Blowing the whistle: what do African American adolescents with asthma and their caregivers understand by "wheeze?".

AIMS: To investigate what African American adolescents with asthma and their caregivers understand by "wheeze". METHODS: Caregivers (n = 35) and adolescents (n = 35) were each asked to describe what they understood by "wheeze". Respondents were also shown a video clip of an adolescent wheezing and asked: a) to describe the breathing of the adolescent in the video; and, b) whether the adolescent respondent's breathing had ever been similar to the video-presented symptoms. RESULTS: Most caregivers described wheeze in terms of sound alone (61.8%) while the majority of adolescents described wheeze as something that is felt (55.8%). Few caregivers and adolescents (5.8% each) included "whistling" in their descriptions of "wheeze". Most caregivers and adolescents used the word "wheeze" when describing the video clip, but nearly one-quarter of the caregivers and one-third of the adolescents felt that the adolescent's breathing was never similar to the video. CONCLUSION: Caregiver and adolescents descriptions of wheeze are different from each other and both may be different from clinical definitions of the term. Study findings have implications for the ways in which questions about "wheeze" are framed and interpreted.

Primary care pediatrician knowledge of nutritional rickets.

OBJECTIVE: The purpose of this study is to determine primary care pediatricians' level of awareness in the diagnosis and management of rickets. The information will be useful in assessing the need for provider education related to appropriate advice regarding vitamin D supplementation for infants. STUDY DESIGN: A one-page questionnaire was sent to a sample of 510 pediatricians in states surrounding the Great Lakes. These physicians were chosen depending based on practice listings from local telephone directories. Results were analyzed using the Chi-squared (chi2) test. RESULTS: Of the 248 respondents, 43% (n = 105) had encountered at least one actual or suspected case of rickets in the past five years. Sixty-nine percent of respondents chose vitamin D deficiency rickets-specific diagnostic tests, 24% chose rickets-specific tests, and 7% chose tests that are not specific to diagnosing rickets. Ninety-four percent of respondents chose treatments specific to vitamin D deficiency rickets, while 6% chose treatments not specific to rickets. CONCLUSION: Most primary care pediatricians from major metropolitan areas in the Great Lakes region are aware of the appropriate methods to diagnose and treat vitamin D-deficiency rickets. However, educational interventions are still necessary for both physicians and parents to promote widespread use of vitamin D supplementation in all breastfed infants.

Using film in multicultural and social justice faculty development: scenes from Crash.

We designed a faculty development workshop integrating scene excerpts from the Academy Award-winning movie Crash and active learning methods to encourage faculty participation and generate participant dialogue. The aims of this workshop were to enhance awareness of issues related to teaching in a multicultural classroom; stimulate discussion on teaching and learning about potentially contentious issues linked to race, ethnicity, religion, gender, geographical origin, and class; and expose faculty to the use of multimedia to facilitate discussion on topics of diversity and social justice. Twenty-five faculty attended 3 workshops in various venues, 18 of whom completed workshop evaluations. The workshop evaluation revealed that all participants believed that the scene excerpts and discussions helped them to reflect on their own attitudes toward race and diversity and felt better prepared to effectively facilitate classroom discussions on similar issues. This workshop is a useful tool for helping faculty to develop the skills and confidence to facilitate, manage, and stimulate discussions on controversial issues in multicultural education that may otherwise be avoided due to lack of expertise or experience.

Discussion of illness during well-child care visits with parents of children with and without special health care needs.

OBJECTIVES: To compare parents of children with special health care needs (CSHCN) with other parents to determine parents' expectations and priorities for discussing concerns related to a child's acute or chronic illness at well-child care visits, the association of unmet expectations and priorities with satisfaction, and whether discussing illness displaces prevention topics. DESIGN: Written, self-administered survey of parents at well-child care visits. SETTING: Two community-based pediatric practices in suburban southeast Michigan. PARTICIPANTS: Five hundred parents with children aged 6 months to 12 years. MAIN EXPOSURE: Having a special health care need. MAIN OUTCOME MEASURES: Expectations and priorities for discussing illness-related topics (chronic and acute illnesses, medications, specialist referrals, and effects of health on life overall), actual discussion regarding illness and preventive topics, and satisfaction. RESULTS: Compared with parents of children without chronic conditions, parents of CSHCN were more likely to expect to discuss their child's illness (81% vs 92%, respectively; P < .001); 79% of parents of CSHCN ranked illness among their top 3 priorities (vs 53% of other parents [P < .001]). Parents of CSHCN reported discussing a mean of 3.2 illness topics, as compared with a mean of 2.2 illness topics for other parents (P < .001). Having more than 1 unmet expectation for discussing illness was associated with higher odds of lower satisfaction (for parents of CSHCN: odds ratio, 7.2; 95% confidence interval, 2.9-18.3; for other parents: odds ratio, 3.0; 95% confidence interval, 1.7-5.5). Discussing more illness topics was associated with discussing more preventive topics (P < .001). CONCLUSIONS: Discussing illness is frequently expected and highly prioritized at well-child care visits, particularly for parents of CSHCN. Unmet expectations are associated with lower satisfaction. Incorporating illness concerns at well-child care visits may improve chronic disease management.