desired trajectory of the professional path (3–6 years)]; postgraduate stage [debut of professional activity (residency), "challenges of professional autonomy"]. CONCLUSION: The analysis of the corpus of narratives of young doctors made it possible to identify the key temporal points of the trajectory of their professional formation in the modern situation, and showed that the formation and professional self-determination of a medical specialist is determined not only by internal motivation, but also by the influence of social agents (specific for each stage), the conditions of the social and professional environment.

Israeli pediatricians' confidence level in diagnosing and treating children with skin disorders: a cross-sectional questionnaire pilot study.

Pediatricians daily see large numbers of patients with skin disorders. However, they encounter limited guidance as a result of a marked deficiency in pediatric dermatologists. Hence, reevaluation of training opportunities during pediatric residency has become essential. Our aim was to evaluate the confidence level of pediatric residents and specialists in diagnosing and treating skin disorders in children and to determine career and training-related characteristics that influence it. Conducted as a cross-sectional study, we administered a questionnaire to 171 pediatricians across Israel. We assessed respondents' self-efficacy about their ability to diagnose and treat skin disorders and collected data regarding their previous dermatology training and preferred training methods. 77.8% of respondents reported below or average self-efficacy scores in diagnosing and managing children with skin disorders. Older age (>40 years old; OR = 5.51, p = 0.019), treating a higher number of patients with skin disorders (OR = 2.96, p = 0.032), and having any training in dermatology, either during medical school or residency (OR = 7.16, p = 0.031, OR = 11.14, p = 0.003 respectively), were all significant parameters involved in pediatricians reporting high self-efficacy in skin disorder management. Most pediatric residents and pediatricians have average or below-average confidence in managing pediatric skin disorders. We suggest incorporating dermatology rotations during pediatric residency to improve young pediatricians' self-efficacy in managing skin disorders and ultimately help pediatricians provide better care for patients presenting with dermatological conditions. These findings can ultimately help refine a pilot program in dermatology that might be implemented during pediatric residency.

Utilization of smart technology for pediatric cardiac consultations in acute care settings: Pediatricians’ perspective

Objectives Smart technology (ST) is starting to be integrated into cardiology medical practice. Therefore, this work aims to assess the extent of ST utilization among young pediatricians in acute pediatric cardiology consultations. Methods Between December 2021 and May 2022, a survey was distributed online to pediatricians linked to emergency services regarding pediatric cardiology consultations. The questionnaire was formulated to gather demographic data of participants, ST devices, and applications used. Questions explored cardiac diseases and acute presentations where ST was used. Pediatrician’s perspective of the benefits, outcome, limitations, and drawbacks of this consultation form was investigated. Results Smartphones were the most used ST device 83/85 (97.65%) for acute cardiac consultation in pediatrics, especially messaging applications such as WhatsApp (92.94%); none of participants chose emails or simple short message service. The most accurately transferred data were vitals, laboratory results, and electrocardiogram. Arrhythmia was reported as the disease benefits the most from ST consultations. Starting supportive therapy was the highest immediate benefit from pediatricians’ perspectives. Although it could not impact mortality, ST was thought to shorten the waiting time for consultations by 65 (76.47%). The major ST limitation was network coverage difficulties (50.58%), and possible consultation delay was the significant drawback in acute settings. Conclusion Smartphones are widely utilized for pediatric cardiac consultations in acute conditions, especially messaging applications. Most acute cardiac consultations are performed for heart failure and arrhythmia in children with the high benefit of shortening the waiting time for preliminary cardiac specialized opinion. However, several concerns about the limitations and drawbacks of ST use in acute cardiac specialty consultations warrant further research and organization.

Adverse Events Following Immunization- The Known Unknowns and Black Box : Based on 10th Dr. I. C. Verma Excellence Award for Young Pediatricians Delivered as Oration on 9th Oct. 2022.

Although vaccines are one of the most rigorously tested biological products, the safety concerns persist globally. The vaccine safety concerns linked to measles, pentavalent and human papillomavirus (HPV) vaccines have affected the vaccine coverage significantly in past. While surveillance of adverse events following immunization (AEFI) is part of the national immunization program mandate, it suffers from challenges and biases related to reporting, completeness, and quality. Some conditions of concern, termed as adverse events of special interest (AESI) following vaccination, mandated specialised studies to prove/disprove the association. The AEFIs/AESIs are usually caused by one of the four pathophysiologicmechanisms, but for several AEFIs/AESIs, the exact pathophysiology remains elusive. For the causality assessment of AEFIs, a systematic process with checklists and algorithm are followed to classify into one of the fourcausal association categories. While the causal association primarily banks on epidemiological observations for several AEFIs, the emerging evidences indicate roles of underlying genetic, gender, age and other pro-inflammatory risk factors for AEFIs and AESIs. The emerging evidences suggest role of antigenic mimicry, autoantibody(ies) and underlying genetic susceptibility for the AEFIs/AESIs. The uncertainty about the frequency, profile, interval, and severity of AEFIs/AESIs and variations across the population, ambiguity about the exact pathophysiology mechanism, absence of definite markers, suggest a possible black box effect of the vaccines. Unless these unanswered questions concerning the AEFIs/AESIs are addressed appropriately and communicated to the stakeholders (professionals, care providers, beneficiaries, general public and media), the anti-vaccine movement shall keep challenging the vaccine and vaccination program.

Knowledge, Attitude, and Practice of Young Paediatricians About Chelation Therapyin Transfusion-Dependent Thalassemia Major Children

Objective: To determine the knowledge, attitude, and practice of young paediatricians about chelation therapy in transfusiondependent thalassemia major children.
 Study Design: KAP survey
 Place and Duration of Study: Six different hospitals in Rawalpindi and Islamabad Pakistan, from Jul 2019 to Jan 2020.
 Methodology: We study enrolled a sample of 98 doctors. The study included all residents (R1, R2, R3, and R4) and senior registrars of the six hospitals, while those on leave for any reason like maternity or others were excluded. A pre-validated questionnaire was used to collect the data.
 Results: Out of 98, maximum residents were of third-year (R3) 27(27.6%), followed by the second-year resident (R2) and senior registrar (SR) 19(19.4%). About 52(53.1%) residents reported that they did not have any thalassemia centre in their facility,with a maximum from Rawalpindi 65(66.3%). The study revealed that 61.2% study population had fair knowledge and attitude towards chelation therapy, while 22(22.4%) had poor and 16(16.3%) had satisfactory scores. The study revealed varied practices except for combination therapy, where 82.7% preferred it. The study showed a significant association between different categories of knowledge and attitude with professional levels, (p-value = 0.014).
 Conclusion: The majority had a fair knowledge and attitude towards chelation therapy, while the practice varies mostly,except for the maximum preferred combination therapy for chelation. The study further concluded that with an increase in professional experience, knowledge, attitude and practice improved towards better treatment.

Knowledge, attitudes, and practices towards artificial intelligence among young pediatricians: A nationwide survey in France.

To assess the knowledge, attitudes, and practices (KAP) towards artificial intelligence (AI) among young pediatricians in France. We invited young French pediatricians to participate in an online survey. Invitees were identified through various email listings and social media. We conducted a descriptive analysis and explored whether survey responses varied according to respondents' previous training in AI and level of clinical experience (i.e., residents vs. experienced doctors). In total, 165 French pediatricians participated in the study (median age 27 years, women 78%, residents 64%). While 90% of participants declared they understood the term "artificial intelligence", only 40% understood the term "deep learning". Most participants expected AI would lead to improvements in healthcare (e.g., better access to healthcare, 80%; diagnostic assistance, 71%), and 86% declared they would favor implementing AI tools in pediatrics. Fifty-nine percent of respondents declared seeing AI as a threat to medical data security and 35% as a threat to the ethical and human dimensions of medicine. Thirty-nine percent of respondents feared losing clinical skills because of AI, and 6% feared losing their job because of AI. Only 5% of respondents had received specific training in AI, while 87% considered implementing such programs would be necessary. Respondents who received training in AI had significantly better knowledge and a higher probability of having encountered AI tools in their medical practice (p < 0.05 for both). There was no statistically significant difference between residents' and experienced doctors' responses. In this survey, most young French pediatricians had favorable views toward AI, but a large proportion expressed concerns regarding the ethical, societal, and professional issues linked with the implementation of AI.

Prevention of malocclusion and the importance of early diagnosis in the Italian young population.

Malocclusion is an alteration of the normal relationships between skeletal, muscle and dental structures that can lead to impaired functionality as well as aesthetic alteration of the stomatognathic system. Functional alteration can affect various aspects, ranging from chewing ability to respiratory disorders. Paediatricians and dentists are called to prevent and diagnose these conditions as early as possible in order to preserve the patient's health. The purpose of this research is to study the incidence of malocclusion and its relationship with Obstructive Sleep Apnea Syndrome (OSAS) in a young population. Also, the role of paediatricians and dentists in prevention and early diagnosis of this condition was evaluated METHODS: An anonymous survey was given through Google form to 300 Italian children (139 males and 161 females) from different private dental practices in Italy. No personal information that identifies the individuals was collected, and the data was analysed in aggregate form only. All data was collected and statistically analysed. The data highlight the patients' good attitude towards dental check-ups, which help to intercept malocclusions. Unlike the past, the knowledge of the importance of oral health and dental occlusion is high among young patients, parents and paediatricians. This study underlines the role of paediatricians as key players in the prevention of dental health problems.

Antimicrobial Resistance: The 'Other' Pandemic! : Based on 9th Dr. I. C. Verma Excellence Award for Young Pediatricians Delivered as Oration on 19th Sept. 2021.

Antimicrobial resistance is projected to kill 10 million people by 2050. The biggest driver of antimicrobial resistance is excessive/unrestricted use of antimicrobials in humans and animals. Antimicrobial resistance is a problem in all types of pathogens including bacteria, mycobacteria, viruses, fungi, and parasites both globally and India and in both adults and children. The areas of greatest concern for India is the epidemic of MDR and XDR tuberculosis and resistance in gram-negative pathogens. The alarming rate of extended spectrum beta lactamase (ESBL) production in Enterobacteriales in both community and health care–associated infections is driving carbapenem use. Rates of carbapenem resistance are now significantly high in health care–associated gram negative pathogens with associated high mortality rates. The key solution to this antimicrobial resistance crisis needs participation of all stakeholders and lies in promoting rational antimicrobial therapy.

Assessment of skills in pediatric renal urology procedures among young pediatricians

Assessment of skills in pediatric renal urology procedures among young pediatricians

Research on training mechanism of young pediatricians in National Center for Children′s Health of China

Research on training mechanism of young pediatricians in National Center for Children′s Health of China

A rare association between group A Streptococcus purpura fulminans and diffuse alveolar hemorrhage in a young girl: A case report

We report the case of a 7-year-old girl with septic shock and coagulopathy associated with purpura fulminans (PF) and diffuse alveolar hemorrhage (DAH) due to group A Streptococcus (GAS) infection identified with 16S ribosomal RNA analysis performed on the skin biopsy. GAS infection with PF associated with DAH is rare in healthy young children but pediatricians should be aware of this condition because of the poor prognosis. The initial treatment for circulatory failure and severe disseminated intravascular coagulation as well as the prompt initiation of antibiotic treatment may be crucial for the outcomes of S. pyogenes PF.

Effectiveness of symptomatic treatment of ARI in children

Acute respiratory diseases (ARIs), a group of infectious diseases with similar epidemiological and clinical characteristics, are the most common reason for seeking medical care, children skipping attendance of educational institutions and parents skipping work. The clinical picture of ARI is characterized by a combination of the following symptoms: increased body temperature, nasal discharge, mostly mucous, nasal congestion, sore or scratchy throat and cough. In some cases, myalgia and manifestations of asthenia such as weakness, rapid fatigue, headache and decreased appetite may be noted. Pathogenetic therapy of ARI is based on clinical syndromes and includes symptomatic, antiviral and antibacterial drugs, also mucolytics, expectorants, cough suppressants; H1-histamine receptor blockers and immunocorrectors if necessary. Hyperthermia is the most significant problem faced by parents of young patients and pediatricians when dealing with ARI. The production of interferon gamma, interleukin-2 and tumor necrosis factor, which stimulate the production of IgG, is significantly increased with fever. Therefore, it is especially important to know the algorithms of behavior and criteria for understanding when and what antipyretics should be prescribed to a child. Administration of antipyretics for fever is aimed not only at stopping the fever, but also to improve the child’s wellbeing and reduce the pain syndrome during ARI. When choosing antipyretics, it is necessary to consider the age of the child, the preferred method of administration, the allowable doses, the frequency of administration, the prevention of complications in children at risk. Antipyretics may be prescribed in the form of combined drugs, not only able to reduce fever, but also eliminate other symptoms that occur against the background of acute respiratory infection.

Occupational identity, job satisfaction and their effects on turnover intention among Chinese Paediatricians: a cross-sectional study

BackgroundThis study contributes to research on the paediatrician shortage by examining occupational identity, job satisfaction and their effects on turnover intention among paediatricians in China.MethodsA multi-stage stratified random sampling method was employed to conduct a questionnaire survey. Of the 4906 survey recipients, valid data were collected from 4198 of the respondents (85.6%). The participants were from seven geographic regions of China (south, central, north, east, northwest, southwest, and northeast). Paediatricians who volunteered and provided written informed consent participated. All variables including basic socio-demographics and work-related characteristics, occupational identity, job satisfaction and turnover intention were based on available literature, and measured on a 5- point Likert scale. Statistical methods such as exploratory factor analysis (EFA), descriptive analysis, common method bias, one-way ANOVA test, Pearson correlation analysis and mediation analysis were used.ResultsSignificant differences were observed among the respondents in terms of turnover intention based on age, education level, marital status, region, the type and grade of practice setting, professional title, years in practise, workload, rest days, and monthly income. Occupational identity and job satisfaction were both negatively related to turnover intention, and occupational identity was positively correlated with job satisfaction (r1 = − 0.601, p < 0.01; r2 = − 0.605, p < 0.01). The results also showed that job satisfaction played a mediating role in the association between occupational identity and turnover intention among Chinese paediatricians.ConclusionsWork conditions, workload and salary are crucial factors of turnover intention among paediatricians in China. Therefore, we suggest that healthcare managers should increase investment in paediatrics, implement salary reforms and dedicate more attention to female and young paediatricians, thus reducing turnover intention among Chinese paediatricians.

110 years of the Department of Pediatrics, Medical Faculty of the N. I. Pirogov Russian National Research Medical University: from the cradle to the XXI century

The article presents the 110-year history of the Department of pediatrics of the medical faculty of the N. I. Pirogov Russian National Research Medical University from its approval at the medical faculty of the Moscow Higher Women’s Courses to the present time. A brief overview of the activities of outstanding Russian pediatricians who led the Department determined its scientific and pedagogical significance in the history of Russian Pediatrics and the development of children’s health in the country, the tradition of scientific pediatric schools. The role of the Department’s scientific student circle in the formation of a young pediatrician is shown. The staff of the Department of pediatrics of the medical faculty of the N. I. Pirogov Russian National Research Medical University celebrates the 110th anniversary of new scientific advances, improves and optimize their teaching activities in training of medical staff.

Qualitative evaluation of asthma services for young people: a sequential simulation study

BackgroundAsthma is the most common chronic disease of childhood and an important preventable cause of mortality in children and young people (CYP). Few studies have brought together CYP and health...

Chronic Myeloid Leukemia in Children: Challenges and Opportunities : Based on 7th Dr. I. C. Verma Excellence Award for Young Pediatricians Delivered as Oration on 29th Sept. 2019.

Treatment with tyrosine kinase inhibitors (TKI) is an effective therapy for children and adolescents with chronic phase of chronic myeloid leukemia (CML). For the majority of patients with CML in low- and middle-income countries (LMIC), imatinib is the TKI of choice for reasons of cost, availability, and experience. Children are exposed to therapy for a greater proportion of their lifetime as compared to adults. The adverse effects of prolonged administration of TKI is a subject of ongoing research, as more experience is collected. Therapy with TKI is currently considered to be life-long. Trials on stopping treatment are ongoing to explore if it may be feasible in selected patients, as reported in adults. Growth-failure is a concerning adverse effect. Currently, it seems unclear if the final height attained is within the expected range of the mid-parenteral height and growth standards. Whether the children will achieve a normal height at the end of their growth potential or remain below the predicted range is critical to decide if therapeutic interventions (E.g., growth hormone therapy, or interruption in TKI) should be considered during the period of growth potential. Research on CML in children is at a relatively slow pace, largely due to the rarity of the disease. This provides a unique opportunity for research in population-dense LMICs, as several tertiary centers tend to have a sizable cohort of children and adolescents with CML on follow-up. This narrative summarises the challenges and opportunities in dealing with CML in children, particularly in reference to a center in LMIC.

Awareness among pediatricians regarding oral health care in children including those with special health care needs: A cross- sectional survey.

Background:Pediatricians are the custodians of the overall health of children and are the ideal healthcare personnel to impart information and instruction about oral health care. The aim of this survey was to evaluate awareness of pediatricians regarding oral health care and prevention of oral diseases in children.Methodology:The study participants consist of 102 young pediatricians working as Junior and Senior Residents. A questionnaire was formulated to evaluate their knowledge about oral diseases and their prevention. The questionnaire also tested the attitude and practices of pediatricians towards oral health of children with special health care needs.Results:Majority of the pediatricians had correct knowledge about dental caries (60%), bottle feeding (88.2%), tongue cleaning (83.3%) and medication causing gum enlargement (92.2%). Few had correct knowledge about recommended age to start tooth brushing (35.3%) and maximum recommended sugar exposures per day (35.3%). Although, majority (62.7%) had correct knowledge about fluoride and its role caries prevention, very few (2.9%) knew about recommended fluoride concentration in toothpaste for children.Conclusion:There was a lack of knowledge amongst pediatrician about oral health care, prevention, and appropriate referral. The study result necessitates the emphasis of improving oral health related knowledge among pediatrician.

Accessing primary health care services for transition-aged young adults with cerebral palsy; perspectives of young adults, parents, and physicians

AbstractBackgroundYoung adults with childhood-onset disabilities experience challenges with accessing age appropriate primary health care services as they transition from pediatric to adult health care services. They often experience a negative impact on their health with associated long-term health and social concerns, disease complications and increased use of emergency services once transitioned to adult services. This is particularly challenging for youth with cerebral palsy (CP) due the complexity of their medical needs. The aim of this study was to explore experiences with accessing or providing primary care services for transitioned-aged young adults with CP from young adult, parent, pediatrician and primary care physician perspectives.MethodsA qualitative descriptive design was conducted to identify the challenges and facilitators for transitioned aged young adults with accessing primary, adult care services. Semi-structured interviews were conducted with 16 participants within the circle of care (4 adults with CP, 4 parents, 4 pediatricians and 4 primary healthcare physicians) for individuals with CP in Toronto, Canada. Interviews were audio-recorded and transcribed verbatim. Qualitative analysis guided both the data collection and the data analysis processes.ResultsData analysis revealed that all participant groups reported transition challenges with respect to accessibility, the suitability of some primary care environments for caring for individuals with complex care needs, gaps in seamless care, and limited time and funding when receiving or providing primary care services to young adults with CP.DiscussionThere is a greater demand for adult healthcare providers now to deliver services for adults with childhood onset disabilities. Transition-aged young adults with CP and complex medical needs have increased challenges with accessing primary care services. Considering the following would improve primary care services transition for this population with complex medical needs: ongoing partnering between pediatric and adult health care streams to promote seamless care; connection to team-based primary care services where family physicians, subspecialties and interprofessional practitioners work together to provide joint care planning; salary compensation for increased service needs due to medical complexity; accessible sites; and development of guidelines for transitioning youth/young adults with complex care needs.

Assessment of the impact of grants awarded by the Sociedad Argentina de Pediatría during the last 20 years (1995-2015)

The Argentine Society of Pediatrics awards grants to young pediatricians, aimed at improving performance and encouraging research. To describe the details of grants awarded; to analyze the proportion of projects that were published and of grantees that remained in areas related to their grant. Descriptive study, through a self-administered survey. 59 research grants were awarded (1995- 2015). The survey was answered by 47 grantees; 14 projects reached publication. Having completed the research at a Pediatric Hospital was associated with publication odds ratio 13,8 (1,6-118), p = 0,01; 132 educational improvement grants were awarded (2005-2015). The survey was answered by 84 grantees. The 85 % continue working in the same area of their grant.