Current Problems in Pediatric and Adolescent Health Care最新文献

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How the public’s knowledge, attitudes, and practice intersect with scientific evidence about fluoride 公众的知识、态度和实践如何与氟化物的科学证据相交叉。

IF 3.7 4区医学 Q1 PEDIATRICS

Current Problems in Pediatric and Adolescent Health Care

Pub Date : 2025-06-01 DOI: 10.1016/j.cppeds.2025.101768

Christine Till PhD , Jana El-Sabbagh B.Sc. , Carly Goodman MA , Mikel Subiza-Pérez PhD , Meaghan Hall MA

For over 75 years, community water fluoridation has been implemented as a public health strategy to reduce dental caries. While early studies suggested dramatic reductions in dental caries, recent evidence indicates that the benefits of community water fluoridation are more modest. Concurrently, concerns have grown over rising rates of enamel fluorosis and possible links between fluoride intake and lowered intelligence in children and thyroid hormone disruption, even at exposure levels found in fluoridated regions. This first part of this paper discusses the historical context and current scientific evidence on the effectiveness of community water fluoridation and safety of systemic fluoride. The second part presents findings from a fluoride survey conducted with 8011 adults in Canada and the U.S. The survey assessed knowledge about fluoride, public perceptions of the risks and benefits of community water fluoridation, and fluoride use with young children. Overall, 60 % of respondents correctly identified why fluoride is added to drinking water. Knowledge of community water fluoridation was higher among older, more educated, and White participants. Among those familiar with community water fluoridation, 51 % expressed support, 27 % opposed it, and 25 % were neutral. Support was primarily driven by confidence in its safety and benefits, while opposition was driven by safety concerns and perceived violations of personal freedom. Trust in public health officials was higher among supporters (87 %) compared with non-supporters of community water fluoridation (52.1 %). When presented with hypothetical risk-benefit scenarios, participants consistently prioritized the prevention of potential health risks, such as reduced IQ, over the relatively modest dental benefit of preventing one cavity. The survey also revealed that most parents report using more fluoride toothpaste for young children than recommended, suggesting a gap in adherence to safe fluoride use guidelines. Our findings highlight mixed public views on community water fluoridation and knowledge gaps surrounding fluoride toothpaste use with children, underscoring the need for clear, evidence-based communication about fluoride exposures.

75年来，社区饮水氟化作为一项减少龋齿的公共卫生战略一直在实施。虽然早期的研究表明可以显著减少龋齿，但最近的证据表明，社区饮水氟化的好处更为有限。与此同时，人们越来越关注氟牙釉质中毒率的上升，以及氟摄入与儿童智力下降和甲状腺激素紊乱之间可能存在的联系，即使在氟化地区的接触水平也是如此。本文第一部分讨论了社区水氟化有效性和系统氟化物安全性的历史背景和当前的科学证据。第二部分介绍了对加拿大和美国8011名成年人进行的氟化物调查的结果。该调查评估了有关氟化物的知识、公众对社区用水氟化的风险和益处的看法，以及幼儿使用氟化物的情况。总体而言，60%的答复者正确地确定了在饮用水中添加氟化物的原因。老年人、受教育程度较高的人和白人参与者对社区饮水氟化的了解程度较高。在熟悉社区水氟化的人中，51%表示支持，27%表示反对，25%表示中立。支持的主要原因是对其安全性和益处的信心，而反对的主要原因是对安全的担忧和对侵犯人身自由的看法。社区饮水氟化的支持者（87%）比非支持者（52.1%）更信任公共卫生官员。当提出假设的风险-收益情景时，参与者始终优先考虑预防潜在的健康风险，如智商降低，而不是预防一个蛀牙的相对适度的牙齿益处。调查还显示，大多数家长报告说，他们给幼儿使用的含氟牙膏比建议的要多，这表明在遵守安全氟化物使用指南方面存在差距。我们的研究结果突出了公众对社区饮水氟化的不同看法，以及围绕儿童使用含氟牙膏的知识差距，强调了对氟化物暴露进行明确、基于证据的沟通的必要性。

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Foreword: Issue 1 Providing a PCPs learning pathway around the RBC, CBC, and bleeding in a pediatric patient. 前言：第1期：在儿科患者中提供围绕红细胞、CBC和出血的pcp学习途径。

IF 3.7 4区医学 Q1 PEDIATRICS

Current Problems in Pediatric and Adolescent Health Care

Pub Date : 2025-05-01 Epub Date: 2025-06-25 DOI: 10.1016/j.cppeds.2025.101760

John W Harrington

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Analyzing the CBC for common pediatric hematologic disorders in primary care. 分析初级保健中常见儿科血液病的CBC。

IF 3.7 4区医学 Q1 PEDIATRICS

Current Problems in Pediatric and Adolescent Health Care

Pub Date : 2025-05-01 Epub Date: 2025-07-01 DOI: 10.1016/j.cppeds.2025.101761

Charlotte McCrary, Eric J Lowe

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Evidence-based practice recommendations for infection prevention in pediatric sickle cell patients: Interventions for the primary care provider. 儿童镰状细胞患者感染预防的循证实践建议：初级保健提供者的干预措施。

IF 3.7 4区医学 Q1 PEDIATRICS

Current Problems in Pediatric and Adolescent Health Care

Pub Date : 2025-05-01 Epub Date: 2025-07-14 DOI: 10.1016/j.cppeds.2025.101763

Elizabeth K Webb, Amanda A Cavness, William C Owen

In this article, we provide pediatric primary care providers (PCPs) with evidence-based recommendations to reduce the risk of life-threatening bacterial infections in pediatric patients with sickle cell disease (SCD). Standard practice guidelines for SCD comprehensive care are lacking in comparison to other chronic diseases. There is a need for continued advocacy for quality healthcare for patients with SCD, including updated standard-of-care guidelines. As a result of these concerning inequities, PCPs and specialty providers are forced to reference and compare recommendations across several different health organizations to identify the best practice. PCPs should feel empowered to follow augmented immunization schedules in pediatric patients with SCD. Immunizations and proper antibiotics can be lifesaving against invasive meningococcal and pneumococcal infections. We outline opportunities for improving quality of care in pediatric patients with SCD for PCPs in the community.

在本文中，我们为儿科初级保健提供者（pcp）提供循证建议，以降低儿科镰状细胞病（SCD）患者发生危及生命的细菌感染的风险。与其他慢性疾病相比，缺乏SCD综合护理的标准实践指南。有必要继续倡导SCD患者的高质量医疗保健，包括更新的护理标准指南。由于这些令人担忧的不公平现象，pcp和专业提供者被迫参考和比较几个不同卫生组织的建议，以确定最佳做法。pcp应该感到有权力在小儿SCD患者中遵循增强免疫计划。免疫接种和适当的抗生素可以挽救生命，对抗侵袭性脑膜炎球菌和肺炎球菌感染。我们概述了改善社区pcp儿科SCD患者护理质量的机会。

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Hemostasis in primary care: A primer. 初级保健中的止血：入门。

IF 3.7 4区医学 Q1 PEDIATRICS

Current Problems in Pediatric and Adolescent Health Care

Pub Date : 2025-05-01 Epub Date: 2025-06-30 DOI: 10.1016/j.cppeds.2025.101762

Kevin E Todd

Bleeding symptoms in children create significant concern for families and pediatricians alike. This article aims to assist primary care providers in the evaluation of children with bleeding symptoms by reviewing the complexities inherent in diagnosing pediatric bleeding disorders, emphasizing the variability in clinical presentations, testing nuances, and aspects of common bleeding diatheses. The incidence of bleeding disorders among pediatric patients referred for bleeding symptoms and abnormal hemostatic screening remains variable, ranging from 4 % to 11 % across different institutions. A meticulous evaluation-including family history, medication review, and assessment of bleeding severity-is an essential first step in identifying potential bleeding disorders. In patients with a high index of suspicion we recommend screening testing including a complete blood count including blood smear for review, activated partial thromboplastin time (aPTT), prothrombin time (PT), von Willebrand factor (VWF) antigen and activity, and fibrinogen level. Common bleeding disorders in pediatrics include factor deficiencies (including von Willebrand disease) and platelet disorders. A collaborative approach between primary care providers and hematologists is paramount to optimizing outcomes for pediatric patients with bleeding symptoms.

儿童出血症状引起了家庭和儿科医生的极大关注。本文旨在通过回顾诊断儿童出血性疾病固有的复杂性，强调临床表现的可变性，测试的细微差别，以及常见出血性疾病的各个方面，帮助初级保健提供者评估有出血症状的儿童。在因出血症状和止血筛查异常而转诊的儿科患者中，出血性疾病的发生率仍然不同，在不同的机构中从4%到11%不等。细致的评估——包括家族史、药物回顾和出血严重程度的评估——是识别潜在出血性疾病必不可少的第一步。对于高怀疑指数的患者，我们建议进行筛查测试，包括全血细胞计数，包括血液涂片检查，活化部分凝血活素时间（aPTT），凝血酶原时间（PT），血管性血友病因子（VWF）抗原和活性，以及纤维蛋白原水平。儿科常见出血性疾病包括因子缺乏（包括血管性血友病）和血小板紊乱。初级保健提供者和血液学家之间的协作方法对于优化儿科出血症状患者的预后至关重要。

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Foreword-advancing quality improvement Part I 前言——推进质量改进第一部分。

IF 3.7 4区医学 Q1 PEDIATRICS

Current Problems in Pediatric and Adolescent Health Care

Pub Date : 2025-04-01 DOI: 10.1016/j.cppeds.2025.101755

John M. Pascoe MD, MPH (Associate Editor)

引用次数: 0

Editorial Board Page 编委会页面

IF 3.7 4区医学 Q1 PEDIATRICS

Current Problems in Pediatric and Adolescent Health Care

Pub Date : 2025-04-01 DOI: 10.1016/S1538-5442(25)00054-9

引用次数: 0

Artificial Intelligence in Quality Improvement 质量改进中的人工智能。

IF 3.7 4区医学 Q1 PEDIATRICS

Current Problems in Pediatric and Adolescent Health Care

Pub Date : 2025-04-01 DOI: 10.1016/j.cppeds.2025.101756

Grant Turek , Kelly C. Sandberg

The introduction of Artificial Intelligence (AI) into the field of medicine be met with hesitation. AI s already showing promise in specific aspects of care and research. Under the guiding hand of clinicians and researchers these new tools can elevate the quality of many different aspects of care. AI tools can benefit the patient, clinician, and quality improver. Embracing and cultivating the work of AI emphasizes the human capabilities of the physician leading to improved clinical care and enhance quality improvement.

将人工智能（AI）引入医学领域会遇到犹豫。人工智能已经在护理和研究的特定方面显示出前景。在临床医生和研究人员的指导下，这些新工具可以提高许多不同方面的护理质量。人工智能工具可以使患者、临床医生和质量改善者受益。拥抱和培养人工智能的工作强调医生的人类能力，从而改善临床护理，提高质量。

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Data Transparency in Healthcare Quality Improvement 医疗保健质量改进中的数据透明度。

IF 3.7 4区医学 Q1 PEDIATRICS

Current Problems in Pediatric and Adolescent Health Care

Pub Date : 2025-04-01 DOI: 10.1016/j.cppeds.2025.101758

Brian Weimerskirch MD, FAAP , Carrie Baker DO, MS, FACEP

In recent years, the American healthcare system has seen a rapid transition to electronic health records (EHR) and a significant accumulation of digital healthcare information.¹^,² Having accurate data are key for quality improvement efforts. Unfortunately, a lack of standardization and limited access to stored data have created barriers to its use.³ The principles of data transparency include making the source and validation methods of the data clearly evident as well as ensuring equitable, easy, and timely access to the data. Data transparency can help utilize this digital transformation to support quality improvement efforts and create an effective learning health system.

近年来，美国医疗保健系统迅速过渡到电子健康记录（EHR），并积累了大量的数字医疗保健信息。拥有准确的数据是质量改进工作的关键。不幸的是，缺乏标准化和对存储数据的有限访问为其使用造成了障碍数据透明的原则包括使数据的来源和验证方法清晰明了，以及确保公平、方便和及时地访问数据。数据透明度有助于利用这种数字化转型来支持质量改进工作，并创建一个有效的学习型卫生系统。

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Sustaining improvement gains 持续改进收益。

IF 3.7 4区医学 Q1 PEDIATRICS

Current Problems in Pediatric and Adolescent Health Care

Pub Date : 2025-04-01 DOI: 10.1016/j.cppeds.2025.101757

Mellissa Mahabee MD , Maddie VanDorpe BSME , Samantha Neumeier MD

A “system” as described by W. Edwards Deming, the father of the quality movement, is a set of interdependent components – structures, people, and processes – working together towards a common purpose.¹ Within health systems, the primary intent and common purpose is to promote, restore, and maintain health by focusing on safety, effectiveness, and efficiency. For these reasons, many organizations devote substantial time and resources to build their improvement capability, but these hard-earned improvements fade as the focus changes to other priorities and workers revert to the old system of doing things. To counter this, many health systems are incorporating methods that ensure initiatives continue to help patients in the short term but also become embedded in the system to help future patients.

The Institute for Healthcare (IHI) in their 2016 White Paper suggests that the key to sustaining improvements in systems is to “focus on the daily work of frontline managers, supported by a high-performance management system (HPMS) that prescribes standard tasks and responsibilities for these managers at all levels of the organization.”² Both these factors are interconnected. An HPMS can be categorized into several areas; quality management, quality control, quality improvement, and a culture of high performance. As a practical example, this paper describes how the IHI framework can be employed to achieve sustainability for quality improvements, using an example of improving problem list utilization at discharge for patients.

正如质量运动之父爱德华兹·戴明所描述的那样，“系统”是一组相互依赖的组成部分——结构、人员和过程——为共同的目标而共同努力在卫生系统内，主要意图和共同目标是通过注重安全、有效性和效率来促进、恢复和维持健康。由于这些原因，许多组织投入了大量的时间和资源来建立他们的改进能力，但是这些来之不易的改进随着焦点转移到其他优先事项和工人恢复到旧的做事系统而褪色。为解决这一问题，许多卫生系统正在采用各种方法，确保各项举措在短期内继续帮助患者，同时也纳入系统，以帮助未来的患者。医疗保健研究所（IHI）在其2016年白皮书中建议，持续改进系统的关键是“关注一线管理人员的日常工作，并以高性能管理系统（HPMS）为支持，该系统规定了组织各级管理人员的标准任务和责任。”这两个因素是相互联系的。HPMS可以分为几个领域；质量管理、质量控制、质量改进和高绩效文化。作为一个实际的例子，本文描述了如何利用IHI框架来实现质量改进的可持续性，并以提高患者出院时问题清单的利用率为例。

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