bluuebunny/crossref_metadata_2025 huggingface dataset:
Mating disruption of the pine sawfly Neodiprion sertifer (Hymenoptera: Diprionidae) in isolated pine stands
Authors: Martini Antonio , Baldassari Nadia , Baronio Piero , Anderbrant Olle , Hedenström Erik , Högberg Hans‐Erik , Rocchetta Gabriella
Published: March 2003

Previous applications of the mating disruption technique to Neodiprion sertifer resulted in decreased numbers of males caught in the treated area but no effect on sex ratio or overall population density.

 The present study assessed the efficacy of mating disruption against N. sertifer outbreaks in pine stands surrounded by agricultural areas or pasture, and therefore isolated from other infested areas.

 Pine stands were treated by placing dispensers with an erythro‐mixture of the acetate ester of 3,7‐dimethyl‐2‐pentadecanol every 10 m in a grid.

 The efficacy of this technique was evaluated by comparing the number of males caught in sticky traps baited with synthetic pheromone, and by comparing the sex ratio and the population density of the sawfly in the subsequent generation between treated and control pine stands.

 The number of males caught within treated areas was significantly lower than in the control area.

 In the treated pine stands 46% of the egg clusters resulted in male cocoons only, compared to 3% of the clusters in the control stand.

 A significant reduction of the sawfly population was observed in the treated pine stands. The results contrast to the earlier mating disruption attempts with N. sertifer and can probably be ascribed to the isolation of the experimental stands.
Oviposition behaviour and response ofMonochamus scutellatus(Coleoptera: Cerambycidae) to conspecific eggs and larvae
Authors: Peddle Shawna , De Groot Peter , Smith Sandy
Published: March 2003

The oviposition behaviour of white‐spotted sawyer beetleMonochamus scutellatus(Say) (Coleoptera: Cerambycidae) females was studied under laboratory and field conditions.

 Females walked over the bark surface and stopped to palpate it with their labial and maxillary palpi. Once a potential oviposition site was located, the female excavated a scar in the bark with her mandibles, deposited an egg and brown plug in the scar and inserted her mandibles again into the scar prior to leaving the area.

 FemaleM. scutellatuspreferred to lay eggs on bolts containing no eggs (control) to those containing eggs from other females, but did not show this preference when provided with control bolts and those containing their own eggs. When females were provided with bolts containing their own eggs and bolts containing eggs from other females, they laid more eggs on bolts containing their own eggs. Females laid more eggs on control bolts than on bolts containing their own larvae or larvae from other females.

 The brown plug in the oviposition scar may provide a protective barrier to the egg, a chemical message that the site is occupied, or both.
Asymmetric plant‐mediated cross‐effects between a herbivorous insect and a phytopathogenic fungus
Authors: Rostás Michael , Hilker Monika
Published: March 2003

Cross‐effects between a herbivorous insect and a phytopathogenic fungus on their common host plant were examined. Specifically, we addressed the questions whether (i) infection of Chinese cabbage leaves by the fungus Alternaria brassicae affects the development and host selection behaviour of the leaf beetle Phaedon cochleariae and (ii) whether herbivory influences host suitability of Chinese cabbage for A. brassicae.

 Feeding on fungus‐infected leaves prolonged larval development and reduced pupal weight of P. cochleariae. Adult beetles avoided feeding and egg deposition on fungus‐infected leaves. In contrast to these local effects, no systemic effect of phytopathogenic infection on the herbivore was detected.

 Herbivory did not influence fungal growth neither locally nor systemically.

 Thus, our results demonstrate an asymmetric relationship between herbivore and fungus. Whereas herbivory had no visible impact on fungal growth, fungal infection of the plant induced local resistance against P. cochleariae.
Biology of Centistes delusorius, a parasitoid of adult apple blossom weevil
Authors: Zijp Jan‐Piet , Blommers Leo H. M.
Published: March 2003

Abstract

Natural control of apple blossom weevil, Anthonomus pomorum (L.), deserves attention, as the pest is regaining importance with the declining use of non‐selective pesticides in apple and pear orchards. In this study the biology of Centistes delusorius (Förster), a specific parasitoid of adult apple blossom weevil, is investigated.

The parasitoid hibernates as young larva in an adult weevil, and juvenile development is resumed in early spring. The fully grown parasitoid larvae leave their hosts during full bloom at the end of April and early May, to pupate. The adults emerging in May oviposit into the newly emerged weevils, which initially feed on apple leaves.

Centistes delusorius was detected in six out of 15 host‐weevil infested orchards, but was only common in two with larger apple trees standing in grass. There, parasitism levels of around 30% were usual in hosts taken from treebands in winter.

The delicate larva is vulnerable, and the thin cocoon provides little protection against either desiccation or drowning on a weedless orchard floor. Observations indicate that successful pupation of C. delusorius demands stable humid conditions and some shelter, such as that found in grass or woodland soils.

Parasitoid females, provided with honey, lived for a mean of 6.3 ± 2.1 days under outdoor conditions in June. Their life span was similar whether they had access to and oviposited in hosts, or not. The species is pro‐ovigenic, and potential fecundity is about 40 eggs. Oviposition usually takes a few seconds. Parasitized female hosts do not reproduce.

Up to 95% of the parasitoid eggs laid in May develop into a second generation, the adults of which appear in July, when the host has entered aestivation. Older (British) records of C. delusorius outside orchards suggest that some parasitized hosts, like the healthy ones, leave the orchard prior to aestivo‐hibernation, so that the latter do not escape parasitoid attack in July.

A trapping sample in late June, when most non‐parasitized weevils have gone into aestivo‐hibernation, is probably the most efficient method to detect parasitized weevils.

The (near‐)absence of C. delusorius in many orchards is probably due not only to pesticide side‐effects, or scarcity of its host, but also to the absence of suitable pupation sites for the wasp.
The effect of cold temperature exposure and long‐day photoperiod on the termination of the reproductive diapause of newly emerged female Pissodes strobi (Coleoptera: Curculionidae)
Authors: Trudel Richard , Lavallée Robert , Bauce É ric , Guertin Claude
Published: March 2003

Abstract

There is confusion in the literature concerning a possible reproductive diapause in the adult white pine weevil Pissodes strobi.

We evaluated the effects of temperature, photoperiod, feeding substrate and mating status on the sexual maturation and oviposition of female white pine weevils.

Less than 30% of female P. strobi became sexually mature and laid eggs without experiencing dormancy under a temperature regime of 2 °C for 4 weeks.

Among the females that experienced a cold temperature treatment after emergence, 80% laid eggs after dormancy when exposed to a long‐day (LD 16 : 8 h) photoperiod and 17.6% laid eggs when exposed to a short‐day (LD 8 : 16 h) photoperiod.

Significantly more eggs were laid by all the females (with and without a cold treatment) when subjected to a long‐day photoperiod compared with a short‐day photoperiod.

A period of cold temperature followed by exposure to a long‐day photoperiod with warmer temperatures is required to break reproductive diapause and to obtain a good oviposition response in female P. strobi.

This study reveals the existence of much intraspecific variation in the response of the white pine weevil to temperature and photoperiod with respect to the induction and termination of reproductive diapause.
Oviposition strategies employed by the western spruce budworm: tests of predictions from the phylogenetic constraints hypothesis
Authors: Leyva Kathryn J. , Clancy Karen M. , Price Peter W.
Published: March 2003

1 Predictions from the Phylogenetic Constraints Hypothesis were tested for the first time in an eruptive forest Lepidopteran species, the western spruce budworm.

2 In previous work, we established that western spruce budworm females exhibit oviposition preferences with regard to tree age, tree vigour and host species. However, there was no evidence to support a link between oviposition preference and larval performance, which supports the Phylogenetic Constraints Hypothesis.

3 Our preference data led us to test whether female budworms use oviposition strategies to select the sites where they lay their egg masses. Our experiments were designed to make direct comparisons between latent and eruptive insect herbivores with respect to two oviposition behaviours: egg retention and avoidance of conspecifics. This type of research has not previously been conducted on any eruptive forest Lepidopteran.

4 Female budworms retained eggs instead of laying them on less preferred hosts in two of three experiments, but the percentage of eggs they retained was significantly less compared to latent insect herbivores.

5 In addition, female budworms actively avoided oviposition in areas with the highest density of conspecific egg masses, but they laid egg masses in all the other locations provided. This contrasts with the pattern seen in latent insect herbivores, which consistently avoid laying their eggs near any sites already used by conspecifics.

6 Our research indicates that there are extreme differences between latent and eruptive insect herbivores with respect to egg retention and avoidance of conspecifics, thus supporting the Phylogenetic Constraints Hypothesis.
Tree killing by Ips typographus (Coleoptera: Scolytidae) at stand edges with and without colonized felled spruce trees
Authors: Hedgren Per Olof , Schroeder L. Martin , Weslien Jan
Published: March 2003

Abstract 1 To maintain biodiversity in managed spruce forests in Sweden more wind‐felled trees must be retained. However, there is concern among forest owners that this may result in higher tree mortality caused by the spruce bark beetle, Ips typographus (L.) (Col. Scolytidae).

2 To simulate wind‐felled trees, living spruce trees were cut at spruce stand edges bordering fresh clear‐cuttings. Treatments comprised edges with zero, one or five cut trees colonized by I. typographus. Edges with naturally wind‐felled trees colonized by I. typographus were also included in the analyses.

3 During the two following summers, the number of trees killed by I. typographus did not differ between edges with and without felled trees, or between edges with one or five felled trees.

4 Within edges with felled trees, there were more killed trees close to the felled trees than at other parts of the edges. Thus, felled trees provided focal points for attacks within edges.

5 It is concluded that small numbers of wind‐felled trees colonized by I. typographus may be left near spruce stand edges without increasing the risk of beetle‐induced tree mortality.
The changing utilization of a children’s emergency department
Authors: Boyle Robert , Smith Craig , McIntyre John
Published: March 2003

Objective To assess the changing pattern of attendance at an emergency department in a children’s hospital.

Design A retrospective review of the attendance register from 1 September 1986 to 31 August 1998.

Setting Derbyshire Children’s Hospital, Derby, serving a mixed urban and rural population within the National Health Service.

Measurement Total number of attendances and admissions each year. For one week in February and August each year: age and case mix assessed. For the period 1994–98: the source of the referral and the outcome of patients referred by their General Practitioner (GP).

Results Over the study period: a rise in attendances from 4853 to 8796; no change in the total number admitted to hospital. A decline in the proportion admitted from 56 to 32%. For the period 1994–98: no change in the number of patients referred by their GP; an increasing number of self‐referrals. Overall age mix: age < 1 year, 27%; age 1–4 years, 42%; age 5–12 years, 26%; age > 13 years, 5%. Overall case mix: medical, 73%; surgical, 9%; trauma/minor injuries, 18%.

Conclusion An important change has occurred in the utilization of our paediatric emergency department with increasing numbers of children seeking hospital assessment, largely via self‐referrals, but not requiring hospital admission.

Implications for practice Future planning and deployment of paediatric resources need to take account of the change in use of hospital emergency services.
The paediatrician’s role in ambulatory health care of the older child in Switzerland
Authors: Carrel Rebecca , Klingler Jean , Ryffel Meinrad , Tschanz Urs , Vuille Jean‐Claude , Westkämper Reinhard , Zumstein Matthias
Published: March 2003

Objective Data selected from a larger study, ‘Schoolchildren in the Paediatric Practice’, were analysed to examine the role of the practising paediatrician in providing care to the older child/adolescent.

Design For the base study, paediatricians in private practice collected data on schoolchildren during two year‐long research segments. At the end of the study, each paediatrician was interviewed. To assist the focused analysis of this paper, statistics on physician utilization patterns and diagnoses were obtained from two external sources.

Setting and Sample Thirty‐four paediatricians practising in the canton of Bern, Switzerland received a sample of 5971 schoolchildren, aged 6–16.

Results The paediatricians saw a decreasing number of children with increasing ages. Other medical specialities showed no comparable decline. The length of time a paediatrician had been practising was related to having more older patients. The paediatricians expressed mixed opinions about the decline in older patients, with 59% stating this to be normal or not a problem. A minority felt the situation was a serious threat to the profession. Issues concerning the paediatricians included the image of the profession, the medical and administrative management of adolescent visits, and inadequate reimbursement.

Implications for practice To take the lead in assuring adequate care for the country’s older children, Swiss paediatricians need to clarify their desired role and address the questions of competence, training needs, personal barriers to offering services, and manpower coverage.
An evaluation of a home palliative care programme for children
Authors: Dangel Tomasz , Fowler‐Kerry Susan , Karwacki Marek , Bereda Joanna
Published: March 2003

Objective To measure the quality of a paediatric hospice home care programme and to assess the needs and concerns, both met and unmet, of parents who received hospice services.

Sample One hundred and thirty‐six questionnaires were sent to parents or primary caretakers of 87 children who had died under the hospice home care. Eighty questionnaires (59%) were returned, representing 54 patients.

Methods Responders were asked about: (1) their decision to choose hospice care, (2) difficult problems experienced during hospice care, (3) communication with their children, (4) how parents and children experienced dying, and (5) evaluation of the specific service components.

Results The majority of responders decided to bring their child home from hospital because further hospital care was not considered beneficial, and because they wanted the whole family to be together. Also, the child wished to be at home. Feelings of helplessness and fear were the most common and difficult problems reported. The majority of responders were not able to speak honestly with their child about their death. Most of the children died peacefully and did not suffer. Satisfaction with the hospice home care programme was high. Satisfaction with the hospice home care programme was not explained solely by the presence or absence of financial support from the hospice programme.

Conclusion The questionnaire developed for evaluation of this paediatric home care programme has yielded valuable information directed at improving the care of terminally ill children and their families.

Implications for practice The data obtained from this study may be used to improve the quality of service delivery, and also to provide useful documentation for institutions involved with the development of health care policy, education, and funding, such as the ministry of health, foundations, and health insurance companies.
Children's response to vaccine fluid injection versus needle puncture pain during routine immunization
Authors: Goodenough Belinda , Perrott David A , Dongen Katinka van , Brouwer Nanda , Champion G David
Published: March 2003

Objective To determine whether there is a significant and observable behavioural reaction in young children to the entry of vaccine fluid that is separate from the pain of needle puncture.

Setting/sample Twenty‐four children, aged 4–6 years, undergoing routine outpatient immunization by intramuscular injection in an Australian paediatric teaching hospital.

Measurement Facial, motor, vocal and verbal reactions, as well as global pain responses were coded by two independent observers as the needle entered the child's arm, and as the vaccine was injected from the syringe. Children and parents used the Faces Pain Scale to give a global rating of needle pain.

Results A distinctive behavioural reaction to the vaccine injection phase of immunization was observed. While children's own needle pain ratings tended to be more extreme than those of their parents, the variance in children's global scores was best predicted by an independent observer's ratings of motor behaviour to needle puncture and vocal response to vaccine injection.

Conclusions/implications for practice A significant pain‐related behavioural reaction may be observed in relation to the vaccine injection component of routine immunization. Preparation of children for routine immunization should not focus merely on pain due to needle puncture, but also on potential sensations associated with vaccine injection.
Parental and professional perceptions of the levels of disability in children with Down's syndrome
Authors: Bhattacharya Mukta , Sidebotham Peter
Published: March 2003

Objectives, subjects and methods A study was undertaken to determine whether parents of children with Down's syndrome view their child's levels of disability differently from their medical assessments. Questionnaires, based on a standard medical assessment were sent to the parents of 72 children with Down's syndrome aged 0–18 years. Data on the children's most recent medical assessment were obtained from the special needs module of the child health computer.

Results From the 47 returned questionnaires, there were no significant differences in parental and professional assessments of the children's mobility, hand function or hearing. Parents rated their child's vision, behaviour, health and growth, and personal care as significantly more impaired than did the doctors, but rated their speech and language as less impaired.

Conclusions This study suggests that there are some differences between parental and professional assessments of disability levels in children with Down's syndrome and that medical assessments could take a more family‐orientated approach.
Can a social service register of children with disabilities be used for planning services?
Authors: Colver Allan F , Atkinson Eve , Short David
Published: March 2003

Objective To compare a health and a social service register of children with disability in order to assess their potential for planning services.

Design Descriptive.

Setting Children with disability resident in North Tyneside, a Local Government Authority in England.

Main variables studied Disability and its severity.

Results There were 1692 children on the health register and 83 on the social service register. Only 20% of the children with the most severe disability were on the social service register. There was good agreement between parents' and paediatricians' rating of severity for the children with the most severe disability. Although the health register had details of all children with disability, it did not record details of current needs.

Conclusions The social service register did not provide data about all children with disability, and in particular only listed 20% of the children with the most severe disability. Therefore, the social service register does not appear suitable for providing data for overall planning of services, although it is helpful in describing and co‐ordinating the care of a smaller number of children and families whose problems were active, complex and unresolved, and where social services had an active role.
A 2.5‐year follow‐up of infants treated for severe sleep problems
Authors: Thunström Malena
Published: March 2003

Objective Sleep problems are common during infancy, and treatment programmes based on behavioural techniques have been reported to have high rates of short‐term improvement (80–90%) when used with support from a therapist.

However, follow‐up periods longer than 3 months are rare. The aim of this study was to describe the changes in sleep of 24 sleep‐disturbed infants after an interventional sleep programme. Comparisons with a healthy control group were made for a follow‐up period of 2.5 years.

Settings The case group was recruited from a parental questionnaire population study and sample of 2518 children aged between 6 and 18 months. The response rate was 83%. The group consisted of those 6–12‐month‐old children who fulfilled specific criteria for severe and chronic sleep problems (n = 27). A healthy control group was matched with regard to age and sex.

Methods The parents of the case group were offered a sleep programme based on the premise of controlled crying, and 24 families chose to participate. In addition to the behavioural technique, an interdisciplinary approach was used, taking the whole family situation into consideration. Sleep diaries and questionnaires were sent to cases and controls for follow‐ups at 1 month, 1 year and 2.5 years, respectively, after admission.

Results One month after initiation of the treatment programme in the case group, significant changes had taken place. The average number of times the case babies

woke up had diminished from 6.0 to 1.8 times per night, and night‐time sleep had

increased, on average by 67 minutes. A 92% rate of improvement was reported.

The changes were stable over time. Comparisons with the healthy controls after 1 year and after 2.5 years revealed no significant group differences in sleep characteristics. The families in the case group managed to maintain the achieved changes in infant sleep behaviour on their own; continuous therapist support was not necessary. This was true even for formerly depressed and psychosocially burdened parents.

Conclusions A combination of behavioural technique and interdisciplinary family work has positive and long‐lasting effects in children with severe and chronic sleep problems.

Implication for practice Even severely sleep‐disturbed infants coming from families with depression and psychosocial problems can be helped to sleep well with a relatively short but intense and multidisciplinary sleep programme.
Training residents in pediatric literacy: impact on knowledge, attitudes and practice
Authors: Hazzard Ann , Dabrow Sharon , Celano Marianne , McFadden‐Garden Terri , Melhado Trisha
Published: March 2003

Objective To determine whether training in emergent literacy‐building techniques increases self‐reported literacy‐related knowledge, attitudes, and intervention with patients.

Design Quasi‐experimental; prepost with intervention and comparison groups.

Subjects/setting Pediatric resident continuity clinics in three urban locations, serving primarily low‐income patients. A total of 66 residents participated.

Intervention Residents in the intervention group (n = 48) were scheduled to receive a half‐hour training session as part of their clinic didactic series. In addition, some intervention residents were exposed to other literacy‐related training such as Grand Rounds, readings, and individual modelling by a supervising physician related to specific clinic families. Residents in the comparison group (n = 18) received no literacy training.

Measurement A demographic questionnaire was administered at pretesting. The Knowledge About Literacy Development and Attitudes Regarding Early Childhood Literacy Scales were administered prior to training and 6 months later. The Practice Activities questionnaire was administered at post‐testing only.

Results Relative to 18 comparison subjects, 48 residents in the intervention group exhibited trends toward more frequent assessment of literacy milestones and more frequent literacy‐related anticipatory guidance. Specifically, the observation of modelling by a supervising physician was significantly related to an increased frequency of literacy‐related assessment and anticipatory guidance and to a trend toward more positive attitudes. Intervention and comparison residents did not significantly differ overall in knowledge or attitude gains. However, literacy‐facilitative attitudes were significantly correlated with frequency of literacy‐related anticipatory guidance.

Conclusions/implications for practice Residents had fairly high initial levels of general literacy‐related knowledge

and positive attitudes about providing guidance in this area to parents.

Exposure to specific training in this area does appear to lead to an increased likelihood of addressing these issues in practice. Modeling by a supervising physician may be a particularly important component of training that can help residents learn how to integrate literacy assessment with overall developmental assessment and family guidance.
Social gradients in child health: why do they occur and what can paediatricians do about them?
Authors: Spencer Nick
Published: March 2003

Objective To consider the impact of gradients in social risk factors on birthweight, child mental health and behavioural problems within a framework to guide paediatricians contributions to the prevention of adverse outcomes.

Methods Review of fifty studies on the impact of varying levels of social risk.

Results Many adverse child health outcomes show a finely graded pattern of risk from the least to the most disadvantaged children. Reduced mean birthweight and impaired child mental health are two important examples with implications for the life course. The cumulative and additive effects of risk and protective factors are the most likely explanation for social gradients.

Conclusions/implications for practice Interventions aimed at modifying single risk factors are likely to have limited influence on social gradients. Health and social policies addressing underlying material and social inequalities are likely to have the greatest potential for modifying risk. Paediatricians have a role in advocacy and in ensuring equality of access to their services.
Childhood immunization in rural family and general practices: current practices, perceived barriers and strategies for improvement
Authors: Deutchman Mark , Brayden Robert , Siegel Carol D , Beaty Brenda , Crane Lori
Published: March 2003

Objective Immunizations are an important component of well child care, yet children around the world are commonly not fully immunized. The goal of this research was to assess current immunization practices, perceived barriers to immunization, and identify strategies that might improve immunization rates.

Design setting and measurement Rural family and general practitioners in the 52 nonmetropolitan statistical area counties of Colorado who might include the care of children in their practice were surveyed regarding their immunization practices. Responses were used to identify ways in which these physicians comply with published standards for immunization practices and the barriers they perceived to immunization.

Results Nearly all rural Colorado family and general practitioners provide services to children, and most currently provide immunizations. The majority send at least some of their patients to other sources of care for immunizations. Common deficiencies in immunization practices and patient barriers are similar to those encountered internationally. These include not immunizing at sick visits, not providing for ‘walk‐in’ immunizations, not making immunization available during evenings and weekends, failing to perform immunization screening at every visit and having no formal reminder or tracking systems. Patient barriers include cost, parental attitudes, language barriers, transportation and patient mobility. Provider barriers are lack of availability of immunization records (immunization tracking), low reimbursement rates, problems with keeping small volumes of vaccines, record‐keeping problems and their own failure to counsel parents about the importance of immunization, to immunize at sick visits and to screen for immunization status at all visits.

Implications for practice Rural family physicians and general practitioners are well positioned to have a positive impact on childhood immunization rates, as they provide the majority of care to rural children. Better adherence to standards for immunization practice should help improve immunization rates. Problems related to reimbursement and immunization tracking are likely to remain.
Is preschool child health surveillance an effective means of detecting key physical abnormalities?
Authors: Bhrolchain Cliona Ni
Published: March 2003

Method This was a prospective study of a 1‐year cohort of children born to mothers registered with 25% of general practices in Nottingham. A cohort of 2308 babies was followed up for 15–18 months. All referrals for five tracer physical conditions (undescended testes, congenital heart disease, squints, developmental dysplasia of the hip and congenital hearing loss) were followed up through hospital record systems and copies of child health surveillance reviews from the personal child health records.

Results One thousand, nine hundred and seventy‐two (85%) of the initial cohort were followed up. Four hundred and thirteen (21%) children had been referred for one of the tracer conditions and 91% had been referred directly from child health surveillance reviews. Only 49 (12%) children needed treatment or follow‐up after assessment. The sensitivity of screening was high, ranging from 72% for congenital heart disease to 100% for developmental dysplasia of the hip and hearing loss. However, false positive rates were also very high, ranging from 60% for undescended testes to 97% for developmental dysplasia of the hip and hearing loss. Thus the positive predictive value of referral for dysplasia of the hip or hearing loss was only 5%, with a negative predictive value of 100%. In contrast, the positive predictive value for undescended testes was 67%, with a false negative rate of 14%. Eighty‐four per cent of those who needed treatment or follow‐up after assessment had been referred from the child health surveillance programme. The largest proportion of abnormalities was identified from the 6‐week review, but most referrals came from the neonatal review and the health visitor distraction test.

Conclusion The majority of children with the five tracer conditions used in this study were identified during child health surveillance examinations.
Doctor–patient relationships in primary care: Doctor, help! My child has cancer.
Authors: Proops Rosalyn
Published: March 2003

The following extracts are first, from an article by the mother of a child who had died of neuorblastoma. In it, she argued that her general practitioner, although generally supportive, should have taken more of the initiative in offering help during her child’s illness. Second, are extracts from her general practitioner’s response.

The parent A call for help may be an obvious one, from parents trying to come to terms with their child having cancer, or a hidden plea from parents outwardly coping with the demands thrust upon them, but who are inwardly desperately struggling. Are both these calls for help recognized and responded to by their family doctor? Our family doctor, contrary to my expectations, did not maintain contact with us during our son’s illness until the final stages. We were surprised and hurt by his attitude and mistakenly took his lack of contact as a lack of interest. Regular contact with us should have been an integral part of his role as our family doctor. Poor communication is the root of many problems – communication between treatment centre and general practitioner; between local hospitals and general practitioner; and between general practitioner and family.

The doctor At the base of these (contradictory thoughts and emotions) is the unique and multilayered relationship between general practitioner and patient, whether an individual or a family. We are still a long way from a satisfactory team approach to serious and terminal childhood illnesses . . .
Advising parents of asthmatic children on passive smoking: randomised controlled trial.
Authors: Reading Richard
Published: March 2003

Objective A randomised controlled trial to investigate whether parents of asthmatic children would stop smoking or alter their smoking habits to protect their children from environmental tobacco smoke.

Participants 501 families with an asthmatic child aged 2–12 years living with a parent who smoked.

Intervention Parents were told about the impact of passive smoking on asthma and advised to stop or change their smoking habits to protect their child’s health.

Main outcome measures Salivary cotinine concentrations in children, and changes in reported smoking habits of the parents 1 year after the intervention.

Results One year after the baseline visit, a small decrease in salivary cotinine concentrations was found in both groups of children, but there was no significant difference between the groups. Overall, 98% of parents in both groups still smoked at follow‐up. However, there was a nonsignificant tendency for parents in the intervention group to report smoking more at follow‐up and to having a reduced desire to stop smoking.

Conclusions A brief intervention to advise parents of asthmatic children about the risks from passive smoking was ineffective in reducing their children’s exposure to environmental tobacco smoke. If a clinician believes that a child’s health is being affected by parental smoking, the parent’s smoking needs to be addressed as a separate issue from the child’s health.
Oral versus initial intravenous therapy for urinary tract infections in young febrile children.
Authors: Jacobson Robert M
Published: March 2003

Background The standard recommendation for treatment of young, febrile children with urinary tract infection has been hospitalization for intravenous antimicrobials. The availability of potent, oral, third‐generation cephalosporins, as well as interest in cost containment and avoidance of nosocomial risks prompted evaluation of the safety and efficacy of outpatient therapy.

Methods In a multicentre, randomized clinical trial, the investigators evaluated the efficacy of oral versus initial intravenous therapy in 306 children 1 to 24 months old with fever and urinary tract infection, in terms of short‐term clinical outcomes (sterilization of the urine and defervescence) and long‐term morbidity (incidence of reinfection and incidence and extent of renal scarring documented at 6 months by 99mTc‐dimercaptosuccinic acid renal scans). Children received either oral cefixime for 14 days (double dose on day 1) or initial intravenous cefotaxime for 3 days followed by oral cefixime for 11 days. Costs were estimated using charge‐data.

Results Treatment groups were comparable regarding demographic, clinical, and laboratory characteristics. Of the short‐term outcomes: (1) repeat urine cultures were sterile within 24 h in all 306 children, and (2) mean time to defervescence was 25 and 24 h for children treated orally and intravenously, respectively. Of the long‐term outcomes: (1) symptomatic re‐infections occurred in 4.6% of children treated orally and 7.2% of children treated intravenously; (2) renal scarring at 6 months was noted in 9.8% of children treated orally versus 7.2% of children treated intravenously; and (3) mean extent of scarring was ~8% in both treatment groups. Mean costs were at least twofold higher for children treated intravenously ($3577 versus $1473) compared with those treated orally.

Conclusions Oral cefixime can be recommended as a safe and effective treatment for children with fever and urinary tract infection. Use of cefixime will result in substantial reductions of health care expenditures.
Autistic disorders in children with CHARGE association.
Authors: Stalker Deborah
Published: March 2003

CHARGE association (Coloboma, Heart defect, choanal Atresia, Retarded growth and development, Genital hypoplasia and Ear abnormalities) is thought to arise following an insult during early embryogenesis, probably around day 20–24. The pathogenesis of autism is not fully understood, but abnormalities in brain metabolism have been detected in the brainstem, cerebellum and mesolimbic system. The association with learning difficulties is well known.

The authors report the cases of three children with characteristic features of CHARGE association. Two of the children described had severe bilateral hearing loss and were assessed as having severe retardation; neither had any speech. The third had mild hearing impairment, an IQ of 80 and some verbal and sign language. All three fulfilled the criteria for autistic disorder (Diagnostic and Statistical Manual of Mental Disorders IV).
Stress experienced by mothers of Malaysian children with mental retardation.
Authors: Coghlan David
Published: March 2003

Objective To compare parenting stress among Malaysian mothers of children with mental retardation and a control group, and to determine factors associated with stress.

Method Seventy‐five mothers of children with mental retardation aged 4 to 12 years and 75 controls (paediatric clinic attenders without disabilities) participated in the Parenting Stress Index (PSI). Intelligence quotient (IQ) and Child Behaviour Checklist (CBCL) scores, together with socio‐economic data, were entered into a multiple stepwise regression analysis, using the PSI as the criterion.

Results Mothers of children with mental retardation scored significantly higher than control subjects in both the child‐related domain (difference between means 26.1) and parent‐related domain (difference between means 15.0) of the PSI. The total child behaviour scores from the CBCL (p < 0.01), IQ scores (p < 0.01) and sibship size (p < 0.01) were associated with child‐related domain scores. For the patient‐related domain, CBCL (p < 0.01) and IQ scores (p = 0.01) remained important factors, but Chinese ethnicity (p < 0.01) and maternal unemployment (p < 0.01) were also significant predictors of stress.

Conclusion A large proportion of mothers of children with mental retardation experienced substantial parenting stress, especially Chinese and unemployed mothers, and this warrants appropriate intervention.
An assessment of selected preventive screenings among children aged 12 to 35 months in a hospital‐based, Medicaid managed care practice
Authors: Vivier Patrick M , Flanagan Patricia , Simon Peter , Diana Birkin James , Brown Lois , Alario Anthony J
Published: March 2003

Objectives The goal of this study was to assess (i) whether preschool children enrolled in a hospital‐based, Medicaid managed care practice had received recommended preventive screenings, including blood lead, hematocrit and tuberculosis testing, and (ii) the prevalence of positive results in these screens.

Design and methods All children between 12 and 35 months of age who had been continuously enrolled in the practice for the last 6 months of 1996 were included in the study, regardless of their visit frequency. Medical records were reviewed for the study children. The dates and results of all blood lead, hematocrit and tuberculosis tests were abstracted.

Results Eight hundred and twelve children met the study inclusion criteria. All but two of these children had a hospital medical record available for review. Six hundred and ninety of the 812 children (85.0%) had a documented blood lead test. Of those screened, more than one‐quarter (190 of 690; 27.5%) had at least one result ≥ 10 μg/dL. A hematocrit result was documented for 742 of the study children (91.4%), and 377 of these children (50.8%) were anemic on at least one test (defined as a hematocrit two standard deviations below published norms). Two‐thirds of study children (536) had documentation of a tuberculosis screen being performed, with two‐thirds of these having a documented reading. None of the 342 children with a documented tuberclin skin test reading had a positive test.

Conclusions Screening rates were relatively high in this study group, especially when one considers that the denominator for screening rates was based on enrollment in the practice, regardless of whether or not the child had been seen. The results of these screening tests provide evidence for the high burden of lead poisoning and anemia in this low‐income population.

Implications for practice This study demonstrates that it is feasible to carry out assessments based

on defined primary care responsibilities, allowing for a more population‐based approach to health care in hospital‐based clinics.
HIV in primary care: an educational initiative for child health providers
Authors: Stille Christopher J , Berrien Virginia , Krause Peter J
Published: March 2003

Background With recent progress in controlling HIV disease in children, infected children are living longer than ever before. Their health care needs include health supervision services, such as developmental monitoring and anticipatory guidance, which are best provided by child health providers (Providers). Providers need to know about the care of children with HIV infection in order to provide optimal health supervision services.

Objective To design a curriculum to educate providers about the care of children with HIV infection, targeted to the needs of local providers.

Setting The primary care centre of an urban children's hospital in Connecticut during 1997–98.

Intervention We observed clinical cases; conducted a needs assessment, including discussions with providers and a review of educational resources; and held discussions with infectious disease subspecialists. From these, we designed a series of seminars covering individual topics generated mainly by providers. We then conducted a grand rounds lecture to cover the topics more broadly. All participants received a booklet covering the topics discussed.

Impact Providers received the sessions well. Self‐reporting suggested changes in their care of children with HIV infection, including increased confidence in decision‐making about routine health issues, more aggressive immunization, and better coordination of care with subspecialists. Many suggestions for further sessions were generated.

Conclusion An educational program tailored to the needs of local child health providers may be helpful in the care of their patients with HIV infection. This program can promote high‐quality, co‐ordinated care for the complex needs of these patients.
Early predictors of admission or prolonged emergency department treatment for children with acute asthma
Authors: Shope Timothy R , Cabana Michael D , Zorc Joseph J
Published: March 2003

Objective To determine whether demographic, historical and clinical information available at the time of presentation to the pediatric emergency department (ED) can be used to predict which children with acute asthma are likely to require extended treatment (>5 hours in ED or hospital admission).

Design Concurrent cohort study.

Setting and sample Inner‐city, university‐based pediatric ED. Subjects were 1–18 years old (n = 181) receiving standardized asthma therapy with frequent beta‐agonists and corticosteroids.

Measurement Upon ED presentation, demographic information, asthma history and seven clinical variables were assessed. Bivariate analysis and multivariable logistic regression were used to identify significant predictors of extended treatment. Positive predictive values (PPVs) for individual and combined variables were calculated.

Results Overall, 30% (54 of 181) subjects required extended treatment; 8% (15 of 181) required treatment in the ED > 5 hours and 22% (39 of 181) were admitted. All but one of the asthma severity score items were significantly associated with prolonged treatment (suprasternal indrawing, P = 0.07; all others, P < 0.05). When these items were combined into the asthma scores from which they were originally derived, PPVs for extended treatment were only 45 and 50%, respectively. These PPVs for extended treatment were no better than those for individual items, which ranged between 36 and 50%. Demographic information and prior asthma history were not associated with extended treatment.

Conclusions/implications for practice Although individual asthma severity score items and asthma severity scores assessed at ED presentation were associated with extended treatment, no variable, alone or in combination, had a clinically useful PPV. Decisions regarding observation unit admission for pediatric asthmatics should not solely be based on initial clinical assessment.