The Rourke Baby Record Infant/Child Maintenance Guide: do doctors use it, do they find it useful, and does using it improve their well-baby visit records?

Background. The Rourke Baby Record (RBR) - http://www.rourkebabyrecord.ca - is a freely available evidence-based structured form for child health surveillance from zero to five years. Family physicians/general practitioners (FP/GPs) doing office based well-baby care in three Ontario Canada cities (London, Ottawa, and Toronto) were randomly sampled to study the prevalence and utility of the RBR and documentation of well-baby visits. Methods. Database with telephone confirmation was conducted to assess the prevalence of use of the RBR. Study Part 1: Questionnaire mailed to a random sample of 100 RBR users. Outcome measures were utility of, helpfulness of, and suggestions for the RBR. Descriptive analysis was employed. Study Part 2: Retrospective chart review of well-baby visits by 38 FP/GPs using student t-tests and factor analysis. Outcome measures were well-baby visit documentation of growth, nutrition, safety issues, developmental milestones, physical examination, and overall comprehensiveness. Results. The RBR was used by 78.5% (402/512) of successfully contacted FP/GPs who did well-baby care in these 3 cities. Study Part 1: Questionnaire respondents (N = 41/100) used the RBR in several ways, and found it most helpful for assessing healthy child development, charting/recording the visits, managing time effectively, addressing parent concerns, identifying health problems, and identifying high risk situations. The RBR was seen to be least helpful as a tool for managing or for referring identified health problems. Study Part 2: Charts from a total of 1,378 well-baby visits on 176 children were audited. Well-baby care provided by the 20 FP/GPs who used the RBR compared to that by the 18 non-users was statistically more likely to include documentation of type of feeding (p = 0.023), discussion of safety issues (p < 0.001), assessment of development (p = 0.001), and overall comprehensiveness (p < 0.001). Well-baby care provided by the RBR users compared to that by the non-users was not more likely to include documentation of measurement of growth (p = 0.097), or physical examination (p = 0.828). Conclusion. The RBR was widely used by FP/GPs in these settings. RBR users found it helpful for many purposes, and had a consistently high rate of documentation of many aspects of well-baby care. The Rourke Baby Record has become a de facto gold standard clinical practice tool in knowledge translation for pediatric preventive medicine and health surveillance for primary care pediatric providers

Mental health-care utilization in survivors of childhood cancer and siblings: the Swiss childhood cancer survivor study

PURPOSE: We aimed to (1) describe the utilization of mental health-care in survivors and siblings, the association with severity of distress, and visits to other professionals in distressed survivors not utilizing mental health-care; and (2) identify factors associated with utilization of mental health-care in distressed survivors. METHODS: Within the Swiss Childhood Cancer Survivor Study, we sent postal questionnaires to all participants aged <16 years at diagnosis (1976-2003), who survived ≥5 years after diagnosis and were aged ≥16 years at study. Survivors and siblings could indicate if they utilized mental health-care in the past year. Psychological distress was assessed with the Brief Symptom Inventory-18 (BSI-18). Participants with scores T ≥ 57 on two of three scales or the Global Severity Index were considered distressed. RESULTS: We included 1,602 survivors and 703 siblings. Overall, 160 (10 %) and 53 (8 %), utilized mental health-care and 203 (14 %) and 127 (14 %) were considered distressed. Among these, 69 (34 %) survivors and 20 (24 %) siblings had utilized mental health-care. Participants with higher distress were more likely to utilize mental health-care. Distressed survivors not utilizing mental health-care were more likely to see a medical specialist than nondistressed. In the multivariable regression, factors associated with utilizing mental health-care were higher psychological distress and reporting late effects. CONCLUSIONS: Our results underline the importance of developing interventional programs and implementing psychological screening in follow-up of survivors. It is also important to systematically address siblings' needs. In follow-up, patients at risk should be informed about existing possibilities or advised to visit mental health professionals

Pediatria no século 21: uma especialidade em perigo Pediatrics in the 21st century: a specialty in danger

OBJETIVO: Revisar a literatura sobre trabalho médico, formas de remuneração, avanço tecnológico e sua influência na Pediatria. FONTES DE DADOS: Artigos publicados em inglês e português nas bases de dados Medline, Lilacs e SciELO no período de 1990 a 2007. Foram utilizadas as palavras-chave"Puericultura","Pediatria","trabalho médico","honorários médicos","mercado de trabalho" e"desenvolvimento tecnológico". SÍNTESE DOS DADOS: Diante do estado atual de avanço tecnológico em todas as áreas do conhecimento, especialmente na Medicina, é necessário resgatar o papel do pediatra apesar das mudanças nas relações de trabalho, formas de remuneração, formação cada vez mais especializada e condições de trabalho aviltantes. Se, de um lado, as novas tecnologias são benéficas para a Medicina, para o médico e para o paciente, do outro o atendimento médico do clínico, principalmente do pediatra, não está sendo devidamente valorizado. CONCLUSÕES: É preciso que a classe pediátrica assuma a responsabilidade pela situação na qual essa especialidade se encontra, pois o pediatra se submete a condições de trabalho indignas do ponto de vista pessoal e social, obrigado à quantidade em detrimento da qualidade, tornando-se suscetível ao erro médico<br>OBJECTIVE: To review the literature about medical work, payment for medical labor, technological advances and its influence in Pediatrics. DATA SOURCES: Articles from 1990 to 2007 in English and Portuguese were retrieved in the Medline, Lilacs and SciELO databases using the following key-words:"well baby clinic","Pediatrics","physician working conditions","medical fees","labor market" and"technological development". DATA SYNTHESIS: Considering the technological advance in all areas of knowledge, especially in Medicine, and despite changes in work relationships, forms of payment, higher levels of specialization and improper working conditions, the role of pediatricians must be recovered. New technologies are beneficial for Medicine, physicians and patients; on the other hand, clinical care offered by pediatrician, is not properly valued. These facts discourage the Pediatrics practice, which has an undisputed relevance for Brazilian society. CONCLUSIONS: It is necessary that pediatricians fight against their current situation, since they are submitted to improper personal and social conditions at work, forced to focus on quantity over quality, and becoming susceptible to medical error