Many children living with chronic and life-threatening conditions experience pain and other distressing symptoms. Control of pain and symptoms is the foundation upon which competent palliative care is built. Yet children and families suffer when they encounter pediatricians and other professionals who are ill-prepared to offer them competent and compassionate palliative and end-of-life care. The Institute of Medicine (IOM) report on Improving Palliative and End-of-Life Care for Children and Their Families (2002) calls upon pediatric health professionals to address the needs of children and families for comprehensive palliative care services. In addition, routine assessment and management of pain is now a required component of patient care according to the Joint Commission for the Accreditation of Health Care Organizations (JCAHO). This session will outline basic tenets of pain and symptom management for children and adolescents, their implementation across care settings and consideration of the continued barriers to full implementation of these care standards.

Assessment and Management of Pain in Children and Adolescents
Neil L. Schechter, St. Francis Hospital and Medical Center, Hartford, CT

Reducing Barriers to Effective Pain and Symptom Management at the End of Life
Nancy Hutton, Johns Hopkins University School of Medicine, Baltimore, MD

Palliative Pain and Symptom Management in Pediatric Tertiary Care Settings
Joanne Wolfe, Dana-Farber Cancer Institute and Children's Hospital, Boston, MA

The Child Abuse SIG welcomes all physicians who are interested in the issues that face maltreated children and the physicians who care for them. Each year we meet to discuss subjects that are controversial or challenging and share research that informs our practice. We also try to highlight work being done by colleagues in our host city. This year in San Francisco is no different. We will meet on Sunday afternoon, May 2, 2004, for an afternoon of education and collegial controversy! Please save the date, and plan to join us.
 

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

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.
 

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

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

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.

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:

With the increasing number of homeless adolescents in the United States, health care providers can expect to address numerous medical issues within this population. As a group, homeless adolescents have unique health care needs, yet they are unlikely to receive the quality of health care that appropriately meets these needs. This workshop is designed to:

1. Inform participants of the wide range of medical/psychosocial problems which face homeless teenagers today;
2. discuss the numerous barriers to receiving primary care;
3. present strategies for overcoming existing barriers;
4. provide participants with tools to advocate for homeless adolescents in their communities.
    

Estimates of children exposed to intimate partner violence (IPV) range from three to ten million annually. In 1998 the AAP issued a policy statement that identified the abuse of mothers as a child health issue. As pediatricians we have a role in recognizing and intervening in IPV. This workshop presents components of the curriculum we devised to provide pediatricians with the knowledge, attitudes and skills needed for screening for IPV in a pediatric setting. The curriculum uses a mixture of formats—interactive lecture, large group discussion and small group scenarios. We will also discuss the results of our experience with designing, implementing and evaluating an IPV screening program in a pediatric ED.

The Serving the Underserved (SUS) SIG is dedicated to improving the health care of high-risk pediatric populations such as children who are economically disadvantaged, uninsured and underinsured, homeless and face barriers to accessing quality health care. SUS focuses on clinical practice, research and advocacy that further this cause. This year we plan to expand upon past work centered around teaching. The bulk of the meeting will consist of a forum on approaches to teaching pediatric residents about underserved children. We will also have further discussion, as follow-up to previous meetings, on practice-based research networks and the Dyson Foundation’s Community Pediatrics Training Initiative. Time will also be spent on long-range planning: How can SUS best meet the needs of its members?

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