What's the difference? Pediatric residents and their inaccurate concepts regarding statistics.

Two multiple-choice questions were designed to assess pediatric knowledge of two statistical concepts: (1) correlation and (2) probability values for statistical significance. One question was administered to 684 residents from 24 major pediatric training programs; this response rate represented 84% of all residents in these programs (PL-1, PL-2, and PL-3 years). In 20 of these programs, the second question was administered to 437 residents, representing a 79% response rate. Less than 20% of the residents responded correctly to the first question, and approximately half chose correctly on the second question. Further, no trend toward improvement was apparent with additional years of residency training. This limited knowledge of statistical concepts suggests that pediatricians are not well equipped to evaluate the scientific merit of research reported in pediatric journals.

Current status of behavioral pediatric training for general pediatric residents: a study of 11 funded programs.

The W. T. Grant Foundation has funded training in behavioral pediatrics for pediatric residents at 11 medical centers. The approaches toward training taken by the 11 funded programs, based on information systematically collected by interviews conducted with departmental chairmen, faculty, and residents during a program visit to each medical center, are described. No single training site emerged as optimal for teaching behavioral pediatrics, although linking such teaching to a "low priority" setting was an educational obstacle. A serious problem in many programs was the lack of ongoing research in behavioral pediatrics. Success in teaching behavioral pediatrics was dependent upon faculty support and a mandatory experience in behavioral pediatrics for all residents.

Evaluation of a residency training program in behavioral pediatrics.

The impact of behavioral training upon first-year residents was evaluated by assessing attitudes with regard to 15 clinical "entities," including behavioral disorders, physical disorders, and "mixed" disorders. Each entity was rated at four times: beginning of the year, start of the behavioral rotation, end of the rotation, and end of the year. Multiple-choice questions were also included to assess knowledge regarding behavioral pediatrics. Data were collected from 37 residents, from 1977 to 1980. For behavioral disorders and mixed disorders, residents' self-reported competence increased with regard to diagnosis, management, advising parents, and knowledge of resources. Further, the greatest change occurred during the 2-month rotation. In contrast, change in perceived competence for physical disorders was not specific to the rotation but, rather, increased evenly over the year. Ratings of faculty and housestaff interest remained constant across testing points, and residents' "desire to learn more" and prediction of "future relevance" showed a slight decrease over time, for all disorders. Knowledge regarding behavioral pediatrics increased significantly from the beginning of the year to the start of the rotation, and also during the rotation. These data demonstrate that changes in residents' perceived competence are directly related to their rotation experience, and suggest that behavioral issues can be introduced successfully during the first year of residency training.

Children with cystic fibrosis: I. Psychological test findings of patients, siblings, and parents.

Psychological evaluation of 43 families, each with a child with cystic fibrosis, is reported. Personality testing of the parents showed that 32% of the fathers and 22% of the mothers obtained scores in the range suggestive of emotional disturbance. The Family-Concept O Sort assessment of family interaction indicated that the primary effect of having a child with cystic fibrosis was in terms of decreased family satisfaction and family adjustment. The results do not support previous estimates of an increased incidence of emotional disturbance in children with cystic fibrosis. Evidence for negative psychological impact of chronic illness on sibling development was also lacking. Future research would benefit from a focus on the strengths and resilience of children with cystic fibrosis and their families.

Teenagers' preferences regarding the presence of family members, peers, and chaperones during examination of genitalia.

During physical examination that include the genitalia, teenagers are typically separated from their parents and females are provided with a chaperone. To assess teenagers' attitudes regarding this practice, 140 females and 60 males awaiting treatment in a general adolescent clinic were asked their opinion about a physical examination that include the genitalia. Teenagers indicated whether they would want to be accompanied during the examination, and by whom, as a function of the hypothetical clinical situation that varied the sex and familiarity of the physician. Choices reflected teenagers' age and sex, rather than physician characteristics. Young males and females strongly preferred to be accompanied, generally by a family member. With increasing age, males preferred to be alone with the physician whereas females preferred to be accompanied. Regardless of sex and age, virtually none chose the company of peers. Despite strong development differences, however, there also were pronounced individual differences among teenagers of the same age. Our results suggest that service delivery be adapted to the particular preference expressed by individual teenagers. Needs assessment for adolescent programs may best be achieved by conducting similar surveys in local clinical settings.

Factors influencing pediatric interns' relationships with dying children and their parents.

Events and feelings immediately surrounding the deaths of children in the hospital were investigated in order to identify factors that might influence a house officer's ability to relate in a personally satisfying way to dying children and their parents. Open-ended interviews with the involved interns and their supervising residents were conducted within 36 hours of the deaths of 31 hospitalized children to gain insight into the reactions and responses of new physicians managing terminally ill patients. Interns' relationships with children who were fatally ill appeared to be influenced by two factors: the child's age and the child's neurologic status. The interns' relationships with parents reflected their attitudes toward the children but were also affected by the duration of the illness, especially in instances when the patients were comatose or severely impaired. Senior medical staff awareness of the age and responsiveness of dying patients and the duration of their illness can help to provide case-specific guidance and support to the interns. Such support may help prevent that excessive distancing or over involvement that can impair the interns' abilities to provide optimal emotional support to patients, the families, or themselves.

Course and outcome of chronic fatigue in children and adolescents.

PURPOSE: To describe the epidemiology, symptoms, and psychosocial characteristics of children and adolescents evaluated in a chronic fatigue program and determine the course and outcome of the syndrome in these patients. METHODS: During the summer of 1994, chart review was performed for the 58 patients evaluated between 1990 and 1994 and a telephone follow-up was conducted with 42 of the 58 families. Patients were predominantly female (71%) and white (94%), with 50% between the ages of 7 and 14 years and 50% between the ages of 15 and 21 years (mean age 14.6 years). RESULTS: At time of presentation, 50% of patients had been fatigued for 1 to 6 months and 50% had been fatigued for 7 to 36 months. Sixty percent indicated the fatigue had begun with an acute illness and 60% had a history of allergies. Most commonly reported symptoms were fatigue (100%), headache (74%), sore throat (59%), abdominal pain (48%), fever (36%), and difficulties with concentration and/or memory (33%). Most patients had a worsening of school performance and a decrease in social activities. On follow-up, there was significant improvement in many patients during the summer after the first visit, with continued improvement in most patients during the second and third years. At time of the follow-up telephone call, 43% of families considered their child "cured" and 52% considered their child "improved," whereas only 5% considered their child to be "the same." Statistical analyses demonstrated no demographic or clinical factors that distinguished between those who did or did not participate in the follow-up study, or between those who did or did not do well on follow-up. CONCLUSIONS: These data demonstrate that children and adolescents with chronic fatigue have a syndrome that is similar to that described in adults, but that the syndrome differs in several ways, most specifically, presentation earlier in the course of the illness and a more optimistic outcome.

School-based health center utilization: a survey of users and nonusers.

BACKGROUND: As school-based health centers (SBHCs) continue to grow, it remains important to study use of the centers. The extent to which mental health problems exist in the students with access to the centers, whether those students are using the available services, if they are satisfied with the services, and the reasons for nonuse by those students who do not enroll are all meaningful questions. METHODS: The above issues were studied in an urban high school with a 2-year-old SBHC by administering questions during physical education classes on health center use and mental health concerns. The 630 respondents were 45% male, 55% female, 61% black, 29% Hispanic, 54% in grades 9 or 10, 46% in grades 11 or 12. RESULTS: Sixty percent of the students were registered in the SBHC; 40% were not registered. Seventy-five percent of registered students reported average use (< or =3 visits); females were more likely than males (P=.017) to be frequent (>3 visits) users of SBHC services. Mental health problems among all participants included depression in 31%, use of alcohol 1 time or more per month in 21%, use of alcohol daily in 5%, suicidal ideation in 16%, history of a suicide attempt in 10%, knowing someone who had been murdered in 50%, and being in at least 1 fight at school in 26%. Frequent users, average users, and nonusers did not differ by age, grade, race, or any of the measured mental health problems. Among the 472 students who completed the survey section on SBHC perceptions, 305 described health center use: 92% were satisfied with health center services, 79% were comfortable being seen in the SBHC, 74% believed visits were kept confidential, 61% told their parents about each visit, and 51% considered the SBHC their regular health care source. The health center was used for mental health services by 34% and sexuality-related care by 15%. The 167 students who described reasons for not using the SBHC most frequently reported that they already had a physician (60%), did not need it (50%), prefer continuing previous health care (45%), did not get around to it (30%), parents were opposed (20%), were not comfortable (19%), did not know about the service (19%), and did not want problems known (19%). CONCLUSIONS: We conclude that, in this urban high school, (1) average users, frequent users, and nonusers did not differ in the mental health problems measured in this study; (2) those who used the SBHC indicated strong satisfaction with the care received; and (3) those who did not use the SBHC chose to stay away for a variety of reasons, most commonly the availability of other care or the perception of lack of need.

Micronuclei in mice treated with monocrotaline with and without phenobarbital pretreatment.

Monocrotaline is a very potent toxin, producing significant effects of pneumotoxicity, hepatotoxicity, and teratogenicity, as well as carcinogenicity. In addition, the compound has been clearly shown to be mutagenic after metabolic activation. The goal of the experiments reported here was to confirm the reported clastogenesis induced by this agent in vivo and to evaluate the impact of modulation of metabolic activity by phenobarbital, a potent P-450 inducer (both Phase I and Phase II enzymes). The method used in addressing this problem relied on a new technique for monitoring clastogenesis in vivo, i.e., the acridine orange micronucleus assay method originally exploited by Hayashi et al. [1990]. The result of our experiments confirmed monocrotaline to be an effective clastogen in vivo, using the acridine orange method of assessment. The peak in induction of micronuclei occurred on the second day following intraperitoneal administration of the drug. Administration of phenobarbital prior to monocrotaline did appear to modulate the micronucleus induction. At 30 mg/kg bw monocrotaline, the pretreatment with phenobarbital appears to increase the intensity of monocrotaline clastogenesis, while the effect at higher doses (60 and 125 mg/kg bw) is a reduction in potency, presumably reflecting increased importance of Phase II metabolism for monocrotaline at these doses. Thus the study reported here confirms the potent in vivo clastogenesis of monocrotaline, and provides evidence for a dose-related shift in mechanism for the phenomenon.

Psychosocial risk to mother and child as a consequence of adolescent pregnancy.

PIP: The major developmental task of adolescence is to establish an identity. Psychological difficulties related to teenage pregnancy and motherhood may reflect the developmental stage of the early or midadolescent girl. Identity formation is vital for a close, meaningful relationship with one's sexual partner if it precedes the point of intimacy. Even young teenagers usually engage in intercourse with partners who represent relatively stable relationships; continuous promiscuous sexual activity reflects psychological problems. Since they are more likely to have experienced social and/or academic failure, teenages who become mothers tend to view family, school, and peers as sources of self-devaluing experiences. Becoming a mother provides an identity and a purpose. Elective abortion may be associated with feelings of guilt and anger that abortion was necessary. Varying degrees of depression are common. Teenage mothers will generally reach a lower educational level and be less successful vocationally than other teenagers. The older the adolescent is at the time of conception the more apt she is to complete high school or be gainfully employed. A key factor is the availability of family members for financial, psychological, and child care assistance. Psychosocial problems are caused by the inability to complete identity formation and lack of economic and social support.^ieng

Behavior of vanadate and vanadyl ion in canine blood.

Radiolabeled vanadium as either vanadyl ion or vanadate ion was injected intravenously into adult beagle dogs, and blood samples were collected at various times up to 48 hr post injection. For each sample, the distribution of vanadium between the cells and the plasma was determined, and the plasma was analyzed by electrophoresis to identify specific vanadium-binding proteins. Initially, vanadyl ion left the bloodstream more rapidly than vanadate, but the rates equalized after about 5 hr. A significant fraction of the vanadium in blood was associated with the cellular component following injection of both forms of vanadium. About 77% of the plasma vanadium was eventually bound by the serum iron transport protein transferrin, regardless of the vanadium species initially injected. For both vanadyl and vanadate, about 30 hr were required to reach the maximum degree of transferrin binding.

Stated and unstated reasons for visiting a high school nurse's office.

PURPOSE: To determine the presenting complaints of students visiting a high school nurse's office and seek associations between specific presenting complaints and psychosocial problems. METHODS: One hundred eighty-six students visiting the school nurse in a suburban high school were surveyed with a questionnaire developed by the investigators. Categorical data were compared utilizing chi-square or Fisher's Exact Test. Associations were determined by the Kruskal-Wallis Test. RESULTS: Headaches (25%), infections (17%), stomach aches (12%), and dizziness or tiredness (12%) were the most common presenting complaints. Students indicated that "not sleeping well" and "stress" were two factors that most frequently played a role in their visits. Most students wanted either to rest or await going home; few were interested in receiving medical care or talking to the nurse. Specific complaints of headache, dizziness or tiredness, and no specific symptom were associated (p < .05) with not sleeping well, family problems, stress, school problems and depression. CONCLUSIONS: Complaints of headache, dizziness or tiredness, and no specific symptoms may be used as markers for exploring possible psychosocial problems underlying a visit to the school nurse. If school nurses are to address psychosocial issues, they will need to look beyond stated reasons to unstated reasons for visits. Ways to achieve this expanded level of care are discussed.

Abnormalities in weight status, eating attitudes, and eating behaviors among urban high school students: correlations with self-esteem and anxiety.

PURPOSE: The study's objective was to determine the prevalence of abnormalities in weight, eating attitudes, and eating behaviors among an urban teenage population. METHODS: Measures of weight, height, and blood pressure were obtained from 1,001 students attending regularly scheduled physical education classes in a New York City high school the population of which was 66% black and 23% Hispanic. The mean age was 16 years old; 55% were female and 45% were male. Approximately three quarters of the students completed the Eating Attitudes Test (EAT-26), Rosenberg Self-Esteem Scale, Spielberger Trait Anxiety Inventory, and a questionnaire on eating behaviors. RESULTS: By percent ideal body weight (%IBW), 25% of students were obese (>20% above IBW), 18% were overweight, and 5% were underweight. Abnormal EAT scores (>21), were found in 6% of males and 15% of females. Students reported that they had engaged in the following nutritional behaviors at least three times in the past week: eating candy (59%), skipping breakfast (58%), skipping lunch (42%), eating fast foods (28%), and skipping dinner (14%). Self-esteem was high in 60%, medium in 21%, and low in 19%. Mean self-esteem was significantly higher (P < .0001) than established norms. Self-esteem and anxiety were inversely correlated (r = .40, P < .001), and low self-esteem and high anxiety were both associated with high EAT scores (r = .29, P < .001). Self-esteem and anxiety of obese students did not differ from those who were of normal weight. CONCLUSIONS: Among this population of urban high school students there were: (a) a large number of overweight adolescents; (b) a significant subgroup with eating attitudes suggestive of an eating disorder; and (c) high levels of self-esteem and normal levels of anxiety, which were independent of weight status.

Violence and mental health problems among urban high school students.

PURPOSE: We sought to determine the extent of exposure to violence and its relationship to other mental health risks among an urban teenage population. METHODS: Students attending regularly scheduled physical education classes completed a Violence Survey, a Suicidal Ideation Survey, the Depression Self-Rating Scale (DSRS), and the Adolescent Alcohol Involvement Scale. Of the 630 students who completed the anonymous assessment 45% were male, 55% female, 61% black, 30% Hispanic; 54% grades 9-10, and 46% grades 11-12. RESULTS: Half of the students reported knowing someone who had been murdered, 61% indicated they had witnessed a robbery, 59% had witnessed a beating, 37% had witnessed a shooting, and 31% had witnessed a stabbing. Mental health problems reported by these students included: depression (DSRS score > 13) in 31%, suicidal ideation in 16%, suicide attempts in 10%, drinking > 1 x per month in 21%, and drinking daily in 5%. Univariate analysis revealed that students who witnessed a shooting or stabbing were more likely (p < .05) to be both male and black. Multivariate analysis revealed that students reporting knowing someone who was murdered were twice as likely to report suicidal ideation and four times as likely to report suicide attempts. Witnessing a stabbing was associated with twice the likelihood of reporting suicide ideation and three times the likelihood of reporting suicide attempts. Witnessing a shooting was associated with twice the likelihood of alcohol use. Witnessing a beating or robbery had no significant relationship to measured variables. CONCLUSIONS: Among this population of urban teenagers there are many who have witnessed violence and a subgroup who have witnessed shootings and stabbings and are at increased risk for mental health problems. A comprehensive medical and psychosocial history should include a violence assessment for all urban teens.

Sports participation in an urban high school: academic and psychologic correlates.

PURPOSE: To study positive and negative correlates of sports participation in inner-city youth. METHODS: We distributed anonymous questionnaires to 838 students in gym classes of an urban New York City High School. Forty five percent of students were male and 55% female, with mean age 16.0 years; 64% in grades 9-10, and 36% in grades 11-12; 63% black, 27% Hispanic, and 10% other; and 30% A/B students, 38% C students, and 32% D/F students. RESULTS: All students reported some involvement in sports: 37% in 1-2 sports, 29% in 3-4 sports 24% in > or = 5 sports; 20% played on local teams, and 12% on junior or senior varsity. Approximately one-third each reported no weekday sports participation (30%), 1-2 hours per day (34%), or > or = 3 hours (36%); and 34% reported no participation on weekends, 26% reported 1-2 hours per day, and 40% > or = 3 hours. Basketball, volleyball, baseball, and weight lifting were the most common sports. Enjoyment, recreation, and competition were the most commonly reported reasons for participation. While 86% of subjects considered school "extremely" or "very" important, 35% considered sports "extremely" or "very" important. However, many believed they would "definitely" or "probably" receive an athletic scholarship (52% males, 20% females). Males reported more (p < .05) weekday, weekend, and team participation, and greater expectations (p <.001) of a future in sports. Sports involvement was not statistically associated with academic performance or scores on either the Rosenberg Self-Esteem Scale or Depression Self Rating Scale. Steroid use, at least once, was reported by 11% of males and 4% of females. Thirteen percent of students (21% males, 6% females) tried to gain weight for sports and 20% of both males and females tried to lose. Sports injuries within the past year were reported by 15% of students, and approximately three-quarters could correctly answer each of five questions about basic first aid. CONCLUSIONS: The data indicate that most of these urban youth had athletic involvement, many had unrealistic expectations for their futures, and some utilized unhealthy behaviors in an attempt to enhance performance. Among these students, no association was found between sports involvement and academic performance, self-esteem, or depression.

AIDS knowledge, concerns, and behavioral changes among inner-city high school students.

Knowledge of AIDS, attitudes toward AIDS and condoms, and behavioral changes because of AIDS were studied in 771 students, Grades 9-12 (mean age, 16 years) who completed anonymous questionnaires in gym classes of a New York City high school. Students demonstrated good knowledge of AIDS, with some misconceptions, and significant concerns about AIDS, with some behavioral changes, but most continued to engage in high-risk behaviors. These data indicate that efforts aimed at HIV/AIDS prevention in adolescents must translate knowledge and concerns into behavioral change.

Adolescent preferences for rooming during hospitalization.

PURPOSE: To determine adolescents' rooming preferences during hospitalization. METHODS: A questionnaire designed by the authors was administered to 95 adolescents (59 inpatients and 36 outpatients) in 1996. Differences between groups were analyzed by Chi-square. RESULTS: The adolescents were equally divided between a preference to room alone (40%) or with one other person (39%). Fewer adolescents (20%) preferred more than one other roommate. When analyzed by gender, females were significantly more likely than males to prefer to room alone [53% vs. 28% (chi(2) = 5.34; p < 0.05)]. The majority of both inpatient and outpatient groups (93%) indicated a preference for a companion-in particular their mother-to stay with them overnight in the hospital during medically difficult times. CONCLUSIONS: These findings support our recommendation that there should be equal numbers of single and double rooms in adolescent inpatient units to accommodate these divided preferences among adolescents. Individual adolescent rooming preferences should be elicited and honored whenever feasible.

"Out of control" behavior in adolescents.

The physician should approach a problem of "out of control" behavior in an adolescent as a family issue rather than an individual issue, for not only the behavior itself bu the parental response to the behavior are key factors in understanding and coping with it. Areas of commonly encountered misbehavior are explored.

Corporal punishment.

Pediatricians differ on the optimal ways to discipline children. The major controversy surrounds the use of corporal punishment. In an effort to resolve this controversy, the American Academy of Pediatrics (AAP) cosponsored a conference entitled "The Short and Long-Term Consequences of Corporal Punishment" in February 1996. This article reviews scientific literature on corporal punishment and summarizes the proceedings from the conference. The authors conclude that, although the research data are inadequate to resolve the controversy, there are areas of consensus. Practitioners should assess the spanking practices of the parent they see and counsel parents to avoid those that are, by AAP consensus, dangerous, ineffective, or abusive.

A nationwide survey of behavioral pediatric residency training.

This survey assessed the prevalence of behavioral pediatric residency training in the U.S., the professional background of faculty, training methods utilized, curriculum content, and barriers to expansion of behavioral training. Questionnaires were returned by 60% of 246 accredited pediatric residency programs; of these, 49% had a "formal" behavioral training program, 38% offered some training, and 13% offered none. Formal programs identified 419 faculty members involved in teaching behavioral pediatrics to residents: physicians (48%), psychologists (21%), social workers (19%), nurses (8%), other (4%). Mandatory training was more frequent than elective training; continuous training was more likely than block rotations to be mandatory. "Inadequate funding" and "lack of appropriately trained faculty" were most frequently cited as barriers to expansion of the teaching of behavioral pediatrics.