Thesis (M.Med. (Diagnostic Radiology)) -- University of Limpopo, 2022 / BACKGROUND: Ionizing radiation is detrimental to growing cells. The potential risk of any dose of radiation in growing cells can lead to permanent damage of basic cellular structure resulting in a high risk of developing cancer in children. Therefore, paediatric doctors need sufficient knowledge to protect their patients from late effects of radiation resulting from medical use. Most studies report poor knowledge of radiation safety measures among doctors. PURPOSE: The purpose of this study is to assess the knowledge of radiation safety and radiation doses among paediatric doctors in Pietersburg and Mankweng Hospitals, Limpopo province, South Africa. OBJECTIVE: To assess the paediatric doctors’ knowledge of radiation doses used in radiological diagnostic imaging examinations, as well as their knowledge of radiation safety measures. METHODOLOGY: This is a survey of paediatric doctors in the paediatrics general ward, paediatric oncology, intensive care and neonatal units, and paediatric surgery department, at Pietersburg and Mankweng Hospitals. A self-administered questionnaire with 23 items on knowledge of radiation safety and radiation doses emitted during normal radiological examinations is used to collect the data in May 2021. Data are analysed using Statistical Package for Social Sciences (SSPS) version 26.0 software. Chi-squared test is used to analyse the relationship between variables. Analysis of variance (ANOVA) is used to analyse the differences between variables. A p value of <0.05 is considered statistically significant. A total score of 50% in each section is used to denote adequate knowledge. The result are presented in charts and tables. RESULTS: Out of 52 paediatric doctors, 47 completed the questionnaire achieving a 90.4% response rate. Majority of participants were females (n = 31; 66%). Overall, only 10 (21.2%) of the participants scored 50% and above, including three consultants, two registrars, two medical officers and one medical officer intern. Twenty-five (53.1%) participants scored 50% and above on knowledge of radiation safety. Nearly half (44.7%) of the doctors were familiar with the concept of ALARA principle in radiation dose optimisation. Three participants scored more than 50% in the knowledge of radiation doses section. Only five (10.6%) and 17 (36%) participants correctly identified MRI and ultrasound, respectively, as the radiological diagnostic modalities that do not utilize ionizing radiation. CONCUSION: The level of knowledge of radiation safety and radiation doses among the paediatric doctors are poor. A very small number of the paediatric doctors were able to identify non-ionizing radiation modalities that can be used as an alternative to reduce radiation exposure to paediatrics during radiological investigations. Paediatric doctors will benefit from courses on radiation safety and radiation doses to improve their knowledge and/or eliminate unwarranted exposure of their patients to ionizing radiation.

Introduction: The field of implementation science provides the variables adoption and reach, which can be used to evaluate aspects to access, a primary incitement for integrated care. This study compared two integrated models: In Year 1, behavioral health consultants worked collaboratively with pediatricians to provide brief on-the-spot consultations to patients with behavioral concerns, and in Year 2, a structured, evidence-based treatment (EBT), the Family Check-Up, was developed to be delivered in conjunction with the existing collaborative model. Method: A chart review revealed the number of children who (a) attended a 4- to 5-year-old well-visit, (B) were screened, (c) were identified as having behavior problems, (d) were referred, and (e) accessed the services. Outcomes were calculated as percentages of children with behavioral concerns who were referred to (adoption) and received (reach) the services in each year. Results: Key findings were that (a) physician referrals increased when an EBT was added, but (b) patients had better first-session contact with the brief approach than the EBT, which few patients completed. Discussion: Results underscore the utility of measuring adoption and reach as partial indicators of access to services. These are accessible variables, collected in every practice that can be measured routinely in the context of quality improvement and, ideally, reported in studies as a way to disseminate knowledge about how to build behavioral health technology into primary care. Future research should strive for more rigor in measuring adoption and reach, and consider including a number of other implementation outcomes.

This study examines state variations in health care services for children with Autism and other developmental disabilities across the fifty states through the Autism and Developmental Disabilities Monitoring Network (ADDM). The ADDM network monitors and tracks the number of children with Autism and other developmental disabilities. The purpose of this study is, first, to understand the differences between the states in the implementation of the ADDM network and, second, to determine what state factors (political variable, i.e., party identification; structural administrative variables, i.e., Medicaid Home and Community Based Service Waiver, HCBS (Section1915C) and the number of pediatricians per 10,000 children; Autism prevalence variable, i.e., Autism among children in special education per 10,000 children; and state economic variables, i.e., spending per pupil for children with Autism in special education, children in poverty, and state financial health) influence the likelihood of a state applying for the ADDM network. Furthermore, the purpose of this study is to consider the potential impact of these various state characteristics in order to understand what state factors might contribute to such differences. The results reveal that structural administrative and economic factors influence a state’s decision to apply for the ADDM network. Furthermore, political factors (e.g., Democratic party control of governorship and legislature) did not influence a state’s decision to apply for the ADDM network. However, when controlling for Republican political party identification, the structural administrative, economic, and political (Republican-controlled legislature) state characteristics influence whether a state applying for the ADDM network. The results indicate that political party control does not play a significant role in determining whether a state will apply for the ADDM network. In expanding the research, to include another structural administrative factor (prior application), political party control (i.e., Republican-controlled legislature) was no longer significant. Thus, the bureaucratic environment is not influencing the actions of state administrators. Instead the individual characteristics of the state is influencing whether a state will apply for the ADDM network. Understanding the differences between the states in the implementation of the ADDM network provides a comprehensive model for establishing the ADDM network or similar programs in other states.