This year’s theme will be “Promoting Adherence to HIV Treatment Recommendations”.  Our Baltimore based programs will present a range of activities we have used to try to support successful adherence.  Other programs are invited to share their efforts—especially if they work!  If you are willing to present in this small group, workshop format, please email Nancy Hutton at nhutton@jhmi.edu.

This SIG supports primary care programs to promote reading aloud and the developmental aspects of literacy, based on the Reach Out and Read (ROR) model. The three-hour meeting will focus on sharing innovations in physician and volunteer training, program organization, fund-raising, and regionalization. Time will be devoted to in-depth discussions of multi-cultural and multi-lingual aspects of literacy intervention, advocacy around literacy, and a review of the SIG's multi-site research project, the Before-and-After-Books-and-Reading (BABAR) study. A separate training session will be offered for programs just getting started. The SIG is coordinated by Perri Klass (BU School of Medicine and Reach Out and Read, Boston) and Robert Needlman (CWRU School of Medicine and DrSpock.com).

The focus of this group is on advancing the recognition, assessment, and management of pain in children. The orientation of the SIG is not on how to manage pain but on the development of strategies that will promote change in health care institutions and individual practice patterns. Presentations may concern the management of pain in specific age groups (e.g. infancy), specific settings (e.g. ambulatory, ED, NICU), specific populations (e.g. developmentally disabled), individuals with specific pain problems (sickle cell, cancer, RSD, headache) or on strategies to promote changes in institution or individual attitudes and practice. The SIG will allow a forum for discussion and sharing of ideas with the goal of reducing pain in pediatric practice.

The Serving the Underserved (STUS) SIG meeting will build on the momentum of last year's meeting and will include:

Research/program evaluation in the STUS arena. We will highlight several successful STUS community-based projects with a special emphasis on successful program evaluation. Presenters will highlight lessons learned and academic areas to be advanced in this area. Discussants will review related resources including the AAP Center for Child Health Research and the PROS Network.

STUS curriculum development. There has been a lot of progress with the STUS SIG web-based curriculum over the last year. We will discuss this project and other curriculum development advances in the STUS field.

Community and the underserved. We will follow up last year's program with a discussion of the progress being made in improving care and education in the community. Discussants from the Dyson Initiative and CATCH will be included.

Legislative update. We will review the status of key federal and state legislative efforts regarding health services for underserved pediatric/adolescent populations.

Come and join us as we work to improve health services and STUS related teaching for underserved pediatric and adolescent populations.

Approaches to the diagnosis, prevention, and treatment of chronic conditions in childhood and adolescence have changed greatly with greater survival of most children, even with severe conditions. Thus, for most children, new issues include preparation for adulthood rather than expectation of early death. Community pediatricians have increasing numbers of children with chronic conditions in their practices and thereby face new challenges in the care of these children and their families. Advances in molecular biology and genetics will lead to more effective ways to identify and treat many conditions. At the same time, children and adolescents face a great rise in new epidemics of chronic conditions, with marked increases in obesity, asthma, Type 2 diabetes, mental health conditions (especially ADHD and depression). This session will examine new advances in the biology of chronic conditions, important changes in epidemiology, consideration of important outcomes for children and adolescents with chronic conditions, and new efforts to improve their pediatric care.

Overview

New Morbidities: Clinical and Social Changes in Childhood Chronic Conditions
James M. Perrin, Mass General Hospital for Children, Harvard Medical School, Boston, MA

Prospects for New Treatments
Alan B. Ezekowitz, Massachusetts General Hospital, Boston, MA

Improving the Care of Children with Chronic Illness
Carole M. Lannon, AAP liaison, National Initiative for Children's Helathcare Quality, University of North Carolina, Chapel Hill, NC

Outcomes of Chronic Conditions: What Should We Measure?
Ruth E. K. Stein, Albert Einstein College of Medicine/Children's Hospital of Montefiore, Bronx, NY

The U.S. is experiencing an epidemic of pediatric obesity. However, many primary care providers report that obesity is one of the most frustrating and difficult problems in their practices. In this workshop, we will provide practical strategies for evaluating and treating obese children in primary care. To maximize learning and relevance the session will be split. During the first third of the session, we will present expert committee recommendations for evaluation and behavioral treatment strategies. We will address skills for identification of obesity, screening for both rare endogenous causes of obesity and more common obesity-associated conditions or risk factors, assessment of emotional and psychosocial states, eating and activity assessment, and indications for consultation with an obesity specialist. For treatment, we will address the most successful strategies for diet and physical activity counseling, changing the household environment, self- monitoring, goal setting and contracting, parenting skills training, maintenance and relapse prevention, and the potential role of drug therapies. The second two-thirds of the session will consist of case discussions and group problem solving. Cases will be provided but attendees will be asked to bring their own cases as well. Several additional experienced obesity specialists will also be present to participate in the case discussions.

T. N. Robinson and S. E. Barlow, Department of Pediatrics, Stanford University, Palo Alto, CA & Department of Pediatrics, St. Louis University School of Medicine, St. Louis, MO

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

Providing pediatric subspecialty care to underserved rural communities has been a long-standing challenge. Several different health care delivery models have addressed this issue, the most common being outreach outpatient clinics with traveling Pediatric subspecialty teams based at tertiary children's centers. This workshop will expose the participant as to how we have utilized telemedicine, live 2 way video linkages, between the rural health care centers and our children's center. We provide 3 types of pediatric patient care: 1) Outpatient subspecialty consultation and follow-up, 2) PICU to rural adult ICU/adult intensivists for critically ill children, 3) Rural emergency rooms to our pediatric emergency room for acutely ill and injured children. Although the model of outpatient consultation is well established, the PICU to Adult ICU is a new model and has many challenges and opportunities that will be discussed. These include acceptance of a rural partner, ability of the PICU to triage and control all patient flow and beneficial relationships derived by supporting appropriate patients to remain in the local community. The rural ER to pediatric emergency room model involves a complex electronic network but is well received in rural communities. A limited discussion of technical details will also be available.

R. J. Dimand, J. P. Marcin, H. J. Kallas, Department of Pediatrics, University of California Davis, Sacramento, CA

The repercussions of violence affect pediatric patients and their families every day. Many residency training programs struggle with how to address this new epidemic. This workshop presents a model of a creative, comprehensive violence assessment and prevention curriculum, encouraging medical educators to explore new teaching methods. We hope to stimulate a lively discussion of educational strategies: didactic presentations, multimedia demonstrations, standardized patient interviews, community resource displays and evaluation methods. Attendees will be trained in case-based role-play scenarios to facilitate learners' communication skills within the patient-physician encounter. The workshop will offer specific didactic outlines and examples of pertinent videotapes and community resource displays as springboards for conversation regarding improvement of resident violence education. The model suggests one evaluation method that reinforces the newly acquired competencies via the creation of learner contracts. Small group discussions will be used to generate new ideas in violence-related curriculum development and evaluation.

Shannon Phillips, Jill Mazurek, Mary Ciccarelli, Marilyn Bull, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN

In 1997, the Residency Review Committee required that all pediatric residents be prepared for the role of child advocate. Last year, our SIG accepted the challenge of developing standards for child advocacy training. We welcome all who are interested in teaching about child advocacy to join us in that task. We are particularly interested in hearing from residents about their experiences - what have you done, what worked and what are the generalizable lessons for other programs. E-mail your thoughts to the co-chairs, David Keller (david.keller@ummed.edu) or Rosalind Vaz (RVaz@lifespan.org). We look forward to seeing you in Baltimore!

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

The importance of community-based pediatric training was formally recognized when, in 1996, the Residency Review Committee (RRC) for Pediatrics mandated structured educational experiences in community pediatrics. Under the leadership of late Foundation president pediatrician Anne E. Dyson, the Dyson Foundation, launched a program to stimulate innovation in community pediatrics residency training. The ultimate goal of The Dyson Initiative-Pediatric Training in the Community, which allocates $2.5 million over five years to pediatric residency programs, is to expand the repertoire of residency training to include teaching and experiences in community-based medicine and advocacy.

This workshop will focus on curricular changes that can be implemented to strengthen community-based training. Representatives from Dyson Initiative-funded sites will present innovative curricular enhancements, focusing on those changes that need not require a large monetary investment. They will also discuss the faculty development strategies that accompany curricular change. In the second part of the workshop, Dyson Initiative grantees will present their experience with community collaboration. Practical lessons learned from taking the residency outside the hospital/clinic walls will provide participants with insight into this integral facet of community pediatrics.

M. K. Goyal and J. S. Palfrey, The Dyson Foundation, Millbrook, NY and Dept of General Pediatrics, Children's Hospital, Boston, MA.

Children are a vulnerable class of research subjects because they lack the developmental, intellectual and legal capacity to provide informed consent. Research information is given to parents who are asked to make a decision regarding participation based on their perception of what is in the best interest of their child and society at large. We propose to conduct a workshop for new investigators that will accomplish the following goals: (1) Workshop participants will be able to present the essential elements of informed consent to parents in both written and verbal format. (2) Participants will be able to discuss research involvement with children in a manner appropriate for the child's age, maturity and psychological state. (3) Participants will be able to evaluate the appropriateness of involving adolescents in research with/without parental permission. These goals will be accomplished using a combination of didactic and interactive methods. Case studies consisting of background information, case vignettes, discussion questions and references will be used to explore ethical principles and federal regulations guiding the consent process. Sample consent documents, and videotapes of investigators interacting with parents and potential subjects will be reviewed and critiqued by workshop participants for content, style and effectiveness of communication. The workshop evaluation will consist of pre and post-test questions designed to allow the participant to directly assess their knowledge and skill acquisition.

K. L. Meert, G. Deisinger and E. R. Stinson, Department of Pediatrics, and Office of Research and Graduate Studies, Wayne State University, Detroit, MI.

Shaken Baby Syndrome is the most common cause of morbidity and mortality in inflicted, abusive head injury; the leading cause of traumatic death in infancy. Recent medical and legal controversies involving high -profile court cases as well the fact that the syndrome is frequently overlooked or misdiagnosed will be focused issues in this workshop. The workshop is designed to guide the physician through the process of diagnostic evaluation, therapeutic intervention, working with a child protection team response that includes medical, psychosocial, law enforcement and legal components, collection of evidence, preparation for court and aspects of expert testimony.

Covered topics will include epidemiology, history taking, physical exam, differential diagnosis, laboratory, radiological and diagnostic testing, crime scene investigation, forensic evidence and the legal response. Factual educational material will be presented with varied audiovisual formats including videotapes of perpetrators as well as demonstrations of the physical dynamics of shaking. The audience will have the opportunity to directly participate through the utilization of role modeling, mock investigation and courtroom trial.

M. Frogel and D. Esernio-Jenssen, Schneider Children's Hospital, New Hyde Park, NY and M. Fisher, Special Victim's Bureau, District Attorney's Office, Queens, NY

This symposium will address a topic of considerable public debate, especially as it relates to research involving human subjects, among these clinical trials using children as subjects, and research involving gene therapy. A recent two-day meeting at NIH was devoted to this subject and it is likely that there will be new and more explicit guidelines promulgated by HHS. The symposium will address these issues from the perspective of academic pediatrics and pediatric research, in particular with regard to the impact on education at both the undergraduate and graduate levels and the availability of appropriate tests and therapies for children. The role of professional societies, such as the sponsoring members of the PAS meeting, will be examined. The symposium is planned to allow at least 30 minutes of interactive discussion between the members of the panel and the audience.

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

Primary care physicians increasingly encounter behavior problems (e.g., noncompliance, sleep problems, and ADHD), but sometimes these problems do not resolve with an exclusive child-symptom centered approach. Furthermore, physicians are encountering interaction-psychosocial problems (e.g., relationship and communication problems, family affective disorders, social-emotional complications of ADHD and learning problems, parent-teen conflict, and parent stresses) that require a family systems approach to assessment and treatment, i.e., viewing the problems and the solutions within the family-social context in which they arise. Most physicians are not trained in family systems-family interviewing techniques, which are needed for these clinical situations.

The goal of this workshop is to teach these techniques. Specifically, attendees will learn basic family systems principles, three models of interviewing techniques, the use of family drawings and genograms, and how to deal with the difficult family.

The workshop will be very interactive. Teaching techniques include case studies, brief didactics, videotapes of family interviews, and extensive handouts. Attendees should bring their own case studies for discussion.

William Coleman, Dept. of Pediatrics, Univ. of North Carolina, Chapel Hill, NC

In the late 1990s, there has been an epidemic of schoolyard shootings. Yet data seem to show that the rate of juvenile violence is decreasing. Why the discrepancy? Can adolescents who are prone to commit violent crimes be identified ahead of time? Why do they commit such crimes. Are we "teaching" our children how to kill? What role do the media play in these crimes?

This workshop will employ an informal approach to answering at least some of these questions, using data, case vignettes, role playing and video clips.

Dr. Strasburger is a nationally known expert on children, adolescents, and the media. Lt. Col. Dave Grossman is an Army Ranger, a West Point Psychology Professor, and a Professor of Military Science who wrote the Pulitzer-Prize-nominated book, On Killing, and the recent book, Stop Teaching Our Kids to Kill. He was a consultant after the Jonesboro, AR, Paducah, KY, Springfield, OR, and Littleton, CO school shooting incidents and testified in the trial of Timothy McVeigh.

Vic Strasburger, M.D., Professor of Pediatrics, Univ. of New Mexico School of Medicine and Lt. Col. Dave Grossman, U.S. Army (Ret.)

Despite clinicians' universal intentions to provide excellent care, actual care often falls short. These gaps in care lead to worsened health status, decreased satisfaction, increased costs, and clinician and staff distress. Achieving major enhancements in care requires substantial restructuring of the approach to care and changing office systems to better meet patient, family, and staff needs.

The National Initiative for Children's Healthcare Quality (NICHQ) seeks to eliminate the gap between what is and what can be in health care for all children by raising the will to improve, developing better strategies to accomplish change, and directly assisting practices in their improvement activities. This direct assistance entails measuring current performance, training practice staff about how to achieve change, providing expertise in providing tools and materials to enhance improvement, and supporting change through the formation of "collaborative learning groups." NICHQ, building on the practice guidelines of the American Academy of Pediatrics, has launched a new project to transform care for children with ADHD.

The objective of this workshop is to provide participants with the fundamentals of how to promote change in primary care settings for children so that they better meet the needs of children, families, clinicians, and staff. We will build on the example of ADHD, and give participants the opportunity to plan actual changes they might bring back to their care settings.

C. J. Homer, P. Margolis, P. Heinrich, L. White, J. Perrin. National Initiative for Children's Healthcare Quality, Boston, MA; Chapel Hill, NC; and Seattle, WA; Mass General Hospital for Children, Boston, MA

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 participation of children in research is a double-edged sword. Children are vulnerable and need protection, yet their participation is critical to ensure improvements in the medical care of this same population. The fundamental question is how to balance the need for protection and access in a manner that is ethically sound and yet pragmatically feasible.

In this workshop, we will look at various recent publications in pediatric journals and present several vignettes to explore ethical and policy issues regarding the participation of children as human subjects. Through the scenarios, we will discuss such issues as: 1) the questions raised by the need to balance access versus protection; 2) the potential impact on this balance of the new NIH and FDA policies that went into affect in the late 1990s; 3) ethical issues regarding consent to participation (e.g., should adolescents be able to consent to research without parental participation?); and 4) ethical issues in research design (e.g. when are placebos morally justifiable?). For each vignette and journal article, the workshop leaders will then present where there is and is not consensus between bioethicists.

L. F. Ross, J. D. Lantos, G. Koren, S. Leikin, University of Chicago, Chicago IL (LFR, JDL), University of Toronto, Toronto Canada (GK), Office of Human Protection Research, Department of Health and Human Services, Washington, DC (SL--probable).

The medical home model of care is described as accessible, family-centered, comprehensive, continuous, coordinated, compassionate and culturally-competent. Components include attention to mental health, parent support, education, religious and spiritual support, access to specialists, and finances.

Community pediatrics recognizes economical, educational, environmental, social, political and family forces that impact on child health. Service integration and advocacy are seen as key to the medical model and the practice of community pediatrics. The role of the interdisciplinary team proposes new avenues for effective health care delivery. Translating these concepts into reality as part of program design is challenging. Integrating residency education, program evaluation, and promoting sustainability require a deliberate process. This workshop will address the key components of innovative programs providing improved access to care for children and adolescents. The panelists will review the literature, summarize the experience of the broad-based community partnerships of the Community Access to Child Health Programs (CATCH) and the experience of the recipients of the APA Health Care Delivery Award. The extent to which these models reflect evidence-based practice will be discussed. Specific resources to develop programs will be shared with the workshop participants.

D. Laraque, J. Cox, M. LoFrumento, T. Tonniges, K. Capitulo and the APA Health Care Delivery Committee. Mt Sinai Medical Center, NY; Children's Hospital, Boston; Franklin Pediatrics, NY; American Academy of Pediatrics

There is a growing body of research examining the prevention of child abuse and neglect. The link between domestic violence and child maltreatment has become increasingly clear, with important implications for pediatricians. Recent studies have demonstrated the potential impact that various strategies could have on the incidence of abuse and neglect. This symposium will present new information regarding the use of home visitors and the role of physicians in identifying and preventing abuse. The presenters will also discuss the need to establish child abuse prevention as a higher priority for funded research and as a major public health concern.

A National Call to Action To End Child Abuse
David Chadwick, Director, Emeritus Center for Child Protection, Children's Hospital, San Diego, CA, Emeritus, Center for Child Protection, Children's Hospital, San Diego, CA

Domestic Violence, Child Maltreatment, and the Pediatrician's Role
Howard Dubowitz, Professor of Pediatrics, Chief, Division of Child Protection, University of Maryland School of Medicine, Baltimore, MD

Building Systems To Improve Preventive Care: Linking Home and Office-based Prevention
Peter A. Margolis, Children's Primary Care Research Group, University of North Carolina School of Medicine, Chapel Hill, NC

Preparing Physicians To Identify and Prevent Abuse
Desmond K. Runyan, Professor and Chair of Social Medicine, University of North Carolina School of Medicine, Chapel Hill, NC

The Pediatric Environmental Health Special Interest Group is again invites your participation at our annual session at the Spring Pediatric Academic Societies Meeting in Baltimore. Our agenda will include the following:

1. Educational /Training session - Toxic Effects of Herbal Remedies - - Michael Shannon, M.D.
2. Pediatric Environmental Health Training during Pediatric Residency Programs - examples from the field
3. New Ambulatory Pediatric Association Environmental Health Fellowship - a status report
4. Environment Health and the Underserved - collaborative opportunities
5. Research Presentations

SIG Business

The Injury Control Special Interest Group of the APA will hold its annual meeting on Tuesday, May 1st, from 8:45-11:45am in Baltimore, Maryland. A special presentation will be made by Dr. Michael Weitzman from the AAP's Child Health Research Institute concerning new research initiatives within the Institute and how injury control research issues might be addressed. A second presentation on PROS is also tentatively planned. Dr. Mort Wasserman (or another staff member) of the PROS Network, will discuss how PROS works and how it might be utilized to answer clinical questions concerning childhood injuries.

Reports from SIG members on their local activities in injury control will also be discussed. New funding opportunities will also be explored through the pertinent Federal agencies. All are invited to attend the SIG.

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

Despite increasingly prevalent curricula on cultural sensitivity and awareness in medical school, there are no published descriptions of faculty development programs to prepare primary care educators to teach students this material in community settings. This workshop will describe and involve participants in a curriculum developed at the UMASS Community Faculty Development Center that teaches primary care physicians to incorporate cultural competence and patient advocacy into their office-based teaching activities. The curriculum is delivered in 3 modules presented to our community faculty during a faculty development series. Participants will be provided with a concentrated version of our three modules.

Participants will be oriented to the educational planning process (GNOME) developed at our institution. We will discuss how to assess the needs of students with regard to cultural sensitivity, using an interactive format and videotaped examples. Teaching methods that assist with attitudinal objectives including collaborative and facilitative teaching styles, self-reflection and role modeling will all be emphasized. After a short break, 4 specific strategies that facilitate the development culturally competent students will be reviewed: the Patient-Centered Interview; the Social Review of Systems; the LEARN negotiation technique; and use of the community as teacher. Following a large group video demonstration role-play, participants will then break out into small groups. Teaching case vignettes that emphasize needs assessment, attitudinal objectives and teaching skill objectives will be role-played in the small groups, and discussed. Finally, we will reconvene to present workshop evaluation data and discuss ways in which this curriculum could be adapted to their home institution.

D. M. Keller, W. J. Ferguson. Departments of Pediatrics and Family Medicine/Community Health, UMASS Medical School, Worcester MA

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

The roles of nature and nurture in shaping behavior are complex and our understanding of them is constantly expanding. Exciting recent findings have given us new perspectives on biologic influences on brain functioning and subsequent behavior. Genetic conditions can be reflected in clearly identifiable behavioral phenotypes. Prenatal exposure to nicotine can have effects that are measurable in adolescence, and low level exposure to environmental toxins are impacting cognitive and behavioral functioning of the current generation. Three outstanding speakers will discuss these advances in our knowledge of neuroscience and their implications for the identification and treatment of a variety of neurodevelopmental conditions.

Overview
Daniel Lee Coury, Children's Hospital, Columbus, OH

Fragile X Syndrome: A Model of Gene-Brain Behavior Relationships
Randi J. Hagerman, University of California at Davis Medical Center, Sacramento, CA

Tobacco, Nicotine and Fetal Brain Damage: The Smoking Gun in ADHD and SIDS
Theodore Slotkin, Duke University Medical Center, Durham, NC

Neurotoxicity of Low-Level Exposure to Pesticides and PCBs
Philip John Landrigan, Center for Children's Health & the Environment, Mt. Sinai School of Medicine, New York, NY

The role of experience and the environment in early child development has long been appreciated, but it has been likened to loading software on a computer.  Recent research in neurobiology suggests that early experiences are not only loading software but actually changing the hard wiring of the brain.  Many of the brain’s pathways are in place by three years of age.  What are the implications for this research?  Do these pathways continue to change and evolve with experience? What are the effects of early insults on brain development? This program will focus on the Institute of Medicine Report From "Neurons to Neighborhoods".  The speakers will focus on what is known about the neurobiology of brain development and the implications this research has on child development programs.  The session will highlight how the current knowledge of brain development will impact future research as well as how it may translate into public policy.

Overview
Barry S. Zuckerman, Boston University School of Medicine, Boston, MA

The Critical Period Viewpoint and a More Complete View of the Effects of Experience on the Brain
William Greenough, University of Illinois College of Medicine, Chicago, IL

Early Biologic Insults on Brain Development
Betsy Lozoff, University of Michigan, Ann Arbor, MI

Neurons to Neighborhood: Translating the Science to Policy and Program
Deborah Phillips, Georgetown University, Washington, DC

Discussion

A major challenge of daily professional life is keeping abreast of the rapid changes in infectious diseases — pathogens, antimicrobial resistance, therapies and prevention. Four topics are selected because of their timeliness and the importance of new information.

Vaccines: The Good, Bad and Ugly
Jon S. Abramson, Wake Forest University School of Medicine, Winston-Salem NC

Meningococcal Vaccine: Experience and Experiment
Dan M. Granoff, Children's Hospital Oakland Research Institute, Oakland, CA

The MRSA Shows No Mercy
Betsy C. Herold, Mt. Sinai School of Medicine, New York, NY