Abstract Pacific Northwest wildfire smoke events have been increasing in prevalence and severity over the past three decades, resulting in documented negative health outcomes in adults. However, there is less evidence demonstrating the effect of wildfire smoke in pediatric populations. To evaluate the association between wildfire smoke exposure and healthcare utilization in a pediatric tertiary medical center in Seattle, WA. We utilized a case–crossover study to determine the odds of pediatric emergency department (ED) visit/ hospital admission at Seattle Children’s Hospital on wildfire smoke days versus non-wildfire smoke days during wildfire season (June to September), 2006–2020. The health outcomes dataset reports hospital encounters in two categories: ED visits or admissions that are for inpatient or observational purposes. The health outcomes dataset reports hospital encounters in two categories: ED visits or admissions that are for inpatient or observational purposes. The reported encounter types are mutually exclusive. We stratified analyses by individual-level characteristics and examined associations for lagged exposures 0–7 d prior to admission. In adjusted analyses, smoke exposure was associated with a 7.0% (95% CI: 3.0%–12.0%) increase in odds of all-cause hospital admissions and a 0.0% (95% CI: −3.0%, 3.0%) change in odds of all-cause ED visits. We also observed increases in the odds of all-cause hospital admissions ranging from 4.0% to 8.0%, for lagged exposure on days 1–7. When stratified by health outcomes, we found a 9.0% (95% CI: 1.0%–17.0%) and an 11.0% (95% CI:1.0%–21.0%) increase in the odds of ED visits for respiratory and respiratory infection-related concerns, respectively. Our results demonstrate associations between wildfire smoke and negative health effects in children. Similar to other studies, we found that wildfire smoke exposure was associated with an increase in respiratory-related ED visits and all-cause hospital admissions in a pediatric population. These results will help inform patient education and motivate interventions to reduce pediatric morbidity during wildfire season.
The annual London School of Paediatrics(LSP) trainee survey, of on average 950 trainees, year on year shows variation in overall training placement satisfaction amongst the 31 Trusts. The 2022 LSP survey showed that 78% of trainees rated their placement as good/excellent, which leaves a quarter of trainees experiencing training which is average, below average and poor. To ensure a high standard of training is available to all trainees across Trusts and the variation in trainee placement satisfaction is minimised, Excellence Exchanges ('EEs') have been developed. The 'EEs' provide an opportunity for Trusts to showcase their 'Excellence' and share how they have resolved challenges faced in providing training. The Exchanges also ascertain using the LSP survey which areas of training to improve locally and develop solutions with support from the LSP and Deanery.
Method
The 'EEs' are widely advertised and individual Trusts voluntarily sign up to participate. The 'EE' is organised by the LSP Trainee Committee and supported by HEE/London Deanery (Head of School and TPDs) and LSP (College Tutors and Trust Reps). Integrated working between the Deanery, LSP and at the Trust level locally by the Trainees and Consultants is key to the execution and success of the 'Exchange'. There is a preparation pack and the 'Exchange' follows a set structure with a Powerpoint to ensure the process is standardised and each 'EE' discusses; the LSP survey data, The Excellence (what and how maintained) and Improvements (what and plan). Exchange posters are completed and a local 'EE' champion supervises QI work and feedback. All excellence and learning from the Exchange is collated and shared on the LSP website and Bulletin.
Results
To date, six Trusts have participated in an 'EE' of which 2 were Tertiary centres and 4 District General Hospitals. Four exchanges occurred in person and 2 virtually. Three further Trusts have been scheduled. The feedback has been overwhelmingly positive. One college tutor commented 'such a buzz and great to have your insights. Work afoot to start our action plan'. Another College Tutor commented on 'the relaxed, friendly and non-threatening nature of the Exchange'.
Conclusion
The 'Excellence Exchanges' are a welcomed initiative by trainees and trainers to ensure high quality training is provided and maintained in Trusts across the LSP. The Exchanges are a structured and non-judgemental way for shared learning and improvement work to take place locally with support from the Deanery.
Abstract Background Australian policy reports recommended schools to be leveraged to better support student mental health, with a focus on regional and rural areas where students have poorer mental health outcomes. In designing solutions to address this systemic gap, decision‐makers require an understanding of the barriers and facilitators experienced by regional and rural schools. However, current literature has focused on metropolitan schools and neglected to explore facilitators. Objective To review the evidence on barriers and facilitators in delivering student mental health support experienced by regional and rural schools in Organisation for Economic Co‐operation and Development nations. Design A mixed‐methods systematic review of peer‐reviewed and grey literature. Findings The search identified 4819 studies. A full‐text review by 2 reviewers resulted in 5 papers, which met the inclusion criteria and were assessed using methodological appraisal. One study used qualitative data, 2 studies used quantitative data, and 2 studies were a mixed‐methods design. Discussion While there was a paucity of studies, this review draws together the most up‐to‐date research. The barriers and facilitators were categorised into 3 themes: access to services and resources; mental health literacy of staff and parents; and communication and collaboration between stakeholders. Conclusion This review presents a comprehensive synthesis of the literature and highlights opportunities to leverage rural and regional schools to support student mental health, focusing on the quality of communication and collaboration, and increasing access to services and resources, and mental health literacy. Research should explore the unique advantages of rural and regional areas to inform policy, including a focus on strengths.
High quality paediatric training is essential to the provision of excellent child health care both now and in the future. To ensure a high standard of training is maintained within The London School of Paediatrics, an annual trainee survey has taken place since 2012. The COVID-19 pandemic brought new challenges to paediatric training (and meant that many of the usual metrics to assess training across the region became obsolete) and in September 2020, The School conducted an abbreviated, tailored survey to capture experiences of trainees, and challenges faced in training during a pandemic.
Objectives
To ascertain the ways in which London paediatric trainees were impacted by the emergency operational response to the first wave of the COVID-19 pandemic. To provide rapid feedback to training centres to inform the response to any subsequent surges.
Methods
950 (769 in programme) London Paediatric trainees were surveyed about their March-September 2020 training placement. Online survey was emailed directly, with reminders, and promoted via social media. Five closed questions addressed overall placement satisfaction (excellent to poor), performance areas (morale, educational supervision, teaching and rest/catering facilities), and specific impact of covid-19. Three free text questions addressed the impact of covid-19, positive practices and initiatives, and areas of improvement.
Results
There were 638 responses, with 566 from in-programme trainees (74% of in-programme trainees). 83.4% trainees rated their placement excellent/good (2019, 84%) and 5.8% rated it poor/below average (2019, 4%). There was inter-sector variability, with higher number of poor/below average ratings in the sector with most disruption to service. 147 (23%) trainees were seconded from their placement, 102 (16%) to another paediatric department and 45 (7%) to an adult department. 102 (16%) trainees worked additional antisocial hours to cover for seconded colleagues, and 165 (26%) worked additional antisocial hours for other reasons. 38 (6%) trainees had no direct patient contact. Only 125 trainees (20%) reported that their work was not impacted by COVID. Other ways in which work was impacted included: cancelled OOP (11), PICU taken over for adult patients (13), department closed without redeployment (5). The performance area most impacted by the pandemic was the provision of educational supervision. There was improvement in provisions for rest, food and drink. Thematic analysis of the free text identified that good team relationships, senior support and a supportive work environment were key to a positive training experience. Challenges faced were around teaching, lack of learning opportunities and poor communication. 8% of trainees highlighted that lack of communication worsened their training experience.
Conclusions
The survey shows that overall, the excellent standards of training were maintained during the first wave, despite evidence of significant disruption to services. The highlighted challenges can be used to guide training provision during the ongoing pandemic, and ensure that trainees continue to receive the highest standard of training.
Chronic nonbacterial osteomyelitis (CNO) is a rare autoinflammatory disease that causes bone destruction, soft tissue swelling, and bone pain1. Diagnosis and treatment are hindered by a lack of a reliable laboratory test to assess disease activity. Bone inflammation in CNO is associated with increased osteoclastic activity and bone resorption, causing focal accelerated breakdown of bone collagen. This may be measured through elevated urinary N-terminal telopeptide (NTx). Miettunen, et al reported rapid decline of urinary NTx in children with CNO after pamidronate treatment and subsequent rise of NTx was correlated with disease flare2. The initial NTx from patients with CNO was not different from that of healthy children. Correlation of NTx with disease activity in patients with CNO not treated with pamidronate has not been investigated. We sought to determine if NTx values correlate with CNO disease activity in children treated without a bisphosphonate. Children with a CNO diagnosis made by a pediatric rheumatologist as well as their nonadult healthy siblings were recruited from the rheumatology clinics after written informed consent was obtained (approved by Seattle Children’s Hospital, IRB 14426, and University of Iowa, IRB 200308051). Inclusion criteria consisted of a clinical diagnosis of CNO, … Address correspondence to Dr. Y. Zhao[4][1], 4800 Sand Point Way NE, Seattle, WA 98105, USA. Email: yongdong.zhao{at}seattlechildrens.org. [1]: #ref-4
Paresthesias have previously been reported among adults in occupational and non-occupational settings after dermal contact with pyrethroid insecticides. In this report, we describe a preverbal 13-month-old who presented to his primary care pediatrician with approximately 1 week of odd facial movements consistent with facial paresthesias. The symptoms coincided with a period of repeat indoor spraying at his home with a commercially available insecticide containing two active ingredients in the pyrethroid class. Consultation by the Northwest Pediatric Environmental Health Specialty Unit and follow-up by the Washington State Department of Health included urinary pyrethroid metabolite measurements during and after the symptomatic period, counseling on home clean up and use of safer pest control methods. The child’s symptoms resolved soon after home cleanup. A diagnosis of pesticide-related illness due to pyrethroid exposure was made based on the opportunity for significant exposure (multiple applications in areas where the child spent time), supportive biomonitoring data, and the consistency and temporality of symptom findings (paresthesias). This case underscores the vulnerability of children to uptake pesticides, the role of the primary care provider in ascertaining an exposure history to recognize symptomatic illness, and the need for collaborative medical and public health efforts to reduce significant exposures in children.
Agricultural work is one of the most dangerous jobs for adolescents. Through a university-community partnership, the authors surveyed young primarily acculturated Latino-American farmworkers 14 to 18 years of age regarding their agricultural work experience. Topics included occupational health and safety education, work history, and information sources. The authors also evaluated the Rapid Clinical Assessment Tool (RCAT), a pictorial tool for identifying agricultural tasks to enhance discussion with clinical providers. One hundred forty youth with farmwork experience completed the survey; 6% reported a previous work-related injury or illness and 53% reported receiving some workplace health and safety training. Correct identification of legally restricted duties for youth varied but were generally low: participants identified working alone past 8 pm (57%), driving a forklift (56%), doing roofing work (39%), working in freezers (34%), and driving a delivery vehicle (30%). The Internet was identified as the most likely and reliable place youth would go to find information on workplace health and safety. Few (15%) reported clinician-initiated conversations on occupational health; however, a high proportion responded positively to questions regarding the usefulness of the RCAT for this purpose. This study highlights the need for workplace health and safety guidance for youth employed in agriculture. The results support Internet-based outreach and use of the RCAT to help facilitate occupational health discussions in clinical settings.
Abstract Purpose The American Academy of Pediatrics emphasized in a 2007 policy statement the importance of educating trainees on the impacts of climate change on children’s health, yet few studies have evaluated trainee knowledge and attitudes about climate change–related health effects in children. This multi-institution study assessed pediatric resident and program director (1) knowledge/attitudes on climate change and health, (2) perspectives on the importance of incorporating climate and health content into pediatric graduate medical education, and (3) preferred topics/activities to include in climate and health curricula. Method This mixed-methods study employed an anonymous cross-sectional survey of pediatric residents and residency program directors from Association of Pediatric Program Directors (APPD) Longitudinal Educational Assessment Research Network (LEARN)–affiliated programs. Multivariable regression models and factor analyses were used to examine associations among resident demographics and resident knowledge, attitudes, and interest in a climate change curriculum. A conventional content analysis was conducted for the open-ended responses. Results Eighteen programs participated in the study with all program directors (100% response rate) and 663 residents (average response rate per program, 53%; overall response rate, 42%) completing respective surveys. Of the program directors, only 3 (17%) felt very or moderately knowledgeable about the association between climate change and health impacts. The majority of residents (n=423, 64%) agreed/strongly agreed that physicians should discuss global warming/climate change and its health effects with patients/families, while only 138 residents (21%) agreed/strongly agreed that they were comfortable talking with patients and families about these issues. Most residents (n=498, 76%) and program directors (n=15, 83%) agreed/strongly agreed that a climate change curriculum should be incorporated into their pediatrics training program. Conclusions Pediatric residents and program directors support curricula that prepare future pediatricians to address the impact of climate change on children’s health; however, few programs currently offer specific training, despite identified needs.
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