Proximal hypospadias and risk of acquired cryptorchidism.

Purpose: We hypothesized that boys with proximal hypospadias are at increased risk for acquired cryptorchidism.

Materials And Methods: We retrospectively studied the records of 114 boys who underwent repair for proximal hypospadias and had at least 1 year of followup, and 342 age matched boys receiving well child examinations. We used chi-square analysis to determine if cryptorchidism prevalence differed between the cohorts.

A randomized controlled trial to evaluate the effectiveness of a distance asthma learning program for pediatricians.

Objectives: To assess provider acceptability of a distance learning program for pediatric asthma and pilot test its effects on physician knowledge, attitudes and treatment practices.

Design: Randomized controlled trial.

Setting: Louisville and the surrounding central Kentucky region.

Role of the gut microbiota in defining human health.

The human superorganism is a conglomerate of mammalian and microbial cells, with the latter estimated to outnumber the former by ten to one and the microbial genetic repertoire (microbiome) to be approximately 100-times greater than that of the human host. Given the ability of the immune response to rapidly counter infectious agents, it is striking that such a large density of microbes can exist in a state of synergy within the human host. This is particularly true of the distal gastrointestinal (GI) tract, which houses up to 1000 distinct bacterial species and an estimated excess of 1 x 10(14) microorganisms.

Physician views on barriers to primary care for young adults with childhood-onset chronic disease.

Objective: Growing numbers of children with severe chronic illnesses are surviving to adulthood. Little is known about what primary care physicians perceive as the resources for and barriers to providing primary care services for young adults who transfer care from pediatric to adult medicine practitioners. The objective of this study was to describe primary care physicians' resources for and barriers to caring for young adults with childhood-onset chronic diseases.

Partially hydrolyzed 100% whey protein infant formula and reduced risk of atopic dermatitis: a meta-analysis.

Objective: A reduced risk of atopic dermatitis (AD) among healthy infants who received 100% whey protein partially hydrolyzed formula (PHF-W) compared with intact protein cow's milk formula (CMF), has been reported in several studies. To validate these observations and estimate the magnitude of this potential association with greater statistical precision, we conducted a meta-analysis of clinical trial and intervention studies.

Materials And Methods: A total of 18 articles representing 12 independent study populations met our inclusion criteria.

Parental satisfaction and the ability to recall the physician's name.

During urgent care visits, families may not see their regular physician and may not even recall the name of their provider. The authors conducted a cross-sectional parental satisfaction survey at pediatric ambulatory clinics to assess whether parent recall of their treating physician's name is associated with parental satisfaction. For urgent care, ability to recall the physician's name was positively associated with parental satisfaction (odds ratio [OR] = 2.

Decreasing frequency of asthma education in primary care.

Background: Provision of asthma education is associated with decreased hospitalizations and emergency department visits for patients with asthma. Our objective was to describe national trends in the provision of asthma education by primary care physicians in office settings.

Methods: We used the National Ambulatory Medical Care Survey, a nationally representative dataset of patient visits to office-based physicians.

Lactobacillus casei abundance is associated with profound shifts in the infant gut microbiome.

Colonization of the infant gut by microorganisms over the first year of life is crucial for development of a balanced immune response. Early alterations in the gastrointestinal microbiota of neonates has been linked with subsequent development of asthma and atopy in older children. Here we describe high-resolution culture-independent analysis of stool samples from 6-month old infants fed daily supplements of Lactobacillus casei subsp.

Potential roles and clinical utility of prebiotics in newborns, infants, and children: proceedings from a global prebiotic summit meeting, New York City, June 27-28, 2008.

Initial bacterial colonization, including colonization with health-positive bacteria, such as bifidobacteria and lactobacilli, is necessary for the normal development of intestinal innate and adaptive immune defenses. The predominance of beneficial bacteria in the gut microflora of breast-fed infants is thought to be, at least in part, supported by the metabolism of the complex mixture of oligosaccharides present in human breast milk, and a more adult-type intestinal microbiota is found in formula-fed infants. Inadequate gut colonization, dysbiosis, may lead to an increased risk of infectious, allergic, and autoimmune disorders later in life.

Changes in prescribing of antiviral medications for influenza associated with new treatment guidelines.

In 2006, the Centers for Disease Control and Prevention recommended discontinuing the use of adamantanes (amantadine and rimantadine) to treat influenza because of high levels of resistance to this class of antivirals. We examined changes in prescribing practices resulting from this recommendation and found that prescribing of adamantanes declined nationwide, with these drugs accounting for approximately 40% of the antivirals prescribed for influenza from 2000 to 2005 and only 2% in 2006. This finding provides evidence of a rapid change in clinical practice associated with the dissemination of treatment guidelines.

The unintended consequences of quality improvement.

Purpose Of Review: The focus on quality improvement has led to several types of initiatives in pediatric care; however, these programs may lead to potential unintended consequences.

Recent Findings: Unintended consequences of quality improvement programs that have been described are reviewed. Unintended effects on resource utilization include effects on costs, as well as the inability to apply programs across different populations and affect disparities in care.

Do school-based asthma education programs improve self-management and health outcomes?

Context: Asthma self-management education is critical for high-quality asthma care for children. A number of studies have assessed the effectiveness of providing asthma education in schools to augment education provided by primary care providers.

Objective: To conduct a systematic review of the literature on school-based asthma education programs.

Pediatricians' perspectives on the impact of MRSA in primary care: a qualitative study.

Background: The incidence of skin and soft-tissue infections (SSTIs) has rapidly increased among children in primary care settings since the emergence of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA). Recent treatment recommendations emphasize CA-MRSA as the primary cause, performing incision and drainage (I&D) as the primary therapy, and not prescribing antibiotics for uncomplicated cases. It is unknown how this epidemic has impacted primary care pediatricians in terms of their practice patterns and barriers they face to providing recommended therapies.

Physician communication regarding cost when prescribing asthma medication to children.

Children with asthma require multiple medications, and cost may be a barrier to care. The purpose of this study was to determine how often physicians ask about cost when prescribing new asthma medication and to identify factors influencing queries. We surveyed pediatricians and family physicians and asked whether they asked about cost when prescribing new asthma medication and if cost was a barrier to prescribing.

At what age do children start taking daily asthma medicines on their own?

Objective: Use of daily controller medications is a critical task in management of persistent asthma. Study aims were to examine (1) the association between child age and extent of daily controller-medication responsibility in a sample aged 4 to 19 years, (2) parent, child, and disease predictors of child daily controller-medication responsibility and overall daily controller-medication adherence, and (3) the association between child daily controller-medication responsibility and overall daily controller-medication adherence.

Methods: We conducted a cross-sectional telephone survey of 351 parents of children who were prescribed daily controller medication.

'The apple doesn't fall far from the tree': the role of parents in chronic disease self-management.

Medical nonadherence has been termed the "Achilles' heel of modern healthcare." In considering the need to improve medical adherence among chronically ill children, it is necessary to understand parent adherence. Parents have long been acknowledged to be the primary socialization agents in children's development across the various domains of functioning.

Long-term outcomes of physician peer teaching.

Research conducted in 10 cities assessed long-term pediatric asthma outcomes from a peer teaching intervention for physicians to improve their asthma-related clinical and counseling skills. Hypotheses were better outcomes for patients, symptom reduction, less health care use, and enhanced view of the physician. Peers trained 53 intervention group pediatricians (seeing 418 patients); 48 pediatricians (seeing 452 patients) were controls.

Barriers to adherence to cystic fibrosis infection control guidelines.

Background: In 2003, the American Cystic Fibrosis (CF) Foundation published revised, evidence-based guidelines for infection control. We sought to assess potential barriers to adherence to these guidelines experienced by health care professionals (HCPs) caring for CF patients.

Methods: From April 2004 to December 2005, a knowledge, attitude, and practice survey was administered to HCPs at randomly selected CF centers in the United States to explore potential barriers to adherence to selected guidelines: (1) obtaining quarterly cultures from CF patients, (2) discouraging socialization among CF patients during hospitalization, (3) educating patients and families about hand hygiene, (4) educating patients and families to clean and disinfect home nebulizers, and (5) cleaning the clinic exam rooms between CF patients.

Comfort of general internists and general pediatricians in providing care for young adults with chronic illnesses of childhood.

Background: As an increasing number of patients with chronic conditions of childhood survive to adulthood, experts recommend that young adults with chronic conditions transfer from child-focused to adult-focused primary care. Little, however, is known about how comfortable physicians are caring for this population.

Objectives: To assess the comfort of general internists and general pediatricians in treating young adult patients with chronic illnesses originating in childhood as well as the factors associated with comfort.