Pediatric chronic patients at outpatient clinics: a study in a Latin American University Hospital

Alveno, Renata A.; Miranda, Caroline V.; Passone, Caroline; Waetge, Aurora Rosaria Pagliara; Hojo, Elza S.; Farhat, Sylvia Costa Lima; Filho, Vicente Odone; Tannuri, Uenis; Carvalho, Werther Brunow de; Carneiro‐Sampaio, Magda; Silva, Clóvis A.

doi:10.1016/j.jped.2017.07.014

Cited by 19 publications

(25 citation statements)

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“…The result of the present study was different from that of research on MD/PhD programs in Canada and the United States, which found that men were the predominant gender (9,10,13,20). (5) Results are presented as n (%), HRQL-health-related quality of life, STI-sexually transmitted infection.…”

Section: ' Discussioncontrasting

confidence: 97%

“…Previous research has shown that personal, professional, and educational characteristics, ratings of overall satisfaction, physical/psychological stress, and professional issues after undergraduate, fellowship, and residency training are different around the world (5,6,(16)(17)(18). However, to the best of our knowledge, simultaneous analysis of these data has not been carried out among health professionals in Latin America, after master's, doctoral, and post-doctoral degree completion.…”

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confidence: 99%

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Profile of health professionals who completed a master's, doctoral, or post-doctoral degree in one Brazilian pediatric program

Silva

Trindade

Cruz

et al. 2020

Clinics

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OBJECTIVE: This study aimed to determine the personal and professional characteristics, and the physical, psychiatric/psychological, and professional issues that exist among master's-, doctoral-, and post-doctoral-level health professionals. METHODS: A cross-sectional, online, self-reported survey of 452 postgraduates who completed master's, doctoral, or post-doctoral degrees in one graduate program in pediatrics in Sã o Paulo, Brazil, was conducted. RESULTS: The response rate was 47% (211/453). The majority of participants were women (78%) and physicians (74%), and the median age was 47 years (28-71). Master's, doctoral, and post-doctoral degrees were reported by 73%, 53%, and 3%, respectively. High workload (440 hours/week) occurred in 59%, and 45% earned X15 minimum wages/month. At least one participation in scientific meeting in the past year was reported by 91%, and 79% had published their research. Thirty-nine percent served as a member of a faculty of an institution of higher learning. The data were analyzed by two age groups: participants aged p48 years (group 1) and participants aged 448 years (group 2). The median rating of overall satisfaction with the profession in the past year [8 (0-10) vs. 9 (1-10), p=0.0113]; workload 440 hours/week (53% vs. 68%, p=0.034); and X15 minimum wages/month (37% vs. 56%, p=0.0083) were significantly lower in group 1. Further analysis by gender revealed that the median rating of overall satisfaction with the profession in the past year [8 (0-10) vs. 9 (3-10), p=0.0015], workload 440 hours/week (53% vs. 83%, p=0.0002), and X15 minimum wages/month (37% vs. 74%, p=0.0001) were significantly lower in women compared with men. The median rating of overall satisfaction with the mentorship supervision provided was significantly higher among the women 10 (5-10) vs. 10 (2-10), p=0.0324]. CONCLUSIONS: The majority of master's-, doctoral-, and post-doctoral-level health professionals were women and physicians, and had published their thesis. Younger postgraduates and women reported low salaries, less likelihood of working 440 hours/week, and less overall satisfaction with their profession. Further longitudinal and qualitative studies are warranted to assess career trajectories after graduation.

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Section: ' Discussioncontrasting

confidence: 97%

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confidence: 99%

Profile of health professionals who completed a master's, doctoral, or post-doctoral degree in one Brazilian pediatric program

Silva

Trindade

Cruz

et al. 2020

Clinics

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“…PCDs were classified according to the duration of the disease (over three months), and the diagnosis was established by the physician's scientific knowledge, valid methods or tools based on professional standards, and/or diagnostic classification criteria. 1,6 The 10th Revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) was also systematically evaluated to characterize the main PCD diagnoses. 6,21 We assessed the following 23 pediatric specialties, according to the electronic data system: Allergy & Immunology, Cardiology, Endocrinology, Gastroenterology, Genetics, Hematology, Hematopoietic Cell Transplantation, Hepatology, Infectious Diseases, Nephrology/Renal Transplantation, Neurology, Nutrology, Oncology, Orthopedics, Palliative and Pain Care, Pediatric Surgery/Liver Transplantation, Pulmonology, Psychiatry, Rheumatology, and others (Adolescent Care, Preterm Care, and Pediatric Teaching Clinic).…”

Section: Methodsmentioning

confidence: 99%

“…This fact is due to the advancements in medical diagnosis, with new technologies and specific treatments for different illnesses and comorbidities. [1][2][3][4][5][6][7][8][9][10][11] Of note, child and adolescent populations with chronic health disabilities requiring highly complex medical care have been increasingly followed-up in tertiary centers. A French study with individuals younger than 14 years old showed that 3.3% of patients had long-term conditions, and 1.4% had complex chronic diseases.…”

Section: Introductionmentioning

confidence: 99%

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Complexity of Pediatric Chronic Disease: Cross-Sectional Study With 16,237 Patients Followed by Multiple Medical Specialties

Passone

Grisi

Farhat

et al. 2020

Rev. paul. pediatr.

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Objective: To assess demographic data and characteristics of children and adolescents with pediatric chronic diseases (PCD), according to the number of specialties/patient. Methods: We performed a cross-sectional study with 16,237 PCD patients at outpatient clinics in one year. Data were analyzed by an electronic data system, according to the number of physician appointments for PCD. This study assessed: demographic data, follow-up characteristics, types of medical specialty, diagnosis (International Statistical Classification of Diseases and Related Health Problems - ICD-10), number of day hospital clinic visits, and acute complications. Results: Patients followed by ≥3 specialties simultaneously showed a significantly higher duration of follow-up compared to those followed by ≤2 specialties [2.1 (0.4-16.4) vs. 1.4 (0.1-16.2) years; p<0.001] and a higher number of appointments in all specialties. The most prevalent medical areas in patients followed by ≥3 specialties were: Psychiatry (Odds Ratio - OR=8.0; confidence interval of 95% - 95%CI 6-10.7; p<0.001), Palliative/Pain Care (OR=7.4; 95%CI 5.7-9.7; p<0.001), Infectious Disease (OR=7.0; 95%CI 6.4-7.8; p<0.001) and Nutrology (OR=6.9; 95%CI 5.6-8.4; p<0.001). Logistic regressions demonstrated that PCD patients followed by ≥3 specialties were associated with high risk for: number of appointments/patient (OR=9.2; 95%CI 8.0-10.5; p<0.001), day hospital clinic visits (OR=4.8; 95%CI 3.8-5.9; p<0.001), emergency department visits (OR=3.2; 95%CI 2.9-3.5; p<0.001), hospitalizations (OR=3.0; 95%CI 2.7-3.3; p<0.001), intensive care admissions (OR=2.5; 95%CI 2.1-3.0; p<0.001), and deaths (OR=2.8; 95%CI 1.9-4.0; p<0.001). The diagnosis of asthma, obesity, chronic pain, and transplant was significantly higher in patients followed by ≥3 specialties. Conclusions: The present study showed that PCD patients who required simultaneous care from multiple medical specialties had complex and severe diseases, with specific diagnoses.

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An Update on the Management of Childhood-Onset Systemic Lupus Erythematosus

et al. 2021

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Childhood-onset systemic lupus erythematosus (cSLE) is a prototype of a multisystemic, inflammatory, heterogeneous autoimmune condition. This disease is characterized by simultaneous or sequential organ and system involvement, with unpredictable flare and high levels of morbidity and mortality. Racial/ethnic background, socioeconomic status, cost of medications, difficulty accessing health care, and poor adherence seem to impact lupus outcomes and treatment response. In this article, the management of cSLE patients is updated. Regarding pathogenesis, a number of potential targets for drugs have been studied. However, most treatments in pediatric patients are off-label drugs with recommendations based on inadequately powered studies, therapeutic consensus guidelines, or case series. Management practices for cSLE patients include evaluations of disease activity and cumulative damage scores, routine non-live vaccinations, physical activity, and addressing mental health issues. Antimalarials and glucocorticoids are still the most common drugs used to treat cSLE, and hydroxychloroquine is recommended for nearly all cSLE patients. Disease-modifying antirheumatic drugs (DMARDs) should be standardized for each patient, based on disease flare and cSLE severity. Mycophenolate mofetil or intravenous cyclophosphamide is suggested as induction therapy for lupus nephritis classes III and IV. Calcineurin inhibitors (cyclosporine, tacrolimus, voclosporin) appear to be another good option for cSLE patients with lupus nephritis. Regarding B-cell-targeting biologic agents, rituximab may be used for refractory lupus nephritis patients in combination with another DMARD, and belimumab was recently approved by the US Food and Drug Administration for cSLE treatment in children aged > 5 years. New therapies targeting CD20, such as atacicept and telitacicept, seem to be promising drugs for SLE patients. Anti-interferon therapies (sifalimumab and anifrolumab) have shown beneficial results in phase II randomized control trials in adult SLE patients, as have some Janus kinase inhibitors, and these could be alternative treatments for pediatric patients with severe interferon-mediated inflammatory disease in the future. In addition, strict control of proteinuria and blood pressure is required in cSLE, especially with angiotensin-converting enzyme inhibitor and angiotensin receptor blocker use.

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Pediatric chronic patients at outpatient clinics: a study in a Latin American University Hospital

Abstract: This study evaluated a large population in a Latin American hospital and suggested that early adolescents with chronic diseases required many appointments, multiple specialties and hospital admissions.

Cited by 19 publications

References 26 publications

Profile of health professionals who completed a master's, doctoral, or post-doctoral degree in one Brazilian pediatric program

Profile of health professionals who completed a master's, doctoral, or post-doctoral degree in one Brazilian pediatric program

Complexity of Pediatric Chronic Disease: Cross-Sectional Study With 16,237 Patients Followed by Multiple Medical Specialties

An Update on the Management of Childhood-Onset Systemic Lupus Erythematosus

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