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In Reply While I appreciate the concern by Lund regarding balancing quantity and quality of buprenorphine-waivered practitioners, I will argue that increasing quantity may in fact secure several of the aims Lund outlines in his response. First, because trainees do not have their own license, prescribing buprenorphine can only be done under the auspices of an upper level clinician, something that incentivizes faculty to acquire their own certification. In my own institution, we have just one pediatrician licensed to prescribe buprenorphine. His own expertise evolved by aligning with family medicine and psychiatry colleagues under what is the suggested “train the trainer” model. Concordant with the didactic model of medicine, having a cohort
To the Editor The Viewpoint by Dwarakanath provided a thoughtful description of the adolescent opioid use disorder (OUD) epidemic and the limited access to recommended care. The remedy presented was requiring pediatric residents to take an 8-hour course and become waivered to prescribe buprenorphine. Pediatric residents’ exposure to addiction medicine is so limited that this would be quantitatively more training than many now receive. However, the goals should be to increase treatment capacity and improve the quality of care in this domain, not just a numerical increase in hours of exposure. For these goals to be achieved, a more comprehensive and operational approach is needed.
Maternal vitamin D deficiency remains a substantial health problem in many areas. In addition to nutritional factors and the use of vitamin D supplements, other factors, such as genetic determinants and the current Western indoor lifestyle, affect not only vitamin D status but also bone strength and mineral accrual. Many health authorities recommend maternal vitamin D supplementation to prevent vitamin D deficiency and associated adverse pregnancy and offspring outcomes. Commonly, daily supplementation of 400 to 600 IU of vitamin D is recommended for pregnant women.
To the Editor We thank Belamarich and Racine for their comments on our publication, “Treating Parents for Tobacco Use in the Pediatric Setting: The Clinical Effort Against Secondhand Smoke Exposure Cluster Randomized Clinical Trial.” We share their concern that tobacco use is a public health crisis requiring multiple approaches and broad public health efforts. Despite multiple and persistent efforts to denormalize tobacco use, data have shown that parents continue to smoke and expose their children to tobacco smoke. Parents are the most important group to invest in for tobacco cessation strategies because when they quit, they gain more than 10 years of life on average and have extra money to spend on their families while they protect their
In Reply We thank Wang et al for their comments on our meta-analysis. The authors suggest further exploration of between-study heterogeneity, specifically by subgrouping studies according to sample size and parental education as well as by regressing the frequency and duration of electronic cigarette (e-cigarette) use on a continuous scale. While we agree with Wang et al that our summary and subgroup analyses revealed high levels of between-study heterogeneity, we note that 19 of 21 studies included in our meta-analysis showed a clear positive association between e-cigarette and marijuana use. The 2 remaining studies (one smaller and one larger study) contained odds ratios for the association between e-cigarette and marijuana use that were
Regionalization of perinatal care has long been known to improve neonatal outcomes. The March of Dimes, in their original iteration of Toward Improving the Outcome of Pregnancy in 1976, strongly advocated for regionalized perinatal care and development of levels of neonatal care. In response, health care systems created regional perinatal networks to facilitate antenatal transfer of women at risk for preterm birth in the hopes of improving neonatal outcome and maternal care. In the 1990s, with the advent of managed care and expansion of Medicaid reimbursement, hospitals sought to control costs within systems. These changes led to an increase in the number of community neonatal intensive care units, which have outpaced local acuity and volum.
Pediatric primary headache is one of the leading health care issues in high-income countries that is rising in prevalence. Frequent headaches are strongly associated with a lower quality of life and poorer academic performance and are a leading cause of school absence. The classification system of the International Headache Society provides a navigation system to phenomenologically diagnose migraines, tension-type headaches, and other primary headaches (https://ichd-3.org/wp-content/uploads/2018/01/The-International-Classification-of-Headache-Disorders-3rd-Edition-2018.pdf); however, pediatric-specific factors have not been considered sufficiently.

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