Pediatric Chairs Research Articles

Physical functioning of children/adolescents who have completed acute lymphoblastic leukemia treatment

The purpose of this paper is to evaluate the quality of life of children who have completed ALL treatment with respect to physical functioning as compared to healthy children of similar age. Materials and methods. The research was conducted among patients treated in the Chair and Clinic of Pediatrics, Hematology and Oncology of Nicolaus Copernicus University Collegium Medicum in Bydgoszcz, who completed acute lymphoblastic leukemia treatment. It comprised children whose ALL treatment had finished at least 6 months prior to the research. The final group of patients who participated in the research consisted of 64 persons. Research referring to healthy children was carried out among students of primary schools, junior high schools and kindergartens throughout Bydgoszcz. Only children who had never undergone hospital treatment and did not suffer from chronic diseases were qualified for the said research. The comparative group included 70 healthy children. In order to evaluate the quality of life of children who had undergone ALL treatment and of healthy children James W. Varni’s standardized research instrument was used. Results. As far as children’s/adolescents’ subjective opinion is concerned, physical functioning was evaluated the lowest by adolescents aged 13-18. Pain and fatigue have a significant influence on lowering their quality of physical functioning. The highest evaluation of physical functioning was observed among patients aged 5-7. As far as indirect evaluation is concerned one can notice that physical functioning was evaluated the lowest by parents of children aged 13-18 and 2-4. While comparing physical functioning in both research groups major statistical differences in favour of the comparative group were noticed. Conclusion. The quality of life within the sphere of physical functioning of children and adolescents who have completed treatment is significantly lower than among healthy children.

Diversity and inclusion training in pediatric departments.

The diversifying US population of children necessitates assessing the diversity of the pediatric academic workforce and its level of cultural competency training. Such data are essential for workforce and educational policies. An 8-question survey was sent to 131 US pediatric chairs to assess plans for diversity, targeted groups, departmental diversity, diversity measures, perceived success in diversity, and presence and type of cultural competency training. In all, 49.6% of chairs responded, and three-quarters of them reported having a plan for diversity, which targeted racial; ethnic; gender; lesbian, gay, bisexual, and transgender; disabled; and social class groups. Of the residents, 75% were women, as compared with 54% of faculty and 26% of chairs. Racial and ethnic diversity was limited among trainees, faculty, and leaders; <10% of each group was African American, Hispanic, or Native American. Asian Americans were more common among trainees (15%-33%) but were less common in faculty and leadership positions (0%-14%). Lesbian, gay, bisexual, and transgender physicians were represented in some groups. Measures of diversity included the number of trainees and faculty, promotion success, climate assessments, and exit interviews. Overall, 69% of chairs reported being successful in diversity efforts. A total of 90% reported cultural competency training for trainees, and 74% reported training for faculty and staff. Training in cultural competency included linguistic training, primarily in Spanish. Pipeline issues for minorities are ongoing challenges. Pediatric leadership needs more representation of racial and ethnic minorities, women, and LGBT. Suggestions for workforce and educational policies are made.

Pioneers of congenital and structural heart disease

Ziyad M Hijazi is an interventional cardiologist who specializes in treating congenital and structural heart disease in both children and adults at Sidra Medical & Research Center. He is a pioneer in the non-surgical repair of congenital and structural heart defects. As Acting Chief Medical Officer, Chair – Pediatrics, and Medical Director – Sidra Cardiovascular Center of Excellence, Dr Hijazi drives the strategic direction of the Department of Pediatrics and integrates research and education priorities into a program of excellent clinical service delivery. He also holds the position of Chair of Pediatrics at Weill Cornell Medical College, Qatar – Sidra’s academic partner. After graduation from medical school and upon completion of his internship in Amman, Jordan, Dr Hijazi moved to the USA to begin postgraduate training in the Department of Epidemiology and Public Health at Yale University, School of Medicine where he was subsequently awarded a Masters of Public Health. He remained at Yale University where he completed a residency in pediatrics and a fellowship in pediatric cardiology. Upon completion of his fellowship training, he joined the faculty at Tufts University School of Medicine as an assistant professor. In 1997, he was promoted to Associate Professor of Pediatrics and Medicine, and in 1999 Dr Hijazi accepted a faculty appointment at the University of Chicago as Endowed Professor of Pediatrics and Medicine, and chief of the division of cardiology. He has been successful in building a pre-eminent pediatric cardiology program, which is nationally and internationally recognized for its outstanding clinical service and innovative technologies. In 2007, Dr Hijazi became the Director of the Rush Center for Congenital and Structural Heart Disease at Rush University Medical Center and in 2010 he became the James A Hunter MD University Chair

A Paired Outcomes Study Comparing Two Pediatric Wheelchairs for Low-Resource Settings: The Regency Pediatric Wheelchair and a Similarly Sized Wheelchair Made in Kenya

This comparative study of two similar wheelchairs designed for less-resourced settings provides feedback to manufacturers, informing ongoing improvement in wheelchair design. It also provides practical familiarity to clinicians in countries where these chairs are available, in their selection of prescribed wheelchairs. In Kenya, 24 subjects completed 3 timed skills and assessments of energy cost on 2 surfaces in each of 2 wheelchairs: the Regency pediatric chair and a pediatric wheelchair manufactured by the Association of the Physically Disabled of Kenya (APDK). Both wheelchairs are designed for and distributed in less-resourced settings. The Regency chair significantly outperformed the APDK chair in one of the energy cost assessments on both surfaces and in one of three timed skills tests.

Paediatric or pediatric dentistry?

Paediatrics (or pediatrics) is the branch of medicine that deals with the medical care of children. A medical practitioner who specialises in this branch of medicine is known as a paediatrician (or pediatrician), and similarly in dentistry a dental practitioner who specialises in the dental treatment of children is known as a paediatric (or pediatric) dentist or alternatively as a paedodontist (or pedodontist). However, there is much confusion as to which of the two spellings is correct and many are unaware of the etymology (origin) of the word. Many students, general practitioners and indeed specialists have frequently asked “is it paediatric or pediatric dentistry that is the correct spelling?” Further confusion is caused by some podiatry words beginning with “pedo” (relating to feet). In ancient times physicians like Hippocrates understood the differences in growing and developing children and that this necessitated different treatment and management. Byzantine physicians made significant contributions to child care and built baby shelters (children’s hospitals). Later, a Persian physician (Al-Razi, 865–925 CE) published a short treatise on diseases among children and the first printed book on paediatrics (or pediatrics) was in Italian (Bagellardo 1472). Paediatrics (or pediatrics) as a specialised field of medicine developed in the mid-19th century, with the German Abraham Jacobi (1830–1919), who later worked in New York, USA, regarded as the father of paediatrics (or pediatrics). The first paediatric (or pediatric) hospital was the Hopital des Enfants Malades (Hospital for Sick Children), which opened in Paris in 1802 and accepted patients up to the age of 15 years. Following this a separate Paediatric (or Pediatric) Pavillion was created at the Charite Hospital in Berlin in 1830 and later in St. Petersburg (1834), Vienna (1837) and Wroclaw (1837). Great Ormond Street Hospital for Sick Children in London was formed in 1852 and in the USA the first children’s hospitals were the Children’s Hospital of Philadelphia (1855) and then Boston Children’s Hospital (1869). Academically the first University Chair of Paediatrics (or Pediatrics) in the UK was founded in Scotland in 1924 with the appointment of Professor Leonard Findlay. The first Chair of Paediatrics (or Pediatrics) in the USA was established earlier, in 1888, with the appointment of Professor Thomas Morgan Rotch at Harvard. In dentistry the first European Professor of Paediatric (or Pediatric) Dentistry was Gottorm Toverud at the University of Oslo, Norway. Scholarly journals for paediatrics (or pediatrics) were founded from 1884 (Archives of Pediatrics) and the first for paediatric (or pediatric) dentistry was in 1933 (Journal of Dentistry for Children). The American Academy of Pediatric Dentistry was founded in 1947, with its journal Pediatric Dentistry first published in 1978. By comparison, the European Academy of Paediatric Dentistry was founded in 1990 and our own journal was first published in 2000, originally as the European Journal of Paediatric Dentistry and since 2006 as the European Archives of Paediatric Dentistry. The question still remains: “is paediatric or pediatric the correct spelling?” The word paediatric (or pediatric) originates from two Greek words: παiς (pais or paedion = child) and ατρός (iatros = doctor or healer). The Ancient Greek diphthongs\αι[ and\οι[ were transliterated into Latin as \ae[ and \oe[. Therefore, the original spelling in English was “paediatric”. Noah Webster (1758–1843), an American lexicographer and English spelling reformer, K. J. Toumba (&) Department of Paediatric Dentistry, Leeds Dental Institute, Clarendon Way, Leeds LS2 9LU, UK e-mail: k.j.toumba@leeds.ac.uk

History of pediatric chair of the State-Financed Educational Institution of Additional Professional Education «Russian Medical Academy of Postgraduate Education» of the Ministry of Healthcare of the Russian Federation

History of pediatric chair of the State-Financed Educational Institution of Additional Professional Education «Russian Medical Academy of Postgraduate Education» of the Ministry of Healthcare of the Russian Federation

NR0B1 (DAX1) mutations in patients affected by congenital adrenal hypoplasia with growth hormone deficiency as a new finding

X-linked adrenal hypoplasia congenita (AHC,OMIM#300200) is a rare disorder of the adrenal cortex caused bymutations in the NR0B1 (DAX1) (dosage-sensitive sex reversal, adrenal hypoplasia critical region, on chromosome X, gene 1) gene (OMIM*300473). NR0B1 (DAX1) is located on the short arm of the X chromosome (Xp21.3-p21.2) and encodes for an orphan nuclear hormone receptor (transcription factor) (Zanaria et al. 1994). NR0B1 (DAX1) is expressed in the adrenals, gonads, hypothalamus, and pituitary gland, and it is responsible for controlling the development and function of these tissues. NR0B1 (DAX1) protein functions as a dominant negative regulator (transcriptional repressor) in the hypothalamic– pituitary–adrenal–gonadal axis. It regulates the expression of other proteins involved in the adrenal steroidogenesis pathway, such as steroidogenic factor 1 (SF-1), steroidogenic acute regulatory protein (StAR), P450scc and 3β-hydroxysteroid dehydrogenase (Lalli et al. 2000; Iyer and McCabe 2004). Almost 200 mutations in theNR0B1 (DAX1) gene have been identified to date (The Human Gene Mutation Database—data for 10.08.11) (http://www.hgmd.org). The most commonly found mutations in AHC patients are frameshift and nonsense mutations, which are located throughout the entire length of the NR0B1 (DAX1) gene. Missense mutations are not so common and are located mainly in the region that encodes for a ligandbinding domain at the C-terminus of the NR0B1 (DAX1) protein (Achermann et al. 2001a). Some patients have more complex X-chromosome rearrangements that include the deletion of larger parts of the X chromosome, including NR0B1 (DAX1), DMD (dystrophin), GK (glycerol kinase) and IL1RAPL (interleukin 1 receptor accessory protein-like) genes (Choi et al. 2005). AHC symptoms are noticed very early in postnatal life. The disorder is characterized by salt-wasting syndrome, hypoglycemia in early infancy or childhood, poor weight gain, vomiting, prolonged neonatal jaundice, and skin hyperpigmentation. In laboratory tests, hyponatremia, hyperkalemia, low levels of cortisol, aldosterone, and adrenal androgens are found, in contrast to high levels of adrenocorticotropic hormone (ACTH) and plasma renin activity (Achermann et al. 2000; Nakae et al. 1997; Wiltshire et al. 2001; Verrijn Stuart et al. 2007). Very frequently, patients are admitted to hospital in a life-threatening condition. AHC is lethal unless appropriate steroid replacement therapy is provided to these patients. Most patients with AHC also suffer from hypogonadotropic hypogonadism, since mutations in the NR0B1 (DAX1) gene A. Rojek (*) :M. Niedziela 2nd Chair of Pediatrics, Department of Pediatric Endocrinology and Rheumatology, Molecular Endocrinology Laboratory, Poznan University of Medical Sciences, 27/33 Szpitalna Street, 60-572 Poznan, Poland e-mail: aleksandra.rojek@gmail.com

Editorial introductions

Current Opinion in Pediatrics was launched in 1989. It is one of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of pediatrics is divided into 18 sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. In addition to this, Henry H. Bernstein also invites a prominent authority in the field of Office Pediatrics to write on the subject for each issue. Here we are pleased to introduce the Section Editors for this issue. SECTION EDITORS H. Scott BaldwinH. Scott BaldwinDr Baldwin is the Katrina Overall Chair in Pediatrics and Professor of Pediatrics and Cell and Developmental Biology at Vanderbilt, USA. He serves as Chief of the Division of Pediatric Cardiology and Co-Director of the Pediatric Heart Institute at the Monroe Carell Jr. Children's Hospital, USA. Dr Baldwin received his MD from the University of Virginia, USA, did his pediatric residency and chief residency at the University of Rochester, USA, and completed a pediatric cardiology fellowship at the University of Iowa, USA. He then joined the faculty at the University of Pennsylvania and Children's Hospital of Philadelphia, USA, where he served as Co-Director of Cardiovascular Research before moving to Vanderbilt assuming the role of Vice-Chair of Pediatrics for Laboratory Based Research prior to becoming the Chief of Pediatric Cardiology. Dr Baldwin's interests concentrate on understanding the molecular and genetic etiology of congenital heart diseases. Studies in the laboratory are based on the hypothesis that the developing vasculature provides important patterning information that directs subsequent cardiac and pulmonary morphogenetic events and thus understanding the molecular basis of endothelial heterogeneity is essential in defining the mechanisms and treatment of congenital cardiac disease. His laboratory has developed strategies for endocardial specific gene deletion to allow temporal and spatial gene manipulation throughout the vascular system. He is currently involved in several interdisciplinary collaborations to determine if knowledge about normal valve development can be used to guide development of tissue engineered heart valves for use in the pediatric population. Dr Baldwin is a fellow of the American Heart Association, a fellow of the American College of Cardiology, and a member of the Academic Pediatric Society. He currently serves on the AHA Council of Cardiovascular Diseases in the Young as well as a member of the national AHA Research Oversight Committee. He is also Chair of the Scientific Board for the Sarnoff Foundation, an organization dedicated to providing medical students with an in-depth cardiovascular focused research experience by supporting a one to two year hiatus from medical school to participate in a basic laboratory investigation and he is the principle investigator of an NIH/NHLBI training grant specifically focused on development of both MD and PhD training in disease processes relevant to congenital and acquired heart disease. Robert WyllieRobert WyllieDr Robert Wyllie is the Chief Medical Operations Officer at the Cleveland Clinic, USA, and Vice Chair of the Office of Professional Staff Affairs. Dr Wyllie is a member of the Cleveland Clinic Board of Governors, other offices held include President of the Staff and member of the Board of Trustees. Dr Wyllie was the initial holder of the Calabrese Chair of Pediatrics and served as the Chairman of the Pediatric Institute, and Physician and Phrygian-In-Chief of the Cleveland Clinic Children's Hospital from 2006 to 2011. Dr Wyllie is a Professor in the Lerner College of Medicine, USA, and has participated in more than 250 presentations at scientific meetings, written over 150 manuscripts and chapters, and edits one of the major textbooks in pediatric gastroenterology, now in its fourth edition. Together with his wife, Dr Elaine Wyllie, Director of the Cleveland Clinic's Center for Pediatric Neurology, he raised two sons who are pursuing their own careers in science and technology.

Editorial introductions

Editorial introductions

WS21.5 Newborn screening for cystic fibrosis – Polish four years’ experience with CFTR sequencing strategy

WS21.5 Newborn screening for cystic fibrosis − Polish four years’ experience with CFTR sequencing strategy K. Wertheim-Tysarowska1, A. Sobczynska-Tomaszewska1,2, M. Oltarzewski3, K. Czerska1,2, D. Sands3, J. Walkowiak4,5, J. Bal3, T. Mazurczak3. 1Institute of Mother and Child, Department of Medical Genetics, Warsaw, Poland; 2Health Care Center Genomed, Warsaw, Poland; 3Institute of Mother and Child, Warsaw, Poland; 4Poznan University of Medical Sciences, Ist Chair of Pediatrics, Department of Gastroenterology & Metabolism, Poznan, Poland; 5Poznan University of Life Sciences, Department of Dietetics, Poznan, Poland

Navigating the stages of an academic career for paediatricians

In Canada, a major proportion of the country’s paediatricians work within the context of the paediatric academic health science centres (PAHSCs). These are either free-standing children’s hospitals or children’s units within general hospitals, all affiliated with a university faculty of medicine. In a recent work force analysis by the Paediatric Chairs of Canada (PCC), an association linking the 16 medical school departments of paediatrics, 1701 full-time and major part-time faculty members were identified, representing slightly more than one-half of the country’s paediatricians (1). The remaining paediatricians are increasingly involved in academic activities as more community hospitals become associated with expanding medical schools. Medical students intent on a career in paediatrics and, perhaps more importantly, paediatric residents deciding on their career paths, ought to be well informed about the options open to them, the appropriate training for each of these options as well as the expectations when entering their field of choice. Here, we address the issue of stages or phases of an academic career, and what to expect and how to successfully navigate the challenges of each phase. We make some assumptions, namely that the training for the position has been appropriate and that the job or career activity profile into which the candidate has been recruited matches this training. This is not to minimize either of these aspects of career planning and development; rather, they warrant attention in a separate article.

Treatment Rather Than Avoidance May Be Within Reach for Children With Food Allergies

THE PEANUT BUTTER SANDWICH THAT most American adults view nostalgically as a mainstay of their childhood has become a food to be feared by an increasing number of parents today. Although data on the epidemiology of food allergies are scant, studies suggest that peanut allergies have tripled in the last 15 years, with 3 million Americans now claiming to be allergic to peanuts or tree nuts. Allergies to cow’s milk, egg, wheat, and soy have also spiked. “We believe there are just as many milk and egg allergies as there are for peanut,but those studieshaven’tbeendone,” said Robert Wood, MD, professor of pediatrics and chief of the Division of Allergy and Immunology at Johns Hopkins Children’s Center. The National Center for Health Statistics reported in 2007 that 3.9% of children had a food allergy in the past 12 months—an 18% increase from 1997 to 2007. “There is more allergic and autoimmune disease today than there was previously, but food allergies seem to outpace that,” said Wesley Burks, MD, chair of pediatrics, University of North Carolina, Chapel Hill. Anumberofhypothesesattempt toexplain the rise in food allergies in the United States and other developed countries. One is that parents may have unwittingly made their children more prone to food allergies by delaying the introduction of potentially allergenic foods in their babies’ diets and following World Health Organization guidelines to exclusivelybreastfeed for the first 6months. “Years ago, babies started solid foods much earlier,” said Gideon Lack, MD, professor of pediatric allergy at Kings College, London, who is leading 2 allergy-prevention trials to determine whether introducing peanut, milk, egg, fish, wheat, and sesame in the first year of life may protect against the development of food allergies. The LEAP (Learning Early About Peanut Allergy) trial is following up 640 babies for 7 years with results expected in 2014, and the EAT (Enquiring About Tolerance) trial will have results in 2015. In a 2008 study, Lack and colleagues showed that Jewish children in Israel, who are typically weaned at 6 months with a peanut food called Bamba, were one-tenth as likely to develop peanut allergy compared with Jewish children in the United Kingdom, who typically are not given peanuts when they are infants (Du Toit G et al. J Allergy Clin Immunol. 2008;122[5]:984-991). “If indeed oral tolerance works, there may be a relatively narrow window of immunological opportunity to expose children to allergenic foods and induce (natural) tolerance,” said Lack. “We suspect with peanuts it’s in the first 10 months of life. For egg, based on an Australian study, it’s probably in the first 6 months, and for cow’s milk, it could be even earlier.” Cleaner living environments have also shielded children from exposure to infectious agents, thereby altering the gastrointestinal microbiome. Bacteria in the gastrointestinal tract aren’t regulating allergic immune responses as effectively as they did in the past, so children are reacting to more potential allergens, said Hugh Sampson, MD, chief of the Division of Allergy and Immunology in the Department of Pediatrics and director of the Jaffe Food Allergy Institute at Mount Sinai Medical Center in New York City. Hyper hygiene may also be behind the rise in eczema, which is a portal for allergens to enter the body. “About 90% of babies who develop food allergies have eczema in the first year of life,” said Lack. “Eczema is also a strong predictor of asthma and allergic respiratory disease, as are egg and peanut allergies.”

Are the career choices of paediatric residents meeting the needs of academic centres in Canada?

Responsibility for training paediatric medical subspecialists in Canada lies primarily with the 16 academic paediatric departments. There has been no mechanism to assess whether the number of residents in training will meet the needs of currently vacant positions and/or the predicted vacancies to be created by anticipated faculty retirement in the next five years across the different paediatric medical subspecialties. At the present time, the training of the paediatric physician is not linked with the current and future needs of the academic centres where the vast majority of these paediatric subspecialists are employed. The academic paediatric workforce database of the Paediatric Chairs of Canada (PCC) for the surveys obtained in 2009/2010 were analyzed. Data included the number of physicians working in each subspecialty, the number of physicians 60 years of age or older, as well as the number of residents and their level of training. There are some paediatric subspecialties in which the actual number of trainees exceeds the currently predicted need (eg, cardiology, critical care, hematology-oncology, nephrology, neurology, emergency medicine and genetic-metabolic). On the other hand, for other specialties (eg, adolescent medicine, developmental paediatrics, gastroenterology and neonatology), assuming there is no significant change to selection patterns, an important gap will persist or appear between the need and the available human resources. The present analysis was the first attempt to link the clinical orientation of trainees with the needs of the academic centres where the vast majority of these paediatric subspecialists work.

New PSA Guidelines Discourage Overscreening

T he new prostate cancer screening recommendation that the U.S. Preventive Services Task Force issued in October provoked the predictable firestorm of controversy between proponents of early detection and critics who believe many screening tests have been overpromoted. But the reaction was more muted than expected, leading some to suggest that the pendulum might be swinging away from routine screening. “I ’ m extremely hopeful we ’ re near the tipping point,” said Virginia Moyer, M.D. , task force chair and professor of pediatrics at Baylor College of Medicine in Houston. “People are beginning to recognize that all early detection is not good. Just because it falls under the heading of prevention doesn ’ t mean it ’ s good without data to demonstrate the benefi t.” Moyer believes the tipping point has to do with a more sophisticated understanding of what cancer is. “The public thinks once you have a cancer cell in your body, it will progress predictably and inevitably to a terrible death,” she said. “That is simply not true of most cancers. It ’ s certainly not true of prostate cancer, not true of breast cancer, not true of most skin cancers, not true of all cervical cancers. You have a disease that is highly variable. Knowing you have cancer cells in your prostate or breast doesn ’ t mean that, unless you do something radical, you ’ re going to die of that. A signifi cant proportion of people whose disease is detected by screening never would have known about their disease in their entire lifetime. A good proportion would have died of something else before the cancer progressed to being clinically signifi cant, and many would have died of old age. “That ’ s not true for everyone,” she concedes. “Some people will have progressive, terrible disease. But unfortunately, much of the aggressive disease is rapidly progressing and, therefore, not likely to be caught by screening.” Prostate cancer is the most common malignancy in U.S. men, not counting skin cancer. The American Cancer Society expected 240,890 prostate cancer diagnoses in 2011 and expected that 33,720 men would die of the disease.

Value Placed on Formal Training in Education by Pediatric Department Chairs and Residency Program Directors

While much is known about how educational leaders at the medical school level (eg, deans) view the importance of formal training in education for medical school teachers, little is known about how leaders at the clinical level (eg, department chairs) view such training. We sought to determine how pediatric department chairs and residency program directors view the value of formal training in education, such as that at a Master of Education (MEd) level, and to estimate the number of clinical pediatric faculty with or pursuing such training. A survey designed to assess the value placed on formal training in education and to estimate the number of clinical faculty with or pursuing such training was mailed to pediatric department chair persons and residency program directors at all 131 allopathic medical schools in the United States and Puerto Rico. Eighty department chairs (61%) responded, and most indicated that when hiring new faculty, they view an applicant with an MEd as having an advantage. Both chairs and residency directors considered an MEd to be advantageous for a residency director by a ranking of 4.5 and 4.2, respectively, on a scale of 1 to 5 (P = .008). Of the 80 chairs who responded, 58.8% of respondents reported one or more faculty in their department had or was pursuing an MEd. Of the 72 responding residency directors (55%), 11 respondents (15.3%) indicated that they had an MEd. More than half the medical school pediatric chairs responding to the survey had one or more clinical faculty with or pursuing an MEd in their departments. Survey results indicated that such training is valued by both department chairs and residency directors. Given the time and expense involved in obtaining an MEd, awareness of these data 5 be helpful to those considering pursuing, offering, or requiring such training.

Variability of the Pediatric Subspecialty Workforce in Canada

To assess the regional variability of the pediatric subspecialty workforce in the academic health science centers in Canada, because effective and efficient delivery of specialized pediatric health care depends on the pediatrician workforce. This was an analysis of the pediatric subspecialty workforce database of the Pediatric Chairs of Canada for the surveys obtained between 2003/04 and 2005/06. In 2003/2004, 960 pediatrician specialists who spent a majority of their time supporting clinical, educational, research, and administrative activities within the 16 Canadian medical schools were reported. In 2004/05, this figure was 1044, and in 2005/06, it was 1140. The growth was due predominantly to increases in physician workforce in the fields of emergency medicine, respiratory medicine, and neonatology. The average academic pediatric workforce, excluding general pediatricians, increased from 12.86/100 000 child population in 2003/04 to 13.99 in 2004/05 and 15.27 in 2005/06. Substantial regional variability exists, with 4-fold differences in academic pediatrician workforce among the low-supply provinces (Saskatchewan, British Columbia, and Ontario) and high-supply provinces for both total workforce and subspecialists. The substantial variability in the supply of pediatric subspecialists across Canada requires additional analysis to determine any relationship to child health outcomes.

What’s New with Upper Respiratory Infections?

&lt;p&gt;Professor Ellen Wald, the chair of Pediatrics at the University of Wisconsin, has long been a highly respected voice in the pediatric infectious diseases community, and she has organized an outstanding set of articles for this issue of &lt;em&gt;Pediatric Annals.&lt;/em&gt; I am very grateful for her editorship of these contributions, mostly by her disciples and former trainees. The topics covered here obviously account for the majority of sick children doctor visits.&lt;/p&gt; &lt;p&gt;In what may be a first for this journal, we have a two-generation contribution, as Ellen is the Guest Editor, and her son, Eric Wald, now an attending physician in our pediatric intensive care unit at Children’s Memorial Hospital in Chicago, has authored an excellent up-to-date review of croup (page 16). Finally, there is consensus on the role of corticosteroids in croup, with uniform recommendations for their use in croup of any severity.&lt;/p&gt; &lt;p&gt;Ellen Wald has long been considered the &amp;ldquo;sinusitis guru&amp;rdquo; in our field, and she has recruited outstanding individuals to coauthor a review of acute sinusitis (Greg DeMuri, see page 34) and to author a review of chronic sinusitis (Itzhak Brook, see page 41). These are the clearest reviews of these topics I’ve seen recently and will be of great assistance to pediatricians on the front lines. Similarly, Shaikh and Hoberman succinctly review acute otitis media (see page 28) and include great photos of tympanic membranes.&lt;/p&gt; &lt;p&gt;Last, but by no means least (because it is one of my favorite topics of interest), we have an excellent review of pharyngitis by Judy Martin (see page 22), with appropriate emphasis on the continuing need to identify and treat streptococcal pharyngitis and on the fact that penicillin or amoxicillin continue to be the drugs of choice. This article doesn’t have the space or intent to discuss why acute rheumatic fever (ARF) has become such a rare disorder almost everywhere in the United States and Canada and in many other developed areas. We had the opportunity to compare the M-types of group A strep that caused acute pharyngitis in children in the 1960s in Chicago with those causing pharyngitis this decade (40 years later). We found a dramatic decline in the proportion of so-called &amp;ldquo;rheumatogenic&amp;rdquo; types of group A strep causing acute pediatric pharyngitis both in Chicago and across the United States and Canada. We believe that this, in large measure, explains why ARF has declined so dramatically over the past decades. At our hospital in Chicago, we now see a handful of children with Sydenham chorea and maybe one with acute rheumatic carditis each year, whereas we see about 70 Kawasaki patients annually. [For more information, see Shulman ST, Stollerman G, Beall B, Dale JB, Tanz RR. Temporal changes in streptococcal M protein types and the near-disappearance of acute rheumatic fever in the United States. &lt;em&gt;Clin Infect Dis.&lt;/em&gt; 2006;42(4):441-447.]&lt;/p&gt; &lt;p&gt;The pharyngitis article in this issue, of course, is focused mainly on streptococcal pharyngitis. The four stamps chosen to accompany this article all honor Louis Pasteur, and if you look very carefully, two of them actually portray cocci in chains (streptococci).&lt;/p&gt; &lt;p&gt;Pasteur (1822-1895) is considered, with Robert Koch, the founder of the science of bacteriology. Among Pasteur’s many contributions to the field was his recognition of the parallel between fermentation, which he showed was caused by bacteria, and purulent infection/putrefaction of tissues, also caused by bacteria.&lt;/p&gt; &lt;p&gt;Pasteur was born in the town of D&amp;ocirc;le, France, in the Jura region, in his father’s tannery/family home, and the family and tannery business later moved to the town of Arbois. Both of these sites are now interesting museums in small French cities. Pasteur’s initial scientific interests were in crystal structure and other chemical topics, which eventually led to his discovery of the world of bacteriology. Of course, he also became famous, even revered, for his development of a highly effective vaccine against the universally fatal infection rabies.&lt;/p&gt; &lt;p&gt;The two Pasteur stamps that portray streptococci are the red, brown, and blue one from the French territory of Afars and Issas (now Republic of Djibouti) and the blue and brown one from the Archipelago of Comoros in the Indian Ocean off the southeast coast of Africa. The yellow and brown Pasteur stamp is from a British colony, St. Helena, a volcanic island in the South Atlantic, and the fourth is from France.&lt;/p&gt;

NHLBI training workshop report: The vanishing pediatric pulmonary investigator and recommendations for recovery

The adequacy of the pipeline of advanced pulmonary fellows to supply appropriately trained and committed researchers to enter academic careers was the major topic of a recently held National Heart Lung and Blood Institute NHLBI Workshop: Respiratory Medicine-Related Research Training for Adult and Pediatric Fellows. The special challenges and opportunities for the academic pediatric pulmonary trainee were discussed as part of this workshop and are discussed as a companion paper to the report by the full workshop. Surveys were conducted of pediatric chairs of academic departments and pediatric pulmonary training directors in the United States to examine the current status and opportunities for the pediatric pulmonary trainee. Strategies for recruitment and retention of talented young trainees and junior faculty are proposed.

NHLBI Training Workshop Report: The Vanishing Pediatric Pulmonary Investigator and Recommendations for Recovery

The adequacy of the pipeline of advanced pulmonary fellows to supply appropriately trained and committed researchers to enter academic careers was the major topic of a recently held National Heart Lung and Blood Institute NHLBI Workshop: Respiratory Medicine-Related Research Training for Adult and Pediatric Fellows. The special challenges and opportunities for the academic pediatric pulmonary trainee were discussed as part of this workshop and are presented as a companion article to the report by the full workshop. Surveys were conducted of pediatric chairs of academic departments and pediatric pulmonary training directors in the United States to examine the current status and opportunities for the pediatric pulmonary trainee. Strategies for recruitment and retention of talented young trainees and junior faculty are proposed.

Global Health Training for Pediatric Residents

The FOPO Global Health Working Group concludes that global health experiences are important for pediatric residency training and offers five recommendations: 1) There is a need to articulate clearly the rationale supporting the creation of global health experiences in pediatric residency programs. 2) A core curriculum needs to be established for a consistent and meaningful educational experience. The curriculum should include the underlying principles discussed above and should engage representatives from potential host countries in the development of the curriculum. 3) Promoting the opportunity for a global health experience in all residency programs will require a collaborative effort across programs, perhaps at the national level through the Association of Pediatric Program Directors or through the already established Global Health Education Consortium (GHEC).34 A clearinghouse for curricula and for host organizations/institutions both abroad and within the United States and Canada should be established. 4) Global health training needs to be studied rigorously, and lessons learned should be shared. 5) Pediatric residency programs should respect the rights, autonomy, and confidentiality of patients and families in clinical care, research, and operational programs. The FOPO Global Health Working Group looks forward to serving as a focal point to promote discussion on this important issue to the health of our world's children.