Pediatricians', obstetricians', gynecologists', and family medicine physicians' experiences with and attitudes about breast-feeding.

OBJECTIVES: Investigate physicians' breast-feeding experiences and attitudes using a survey based on two behavioral theories: theory of reasoned action (TRA) and the health belief model (HBM). METHODS: There were 73 participants included in the investigation. These participants were resident and faculty physicians from pediatrics, obstetrics/gynecology, and family medicine at a university campus, located on the US-Mexico border. The sample was reduced to 53 and 56 records for the attitude and confidence variables, respectively. Physicians answered a survey about their breast-feeding experiences and attitudes to learn about intention and ability applying constructs from TRA and HBM. An attitude scale, confidence variable (from self-efficacy items), and a lactation training index were created for the analysis. RESULTS: Analysis of the association between physicians' breastfeeding experiences and their attitudes revealed physicians are knowledgeable about breast-feeding and have positive attitudes towards breast-feeding. They did not seem to remember how long they breast-fed their children or whether they enjoyed breast-feeding, but they wanted to continue breast-feeding. Physicians cite work as a main reason for not continuing to breast-feed. CONCLUSIONS: Physicians' attitudes toward breast-feeding are positive. They are expected to practice health-promotion behavior including breast-feeding; however, physicians' breast-feeding rates are low and although they are knowledgeable about breast-feeding their training lacks on didactic depth and hands-on experience. If physicians learn more about breast-feeding and breast-feed exclusively and successfully, the rates in the United States would increase naturally.

Utilizing quality improvement methods to improve patient care outcomes in a pediatric residency program.

OBJECTIVE: Although there is an expectation for outcomes-oriented training in residency programs, the reality is that few guidelines and examples exist as to how to provide this type of education and training. We aimed to improve patient care outcomes in our pediatric residency program by using quality improvement (QI) methods, tools, and approaches. METHODS: A series of QI projects were implemented over a 3-year period in a pediatric residency program to improve patient care outcomes and teach the residents how to use QI methods, tools, and approaches. Residents experienced practice-based learning and systems-based assessment through group projects and review of their own patient outcomes. Resident QI experiences were reviewed quarterly by the program director and were a mandatory part of resident training portfolios. RESULTS: Using QI methodology, we were able to improve management of children with obesity, to achieve high compliance with the national patient safety goals, improve the pediatric hotline service, and implement better patient flow in resident continuity clinic. CONCLUSION: Based on our experiences, we conclude that to successfully implement QI projects in residency programs, QI techniques must be formally taught, the opportunities for resident participation must be multiple and diverse, and QI outcomes should be incorporated in resident training and assessment so that they experience the benefits of the QI intervention. The lessons learned from our experiences, as well as the projects we describe, can be easily deployed and implemented in other residency programs.

Screening Mexicans for psychosocial and behavioral problems during pediatric consultation.

BACKGROUND: Psychosocial and behavioral problems should be detected early during the pediatric consultation to prevent more severe psychosocial impairment as children move into adolescence. The pediatric visit offers an excellent opportunity to assess possible problems using screening tools. The aim of this study is to assess whether an adaptation of a screening tool (Pediatric Symptom Checklist) using visual aids is valid and suitable for the early detection of psychosocial problems among a sample of Mexican children and adolescents. METHODS: We included 411 of 468 (87.8%) Mexican mothers or female caretakers of children and adolescents aged 4-16 undergoing routine health assessments in two Preventive Child Health Clinical Services in El Paso, Texas, USA. Mothers or female caretakers completed the Pictorial Pediatric Symptom Checklist and a psychological comprehensive test known as the Child Behavior Checklist (CBCL). Sensitivity and specificity was established using the CBCL as criteria for the validity of the PPSC. RESULTS: The PPSC screening tool performed well as demonstrated by its detection rates of psychosocial and behavioral problems among the sample of Mexican children. Sensitivity and specificity at the standard cut-off scores was 69.6% and 95.2% for children 4-5 years old and 61.8% and 91.8% for children 6-16 years old respectively. The results were slightly lower than those found using the PSC among other ethnic groups in the United States, with a sensitivity and specificity of 71.7% and 93.0%, respectively. CONCLUSIONS: The PPSC is a simple, effective tool that can detect on average more than 65% of the children and adolescents with possible psychosocial problems during pediatric consultations. This free screening tool detected psychosocial problems in pediatric populations of Mexican origin living on the border and may be also effective for Mexican children living in Mexico.

Screening mexicans for psychosocial and behavioral problems during pediatric consultation / Detección de problemas psicosociales y de comportamiento en población pediátrica originaria de México

Background. Psychosocial and behavioral problems should be detected early during the pediatric consultation to prevent more severe psychosocial impairment as children move into adolescence. The pediatric visit offers an excellent opportunity to assess possible problems using screening tools. The aim of this study is to assess whether an adaptation of a screening tool (Pediatric Symptom Checklist) using visual aids is valid and suitable for the early detection of psychosocial problems among a sample of Mexican children and adolescents. Methods. We included 411 of 468 (87.8%) Mexican mothers or female caretakers of children and adolescents aged 4-16 undergoing routine health assessments in two Preventive Child Health Clinical Services in El Paso, Texas, USA. Mothers or female caretakers completed the Pictorial Pediatric Symptom Checklist and a psychological comprehensive test known as the Child Behavior Checklist (CBCL). Sensitivity and specificity was established using the CBCL as criteria for the validity of the PPSC. Results. The PPSC screening tool performed well as demonstrated by its detection rates of psychosocial and behavioral problems among the sample of Mexican children. Sensitivity and specificity at the standard cut-off scores was 69.6% and 95.2% for children 4-5 years old and 61.8% and 91.8% for children 6-16 years old respectively. The results were slightly lower than those found using the PSC among other ethnic groups in the United States, with a sensitivity and specificity of 71.7% and 93.0%, respectively. Conclusions. The PPSC is a simple, effective tool that can detect on average more than 65% of the children and adolescents with possible psychosocial problems during pediatric consultations. This free screening tool detected psychosocial problems in pediatric populations of Mexican origin living on the border and may be also effective for Mexican children living in Mexico.

Antecedentes. Los problemas psicosociales y de comportamiento deben ser detectados durante la consulta pediátrica para prevenir problemas irreparables y severos cuando el niño pasa a la adolescencia. La visita pediátrica ofrece una excelente oportunidad para detectar posibles problemas utilizando "pruebas rápidas" de diagnóstico. El objetivo de este estudio es determinar la validez diagnóstica de una adaptación de una prueba rápida conocida como "Pediatric Symptom Checklist" utilizando apoyos visuales para la detección de problemas psicosociales en una muestra de niños y adolescentes mexicanos. Métodos. Se trabajó con una muestra de 411 (87.8%) madres mexicanas de niños y adolescentes de 4 a 16 años, asistiendo a servicios preventivos en dos clínicas en El Paso, Texas, Estados Unidos. Las madres completaron la adaptación de la prueba rápida "PPSC" y una prueba psicológica comprensiva conocida como el "Child Behavior Checklist". Se utilizó el método de sensibilidad y especificidad para establecer la validez diagnóstica del PPSC. Resultados. La prueba rápida del PPSC se comportó favorablemente como se muestra en los resultados de detección de problemas psicosociales y de comportamiento en la muestra de niños y adolescentes. Los puntos de corte convencionales para el PPSC dieron una sensibilidad de 69.6% y especificidad de 95.2% para los niños en edades 4 a 5 años y de 61.8% y 91.8% para las edades de 6 a 16 años, respectivamente. Los resultados cuando se comparan con los reportados en otros grupos étnicos en los Estados Unidos (sensibilidad 71.7% y especificidad 93.0%) son ligeramente menores. Conclusiones. La prueba rápida del PPSC es una herramienta sencilla y efectiva que detectó en promedio más de 65% de los niños y adolescentes con posibles problemas psicosociales durante la consulta pediátrica. Esta "prueba rápida" que es gratuita detectó problemas psicosociales en poblaciones pediátricas de origen mexicano viviendo en la frontera y puede ser efectiva para niños y adolescentes que viven en México.

Patient communication: a multidisciplinary approach using animated cartoons.

Communication is a major problem in the management of patients. Miscommunication occurs frequently in populations with low reading skills, illiteracy does not completely account for the observed low rates of recall of communicated information. Transmission of the message also plays an important role. Successful strategies to improve communication with patients include the use of videotapes, videotape modeling or cartoon illustrations. Do these products communicate effectively because they overcome illiteracy or because they also transmit a very clear message? Can good transmission of messages overcome illiteracy? In this study, we compared the effectiveness of a printed message about polio vaccinations with the same message converted into a production of animated cartoons using marketing and advertising techniques. The production that resulted from using this strategy showed that in the setting of this study, a well-designed animated cartoon is more effective in delivering a message than the same information provided in written instructional materials.