The use of handheld computers in medicine has grown dramatically. This session is intended for those who have a handheld computer (Palm or Pocket PC), or are considering purchasing one, but who have not yet learned how to use it. The goal of the session is to help the beginner achieve a working familiarity with handheld computing such that they will leave the session ready, able and eager to use their own device in their daily life and clinical practice. Ideally, all participants should bring their own handheld. The session will include an overview of the devices and their desktop software; mastery of the basic (built-in) functions: datebook/calendar, address book, memo pad, to-do lists; and add-on applications: where to find them, how to install them and what applications are available specific to clinical pediatrics. Participants should be familiar with the use of personal computers and the Internet, but no prior knowledge of handheld computing is assumed.

Introductions and Overview of Mini Course

Lecture (with Audience Participation)—PDA Basics, Hardware and Software, the Palm OS and Its Functions

Palm OS Functions, Continued; PPC OS

Medical and Pediatric Applications for the PDA
 

This 6-hour mini course is intended for faculty who teach and do research on pediatric environmental health problems. We will use an evidence-based approach and focus on research that is needed to clarify unresolved issues. The challenges and controversies in the field of pediatric environmental health will be presented, and there will be time to discuss prevention strategies for the clinic and the community. The participants will develop and share ideas to use in teaching, research and practice. (There is a separate workshop for Chief Residents on May 4, 2003.)

Content of this session is similar to session 6200 An Introduction to Children's Environmental Health

In the current climate of funding opportunities, the ability to successfully obtain extramural support involves applying for grants that are appropriate for an investigator's career stage and drafting a clear and focused application. In this session, we will discuss career-stage-appropriate funding opportunities from the NIH. We will also address how to write a grant application, focusing on strategies with proven success. The working of NIH study sections will be reviewed along with how to best address the concerns of review panels. We will also focus on how to obtain funding for fellowship postdoctoral training and early stages of an academic career.
 

The U.S. rapidly is growing more culturally diverse. In several cities, whites already are in the minority. Culture has a profound impact on pediatrics, affecting multiple aspects of clinical care, including outcomes, processes, quality, satisfaction, obtaining an accurate history and adherence. Cultural competency is the ability to recognize and appropriately respond to key cultural characteristics that affect clinical care in the major cultural groups seen in your practice. In this workshop, participants will learn about a model of cultural competency that can be applied to any cultural group that might be encountered by the pediatrician. This model is based on five aspects of culture that affect clinical care: 1) normative cultural values; 2) language issues; 3) folk illnesses; 4) parent beliefs; and 5) provider practices. The spectrum of the world’s cultures will be used to illustrate the most important ways that culture impacts pediatric care, drawing on the rich available literature and the personal experience of the workshop leaders.

Using an evidence-based approach derived from critical studies on Latino and African-American culture, workshop participants will learn and master the cultural competency model. Illustrative cases (including videotapes) will be presented to challenge participants and further solidify their skills. Participants can expect to acquire practical skills for recognizing and appropriately responding to crucial aspects of culture and language that affect pediatric care.
 

Background: Observational research studies have become increasingly complex. The results of observational research studies can be driven by properties other than chance or causation. While these factors may drive the p values of the results, they also change the appropriate interpretation.

Workshop Methods: In the first half of this workshop, we will formally define confounding, effect modification, restriction vs. heterogeneity of exposure, intermediate variables, selection bias and differential vs. nondifferential information bias. In the second half, we will use a case-based approach to illustrate examples of studies in which the results are driven by these factors and compare differences in the appropriate interpretation in the presence and absence of these factors. Minimal math skills will be needed, however, familiarity with basic concepts of study design and data analysis (case control vs. cohort study, interpretation of Ors, etc.) is recommended. We will specifically illustrate examples of effect modification vs. confounding, intermediate variables vs. confounding, selection bias, underpowered studies, and the role of measurement error in determining effect estimates.
 

The SIG this year will be covering some old ground as well as new as the torch is passed from Ron Samuels and Jeff Brown to Peter Sherman and Wendy Hobson-Rohrer.

We received some great suggestions from the e-mail that was sent to SIG members and look forward to further input from members at the meeting in Seattle.

After everyone introduces themselves, we will spend the bulk of the meeting exploring issues surrounding research with underserved pediatric populations.

This will include a presentation from CORNET, a APA-endorsed practice-based network that focuses on underserved children. Mort Wasserman, who is Director of the AAP’s Pediatric Research in Office Settings, will talk about their experience to date. Finally Jennie McLaurin will discuss the work she has done with the Bureau of Primary Health Care, using data to improve health care delivery for children from migrant families. We hope that this will lead into a lively debate on doing research in this arena.

We will spend some time on an update regarding the underserved curriculum that many of you have been working on and an update on the Dyson Foundation Community Pediatrics Training Initiative. We will end the meeting with a discussion on future directions for the SUS SIG.
 

The field of medicine is replete with examples of ways that handheld computers may be used to educate, organize and inform clinicians. There are also examples of how researchers may benefit from this technology. During this more advanced session, we will discuss some of these uses of handheld computers. We will provide examples of software in a variety of domains and discuss their historical, current and future use. We also will demonstrate some future technology and discuss its implications. At the conclusion of this session, participants will have increased familiarity with state-of-the-art applications, techniques to install them and the future of handheld computers and wireless networking.

Introductions and Overview of Mini Course

Lecture with Audience Participation: The Top 10 Novel Uses of PDAs in Health Care

Exercises and Demonstrations
 

Tobacco, marijuana and alcohol have long been recognized as the "gateway drugs" or the drugs adolescents first begin to abuse. Each drug has inherent dangers, one of which is they can serve as stepping stones to abuse of other drugs. This session will review current issues involved with each of these three drugs—issues that involve the pediatric researcher and clinician as well as society itself. The first hour will be devoted to tobacco, the second to marijuana and the final to alcohol. Questions and answers will be encouraged from the audience.

Pediatricians are often asked to evaluate children for sexual abuse, yet deciding when, where, how and by whom the evaluation should be done are problematic given the rapidly changing interpretation of physical findings and testing and the paucity of data regarding the optimal provision of health services for this population.

This workshop will address the multiple decisions facing the primary pediatrician in sexual abuse evaluation by using an interactive, case-based approach and clinical decision analysis in a 60–90-minute workshop session. Participants will receive a brief introduction to the literature regarding triaging sexual abuse cases based on child age, gender and recency of contact and will be updated regarding interview techniques, interpretations of findings and medical and legal outcomes.

Using predictive values for outcomes based on timing, behaviors, disclosure and physical findings, participants will then select and evaluate the effects of their various choices at each clinical decision point (triage, type of evaluation, testing, referral) in 4–6 test cases. Clinical decision analysis will be used to optimize health and legal outcomes based on the participants’ choices. Potential strategies for health services for child sexual abuse will be reviewed with participants based on locally available resources.
 

This 6-hour mini course is intended for faculty who teach and do research on pediatric environmental health problems. We will use an evidence-based approach and focus on research that is needed to clarify unresolved issues. The challenges and controversies in the field of pediatric environmental health will be presented, and there will be time to discuss prevention strategies for the clinic and the community. The participants will develop and share ideas to use in teaching, research and practice. (There is a separate workshop for Chief Residents on May 4, 2003.)

Content of this session is similar to session 6200 An Introduction to Children's Environmental Health

The period of adolescence encompasses dramatic changes, both physical and emotional. Taking care of these youth requires not only patience, compassion and flexibility but also knowledge of the biologic, psychological and cultural transformations. Adolescents aged 11–21 years made 61.8 million visits to physicians in 1994 and continue to see their primary care providers for continuity health care. There is a terrific opportunity for preventive health interviewing in these visits. In this workshop, the participants will become familiar with GAPS and Bright Future Guidelines for the adolescent visit, as well as effective coding and billing procedures. There will also be a panel of adolescents who will talk about how they want to be interviewed and provide insight into positive and negative experiences that they have had during their health visits.
 

This interactive session will provide the attendee with basic information on publication of a manuscript, as derived from the perspective of an editor. Issues (with data provided when possible) to be discussed are:

A. View From the Inside

1. Characters involved
2. Manuscript flow
3. Peer review process
4. Working with the author

B. View From the Outside

1. How to choose the right journal for your paper
2. How to prepare the cover letter
3. How to prepare the abstract
4. How to prepare the body of the manuscript
5. How to prepare the references

C. Conflict of Interest and Ethics
 

With their numbers continuing to grow at an alarming rate, health care needs of the more than 500,000 children in foster care often remain unmet. Children in foster care suffer from inordinately high rates of acute and chronic illnesses, lack of preventive health care, mental illness and developmental delays. Inefficient child welfare agencies, inadequate health care funding and a dearth of qualified health care and mental health care professionals willing to treat this population of children compound the problems.

The 21st century heralds a paradigm shift in medical education with a focus turned to competence and outcomes. The Accreditation Council for Graduate Medical Education (ACGME) is spearheading a competency-based system of graduate medical education coincident with the American Board of Pediatrics’ (ABP) initiative to transition from periodic "recertification" to "maintenance of certification." Our greatest challenge as educators lies in developing tools to evaluate competence during training and to equip all trainees with the skills necessary to achieve quality continuous professional development in order to maintain their certification in pediatrics.

The overarching goal of this workshop is to explore the value of using technology as a tool for promoting self-assessment and lifelong learning in continuous professional development. We will demonstrate how physicians can use an innovative web-centered tool to document competence in practice-based learning and improvement. Participants will discover how to create and manage a personal list of educational needs based on their professional experiences, develop individualized learning plans to address these needs and then document the impact of learning on their practice.

The outcome of implementing this web-based technology will be the ability to demonstrate competence of our trainees in the domain of practice-based learning and improvement to the ACGME and the preparation of tomorrow’s physicians to demonstrate evidence of continuous professional development in maintaining their certification.

What should you do when parents want you to continue burdensome treatments, which you think are futile? What should you do when parents want you to stop intensive care treatment, the continuation of which you think is in the best interests of the child? Who ought to make decisions for the not yet competent? Is it the parents, the doctors, the ethics committee, society or some other disinterested third party? The goal of this seminar is to consider the complexity of these difficult decisions, looking at factual and evaluative considerations. Through interactive case discussion we will identify the problems and potential pitfalls in decision-making for the pediatric population.
 

The purpose of this symposium is to describe the benefits to pediatricians of collaborating with public health specialists and to offer examples of some effective collaborations. Speakers will identify resources available to pediatricians who want to engage in public health efforts.

This program will give a "pediatric perspective" to smallpox bioterrorism preparedness planning efforts now under way within federal, state and local public health agencies. It will include a review of smallpox epidemiology, clinical disease, smallpox (vaccinia) vaccine and lessons learned from the WHO Smallpox Eradication Program. The nature of the current threat and responses to that threat will be discussed.

American Indians and Alaska Natives (AI/AN) represent the smallest ethnic group in the United States. Large disparities exist between child health status indicators in this population and the rest of the U.S. population. The AI/AN population is also unique in that tribally enrolled AI/AN members have access to a unique healthcare system sponsored by the federal Indian Health Service (IHS). Increasingly, the IHS is turning over control of Indian health care to tribal health entities, thereby encouraging autonomy and self-determination. A consequence of this transfer of responsibility, IHS is providing fewer centralized administrative and consultative services to independent tribes. As a result, tribes will become increasingly reliant on alternative sources of assistance. Potentially rewarding new opportunities exist for pediatricians from universities and pediatric organizations to provide clinical and public health consultation to these newly independent tribes and their regional consortia. This workshop is aimed at clinician-teachers and investigators interested in developing closer ties to tribes and urban Indian organizations in their area. The following topics will be discussed during the session: 1. The evolution and devolution of the IHS: a contextual history of health services for AI/AN’s (didactic); 2. community-based participatory research in Indian communities: tribal expectations (panel discussion); 3. creating and optimizing educational opportunities for medical students and residents in AI/AN health sites (panel discussion). 4. advocacy for Native American health: how can we help? (interactive presentation).
 

Objectives: 1) increase and promote skill acquisition on cultural competency among health care providers, 2) increase understanding of cultural values and health beliefs/practices among a culturally diverse populations. Participants will be given a brief introductory quiz to assess their previous experience on the subject. An ethnicity/cultural awareness exercise will follow. Video clips of case scenarios highlighting cultural issues and health practices, which may become important during a well-child visit, will be shown. Information on cultural education/training issues, culture-specific terminologies, common pitfalls for cultural bias/misunderstandings and practical ways to improve cultural sensitivity/proficiency will be offered. Demographic characteristics of the U.S. populations, guidelines for using interpreters and culture-bound syndromes will be reviewed. Participants will then divide into three stations to gain exposure to three featured cultures: Islamic, African-American and Hispanic. They will experience culture-specific items and participate in role-playing. The three groups will meet again for a panel discussion and problem-solving exercises. In conclusion, participants will summarize the propositions to employ the culturally specific therapies.
 

Previously offered and well received at PAS. The BaFa BaFa simulation will: (1) provide an immersion experience in the challenges and rewards of cross-cultural interaction, (2) highlight the importance to medicine of such qualities as self-awareness; willingness to try to "see through others' eyes" when differences in values and expectations make interaction or understanding difficult and the capacity to act upon these in formulating workable action plans; and (3) provide facilitator training to participants. Format: Participants divide into two fictitious cultures, moving into separate locations to learn the basic values and behavioral norms of their new cultures. Following a brief enculturation period, the groups exchange teams of visitors who interact in their host cultures and attempt to describe to their co-culturists their experiences and interpretations of the "others." When all players have had a chance to visit, the groups reunite in a final hour plenary to debrief and discuss their experiences, insights and impressions. Plenary includes practical and logistical information to facilitate importation of BaFa BaFa to participants' home institutions. Both entertaining and insight-producing, this unique exercise is readily adaptable to a variety of medical educational purposes and settings. *Note: The simulation cannot accommodate late arrivals once enculturation stage has begun (about 15 minutes p start).
 

Receive helpful pointers to make your talks memorable and useful. This session will introduce methods of planning and organizing presentations, preparing and designing visual aids, handouts and clear delivery.
 

Many of the leading causes of childhood illness and death are potentially preventable. Yet knowledge of how to encourage healthier behaviors has lagged behind knowledge of potential therapies and prevention strategies. Community intervention trials are the "gold standard" for large-scale health behavior change.

This workshop is designed for those interested in conducting community interventions. The workshop will have three sections: The first section discusses the design of intervention trials, including theory-based strategies, selection of relevant control groups and effectiveness measures. The second section reviews successful implementation strategies with illustrative examples. The third section reviews the evaluation of community trials, including the analysis of clustered data and time trends. Participants will work in teams to develop intervention trials to illustrate the concepts presented. Participants can expect to acquire practical skills and resources to aid in conducting a community intervention.
 

Over 132,000 children from 36 countries have been adopted by U.S. families since 1991. It is likely, therefore, that most pediatricians will encounter internationally adopted children in their practice. Prior to international adoption, parents tend to seek out expert pediatric advice regarding the health of their prospective child. However, addressing complicated pre-adoption issues with prospective parents, especially in the age of evidence-based medicine, can be extremely challenging. This workshop is designed to: 1) educate participants about issues critical to review with families at a pre-adoption visit; 2) identify the adoptee's unique medical needs; 3) clarify roles for practitioners caring for the internationally adopted child before and after adoption. Using an interactive approach, the workshop will address: 1) the pre-adoptive visit—keys to interpreting medical records/photos/video of the child from abroad, and how to counsel parents regarding specific issues such as FAS and HIV/Hepatitis B; 2) post-adoptive medical screening, diagnoses and treatment of medical conditions; 3) practice guidelines regarding immunizations; 4) assessment of growth, development and nutrition; and 5) guidance on adjustment problems, developmental delays and identifying more complex behavioral and developmental concerns.
 

The 2001 World Trade Center and anthrax attacks established terrorism as a reality in this country. In addition to anthrax, critical biological agents include smallpox, plague, tularemia, botulinum toxin, and viral hemorrhagic fever. Release of sarin nerve gas in the Tokyo subway system by the Aum Shinrikyo cult in 1995 resulted in some 5,000 casualties, including 12 deaths, and the threat of a radiation incident perpetrated by terrorists is also real. Pediatricians have a key role in the management of illness after a terrorist incident, including biological, chemical or nuclear releases. Effective preparedness requires an increased index of suspicion for unusual diseases or clusters of illness, with prompt reporting to public health authorities to facilitate recognition of an outbreak and subsequent intervention. Psychological effects of a domestic terrorist disaster on children will also need to be managed appropriately. This workshop will address the epidemiologic, clinical, preparedness and response issues relevant to biological, chemical and nuclear threats to children, who are especially vulnerable. Specific and detailed diagnostic and management information will be provided, as well as emergency contact and educational resource information.
 

Inflicted neurotrauma is a leading cause of injury mortality and morbidity in infants and young children, and much research attention has been devoted to improving our understanding of the cause and consequences of this problem. However, the topic remains controversial, in part because of the difficulties inherent in studying child abuse injuries. Included among these problems is the lack of standard clinical definitions of inflicted injury for research purposes. During the first part of the child abuse SIG, we will have a panel and group discussion of standards for defining inflicted head trauma.

As part of the child abuse SIG, each year we will try to highlight the work being done by colleagues in our host city. This year, we will discuss the legal challenges faced by hospitals and physicians who identify children who suffer from pediatric condition falsification, (AKA Munchausen syndrome by proxy).

Finally, we will present short research papers to stimulate our thinking and improve our practice. See you in Seattle!!
 

In the face of dramatic alterations in health care delivery during the 1990s, the roles of pediatric generalists and subspecialists have changed. This has led to national debate as to how general pediatricians and subspecialists should be trained, how they should interact and what final product or solution is desired. Both the United States and Canada are affected by these changes. In this session three experts will cover important aspects of this emerging problem.

In low- and middle-income countries where more than 80% of the world’s population lives, birth defects and other perinatal problems cause more loss of healthy years of life to early mortality and disability than almost any other condition. Yet, development of strategies for the prevention and care of birth defects has received insufficient international attention to date. The reasons for this include: a general lack of knowledge of the problem and of the considerable social and economic toll it imposes; a lack of awareness of the potential for prevention; and, as important, the absence of an international framework of mechanisms for promoting cooperative actions and solutions.

This session will present statistics on the global toll of birth defects and discuss a recent report of the U.S. Institute of Medicine commissioned to identify cost-effective opportunities for care and prevention of birth defects in developing countries. Specific recommendations for priority research, capacity building and institutional efforts to reduce adverse birth outcomes will also be discussed. The session will explore the applicability of the report’s findings to developing countries. It will also suggest what actions are required to implement appropriate public health strategies. It will conclude with a presentation on research directions for care and prevention.

Family presence for procedures is a relatively new concept in pediatric medicine. Studies have shown that many parents prefer to be with their children when they undergo painful or invasive procedures. Some physicians are reluctant to accept this break with tradition and refuse to allow parents in the room. The purpose of this workshop is to develop an approach to successful procedures with parental presence. Workshop leaders (including physicians, social work, housestaff) will address critical issues such as:

• Review of the literature—what do parents/families want?
• What is best for the children?
• What rights do the parents have? How about the physicians?
• Are some situations/procedures (i.e., resuscitations) "off-limits"?
• How can we instill confidence in trainees when the family is watching?
• Can we preserve teaching opportunities?
• Are there safety risks? Legal issues?
• Enlisting the help of others: the role of liaisons, social workers, therapists

Using case scenarios and role-playing, workshop leaders will address the pros and cons of family presence for procedures. Participants will be expected to share their experiences and ideas to move forward with this "unconventional" approach to medical care. It is expected that through discussion and debate we will implement a system for success.
 

Patients and their families in low-income communities require a multidisciplinary healthcare team that includes lawyers to protect the health of their children and to navigate the bureaucratic barriers to government benefits. These patients often require assistance that extends beyond the traditional training of physicians. Doctors must become familiar with advocacy resources and learn to use new tools to assist their patients with diverse social-medical problems. The goals of the workshop are to:

• Teach pediatricians and other health care providers about the basics of legal advocacy by providing them with the necessary tools and resources to proactively address the social issues that affect children’s health and wellness.
• Introduce pediatricians to new tools including eight innovative ‘Advocacy CPGs’ and the ‘Advocacy Code Card.’ These tools guide physicians’ assessment of families’ social needs and provide appropriate resources, general tips and a sample advocacy letter.
• Demonstrate and offer access to The Online Advocate – a new, web-based tool that prints ‘Rx for Advocacy’ prescriptions to facilitate the referral process and helps providers ascertain which referrals could help a family.
• Emphasize the unique ability of collaborations with legal services located within pediatric clinics to comprehensively care for children’s health. Participants will learn methods to establish legal liaisons and review cases involving medical-legal alliances.
   

The incidence of lawsuits in the United States continues to rise. Within this environment, pediatricians are vulnerable to litigation yet often have limited experience and information about the legal process and relevant principles of law. Legal dilemmas are particularly common in acute care settings and frequently are managed without the immediate advice of counsel. In this workshop, participants will explore basic legal issues that impact on medical practitioners, gain familiarity with the litigation process and examine strategies for testifying in court. A team of specialists in pediatric emergency medicine, malpractice issues, court testimony and forensic medicine will begin the workshop with an interactive presentation of case scenarios that highlight common statutory dilemmas, malpractice issues and the litigation process (civil and criminal). Participants will then view videotapes of court testimony and discuss strategies for testifying as a fact or expert witness. Workshop leaders and participants will conclude the session with small group discussions of individual experiences with civil or criminal proceedings and legal testimony. A complete syllabus will be provided for the workshop that is designed for use as a teaching manual.
 

Al Aynsley-Green, National Clinical Director for Children, Department of Health, Her Majesty's Government, Nuffield Professor of Child Health, The Institute of Child Health, University College London
University of London, Director of Clinical Research & Development, Great Ormond Street Hospital for Children and The Institute of Child Health, London

What happens when there is a public national concern about excessive poor outcomes at a Children's Medical Center? This was the scenario in Bristol, England, where a crisis in the outcome of children after cardiac surgery developed even when well–trained, committed, concerned clinicians and subspecialists were intimately involved. Because of this, Professor Al Aynsley-Green, President of the Academic Paediatricians, was appointed to the new post of National Clinical Director for Children by Parliament and to Chair a Children's Taskforce to answer the question of how can such a negative experience like this be turned into positive outcomes for children? He is charged to secure the health and well-being of all children throughout childhood into adult life by developing a National Service Framework for children's services across health, social care and education.

Lessons he has learned and experiences he has lived will be shared to help pediatricians around the world with our quest to improve the lives and health of children. The goals, activities and experiences of the Children's Taskforce, as well as six external working groups, are exportable, practical and logical. Strategies used for developing opportunities not only to improve child health at a local level but also at a national level will be discussed.

Opportunities for questions and discussion will be provided so attendees can share effective techniques to improve child life and health.

This symposium covers four issues in vaccination. The American Academy of Pediatrics and CDC currently are moving toward a recommendation for universal annual vaccination of infants with killed or live influenza vaccine. Why is this? Now that Rotashield is off the market, a new rotavirus vaccine is needed and may be on the way. Despite good protection of children by vaccination, pertussis infections are rising in adolescents and adults. Can they be controlled? Recent disruptions in vaccine supply have caused pediatricians significant problems. What are the causes and solutions?

Outcome measures are a vital part of research design. Many studies continue to use morbidity and mortality, admission to the hospital, cost of care and other gross measures that do not define true outcomes for patients. A model for outcome determination using disease specific outcomes that define long-term outcomes, proximate outcomes, global long term outcomes and global proximate outcomes can serve as the conceptual framework for decisions about assigning specific outcome measures for a study. A conceptual framework using disease-specific and global outcomes based on diversity and severity of the process to be studied will be discussed. Quality of Care Measures will be differentiated from true outcome measures.

Applying the methods and tools of outcomes research and the evaluation of the impact of health care on the health outcomes or "end result" of patients and populations to various clinical domains are critical to research design. They are an integral part of translational research.

Translating, disseminating and implementing research results and applying them to clinical care and policies affecting clinical care are critical to improving patient outcomes. A hierarchy of research impact and an approach to translational/implementation research will be discussed. Implementation research examines the science of translating clinical and organizational research into practice and policy. Evidence-based implementation strategies are in turn based on the findings of implementation research. Results of implementation research, including research in children’s health care, will be discussed. Models will be given that can be applied to research protocols.

Environmental health is an increasingly important field within public health. This course will focus on children's environmental health. Children are different than adults in their exposure and susceptibility to environmental hazards. The workshop will emphasize the special needs of children from epidemiologic, physiologic and public policy perspectives. Participants will be provided with several case studies and access to reference material. They will work through the cases to discover clinical information or public policy approaches to dealing with environmental health problems. Participants will be able to: identify the characteristics of children that make them especially vulnerable to environmental insults; describe the unique exposures that children have to environmental hazards; describe the effects of certain specific pollutants on children, and identify components of federal, state and local governments that have an impact on children's environmental health.

The creation of this workshop is funded by a grant from the Association of Occupational and Environmental Clinics.

Content of this session is similar to session 3151 Pediatric Environmental Health (Part I) and 3650 Pediatric Environmental Health (Part II)
 

Despite the high prevalence of developmental and behavioral disorders in children, limited medical services exist in most communities for the diagnosis and management of affected children. As a result, necessary specialized care may not be adequately rendered.

In this workshop, a pediatrician–nurse practitioner (NP) panel will present a model of collaborative care for affected children, including NPs as care providers to increase the availability of clinicians competent to provide these specialized services. An interactive discussion based on case vignettes will be held, delineating each professional’s role for provision of services in this collaborative model. Cases will include children with language delay, learning difficulties and disruptive behavior. Issues to be discussed will include service funding, specialized staff training and development of community networks. Upon completion of the workshop, the attendee will better understand issues in service delivery to children with neurodevelopmental and behavioral disorders and the use of a collaborative MD–PNP model for such care.
 

Recent financial scandals affecting successful and respected companies have focused public attention on conflicts of interest involving corporate officers, stockholders, and customers. In the medical research world, too, recent events have raised questions about conflicts of interest affecting investigators, research subjects and patients. Examples of the latter include the financial interests of gene-transfer experimenters (the Gelsinger case at the University of Pennsylvania) and study goals versus individual subject/patient interests in the Kennedy Krieger law suit (Hopkins lead abatement study). Despite the potential pitfalls, pediatric researchers receive only perfunctory training in handling them. This workshop will provide investigators with a framework for and experience with considering real and perceived conflicts of interest in their research. We seek to provide guidance and support for investigators who need to recognize and face ethical concerns that may arise from proposed and actual research. During the workshop, we will describe potential conflicts of interest affecting: (1) individual researchers, (2) institutions (hospitals and universities), (3) research subjects/patients and (4) the public at large, including the mass media. Short presentations will set the stage for attendees to participate in role playing with a variety of scenarios and to present and discuss their own cases.
 

This session will address the topic of "perinatal origins of adult disease." The three speakers will address different aspects related to the early origins of adult disease. Dr. Kent Thornburg will address the issues related to the fetal origins of adult-onset cardiovascular disease, Dr. Guiseppe Colasurdo will discuss the impact on adult-onset reactive airway disease due to postnatal exposure to environmental stimulants, and Dr. Pinchas Cohen will cover the influence of postnatal insulin-like growth factor on the development of carcinogenesis. All three speakers will shed light on the mechanisms underlying the phenomenon of "Perinatal Origins of Adult Disease" in three different disease states using various animal models. This session will provide cutting edge information that will help set the stage for future interventions targeted at the mechanisms outlined.

Academic Medical Centers (AMCs) are the result of unique partnerships between medical schools, research institutes, and teaching hospitals and are among the treasures of our society. During the past century, AMCs have evolved in response to need and opportunity as well as to social and economic forces. They have made possible unprecedented advances in human health, in biological sciences, in medical technology, and in the education of a very specialized and knowledgeable cadre of scientists, physicians, and other health care professionals. In the process, AMCs have grown large and ever more complex and require continuous inputs of resources to sustain them. Despite the apparent success of AMCs and their widely appreciated intrinsic value, they are challenged as never before. The diversity and complexity of missions has created stresses upon the social order. Financial pressures resulting from a fragmented, market driven reimbursement system, lack of adequate attention to preventive services and to cost of care issues, questions about true measures of quality, ever more expensive research infrastructure requirements, changing social expectations combined with a relative illiteracy regarding science and health in the general public threaten AMCs existence as we know them. Despite fears that these factors have the potential to create a "perfect storm" that will derail the momentum for progress, a detailed understanding of AMCs history, current circumstances, and future prospects gives cause for optimism. With thoughtful leadership, commitment to values, and a willingness to lead change in many areas, AMCs can continue to thrive and achieve even greater success.

The speakers in this symposium are a practitioner of medicine and historian who has written two very widely read and highly acclaimed books about these issues, Learning to Heal and Time to Heal (Kenneth Ludmerer) and a former medical school clinician, teacher, investigator, and dean who is now one of the nations most ardent and eloquent spokespersons for AMCs in his role as president of the Association of American Medical Colleges (Jordan Cohen).

This session examines specific solutions to high-risk behavior in youth, beginning with an overview of current epidemiologic issues. Principles of resilience in adolescents are then examined, based on current research data. Finally, principles of caring for gay and lesbian youth are presented using an interactive approach with the audience. The emphasis in this hot topic session is on helping pediatric researchers and clinicians understand what high-risk behavior in youth is and what research is showing to be helpful.

Over the past several years, it has become increasingly apparent that there are major disparities in health status among different segments of our population. This is as true for children as it is for adults. The causal factors responsible for these differences are multiple and complex. They include genetic factors (e.g. susceptibility to disease, response to environmental challenges, and drug metabolism), cultural and environmental factors (e.g. diet, activity, and ecological exposures), and factors that determine access to health care services. If we are to have a positive impact on the incidence and outcomes of many of these major health issues for children, we will need to better understand the causes of these differences and to determine which interventions will provide the most positive results.