Well-Child Examinations are an integral part of monitoring growth and development for children. These visits allow for establishment of a therapeutic relationship between patient and caregiver, and provide opportunities to screen for underlying conditions while simultaneously following growth and development milestones. Well-child examinations provide opportunities for parents to voice concerns and help to identify those children at risk for delays or underlying medical conditions. When these conditions are identified early, they tend to have an improvement of outcomes. Since the core items to be included in wellness examinations vary by age, insurance provider, and risk factors, our aim is to measure and improve the knowledge and comprehension of examination components among a group of Family Medicine resident physicians that provide primary care to a pediatric population. Provider knowledge and understanding was measured by means of a set of multiple-choice questions prior to an educational session. A post-educational examination was then administered to assess recruitment and retention of information. There appeared to be an overall positive trend toward increased knowledge base following the education session, indicating and improvement of understanding and medical knowledge.

Postpartum depression (PPD) refers to the onset of depressive symptoms anytime within first year following the birth of a child. PPD affects approximately 10-20% of new mothers and often goes underdiagnosed and untreated. Left untreated, PPD can predispose women to more severe and frequent future depressive episodes. Literature suggests depression in mothers may have long-term negative effects on infants’ and children’s psychosocial development. The American Academy of Pediatrics (AAP) has identified pediatric primary care as the ideal location to screen and refer mothers possibly suffering from depression. Routinely assessing PPD in mothers during well-child checks is not only recommended, it is increasingly being considered a best practice standard. The AAP calls for further research to improve the feasibility of assessing and treating PPD in mothers in pediatric primary care. This paper is part of a larger study that will be evaluating the effectiveness of screening new mothers for PPD in pediatric primary care settings and providing a brief same day interventions. The current aims of this portion of the study will be to evaluate 1) referral results, and 2) mothers’ level of satisfaction with the protocol. Research assistants (RA) will approach mothers of infants, birth to 6 months of age in the waiting rooms of ETSU Pediatrics in Johnson City, TN. Mothers will be given a brief description of PPD, the study and will be asked to participate by signing a voluntary informed consent document. As part of the visit, nurses will distribute and score the Edinburg Postpartum Depression Scale (EPDS). Mothers scoring 9 or above will receive a brief educational brochure about PPD, a brief intervention and a one week follow-up phone call with an onsite behavioral health consultant (BCH) or social worker (SW). At mothers’ discretion, an appropriate outside referral to preferred provider will be made, if necessary. Approximately two weeks postintervention, a satisfaction survey by phone will be administered by RAs. The survey will examine referral results (e.g., of high scores, what recommendations were made, did mothers follow through, treatments received, was there improvement in EPDS score) and the mothers’ level of satisfaction with the protocol (e.g., satisfaction with how protocol was handled by staff and how well mothers felt their needs were addressed). Satisfaction will be noted on a likert-scale ranging from 0 (no satisfaction) to 10 (very satisfied). Data is pending and collection will start during the first week of March showing EDPS uptake, referral results and mother satisfaction. Data is expected for approximately 60-100 new mothers.

U.S. immunization and well child-care rates are below desired levels with lower income individuals being at higher risk for receiving inadequate care. To enhance the understanding of motivating factors to health care utilization, this study explored relationships between a mother's interaction style (secure, anxious, avoidant), her reported experiences with pediatric health care and her child's utilization of pediatric health care. Participants included 126 US-born, English-speaking women with an infant 12 to18 months of age. Linear regression analyses found no bivariate associations between maternal interaction style and reported experiences of care. Poisson regression analyses measured associations of maternal interaction style, reported experiences of care, and moderating variables with health care visits and immunizations received. Main effect models found no associations between maternal interaction style and reported experiences of care. Significant associations were identified between provider ratings and sick visits. There were no associations between provider office ratings and utilization rates. When interaction style and provider/provider office ratings were included in the model, high provider ratings (P<.05) and high anxious interaction scores (p<.0001) were associated with more sick visits while higher avoidant interaction style scores (p<.01) were associated with decreased use of sick visits. Multivariate modeling identified provider rating (p<.05) and anxious interaction score (p<.01) as main effects, child's health rating as a confounder, as well as target child being mother's first, WIC/Healthy Start participation, maternal bonding and feelings about going to the doctor acting as moderators to associations between interaction style and sick/follow-up visits. Secure interaction style scores were associated with increased use of emergency department visits, controlling for the confounding effects of maternal bonding and the moderating effects of child's health status and maternal age. Findings indicate that, in some cases, maternal interaction style is associated with how and when mothers access health care for their children. The confounders and moderators identified also highlight the need for more understanding regarding what motivates individuals. Finally, there were racial and ethnic differences including higher rates of avoidant interaction styles in Black, non-Hispanic mothers. Predicting health care utilization patterns will help better target the specific needs of mothers and ultimately improve health outcomes.

Over six million insured children belong to families where the parents in their household lack health insurance. Studies have indicated insured low-income children with uninsured parents are less likely to have physician visits and well-child visits than their counterparts with insured parents. However, self-selection may be responsible for the relationship found between parental insurance and well-child visits. No studies have been undertaken to examine the impact of parental insurance on the utilization of children with chronic conditions. Social Cognitive Theory was used to model children's health care utilization and explain the relationship between parental insurance and that utilization. The objectives of the study are to estimate the effect of health insurance for the primary parent on (1) insured children's well-child visits and (2) physician visits for asthma in insured children. This study used a cross-sectional design. The data source was the 2007 Medical Expenditure Panel Survey-Household Component. The sample consisted of children 17 years or less who were insured through the same source(s) for the entire year and had a primary parent who was either insured or uninsured the entire year. The dependent variable for the entire sample was whether or not the child had at least one well-child visit during the year. The dependent variables for the subsample of children with asthma were (1) whether or not the child had at least one asthma-related physician visit and (2) whether or not the child had at least two asthma-related physician visits. The independent variables were the same for the three analyses and were selected to represent the Social Cognitive Theory determinants. These included parent (insurance, sex, worry, education, language, employment, health use, health, risk aversion, and self care expectation), child (source of coverage, age, health, race, and oldest child), and household (Metropolitan Statistical Area, region, number of children, number of parents, and income) variables. Probit and bivariate probit models were estimated for each dependent variable. The percentage of children with insured parents that had a well-child visit during the year was significantly higher than the percentage of children with uninsured parents that had a well-child visit (50.6% vs. 42.8%, respectively). However, multivariate analyses revealed no significant relationship between parental insurance and well-child visits. The percentages of children with insured and uninsured parents that had an asthma-related physician visit were 29.6% and 32.6%, respectively. The percentages that had at least two asthma-related visits were 14.9% and 14.6%, respectively. No significant relationship was found between parental insurance and asthma-related physician visits. The region of the United States where the child lived and whether the child's parent was employed were associated with each type of utilization. Other determinants were also associated with children's utilization, but these varied with the type of utilization. In conclusion, insured children with insured parents are no more likely to have a well-child or asthma-related physician visit during the year than insured children with uninsured parents.

No description available.

O objetivo geral do estudo foi analisar o processo de trabalho da enfermeira materno infantil (EMI), orientado ao cuidado da criança sadia no Programa de Vigilância da Nutrição, Crescimento e Desenvolvimento da Criança menor de 5 anos de idade, em uma instituição da Seguridade Social no México. Fundamentou-se nas concepções do processo de trabalho em saúde de Mendes-Golçalves (1994), no processo de trabalho da enfermagem como proposto por Almeida (1991) e Almeida e Rocha (1997), e nas concepções teóricas da micropolítica do trabalho vivo em saúde, que permitiram focalizar o espaço intercessor trabalhador/usuário (MERHY, 1997, 2004). Utilizou-se a abordagem qualitativa com observação sistemática direta e entrevista semi-estruturada. Os sujeitos do estudo foram as enfermeiras (EMI), as assistentes médicas da EMI (AEMI) e as mães que compareceram à consulta de enfermagem. Observaram-se 87 consultas proporcionadas pelas EMI, e observação à área da recepção atendida pela AEMI, assim como entrevista a este pessoal (6 entrevistas) e as mães (25 entrevistas). A saturação dos dados e a compreensão do significado foram os critérios para estabelecer o número necessário de observações e entrevistas. As consultas proporcionadas pela EMI identificaram-se centradas na realização de procedimentos como: verificação do peso, estatura e revisão da carteira de vacinas conforme os protocolos de atenção (tecnologias duras), com diálogos mais bem identificados como monólogos da EMI à mãe. Verificou-se que o encontro entre a mãe/filho portadores de uma dada necessidade de saúde com a EMI portadora de um arsenal de saberes específicos e práticas, envolve um encontro de situações não equivalentes, a mãe tem a necessidade de que a EMI, no mínimo a cumprimente e a acolha. Assim o trabalho da EMI é capturado pelo trabalho morto, pela configuração institucional que se expressa no tempo de atendimento, na consulta marcada com antecedência, no seguimento dos protocolos e rotinas impostos pelo serviço que não permitem o estabelecimento de um núcleo cuidador. Mas como o trabalho da EMI é trabalho em saúde que se efetiva em um processo quase-estruturado, a EMI foi capaz de produzir trabalho vivo como fonte de tecnologias leves (tecnologias de relações, de acolhimento), baseando-se principalmente em seu autogoverno que lhe permitiu o estabelecimento de um núcleo de cuidado mãe/filho-centrado. A conformação da equipe de saúde foi identificada como equipe agrupamento caracterizada pela fragmentação e especificidade do trabalho com comunicação de aspectos só pessoais. As mães perceberam o cuidado à criança sadia como a realização de procedimentos, verificação do peso e estatura, ter um registro dos avanços no desenvolvimento de seu filho e o fornecimento da cota de leite, que surgiu como um orientador/desorientador da atenção que coloca os atores sociais em conflito com necessidades distintas. Recomenda-se a flexibilização das normas e rotinas que permitam a construção de um núcleo cuidador mãe/filho-centrado, baseado nas tecnologias leves como o acolhimento e a confiança, para que a mãe possa colocar suas dúvidas relacionadas ao cuidado de seu filho e desenvolva um grau de autonomia e assim reconhecer à enfermeira como cuidadora, educadora, conselheira e promotora da saúde / The general aim of this study was to analyze the work process of maternal child nurses, directed to the care of healthy children in the Program of Nutrition Surveillance, Growth and Development for children under 5 years of age at a social security institution in Mexico. This research was based on the concepts of health work process by Mendes-Gonçalves (1994), the nursing work process proposed by Almeida (1991) and Almeida and Rocha (1997) and on the theoretical conceptions of micropolitics of health work involving human staff, enabling the author to focus the worker/user space (1991) (MERHY, 1997, 2004). A qualitative approach was used through systematic direct observation and semi-structured interviews. The subjects were maternal child nurses, medical assistants who welcomed the patients when they arrived and mothers who went to the nursing consultation. 87 nursing consultations were observed as well as the reception of patients. In addition, author interviewed the staff (6 interviews) and mothers (25 interviews). Data saturation and meaning comprehension were the criteria to establish the necessary number of observations and interviews. The consultations were identified as centered in procedures such as: weight and height measurement, review of the vaccination record according to the care protocols (hard technologies) with dialogues identified as monologues of nurses to the mothers. Findings showed that the meeting between mother and child with specific health needs and nurses with large scientific and practical knowledge involves an approximation of non-equivalent situations. The mothers expect, at least, that nurses will be able to welcome them. Thus, the maternal child nurse work is captured by a work with machines, the institutional configuration that is expressed during the consultation period, with the appointment determined previously, in following protocols and routines imposed by the service and that do not allow the establishment of a caring core. However, with nurses work, the health work happens in a nearly-structured process and nurses were able to produce a live work as a source of soft technologies (relationship and welcome technologies), based mainly in their self-governance and allowing the establishment of a nucleus of care centered in the mother/child. The conformation of the health team was identified as a grouping team characterized by the fragmentation and specificity of the work with only the communication of personal aspects. Mothers perceived that the care of a healthy child is based on procedures to verify height and weight, registration of the development of their children and the supply of a milk portion, that appeared as a factor that guided/disturbed the care as resulted in conflict among the social actors with different needs. The author recommends the flexibilization of the norms and routines, enabling the construction of a nucleus centered in the mother/child, based on soft technologies of welcome and trust, allowing mothers to ask their questions related to the care of their children as well as to develop a level of autonomy, recognizing the nurse as a care provider, educator, advisor and health promoter.

O objetivo geral do estudo foi analisar o processo de trabalho da enfermeira materno infantil (EMI), orientado ao cuidado da criança sadia no Programa de Vigilância da Nutrição, Crescimento e Desenvolvimento da Criança menor de 5 anos de idade, em uma instituição da Seguridade Social no México. Fundamentou-se nas concepções do processo de trabalho em saúde de Mendes-Golçalves (1994), no processo de trabalho da enfermagem como proposto por Almeida (1991) e Almeida e Rocha (1997), e nas concepções teóricas da micropolítica do trabalho vivo em saúde, que permitiram focalizar o espaço intercessor trabalhador/usuário (MERHY, 1997, 2004). Utilizou-se a abordagem qualitativa com observação sistemática direta e entrevista semi-estruturada. Os sujeitos do estudo foram as enfermeiras (EMI), as assistentes médicas da EMI (AEMI) e as mães que compareceram à consulta de enfermagem. Observaram-se 87 consultas proporcionadas pelas EMI, e observação à área da recepção atendida pela AEMI, assim como entrevista a este pessoal (6 entrevistas) e as mães (25 entrevistas). A saturação dos dados e a compreensão do significado foram os critérios para estabelecer o número necessário de observações e entrevistas. As consultas proporcionadas pela EMI identificaram-se centradas na realização de procedimentos como: verificação do peso, estatura e revisão da carteira de vacinas conforme os protocolos de atenção (tecnologias duras), com diálogos mais bem identificados como monólogos da EMI à mãe. Verificou-se que o encontro entre a mãe/filho portadores de uma dada necessidade de saúde com a EMI portadora de um arsenal de saberes específicos e práticas, envolve um encontro de situações não equivalentes, a mãe tem a necessidade de que a EMI, no mínimo a cumprimente e a acolha. Assim o trabalho da EMI é capturado pelo trabalho morto, pela configuração institucional que se expressa no tempo de atendimento, na consulta marcada com antecedência, no seguimento dos protocolos e rotinas impostos pelo serviço que não permitem o estabelecimento de um núcleo cuidador. Mas como o trabalho da EMI é trabalho em saúde que se efetiva em um processo quase-estruturado, a EMI foi capaz de produzir trabalho vivo como fonte de tecnologias leves (tecnologias de relações, de acolhimento), baseando-se principalmente em seu autogoverno que lhe permitiu o estabelecimento de um núcleo de cuidado mãe/filho-centrado. A conformação da equipe de saúde foi identificada como equipe agrupamento caracterizada pela fragmentação e especificidade do trabalho com comunicação de aspectos só pessoais. As mães perceberam o cuidado à criança sadia como a realização de procedimentos, verificação do peso e estatura, ter um registro dos avanços no desenvolvimento de seu filho e o fornecimento da cota de leite, que surgiu como um orientador/desorientador da atenção que coloca os atores sociais em conflito com necessidades distintas. Recomenda-se a flexibilização das normas e rotinas que permitam a construção de um núcleo cuidador mãe/filho-centrado, baseado nas tecnologias leves como o acolhimento e a confiança, para que a mãe possa colocar suas dúvidas relacionadas ao cuidado de seu filho e desenvolva um grau de autonomia e assim reconhecer à enfermeira como cuidadora, educadora, conselheira e promotora da saúde / The general aim of this study was to analyze the work process of maternal child nurses, directed to the care of healthy children in the Program of Nutrition Surveillance, Growth and Development for children under 5 years of age at a social security institution in Mexico. This research was based on the concepts of health work process by Mendes-Gonçalves (1994), the nursing work process proposed by Almeida (1991) and Almeida and Rocha (1997) and on the theoretical conceptions of micropolitics of health work involving human staff, enabling the author to focus the worker/user space (1991) (MERHY, 1997, 2004). A qualitative approach was used through systematic direct observation and semi-structured interviews. The subjects were maternal child nurses, medical assistants who welcomed the patients when they arrived and mothers who went to the nursing consultation. 87 nursing consultations were observed as well as the reception of patients. In addition, author interviewed the staff (6 interviews) and mothers (25 interviews). Data saturation and meaning comprehension were the criteria to establish the necessary number of observations and interviews. The consultations were identified as centered in procedures such as: weight and height measurement, review of the vaccination record according to the care protocols (hard technologies) with dialogues identified as monologues of nurses to the mothers. Findings showed that the meeting between mother and child with specific health needs and nurses with large scientific and practical knowledge involves an approximation of non-equivalent situations. The mothers expect, at least, that nurses will be able to welcome them. Thus, the maternal child nurse work is captured by a work with machines, the institutional configuration that is expressed during the consultation period, with the appointment determined previously, in following protocols and routines imposed by the service and that do not allow the establishment of a caring core. However, with nurses work, the health work happens in a nearly-structured process and nurses were able to produce a live work as a source of soft technologies (relationship and welcome technologies), based mainly in their self-governance and allowing the establishment of a nucleus of care centered in the mother/child. The conformation of the health team was identified as a grouping team characterized by the fragmentation and specificity of the work with only the communication of personal aspects. Mothers perceived that the care of a healthy child is based on procedures to verify height and weight, registration of the development of their children and the supply of a milk portion, that appeared as a factor that guided/disturbed the care as resulted in conflict among the social actors with different needs. The author recommends the flexibilization of the norms and routines, enabling the construction of a nucleus centered in the mother/child, based on soft technologies of welcome and trust, allowing mothers to ask their questions related to the care of their children as well as to develop a level of autonomy, recognizing the nurse as a care provider, educator, advisor and health promoter.