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Trial Registration: NCT02058342. Registered 6 February 2014 retrospectively registered.

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BACKGROUND: Physical activity is associated with improved cardiometabolic markers in children with nonsyndromic obesity (NSO). Prader-Willi Syndrome (PWS) is a neurodevelopmental disorder characterized by obesity. OBJECTIVE: To compare cardiometabolic changes in response to a home-based parent-facilitated physical activity intervention between children with PWS or with NSO. METHODS: Participants included 18 children with PWS (age = 10.5 ± 0.7y; body fat = 44.6 ± 2.0%) and 30 children with NSO (age = 9.7 ± 0.2y; body fat = 44.8 ± 1.2%). Active Play @ Home was a 24-week physical activity intervention curriculum containing playground-based and active video games completed 4 days per week. Pre- and post-intervention measurements included physical activity, body composition, blood samples analysed for glucose, insulin, lipids and cytokines, and insulin resistance computed using the homeostatic model of assessment for insulin resistance (HOMA-IR). RESULTS: All children (n = 48) showed a significant decrease in Interleukin-8 (3.64 ± 0.24 vs. 3.06 ± 0.22 pg/mL). Children with obesity who did not gain or who lost body fat percentage (n = 18) demonstrated a significant decrease in HOMA-IR (3.17 ± 0.39 vs. 2.72 ± 0.34) and an increase in high-density lipoprotein (44.30 ± 2.51 vs. 47.29 ± 2.59 mg/dL). All other measurements showed no significant changes. CONCLUSIONS: The most favourable changes in cardiometabolic factors were observed in children with nonsyndromic obesity who demonstrated no gain or a decrease in body fat percentage.

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OBJECTIVE: To compare the use of alternative therapy (AT) in families of children with cancer with its use in those with routine pediatric conditions. BACKGROUND AND RATIONALE: AT refers to healing practices such as therapeutic massage, acupuncture, and use of medicinal herbs that have become increasingly popular with the general public, but are not widely accepted by the medical profession. Although studies have investigated the use of AT in the families of both healthy children and children with cancer, no comparison of the incidence of its use between these two populations has been published. We hypothesized that AT was used more frequently among the families of children with cancer. METHODS: Using a prevalence survey design, we interviewed 81 parents of children with cancer attending a pediatric hematology/oncology clinic and 80 parents of children attending a continuity care clinic for routine check-ups and acute care. We explored the types of AT being used, the reasons for its use, and the frequency with which it was discussed with the patient's physician. RESULTS: 1) Overall, 65% of the cancer group were using AT, compared with 51% of the control group. This was not statistically significant. 2) Prayer, exercise, and spiritual healing were three AT practices most often used by the cancer group, and prayer, massage, and spiritual healing by the control group. 3) Discussion of AT with the physician varied according to group, with 53% of the cancer patients discussing its use; income level, with 59% of parents in the higher income group discussing its use; and ethnicity, with 47% of whites discussing its use. CONCLUSION: Use of AT is not limited to the families of children with life-challenging illnesses, but is commonly used by those of children with routine pediatric problems. Pediatricians need to be aware that their patients may not tell them about AT practices they are using in addition to prescribed treatment.

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The Accreditation Council for Graduate Medical Education (ACGME) established guidelines in 1989 requiring pediatric residents to attend a continuity clinic (CC) one half-day per week. OBJECTIVE. To assess pediatric residents' CCs, with an emphasis on those factors potentially affecting house staff education and patient care. DESIGN AND PARTICIPANTS. A multi-item questionnaire designed to assess the educational, administrative, and clinical components of CCs was distributed to all US CC directors. RESULTS. Responses were received from 164 programs (74.9%), which represented more than 90% of all house staff in accredited US pediatric programs. Fifty-five percent of programs acknowledged non-ACGME-approved exemptions from attendance, and 64% changed CC schedules dependent on in-patient rotation assignment. Less than half of the programs had core curricula or didactic conferences. Most programs (76%) were located in hospital clinics. Clinic resources and equipment were often limited; faculty preceptors and nursing and clerical support staff were frequently insufficient in number. On average, PL1s saw four patients per session, whereas PL2s and PL3s saw five. Continuity of care for the patient for phone calls, acute and after-hours visits, and hospitalization was limited. Directors' perceived support for CCs' educational programs ranged from a high of 87% by generalists to a low of 33% by intensivists. CONCLUSIONS. Despite the ACGME directives, many residency programs have not provided the required priority, protected time, or adequate resources for CCs. The recent emphasis on health care reform and primary care medical education highlights the prominent role the CC should play as an important site in our teaching of longitudinal and ambulatory medicine. Departmental support and committed resources necessary to enhance the experience and to meet the educational challenge successfully will be required.

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This study assessed primary care physicians' familiarity and attitudes toward oral rehydration therapy in the management of mild, moderate or severe diarrheal dehydration in children. An anonymous questionnaire was distributed to a cross-sectional representation of pediatricians, family practitioners and pediatric residents in North Central Florida. All were familiar with this type of therapy. Fewer were familiar with the Florida Oral Rehydration Therapy Program. Pediatricians reported significantly higher self-assessment scores than family practitioners or residents, and more of them were familiar with the American Academy of Pediatrics' recommendations for treatment of dehydration. Pediatric residents used intravenous therapy more frequently than pediatricians or family practitioners. The major obstacles to oral rehydration therapy use were identified as parental acceptance, compliance, and lack of a specific treatment area. The findings of this study suggest that pediatricians are more confident in their assessment, management and use of this type of therapy in children. Efforts to increase its use should focus on educational programs for physicians and parents. Dissemination of information to parents and pediatric providers may promote early treatment which should prevent more severe degrees of dehydration, decrease hospitalization and possibly prevent unnecessary deaths.

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The effector mechanisms responsible for autoimmune beta cell destruction in insulin dependent (type 1) diabetes (IDD) remain elusive. In order to investigate whether T lymphocytes bearing the gamma-delta T cell receptor (gamma delta+ T cells) could be involved in this process, we measured percentages of peripheral blood gamma delta+ T cells in IDD patients, relatives of IDD probands and controls. High levels of gamma delta+ T cells strongly differentiated 23 relatives at high risk for IDD on the basis of positive islet cell autoantibodies (ICA positive relatives) from 59 controls (P = 0.0013), whereas 26 ICA negative relatives, 14 recent-onset and nine long term IDD patients could not be distinguished from controls on the basis of percentages of gamma delta+ T cells. These data suggest that increased levels of circulating gamma delta+ T cells correlate with the ongoing autoimmune process in pancreatic islets of subjects at high risk for IDD and may thus represent an additional marker for the development of the disease.

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Linkage analysis of Kell:PTC loci demonstration close linkage, theta = 0.045 with a lod score of 10.78. The results, which include the Sutter blood group, support the hypothesis that Sutter is a part of the Kell system.

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