Retiring From Pediatric Emergency Medicine Too Soon?: A Survey to Discover the Reasons and Start a Conversation About Solutions

OBJECTIVE

Pediatric emergency medicine is a subspecialty known for high acuity, high stress, and variable scheduling that may be difficult to maintain as one gets older. This survey sought to gain information on the reasons or plans for early retirement in pediatric emergency medicine and offer ways to address these concerns to improve longevity in the field.

METHODS

A cross-sectional survey was sent via email to board-certified pediatric emergency medicine physicians who were older than 50 years to assess preretirement and postretirement considerations. Results were collected from October 3, 2019, through March 15, 2020.

RESULTS

Pediatric emergency medicine physicians who find it more difficult to perform simple procedures are 3.02 (1.23-7.36) times more likely to retire before the age of 66 years. In addition, women were significantly more likely to report an intention to retire before the age of 66 years versus men (50% vs 31%, P = 0.022).

DISCUSSION

The topic of retirement in a field that requires a wide range of procedural skills as well as constantly evolving technology is important. Understanding when and why physicians choose to retire may identify strategies to make it possible for pediatric emergency medicine physicians to prolong their careers. This may involve changes in work hours, a shift in responsibilities to a greater educational or mentor role, and/or providing opportunities to maintain skills.

CONCLUSIONS

Perceived basic procedure skills deterioration significantly increased the risk for early retirement. In addition, women were significantly more likely to express intention to retire before the age of 66 years. Further research should be directed toward obtaining more detailed information to develop strategies to retain pediatric emergency medicine physicians in a capacity that benefits the physician, their institution, and their patients.

Distribution of comorbidities as primary diagnoses by obesity class among patients in a large US paediatric healthcare system

There is little documentation of the distribution of specific health conditions across obesity classes (I, II, III), especially for paediatric populations who are seen for routine care in large United States US healthcare systems. The aim of this study was to assess the odds of presenting ≥2 obesity-related comorbidities as well as assess the overall distribution of these co-morbidities in children by class I/II/III obesity status controlling for key sociodemographic characteristics. This retrospective (2015-2019) electronic health record review analysed 49 276 patients from the Children's Health System of Texas diagnosed with obesity-related health conditions by obesity status (no obesity, class I, II, III). Crude and adjusted logistic regression models examined the association between obesity class and the likelihood of ≥2 comorbidities as primary diagnoses. Patients with class I obesity were 22% more likely (OR 1.22, 95% CI, 1.16, 1.27), patients with class II obesity were almost 50% more likely (OR 1.44, 95% CI, 1.35, 1.53) and those with class III obesity twice as likely (OR 2.04, 95% CI 1.91, 2.18) to be diagnosed with ≥2 comorbidities as primary diagnoses, compared with patients classified with no obesity. Children with obesity, particularly severe obesity, should be monitored closely by paediatricians for possible diagnoses of risk factors that could lead to adult chronic disease.

Potential Utility of School-Based Telehealth in the Era of COVID-19

BACKGROUND

The COVID-19 pandemic presents unique opportunities for preexisting school telemedicine programs to reach pediatric populations that might otherwise experience a lapse in health care services.

METHODS

A retrospective analysis of one of the largest school-based telemedicine programs in the country, based in the Dallas-Fort Worth (DFW), Texas was conducted that included 7021 pediatric patients who engaged in telehealth visits from 2014 to 2019.

RESULTS

Asthma or other respiratory disease was the primary diagnosis (28.4%), followed by injury or trauma (18.4%), digestive disorders (6.9%), and ear/eye/skin disease (6.9%). More participants were from the North (34.4%) and West (33.2%) ISD compared to the South (20.6%) and East (11.7%) schools. Likewise, the majority of COVID-19 cases were in the North (61.8%) and West (31.6%) DFW regions, leading to 989 (59.9%) and 551 (33.4%) deaths, respectively.

CONCLUSIONS

School-based telehealth programs have the potential to reach large pediatric populations most in need of health care due to COVID-19-related lapses in services, and to address COVID-19-related health issues as schools reopen. In the future, utilization could be expanded to contact tracing, testing, and screening for COVID-19.

Determinants of accurate visual perception of child anthropometric phenotype among ethnically diverse preschool parents in the United States

The literature reports that regardless of the high obesity prevalence estimates in young children, parents often do not accurately perceive their child's weight status. The purpose of this analysis was to examine the association between parent/child demographic characteristics including ethnicity, country of birth and years living in the United States and the perception of child's anthropometric phenotype status based on a visual silhouette instrument. Caregiver (n = 456) and child sociodemographic, perception of child anthropometric phenotype status and height/weight measurements were collected in 2015, from 24 childcare centres in Miami, Florida, among children ages 2-to-5 years old. Chi-square analysis determined parent perception accuracy by actual child healthy (<body mass index [BMI] 85th percentile) or unhealthy (≥ BMI 85th percentile) status. Multivariable linear regression modelled phenotype trends by caregiver perception. Twenty-eight per cent of the sample was of unhealthy weight. Overall, 74.6% of caregivers did not accurately identify their child's BMI phenotype category versus 25% who did (p < .001); 8% of Hispanic and 13% of non-Hispanic parents of a child with an unhealthy BMI correctly identified their child's anthropometric phenotype. A higher proportion of Cuban (22%) caregivers of a child with an unhealthy BMI percentile versus Mexican caregivers (13.9%) visually identified their child as healthy weight. Child BMI percentile was significantly associated with parent perception of child healthy phenotype (OR: 1.05, 95% CI 1.04, 1.06). Findings here add evidence to the existing body of literature that emphasise parent perception of child weight status as a critical lynchpin in the childhood obesity epidemic. Intervention efforts must continue to educate parents on healthy weight development strategies.

Impact of COVID-19 stay-at-home orders on weight-related behaviours among patients with obesity

How the impact of the COVID-19 stay-at-home orders is influencing physical, mental and financial health among vulnerable populations, including those with obesity is unknown. The aim of the current study was to explore the health implications of COVID-19 among a sample of adults with obesity. A retrospective medical chart review identified patients with obesity from an obesity medicine clinic and a bariatric surgery (MBS) practice. Patients completed an online survey from April 15, 2020 to May 31, 2020 to assess COVID-19 status and health behaviours during stay-at-home orders. Logistic regression models examined the impact of these orders on anxiety and depression by ethnic group. A total of 123 patients (87% female, mean age 51.2 years [SD 13.0]), mean BMI 40.2 [SD 6.7], 49.2% non-Hispanic white (NHW), 28.7% non-Hispanic black, 16.4% Hispanic, 7% other ethnicity and 33.1% completed MBS were included. Two patients tested positive for severe acute respiratory syndrome coronavirus 2 and 14.6% reported symptoms. Then, 72.8% reported increased anxiety and 83.6% increased depression since stay-at-home orders were initiated. Also 69.6% reported more difficultly in achieving weight loss goals, less exercise time (47.9%) and intensity (55.8%), increased stockpiling of food (49.6%) and stress eating (61.2%). Hispanics were less likely to report anxiety vs NHWs (adjusted odds ratios 0.16; 95% CI, 0.05-0.49; P = .009). Results here showed the COVID-19 pandemic is having a significant impact on patients with obesity regardless of infection status. These results can inform clinicians and healthcare professionals about effective strategies to minimize COVID-19 negative outcomes for this vulnerable population now and in post-COVID-19 recovery efforts.

Changes in cardiovascular health and physical fitness in ethnic youth with intellectual disabilities participating in a park-based afterschool programme for two years

BACKGROUND

Youth with intellectual disabilities are more likely to be an unhealthy weight and less physically active than youth without intellectual disability.

OBJECTIVE

The effects of Fit2Play, a park-based afterschool programme on cardiovascular/fitness health outcomes among youth with intellectual disability, were prospectively assessed.

METHODS

Youth ages 6 to 22 with intellectual disability who participated in Fit2Play for either one or two school years between 2010 and 2016 (N = 297, mean age 14.1 years, 70% Hispanic, 20% non-Hispanic black, 72% male) were examined via a fitness battery at the beginning/end of the school year(s). Effects of length of Fit2Play participation on body mass index (BMI) %ile, skinfold thicknesses, systolic/diastolic blood pressure (SBP/DBP) %iles, fitness tests, and health and wellness knowledge) were evaluated via two-level repeated measures analysis adjusted for child gender, age, ethnicity and area-level poverty.

RESULTS

Adjusted models showed that up to two years of Fit2Play participation was significantly associated with improved BMI %ile, skinfold thicknesses, SPB/DBP %iles and PACER scores (p < 0.05 for all). One and two years of programme participation was associated with a 6% [95% CI: 0.92, 0.96] and 10% [95% CI: 0.87, 0.93] reduction in SBP%ile, respectively (p < 0.001), and a 36% [95% CI: 1.28, 1.45] and 57% [95% CI: 1.44, 1.70] increase in PACER score laps, respectively, compared to baseline.

CONCLUSIONS

Results here suggest that park-based, structured afterschool programmes with a focus on health and wellness can be a rich resource for this nation by offering both exclusive and immersion programmes for children with intellectual disability to foster cardiovascular health in all youth.

Prevalence of intestinal parasites in rural Southern Indians

OBJECTIVE

To determine the prevalence of intestinal protozoal and helminthic infection in a rural population.

METHOD

Seventy-eight members of 15 families from a village were studied. Stool samples from all subjects were examined on alternate days for one month.

RESULTS

The overall prevalence rate of various parasitic infections was 97.4%, with only 2 of 78 subjects not excreting parasites in any of their 15 samples. Eighteen (23.1%) persons had only one type of parasite, while 58 (74.3%) excreted multiple parasites. Giardia and Cryptosporidium were the commonest protozoan infections, affecting 42/78 (53.8%) and 31/78 (39.7%), respectively. Hookworm infestations were the commonest helminthic infections, seen in 48/78 (61.5%). Based on excretion patterns, the asymptomatic individuals could be divided into 2 groups of infrequent and frequent excretors, indicating that the host response may determine the level of parasite replication in the gut.