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The article discusses the methods for controlling cross-infections caused by gram negative bacilli on the Pediatric Contagion Unit of Meadowbrook Hospital in Long Island, New York. Between March 1 and April 30, 1964, ten children who were admitted at the hospital because of capillary bronchiolitis or laryngotracheobronchitis developed gastroenteritis. The children, all under two years of age, developed severe vomiting, diarrhea and dehydration several days after their hospital admission. The possible etiologic agents for the disease were Aerobacter cloacae and Pseudomonas aeruginosa which were spread by contaminated equipment at the hospital. To prevent cross infection with gram negative bacilli the hospital decided to establish accurate cleaning and disinfection technics for hospital equipment.

Pediatric antibiotic prescriptions originate from an increasingly broad range of ambulatory settings. In this retrospective study, pharyngitis, otitis media, sinusitis, pneumonia, and upper respiratory infection cases, at 11 primary care offices, 2 independent urgent care centers (UCCs), and a pediatric emergency department in Western New York, were analyzed relative to medical society practice guidelines and antibiotic utilization. Of 2358 eligible visits across all sites, 25% were for study diagnoses, with 38% at UCC (P <.01). Across all sites, 26% of pharyngitis cases given antibiotics did not have diagnostic evidence of bacterial infection. At primary care offices and UCCs, guideline recommended first-line agents for pharyngitis and otitis media were used in only 58% and 63% of treated cases, respectively. Overall, an estimated 9855 to 12 045 avoidable antibiotic and 8030 non-guideline antibiotic courses annually are represented by the 14 sites studied. These and other study findings highlight numerous opportunities for outpatient pediatric antibiotic stewardship. [ABSTRACT FROM AUTHOR]

The article presents a study related to sexually transmitted infection of Chlamydia Trachomatis (CT) among adolescents. Topics discussed includes treatment required for infected individuals for reducing the risk of spreading and reproductive complications, ideal treatment for infection including medication administration, treatment of sex partners, and expedited partner therapy with antibiotic prescriptions, and requirement of test for reinfection.

Objective. To assess current practices of New York State pediatricians as they transition youth with special health care needs to adult-oriented medical care. Methods. A survey of New York State pediatricians included 6 critical steps from 2002 consensus statement, 11 essential steps adapted from recent literature, and questions targeting age of starting transition and availability of transition policy. Results. Of 181 respondents, only 11% have a transition policy. Most assist patients in transition process; identify an adult provider (92%); and create portable medical summary (57%). Only 3% start planning process at recommended age. No respondents are compliant with all 6 critical steps; subspecialists were more likely to report compliance to more than 4 steps. Conclusions. Participating pediatricians are making gains, yet effort is needed, to incorporate the essential steps into practice for transitioning youth with special health care needs. Recognition of barriers, use of electronic tools, and clarifying subspecialist’s approach, may improve compliance with transition recommendations. [ABSTRACT FROM AUTHOR]

Objective. Personal health records (PHRs) may address the needs of children with attention deficit hyperactivity disorder. Among parents, we assessed acceptance, barriers, and intentions regarding use of PHR for their children with attention deficit hyperactivity disorder. Methods. Survey of parents from 3 practices in Rochester, NY. Stepwise logistic regression analysis explored factors predicting respondents’ intentions for future use of PHR, accounting for care coordination needs, caregiver education, socioeconomic status, and satisfaction with providers. Results. Of 184 respondents, 23% had used the PHR for their child, 82% intended future use. No difference was observed between users and nonusers regarding gender, age, race, or education. Users were more likely than nonusers to reside in the suburbs (P = .03). Caregivers were more likely to plan future use of the PHR if they felt engaged as partners in their child’s care (adjusted odds ratio = 2.3, 95% confidence interval = 1.2, 4.5). Conclusions. Parents are enthusiastic about PHRs. Future work should focus on engaging them as members of the health care team. [ABSTRACT FROM PUBLISHER]

Background. Children residing in long-term care facilities (LTCFs) have complex medical problems and unique care needs, yet research in this setting is rare. As part of an intervention study to improve patient safety (Keep It Clean for Kids [KICK]), we describe the challenges encountered and recommend approaches to build a successful and sustained collaborative relationship between pediatric LTCFs and the research team. Methods. We implemented a program with 5 components: leadership commitment, active staff participation by the creation of KICK teams, workflow assessments, staff training in the World Health Organization’s “5 Moments for Hand Hygiene,” and electronic monitoring and feedback to staff regarding hand hygiene practices. Results. Major challenges encountered were establishing trust, building research teams, enhancing staff participation, and engaging families and visitors. Approaches to deal with these challenges are discussed. Conclusions. Conducting research in pediatric LTCFs requires sustained commitment to dealing with challenges and establishing collaborative relationships with administrative and frontline staff. [ABSTRACT FROM PUBLISHER]

Objective. To assess the association of insurance status on infant rehospitalization in a population-based setting. Methods. In this longitudinal retrospective study, hospitalizations were tracked for 1 year after birth discharge for 203 031 infants born in hospitals during 2008 using data from the New York State Inpatient Database. Relative risk was estimated using multivariable negative binomial regression models. Results. Rehospitalization occurred in 9010 infants (4.4%). Medicaid coverage and being uninsured were strong predictors of rehospitalizations after adjustment for birth weight and other factors. Medicaid also bears a disproportionate share of the economic burden. Normal birth weight infants have the lowest risk, but comprise the majority of costs. Jaundice and acute bronchiolitis were the leading causes of rehospitalization within 30 days and 1 year, respectively. Discussion. Future research can explore the preventability of rehospitalizations, and evaluate novel strategies for discharge and postnatal care coordination especially for uninsured and Medicaid-enrolled infants. [ABSTRACT FROM PUBLISHER]

We determined the cost of care for 2 diagnosis and management approaches for acute otitis media (AOM) among children 6 to 30 months old. A case–control design was used. Cases included 208 children diagnosed with AOM based on a bulging tympanic membrane (TM) and treated with amoxicillin/clavulanate. Controls (5:1 ratio) included 1020 children with AOM diagnosed not requiring bulging of the TM and treated with amoxicillin. Fewer cases (49%) than controls (69%) were diagnosed with AOM (P < .001), fewer were diagnosed with recurrent AOM or AOM treatment failure (0.34 vs 1.6/child; P < .0001), and fewer had insertion of tympanostomy tubes (6.3% vs 14.8%) due to recurrent AOM (P < .0001). The combined direct payments and indirect costs for management of AOM were $539/case versus $1,023/control. Using Rochester NY payments generalized to the US birth cohort, this case diagnosis and treatment strategy could save $1.008 billion per year. [ABSTRACT FROM PUBLISHER]

Objective. To explore the utility of clinician screening for anxiety in pediatric food-allergic patients. Study Design. In Phase I, 39 patients completed an anxiety questionnaire while their allergists completed a companion questionnaire estimating their patient’s responses. Allergists then attended an educational workshop to improve their anxiety detection. In Phase II, following the workshop, questionnaires were completed by an additional 39 patients and their allergists. Results. The percentage of clinician questionnaires with a “do not know” response decreased from 70% to 5% after the workshop. Correlation between allergists’ and children’s responses remained nonsignificant (r = .314, P = .321) before the workshop and after (r = .303, P = .068) and only 25% of patients who reported elevated anxiety were identified. Additionally, clinicians expressed poor acceptability of the screening. Conclusions. After the workshop, clinicians did not more accurately detect anxiety and found the process intrusive. Alternative methods for uncovering anxiety among high-risk patients are needed. [ABSTRACT FROM PUBLISHER]

Objective. To examine desired characteristics of an online immunization record for parents from a predominantly Latino, low-income population. Methods. Four focus groups were conducted with parents (n = 29) from an urban, primarily Latino, low-income population in New York. The data were collected and analyzed during winter 2008-2009. Results. Participants expressed interest in using an online immunization record that has the ability to show a child’s immunization status and to access consumer health information related to vaccinations. Participants suggested that the online record be translated into multiple languages and provide user-friendly interfaces. Participants were enthusiastic about the benefits offered by the online immunization record, highlighting having an electronic copy of their child’s immunization record available. Concerns over disclosing personal information were raised, and safeguards to protect confidentiality were requested. Conclusions. If concerns about privacy are adequately addressed, parents of low-income, urban children are likely to use and benefit from an online immunization record. [ABSTRACT FROM PUBLISHER]

Strategies to increase adolescent immunization rates have been suggested, but little is documented about which strategies clinicians actually use or would consider. In spring 2010, we surveyed primary care physicians from 2 practice-based research networks (PBRNs): Greater Rochester PBRN (GR-PBRN) and national pediatric COntinuity Research NETwork (CORNET). Network clinicians received mailed or online surveys (response rate 76%, n = 148). The GR-PBRN patient population (51% suburban, 33% rural, and 16% urban) differed from that served by CORNET (85% urban). For nonseasonal vaccines recommended for adolescents, many GR-PBRN and CORNET practices reported using nurse prompts to providers at preventive visits (61% and 52%, respectively), physician education (53% and 53%), and scheduled vaccine-only visits (91% and 82%). Strategies not used that clinicians frequently indicated they would consider included patient reminder/recall and prompts to providers via nurses or electronic health records. As preventive visits and immunization recommendations grow more complex, using technology to support immunization delivery to adolescents might be effective. [ABSTRACT FROM PUBLISHER]

Objective. Despite evidence for its feasibility, the usage of mental health screening in primary care practices with overburdened providers and few referral options remains unclear. This study explores the effects of routine screening on mental health problem identification and management in a low-resource setting. Methods. Medical records of 5 to 12 year-old children presenting for well visits before and after screening was implemented were reviewed. Multivariate logistic regression was used to explore associations between study period and identification/management practices. Changes in the number of visits and wait times for a co-located referral service were assessed post hoc. Results. Parents disclosed more mental health problems, and providers initiated more workups but referred fewer patients after screening was implemented. The proportion of new visits and wait times for the referral service did not change. Conclusions. Even in low-resource settings, screening may facilitate parental disclosure and increase clinical attention to mental health problems without overburdening referral services. [ABSTRACT FROM PUBLISHER]

This study surveyed pediatric primary care providers at a major academic center regarding their attitudes and practices of obesity screening, prevention, and treatment. The authors compared the care providers’ reported practices to the 2007 American Medical Association and Centers for Disease Control and Prevention Expert Committee Recommendations to evaluate their adherence to the guidelines and differences based on level of training and specialty. Of 96 providers surveyed, less than half used the currently recommended criteria for identifying children who are overweight (24.7%) and obese (34.4%), with attendings more likely to use the correct criteria than residents (P < .05). Although most providers felt comfortable counseling patients and families about the prevention of overweight and obesity, the majority felt their counseling was not effective. There was considerable variability in reported practices of lab screening and referral patterns of overweight and obese children. More efforts are needed to standardize providers’ approach to overweight and obese children. [ABSTRACT FROM PUBLISHER]

The Robert Wood Johnson Foundation National School Health Program is described from the perspectives of history, purpose and objectives, administration, and basic design of the sites located in Colorado, New York, North Dakota, and Utah. The evaluation component and certain current process outcomes are discussed briefly. [ABSTRACT FROM AUTHOR]

This article deals with the question of where adolescents now seek health care and where they would like to go in lieu of growing health problems. This article describe a survey made to determine what pediatricians in Monroe County in upstate New York were doing with regard to adolescent health care in their offices, and to document their postgraduate interests in adolescence. Nearly all the pediatricians surveyed provided care for adolescents between 12 and 19 years of age. Most of these teenagers had been going to the same physicians since infancy. Despite the multiple new problems of adolescence, such as in the sexual and behavioral areas, these pediatricians still took care of their teenage patients mostly for medical problems such as infectious, dermatologic, allergic concerns, and obesity. Forty per cent had no provisions for gynecologic services. Of the behavioral problems seen, the most frequent difficulty was related to poor communication between teenagers and parents. Twenty-two per cent of the doctors reported that they saw depression in adolescents either frequently or very frequently.

Focuses on hyperactivity of apartment bound children in New York. Interphases between physical, social and mental health; Lack of available recreational opportunities.

Reports on topics about antibiotics and infectious diseases discussed at the 1968 Interscience Conference on Antimicrobial Agents and Chemotherapy in New York City. Effectiveness of carbenicillin; Orally absorbable cephalosporin, named cephalexin; Minocycline and clinimycin.