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

The Children with Special Health Care Needs (CSHCN) Screener, a survey instrument developed by the Child and Adolescent Health Measurement Initiative at the Foundation for Accountability, is now included regularly in the child health supplement of the Agency for Healthcare Research and Quality's Medical Expenditure Panel Survey (MEPS), an annual nationally representative survey of American households, including approximately 7,000 children. The CSHCN Screener is also used to identify CSHCN in the Centers for Disease Control and Prevention (CDC) National Survey of Children with Special Health Care Needs, which was sponsored by the Health Resources and Services Administration (HRSA) and designed to collect data on a representative sample of 750 CSHCN in every State. Both surveys offer numerous opportunities to derive information about key aspects of children's health care for CSHCN. These aspects of health care include coverage and access, functional status and impact, use of care, health care expenditures and quality.

This workshop will provide demonstrations on how to score the CSHCN Screener and use it with selected other variables in the datasets, providing examples of key findings. The format will demonstrate use of the screener with other surveys and allow for interaction with the experts who are intimately familiar with how to use the CSHCN Screener with other survey components. Participants will be asked to look at materials in advance, including information about the surveys at http://www.cdc.gov/nchs/about/major/slaits/cshcn.htm (National Survey of CSHCN) and http://www.ahrq.gov/data/mepsix.htm (MEPS), an article about the screener (Bethell et al., Ambul Pediatr. 2002 Jan-Feb;2(1):49-57) and a guide to scoring the CSHCN screener tool (to be provided before the PAS meeting).
 

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
 

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

This year the Ethics SIG will discuss two different but important topics:

1. Ruth Etzel, from the Alaska Native Medical Center, will present the draft version of a code of ethics for general pediatric research which was developed by the Ambulatory Pediatric Association in cooperation with the Association of American Medical Colleges.
2. James Jarvis, from the University of Oklahoma, will discuss autonomy and the enlightenment origins of medical ethics.

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

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
 

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

The aim of this workshop is to enable individuals and groups to understand options and make effective choices in launching or enhancing careers and programs in child health services research. Topics include:

1. Finding new opportunities in child health services research;
2. Assessing infrastructure and capacity for health services research;
3. Mentorship in child health services research;
4. Designing research partnerships with health plans;
5. Getting started in child health services research: a division chief's perspective;
6. Top 10 tips for new investigators in child health services research.

Format includes ample time for interaction and group discussion. Presenters represent both new and established investigators and programs at three hospitals and four universities.
 

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

Patient safety has become a national focus and initiative from government to regulatory/accreditation bodies to institutions. A substantial proportion of the initial efforts are on understanding epidemiology and risk factors and developing organizational models and tools for identifying concerns and fostering safety improvements. Research to date has identified that children do experience medical errors, these events have unique risk factors and while some types of errors are comparable to adult populations, other types are unique to children. In this session we will examine several key elements in efforts to address safety now and in the future: how to tackle patient safety in real time and create cultural change, role of information technology, how to create and promote metrics to measure performance and sources of funding for ongoing work.

In specific, we will examine one institution’s successes and lessons learned from implementing a combined ‘top down’ and ‘bottom up’ system of teams to address safety. We will examine the history of information technology and hear work evaluating the use of information technology in the primary care setting. Next we will examine national efforts to create pediatric-specific measures of quality of care and how these measures are being promoted and implemented nationwide. Last we will hear an overview of research findings to date from the Agency for Healthcare Research and Quality’s $165 million investment in patient safety research and explore new and ongoing funding sources for this research.

The Josie King Patient Safety Program at Johns Hopkins University
Marlene R. Miller, Johns Hopkins University, Baltimore, MD

Role of IT in Patient Safety
Kevin B. Johnson, Vanderbilt University Medical Center, Nashville, TN

PediQS and National Efforts To Promote Measurement of Children’s Healthcare
Stephen Lawless, Nemours Foundation, Wilmington, DE

AHRQ’s Patient Safety Initiative and Findings to Date
Dan Stryer, Agency for Healthcare Research and Quality, Rockville, MD

Discussion
 

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.
 

The current plan for the Health Services Research SIG is to focus our discussions on two areas:

1. Epistemological Models for Action (Impact) Research. A brief conceptual model will be presented and opened to the group for discussion. The focus will be on how and when you can consider to have demonstrated something sufficiently that you can rely on it for future actions. This young area is critical for quality improvement and other translational research.

2. Calculating Risk Ratios from Logistic Models, A Novel Method. This discussion will present a method that represents a fundamentally new approach to the interpretation of logistic models that avoids much of the bias present when using odds ratios to describe risk ratios.

As always, the SIG will include a brief organizational meeting and the opportunity for networking among and between young researchers and senior colleagues. The meeting will be chaired by Larry Kleinman of Quality Matters, Inc, the Harvard School of Public Health and the Penn State College of Medicine. We welcome new and old members and invite suggestions for future activities of interest.
 

Premature birth accounts for nearly 75% of the neonatal mortality and up to 50% of the long-term neurologic disability in children. In the United States, the incidence of premature birth has not decreased over the past 40 years and, in fact, despite considerable investigational, public health and clinical effort, has increased slightly in the past decades. The faculty of this session will discuss the epidemiology of premature birth and our current understanding of the etiology of premature labor. Current and future investigational, interventional and therapeutic strategies will be outlined.

Biological Influences on the Premature Labor
Robert L. Goldenberg, University of Alabama, Birmingham, AL

Insights from Clinical Trials in the Management of Premature Labor
Jay Donald Iams, Ohio State University, Columbus, 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