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Objective: In 1995, the Children's Medical Services (CMS) of the State of Georgia contracted with the Department of Pediatrics of the Medical College of Georgia (MCG) and the MCG Telemedicine Center to develop telemedicine programs to provide subspecialty care for children with special health care needs. This article presents project statistics and results of client evaluation of services, as well as physician faculty attitudes toward telemedicine., Design: A demonstration project using telemedicine between a tertiary center and a rural clinic serving children with special health care needs was established. Data were collected and analyzed for December 12, 1995 to May 31, 1997, during which 333 CMS telemedicine consultations were performed., Results: Most CMS telemedicine consultations (35%) involved pediatric allergy/immunology. Other subspecialties included pulmonology (29%), neurology (19%), and genetics (16%). Overall, patients were satisfied with the services received. Initially, physician faculty members were generally positive but conservative in their attitudes toward using telemedicine for delivering clinical consultation. After a year's exposure and/or experience with telemedicine, 28% were more positive, 66% were the same, and only 4% were more negative about telemedicine. The more physicians used telemedicine, the more positive they were about it (r =.30)., Conclusions: In terms of family attitudes and individual care, telemedicine is an acceptable means of delivering specific pediatric subspecialty consultation services to children with special health care needs, living in rural areas distant to tertiary centers. Telemedicine is more likely to be successful as part of an integrated health services delivery than when it is the sole mode used for delivery of care.

Have you ever wondered if children coming into your dental operatory these days really are fatter, or is it just your imagination? And if they are fatter, how does it relate to what they are eating and what is the approach to treatment? This review article is written for dental health professionals, their own children, and their young patients and families, and will briefly address these issues.

Objective: In adults visceral adipose tissue (VAT) has been shown to be more highly correlated with cardiovascular (CV) risk factors than are other measures of adiposity such as subcutaneous abdominal adipose tissue (SAAT), percent body fat (%BF), or total body fat mass (TFM). We examined the relations between these measures of fatness and CV risk factors in obese children., Study Design: Subjects were 64 obese (27% to 61% BF) children (24 black girls, 19 white girls, 11 black boys, 10 white boys) aged 7 to 11 years. VAT and SAAT were measured with magnetic resonance imaging. TFM and %BF were determined with dual x-ray absorptiometry. Hierarchical stepwise multiple regression analyses were used to determine the proportions of variance in CV risk factors explained by the demographic and adiposity measures., Results: VAT but not SAAT, %BF, or TFM explained a significant proportion of the variance (r2 range = 0.10 to 0.21) in several lipid/lipoprotein risk factors including triacylglycerols, high-density lipoprotein cholesterol, the ratio of total cholesterol to high-density lipoprotein cholesterol, and low-density lipoprotein particle size., Conclusion: Many of the deleterious relations between VAT and lipid/lipoprotein risk factors seen in adults were already present in this sample of obese children.

The bilirubin-binding ability of neonatal serum was measured and compared with the serum bilirubin concentration and the serum bilirubin/albumin ratio. The bilirubin/albumin ratio correlated no better with the bilirubin-binding ability than the bilirubin concentration alone.

The aim of this project was to review the course of infants referred for consideration of extracorporeal membrane oxygenation (ECMO) to identify maximal ventilator settings that, when exceeded, did not provide clinical benefit to the patient. These settings might then be used in defining failure of conventional mechanical ventilation. We reviewed referral records and hospital charts of all infants treated for severe respiratory failure due to meconium aspiration syndrome during the 52.5 month period from March 15, 1985, to August 1, 1989. At an inspiratory pressure > 35 cm H2O, 75% (43/57) of patients eventually required ECMO, and 28% (4/14) of the infants who did not receive ECMO died. When the inspiratory pressure was > or = 40 cm H2O, 39/49 patients required ECMO, and 30% (3/10) of those not treated with ECMO died. Once the inspiratory pressure was > 45 cm H2O, 91% (29/32) of patients required ECMO, and only one third of those not treated with ECMO survived. Although the limitations for conventional therapy suggested in this paper may be helpful to clinicians, each center needs to establish guidelines for maximal conventional ventilator support. If these guidelines are clearly defined, alternative methods of therapy can be used once these criteria are achieved.

Background: It is unclear whether cardiovascular fitness influences risk factors for coronary artery disease and non-insulin-dependent diabetes mellitus independently of level of body fat because fitness is often measured in tasks that involve moving body weight (eg, running) and because body weight and level of body fat are correlated., Objective: To measure fitness during a task in which body weight was controlled experimentally (ie, supine cycling)., Design: Cross-sectional., Participants: Seventy-four children, 7 to 13 years of age, recruited through school flyers and newspaper advertisements, varying in level of body fat from 7% to 61%. There were 31 boys and 43 girls; 35 were white and 39 were black., Main Independent Variables: Cardiovascular fitness was expressed as submaximal heart rate while cycling at a power output of 49 W, and level of body fat was measured with dual x-ray absorptiometry., Main Outcome Measures: Blood pressure and levels of triglycerides, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, insulin, glucose, and glycohemoglobin., Results: Controlling for age and sex, level of body fat was significantly (P < .01) related to unfavorable levels of systolic blood pressure (r = 0.32), triglycerides (r = 0.42), high-density lipoprotein cholesterol (r = -0.31), insulin (r = 0.50), and total cholesterol to high-density lipoprotein cholesterol ratio (r = 0.37); submaximal heart rate was not significantly correlated with any of the other variables., Conclusions: When cardiovascular fitness was measured in a weight-independent task, it was not significantly related to level of body fat or the major coronary artery disease and non-insulin-dependent diabetes mellitus risk factors. In addition, we confirmed previous findings that higher levels of body fat are associated with a very unfavorable risk profile.

This study seeks to better describe the characteristics and outcomes of infants who stay for prolonged periods in the neonatal intensive care unit (NICU). Of 1174 consecutive admissions to a NICU, 73 (6%) met criteria for long-term neonatal intensive care (LTNIC). NICU care totaled 24,631 days; LTNIC infants needed 9152 days (37%). Average NICU stay for LTNIC infants was 125 days (SD +/- 102 days), compared with 14 days +/- 17 days for non-LTNIC infants. The LTNIC infants < or = 1500 gm accounted for 22% of the NICU days of care. There were no differences in gestational age, birth weight, gender, or race between LTNIC and non-LTNIC infants. Survival at discharge was not different, although when neonatal deaths (< or = 28 days) were excluded, the survival of LTNIC infants was significantly less (p < 0.0001). Of 56 LTNIC infants who survived to NICU discharge, 11 (three < or = 1500 gm) subsequently died before 2 years of age, and 10 (six < or = 1500 gm) were probably developmentally delayed. Infants with the longest NICU stays often have multiple medical and surgical problems and unfavorable outcomes, and they consume a disproportionately large percentage of NICU resources. Efforts to contain NICU costs, increase NICU bed availability, and improve NICU outcomes should not ignore infants who require prolonged NICU stays.

The relationship between nutrition and dentistry has been longstanding. Today, dental healthcare providers need to broaden the definition of "dental nutrition" from a narrow focus on the relationship of foods to caries, periodontal disease and oral lesions, to concerns about the overall nutritional adequacy of a patient's diet. This article discusses some of the latest nutrition recommendations put forth by major United States' health organizations and comments on their applicability to dental patients.

1. Parenteral amino acid solutions undergo photooxidation, which may be an important factor in total parenteral nutrition-associated hepatic dysfunction. Light-exposed parenteral solutions containing amino acids, in addition to vitamins and trace minerals, generate free radicals, which, in turn, may contribute to this type of injury. This study examined the characteristics of H2O2 production in a parenteral amino acid solution modelled on a commercially available paediatric parenteral amino acid solution. 2. The solution was exposed to light in the presence of riboflavin-5'-monophosphate (riboflavin), and peroxide formation in the presence and absence of catalase (H2O2 formation) was assayed using potassium iodide/molybdate. 3. Peak H2O2 production occurred at a light intensity of 8 microW cm-2 nm-1 in the 425-475 nm waveband and was linear to 2 h of light exposure. H2O2 production reached 500 mumol/l at 24 h. 4. H2O2 was directly related to a riboflavin concentration of up to 20 mumol/l and was maximal at 30 mumol/l. 5. H2O2 production was greatest in the amino acid/riboflavin solution at a pH of between 5 and 6. 6. Under the conditions of light exposure intensity, light exposure time, riboflavin concentration and pH found during the administration of parenteral nutrition in neonatal intensive care units, net H2O2 production occurs in solutions modelled on a paediatric parenteral amino acid preparation.

A viscoelastometer, the SonoClot Coagulation Analyzer, has been proposed for use in the evaluation of platelet function. The purpose of this study was to evaluate systematically this instrument when used with whole blood. Under laboratory conditions, the coefficient of variation (cv) of determinations of whole blood activated clotting time (ACT) on the instrument was approximately 7.0 percent. In contrast, the cv of measurements on whole blood related to the graphic events associated with clot formation ranged from 9.2 to 41.7 percent. Because of the large and variable cvs associated with these measurements of clotting, the SonoClot Analyzer cannot presently be recommended for use in studies designed to examine quantitatively the clotting function in whole blood.

The National Cholesterol Education Program (NCEP) has endorsed physician case finding as the primary method to detect individuals with elevated cholesterol levels. Despite this recommendation, promotional and for-profit public screening programs have flourished. We surveyed participants of a mall-based cholesterol screening program 1 year after their screening. Sixty-four percent of those screened had not previously known their cholesterol levels. Those who were newly screened were less likely to benefit from this testing than the general public, since they were older (mean age, 55.3 years), more likely to be female (67.4%), and nonsmokers (88%). Screenees had excellent recall of their cholesterol level (mean absolute reporting error, 0.24 mmol/L [9 mg/dL]) and a good understanding of cholesterol as a coronary heart disease risk. Those with elevated cholesterol levels reported high distress from screening but no reduction in overall psychosocial well-being and an actual decrease in absenteeism. Only 53.7% of all who were advised to seek follow-up because of an elevated screening value had done so within the year following the screening program. However, of those with values greater than 6.2 mmol/L (240 mg/dL), 68% had sought follow-up. Many of those who participate in public screening programs have been previously tested, fall into low-benefit groups, or fail to comply with recommended follow-up. We therefore conclude that cholesterol screening programs of the type now commonly offered are unlikely to contribute greatly to the national efforts to further reduce coronary heart disease.