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OBJECTIVE. The goal was to test the hypothesis that participation in a community-based home-visiting program is associated with a decreased risk of infant death. METHODS. A retrospective, case-control design was used to compare the risk of infant death among participants in Cincinnati's Every Child Succeeds program and control subjects matched for gestational age at birth, previous pregnancy loss, marital status, and maternal age. The likelihood of infant death, adjusted for level of prenatal care, maternal smoking, maternal education, race, and age, was determined with multivariate logistic regression. The interaction between race and program participation and the effect of home visiting on the risk of preterm birth were explored. RESULTS. Infants whose families did not receive home visiting (n = 4995) were 2.5 times more likely to die in infancy compared with infants whose families received home visiting (n = 1665). Black infants were at least as likely to benefit from home visiting as were nonblack infants. No effect of program participation on the risk of preterm birth was observed. CONCLUSION. The current study is consistent with the hypothesis that intensive home visiting reduces the risk of infant death. Key Words home visiting, infant death, THE AMERICAN ACADEMY of Pediatrics encourages pediatricians to "support referral of high-risk parents to home-visitation programs as early as possible, ideally before or at the time of the prenatal visit [...]

OBJECTIVE. Evaluation procedures that rely solely on attending physician ratings may not identify residents who display poor communication skills or unprofessional behavior. Inclusion of non-physician evaluators should capture a more complete account of resident competency. No published reports have examined the relationship between resident evaluations obtained from different sources in pediatric settings. The objective of this study was to determine whether parent and nurse ratings of specific resident behaviors significantly differ from those of attending physicians. METHODS. Thirty-six pediatric residents were evaluated by parents, nurses, and attending physicians during their first year of training. For analysis, the percentage of responses in the highest response category was calculated for each resident on each item. Differences between attending physician ratings and those of parents and nurses were compared using the signed rank test. RESULTS. Parent and attending physician ratings were similar on most items, but attending physicians indicated that they frequently were unable to observe the behaviors of interest. Nurses rated residents lower than did attending physicians on items that related to respecting staff (69 % vs 97 %), accepting suggestions (56 % vs 82%), teamwork (63% vs 88%), being sensitive and empathetic (62% vs 85%), respecting confidentiality (73% vs 97%), demonstrating integrity (75% vs 92%), and demonstrating accountability (67% vs 83%). Nurse responses were higher than attending physicians on anticipating postdischarge needs (46% vs 25%) and effectively planning care (52% vs 33%). CONCLUSIONS. Expanding resident evaluation procedures to include parents and nurses does enhance information that is gathered on resident communication skills and professionalism and may help to target specific behaviors for improvement. Additional research is needed to determine whether receiving feedback on parent and nurse evaluations will have a positive impact on resident competency. Key Words medical education resident education/ training, multisource feedback patient--doctor communication, professionalism Abbreviations ABIM--American Board of Internal Medicine PSQ--Patient Satisfaction Questionnaire, COMMUNICATION AND PROFESSIONALISM are fundamental to the patient-physician relationship. Effective communication improves patient satisfaction and health outcomes, (1,2) whereas poor communication and unprofessional behavior are linked to patient complaints and [...]

Problem The prevalence of vitamin D insufficiency, its etiology, and associated sequelae among acutely injured burn patients is unknown. Objective This study assessed vitamin D and endocrine status, as well as the effect of anabolic agents, in pediatric patients who had sustained burns in excess of 25% total body surface area (TBSA). Subjects Sixty-nine patients with a mean TBSA burn of 50.6[+ or -]2.2% (range 27% to 94%) and full thickness injury of 41.3[+ or -]3.0% (range 0% to 94%) were studied. Subjects ranged in age from 0.6 to 18 years (mean, 5.8[+ or -]0.6 years). Main Outcome Measures Blood samples were obtained for serum 25-hydroxyvitamin D (D25), 1,25-dihydroxyvitamin D (D1,25), albumin, cortisol, triiodothyronine (T3), tetraiodothyronine ([T.sub.4]), thyroid stimulating hormone (TSH), and parathormone (PTH). Results Two hundred eighty morning blood samples of D25 and D1,25 demonstrated that 45% and 26.2% were low and 8.9% and 11% were very low, respectively. At least one low D25 or D1,25 level occurred in 62.3% of all subjects. Very low levels were noted in 23.2% of all patients. There was an increased incidence of hyperparathyroidism in patients with very low serum D25. Vitamin D25 and D1,25 levels were lower in subjects with larger burns or inhalation injury, as well as those treated with thyroxine or oxandrolone. Serum albumin, cortisol, [T.sub.4], and TSH were not correlated with concentration of vitamin D. Conclusions Demonstration of a high incidence of low serum vitamin D indicates vitamin D status may be significantly compromised in burned children. It is unclear why vitamin D deficiency exists in this population. The most effective way to improve vitamin D status remains elusive at this time. J Am Diet Assoc. 2004;104:931-941.

Americans were more likely to know at least one of the warning signs of a stroke in 2000 than they did in 1995, according to a survey of 2,173 residents of Cincinnati, Ohio. However, the number of Americans who know at least one of the risk factors for stroke did not change during that time period. People at high risk for stroke were especially ignorant of the risk factors and warning signs of a stroke.