Pediatrics

Infant Demographic Profile and Parent Report of Treatment Outcomes

By Frank M. Painter|April 25, 2018|Pediatrics|

Infant Demographic Profile and Parent Report of Treatment Outcomes at a Chiropractic Clinic in the UK:
An Observational Study

SOURCE: J Clinical Chiropractic Pediatrics 2017 (Jan); 17 (1): 1398–1404

Johanna M. Jaskulski, MChiro and Joyce E. Miller, BS, DC, PhD

Private practice.
ProChiro Baesweiler,
Nordrhein-Westfalen, Deutschland

Background: Children, particularly infants, commonly present to chiropractors. Few studies have concentrated on the demographic profile of infants as well as clinical changes reported by parents of infants under chiropractic care.

Objectives: To identify the demographic profile of infants presenting to a chiropractic clinic and to investigate any change of infant symptoms and maternal feelings following an episode of chiropractic care.

Setting: This health care observation study was performed at a chiropractic teaching clinic on the south coast of England.

Subjects/Patients: The study included all mother-infant dyads who presented to the clinic between August 2011 and June 2015 and could read and write English and who consented to complete the forms. Exclusion criteria were mothers of infants older than one year of age at presentation.

Methods: All mothers were asked to complete two questionnaires at the initial visit and two follow-up questionnaires at discharge. Data collected were sociodemographic characteristics along with questions asking for graded responses regarding the daily amount of irritable behavior in their child, level of distress the mother feels with her child’s behavior, restfulness of infant sleep during the week and difficulty to console the child when crying as well as to the clinical experience provided. Additionally, the validated Edinburgh Postnatal Depression Scale (EPDS) was used as a report of the mother’s feelings.

Results: 413 mothers completed the intake questionnaires. 197 (48%) mothers completed the discharge questionnaires. At intake, 50.3% (n=182) of the patients were four weeks of age or younger. The presenting complaint appeared before the age of two weeks in 79.1% (n=161) of the cases. 30.2% (n=160) presented with colic/crying and 22.9% (n=121) with a feeding related complaint. The modal length of an episode of care was two weeks. Over the course of treatment, average maternal distress levels reduced by 48%. Mean amount of irritability reduced by 31%; mean restfulness of sleep improved by 27% and mean difficulty to console reduced by 38% in the infant. The median EPDS score dropped by 50% over the time of care. 96.3% of parents rated 8–10 satisfaction with care on a scale of 1–10.

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Association Between Use of Acid-Suppressive Medications

By Frank M. Painter|April 3, 2018|Pediatrics|

Association Between Use of Acid-Suppressive Medications and Antibiotics During Infancy and Allergic Diseases in Early Childhood

The Chiro.Org Blog

SOURCE: JAMA Pediatrics 2018 (Apr 2) [Epub]

Edward Mitre, MD; Apryl Susi, MS; Laura E. Kropp, MPH

Department of Microbiology and Immunology,
F. Edward Hébert School of Medicine,
Uniformed Services University of the Health Sciences,
Bethesda, Maryland

A new Study reports:
Infants who are given antacids like Zantac or Pepcid
are more likely to develop childhood allergies

FROM: TIME Magazine ~ April 2, 2018

Infants who are given antacids like Zantac or Pepcid are more likely to develop childhood allergies, perhaps because these drugs may alter their gut bacteria, a new large study suggests.

Early use of antibiotics also raised the chances of allergies in the study of nearly 800,000 children.

Researchers combed the health records of kids born between 2001 and 2013 and covered by Tricare, an insurance program for active duty and retired military personnel and their families. A surprising 9 percent of the babies received antacids, reflecting the popularity of treating reflux in infancy.

Over four years, more than half of all the children developed allergies to foods or medications, rashes, asthma, hay fever or other allergic diseases. The study couldn’t prove causes, but the connection with antacids and antibiotics was striking.

For children who received an antacid during their first six months, the chances of developing a food allergy doubled; the chances of developing a severe allergic reaction called anaphylaxis or hay fever were about 50 percent higher. For babies who received antibiotics, the chances doubled for asthma and were at least 50 percent higher for hay fever and anaphylaxis.

The results were published Monday in JAMA Pediatrics.

The Abstract:

Importance Allergic diseases are prevalent in childhood. Early exposure to medications that can alter the microbiome, including acid-suppressive medications and antibiotics, may influence the likelihood of allergy.

Objective To determine whether there is an association between the use of acid-suppressive medications or antibiotics in the first 6 months of infancy and development of allergic diseases in early childhood.

Design, Setting, and Participants A retrospective cohort study was conducted in 792,130 children who were Department of Defense TRICARE beneficiaries with a birth medical record in the Military Health System database between October 1, 2001, and September 30, 2013, with continued enrollment from within 35 days of birth until at least age 1 year. Children who had an initial birth stay of greater than 7 days or were diagnosed with any of the outcome allergic conditions within the first 6 months of life were excluded from the study. Data analysis was performed from April 15, 2015, to January 4, 2018.

Exposures Exposures were defined as having any dispensed prescription for a histamine-2 receptor antagonist (H₂RA), proton pump inhibitor (PPI), or antibiotic.

Main Outcomes and Measures The main outcome was allergic disease, defined as the presence of food allergy, anaphylaxis, asthma, atopic dermatitis, allergic rhinitis, allergic conjunctivitis, urticaria, contact dermatitis, medication allergy, or other allergy.

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The Quality of Life of Children Under Chiropractic Care Using PROMIS-25

By Frank M. Painter|January 2, 2018|Pediatrics|

The Quality of Life of Children Under Chiropractic Care Using PROMIS-25: Results from a Practice-Based Research Network

The Chiro.Org Blog

SOURCE: J Altern Complement Med. 2017 (Dec 20) [Epub]

Joel Alcantara, DC, Andrea E. Lamont, PhD,
Jeanne Ohm, DC, and Junjoe Alcantara, DC

The International Chiropractic Pediatric Association,
327N Middletown Road
Media, PA 610-565-2360

OBJECTIVES: To characterize pediatric chiropractic and assess pediatric quality of life (QoL).

DESIGN: A prospective cohort. Setting/Locations: Individual offices within a practice-based research network located throughout the United States.

SUBJECTS: A convenience sample of children (8-17 years) under chiropractic care and their parents.

EXPOSURE: Chiropractic spinal adjustments and adjunctive therapies.

OUTCOME MEASURES: Survey instrument measuring sociodemographic information and correlates from the clinical encounter along with the Patient Reported Outcomes Measurement Information System (PROMIS)-25 to measure QoL (i.e., depression, anxiety, and pain interference). Sociodemographic and clinical correlates were analyzed using descriptive statistics (i.e., frequencies/percentages, means, and standard deviations). The PROMIS-25 data were analyzed using scoring manuals, converting raw scores to T score metric (mean = 50; SD = 10). A generalized linear mixed model was utilized to examine covariates (i.e., sex, number of visits, and motivation for care) that may have played an important role on the PROMIS outcome.

RESULTS: The original data set consisted of 915 parent-child dyads. After data cleaning, a total of 881 parents (747 females, 134 males; mean age = 42.03 years) and 881 children (467 females and 414 males; mean age = 12.49 years) comprised this study population. The parents were highly educated and presented their child for mainly wellness care. The mean number of days and patient visits from baseline to comparative QoL measures was 38.12 days and 2.74 (SD = 2.61), respectively. After controlling for the effects of motivation for care, patient visits, duration of complaint, sex, and pain rating, significant differences were observed in the probability of experiencing problems (vs. no reported problems) across all QoL domains (Wald = 82.897, df = 4, p < 0.05). Post hoc comparisons demonstrated the children were less likely to report any symptoms of depression (Wald = 6.1474, df = 1, p < 0.05), anxiety (Wald = 20.603, df = 1, p < 0.05), fatigue (Wald = 22.191, df = 1, p < 0.05), and pain interference (Wald = 47.422, df = 1, p < 0.05) after a trial of chiropractic care.

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The Use of the RAND VSQ9 to Measure the Quality of Life

By Frank M. Painter|December 25, 2017|Pediatrics|

The Use of the Patient Reported Outcomes Measurement Information System and the RAND VSQ9 to Measure the Quality of Life and Visit-Specific Satisfaction of Pregnant Patients Under Chiropractic Care Utilizing the Webster Technique

The Chiro.Org Blog

SOURCE: J Altern Complement Med. 2017 (Dec 20) [Epub]

Joel Alcantara, Andrea Lamont Nazarenko,
Jeanne Ohm, and Junjoe Alcantara

The International Chiropractic Pediatric Association,
Media, PA.

OBJECTIVE: To quantify the quality of life (QoL) and visit-specific satisfaction of pregnant women.

DESIGN: A prospective cohort within a practice-based research network (PBRN). Setting/locations: Individual chiropractic offices.

SUBJECTS: Pregnant women (age ≥18 years) attending chiropractic care.

INTERVENTION(S): Chiropractic care (i.e., The Webster Technique, spinal adjustments, and adjunctive therapies).

MAIN OUTCOME MEASURES: The RAND VSQ9 to measure visit-specific satisfaction and the Patient Reported Outcomes Measurement Information System (PROMIS®)-29 to measure QoL.

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Pediatric Patients in Swiss Chiropractic Clinics

By Frank M. Painter|November 10, 2017|Pediatrics|

Pediatric Patients in Swiss Chiropractic Clinics:
A Questionnaire Survey

The Chiro.Org Blog

SOURCE: J Manipulative Physiol Ther. 2017 (Oct 24) [Epub]

Mette Hobaek Siegenthaler, DC, MSc

Holbeinpraxis,
Swiss Academy for Chiropractic,
Berne, Switzerland

OBJECTIVES: The purpose of this study was to investigate practice characteristics of chiropractors who treat pediatric patients in Swiss chiropractic clinics.

METHODS: An online survey questionnaire was created and tested for face and content validity. Participation by Swiss chiropractors was voluntary and anonymous and completed November to December 2015. The data were analyzed using SPSS. The analysis consisted of descriptive statistics.

RESULTS: The sample consisted of 144 chiropractors, which represented a 53% response rate, and 98% of the responding practitioners treated patients younger than age 18. The proportion of pediatric patients treated was 8.7%. The most common pediatric age groups were schoolchildren and adolescents, with infants younger than 6 months being the third most common. Musculoskeletal complaints were the most common conditions treated in all age groups. In children younger than 2 years old, nonmusculoskeletal conditions were well represented. Prophylactic examination was common among children 6 years and younger.

A total of 61% of responding chiropractors received direct referrals from medical doctors and 56% received direct referrals from pediatricians. The most common age groups for referrals from pediatricians were schoolchildren and adolescents. Only 15% of the chiropractors wrote reports about their pediatric patients to their pediatrician often or regularly; 90% of the responding chiropractors stated they rarely or never refer to a pediatric specialist, and 80% of the chiropractors have never or have rarely been invited to attend medical congresses or to teach the pediatric health care community about chiropractic care for children.

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Attitudes and Opinions of Doctors of Chiropractic Specializing in Pediatric Care Toward Patient Safety

By Frank M. Painter|March 24, 2017|Chiropractic Care, Pediatrics, Safety|

Attitudes and Opinions of Doctors of Chiropractic Specializing in Pediatric Care Toward Patient Safety: A Cross-sectional Survey

The Chiro.Org Blog

SOURCE: J Manipulative Physiol Ther. 2016 (Sep); 39 (7): 487–493

Katherine A. Pohlman, DC, MS, Linda Carroll, PhD,
Lisa Hartling, PhD, MSc, Ross Tsuyuki, PharmD, MSc,
Sunita Vohra, MD, MSc

Research Institute,
Parker University,
Dallas, TX.

OBJECTIVE: The purpose of this cross-sectional survey was to evaluate attitudes and opinions of doctors of chiropractic (DCs) specializing in pediatric care toward patient safety.

METHODS: The Medical Office Survey on Patient Safety Culture of the Agency for Healthcare Research and Quality was adapted for providers who use spinal manipulation therapy and sent out to 2 US chiropractic organizations’ pediatric council members (n = 400) between February and April 2014. The survey measured 12 patient safety dimensions and included questions on patient safety items and quality issues, information exchange, and overall clinic ratings. Data analyses included a percent composite average and a nonrespondent analysis.

RESULTS: The response rate was 29.5% (n = 118). Almost one- third of respondents’ patients were pediatric (≤17 years of age). DCs with a pediatric certification were 3 times more likely to respond (P < .001), but little qualitative differences were found in responses. The patient safety dimensions with the highest positive composite percentages were Organizational Learning (both administration and clinical) and Teamwork (>90%). Patient Care Tracking/Follow-up and Work Pressure and Pace were patient safety dimensions that had the lowest positive composite scores (<85%). The responses also indicated that there was concern regarding information exchange with insurance/third-party payors. Two quality issues identified for improvement were (1) updating a patient’s medication list and (2) following up on critically abnormal results from a laboratory or imaging test within 1 day. The average overall patient safety rating score indicated that 83% of respondents rated themselves as “very good” or “excellent.”

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Pediatrics

Infant Demographic Profile and Parent Report of Treatment Outcomes

Infant Demographic Profile and Parent Report of Treatment Outcomes at a Chiropractic Clinic in the UK: An Observational Study

Association Between Use of Acid-Suppressive Medications

Association Between Use of Acid-Suppressive Medications and Antibiotics During Infancy and Allergic Diseases in Early Childhood

The Quality of Life of Children Under Chiropractic Care Using PROMIS-25

The Quality of Life of Children Under Chiropractic Care Using PROMIS-25: Results from a Practice-Based Research Network

The Use of the RAND VSQ9 to Measure the Quality of Life

The Use of the Patient Reported Outcomes Measurement Information System and the RAND VSQ9 to Measure the Quality of Life and Visit-Specific Satisfaction of Pregnant Patients Under Chiropractic Care Utilizing the Webster Technique

Pediatric Patients in Swiss Chiropractic Clinics

Pediatric Patients in Swiss Chiropractic Clinics: A Questionnaire Survey

Attitudes and Opinions of Doctors of Chiropractic Specializing in Pediatric Care Toward Patient Safety

Attitudes and Opinions of Doctors of Chiropractic Specializing in Pediatric Care Toward Patient Safety: A Cross-sectional Survey

Infant Demographic Profile and Parent Report of Treatment Outcomes at a Chiropractic Clinic in the UK:
An Observational Study

Pediatric Patients in Swiss Chiropractic Clinics:
A Questionnaire Survey