Telephone dissatisfaction in pediatric practice: Denver and Baltimore.

A survey of pediatricians in private practice in the Denver and Baltimore metropolitan areas was conducted to assess pediatricians' satisfaction with the telephone in their practices. The response rates were 84% (89/106) in Denver and 72% (90/125) in Baltimore. In both cities, 42% of the physicians were dissatisfied with their telephone systems. Dissatisfied physicians were less likely to provide a morning telephone hour (P less than .02), less likely to delegate calls to office staff (P less than .01), more likely to believe that they lacked sufficient time to handle daytime calls (P less than .0001), and more likely to be in group rather than solo practice (P less than .05). Younger age of the respondent approached, but did not reach, statistical significance in its association with dissatisfaction.

Health services use by children enrolled in a hospital-based primary care clinic: a longitudinal perspective.

The use of a hospital-based primary care clinic for health maintenance and illness care and use of the emergency room were monitored for 3 years for 293 children who had been enrolled in the clinic as infants. Infrequent users of one facet of care were infrequent users of other facets of care, and they remained so for all 3 years. The same trends were noted for frequent users. Children who used the clinic for health maintenance infrequently were more likely to have registered in the clinic after 2 months of age and to demonstrate consistently infrequent use throughout the 3 years. Children who used the clinic for illness care infrequently were more likely to have at least two siblings and to demonstrate consistently infrequent use. Children who used the emergency room infrequently were likely to have been consistently infrequent users for emergencies and illness throughout the 3 years. Conversely, those who used the clinic frequently for health maintenance were more likely to have registered before 1 month of age, to have multiple chronic conditions, and to demonstrate consistently frequent use for maintenance throughout the 3 years. Frequent users for illness care were more likely to have none or one sibling, multiple chronic conditions, and to demonstrate consistently frequent use for illnesses. Finally, children who used the emergency room frequently were likely to have multiple chronic conditions and to demonstrate sustained frequent use throughout the 3 years. These results suggest that patterns of use are established as early as the first year of life.

Prevalence of rotavirus on high-risk fomites in day-care facilities.

STUDY OBJECTIVE: The objective of this study was to determine the prevalence of rotavirus contamination on environmental surfaces in day-care environments, using the polymerase chain reaction technique. DESIGN: High-risk fomites were identified in two day-care centers and sampled biweekly during a 6-month study period. Water samples from water-play tables in each center were also collected during the study period. During an infectious disease outbreak, fomites were sampled from the rooms in which the outbreak occurred. Reverse transcriptase/polymerase chain reaction was carried out for viral detection of rotavirus from the fomites, and standard bacteriologic measures were used to detect bacteria in samples from water-play tables. RESULTS: A total of 96 fomite samples were tested for presence of rotavirus from the two centers, of which 18/96 (19%) tested positive for rotavirus. The timing of the positive samples differed between the two centers. In the center that housed infants, a peak of rotavirus-positive fomites coincided with two enteric outbreaks. Rotavirus contamination was found on the telephone receiver, drinking fountain, water-play table, and toilet handles in both centers. Bacteria in large quantities were also identified in water-play table samples. CONCLUSIONS: Moist surfaces including the telephone, water fountains, and water-play tables are common sources of rotavirus contamination within the day-care environment. Until a safe and affordable drug or vaccine against rotavirus is available for general use, avoidance of rotaviral infections is the most effective method for the prevention of rotavirus gastroenteritis.

Childhood fever: correlation of diagnosis with temperature response to acetaminophen.

Many people believe that temperature response to antipyretics in febrile children varies according to diagnosis. To evaluate the validity of this premise, we prospectively studied the temperature response to acetaminophen of febrile children who came to an urban pediatric emergency and walk-in facility. The study group consisted of 1,559 patients between the ages of 8 weeks and 6 years whose temperatures when seen were greater than 38.4 degrees C and who had not received antipyretic treatment within the previous four hours. Acetaminophen (15 mg/kg) was administered to each child and repeat temperatures were taken one and two hours later. Patient management was unaffected by the study, and physicians were unaware of the repeat temperature measurements. Telephone follow-up was conducted with the parents of each child within five days of the initial visit. Children with cultures positive for bacterial disease or chest x-ray films positive for pneumonia had slightly greater one- and two-hour temperature decreases compared with children with other diagnoses. Although statistically significant, we do not consider these differences in response to be clinically useful. We conclude that fever response to acetaminophen is not a clinically useful indicator by which to differentiate the causes of febrile illnesses in young children.

Prevalence of human immunodeficiency virus seropositivity in pediatric emergency room patients undergoing phlebotomy.

Information on the prevalence of human immunodeficiency virus (HIV) infection among children and adolescents requiring medical care is sparse. A small but significant risk of seroconversion occurs in health care workers who handle blood and body fluids of patients infected with HIV. The prevalence of HIV seropositivity in children who had phlebotomy as part of emergency care was measured. Of 749 blood samples, 21 (2.8%) tested positive for HIV antibody by enzyme-linked immunosorbent assay and Western Blot analysis: 14 samples from 6 patients with hemophilia, 6 from 3 patients with acquired immunodeficiency syndrome/acquired immunodeficiency syndrome-related complex, and 1 from a patient with asthma. Of these 21 blood samples, 10 were from 4 children previously known to be HIV positive, 4 were from patients with a known parental risk factor, and 16 were from patients with known history of blood transfusion. One sample was from a children with unknown HIV status and no documented risk factors. Procedures included 9 venipunctures, 17 intravenous line placements, 1 lumbar puncture, and 1 pelvic examination. Most patients with HIV seropositivity had been known to be HIV seropositive or at significant risk for HIV seropositivity. Although the potential risk to health care workers from children without known risk factors for HIV seropositivity was small in this population, the currently recommended infection-control precautions should always be observed.

Occurrence of infectious symptoms in children in day care homes.

Transmission of enteric pathogens is facilitated in child day care centers, including family day care homes, by frequent and intimate exposure among susceptible hosts, with diaper changing as the highest-risk procedure for such transmission. The objective of this study was to evaluate the effectiveness of an intervention program in decreasing the incidence of infectious disease symptoms in children attending family day care homes during a 12-month period. Each of 24 family day care homes was randomly assigned to an intervention or control group. The intervention included four components: (1) a handwashing educational program and (2) use of vinyl gloves, (3) use of disposable diaper changing pads, and (4) use of an alcohol-based hand rinse by the day care provider. Symptoms of enteric disease (diarrhea and vomiting) were significantly reduced in intervention family day care homes (p less than or equal to 0.05), whereas respiratory symptoms were not significantly different between intervention and control family day care homes (p = 0.35). Diarrhea was reported in 1 of every 100 child care days, representing one diarrhea episode per month in a typical family day care home.

Compliance with follow-up appointments generated in a pediatric emergency room.

We studied all follow-up visits generated by initial emergency room (ER) visits made over the course of one year by patients enrolled in a pediatric primary care clinic (PCC). A total of 2,552 ER visits were made by 714 patients, 960 (37.6 percent) of these resulting in a follow-up visit. Of the 960, (82.4 percent) resulted in appointments to the PCC, with a 53.9 percent compliance rate; and 169 (17.6 percent) resulted in appointments to the ER, with an 89.3 percent compliance rate (p less than .001). Factors found to be associated with greater compliance with follow-up appointments were (1) the appointment being made to the ER rather than to the clinic, (2) the child being less than 18 months of age, (3) the patient having private insurance, and (4) an initial ER diagnosis of trauma, seizure, or burn. Factors found to be unrelated to compliance with follow-up visits were the patient's sex (when corrected for trauma cases), race, having a chronic condition, having a telephone, length of time as a clinic enrollee, distance from home to hospital, and type of primary provider (physician versus nurse practitioner).

Television and children: a review.

Television plays an important role in the lives of children, and for some a larger role than that of parents and schools. There are many educational, social, and recreational benefits gained from viewing television for persons of all ages. Detrimental effects, however, are also possible, especially if the viewer lacks the knowledge or emotional maturity to place a program in its proper perspective. Debate has centered on whose responsibility it is to provide children with this understanding and perspective, so that television's benefits outweigh its detriments. This article reviews current research on the amount of television viewing by children, their reasons for doing so, and their understanding of what they see on television. The relationship is discussed between this understanding and the positive and negative effects of certain types of programs and advertisements. Suggestions for educational interventions by parents and teachers are provided.

Latchkey children.

This report reviews the subject of latchkey children. It provides statistics on the number and ages of children involved and the hours per day that they remain without parental supervision. The results and methodological problems of the few studies on latchkey children are discussed, and suggestions for future research are offered. Possible solutions for these children and their parents are suggested.

The telephone in pediatric medicine. A review.

From a review of numerous studies and reports of management of pediatric illness by telephone, it is concluded that innovative methods of teaching effective diagnosis and management by telephone still need to be explored. More research should be done on patient outcomes to assess the adequacy of the initial decision-making process, rather than relying solely on the number of questions asked. This will necessitate studies using actual patient telephone vignettes rather than simulated ones. Finally, research needs to be done on the efficacy of the "telephone hour" used by many physicians to manage their day more efficiently. Such studies could compare patient outcome and parent and physician satisfaction, in practices where the "telephone hour" is standard, to those practices where patient calls are managed as they occur.

Outpatient radiographic exposure in the first five years of life.

Young children receive a variety of diagnostic radiographs over time. In some cases the exposure to radiation may be unwarranted because the films may yield confusing results, or may also need to be repeated because of poor technical quality. Even when the results are clearly negative, the subsequent treatment may proceed as if the film had been positive because of the child's clinical condition. The cumulative effect of such low-dose radiation on infants and children over time is unknown. The number and types of outpatient radiographs received by a cohort of poor children from a hospital-based continuity clinic during their first 5 years of life were reviewed. Also noted were the reason for obtaining the film, whether it was positive for that reason or another, whether the child had a chronic condition that prompted the use of radiograph, and the child's sex, race, and age when the film was obtained. Of the 218 children, 132 (60.6%) received 349 sets of films in their first 5 years. There was no difference in the number of films by race or sex. Chest and posttrauma bone or joint films accounted for 315 sets of films or 90.3% of the total. Overall, 25.8% of the 267 chest films were positive; this varied by age. Only 15% of the chest films were positive in the first year compared with 29 to 49% in the second through fifth years (p less than 0.001). Cough was the respiratory symptom most reliably associated with a positive chest film, both for the cohort (p less than 0.0001) and for children in the first year of life (p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Serum immunoglobulins in the first year of life.

Serum IgG, IgM, and IgA were measured in 316 infants younger than 12 months of age. Information including the child's race, sex, age, and past history of infections or atopy was collected. Birth records were also reviewed to ascertain the child's birthweight and gestational age. Serum IgG levels were higher in black infants than in white infants after the age of 4 months. Serum IgM levels were higher in black females than in black males for infants older than 1 month. For infants younger than 4 months of age, those weighing less than 2500 g at birth had lower IgG levels than those weighing more than 2500 g. Infants younger than 1 month whose gestational age had been less than 36 weeks had lower IgG levels than those greater than 36 weeks. Infants aged 1 to 4 months whose gestational age had been less than 36 weeks had lower IgG levels than did those 40 or more weeks. Infants with a positive history for atopy had lower IgG levels than similarly aged infants with a negative history.

Disclosure of HIV diagnosis to children: when, where, why, and how.

Despite recent recommendations by the American Academy of Pediatrics that strongly encourage disclosure of human immunodeficiency virus (HIV) infection to school-age children, health care providers vary widely in their actual disclosure practices. Concrete guidelines for accomplishing disclosure are not currently available. Nondisclosure can result in a variety of problems, including anxiety, depression, phobias, and exclusion from peer support groups and medical camps. This article reviews the available literature on disclosure of HIV infection to children and describes the disclosure process used in a large, urban pediatric HIV clinic.