Pediatricians' perceptions and practices regarding prevention and treatment of type 2 diabetes mellitus in children and adolescents.

OBJECTIVE: To assess pediatricians' perceptions and practices regarding the prevention and treatment of type 2 diabetes mellitus in children and adolescents in a cross-sectional study. DESIGN: A 3-wave mailing of a questionnaire to 550 pediatricians. Descriptive statistics, analysis of variance, and logistic regression were used for data analyses. SETTING: A national random sample of pediatricians who work in private practice, hospital settings, and/or clinics. RESULTS: Every 1 in 9 respondents referred their patients with type 2 diabetes mellitus for exercise, while most pediatricians referred their patients for dietary interventions (62.3%) and educational services (62.6%). Pediatricians who were confident during counseling and follow-up were significantly (P =.02) more likely than pediatricians who were less confident to refer their patients for exercise, dietary interventions, and educational services. Of the respondents, 15.3% perceived they were well prepared to counsel and provide follow-up to patients with type 2 diabetes mellitus. The leading perceived barriers to counseling and follow-up were inadequate time for counseling, poor adherence of patients, lack of family support, lack of familiarity of clinical practice recommendations, and lack of health care insurance coverage. CONCLUSIONS: Pediatricians who had a higher perceived confidence level and who perceived they were better prepared for the counseling and follow-up of patients with type 2 diabetes mellitus had a greater potential to positively affect their diabetic patients. Improving continuing medical education and residency-based programs is imperative to adequately address the emerging epidemic of type 2 diabetes mellitus in children and adolescents.

Aphonia and epiglottitis in neonate with concomitant MRSA skin infection.

We report an unusual case of a neonate with aphonia due to epiglottitis with a concomitant methicillin-resistant S taphylococcus aureus (MRSA) infection of the genitalia and associated septic emboli to the groin area and mouth. We postulate that the MRSA infection caused a transient bacteremia that seeded the epiglottis, likely causing the epiglottitis. In the evaluation of a neonate with aphonia, while the two primary differentials to consider are vocal cord paralysis and laryngeal web, among other considerations is epiglottitis (supraglottitis).