Due to a national shortage of child and adolescent psychiatrists, pediatric primary care providers (PCPs) are often responsible for the screening, evaluation, and treatment of mental health disorders. COVID-19 pandemic stay-at-home orders decreased access to mental health care and increased behavioral and emotional difficulties in children and adolescents. Despite increased demand upon clinicians, little is known about mental health care delivery in the pediatric primary care setting during the pandemic. This focus group study explored the experiences of pediatric PCPs and clinical staff delivering mental health care during the pandemic. Transcripts from nine focus groups with San Francisco Bay Area primary care practices between April and August 2020 were analyzed using a thematic analysis approach. Providers expressed challenges at the patient-, provider-, and system-levels. Many providers reported increased patient mental health symptomatology during the pandemic, which was often intertwined with patients’ social determinants of health. Clinicians discussed the burden of the pandemic their own wellness, and how the rapid shift to telehealth primary care and mental health services seemed to hinder the availability and effectiveness of many resources. The findings from this study can inform the creation of new supports for PCPs and clinical staff providing mental health care.
Nocturnal atopic dermatitis (AD) flares affect over 60% of children with AD, and are associated with sleep disturbance. 1,2 Little is known about the underlying rhythm of these highly pruritic flares, and whether treatment with sedating antihistamines alters nocturnal motor activity due to itch. 1,3 We hypothesized that nighttime scratching in AD has a rhythm. To evaluate our hypothesis, we performed a case-control study with children aged 6-17 years with moderate/severe AD and healthy age/gender matched controls. Demographic details of the study population have been published. 4 Participants were 65% male, mean age±standard deviation (SD) 11.0±3.2 years in AD (n=20) versus controls (n=20)11.5±3.3(p=0.68). Moderate/severe AD was defined by a SCORing Atopic Dermatitis (SCORAD) score >25, our patients ranged from 28-92, µ±SD=42±17. Disease severity (SCORAD) correlated with Wake After Sleep Onset (WASO), r (spearman) =0.61, p<0.01, n=19.
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