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Tobacco use begins at a young age and is the leading cause of preventable disease, disability and death in the United States.Secondhand smoke increases the risk of ear and respiratory infections, asthma attacks, and unexpected infant death.Smoking cessation research in inpatient pediatrics is rarely a formal quality improvement program and is mostly conducted in academic institutions.We sought to increase smoke exposure screening, smoking cessation education, and referrals in our community hospital pediatric population.With improved screening and documentation, we expect to increase provider awareness and smoking cessation interventions.
All paediatric wards, neonatal nurseries and secondary nurseries are eligible.Interventions included education on smoke exposure screening and helpline referrals, standardized screening and discharge documentation, visual reminders, and helpline wallet cards.
The primary outcome measure was the percentage of pediatric hospital admissions screened monthly for smoke exposure.A secondary outcome was the percentage of pediatric inpatients with a positive smoking screen who received a discharge instruction or a helpline referral (by themselves or a family member).The residence time (LOS) was monitored as a balancing measure.
Results measures were analyzed using Statistical Process Control in SPC for Excel.Baseline and intervention periods for LOS were compared with t-tests.
We increased the baseline mean smoke exposure screening rate from 14% to 73%, meeting the criteria for special-cause variation (Figure 1).Education to avoid exposure to smoke increased from 5% to 57%.Hotline referral rate increased from 0% to 21%.The length of hospital stay did not change significantly.
The vertical line is the time of intervention.1) Begin monthly pediatrician education 2) Standardize EMR documentation, post visual reminders 3) Provide hotline wallet card.UCL=Upper Control Limit, Avg=Mean, LCL=Lower Control Limit Baseline: Dec 2019-Nov 2020.Intervention: December 2020 – June 2021
Pediatrician-led smoking cessation interventions were feasible and effective in community hospital paediatric wards with no significant effect on length of stay.
Pleioblastoma is a rare skin tumor that is often confused with a dermoid or cleft arm cyst.Julian et al reported that pilomatoma was misdiagnosed preoperatively in as many as 75% of cases.
We report the case of a child with Turner syndrome who was diagnosed with piloblastoma on biopsy.We review histopathological features and highlight their association with Turner syndrome.
A 2-year-old woman with Turner syndrome presented with a 6-month-old progressive mass above her right upper lip.
On examination, she performed well, with phenotypic features of Turner syndrome.A 0.5 x 0.5 cm erythematous, warty, well-circumscribed, nontender, movable lesion was found above her lip.
She had the lump removed completely with no complications.Excisional biopsy showed the presence of viable basal cells and shadow cells, confirming the diagnosis of piloblastoma.
Piloblastoma, also known as piloblastoma, is a benign subepidermal tumor of the hair follicle stroma.Lesions occur on the face and neck, with an average age of onset between 5.8 and 7 years.
Lesions are usually asymptomatic, but inflammation and ulceration may occur.The most common clinical presentation is a firm subcutaneous lesion with an irregular surface.Covered skin may be red, blue or show tent signs.Study reports initial development of pioblastoma in children with Turner syndrome.Although animal studies suggest there is a genetic component, the exact cause is unknown.
Histopathologically, piloblastomas appear as masses composed of viable basal cells, shadow cells, calcifications, and ossification.The mainstay of treatment for piloblastoma is complete surgical excision, as the lesions do not resolve spontaneously.Early resection within 12 months of diagnosis was associated with better cosmetic outcomes.Recurrence and malignant transformation are rare.
This case highlights the importance of considering piloblastoma as the cause of a solitary skin nodule, especially when it is on the head, neck, or upper extremities.In addition, physicians caring for children with Turner syndrome should be aware of the prevalence of pioblastoma in this population.
Students at the Fresno High School Women’s Alliance continue to work with pediatricians at UCSF Fresno, using a “youth as a partner” approach to create community action research projects on topics of youth concern.With COVID19 causing students to notice social isolation and growing depression among themselves and their peers, teens at the Women’s League chose last year to focus on improving the mental health of their peers.Mental Health Hopscotch was chosen for its simplicity and ease of use.Its use is further fueled by the fact that it was created by teens in response to the COVID19 pandemic.
Students work with the school’s social-emotional health and support teams to choose mental health interventions during National Mental Health Month.They created a mental health ‘sunshine’ at the school’s entrance, chalked positive affirmations in a sun-shaped chart for all to see, and chalked a mental health ‘sunshine’ on the sidewalk in front of the school Hopscotch.Distribute silicone bracelets with motivational quotes and mental health awareness pencils, stickers and mini buttons to those who have completed hopscotch.A QR code linked to a Google Sheet was used to survey students who had completed hopscotch.
A survey of 42 students was conducted.12% of students said their average stress level was “just right”, 38% said they could “handle” their stress, 21% said they were “stressed” and 19% said they were “starting to lose stress” , and 10% described their stress as “out of control.”Students deal with stress primarily by listening to music (31%), exercising (19%) and sleeping (14%).Half of the students surveyed reported difficulty falling asleep at night, and 90 percent felt that doing mental health hopscotch helped lift their mood.
Although only a limited number of students were surveyed due to the limited number of students at school, most students felt stressed, with half reporting difficulty falling asleep at night.Mental Health Hopscotch provides an easy, fast, and free way to lift student moods, enabling teens concerned about their peers’ mental health to conduct mental health interventions on their own campuses.
Daylight Saving Time (DST) is a biannual time change that moves clocks forward an hour during “Spring Forward”, which can cause most of society to sleep deprivation.During “backwards”, the opposite is true.Circadian rhythm disturbances have been shown to affect cardiovascular, neuropsychiatric, metabolic, immune-related and unexpected events in adults.A 2018 study showed an increase in emergency department (ED) visits in adults in the time after DST.These findings have not been validated in the pediatric population and, if present, could have implications for the number and expectations of managing ED patients.We hypothesized that mass sleep deprivation following spring time changes would lead to increased ED manifestations, especially in certain manifestations (neurological, psychiatric, accidental/traumatic) that may be particularly susceptible to sleep deprivation, and that fall time changes would an opposite effect.
We retrospectively collected and analyzed major medical complaints from all children (0-16 years) who presented to the ED at BC Children’s between 2011 and 2019 during the 2 weeks before and 3 weeks after the twice-yearly DST timing changes.Incidence rate (IR) presentations for ED were calculated from day 0 (the date of the time change) to day 7.Calculate IR for all presentations and segment by specialty.
After excluding contagious manifestations, IR increased in the first week after the spring time change: 6% on Monday, 7% on Tuesday, and 6% on Wednesday, although the results were not statistically significant (p>0.05).Significant declines (p<0.05) after change in time of decline: 12% on Monday, 13% on Tuesday, and 8% on Wednesday.
The IR increased with the seasonal timing of spring, although this did not reach statistical significance.IR dropped significantly in the three days following the fall shift.These findings suggest that widespread sleep deprivation during spring changes can adversely affect children’s health, while additional sleep during autumn changes may be protective.
Circadian disruption caused by DST in children shows a potentially important impact on emergency room visits, and further research could lead to better patient care and ED preparation.This may help in developing policies regarding DST needs.
Adults with a history of adverse childhood experiences (ACEs) are at increased risk of chronic disease and therefore poorer health.However, the impact of chronic disease awareness on adult health outcomes with ACEs has not been studied.The purpose of this study was to determine the relationship between general health status and chronic disease, access to care, and awareness of chronic disease in adults with a history of ACE.
Data from the 2019 Behavioral Risk Factor Surveillance System was analyzed.Descriptive statistics were used to determine the prevalence of ACE, chronic disease, health care access, chronic disease awareness, general health status, and demographic characteristics.Bivariate analysis was performed using the chi-square test for ACE history for all independent variables and general health for all independent variables.Multivariate logistic regression was used to determine the relationship between general health and ACE, adjusted for chronic disease, health care access, chronic disease awareness, and demographics.
Of the 78,112 respondents, 63% reported exposure to at least one ACE.History of ACE was associated with high prevalence of chronic disease (p<0.002), low health care coverage (p<0.0001), low awareness of chronic disease (p<0.006), and reporting of general health status (p<0.0001). Adjusted analysis Among adults, adults with 2, 3, and ≥4 ACE events were 1.24, 1.22, and 1.45 times more likely to report fair/poor health, respectively, compared with adults who did not report ACE events.
Adults with a history of ACE face barriers to achieving health.There is a need to expand ACE screening in the primary setting so that early intervention can improve overall health outcomes.
The prevalence of overweight adolescents has increased dramatically over the past decade.While previous studies have demonstrated the impact of diet, exercise habits, and parenting styles on obesity rates, this early study explored the relationship between hospitalization, social vulnerability indices, social determinants of health, and childhood obesity.
We studied children aged 5 to 17.9 years, observed in inpatient (n=39) and outpatient (n=35) settings at Loma Linda University Health Affiliated Medical Facility between January 2020 and June 2021.We collected body mass index scores (BMI) and demographic information.A standardized questionnaire collected social determinants of health information available in electronic health records.Using home addresses, we determined the Social Vulnerability Index (SVI) associated with their census tracts (Flanagan, 2011) (Centers for Disease Control, 2018).The SVI ranks each region based on four main themes: socioeconomic status, household composition and disability, minority status and language, and housing and transportation.
The most striking comparison was the difference in risk between the inpatient (n=39) and outpatient (n=35) populations.Inpatients were more likely than outpatients to experience social contact risk (p=0.046), financial risk (p=0.0006), and food insecurity (p=0.0077).
When comparing patients living in the upper quartile (n=40) and lower quartile (n=34) of SVI, BMI, financial risk, food insecurity risk, transportation risk, physical activity risk, and stress risk were almost No difference. The same difference exists when comparing the age groups of younger and older children.
BMI ≤ 85% = normal weight or underweight, BMI > 85% = overweight or obese (Kuczmarski, 2002).*Hisp = Cuban, Mexican, Puerto Rican, South/Central American, or other culture, regardless of race (U.S. Census Bureau, 2011).
There were significant differences in risk between pediatric inpatients and outpatients.Actions can be taken to identify hospitalized patients with reduced resources to improve food insecurity, social connection risk, and financial risk.Although SVI is important for understanding each patient’s context, each family has unique social determinants and risks that physicians can address.
Social status and food insecurity (FiS) may contribute to health disparities among youth.This study aimed to assess whether subjective social status (SSS) and FiS were associated with weight-specific quality of life (wQoL) in obese Latino adolescents.We further explored whether relationships differed by gender.
141 Latino youth with obesity (47% male; mean age: 15.3±0.9) completed surveys assessing SSS, perceived FiS, and wQoL (self, society, and environment).After controlling for gender and BMI percentiles, separate linear regression models were performed to examine the relationship between SSS and FiS and wQoL.Data were then stratified by sex to determine Pearson r for wQoL and SSS and wQoL and FiS.
Mean total (64.1±24.9), self (57.3±29.3), social (69.5±25.6) and environmental (60.5±26.3) wQoL, with males reporting higher total, self and environmental wQoL than females (all p<0.05) controlling for BMI back.More than a third of the cohort reported very low levels of food insecurity (36.2%) or marginal food insecurity (34%), which did not differ by gender.Although there were no gender differences in SSS society (mean difference = -0.074, p=0.77) or SSS school (mean difference = -0.354, p=0.28), there was a positive association between SSS school and all wQoL scales, regardless of gender (all p<0.01).SSS schools were total wQoL (β=4.24, p<0.001) and self (β=3.49, p=0.008), social (β=4.40, p<0.001) and environmental (β=4.57, p<0.001) subscales.SSS schools explained 9% of the variance in total, social, and environmental wQoL, and 4% of the variance in ego wQoL.There was an inverse relationship between FiS and all wQoL scales, especially for those who experienced marginal and high FiS (p<0.03 for all).This association was stronger for men on all wQoL scales at all FiS levels, except for high FiS.Marginal FiS was a significant predictor of overall (β=-12.94, p=0.006), ego (β=-12.48, p=0.029), social (β=-12.06, p=0.013) and environment (β=-14.66) , p=0.003) wQoL after controlling for gender and BMI percentiles.High FiS was a significant predictor of overall (β=-22.46, p<0.001), ego (β=-18.56, p=0.016), social (β=-24.16, p<0.001) and environment (β=-22.76) , p<0.001) wQoL after controlling for gender and BMI percentiles.Marginal and high FiS explained 8% of the variance in overall, social, and environmental wQoL, and 3% of the variance in ego wQoL.
In Latino youth with obesity, social status was associated with wQoL, whereas food insecurity was negatively associated with wQoL.
The prevalence of childhood obesity continues to increase.In Nevada, about 40 percent of teens are overweight or obese, and 70 percent of children will remain overweight as adults.Traditional medical school programs do not adequately prepare students to counsel families on this issue.The purpose of this study was to assess the progress of the knowledge base of third-year medical students involved in managing obesity in children and adolescents over the course of a pediatric clinical curriculum.
A survey was conducted among 63 medical students in the third-year clinical trainee program at the University of Nevada, Reno School of Medicine to assess their knowledge of childhood obesity and perceptions of treatment prior to a six-week pediatric traineeship.During the internship, students received instruction in the diagnosis and treatment of obesity.At the end of the internship, the students conducted a post-study survey to assess the knowledge gained during the internship.Paired-samples t-tests and chi-square tests were used to assess pre- and post-survey differences.
After practice, the mean scores for knowledge and comfort in recommending treatment plans for overweight/obese children were pretest (M=1.97, SD=0.91) and posttest (M=3.55, SD=0.89) (t(62)= 10.25, p<0.0001).Before testing (M=2.40, SD=0.90) and after testing (M=3.86, SD=0.77) (t(62)=10.33, p<0.0001).Furthermore, before the test (M=2.91, SD=0.75) and after the test (M=3.34, SD=0.76) (t(62)=3.23, p=0.0019).
The course increases students’ awareness and understanding of childhood obesity.In particular, perceived comfort and ability to counsel patients and families about obesity prevention and treatment increased.As obesity remains a challenge, medical student education in this field must be expanded to address this issue.
The ongoing COVID-19 pandemic presents considerable challenges for heart transplants.Most notably, at the start of the pandemic, our center proposed changes to the outpatient care of post-transplant patients to further prevent virus transmission and protect highly immunosuppressed recipients.For example, blood draws for immunosuppression adjustment were performed at home, and early coronary angiography was cancelled.Video interviews were conducted at 7, 9, and 11 months postoperatively.Despite these changes in management, no formal analysis of the impact of these changes on outcomes in heart transplant recipients has been conducted.Now more than a year from the onset of the pandemic, we sought to examine whether modifications in outpatient care affected 1-year outcomes for transplant patients during the onset of the COVID-19 pandemic.
Between March 6 and September 1, 2020, we evaluated 50 heart transplant patients who were transplanted during the COVID-19 pandemic.These patients were compared with those who received transplants in the same month from 2011 to 2019 (n=482).Endpoints included subsequent 1-year survival, 1-year freedom from heart graft vascular disease (CAV: stenosis ≥ 30%), 1-year freedom from any treatment rejection, 1-year freedom from acute cellular rejection, and 1-year freedom from antibody-mediated rejection , length of hospital stay and ICU stay, and 1-year absence of non-fatal major adverse cardiac events (NF-MACE: MI, new CHF, PCI, ICD/pacemaker, or stroke).
Patients transplanted during the COVID-19 pandemic had similar outcomes compared to patients transplanted in the years prior to the pandemic.There were no significant differences in length of hospital stay and ICU stay between the two groups.There were also no significant differences between the groups in 1-year survival, 1-year freedom from CAV, 1-year freedom from any treatment rejection, and 1-year freedom from acute cellular or antibody-mediated rejection.Patients transplanted during the pandemic had significantly improved NF-MACE degrees of freedom at 1 year.
Heart transplantation during the COVID-19 pandemic appears to be safe, with 1-year outcomes comparable to previous years, despite necessary changes in posttransplant care to mitigate the spread of COVID-19 and protect immunosuppressed populations.
During this time, the COVID-19 pandemic has impacted how our medical staff treat heart transplant (HTx) patients.The patient can be seen virtually via telemedicine, and the patient is self-isolating at home.We do not know the effect of this treatment on HTx outcomes during the COVID pandemic.Medication and medical adherence may have increased as patients self-isolate, and non-COVID infection rates may have decreased as patient self-isolation minimizes exposure.None of these factors had been previously assessed, therefore, we reviewed our large single-center patient population for this study.
Between March 2020 and September 2020, we evaluated 55 HTx patients who were transplanted during this period and followed for 6 months.Patients are self-isolating and changing to virtual visits every other visit to minimize exposure to COVID.The study’s endpoints included 6-month survival, readmission, number of non-COVID infections (defined as the need for intravenous antibiotics), any treatment rejection (ATR), and maintenance of therapeutic immunosuppressive blood levels.The study patients were then compared to a control group for the first three years, on average annually at the same time points on March 13, 2017, March 13, 2018, and March 13, 2019, and followed for 6 months.Each group was averaged and then compared with the study group.
Post time: Jul-18-2022