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Agapidaki E, Souliotis K, Jackson SF, Benetou V, Christogiorgos S, Dimitrakaki C, Tountas Y. Pediatricians' and health visitors' views towards detection and management of maternal depression in the context of a weak primary health care system: a qualitative study. BMC Psychiatry 2014; 14:108. [PMID: 24725738 PMCID: PMC3984632 DOI: 10.1186/1471-244x-14-108] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2013] [Accepted: 04/09/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The present study's aim has been to investigate, identify and interpret the views of pediatric primary healthcare providers on the recognition and management of maternal depression in the context of a weak primary healthcare system. METHODS Twenty six pediatricians and health visitors were selected by using purposive sampling. Face to face in-depth interviews of approximately 45 minutes duration were conducted. The data were analyzed by using the framework analysis approach which includes five main steps: familiarization, identifying a thematic framework, indexing, charting, mapping and interpretation. RESULTS Fear of stigmatization came across as a key barrier for detection and management of maternal depression. Pediatric primary health care providers linked their hesitation to start a conversation about depression with stigma. They highlighted that mothers were not receptive to discussing depression and accepting a referral. It was also revealed that the fragmented primary health care system and the lack of collaboration between health and mental health services have resulted in an unfavorable situation towards maternal mental health. CONCLUSIONS Even though pediatricians and health visitors are aware about maternal depression and the importance of maternal mental health, however they fail to implement detection and management practices successfully. The inefficiently decentralized psychiatric services but also stigmatization and misconceptions about maternal depression have impeded the integration of maternal mental health into primary care and prevent pediatric primary health care providers from implementing detection and management practices.
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Affiliation(s)
- Eirini Agapidaki
- Centre for Health Services Research, Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, 115 27 Athens, Greece
| | - Kyriakos Souliotis
- Centre for Health Services Research, Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, 115 27 Athens, Greece
- Faculty of Social Sciences, University of Peloponnese, Korinth, Greece
| | - Suzanne F Jackson
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Vassiliki Benetou
- Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece
| | - Stylianos Christogiorgos
- Department of Child Psychiatry, University of Athens Medical School, “Aghia Sophia” Children’s Hospital, Athens, Greece
| | - Christina Dimitrakaki
- Centre for Health Services Research, Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, 115 27 Athens, Greece
| | - Yannis Tountas
- Centre for Health Services Research, Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, 115 27 Athens, Greece
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102
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Itzhaky H, Zanbar L. In the front line: the impact of specialist training for hospital physicians in children at risk on their collaboration with social workers. Soc Work Health Care 2014; 53:617-639. [PMID: 25133297 DOI: 10.1080/00981389.2014.921267] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Until recently, dealing with children at risk in Israeli hospitals was almost exclusively the domain of medical social workers. Suspected cases of abuse or neglect must be identified in real-time, during the child's short stay in the hospital, and the decision of whether or not to report the case, and to whom (law enforcement or welfare authorities), must be made. The recognition that effective treatment also demands the involvement of physicians led to the development of an intensive training program for hospital-pediatricians. The current study, based on in-depth interviews with the doctors who participated in the program and the social workers who work with them at 14 hospitals in Israel, examined the impact of the training on cooperation between the two groups, seeking to determine whether the doctors' increased familiarity with the social work profession enhanced team-work. Phenomenological analysis of the interviews revealed several themes, indicating greater collaboration between the doctors and social workers. However, the participants also noted increased friction between the two groups. Possible explanations and practical recommendations for enhancing the potential effectiveness of such collaborations are offered. The study has implications for designing similar training programs as well as for improving the dynamics between the two professions.
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Affiliation(s)
- Haya Itzhaky
- a School of Social Work , Bar Ilan University , Ramat Gan , Israel
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103
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Agapidaki E, Souliotis K, Christogiorgos S, Zervas L, Leonardou A, Kolaitis G, Giannakopoulos G, Dimitrakaki C, Tountas Y. A theory-based educational intervention to pediatricians in order to improve identification and referral of maternal depression: a quasi-experimental study. Ann Gen Psychiatry 2013; 12:37. [PMID: 24266909 PMCID: PMC3874664 DOI: 10.1186/1744-859x-12-37] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Accepted: 10/01/2013] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Maternal depression has a negative impact on both the mother and child's physical and mental health, as well as impairs parenting skills and pediatric health care utilization. The pediatricians' role in identification and management of maternal depression is well established. Although it can be successfully and easily treated, maternal depression remains under-recognized and under-treated. Despite the heightened emphasis, there is lack of interventions to pediatricians in order to improve detection and management of maternal depression. METHODS To address this gap, an educational intervention based on the 'Health Belief Model' was developed, implemented, and evaluated. The present quasi-experimental study, aimed to assess the pediatricians' knowledge, self-efficacy, beliefs, and attitudes toward maternal depression at baseline and post-intervention measurements. A total of 43 randomly selected primary care pediatricians residing in Athens completed a 59-item survey by mail in 2011. Pediatricians in the intervention group received a toolkit about the recognition and management of maternal depression, while pediatricians in the control group received a leaflet about mental health. Descriptive statistics, t test, chi-square, Fisher's exact test, and analysis of variance were used for the statistical analysis. RESULTS Post-intervention measurement revealed differences at a statistical significance level between the two groups, in the following variables: beliefs, attitudes, self- efficacy, perceived barriers, and management practices of maternal depression. Furthermore, at post-measurement, pediatricians in the intervention group demonstrated increased perceived responsibility and increased self-efficacy for detection and referral of maternal depression. CONCLUSIONS Educational interventions to pediatricians seem to be beneficial for the improvement of the pediatricians' knowledge, self-efficacy, and attitudes regarding maternal depression. Studies using large, representative population samples are needed to provide evidence if the training interventions to pediatricians for maternal depression are translated to changes in their clinical practice and improved the patients' health outcomes.
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Affiliation(s)
- Eirini Agapidaki
- Center for Health Services Research, Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Alexandroupoleos st, 25, Athens 115 27, Greece.
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104
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Gonfiantini MV, Villani A, Gesualdo F, Pandolfi E, Agricola E, Bozzola E, Arigliani R, Tozzi AE. Attitude of Italian physicians toward pertussis diagnosis. Hum Vaccin Immunother 2013; 9:1485-8. [PMID: 23732898 DOI: 10.4161/hv.24734] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Resurgence of pertussis has been observed in several countries whereas Italy continues to be a low incidence country. We hypothesize that the low reported incidence of pertussis in Italy could be biased by the attitude of physicians to suspect and diagnose pertussis in different age groups. We investigated the attitude of Italian physicians toward pertussis diagnosis through clinical scenarios. A cross-sectional study was conducted in June 2012 sending online questionnaires to pediatricians and general practitioners (GPs) involved in ambulatory primary care. The questionnaire included five clinical scenarios of patients of different ages (45 d, 5 y, 11 y, 24 y, 58 y) with prolonged cough of at least 2 weeks. Respondents were asked to choose a diagnosis among a list of 14. We observed a decreasing trend of suspected pertussis diagnosis with increasing age of the patient (from 46% at 45 d to 0 at 58 y). In Italy pertussis is seldom suspected in the differential diagnosis of cough particularly in adults. This may cause a significant under-notification of pertussis, with a higher impact in older age groups. Educational programs should be reinforced to consider the differential diagnosis of pertussis in individuals with atypical presentation and in older age groups.
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105
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Abstract
Parents (n = 500) were surveyed about which professional groups they were most likely to seek and follow advice from regarding child discipline as well as their use of corporal punishment (CP). Nearly half of the parents reported that they were most likely to seek child discipline advice from pediatricians (48%), followed by religious leaders (21%) and mental health professionals (18%). Parents who sought advice from religious leaders (vs pediatricians) had nearly 4 times the odds of reporting use of CP. Parents reported that they were more likely to follow the advice of pediatricians than any other professional; however, black parents were as likely to follow the advice of religious leaders as that of pediatricians. Pediatricians play a central role in advising parents about child discipline. Efforts to engage pediatricians in providing violence prevention counseling should continue. Increased efforts are needed to engage other professionals, especially religious leaders, in providing such advice to parents.
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Affiliation(s)
- Catherine A Taylor
- Tulane University School of Public Health and Tropical Medicine, Department of Global Community Health and Behavioral Sciences, New Orleans, LA 70112, USA.
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106
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Abstract
OBJECTIVE To evaluate the clinical utility of the cutoff recommendations for the Vanderbilt ADHD Diagnostic Parent Rating Scale (VADPRS) comorbidity screening scales provided by the American Academy of Pediatrics/National Initiative for Children's Healthcare Quality and to examine alternative cutoff strategies for identifying and ruling out disorders commonly comorbid with attention-deficit/hyperactivity disorder. METHODS A sample of 215 children (142 with attention-deficit/hyperactivity disorder), ages 7 to 11 years, participated in the study. Parents completed the VADPRS and were administered a diagnostic interview to establish diagnoses of oppositional defiant disorder (ODD), conduct disorder (CD), anxiety, and depression. The clinical utility of the VADPRS comorbidity screening scales were examined. RESULTS The recommended American Academy of Pediatrics/National Initiative for Children's Healthcare Quality cutoff strategies did not have adequate clinical utility for identifying or ruling out comorbidities, with the exception of the VADPRS ODD cutoff strategy, which reached adequate levels for ruling out a diagnosis of ODD. An alternative cutoff approach using total sum scores was superior to the recommended cutoff strategies across all diagnoses in terms of ruling out a diagnosis, and this was particularly evident for anxiety/depression. Several individual items on the ODD and CD scales also had acceptable clinical utility for ruling in diagnoses. CONCLUSIONS The VADPRS comorbidity screening scales may be helpful in determining which children likely do not meet diagnostic criteria for ODD, CD, anxiety, or depression. This study suggests that using a total sum score provides the greatest clinical utility for each of these comorbidities and demonstrates the need for further research examining the use of dimensional assessment strategies in diagnostic decision making.
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Affiliation(s)
- Stephen P Becker
- Department of Psychology, Miami University, Oxford, OH 45056, USA.
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Epstein JN, Langberg JM, Lichtenstein PK, Kolb R, Altaye M, Simon JO. Use of an Internet portal to improve community-based pediatric ADHD care: a cluster randomized trial. Pediatrics 2011; 128:e1201-8. [PMID: 22007005 PMCID: PMC3208964 DOI: 10.1542/peds.2011-0872] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [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: 01/22/2023] Open
Abstract
OBJECTIVE To determine the effectiveness of a quality improvement program to improve pediatricians' adherence to existing, evidence-based, attention-deficit/hyperactivity disorder (ADHD) practice guidelines. METHODS Forty-nine community-based pediatricians at 8 practices participated in a cluster-randomized trial. Practices were matched according to the numbers of pediatricians and the proportions of patients receiving Medicaid. The medical charts for a random sample of patients with ADHD for each of the participating pediatricians were examined at baseline and 6 months. All practices participated in 4 sessions of training, including didactic lectures and office flow modification workshops. Practices were then given access to an ADHD Internet portal that allowed parents, teachers, and pediatricians to input information (eg, rating scales) about patients, after which information was scored, interpreted, and formatted in a report style that was helpful for assessment and treatment of patients with ADHD. Physicians evaluated their practice behaviors quarterly and addressed underperforming areas. RESULTS Pediatricians in the intervention group, compared with those in the control group, demonstrated significantly higher rates of many American Academy of Pediatrics-recommended ADHD care practices, including collection of parent (Cohen's d = 0.69) and teacher (d = 0.68) rating scales for assessment of children with ADHD, use of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria (d = 0.85), and use of teacher rating scales to monitor treatment responses (d = 1.01). CONCLUSION A quality improvement intervention that can be widely disseminated by using Internet-based information technology significantly improved the quality of ADHD care in community-based pediatric settings.
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Affiliation(s)
- Jeffery N. Epstein
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio; and ,Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Joshua M. Langberg
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio; and ,Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Philip K. Lichtenstein
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio; and ,Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Rebecca Kolb
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Mekibib Altaye
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio; and ,Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - John O. Simon
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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Guilamo-Ramos V, Bouris A, Jaccard J, Gonzalez B, McCoy W, Aranda D. A parent-based intervention to reduce sexual risk behavior in early adolescence: building alliances between physicians, social workers, and parents. J Adolesc Health 2011; 48:159-63. [PMID: 21257114 PMCID: PMC3118646 DOI: 10.1016/j.jadohealth.2010.06.007] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2010] [Revised: 06/10/2010] [Accepted: 06/11/2010] [Indexed: 10/19/2022]
Abstract
PURPOSE To evaluate the efficacy of a parent-based intervention to prevent sexual risk behavior among Latino and African American young adults. This was delivered to mothers while waiting for their adolescent child to complete an annual physical examination. METHODS A randomized clinical trial was conducted with 264 mother-adolescent dyads in New York City. Adolescents were eligible for the study only if they were African American or Latino and aged 11-14 years, inclusive. Dyads completed a brief baseline survey and were then randomly assigned to one of the following two conditions: (1) a parent-based intervention (n = 133), or (2) a "standard care" control condition (n = 131). Parents and adolescents completed a follow-up survey nine months later. The primary outcomes included whether the adolescent had ever engaged in vaginal sexual intercourse, the frequency of sexual intercourse, and the frequency of oral sex. RESULTS Relative to the control group, statistically significant reduced rates of transitioning to sexual activity and frequency of sexual intercourse were observed, with oral sex reductions nearly reaching statistical significance (p < .054). Specifically, sexual activity increased from 6% to 22% for young adults in the "standard of care" control condition, although it remained at 6% among young adults in the intervention condition at the 9-month follow-up. CONCLUSIONS A parent-based intervention delivered to mothers in a pediatric clinic as they waited for their child to complete a physical examination may be an effective way to reduce sexual risk behaviors among Latino and African American middle-school young adults.
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Affiliation(s)
- Vincent Guilamo-Ramos
- Silver School of Social Work, New York University, Washington Square North, New York, NY 10003, USA.
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Abstract
BACKGROUND Spirometry is the most basic, widely used and effort-dependent pulmonary function test. It assesses the lung volumes and flows, and is ideally suited to describe the effects of restriction or obstruction on lung function. Therefore, keeping in view the clinical applications of spirometry, this study attempts to explore the knowledge and practice about spirometry among pediatricians. MATERIALS AND METHODS A questionnaire-based study was conducted across multiple centers in various hospitals in Riyadh, Saudi Arabia. The structured questionnaire, based upon knowledge and practice of spirometry, was distributed to 150 pediatricians in the various tertiary care hospitals in the metropolitan area of Riyadh. RESULTS Ninety-four percent of 113 pediatricians agreed that spirometry is a valuable tool in pediatric clinical practice. However, knowledge relating to spirometry was lacking among pediatricians, and about 86% of the study population did not demonstrate up-to-date knowledge of spirometry in pediatrics. Only 11% of pediatricians were very confident in interpreting spirometry results. No statistically significant association was observed between the distribution of responses relating to knowledge and practice of spirometry and the study variables including academic position, duration of practicing experience and number of patients attended daily. CONCLUSION The results indicated that pediatricians in Riyadh were lacking adequate knowledge about the clinical applications of spirometry in their daily clinical practice. Hence, it was suggested that pediatricians should attend periodical training, workshops and continuous medical education programmes to enhance their knowledge. This should especially be performed during their pediatric residency training programmes, as spirometry is one of the essential components in clinical practice.
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Affiliation(s)
- Muslim Mohammed Al-Saadi
- Department of Pediatrics, College of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia.
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