Parents' Attitudes toward COVID-19 Vaccination: A Study from Two Centers in Istanbul

Objective Vaccination is an important measure for the prevention of coronavirus disease 2019 (COVID-19). In the present study, we aimed to evaluate parents' attitudes toward vaccinating themselves and their children. We also searched whether information about the multisystem inflammatory syndrome in children (MIS-C), a severe complication of COVID-19, could change parents' decisions on vaccinating their children. Methods A questionnaire form consisting of sociodemographic features, COVID-19 vaccination practices, and knowledge about MIS-C was applied to parents of children attending Bezmialem Vakıf University Hospital from March through June 2022. Factors affecting vaccine hesitancy were evaluated. Results Among 383 parents, COVID-19 history was present in 248 (64.8%), and 165 (43.1%) were hesitant to vaccinate themselves. The number of cases where both parents had received at least one dose of COVID-19 vaccine was 256/354 (72.3%). The most common reasons for vaccine hesitancy were vaccines being new in 53/165 (32.1%) and fears of side effects in 95/165 (57.6%). Parents' hesitation toward vaccination of their children with the COVID-19 vaccine was highest for the 0 to 6 age group (78.9%) (73.6% in the 6–12 age group, and 47.3% in the 12–18 age group). In total, 365/383 (95.3%) parents did not have an opinion about MIS-C. After information was given, 62.5% of the 302 participants who opposed vaccinating children under 6 years changed their decision to have their children vaccinated. Conclusion Although routine childhood vaccinations were performed in 99% of children, more than half of parents were hesitant to vaccinate their children with the COVID-19 vaccine. The majority did not have an opinion about MIS-C. Briefings by pediatricians about complications of COVID-19 will help avoid vaccine hesitancy. [ FROM AUTHOR] Copyright of Journal of Pediatric Infectious Diseases is the property of Thieme Medical Publishing Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Human Resources for Pediatric Health Care of Ukraine.

Introduction. The quality and availability of medical care for children of country depends on the quantity of pediatricians and the quality of their training. This is especially important in the context of the COVID-19 pandemic. Purpose. To assess the state of staffing and training of pediatricians in healthcare institutions of Ukraine in comparison with same world and European indicators and determine the necessary measures for improvement. Materials and methods. For this research we have used methods of the system approach and epidemiological analysis of data from GU "Center of medical statistics of the Ministry of Health of Ukraine" for eleven years (2009-2020). Results. According to the level of training of doctors, including pediatricians, Ukraine has reached total rank of 38th in the European region. Such dynamics of changes in the availability of human resources for healthcare is accompanied by reductions in the volume of training of pediatricians since 2017. According to the Center for Medical Statistics from 31.12.2020 the Ministry of Health of Ukraine provided medical care in pediatric health care institutions of all forms of ownership with the help of 8812 pediatricians, of whom 7925 (90%) were worked in primary health care centers, clinics and hospitals of the Ministry of Health of Ukraine. This numbers are significantly lower than in 2009, when there were 12 450 practicing pediatricians. As we see, the number of pediatricians has decreased by 15.4% for the last 7 years. Conclusion. Importance of the problems with personnel in pediatric healthcare had shown us a necessity of radical government management decisions for improvement of the situation with the training of pediatricians and preventing of risks of limitations of access to pediatric medical assistance and deterioration of quality of medical care for children in the country. This might be possible with rational planning of the state necessity in the training of pediatricians and significant improvement of their social protection and working conditions. Possible steps should include increasing pediatrics necessity state order up to 1000 pediatricians in state medical universities annually by targeted regional medical personnel necessity order, taking into account the needs of the regions and reviewing their training programs in accordance with the modern requirements.Copyright © 2022, Professionalnye Izdaniya. All rights reserved.

Human Resources for Pediatric Health Care of Ukraine.

Introduction. The quality and availability of medical care for children of country depends on the quantity of pediatricians and the quality of their training. This is especially important in the context of the COVID-19 pandemic. Purpose. To assess the state of staffing and training of pediatricians in healthcare institutions of Ukraine in comparison with same world and European indicators and determine the necessary measures for improvement. Materials and methods. For this research we have used methods of the system approach and epidemiological analysis of data from GU "Center of medical statistics of the Ministry of Health of Ukraine" for eleven years (2009-2020). Results. According to the level of training of doctors, including pediatricians, Ukraine has reached total rank of 38th in the European region. Such dynamics of changes in the availability of human resources for healthcare is accompanied by reductions in the volume of training of pediatricians since 2017. According to the Center for Medical Statistics from 31.12.2020 the Ministry of Health of Ukraine provided medical care in pediatric health care institutions of all forms of ownership with the help of 8812 pediatricians, of whom 7925 (90%) were worked in primary health care centers, clinics and hospitals of the Ministry of Health of Ukraine. This numbers are significantly lower than in 2009, when there were 12 450 practicing pediatricians. As we see, the number of pediatricians has decreased by 15.4% for the last 7 years. Conclusion. Importance of the problems with personnel in pediatric healthcare had shown us a necessity of radical government management decisions for improvement of the situation with the training of pediatricians and preventing of risks of limitations of access to pediatric medical assistance and deterioration of quality of medical care for children in the country. This might be possible with rational planning of the state necessity in the training of pediatricians and significant improvement of their social protection and working conditions. Possible steps should include increasing pediatrics necessity state order up to 1000 pediatricians in state medical universities annually by targeted regional medical personnel necessity order, taking into account the needs of the regions and reviewing their training programs in accordance with the modern requirements.Copyright © 2022, Professionalnye Izdaniya. All rights reserved.

Viral Swarm: 'Tripledemic' Pushes Healthcare Facilities to the Brink

The article focuses on the surge of respiratory infections in the U.S. in the last quarter of 2022 that are causing hospitalizations and deaths nationally in an unprecedented trifecta of influenza, respiratory syncytial virus (RSV), and COVID-19. Topics covered include unprecedented levels of RSV happening in pediatric facilities, the challenge of getting people vaccinated, and key differences of the three viruses in terms of patient isolation measures.

COVID-19 Pandemic Impact on Pediatricians Entering the Pediatric Workforce.

OBJECTIVE: Determine extent of impact of coronavirus disease 2019 (COVID-19) pandemic on career choice and employment of pediatricians entering pediatric workforce. METHODS: A national, cross-sectional electronic survey of pediatricians registering for the 2021 American Board of Pediatrics initial general certifying examination on the impact of the COVID-19 pandemic on 3 aspects of career (career choice, employment search, employment offers) was performed. Data were analyzed using descriptive statistics and multivariate logistic regression to determine factors associated with the pandemic's impact on career. Thematic analysis was used to generate themes for open-ended survey questions. RESULTS: Over half (52.3%, 1767 of 3380) of pediatricians responded. Overall, 29.1% reported that the pandemic impacted their career (career choice [10.4%], employment search [15.6%], or employment offers [19.0%]); applicants to general pediatrics (GP) (52.9%) or pediatric hospitalist (PH) positions (49.3%) were most affected. Multivariate logistic regression modeling found those applying to GP (odds ratio [OR]: 3.83, 95% confidence interval [CI]: 2.22-6.60), PH (OR: 9.02, 95% CI: 5.60-14.52), and International Medical Graduates (IMGs) (OR: 1.90; 95% CI: 1.39-2.59) most likely to experience any career impact. CONCLUSIONS: Almost one third of pediatricians registering for the initial general pediatrics certifying examination reported their careers were impacted by the COVID-19 pandemic, with 10% of respondents reporting the pandemic impacted their career choice. Half of new pediatricians seeking employment reported being impacted by the pandemic, particularly IMGs. As the pandemic evolves, career advising will continue to be critical to support trainees in their career choices and employment.

Parental and Pediatricians' Attitudes towards COVID-19 Vaccination for Children: Results from Nationwide Samples in Greece.

Although many studies have examined factors associated with COVID-19 vaccination and healthcare professionals' attitudes towards vaccines, less is known about parents' and pediatricians' attitudes towards COVID-19 vaccination for children. Using two cross-sectional surveys from November to December 2021 in Greece, we aimed to assess parental intention to vaccinate their 5 to 17 years old children against COVID-19 and to evaluate pediatricians' attitudes towards children's vaccination against COVID-19. Overall, 439 parents and 135 pediatricians participated. Of them, 240 (54.7%) intended to vaccinate their children against COVID-19. The most commonly reported reasons for non-intention were the short length of clinical trials and the fear of side effects. Only 16.6% of non-intenders would vaccinate their children if the pediatrician recommended it. The factors associated with higher intention to get vaccinated were a parent's own vaccination against COVID-19, trust in official healthcare guidelines, increased trust in the state and the healthcare system during the pandemic, and older age. Of the pediatricians, 92.6% recommended children's vaccination, and 75.6% agreed with mandating the vaccine. These findings suggest the need to tailor easy-to-understand messages by well-informed pediatricians to address safety concerns, educate, and clarify misconceptions through targeted interventions among those who currently do not wish to vaccinate their children.

The role of advocacy in improving access to care for children with mental illness

Across the country, most professionals caring for children have likely seen an increase in mental illness. Even prior to the COVID‐19 pandemic, there was already a trend of increasing rates of depression and suicidal ideation in American youth (Mojtabai et al., 2016). Since then, the problem has only worsened, as the collective mental health needs of children have been rising rapidly. A combination of factors, from isolation related to school closure and social distancing, to the traumatic effects of losing a parent, have contributed to this dramatic rise in distress (American Academy of Pediatrics, 2021). The CDC reported that the proportion of mental health‐related ED visits increased abruptly after the beginning of the pandemic, with increases of 24% among children aged 5–11 years and 31% among adolescents aged 12–17 years, compared with the same period in 2019 (Leeb et al., 2020). These changes have been widely publicized, and in response to this national crisis, the American Academy of Pediatrics (AAP), American Academy of Child and Adolescent Psychiatry (AACAP), and the Children's Hospital Association (CHA) jointly declared a national state of emergency in October 2021 and created a 10‐point outline for meaningful change in the recognition, prevention, and treatment of childhood mental illness (American Academy of Pediatrics, 2021). In addition, the United States Surgeon General issued an advisory on protecting youth mental health in December 2021 (Department of Health and Human Services, 2021).

Special Section: COVID-19. (Special Section: COVID-19.)

This special issue includes more than 20 articles on various COVID-19 topics of interest to the busy pediatric practitioner. Clinical features include brief reports of rare and unusual presentations or sequelae of COVID-19 infection or COVID-19 vaccination. Several studies report on multisystem inflammatory syndrome of children clinical manifestations. The reader will also find various epidemiologic reports from well-known pediatric centers, both domestic and international, on COVID-19's impact on hospitalization, neonatal care, emergency room visits, outpatient care, children with special needs, and children in special populations. The mental health crisis that COVID-19 has caused among children and adolescents as well as COVID-19 vaccination attitudes and hesitancy are also addressed.

Experience of Pediatricians and Pediatric Surgeons With Virtual Care During the COVID-19 Pandemic: Descriptive Study.

BACKGROUND: Prior to the COVID-19 pandemic, in-clinic visits were the standard of care for pediatric physicians and surgeons at our center. At the pandemic onset, web-based care was adopted at an unprecedented scale and pace. OBJECTIVE: This descriptive study explores the web-based care experience of pediatric physicians and surgeons during the pandemic by determining factors that supported and challenged web-based care adoption. METHODS: This study took place at the Children's Hospital at London Health Sciences Centre, a children's hospital in London, Ontario, Canada, which provides pediatric care for patients from the London metropolitan area and the rest of Southwestern Ontario. The Donabedian model was used to structure a web-based survey evaluating web-based care experience, which was distributed to 121 department-affiliated pediatric physicians (including generalists and subspecialists in surgery and medicine). Recruitment occurred via department listserv email. Qualitative data were collected through discrete and free-text survey responses. RESULTS: Survey response rate was 52.1% (63/121). Before the pandemic, few physicians within the Department of Paediatrics used web-based care, and physicians saw <10% of patients digitally. During March-May 2020, the majority transitioned to web-based care, seeing >50% of patients digitally. Web-based care use in our sample fell from June to September 2020, with the majority seeing <50% of patients digitally. Telephone and Ontario Telemedicine Network were the platforms most used from March to September 2020. Web-based care was rated to be convenient for most providers and their patients, despite the presence of technical difficulties. Challenges included lack of physical exam, lower patient volumes, and poor patient digital care etiquette. Regardless of demographics, 96.4% (116/121) would continue web-based care, ideally for patients who live far away and for follow-ups or established diagnoses. CONCLUSIONS: Transition to web-based care during COVID-19 was associated with challenges but also positive experiences. Willingness among pediatricians and pediatric surgeons to continue web-based care was high. Web-based care experiences at our center could be improved with patient education and targeting select populations. Future research is needed to improve practice efficiency and to inform regulatory guidelines for web-based care.

Human Resources for Pediatric Health Care of Ukraine

Introduction. The quality and availability of medical care for children of country depends on the quantity of pediatricians and the quality of their training. This is especially important in the context of the COVID-19 pandemic. Purpose. To assess the state of staffing and training of pediatricians in healthcare institutions of Ukraine in comparison with same world and European indicators and determine the necessary measures for improvement. Materials and methods. For this research we have used methods of the system approach and epidemiological analysis of data from GU "Center of medical statistics of the Ministry of Health of Ukraine" for eleven years (2009–2020). Results. According to the level of training of doctors, including pediatricians, Ukraine has reached total rank of 38th in the European region. Such dynamics of changes in the availability of human resources for healthcare is accompanied by reductions in the volume of training of pediatricians since 2017. According to the Center for Medical Statistics from 31.12.2020 the Ministry of Health of Ukraine provided medical care in pediatric health care institutions of all forms of ownership with the help of 8812 pediatricians, of whom 7925 (90%) were worked in primary health care centers, clinics and hospitals of the Ministry of Health of Ukraine. This numbers are significantly lower than in 2009, when there were 12 450 practicing pediatricians. As we see, the number of pediatricians has decreased by 15.4% for the last 7 years. Conclusion. Importance of the problems with personnel in pediatric healthcare had shown us a necessity of radical government management decisions for improvement of the situation with the training of pediatricians and preventing of risks of limitations of access to pediatric medical assistance and deterioration of quality of medical care for children in the country. This might be possible with rational planning of the state necessity in the training of pediatricians and significant improvement of their social protection and working conditions. Possible steps should include increasing pediatrics necessity state order up to 1000 pediatricians in state medical universities annually by targeted regional medical personnel necessity order, taking into account the needs of the regions and reviewing their training programs in accordance with the modern requirements. © 2022, Professionalnye Izdaniya. All rights reserved.

Coronavirus disease 2019 (COVID-19) outbreak in pediatrics and the role of pediatricians: a systematic review

The coronavirus disease 2019 (COVID-19) outbreak initiated in Wuhan, China and has spread rapidly all around the world and labeled as a pandemic with almost 168,000 infected cases and 6,500 deaths globally up to March 16, 2020. It is believed that children are less likely than adults to be infected with COVID-19. In this review, we discuss different aspects of COVID-19 infection in pediatrics. COVID-19 in pediatrics occurs in the early stages of its outbreak at a high rate with a family cluster pattern mainly. Children infected with COVID-19 are mostly asymptomatic carriers and the main potential causes of the spread and transmission of the disease in communities. Asymptomatic children with no underlying disease or red flags should follow home isolation protocols. Children with red flags, comorbidities and risk factors or those with severe pneumonia must be admitted to the hospitals. Children's hospitals should be equipped with the acute respiratory diseases ward, quarantine rooms, and intensive care unit to protect other patients and health care staff during the COVID-19 outbreak.

The role of pediatrician during the pandemic

With the emergence of the corona virus disease 2019 pandemic, many containment measures were imposed including lockdowns. As the lockdown is gradually eased out, there are recommendations put in place by both the government as well as international and national professional bodies for restarting and continuing of child health care delivery in a safe manner. The pediatrician has to put in place new norms in terms of infection prevention and control practices, training and motivation of fellow healthcare workers, immunization practices, telemedicine and selfcare to render continuous quality healthcare and to mitigate risk of infection to all including oneself and to the patients.

Cross-Sectional Survey on Long Term Sequelae of Pediatric COVID-19 among Italian Pediatricians.

The persistence of symptoms after recovery from Coronavirus 2019 (COVID-19) is defined as long COVID, an entity that had occurred among adults but which is not yet well characterized in pediatric ages. The purpose of this work was to present some of the data from a survey addressed to Italian pediatricians concerning the impact of long-COVID among children who recovered from severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. The questionnaire was designed and pre-tested in February 2021 by a working group of experts from the Italian Pediatric Society for Allergy and Immunology (SIAIP). The survey was emailed once in March 2021 to a sample of Italian pediatricians. A total 267 Italian pediatricians participated in our survey. According to most pediatricians (97.3%), the persistence of symptoms is found in less than 20% of children. Specifically, with regard to the symptoms that persist even after swab negativization, fatigue was the most mentioned one (75.6%). Long-COVID would seem to be a phenomenon of limited occurrence in pediatric ages, affecting less than 20% of children. Among all of the symptoms, the one that was most prevalent was fatigue, a pathological entity that is associated with many viral diseases.

Preparedness of current and future Saudi Pediatricians to face vaccine hesitancy: Cross-sectional study within the capital city of Saudi Arabia, Riyadh.

BACKGROUND: Vaccines have helped in eradicating many communicable diseases. They are considered major players in preserving children's health. However, concerns about vaccines' ingredients and safety became hot topics globally. With doubt, some parents became hesitant to vaccinate their children. A recent study documented high prevalence of vaccine hesitancy among Saudi parents. OBJECTIVES: This study aims to explore preparedness of current and future pediatricians to face vaccine hesitancy, a growing public health issue in Saudi Arabia. METHODS: This study adopted non-interventional cross-sectional online questionnaire specifically designed to encompass general vaccine hesitancy related questions including Covid-19's vaccines. RESULTS: The study recruited 119 participants form three main tertiary centers in Riyadh. Trainees were the majority with pediatric consultants representing 22%. Females were more than half of total participants (53%). Although familiarity with the term "vaccine hesitancy" was common, it was affected by training level. Among participants, 66% heard about it from social media. Furthermore, only 32% received designated training. Knowledge was suboptimal among all levels except for those who received formal training. Despite 80% encountered vaccine hesitancy, only 55% consider it a common public health issue. Attitude toward vaccine hesitant parents was negative among male physicians (odds ratio of 2.3, P value 0.045). Additionally, majority consider it a form of child neglect (95%). In regard to COVID19's vaccine, 31% were reluctant to get vaccinated themselves. CONCLUSION: Pediatric workforce in Saudi Arabia commonly encounters vaccine hesitancy. The strong stand against vaccine hesitant parents might affect rapport with families. Sub-optimal knowledge, negative attitude and emerging COVID19 vaccine hesitancy might negatively impact future efforts. Tailored training and innovative educational platforms are essentials to address vaccine hesitancy in Saudi Arabia.

Evaluation of COVID-19 vaccine acceptance of healthcare providers in a tertiary Pediatric hospital.

Objective: The aim of this study was to reveal the perceptions of healthcare providers who work in a tertiary children's hospital about domestic and foreign COVID-19 vaccines to determine the frequency of hesitancy toward COVID-19 vaccination prior to its availability in Turkey and to elucidate the reasons for its rejection and distrust.Methods: A questionnaire about COVID-19 vaccination was conducted with 343 healthcare providers, including pediatricians, pediatric nurses, and auxiliary health staff. The questionnaire was conducted online. In the survey, participants were asked about sociodemographic characteristics and opinions on domestic and foreign COVID-19 vaccines, and reasons for vaccine refusal.Results: Women were more likely to be reluctant to get a domestic (p < .001) or foreign (p < .001) COVID-19 vaccine than men. There was a significant relationship between age and vaccine acceptance (p = .01). The younger the age of the healthcare provider, the higher the rate of vaccine hesitancy (r = - 0.25). Years of professional experience were correlated with vaccine acceptance (r = 0,19, p < .05), but vaccine rejection and indecision did not change (p > .05). The factors predicting vaccine acceptance were status as a doctor, more than 10 years of professional experience, and male gender.Conclusion: More than half of the healthcare providers were willing to have a COVID-19 vaccine once available. Indecision rates were found to be high, although rejection rates were not. Status as a doctor, more than 10 years of professional experience, and male gender were factors associated with vaccination intention.

Pediatricians' COVID-19 experiences and views on the willingness to receive COVID-19 vaccines: a cross-sectional survey in Turkey.

Developing an effective and safe vaccine against Covid-19 will facilitate return to normal. Due to hesitation toward the vaccine, it is crucial to explore the acceptability of the COVID-19 vaccine to the public and healthcare workers. In this cross-sectional survey, we invited 2251 pediatricians and 506 (22%) of them responded survey and 424 (84%) gave either nasopharyngeal swap or antibody assay for COVID-19 and 71 (14%) of them got diagnosis of COVID-19. If the effective and safe COVID-19 vaccine was launched on market, 420 (83%) of pediatrician accepted to get vaccine shot, 422 (83%) of them recommended vaccination to their family members, 380 (75%) of them accepted to vaccine their children and 445 (85%) of them offered vaccination to their pediatric patients. Among the participated pediatricians 304 (60%) of them thought COVID-19 vaccine should be mandatory. We found that there are high COVID-19 vaccine willingness rates for pediatricians for themselves, their own children, family members and their pediatric patients. We also found that being a pediatric subspecialist, believing in achieving an effective vaccine, willingness to participate in the phase 1-2 clinical vaccine trial, willingness to get an influenza shot this season, believing a vaccine and vaccine passport should be mandatory were significant factors in accepting the vaccine. It is important to share all information about COVID-19 vaccines, especially effectiveness and safety, with the public in a clear communication and transparency. The opposite will contribute to vaccine hesitancy and anti-vaccine movement.

Pediatric Care Struggles of US Trained International Medical Graduate Pediatricians in COVID-19 Pandemic.

BACKGROUND: Pediatrician shortage and healthcare access has been a serious issue especially in medically underserved and rural areas aplenty in the USA and has further worsened during the coronavirus disease 2019 (COVID-19) pandemic. Many US trained international medical graduates (IMGs) on a visa status serve these areas to fill in the physician gap. These physicians are usually on a visa and the majority of them have approved immigration petitions. During this pandemic, the sudden changes in immigration policies in addition to the longstanding administrative backlog and processing times had posed new challenges to the pediatricians and the communities served by them. The objective of this study was to determine the demographics, level of training and practice, immigration status, the clinical role they played in the communities they served and the various professional and personal setbacks they faced during the pandemic. METHODS: A survey was created and data were collected using data collection platform "Survey Monkey". Screening questions were designed to include only IMG pediatricians on a visa status. RESULTS: A total of 267 IMG pediatricians qualified for the survey on a nationwide basis. Of the physicians that participated in the survey, 58.4% were working in either medically underserved or physician shortage areas, 36% of the total physicians were working in a rural setting, 10.6% of the pediatricians had to be quarantined due to exposure to COVID-19, 0.8% were infected with COVID-19 themselves, and 81.3% of the pediatricians had faced hindrance in being able to work at a COVID-19 hotspot due to work site restrictions because of their visa status. CONCLUSION: IMG pediatricians play a valuable role in taking care of the children in medically underserved areas. The challenges surrounding the immigration backlog are contributing to significant hardships for these pediatricians and their families and are causing a hindrance to healthcare access to the children in medically underserved communities during the pandemic especially limiting the pediatricians' scope and geographic radius of the practice, thus not allowing them to practice to the full extent of their license.

Doctors' shortage in adults COVID-19 units: a call for pediatricians.

Since its first description in China, SARS-CoV-2 has been spreading all over the world causing millions of 31 infections and hundreds of thousands of deaths. The massive raise of cases all over the world even during the current second wave is leading to unprecedented pressures on healthcare services. Growing evidence is highlighting that COVID-19 is a systemic condition that requires doctors with multiple expertise. Paediatricians are trained in these skills. Considering the issue of staff shortage that is facing every country in the world, and the complexity of COVID-19, pediatricians may represent an important source of ready and skilled specialists that can quickly translate the pediatric practice in the COVID-19 care. In conclusion, we highlight through our experience several parallels between the pediatric clinical practice and clinical conditions described in patients with COVID-19 as well as the diagnostic tools and the measures taken in 39 patients with COVID-19. What is Known: • The massive raise of cases all over the world is leading to unprecedented pressures on healthcare services. • Growing evidence is highlighting that COVID-19 is a systemic condition that requires doctors with multiple expertise. What is New: • Pediatricians are trained daily in these skills. • Considering the issue of staff shortage that is facing every country in the world, and the complexity of COVID-19, pediatricians may represent an important source of ready and skilled specialists that can quickly translate the pediatric practice in the COVID-19 care.

The future of telemedicine visits after COVID-19: perceptions of primary care pediatricians.

BACKGROUND: Facing the global health crisis of COVID-19, health systems are increasingly supporting the use of telemedicine in ambulatory care settings. It is not clear whether the increased use of telemedicine will persist after the pandemic has resolved. The aims of this study were to assess the use of telemedicine by Israeli pediatricians before and during the first lockdown phase of the pandemic, and to elucidate how they foresee telemedicine as a medium of medical practice in the post-pandemic era. METHODS: A web-based survey was distributed among Israeli pediatricians in May 2020, soon after the end of first lockdown was announced. The survey assessed the frequency of telemedicine use as well as its influence on clinical decision making before and during the first COVID-19 lockdown, using two hypothetical clinical scenarios. The same scenarios were also used to assess how the pediatricians foresaw telemedicine in the post-pandemic period. In addition, administrative data from Maccabi on telemedicine use before, during and after the first lockdown were retrieved and analyzed. RESULTS: One hundred and sixty-nine pediatricians responded to the survey (response rate = 40%). The percentage of respondents who reported daily use of text messages, pictures and videoconferencing increased from 24, 15 and 1% before COVID-19 to 40, 40 and 12% during the lockdown, respectively (p < 0.05). After the pandemic, projected use of text messages and pictures/videoclips was expected to decrease to 27 and 26% of respondents, respectively (p < 0.05), but pictures/videoclips were expected to increase from 15% of respondents before to 26% of respondents after (p < 0.05). The reported high likelihood of treating suspected pneumonia or prescribing antibiotics for suspected otitis media via telemedicine was expected to decrease from 20% of respondents during the COVID-19 lockdown to 6%% of respondents after (p < 0.05), and from 14% of respondents during the lockdown to 3% of respondents after, respectively. (p < 0.05). Maccabi administrative data indicated that during the lockdown, there was an increase in phone visits and a decrease in in-person visits compared to the pre-lockdown levels of use. One month after the end of the first lock-down there was a partial return to baseline levels of in-person visits and a sustained increase in phone visits. Phone visits accounted for 0% of pediatrician visits before the first lockdown, 17% of them during the lockdown, and 19% of them 1 month after the lockdown relaxation. CONCLUSIONS: The study indicates that use of telemedicine technologies by primary care pediatricians increased substantially during the first COVID-19 lockdown. The study also found that pediatricians expected that use levels will recede after the pandemic. As the pandemic continues and evolves, it will be important to continue to monitor the level of telemedicine use as well as expectations regarding post-pandemic use levels.

Impact of the COVID-19 pandemic on pediatricians' clinical activity in Cameroon.

BACKGROUND: The outbreak of COVID-19 has imposed many challenges on health systems. The purpose of this study was to describe the impact of the COVID-19 pandemic on the clinical activity of pediatricians. METHODS: We conducted a cross-sectional and descriptive online survey among pediatricians practicing in Cameroon. Data were collected through an anonymous pre-tested Google Form®. RESULTS: Among the 118 pediatricians eligible for the survey, 101 responded (85.6%), of whom 61.2% were women. The pediatric outpatient consultations dropped significantly from 60.4% of pediatricians seeing more than 30 patients per week before the pandemic to 9.9% during the pandemic (P<0.000). According to the occupancy rate of hospitalisation beds, 45.5% of pediatricians reported having 76-100% of pediatric hospitalisation beds occupied per week before the pandemic but no pediatrician reported a similar rate during the pandemic (P<0.000). There was a significant increase in the use of telehealth, ranging from no pediatrician using telehealth "very frequently" before the pandemic to 23.8% using it during the pandemic (P<0.000). Most of the pediatricians had at their disposal surgical masks (96%), care gloves (80.2%), hydroalcoholic gel (99.0%), and soap and water (86.1%). For the management of children, 90.1% and 71.3% of pediatricians experienced difficulties accessing COVID-19 PCR and chloroquine, respectively, and 74.3% declared difficulties for proper isolation of patients. More than half (65.3%) of the pediatricians interviewed were "very afraid" or "extremely afraid" of being infected with SARS-Cov-2, respectively 45.5% and 19.8%. The most frequent reasons included fear of infecting their relatives (85.1%) and of developing a severe form of the disease (43.6%). The reluctance to consult health services expressed by the parents was due to: fear of being infected when leaving their home and especially in the health facility (96%), strict compliance with confinement (30.7%), and financial difficulties of families (13.9%). CONCLUSION: This work highlights the impact of the coronavirus pandemic on the clinical activity of Cameroonian pediatricians. Since the beginning of the pandemic, there has been a significant drop in the use of health facilities, which probably has a negative impact on children's overall level of health. Although the preventive measures explain this drop in attendance at health facilities, the parents' fear of being infected when leaving the house was the predominant reason likely to explain this drop in attendance at health facilities. This could constitute an axis for developing messages to parents to encourage a gradual return to child health services.