This session will be the initial venue for release of the proceedings from the current NHLBI Working Group. The Working Group, appointed by the National High Blood Pressure Education Program, is presently conducting an update of the national guidelines for the evaluation and management of hypertension in children and adolescents. Presentations will include reports on the results of a re-examination of the national childhood blood pressure data and the rationale for definition of hypertension in childhood. Speakers will also address the impact of obesity on pediatric hypertension, methods to detect and evaluate target organ damage due to hypertension, blood pressure instrumentation issues and new data on treatment of hypertension in the young, including both pharmacologic and non-pharmacologic treatments.

Definition of Hypertension with a Re-examination of the National Data on Blood Pressure in Children and Adolescents
Bonita E. Falkner, Thomas Jefferson University, Philadelphia, PA

Relationship Between Cardiovascular Risk Factors and Sequelae in Hypertensive Children
Elaine Urbina, Cincinnati Children's Hospital Medical Center, Cincinnati, OH

Pharmacologic and Non-pharmacologic Management of Childhood Hypertension
Joseph T. Flynn, Children's Hospital of Montefiore, Bronx, NY

Measuring Blood Pressure: The Truth Revealed
Bruce Z. Morgenstern, Mayo Clinic, Rochester, MN

As defined by the American Academy of Pediatrics, a goal of the pediatrician is the promotion of children’s optimal growth and development. Efforts at the state and national levels to enhance the effectiveness of child health supervision services have focused on such strategies as the early detection of developmental and behavioral concerns through effective monitoring, the provision of anticipatory guidance to address parental concerns and the promotion of such skills as language and literacy development. Such strategies have been informed by a wealth of new findings in neurobiology. Furthermore, enhancing practice quality may be facilitated by the effective application of basic change principles drawn from the field of organizational development, planning and change. This mini course will examine the impact on children’s development of such components of child health supervision as anticipatory guidance, developmental monitoring and developmental promotion, as well as review techniques to incorporate and promote rapid change within the practice setting. Ample time will be allotted for discussion among speakers and the audience.

The Science of Developmental Promotion
William Greenough, University of Illinois College of Medicine, Chicago, IL

Optimizing Anticipatory Guidance To Enhance Children’s Development
Paula M. Duncan, University of Vermont, Burlington, VT

Strategies for Effective Developmental Monitoring and Early Detection
Michael Regalado, Cedars-Sinai Medical Center, Los Angeles, CA

Promising Strategies To Promote Development
Neal Halfon, University of California, Los Angeles, CA

Enhancing Service Delivery Through Rapid Practice Change
Peter A. Margolis, University of North Carolina School of Medicine, Chapel Hill, NC

Where do generalists fit in the exploding field of genetics? Until recently genetics has played a relatively small part in the medical school curriculum. Its research has proceeded at a phenomenal rate along with its implications for enhanced patient care. Generalists’ expanding responsibilities to incorporate this thread of genetics through each patient encounter and acknowledge the role of genetics in every disease has become increasingly apparent. However the emerging gap in physician knowledge has created an enormous need for education in a previously underemphasized area of medical education.

As generalists, we are the gateway (not gatekeepers) to better health. This session is designed to help us understand the emerging importance of viewing each patient through a "genetic lens." Basic genetic concepts, core competencies and new paradigms will be discussed using a collaborative faculty presentation.

Strategies for teaching genetics and incorporating its practice into primary care will include "missed opportunities," case presentations and interactive educational games. Examples of resources, including internet user-friendly sites will be distributed.

Speakers:

Suzanne B. Cassidy, University of California-Irvine, Orange, CA
Marilyn C. Dumont-Driscoll, University of Florida College of Medicine, Gainesville, FL
Joseph Gigante, Vanderbilt University, Nashville, TN
Teri Lee Turner, Baylor College of Medicine, Houston, TX
 

The United States 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.
 

This workshop will introduce a new teaching tool that can be used to improve the skill of cardiac auscultation. The Cardiac Auscultatory Recording Database (CARD) is an interactive, internet-based virtual cardiology clinic designed to improve the skill of cardiac auscultation among trainees at all levels. By providing the teaching module to health profession trainees and educators, it is envisioned that study of this clinical skill, which has traditionally been possible only during limited hours, on certain clinical rotations, in an often suboptimal learning environment, can proceed at any time, in any location, at the student's convenience and pace. Workshop participants will use infrared stethophones to allow for simultaneous auscultation. This program can be used for individual study or teaching by logging onto our CARD website at www.murmurlab.com
 

Community-based participatory research focuses on social, environmental and health inequities through active involvement of community members, health care providers and researchers in all aspects of the process. This promotes the reciprocal transfer of knowledge, skill, capacity and power between collaborators and helps define best practices in service delivery for the community. Workshop participants will review the key principles, identify community resources following an asset-based approach, develop guiding principles for partnering and conducting service delivery and research, address technical challenges and capacity building and prevent common sources of conflict. Columbia University faculty and two active community partners will share lessons learned in two projects: a home visitation program for families in a Latino immigrant community and a comprehensive asthma initiative for children in a 20-square block area of Central Harlem.
 

Parents whose children have required intense or repeated health care encounters bring unique expertise and perspective to a research process, particularly in areas of inquiry such as patient/physician communication, parent/physician relationship and professionalism. The workshop presenters have involved parents in designing, implementing and interpreting research on topics such as competencies for medical education, shared medical decision-making, parent decision-making about complementary and alternative medicine and health-related quality of life. This workshop will explore topics of research that parents can inform and introduce participants to feasible research methodologies that involve parents as collaborators in designing research, generating data and interpreting results.
 

The performance of minor procedures is important in pediatric residency and office practice. Training for these procedures varies between residency programs causing some residents and practitioners to avoid a procedure or call a consultant because they are uncomfortable with a procedure.

The goal of this workshop is to convey specific techniques and instruction methods for several minor office procedures. This hands-on workshop will demonstrate skills and allow practice as participants rotate through the following stations:

1. Wound repair (use skin glue, staples, sutures)
2. Foreign body removal from ears, nose, eyes. Reimplant avulsed teeth
3. Trouble-shoot G-tubes, trach tube complications
4. Vascular access (master IO lines, needleless systems and IV safety devices)
5. Skin extractions (embedded fishhooks, subungual hematomas, hair tourniquets
6. Genital issues—manage paraphimosis, rectal prolapse, zipper entrapment. Participants should become adept at several procedures and will be able to teach them to others.
    

Pediatric residency programs are adding residents projects to their curricula. The CATCH (Community Access to Child Health) Planning Funds program provides grants to pediatric residents to develop community-based initiatives that increase children's access to medical homes or to specific health services not otherwise available. We will teach program directors and their residents how to develop a community-based project curriculum, including project design and grant writing. Participants will:

1. Identify the steps necessary in preparing the components of a successful resident community based project,
2. Describe the features of successful and unsuccessful grant applications and
3. Identify tools available to residents for project development.

Resources available to residents planning community-based initiatives, including a copy of "A Pediatrician's Guide to Proposal Writing," will be provided.
 

The Integrative Pediatrics SIG of the APA will open with a presentation by David Steinhorn of the Division of Pulmonary and Critical Care at Children's Memorial Hospital in Chicago. Dr. Steinhorn is the Medical Director of the Judith N. Bernstein Center for Integrative Medicine. He will review how this center was conceptualized and created. The center's current set of services and research undertakings will be reviewed. Dr. Steinhorn will provide a model that can serve as a framework for the creation of Integrative Pediatric centers. His talk will be followed by a discussion of the challenges and expectations created by recently published guidelines for residency education in integrative pediatrics.
 

The Newborn Nursery SIG is a group of general and neonatal pediatricians who care for term newborns throughout our country and the world. We are working on problems in detecting and treating sepsis, jaundice and hypoglycemia in newborns and share our frustrations, best practice and solutions. We are striving to improve our family education and resident and medical student teaching in our nurseries. In our meetings, we have formal presentations, ask the expert sessions, planning discussions and question and answer exchanges. After our meetings, we continue our discussions through email questions and surveys. Our goal is to improve patient care, teaching and research questions in our term newborn nurseries.

This mini course will set the stage for several discussions of particular issues of major importance and interest. What is "preparedness" and what are the real risks of continuing terrorism in the United States? What is the current status of preparedness in the U.S. hospital and public health systems? How do children differ from adults in terms of response to weapons of mass destruction (chemical, biological and radiological)? How do these differences matter in disaster planning? Are the needs of children being incorporated in local, state and federal disaster plans? Smallpox, anthrax and other biological threats: Where do we stand? What do we do? Nuclear power plants, nuclear weapons, dirty bombs and potassium iodide: What do we know? The mental health consequences of terrorism: What have we learned since 9/11, how do we prepare children for an increasingly vulnerable world, building resiliency and sustaining a positive vision. The new pediatric agenda: What do we have to teach students, residents and pediatricians about the pediatric aspects of terrorism planning. Children and exposure to weapons of mass destruction: science and the essential research agenda.

Introduction
Paul H. Saenger, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY

Welcome and Context
Irwin Redlener, National Center for Disaster Preparedness, Columbia University Mailman School of Public Health, New York, NY

Pediatric Preparedness for Terrorism and Disasters
David S. Markenson, Columbia University Mailman School of Public Health, New York, NY

Biological Weapons of Terror: What Pediatricians Need to Know
Theodore J. Cieslak, U.S. Army Research Institute of Infectious Diseases, Ft. Detrick, MD

Helping Children and Families Cope with Terrorism
David J. Schonfeld, Yale University School of Medicine, New Haven, CT

Radiologic Terrorism, Children and the Question of Potassium Iodide
Thomas P. Foley, University of Pittsburgh, Children's Hospital of Pittsburgh, Pittsburgh, PA

Potential conflicts of interest litter the halls of academic medical centers like unexploded ordnance. This symposium will discuss both non-financial and financial conflicts of interest and will demonstrate their power to erode trust. There is now overwhelming evidence for systematic bias due to conflicts of interest associated with financial links between researchers and their institutions to commercial entities. We will discuss managing and eliminating conflicts of interest and propose steps to regain public trust.

Overview
Ruth A. Etzel, George Washington University School of Public Health and Health Services, Washington, D.C.

The Importance of Conflicts of Interest to Clinical Researchers
Drummond Rennie, University of California, San Francisco, CA

Discussion
 

This workshop will:

1. Review the contents of national public-use databases, such as the National Health Interview Survey, National Ambulatory Medical Care Survey, National Hospital Discharge Survey and vital statistics databases; and
2. Discuss types of questions that can be answered through analysis of these databases.

Examples from recent literature will be examined. Use of administrative and clinical databases for research also will be presented, along with discussion of data validation issues for these. Participants will develop a concept for a research project using a national database, starting with identification of a question of interest and the primary outcome and predictor variables for the question that are contained in a particular database.
 

For this year, the School and Community would like to continue the format of "residency" and "roadblocks and school partnerships" that was begun at the 2003 meeting. This year we would like to frame these topics by focusing on a particular theme. One of the hottest public health concerns currently is obesity and its relationship to nutrition and exercise. There is a great deal of local, regional and federal funding of initiatives dealing with these issues; many of these require a school or community component. Addressing these issues within a residency program almost ensures a connection with school or community. The SIG would like to explore initiatives that have included residents and or addressed obesity, nutrition and exercise within a school system or community.
 

Children who are victims of violent behavior or merely observers of violence may learn destructive or self-destructive patterns of behavior. Violence is a major public health problem. This symposium will focus on breaking the cycle of violence and will showcase speakers who are working on violence prevention in the pediatric emergency department, school and community. The speakers will demonstrate what can be done by physicians who see the importance of this issue and the ways in which we can make a difference.

Violence Prevention in Primary Care: Moving from Public Health to Private Practice
Robert D. Sege, Tufts-New England Medical Center, Boston, MA

Beyond Treat and Street: Violence Prevention in the Emergency Department
Joel Fein, The Children’s Hospital of Philadelphia, PA

Efforts in the Community
Sheryl A. Ryan, University of Rochester School of Medicine, Rochester, NY

The symposium will provide the state of the art approach to these two common and intimately related conditions. The session will start with discussion of the genetics and embryology of vesicoureteral reflux and their implications in its management. New observations on the modes of treatment and the imaging studies indicated in the infant and child with UTI will be addressed next. As those requiring long-term intervention are mostly children with vesicoureteral reflux, a pediatric urologist point of view of it will follow. Both, long-term medical and surgical management will be reviewed, and the new information on the use of non-surgical endoscopic intervention as a new tool to treat vesicoureteral reflux will be discussed. Finally, our increasing understanding of the role of bladder function and dysfunction in the development, progression and resolution of vesicoureteral reflux and urinary tract infections will be reviewed.

Vesicoureteral Reflux as a Developmental Disorder
Anthony Atala, Children's Hospital, Boston, MA

Acute Urinary Tract Infection—Evaluation and Treatment
Alejandro Hoberman, University of Pittsburgh School of Medicine, Pittsburgh, PA

Surgical and Non-surgical Management of Vesicoureteral Reflux
Linda Shortliffe, Stanford University, Stanford, CA

Dysfunctional Voiding
Seth L. Schulman, Children's Hospital of Philadelphia, Philadelphia, PA
 

The 21st century heralds a paradigm shift in medical education with a focus turned to competence and outcomes. 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.

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.
 

Many new developments in hand-held technology or personal digital assistants (PDA) can positively impact on medical education and medical care. As the technology improves and interfaces with internet-based information and electronic medical records become available, the potential for improving access to information and defining standards of care are clear. Residency programs have utilized PDAs for provision of program information, documentation of procedures/patient panels and access to medical references and information. PDAs have proved useful in a variety of applications in residency program administration. The ability to access medical information from PDA formularies, medical texts and internet sites is now changing the ability of pediatricians to obtain relevant information in a timely manner. Interfaces with electronic medical records offer new opportunities for clinical decision making, documentation and billing.

This workshop will review the trends in the use of the PDA in these areas and demonstrate the use of the PDA in patient tracking, residency program documentation, access to formularies and medical references, searches of medical literature and office and hospital documentation. Participants will be asked to provide feedback and, after discussion in small group settings, will provide a series of recommendations from pediatric faculty regarding the direction of PDA development for pediatric medical education and care and emphasis for PDA applications in the future. We look forward to a stimulating discussion and useful interchange.
 

The Nutrition Friendly (NF) school process has been developed to help address the rising rates of childhood overweight. It is an ecological model based on the coordinated school health model, which impacts the entire school environment including students, staff and families to prevent the development of overweight in children. School community stakeholders in collaboration with the UCLA School of Public Health Nutrition Friendly Schools and Communities Group developed the NF school certification process and self-evaluation tool.

The goal of the workshop is to report on the continued development and preliminary results of the NF School pilot study and introduce the NF School model to any new participants. Participants will also gain an understanding of the participatory action research method used to develop the NF School model.
 

The BIOECOGRAM is a tool used to record child, family, social and environmental factors in a standardized method, placing the child at the very center of the consultation. The workshop will review the AAP recommendations for family-centered care and offer a number of case studies to help participants to use this graphic tool in their day-to-day practice when challenged by both simple and complex behavioral and developmental problems.
 

Conducting research as a community-based pediatrician provides unique challenges and rewards. Most community-based faculty members have extensive experience as clinicians, educators and often as secondary participants in the research projects of institutional-based faculty. The community-based pediatrician's daily working environment generates research ideas that are more readily applicable in the clinical setting. However, pediatricians practicing in the community often lack the time, training and/or experience needed to serve as principal investigators. Participants in this workshop will be asked to bring a research idea that they would like to develop into a reserach plan, and several of these ideas will be selected as examples. These examples will be developed into working proposals during small group sessions. Emphasis will be placed on:

1. Feasibility,
2. Finding a mentor,
3. Partnering with non-community-based researchers and community stakeholders,
4. Funding opportunities and
5. Protecting the interests of patients and principal investigators.
    

Participants will utilize the APA's web-based Educational Guidelines for Residency Training in Pediatrics to identify specific educational topics relevant to the continuity experience. Four preventive screening topics will be used as the educational goals. Participants, working in small groups, will determine in which of the six ACGME competencies the educational goals fit best. Practice-based learning and systems-based practice will be emphasized. Guidelines for teaching and evaluating resident competencies will be developed. The teaching and assessment tools developed will be generalizable to other curriculum topics, including QI projects.
 

The Environmental Health SIG is looking forward to another excellent and informative meeting at the Pediatric Academic Societies' Annual Meeting in San Francisco. In keeping with the tradition of past Environmental Health SIG meetings, leading experts in children’s environmental health will give presentations on important and timely issues. Building on the success of last year’s meeting, we will again invite the APA Environmental Health Fellows to present their research works in progress. Further program details are forthcoming. Please see the PAS meeting website for an agenda as the meeting approaches. We hope to see you in San Francisco and sustain the momentum of increasing attendance annually at our sessions!
 

Current Topics in Breastfeeding and Pediatric Practice

The session addresses AAP Guidelines on breastfeeding, current research findings and applications to pediatric practice.

The AAP Breastfeeding Policy Statement: The 2004 Version
Lawrence M. Gartner, University of Chicago, Chicago, IL

Breastfeeding: Does it Protect Against Obesity in Childhood?
Kathryn Dewey, University of California at Davis, Davis, CA

Contact for information:
Ardythe L. Morrow, Ph.D.
Cincinnati Children’s Hospital Medical Center
Phone: (513) 636-7626
Email: Ardythe.Morrow@chmcc.org
 

The National Children’s Study is a national prospective, longitudinal study of environmental effects, including physical, chemical, biological and psychosocial effects, on child health and development. The goal of the study is to improve the health and well-being of children. The study will examine these environmental effects on the health and development of more than 100,000 children across the United States, following them from before birth until age 21. The study is led by a consortium of federal agency partners: the U.S. Department of Health and Human Services, including the National Institute of Child Health and Human Development (NICHD); the National Institute of Environmental Health Sciences (NIEHS); the Centers for Disease Control and Prevention (CDC); and the U.S. Environmental Protection Agency (EPA). For additional information, visit the website at http://www.nationalchildrensstudy.gov/.

The National Children’s Study—An Overview
Duane Alexander, NICHD, National Institutes of Health, Bethesda, MD

The National Children’s Study—Methods
Peter C. Scheidt, National Institutes of Health, Bethesda, MD

Children’s Health and Environmental Exposures: The Most Important Unanswered but Answerable Questions
Michael Weitzman, The AAP Center for Child Health Research at the University of Rochester, Rochester, NY

Tom Tonniges will provide some background on the evolution of the relationship between the Department of Community Pediatrics at the American Academy of Pediatrics and the ABCD Institute of Northwestern University. He will give a brief introductory presentation on ABCD Principles and its applications to the health care arena. The ABCD Model essentially promotes the concept of recognizing and identifying the inherent assets in each community, in the form of community-based organizations (CBOs) and the need to integrate those assets into community improvement efforts.

Andrew Gold will discuss his involvement with the Community Child Health Partnership (CCHP) Collaboratives and his perspective on the applications of ABCD to achieving child health outcomes.

Richard Pan will provide insight into how he used ABCD principles as the basis for the advocacy program he developed (Community Partnerships with Pediatricians for Healthy Children) for pediatric residents at University of California, Davis Medical School. Specifically, he will discuss the merits of using the ABCD as the basis for fulfilling the ACGME Requirements in Community Experiences for pediatric residents.

Tom Tonniges will then ask participants to break into small groups and complete the following exercises:

1. List the associations that you belong to (not as a part of your job).
2. List the professional associations you belong to.
3. Describe one way you could use your association relationship to address one child health issue (ex. Obesity).

This workshop will address the following questions:

1. Do you think ABCD methodologies provide a useful framework for:
   1. pediatric resident community projects?
   2. practicing pediatricians?
2. How can ABCD Concepts be used to promote the practice of Community Pediatrics?
3. How does the ABCD Concept help to identify and establish effective partnerships with Community Based Organizations(CBOs)?

Pediatricians bring a unique mix of legitimacy, prestige and expertise to advocacy work. Many pediatricians know the benefits of advocacy to themselves, their patients and their communities but are unable to incorporate advocacy into busy clinical practices or academic career development. Of the 28 physicians funded by the OSI Soros Advocacy Fellowship, 10 are pediatricians. Workshop leaders will facilitate small group brainstorming sessions on advocacy skills such as communicating with media and policy makers, using research for advocacy and integrating practical advocacy experience into medical education. Participants will discuss areas of interest for advocacy and potential projects and community partners.
 

The application of imaging technologies to solving questions in biology and medicine is revolutionizing medicine by accelerating analyses in situ and in vivo and providing new perspectives on biological processes as diverse as development, neoplasia and injury repair. In this plenary session, three internationally recognized speakers will focus on developmental processes and discuss how these new imaging technologies are providing dynamic insights into the genetic and epigenetic mechanisms that underpin hematopoiesis and vascular development.

Introduction
Lisa M. Guay-Woodford, University of Alabama at Birmingham, Birmingham, AL

Dynamic Imaging of Fluid Forces in Developing Mouse Vasculature
Mary Dickinson, Beckman Institute–Caltech, Pasadena, CA

Microscopic Imaging of Angiogenesis
Donald M. McDonald, University of California, San Francisco, CA

Watching Hematopoietic Stem Cell Engraftment and Hematopoiesis in Living Animals
Christopher H. Contag, Stanford University School of Medicine, Stanford, CA

Questions from the audience
 

In July of 2003, the FDA approved the use of growth hormone for the long-term treatment of children with idiopathic short stature, also called non-growth hormone deficient short stature. This new indication restricts therapy to children who are at least 2.25 SD below the mean for age and sex, or the shortest 1.2% of children. This corresponds to adult heights of less than 5' 3" in men and 4' 11" in women. Data demonstrating the efficacy and safety of GH therapy for children with idiopathic short stature will be reviewed. Although "idiopathic" short stature has often been held synonymous with "normal" short stature, cases in which the underlying molecular defect(s) have recently been elucidated will be presented. With the new FDA ruling on GH, the challenges of deciding when and how to prescribe GH have become even greater. This symposium will address the potential impact of this ruling at a societal and individual level. We will discuss the dilemmas physicians face in using growth hormone and how the ethics of growth hormone therapy apply to our general practice of medicine.

Long at Last: 13 Years of Data on GH Treatment in Idiopathic Short Stature
Charmian Quigley, Eli Lilly & Company, Indianapolis, IN

Is There a Biological Rationale for Treatment of Idiopathic Short Stature?
Ron G. Rosenfeld, Lucile Packard Foundation For Children's Health, Palo Alto, CA

Everyday Ethical Dilemmas of Treating Short Stature: The Bread, Butter and Bane of Pediatric Endocrinology
David B. Allen, University of Wisconsin Hospital, Madison, WI

Ethical and Policy Issues in Access to HGH
Norman C. Fost, University of Wisconsin Medical School, Madison, WI

Vaccines have an important function in preventing birth defects. The most obvious one is rubella vaccine and its application for the purpose of preventing congenital rubella syndrome (CRS) will be discussed. In addition, prospects of the development of other relevant vaccines will be presented. These will include: cytomegalovirus, parvovirus, herpes simplex and malaria. The first three, because they affect the fetus directly; the last, because of its adverse effect on pregnancy that results in small-for-gestational-age newborns.

Elimination of Rubella from the Americas by the Year 2010
Mirta Roses Periago, Director of PAHO, Panamerican Health Organization (PAHO), Washington, DC

Prevention of CRS by Universal Application of the Rubella Vaccine
Susan E. Reef, Center for Disease Control, Atlanta, GA

Prospects for a Vaccine Against Cytomegalovirus
Stanley A. Plotkin, Aventis Pasteur and the University of Pennsylvania, Doylestown, PA

Prospects for a Vaccine Against Herpes Simplex
Richard J. Whitley, University of Alabama at Birmingham, Children's Hospital, Birmingham, AL

Prospects for a Vaccine Against Parvovirus B-19
Neal S. Young, National Institutes of Health, Bethesda, MD

Prospects for a Vaccine Against Malaria
N. Regina Rabinovich, Bill & Melinda Gates Foundation, Seattle, WA

Discussion

Motivating patients to change unhealthy behaviors is a daily challenge for physicians. Working to change behaviors such as overeating, lack of exercise and substance use is difficult.

This workshop focuses on providing knowledge and skills in assessing readiness and motivating patients to change behaviors. An overview of the literature on motivational interviewing and stages of change will provide the framework for discussion and skill development. Participants will observe, review and discuss videotapes of interviews and counseling sessions for patients in various stage of change. Discussion will identify methods to motivate and facilitate change.

To further refine skills, participants will role play interviewing and counseling in groups. Provisions will be made for discussion after role playing. Resource sharing and networking will be incorporated into the workshop.
 

Faculty often find it difficult to provide feedback about unprofessional behaviors to learners. Finding the right words and being able to explicitly identify the problem exacerbate the discomfort of providing criticism.

This workshop will focus on three components of addressing professionalism:

1. Defining the elements of professionalism,
2. Operationalizing these elements and
3. Crafting feedback to learners that is explicit.

After a brief presentation of the elements of professionalism, small groups will discuss examples of unprofessional behavior, identify the specific problem and then create feedback using explicit language to highlight what breach has occurred and how to resolve it. The results will be discussed with the entire group, and additional strategies identified.
 

Patient safety is a growing national initiative, particularly for children. Several studies have shown that hospitalized children experience rates of medical errors equal to or more frequently than adults and tackling safety in ambulatory settings is a relatively new but growing priority area. Many institutions, organizations and practices have started tackling patient safety as Job One in the context of routine daily practice. Overarching this the AAP and ABP have joined forces to place safety and quality on the forefront for practicing pediatricians and for board certification. This workshop will have several brief presentations from two institutions adopting wide-scale safety initiatives encompassing inpatient and outpatient settings and two representatives from the AAP and ABP to discuss joint efforts to promote quality and safety. Workshop participants will gain knowledge, attitudes and skills to help them bring patient safety and quality to real-time implementation in their daily practice. The workshop will include one hour of presentations from the workshop leaders and then rotating 30-minute roundtables with individual leaders for workshop participants to share:

1. Pediatric patient safety concerns and strategize on wide-scale systems solutions, and
2. Ideas and inputs on joint efforts of AAP and ABP on quality and safety.
    

Since 1993, the Family Advocacy Program at Boston Medical Center has provided legal assistance to low-income patient-families whose children's health is compromised by lack of access to basic needs such as housing, public benefits, family stability/safety, education services and health insurance. FAP also trains clinical staff and residents. We have helped start up dozens of medical–legal collaborations nationally in the past several years. The goal of this workshop is to teach participants how to initiate and/or support a similar effort in their own clinical setting. Participants will learn basic legal advocacy through tools and curriculum developed by FAP and participate in facilitated small group discussion on concrete strategies for implementing a collaboration, including: identifying stakeholders, navigating confidentiality and ethics, demystifying legal services for the health care provider, linking individual advocacy to systemic change and incorporating training for providers and residents. The workshop will utilize case examples and advocacy action plans to bring to life the integration of advocacy in the clinical setting.
 

This workshop will focus on the successes and pitfalls associated with implementation of telemedicine to provide healthcare to rural, underserved populations. An introductory didactic presentation will describe the basics of telemedicine, including a brief technical description of the evolution of telemedicine techniques. Four examples of current clinical programs will be presented: an outpatient model assisting in the care of children with special healthcare needs, a pediatric ICU to rural adult ICU model to help in the care of moderately sick children, a pediatric ED to rural adult ED model to help in the care of acutely ill and injured children and a pediatric physical assault and sexual abuse model to assist rural counties in the assessment and evidentiary exams of acutely abused children. Discussion on these telemedicine programs' effect on quality of care, financial viability, sustainability and benefits to rural communities will be discussed.
 

The Community-Based Physicians SIG was designed to be a forum for all APA members in community settings involved with either/or teaching or office-based research. This set of individuals has unique interests and problems which are shared annually at the PAS meeting. We also share resources with our sister SIG in the AAP, the Resident Education and Training group (RET SIG) within the Department of Community Pediatrics.

Current activities of this SIG include:

1. The presentation of an annual award entitled the National Pediatric Community Teaching Award. Previous winners have been Larry Nazarian of Rochester, NY and Dave Bromberg of Frederick, MD.
2. The publication of a biannual newsletter "Pediatric Community-Based Teaching Newsletter". The Fall 2003 issue is dedicated to a discussion of resident work hour rules, vis a vis teaching.
3. Varied workshops are presented at the PAS meetings including such topics as Medicaid Reimbursement for Teaching, Barriers to Community-Based Teaching and Models for Community-Based Teaching such as the WWAMI Program of the University of Washington
4. Supporting the efforts of the AAP RET SIG in its development of two projects: (1) The Tool Kit—a manual for those community pediatricians interested in teaching residents and medical students; and (2) A Compendium—an all inclusive document to provide community teachers with access to materials to help them improve their teaching and evaluation skills with links to APA Faculty Development material and other web-based documents.
    

Worldwide, more than 1,500 children per day become infected with HIV through mother-to-child transmission. Currently there are 2.7 million children living with HIV infection across the globe, >90% of whom reside in developing countries. While there have been enormous successes in the prevention and treatment of pediatric AIDS in the United States and Europe, it remains an open question as to how effectively these public health gains can be replicated in the poor countries of the world, which bear the greatest burden of disease. Efforts to develop an HIV vaccine appropriate for preventing infection among the world's children and adolescents are finally under way on a global scale. We will discuss these issues and accompanying controversies as they apply to the children of the developing world.

AIDS in Children—A Global Public Health Crisis
David L. Pugatch, Hasbro Children's Hospital and Brown Medical School, Providence, RI

Preventing Mother-to-Child Transmission of HIV in Developing Countries—Successes, Failures and Challenges
Catherine M. Wilfert, Elizabeth Glaser Pediatric AIDS Foundation, Santa Monica, CA and Washington, DC

HIV Treatment for Children—Can the Successes of Rich Countries Be Duplicated in Resource-Poor Settings?
Mark W. Kline, Baylor College of Medicine, Houston, TX

Finding an AIDS Vaccine That Works for the World's Children
Richard A. Koup, Vaccine Research Center, National Institutes of Health, Bethesda, MD

This session presents the field of developmental cognitive neuroscience from a clinical perspective. Typical and atypical language development in children serves as the focus of this session. The impact of recently available magnetic resonance imaging (MRI) techniques such as volumetric MRI and functional MRI (fMRI) will be illustrated. An overview of volumetric MRI and fMRI methods will be presented with developmental and clinically relevant examples . fMRI in typically developing children as compared to adults for a single word processing task will be presented and the possibility that differences represent maturational changes in functional neuroanatomy will be discussed. The application of volumetric imaging and fMRI to the study of a clinically relevant group of children at risk for cognitive deficits, i.e. children born as premature infants, will show how fMRI for non-invasive but quantitative assessment of language processing can be utilized. Finally, results from fMRI study of children with developmental dyslexia will be presented that show disruption in posterior brain neural circuits for reading.

Introduction: Overview of Volumetric and Functional MRI Techniques
Michael Rivkin, Boston Children's Hospital, Harvard Medical School, Boston, MA

Differences in fMRI Activation Between Adults and Children in Single Word Processing
Brad Schlaggar, Washington University School of Medicine, St. Louis, MO

Use of fMRI and Volumetric Imaging To Study Language Processing and Its Cognitive Correlates in Children Born as Premature Infants
Laura R. Ment, Yale University School of Medicine, New Haven, CT

New Insights into the Functional Neuroanatomy of Developmental Dyslexia
Bennett A. Shaywitz, Yale University Medical Center, New Haven, CT
 

As the medical profession moves forward to realize the vision of a family-centered, continuous, comprehensive, coordinated, compassionate, and culturally competent health care system it will be important to assure developmentally appropriate care for young adults with special health care needs. This workshop will explore the epidemiology, medical psychosocial implications and barriers to implementation of the transition from pediatric care to the adult system. Tools for the transition process will be presented.

The Scope of the Problem
Cheri W. Goldman, University of New Mexico Health Science Center, Albuquerque, NM

Pediatrician's Perspective on Transitioning
Stuart Goldstein, Baylor College of Medicine/Texas Children's Hospital, Houston, TX

Internist's Perspective on Transitioning
Richard S. Goldman, University of New Mexico Health Science Center, Albuquerque, NM

Bridging the Gap—Lessons Learned
Patience H. White, George Washington University School of Medicine, Washington, DC

The symposium will be held on May 4, 2004 at the Moscone West Convention Center (8:00am–3:30pm). The symposium will bring together a distinguished, international group of scientists and clinicians to discuss several major childhood health problems of global significance, including:

• Micronutrient deficiency in childhood
• Perinatal aspects of maternal malaria and tuberculosis
• Genetic susceptibility to malaria and tuberculosis

Researchers are invited to submit abstracts relating to the above topics. Abstracts concerning other global health issues suitable for presentation to a diverse audience of paediatric scientists and clinicians will also be considered. Selected abstracts will be chosen for symposium or poster presentations. Submission of abstracts should be made through the PAS electronically at www.pas-meeting.org.

Wednesday, May 5, 8:00am – 5:00pm ~ Hilton San Francisco Hotel

The workshop will be held on May 5, 2004, at the Hilton San Francisco (8:00am – 5:00pm). It will provide an opportunity for individual scientists and clinicians interested in global childhood health issues, and representatives of participating societies, with the unique opportunity to help shape the direction of this new initiative. Plenary sessions and small group meetings will be used to plan for the future of the Programme for Global Paediatric Research. Topics will include:

• Establishing international communication between scientists
• The role of societies and paediatric research organizations in the study of global health problems
• Defining global health problems suitable for collaborative research
• Sites and topics for subsequent symposia

If you wish to attend the workshop and/or require further information please contact:

Contact for information:
Professor Alvin Zipursky
Hospital for Sick Children
555 University Ave.
Toronto, Ontario Canada M5G 1X8
Email: alvin.zipursky@sickkids.ca
Phone: 416-813-8760

Participating organizations are The American Pediatric Society, Chinese Pediatric Society, International Pediatric Association, Japanese Pediatric Society, Pediatric Research, and the Society for Pediatric Research.
 

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 disease prevention and health promotion.

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, effectiveness measures and evaluation. The second section briefly reviews implementation strategies with illustrative examples. Half of the session will be dedicated to small group sessions, in which participants and workshop leaders will discuss intervention designs relevant to participant interest, using the concepts discussed previously. Participants can expect to acquire practical skills and resources to aid in conducting community intervention research.
 

This workshop will focus on enhancing faculty comfort with sports medicine using a hands-on review of functional anatomy related to the lower extremity. This will be followed by small group creative problem solving around three common sport injury cases. Participants will be gently reminded of anatomic considerations with visual aids and guided examination of a live model. Case discussions will emphasize development of creative teaching strategies and discussion of potential trainee evaluation techniques. Participants are encouraged to bring along any sports medicine curricular modules they are willing to share.

Participants completing this workshop should be able to:

1. Identify functional anatomic landmarks,
2. List the most common pediatric sports injuries,
3. Describe teaching strategies to improve trainee access to sports medicine curricula and
4. Develop trainee evaluation strategies.
    

Obesity is currently one of the greatest health threats facing the health of our children and youth. Reasons for this epidemic are rooted in the changing lifestyle of Americans: one that embraces little physical activity and the consumption of large amounts of processed, high caloric foods. While problems in our societal fabric may take decades to address, pediatricians need effective ways to treat children who are already obese or are at imminent risk. Despite the significance and magnitude of this problem, most attempts at therapy have not been effective. We will discuss current dietary, pharmacologic and surgical approaches to therapy that are gaining in popularity in pediatric populations and will address what is known about the effectiveness of these approaches and the controversies associated with them. The rationale for different diets, including "popular" ones, their efficacy and safety will be discussed. Data concerning safety and efficacy of approved and experimental drug therapies in children will be presented. Finally, we will discuss when to consider bariatric surgery in children.

Novel Dietary Treatments for Obesity and Related Complications
David S. Ludwig, Children's Hospital, Boston, MA

Pharmacotherapy of Childhood Obesity
Robert H. Lustig, University of California, San Francisco, CA

Surgical Weight Loss in Pediatrics
Victor F. Garcia, Cincinnati Children's Hospital Medical Center, Cincinnati, OH

Every day, nearly 5,000 children in the United States smoke their first cigarette. Approximately 60% of smokers start by the age of 13 and fully 90% before the age of 20. Publicly the tobacco companies have always maintained that they do not target youth, but internal documents reveal that they set out to aggressively advertise to kids.

This session will describe litigation as a public health strategy for fighting Big Tobacco in the United States and provide examples of the techniques used to attract children to smoking. Global trends and counter-advertising measures will be discussed.

Overview
Ruth A. Etzel, George Washington University School of Public Health and Health Services, Washington, D.C.

Fighting Big Tobacco in the United States: Litigation as a Public Health Strategy
Madelyn J. Chaber, Law Offices of Wartnick, Chaber, Harowitz & Tigerman, San Francisco, CA

Goliath Fleeing from David: The Global March of the Marlboro Man
Ronald M. Davis, Henry Ford Health System, Detroit, MI

Discussion
 

Hot Topics in General Pediatrics is a potpourri of topics of interest to all pediatricians. The topics include lead poisoning, West Nile Virus infection, sleep disorders and esophagitis. Each of these conditions has varied symptoms, signs and manifestations. For each topic there have been new findings that are in the "need to know" category for all pediatric generalists and subspecialists.

Kawasaki Disease
Jane C. Burns, University of California, San Diego, CA

West Nile Fever
Janak A. Patel, Children's Hospital, University of Texas Medical Branch, Galveston, TX

Lead Poisoning
Kevin Osterhoudt, The Children's Hospital of Philadelphia, Philadelphia, PA