Frequency and correlates of bacteriuria among children with neurogenic bladder.

Bacteriuria is a common clinical problem among children with neurogenic bladder due to meningomyelocele or traumatic spinal cord injury. To determine the frequency of bacteriuria among affected children at our institution, we obtained 257 urine specimens from 105 children being seen as outpatients for routine care over a 2-year study period. Specimens were obtained via catheterization. Almost half of these specimens (110/257 or 43%) yielded positive results when tested for urinary pathogens. To assess whether any characteristics of these children were related to the likelihood of bacteriuria, we analyzed further a subgroup of 46 children with normal renal ultrasonography from whom two to five specimens were obtained. There were no statistically significant associations between the likelihood of bacteriuria and the following characteristics: age, gender, socioeconomic status, level of spinal cord lesion, voiding technique, and use of prophylactic antibiotics. Children with neurogenic bladder are at high risk for bacteriuria. The pathogenesis of this bacteriuria, its part in deterioration of the urinary tract, and the possible means of its prevention in this special population all deserve further study.

Perceptions of the gender fairness of the medical education environment.

Many medical institutions are making an effort to create "gender-fair" environments. Perceptions of the current state of the environment may have implications for progress toward this goal. We surveyed faculty, housestaff, and medical students at the University of Virginia School of Medicine (UVASOM) to determine their perceptions of the status of women at that institution. The results showed that women perceived their environment as significantly more inequitable and sexist than their male counterparts did. Women faculty perceived significantly more inequity and sexism than women housestaff or students. Comments from both women and men at UVASOM focused on the need to eliminate discrimination of all kinds and to recruit more women faculty as leaders, mentors, and role models. The UVASOM is now implementing recommendations that should significantly reduce the discrepancy in perceptions of its environment.

Predictive validity of a preschool neurodevelopmental instrument.

The Pediatric Examination of Educational Readiness (PEER) is a combined neurodevelopmental, behavioral, and health assessment for children ages 4 to 6 years old. The purpose of this study was to examine its predictive validity. One hundred seven five-year-olds received the PEER at age five. At age eight, all took the Iowa Tests of Basic Skills (ITBS), a nationally normed achievement battery. Mean ITBS scores were significantly different between those passing and failing the PEER Developmental Attainment section (t = 4.5, df = 105, p less than .001). Of six developmental areas sampled, preacademic skills emerged as the most potent predictor of achievement (R = .43, Re = .18, p less than .001). Neuromaturation scores did not correlate with ITBS results. Sensitivity of the PEER was 45%, specificity was 87% and test accuracy was 79%. We conclude that the PEER is useful in describing current developmental strengths and weaknesses but has limited ability in predicting future learning problems for individual children.