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The purpose of this paper is to demonstrate burnout syndrome among internal medicine and pediatrics residents in a country that does not have the working time directive (WTD) and also to determine the risk factors and consequent impact on efficient functioning in clinical areas.

A 57-item questionnaire was given to internal medicine and pediatrics residents. Responses from 22 pediatrics and 33 internal medicine residents were evaluated.

Demographic findings, burnout scores, having hobbies, social activities and reading books unrelated to medicine were similar between the two groups. Six pediatrics residents (27.3 per cent) and 11 (33.3 per cent) internal medicine residents met the criteria for clinically significant burnout. Personal accomplishment scores and reading books unrelated to medicine were found to be related to burnout.

Burnout is a syndrome characterized by depersonalization, emotional exhaustion and a low sense of personal accomplishment. It is important to document burnout in countries where WTDs are not implemented. Further studies might demonstrate burnout's effect on patient safety, service quality and physician's performance.

Throughout human history and around the world, co-sleeping was the context for human evolutionary development. Currently, most of the world’s peoples continue to practice co-sleeping with infants, but there is increasing pressure on families in the West not to co-sleep. Research from anthropology, family studies, medicine, pediatrics, psychology, and public health is reviewed through the lens of a developmental theory to place co-sleeping within a developmental, theoretical context for understanding it. Viewing co-sleeping as a family choice and a normative, human developmental context changes how experts may provide advice and support to families choosing co-sleeping, especially in families making the transition to parenthood. During this transition, many decisions are made by parents “intuitively” (Ball, Hooker, & Kelly, 1999), making understanding the developmental consequences of some of those choices even more important. In Western culture, families are making “intuitive” decisions that research has shown to be beneficial, but families are not receiving complete messages about benefits and risks of co-sleeping. Co-sleeping can be an important choice for families as they make the life-changing transition to parenthood, if individualized messages about safe infant sleep practices (directed toward their individual family circumstances) are shared with them.

Since the beginning of the 20th century environmental health researchers have known about the association between toxicant exposure and disease. However, that knoweldge has not been well integrated into mainstream medicine. Shedding light on why is the focus of this chapter.

To shed light on this issue I analyze the 2011 American Academy of Pediatrics’ clinical practice guidelines for Attention Deficit/Hyperactivity Disorder (ADHD), focusing specifically on the omission of environmental health research pertaining to ADHD symptoms and exposures, such as lead and mercury.

I found that while environmental researchers have been documenting the link between lead and ADHD for over forty years, the American Academy of Pediatrics has completely omitted this research from its 2012 clinical practice guidelines. Moreover, I argue this omission can be traced to competitive pressures to protect medical jurisdiction, and a reductionist worldview that emphasizes treatment over prevention.

This is the first attempt to analyze the way clinical practice guidelines help reinforce and perpetuate dominant medical perspectives. Moreover, to shed explanatory light, this chapter offers a synthetic explanation that combines materialist and ideological factors.

Beyond the specific case of ADHD, this chapter has implications for understanding how and why environmental health research is omitted from other materials produced by mainstream medicine, such as materials found in the medical school curriculum, continuing medical education, medical journals, and on the medical association web sites.

Although incarceration may have life-long negative health effects, little is known about associations between child incarceration and subsequent adult health outcomes. The paper aims to discuss this issue.

The authors analyzed data from 14,689 adult participants in the National Longitudinal Study of Adolescent to Adult Health (Add Health) to compare adult health outcomes among those first incarcerated between 7 and 13 years of age (child incarceration); first incarcerated at>or=14 years of age; and never incarcerated.

Compared to the other two groups, those with a history of child incarceration were disproportionately black or Hispanic, male, and from lower socio-economic strata. Additionally, individuals incarcerated as children had worse adult health outcomes, including general health, functional limitations (climbing stairs), depressive symptoms, and suicidality, than those first incarcerated at older ages or never incarcerated.

Despite the limitations of the secondary database analysis, these findings suggest that incarcerated children are an especially medically vulnerable population.

Programs and policies that address these medically vulnerable children’s health needs through comprehensive health and social services in place of, during, and/or after incarceration are needed.

Meeting these unmet health and social service needs offers an important opportunity to achieve necessary health care and justice reform for children.

No prior studies have examined the longitudinal relationship between child incarceration and adult health outcomes.

Using Andersen’s (1968) behavioral model of health services use as a guiding conceptual framework, this study examined how receipt of family-centered care relates to the perceived family challenges for families of children with autism spectrum disorder (ASD).

Data from the 2009–2010 National Survey of Children with Special Health Care Needs (NS-CSHCN) were analyzed for 812 parents of children with ASD.

Multiple regression analyses provided substantive statistical evidence that a child’s race, the adequacy of a family’s insurance, and the stability of child’s health care needs significantly contributed to predicting his or her receipt of family-centered care. Further results suggested a relationship between receipt of family-centered care and the perception of challenge for these families; families receiving family-centered care perceive fewer challenges and feel less unmet need for child health services.

Family-centered professionals provide critical voices in the development of policies and programs geared toward improving the health outcomes of children with ASD and their families.

Children must meet various physical demands during the school day in order to be successful from both an educational and a social standpoint. They use important motor skills to move in the halls, sit quietly at a desk, and participate with peers on the playground. Physical therapists play an important role in facilitating the development of these motor skills in order to allow for optimal participation and socialization for each student. This chapter provides a description of the various roles played by the physical therapist within the school setting. The physical therapist may provide direct service to children receiving related services, indirect service to teachers and other staff by providing instruction or recommendations for children within the classroom setting, and consultation for staff and administration addressing issues that affect the student population as a whole.

This study aims to investigate the dynamics of knowledge sharing in health care, exploring some of the factors that are more likely to influence the evolution of idea sharing and advice seeking in health care.

The authors engaged 50 pediatricians representing many subspecialties at a mid-size US children’s hospital using a social network survey to map and measure advice seeking and idea sharing networks. Through the application of Stochastic Actor-Oriented Models, the authors compared the structure of the two networks prior to a leadership program and eight weeks post conclusion.

The models indicate that health-care professionals carefully and intentionally choose with whom they share ideas and from whom to seek advice. The process is fluid, non-hierarchical and open to changing partners. Significant transitivity effects indicate that the processes of knowledge sharing can be supported by mediation and brokerage.

Hospital administrators can use this method to assess knowledge-sharing dynamics, design and evaluate professional development initiatives and promote new organizational structures that break down communication silos. This work contributes to the literature on knowledge sharing in health care by adopting a social network approach, going beyond the dyadic level and assessing the indirect influence of peers’ relationships on individual networks.

Computer-Assisted Learning in Pediatrics Program (CLIPP) and National Board of Medical Examiners Pediatric Subject Examination (NBMEPSE) are used to assess students’ performance during pediatric clerkship. International Foundations of Medicine (IFOM) assessment is organized by NBME and taken before graduation. This study explores the ability of CLIPP assessment to predict students’ performance in their NBMEPSE and IFOM examinations.

This cross-sectional study assessed correlation of students’ CLIPP, NBMEPSE and IFOM scores. Students’ perceptions regarding NBMEPSE and CLIPP were collected in a self-administered survey.

Out of the 381 students enrolled, scores of CLIPP, NBME and IFOM examinations did not show any significant difference between genders. Correlation between CLIPP and NBMEPSE scores was positive in both junior (r = 0.72) and senior (r = 0.46) clerkships, with a statistically significant relationship between them in a univariate model. Similarly, there was a statistically significant relationship between CLIPP and IFOM scores. In an adjusted multiple linear regression model that included gender, CLIPP scores were significantly associated with NBME and IFOM scores. Male gender was a significant predictor in this model. Results of survey reflected students’ satisfaction with both NBMEPSE and CLIPP examinations.

Although students did not perceive a positive relationship between their performances in CLIPP and NBMEPSE examinations, this study demonstrates predictive value of formative CLIPP examination scores for their future performance in both summative NBMEPSE and IFOM. Therefore, students with poor performance in CLIPP are likely to benefit from feedback and remediation in preparation for summative assessments.

Children experience toxic stress if there is pronounced activation of their stress-response systems, in situations in which they do not have stable caregiving. Due to their exposure to multiple poverty-related risks, African American children may be more susceptible to exposure to toxic stress. Toxic stress affects young children’s brain and neurophysiologic functioning, which leads to a wide range of deleterious health, developmental, and mental health outcomes. Given the benefits of early care and education (ECE) for African American young children, ECE may represent a compensating experience for this group of children, and promote their positive development.

The purpose of this paper is to explain how different emergency services adopt and adapt the same hospital-wide lean-inspired intervention and how this is reflected in hospital process performance data.

A multiple case study based on a realistic evaluation approach to identify mechanisms for how lean impacts process performance and services’ capability to learn and continually improve. Four years of process performance data were collected from seven emergency services at a Swedish University Hospital: ear, nose and throat (ENT) (two), pediatrics (two), gynecology, internal medicine, and surgery. Performance patterns were linked with qualitative data collected through realist interviews.

The complexity of the care process influenced how improvement in access to care was achieved. For less complex care processes (ENT and gynecology), large and sustained improvement was mainly the result of a better match between capacity and demand. For medicine, surgery, and pediatrics, which exhibit greater care process complexity, sustainable, or continual improvement were constrained because the changes implemented were insufficient in addressing the higher degree of complexity.

The variation in process performance and sustainability of results indicate that lean efforts should be carefully adapted to the complexity of the care process and to the educational commitment of healthcare organizations. Ultimately, the ability to adapt lean to a particular context of application depends on the development of routines that effectively support learning from daily practices.