INTERNATIONAL HEALTH

Over 75,000 children, from 36 countries, have been adopted by U.S. families since 1990. During 1998 alone, almost 16,000 children have been internationally adopted. It is quite likely that the primary care provider will encounter at least one internationally adopted child in his or her practice. While most of these children may appear healthy and well nourished, more than 50% have an undiagnosed medical condition at the time of the initial evaluation in the United States, regardless of age, sex, or country of origin. This workshop is designed to educate and alert the participants to the unique medical needs of these children so that early treatment and intervention is optimized. The workshop will familiarize the primary care provider working with international adoptees and will clarify his or her role in caring for the internationally adopted child. The first part of the workshop will focus on the following topics: 1) review medical records (photos, video) of the child from abroad, 2) travel preparation for parents, 3) post-adoptive medical screening, diagnoses, and treatment of medical conditions, 4) immunizations, 5) assessment of growth, development and nutrition, 6) coordinating care of special-needs children, and 7) guidance on adjustment problems, language delays, preparation for preschool and school, adoption procedures, cultural issues. The second part of the workshop will consist of small group discussions involving several case studies. The workshop team consists of general pediatricians, infectious disease experts, developmentalists, and international adoption clinic directors who provide services to a large number of internationally adopted children and their parents throughout the country. Written materials reviewing workshop concepts and a list of adoption clinics will be distributed.

E. E. Schulte, J. E. Aronson, L. M. H. Albers, S. Blatt; Children's Hospital at Albany Medical College, International Adoption Medical Consultation Services, Mineola, Children's Hospital, Boston, Department of Pediatrics, Syracuse

Functional Foods in the Pediatric Diet

This topic will be presented by Walter Glinsmann, MD Fellow at the Center for Food and Nutrition Policy at Georgetown University.

Functional foods are defined as foods or food components that provide a health benefit beyond basic nutrition. These functional components may range from alpha carotene and fiber to probiotics and prebiotics. Many families are interested and aware of the functional value of foods and seek information from health care providers about their use in pediatrics. This talk will address issues specific to infancy and childhood with discussion of specific topics to follow.

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 Latino and African-American 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.

G. Flores and G. Askew, Department of Pediatrics, Boston Medical Center and Boston University Schools of Medicine & Public Health, Boston, MA

Check for information on this SIG on our website at www.aps-spr.org in early 2001.

This symposium will provide a broad overview of the state of the pediatric AIDS pandemic. The results of recent trials investigating approaches to prevention and treatment of vertical HIV transmission in the developing world will be discussed. Collaborative approaches and opportunities for partnership in international pediatric AIDS treatment, education, and research will be highlighted.

Overview
Mark W. Kline, Baylor College of Medicine, Houston, TX

Pediatric AIDS: State of the Pandemic
Meg Gwynne Ferris, Baylor College of Medicine, Houston, TX

Approaches to Prevention of Mother-to-Child HIV Transmission in the Developing World
Lynne M. Mofenson, National Institute of Child Health and Human Development, Rockville, MD

Collaborative Approaches to International AIDS Training and Research
Kenneth Bridbord, Fogarty International Center, National Institutes of Health, Bethesda, MD

Models of Partnership in Pediatric AIDS Treatment, Education and Clinical Research: Romania and Botswana
Mark W. Kline, Baylor College of Medicine, Houston, TX

Hello to all of the APA International Health SIG members!
We have collected an excellent group of presenters and anticipate an exciting program.  Please be sure to share the following highlights and invite interested colleagues to attend:

• Lisa Albers, of Boston Children's Hospital, will begin with a discussion of International travel for work and leisure.  During this presentation, the epidemiology of travel related concerns and practical pre-travel preparation, including preventive immunizations and medications, will be discussed. Special considerations for pediatric travelers and physicians working abroad will be emphasized. Resources will be provided for use by physicians preparing their patients for international travel.

• Joe Sherman, of the University of Washington, will discuss his experience and share lessons learned during his recent work in a Pediatric Hiv clinic in Kampala, Uganda.  The objectives of his talk "Peri-natal HIV in Uganda and the Developing World: prevention and care" include (1) the identification of strategies for reducing peri-natal HIV transmission in the developing world, (2) a discussion of challenges of delivering pediatric care in Uganda, and (3) a discussion of the effects of the HIV epidemic in Africa. Of note, many of you may remember Joe as faculty from Georgetown who ran the mobile clinic in Washington, DC.

• Ezekiel Mupere, this year's APA International Health Award recipient, will be our final speaker.  He will discuss his research examining the clinical efficacy of Measles vaccine in Urban Africa and alternative strategies in measles control.  Additionally, he will discuss his clinical work in the Northern Ugandan Gulu district and highlight his recent experience during the Ebola outbreak.  

The objective of this workshop is to address key issues concerning the use and safety of dietary supplements in infants and children. There is a growing body of evidence that nutrients and other bioactive components of foods play a significant role in health promotion and disease prevention in adults and this information has increased the use of dietary supplements in infants and children. However, little is known about the interaction between the use of many of these supplements and developmental physiology and behavior in children. Such knowledge is critical when evaluating either the justification or safety of this trend. Topics to be addressed at the workshop include: 1) Current usage patterns among infants, children and adolescents; 2) Evidence-based justification for dietary supplement use at various developmental stages; 3) Age-dependent factors influencing bioavailability, pharmacology and safety; 4) Behavioral factors that impact attitudes and beliefs about dietary supplements; 5) Biomarkers for the assessment of efficacy and safety; and, 6) Identification of research needs.

P. M. Coates, D. J. Raiten and M. F. Picciano, Office of Dietary Supplements, National Institutes of Health & Office of Prevention Research and International Programs, National Institutes of Child Health and Human Development, Bethesda, MD

Over the past 25 years, US citizens have adopted mot\re than 200,000 foreign-born children. Annually, Americans adopt more children internationally than citizens of all other countries combined. Recently, there have been major shifts in the sending countries, the characteristics of the children and of the adoptive parents and in the medical and ethical questions faced by pediatricians in working with this special population of children.

Using real life examples of medical records and videotapes, this workshop will give the practitioner hands-on experience in the types of issues and range of problems presented to families at the time they are considering adoption. The most common medical, developmental and behavioral concerns will be addressed in the context of what is the "abstractnorm" for different orphanages and cultures.

The second part of the workshop will focus on the short and long-term follow-up of the children after adoption. Again, using real-life examples, the practitioner will have the opportunity to review some of the major issues facing these children and their parents as they recover from a myriad of social and medical insults.

Jerri Ann Jenista, Departments of Pediatrics and Emergency Medicine, St. Joseph Mercy Hospital, Ann Arbor, MI and Provisional Section on Adoption, American Academy of Pediatrics

The Human Genome Project is impacting every aspect of medicine. Dr. Craig Venter, President of Celera Genomics, one of the chief architects of this venture, will discuss the accomplishments of the human genome project and implications for future impact on health and disease in this special one-hour state of the art lecture.

Sequencing the Human Genome
J. Craig Venter, President, Celera Genomics, Rockville, MD

Supported in part by an educational grant from the Columbus Children's Hospital, Columbus, OH