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Sisk B, Cull W, Harris JM, Rothenburger A, Olson L. National Trends of Cases of COVID-19 in Children Based on US State Health Department Data. Pediatrics 2020; 146:peds.2020-027425. [PMID: 32994175 DOI: 10.1542/peds.2020-027425] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/22/2020] [Indexed: 11/24/2022] Open
Affiliation(s)
- Blake Sisk
- American Academy of Pediatrics, Itasca, Illinois; and
| | - William Cull
- American Academy of Pediatrics, Itasca, Illinois; and
| | | | | | - Lynn Olson
- American Academy of Pediatrics, Itasca, Illinois; and
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2
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Aldana PR, Beier AD, Ranalli NJ, Sisk B, Ragheb JR. Prioritizing Pediatricians' Neurosurgical Education: Results From a National Survey of Primary Care Pediatricians. Clin Pediatr (Phila) 2020; 59:902-909. [PMID: 32475161 DOI: 10.1177/0009922820928060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction. We surveyed nonretired American Academy of Pediatrics-member US pediatricians regarding common neurosurgical conditions, identifying specific areas of focus in education. Methods. Data were acquired via self-administered electronic questionnaire. Results. Of 505 total respondents, 56% reported neurology was not a required residency rotation, and 86% had diagnosed craniosynostosis, plagiocephaly, or macrocephaly. Craniosynostosis can mostly be diagnosed by physical examination alone, but almost 50% reported relying on skull X-rays. Fifty-four percent reported diagnosing ocular surface disease (OSD; with 15% to 40% not screening an infant despite well-established cutaneous markers). Seventy-four screened OSD in a patient with sacral dimple. Ninety-seven percent reported treating concussion, but nearly 25% did not manage these patients alone. Two out of 3 patients indicated head injury as most important for continuing education. Conclusion. Improved education for craniosynostosis, OSD, head injury, and concussion management are important for earlier diagnosis, management, and referral of some disorders, while decreasing resource utilization in others. These results should be used when considering pediatrician educational programs.
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Affiliation(s)
- Philipp R Aldana
- University of Florida, Jacksonville, FL, USA.,Wolfson Children's Hospital, Jacksonville, FL, USA
| | - Alexandra D Beier
- University of Florida, Jacksonville, FL, USA.,Wolfson Children's Hospital, Jacksonville, FL, USA
| | - Nathan J Ranalli
- University of Florida, Jacksonville, FL, USA.,Wolfson Children's Hospital, Jacksonville, FL, USA
| | - Blake Sisk
- American Academy of Pediatrics, Itasca, IL, USA
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3
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Lipkin PH, Macias MM, Baer Chen B, Coury D, Gottschlich EA, Hyman SL, Sisk B, Wolfe A, Levy SE. Trends in Pediatricians' Developmental Screening: 2002-2016. Pediatrics 2020; 145:peds.2019-0851. [PMID: 32123018 DOI: 10.1542/peds.2019-0851] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/23/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Current guidelines from the American Academy of Pediatrics recommend screening children for developmental problems by using a standardized screening tool and referring at-risk patients to early intervention (EI) or subspecialists. Adoption of guidelines has been gradual, with research showing many children still not being screened and referred. METHODS We analyzed American Academy of Pediatrics Periodic Survey data from 2002 (response rate = 58%; N = 562), 2009 (response rate = 57%; N = 532), and 2016 (response rate = 47%, N = 469). Surveys included items on pediatricians' knowledge, attitudes, and practices regarding screening and referring children for developmental problems. We used descriptive statistics and a multivariable logistic regression model to examine trends in screening and referral practices and attitudes. RESULTS Pediatricians' reported use of developmental screening tools increased from 21% in 2002 to 63% in 2016 (P < .001). In 2016, on average pediatricians reported referring 59% of their at-risk patients to EI, up from 41% in 2002 (P < .001), and pediatricians in 2016 were more likely than in 2002 to report being "very likely" to refer a patient with global developmental delay, milestone loss, language delay, sensory impairment, motor delays, and family concern to EI. CONCLUSIONS Pediatricians' reported use of a standardized developmental screening tool has tripled from 2002 to 2016, and more pediatricians are self-reporting making referrals for children with concerns in developmental screening. To sustain this progress, additional efforts are needed to enhance referral systems, improve EI programs, and provide better tracking of child outcomes.
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Affiliation(s)
- Paul H Lipkin
- Neurology and Developmental Medicine, Kennedy Krieger Institute, Baltimore, Maryland;
| | - Michelle M Macias
- Division of Developmental-Behavioral Pediatrics, Medical University of South Carolina, Charleston, South Carolina
| | - Briella Baer Chen
- Neurology and Developmental Medicine, Kennedy Krieger Institute, Baltimore, Maryland
| | | | | | - Susan L Hyman
- Department of Pediatrics, University of Rochester, Rochester, New York
| | - Blake Sisk
- Research, American Academy of Pediatrics, Itasca, Illinois
| | - Audrey Wolfe
- Massachusetts General Hospital, Boston, Massachusetts; and
| | - Susan E Levy
- Division of Developmental Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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4
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Sisk B, Green A, Chan K, Yun K. Caring for Children in Immigrant Families: Are United States Pediatricians Prepared? Acad Pediatr 2020; 20:391-398. [PMID: 31790799 DOI: 10.1016/j.acap.2019.11.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 11/25/2019] [Accepted: 11/27/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE A growing number of children in the United States are from immigrant families. We conducted a national survey to examine pediatricians' self-rated preparedness to care for children in immigrant families. METHODS A 2017 survey of American Academy of Pediatrics members assessed respondent characteristics, formal training in and experience with global, public, or immigrant health, and preparedness to care for children in immigrant families. Descriptive statistics and a multivariable logistic regression model examined associations between characteristics, formal training, experience, and preparedness. RESULTS The survey response rate was 47% (n = 758/1628). One third of respondents (33.6%) reported being unprepared to care for children in immigrant families. In bivariate analyses, respondents who had graduated from medical school outside of the United States, had previous education on immigrant health care, or had recent international global health experience were most likely to report feeling prepared to care for children in immigrant families. Multivariable regression model results indicated that prior education on immigrant health (adjusted odds ratio [AOR] 4.07; 95% confidence interval [CI] 2.68, 6.32), graduation from medical school outside the United States (AOR 2.35; 95% CI 1.22, 4.67), and proficiency in a language other than English (AOR 1.78; 95% CI 1.14, 2.80) were independently associated with preparedness. CONCLUSIONS One in 3 US pediatricians report being unprepared to care for children in immigrant families. Wider implementation of graduate and continuing medical education on immigrant child health is needed to ensure that practicing pediatricians have the appropriate skills and knowledge to care for this patient population.
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Affiliation(s)
- Blake Sisk
- Department of Research, American Academy of Pediatrics (B Sisk), Itasca, Ill.
| | - Andrea Green
- Department of Pediatrics, University of Vermont Children's Hospital, Larner College of Medicine at the University of Vermont (A Green), Burlington, Vt
| | - Kevin Chan
- Institute of Better Health and Children's and Women's Health, Trillium Health Partners (K Chan), Mississauga, ON, Canada; Department of Pediatrics, University of Toronto (K Chan), Toronto, ON, Canada
| | - Katherine Yun
- Department of Pediatrics, Children's Hospital of Philadelphia (K Yun), Philadelphia, Pa; Department of Pediatrics, University of Pennsylvania Perelman School of Medicine (K Yun), Philadelphia, Pa
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Abstract
BACKGROUND Interest and participation in global health (GH) experiences have increased over the past 30 years in both medical schools and residencies, but little is known at the level of practicing pediatricians. METHODS Data were compared from the American Academy of Pediatrics Periodic Surveys conducted in 1989 and 2017. The surveys had a response rate of 70.8% in 1989 and 46.7% in 2017. There were 638 and 668 postresidency pediatricians in the 1989 and 2017 surveys, respectively. Descriptive analyses were performed to look at changes in experience and interest in GH. A multivariable logistic regression was conducted specifically looking at characteristics associated with interest in participating in GH experiences in the next 3 years. RESULTS Pediatrician participation in GH experiences increased from 2.2% in 1989 to 5.1% in 2017, with statistically significant increases in pediatricians ≥50 years of age. Interest in participating in future GH experiences increased from 25.2% in 1989 to 31.7% in 2017, with a particular preference for short-term clinical opportunities. In the multivariable logistic regression model, the year 2017 was associated with an increased interest in future GH experience, especially in medical school, hospital or clinic practice settings, as well as among subspecialists. CONCLUSIONS Over the past 28 years, practicing pediatricians have increased their involvement in GH, and they are more interested in future GH experiences. The focus is on short-term opportunities. Our study reveals that practicing pediatricians mirror medical trainees in their growing interest and participation in GH.
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Affiliation(s)
- Kevin Chan
- Institute for Better Health and .,Department of Children's and Women's Health, Trillium Health Partners, Mississauga, Ontario, Canada.,Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Blake Sisk
- American Academy of Pediatrics, Itasca, Illinois
| | - Katherine Yun
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; and
| | - Nicole E St Clair
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin
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6
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Frintner MP, Sisk B, Byrne BJ, Freed GL, Starmer AJ, Olson LM. Gender Differences in Earnings of Early- and Midcareer Pediatricians. Pediatrics 2019; 144:peds.2018-3955. [PMID: 31506302 DOI: 10.1542/peds.2018-3955] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/09/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The US physician workforce includes an increasing number of women, with pediatrics having the highest percentage. In recent research on physicians, it is indicated that men earn more than women. It is unclear how this finding extends to pediatricians. METHODS We examined cross-sectional 2016 data on earnings from the American Academy of Pediatrics Pediatrician Life and Career Experience Study, a longitudinal study of early- and midcareer pediatricians. To estimate adjusted differences in pediatrician earnings between men and women, we conducted 4 ordinary least squares regression models. Model 1 examined gender, unadjusted; model 2 controlled for labor force characteristics; model 3 controlled for both labor force and physician-specific job characteristics; and model 4 controlled for labor force, physician-specific job, and work-family characteristics. RESULTS Sixty-seven percent of Pediatrician Life and Career Experience Study participants completed the 2016 surveys (1213 out of 1801). The analytic sample was restricted to participants who completed training and worked in general pediatrics, hospitalist care, or subspecialty care (n = 998). Overall pediatrician-reported mean annual income was $189 804. Before any adjustment, women earned ∼76% of what men earned, or ∼$51 000 less. Adjusting for common labor force characteristics such as demographics, work hours, and specialty, women earned ∼87% of what men earned, or ∼$26 000 less. Adjusting for a comprehensive set of labor force, physician-specific job, and work-family characteristics, women earned ∼94% of what men earned, or ∼$8000 less. CONCLUSIONS Early- to midcareer female pediatricians earned less than male pediatricians. This difference persisted after adjustment for important labor force, physician-specific job, and work-family characteristics. In future work, researchers should use longitudinal analyses and further explore family obligations and choices.
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Affiliation(s)
- Mary Pat Frintner
- Department of Research, American Academy of Pediatrics, Itasca, Illinois;
| | - Blake Sisk
- Department of Research, American Academy of Pediatrics, Itasca, Illinois
| | - Bobbi J Byrne
- Section of Neonatal-Perinatal Medicine, Department of Pediatrics, School of Medicine, Indiana University, Indianapolis, Indiana
| | - Gary L Freed
- Department of Pediatrics, University of Michigan, Ann Arbor, Michigan; and
| | - Amy J Starmer
- Department of Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Lynn M Olson
- Department of Research, American Academy of Pediatrics, Itasca, Illinois
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Belay B, Frintner MP, Liebhart JL, Lindros J, Harrison M, Sisk B, Dooyema CA, Hassink SG, Cook SR. US Pediatrician Practices and Attitudes Concerning Childhood Obesity: 2006 and 2017. J Pediatr 2019; 211:78-84.e2. [PMID: 31113716 PMCID: PMC8856742 DOI: 10.1016/j.jpeds.2019.04.030] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 04/11/2019] [Accepted: 04/12/2019] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To compare primary care pediatricians' practices and attitudes regarding obesity assessment, prevention, and treatment in children 2 years and older in 2006 and 2017. STUDY DESIGN National, random samples of American Academy of Pediatrics members were surveyed in 2006, 2010, and 2017 on practices and attitudes regarding overweight and obesity (analytic n = 655, 592, and 558, respectively). Using logistic regression models (controlling for pediatrician and practice characteristics), we examined survey year with predicted values (PVs), including body mass index (BMI) assessment across 2006, 2010, and 2017 and practices and attitudes in 2006 and 2017. RESULTS Pediatrician respondents in 2017 were significantly more likely than in 2006 and 2010 to report calculating and plotting BMI at every well-child visit, with 96% of 2017 pediatricians reporting they do this. Compared with 2006, in 2017 pediatricians were more likely to discuss family behaviors related to screen time, sugar-sweetened beverages, and eating meals together, P < .001 for all. There were no observed differences in frequency of discussions on parental role modeling of nutrition and activity-related behaviors, roles in food selection, and frequency of eating fast foods or eating out. Pediatricians in 2017 were more likely to agree BMI adds new information relevant to medical care (PV = 69.8% and 78.1%), they have support staff for screening (PV = 45.3% and 60.5%), and there are effective means of treating obesity (PV = 36.3% and 56.2%), P < .001 for all. CONCLUSIONS Results from cross-sectional surveys in 2006 and 2017 suggest nationwide, practicing pediatricians have increased discussions with families on several behaviors and their awareness and practices around obesity care.
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Affiliation(s)
- Brook Belay
- Division of Nutrition, Physical Activity and Obesity, Centers for Disease Control and Prevention, Atlanta, GA.
| | - Mary Pat Frintner
- Department of Research, American Academy of Pediatrics (AAP), Itasca, IL
| | | | | | - Megan Harrison
- Division of Nutrition, Physical Activity and Obesity, Centers for Disease Control and Prevention, Atlanta, GA
| | - Blake Sisk
- Department of Research, American Academy of Pediatrics (AAP), Itasca, IL
| | - Carrie A. Dooyema
- Division of Nutrition, Physical Activity and Obesity, Centers for Disease Control and Prevention, Atlanta, GA
| | | | - Stephen R. Cook
- Institute for Healthy Childhood Weight, AAP, Itasca, IL;,Department of Research, University of Rochester Medical Center, Rochester, NY
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Gottschlich EA, Larson K, Sisk B, Pat Frintner M. Sleep, Physical Activity, and General Health Status: US Pediatricians and the General US Adult Population. Acad Pediatr 2019; 19:269-277. [PMID: 30103049 DOI: 10.1016/j.acap.2018.08.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 07/24/2018] [Accepted: 08/05/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To examine US pediatricians and US adults on 3 self-reported health measures (sleep, physical activity, and general health status) and to assess factors related to these measures for each group. METHODS Pediatrician data were collected through a 2012 American Academy of Pediatrics Periodic Survey (response rate = 64.0%). US population data originated from the 2012 National Health Interview Survey (response rate = 61.2%). Analytic samples included those currently working and ≥30 years old and were restricted to post-trainees (pediatricians; n = 854) and US adults with at least a bachelor's degree (n = 5447). Accounting for sample demographic differences, predicted probabilities compared the proportions reporting ≥7 hours of sleep, meeting physical activity recommendations, and reporting very good or excellent health. Multivariable logistic regression examined characteristics associated with health measures for pediatricians and US adults separately. RESULTS When the US population demographic profile was adjusted to resemble the pediatrician sample, 7 in 10 pediatricians (71.2%; confidence interval [CI], 68.0-74.5) and US adults (69.9%; CI, 67.8-72.0) reported ≥7 hours of sleep. Pediatricians were more likely than US adults to meet physical activity recommendations (71.4%; CI, 68.0-74.8 vs. 62.9%; CI, 60.6-65.2) and less likely to report very good or excellent health (74.3%; CI, 71.2-77.3 vs. 80.2%; CI, 78.3-82.1). In pediatrician and US population multivariable models, self-identified Asians and those working ≥50 hours were less likely to get ≥7 hours of sleep (P < .05). CONCLUSIONS Most US pediatricians and US adults reported getting the recommended amounts of sleep and physical activity and rated their health as very good or excellent. Those working fewer hours reported more sleep. Organization-directed approaches may be needed to help physicians maintain and improve their health.
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Affiliation(s)
| | - Kandyce Larson
- Department of Research, American Academy of Pediatrics, Itasca, Ill
| | - Blake Sisk
- Department of Research, American Academy of Pediatrics, Itasca, Ill
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Abstract
BACKGROUND AND OBJECTIVE In an effort to transform the health care system, payers and physicians are experimenting with new payment models, mostly in an effort to move from a volume-based system to one based on value. We conducted a national survey to evaluate pediatricians' experience with and views about new value-based models of payment. METHODS An American Academy of Pediatrics 2016 member survey was used to assess provider and practice characteristics, provider experience with value-based payments (VBPs) (through accountable care organizations [ACOs] or pay for quality performance), and provider views about new payment models. We used descriptive statistics and multivariable logistic regression models to examine relationships between experience and views. RESULTS The survey response rate was 48.7% (n = 786 of 1614). Of practicing general pediatricians, 52% reported experience with VBP, 32% believed payment for quality metrics have a "positive impact" on pediatricians' ability to provide quality care for patients, and 12% believed ACOs have a positive impact. Adjusting for covariates, respondents experienced with payments for quality metrics (adjusted odds ratio: 2.01; 95% confidence interval 1.26-3.19) and ACOs (odds ratio: 6.68; 95% confidence interval 3.55-13.20) were more likely to report a positive impact. CONCLUSIONS Although experience and views vary, just more than half of surveyed pediatricians report receiving some form of VBP. Pediatricians reporting this experience are more likely to feel that these payment models have a positive impact on patient care when compared with pediatricians without this experience.
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Affiliation(s)
- Joel S Tieder
- Division of Hospital Medicine, Department of Pediatrics, Seattle Children's Hospital and School of Medicine, University of Washington, Seattle, Washington;
| | - Blake Sisk
- Department of Research, American Academy of Pediatrics, Itasca, Illinois
| | - Mark Hudak
- Department of Pediatrics, College of Medicine, University of Florida, Gainesville, Florida
| | | | - James M Perrin
- Harvard Medical School, Harvard University and Massachusetts General Hospital for Children, Boston, Massachusetts
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Sisk B, Donato KM. Weathering the Storm? The Great Recession and the Employment Status Transitions of Low-Skill Male Immigrant Workers in the United States1. International Migration Review 2018. [DOI: 10.1111/imre.12260] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Using matched data from the Current Population Survey from 2005 to 2011 ( n = 5,507), we use multinomial and binary logistic regression models to examine employment transitions related to the Great Recession for five groups of men with less than a high school degree: foreign-born Mexicans, other foreign-born, and US-born whites, blacks, and Latinos. We find that, during the recession, Mexican immigrants were the most likely to remain continuously employed. However, immigrant workers also experienced high levels of involuntary part-time employment during the recession, suggesting that their relative success in remaining employed was not without its costs.
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Sisk B, Donato KM. Weathering the Storm? The Great Recession and the Employment Status Transitions of Low-Skill Male Immigrant Workers in the United States 1. International Migration Review 2018. [DOI: 10.1177/0197918318776317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Feldman-Winter L, Szucs K, Milano A, Gottschlich E, Sisk B, Schanler RJ. National Trends in Pediatricians' Practices and Attitudes About Breastfeeding: 1995 to 2014. Pediatrics 2017; 140:peds.2017-1229. [PMID: 28924062 DOI: 10.1542/peds.2017-1229] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/27/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The American Academy of Pediatrics (AAP) has affirmed breastfeeding as the preferred method of infant feeding; however, there has been little systematic examination of how pediatricians' recommendations, affiliated hospitals' policies, counseling practices, and attitudes toward breastfeeding have shifted over the past 2 decades. These trends were examined from 1995 to 2014. METHODS Data are from the Periodic Survey (PS) of Fellows, a nationally representative survey of AAP members. PS #30 (1995; response rate = 72%; N = 832), PS #57 (2004; response rate = 55%; N = 675), and PS #89 (2014; response rate = 51%; N = 620) collected demographics, patient and practice characteristics, and detailed responses on pediatricians' recommendations, affiliated hospitals' policies, counseling practices, and attitudes toward breastfeeding. By using bivariate statistics and logistic regression models, the analysis investigated changes over time with predicted values (PVs). RESULTS From 1995 to 2014, more pediatricians reported their affiliated hospitals applied for "baby-friendly" designation (PV = 12% in 1995, PV = 56% in 2014; P < .05), and more reported that they recommend exclusive breastfeeding (65% to 76% [P < .05]). However, fewer respondents indicated that mothers can be successful breastfeeding (PV = 70% in 1995, PV = 57% in 2014; P < .05) and that the benefits outweigh the difficulties (PV = 70% in 1995, PV = 50% in 2014; P < .05). Younger pediatricians were less confident than older pediatricians in managing breastfeeding problems (P < .01). CONCLUSIONS Pediatricians' recommendations and practices became more closely aligned with AAP policy from 1995 to 2014; however, their attitudes about the likelihood of breastfeeding success have worsened. These 2 divergent trends indicate that even as breastfeeding rates continue to rise, continued efforts to enhance pediatricians' training and attitudes about breastfeeding are necessary.
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Affiliation(s)
- Lori Feldman-Winter
- Department of Pediatrics, Children's Regional Hospital, Cooper University Health Care, Cooper Medical School, Rowan University, Camden, New Jersey;
| | | | - Aubri Milano
- Department of Pediatrics, Children's Regional Hospital, Cooper University Health Care, Cooper Medical School, Rowan University, Camden, New Jersey
| | - Elizabeth Gottschlich
- Department of Research, American Academy of Pediatrics, Elk Grove Village, Illinois; and
| | - Blake Sisk
- Department of Research, American Academy of Pediatrics, Elk Grove Village, Illinois; and
| | - Richard J Schanler
- Cohen Children's Medical Center, Northwell Health and Hofstra, Hofstra Northwell School of Medicine, Hofstra University, Hempstead, New York
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Di Rienzo A, Donnelly P, Toomajian C, Sisk B, Hill A, Petzl-Erler ML, Haines GK, Barch DH. Heterogeneity of microsatellite mutations within and between loci, and implications for human demographic histories. Genetics 1998; 148:1269-84. [PMID: 9539441 PMCID: PMC1460025 DOI: 10.1093/genetics/148.3.1269] [Citation(s) in RCA: 113] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Microsatellites have been widely used to reconstruct human evolution. However, the efficient use of these markers relies on information regarding the process producing the observed variation. Here, we present a novel approach to the locus-by-locus characterization of this process. By analyzing somatic mutations in cancer patients, we estimated the distributions of mutation size for each of 20 loci. The same loci were then typed in three ethnically diverse population samples. The generalized stepwise mutation model was used to test the predicted relationship between population and mutation parameters under two demographic scenarios: constant population size and rapid expansion. The agreement between the observed and expected relationship between population and mutation parameters, even when the latter are estimated in cancer patients, confirms that somatic mutations may be useful for investigating the process underlying population variation. Estimated distributions of mutation size differ substantially amongst loci, and mutations of more than one repeat unit are common. A new statistic, the normalized population variance, is introduced for multilocus estimation of demographic parameters, and for testing demographic scenarios. The observed population variation is not consistent with a constant population size. Time estimates of the putative population expansion are in agreement with those obtained by other methods.
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Affiliation(s)
- A Di Rienzo
- Department of Anthropology, Northwestern University, Evanston, Illinois 60208, USA.
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