Pediatrics RSS : Gourt

Hospital in Georgia seeks Pediatrician for 24 hour call coverage :: Georgia :: Weatherby Locums

Job 9508140-0004 Hospital based group seeks locums Pediatric physician to provide call coverage. C - sections and high risk deliveries required. Need is for October, November, December and January dates.

Pediatrician needed in Texas for Holiday coverage, near Dallas. :: Texas :: Weatherby Locums

Job 9558438-0012 This medical practice is seeking a Pediatrician to help provide vacation coverage during the holiday season in December. Locums physician will work with 2 medical assistants. 9am -

Pediatric practice in West Virginia needs immediate coverage :: West Virginia :: Weatherby Locums

Job 9544250-0001 Locums Pediatrician needed to cover location for start as soon as possible. Sick and well visits. Monday - Friday schedule. Monday - Friday 10 am - 6pm Board Certification preferred

Connecticut medical group seeks full time Pediatric coverage :: Connecticut :: Weatherby Locums

Job 9508419-0002 Group seeks a locums Pediatrician to cover on a part time basis beginning September 1st. 9am - 6pm Excellent opportunity to explore locums to perm Outpatient only 12 -15 patients

Solo practice in Texas seeks Pediatrician for staff support :: Texas :: Weatherby Locums

Job 9583500-0003 Practice seeks locums Pediatrics physician to cover during up coming vacation. Outpatient only. August dates available 9am - 5pm 1/2 days on Wednesday Approx 25 patients per day Paid

Virginia practice seeks Pediatrician for vacation coverage :: Virginia :: Weatherby Locums

Job 9502447-0018 Locums Pediatrician needed to provide staff vacation coverage in October and November 2009. Low volume outpatient solo practice. Outpatient only 8 hours per day Solo practice 10 -

Hospital based practice seeks long term Pediatric coverage :: Pennsylvania :: Weatherby Locums

Job 9508585-0022 Short staffed facility seeks Pediatrician to provide coverage to begin as soon as possible. Need is on-going and full time. Monday - Friday 8am - 6pm Ideal candidate must be Board

Hospital based practice seeks locums Pediatric coverage :: Pennsylvania :: Weatherby Locums

Job 9508585-0023 Short staffed facility seeks Pediatrician to provide coverage to begin as soon as possible. Ideal candidate must be Board Certified or Board Eligible within 5 years of residency. Excellent

Pediatrician needed to provide coverage in Kansas :: Kansas :: Weatherby Locums

Job 9500627-0006 Pediatric physician needed to provide coverage - call and clinic needed. Clinic hours are: 8:30am - 5:00pm Monday - Friday. Rounding in nursery, and call for the ED. Clinic and call

Long term opportunity for Pediatrician in Vermont :: Vermont :: Weatherby Locums

Job 9508941-0005 Hospital based group seeks long term and on-going Pediatric coverage. Excellent option for locums physician interested in permanent placement. Average patients per day is 16 - 22. Licensure

Texas Clinic Seeks Long Term Pediatric Coverage :: Texas :: Weatherby Locums

Job 9585424-0004 Long term locums opportunity for pediatric physician. Outpatient only. Ideal candidate will start in October and is on-going. Excellent opportunity to explore permanent placement.

Texas Pediatric office seeks on-going coverage :: Texas :: Weatherby Locums

Job 9501761-0082 Locums Pediatrician needed to cover during remainder of year into next year. Physician will see outpatient cases only. Work with 3 other established physicians. 9am - 4:30pm Outpatient

Practice in Maryland seeks Pediatric coverage :: Maryland :: Weatherby Locums

Job 9607426-0002 Beautiful area of Maryland seeks locums Pediatrician to provide coverage. Monday - Friday 10am - 4pm Basic Pediatric needs: Newborns, well checks and sick visits. Work 3 days in one

Long term need for Pediatric coverage in Utah :: Utah :: Weatherby Locums

Job 9508517-0006 Pediatrician needed to work long term with solo physician for growth and to share call. Ideal candidate must be comfortable with C-Sections and Delivery call coverage Board Eligible,

Long term need for Pediatrician in New York :: New York :: Weatherby Locums

Job 9604335-0001 Outpatient only facility seeks long term Pediatric physician to cover starting immediately. 8am - 6pm Must be Board Certified 100% Pediatrics Assistance with hospital privileges provided

Maryland facility seeks Pediatric coverage :: Maryland :: Weatherby Locums

Job 9608713-0001 Solo practice seeks locums Pediatrician to provide coverage. Work aside experienced, professional support staff. Days and hours are flexible. Outpatient Only Monday - Friday 9a - 5p

Committed Pediatrician needed in New York :: New York :: Weatherby Locums

Job 9501159-0095 Private practice in a beautiful, rural area of upstate New York is in need of a dedicated Pediatrician to provide ongoing inpatient/outpatient coverage beginning immediately. Ideal candidate

Opportunity for Pediatrician in Colorado :: Colorado :: Weatherby Locums

Job 9588702-0002 Pediatric health center is currently seeking full time Pediatrician. Board certified or Board eligible acceptable. 24 - 24 patients per day No in house or C - section call Four 10

Facility in Texas seeks Pediatrician :: Texas :: Weatherby Locums

Job 9559832-0004 Established practice seeks locums Pediatrician to provide coverage. October and December dates available Outpatient only Hours 8:30 - 5:30 20 - 25 patients per day Austin area Paid

Northeast :: Oregon :: Fidelis Partners

PEDIATRICS 300 DAYS OF SUNSHINE, PACIFIC NORTHWEST $200K POTENTIAL LIVE ON THE COLUMBIA RIVER Be a hospital employee of a successful healthcare system * Flexible work week schedule, you choose;

Celebration at the Maasai Girls School in Southwest Kenya, April 2009 [About the Cover]

About This Journal [About This Journal]

This Month in Archives of Pediatrics & Adolescent Medicine [This Month in Archives of Pediatrics & Adolescent Medicine]

Too Beautiful for Suicide [On My Mind]

Antibacterial Medication Use During Pregnancy and Risk of Birth Defects: National Birth Defects Prevention Study [Article]

Objective To estimate the association between antibacterial medications and selected birth defects. Design, Setting, and Participants Population-based, multisite, case-control study of women who had pregnancies affected by 1 of more than 30 eligible major birth defects identified via birth defect surveillance programs in 10 states (n = 13 155) and control women randomly selected from the same geographical regions (n = 4941). Main Exposure Reported maternal use of antibacterials (1 month before pregnancy through the end of the first trimester). Main Outcome Measure Odds ratios (ORs) measuring the association between antibacterial use and selected birth defects adjusted for potential confounders. Results The reported use of antibacterials increased during pregnancy, peaking during the third month. Sulfonamides were associated with anencephaly (adjusted OR [AOR] = 3.4; 95% confidence interval [CI], 1.3-8.8), hypoplastic left heart syndrome (AOR = 3.2; 95% CI, 1.3-7.6), coarctation of the aorta (AOR = 2.7; 95% CI, 1.3-5.6), choanal atresia (AOR = 8.0; 95% CI, 2.7-23.5), transverse limb deficiency (AOR = 2.5; 95% CI, 1.0-5.9), and diaphragmatic hernia (AOR = 2.4; 95% CI, 1.1-5.4). Nitrofurantoins were associated with anophthalmia or microphthalmos (AOR = 3.7; 95% CI, 1.1-12.2), hypoplastic left heart syndrome (AOR = 4.2; 95% CI, 1.9-9.1), atrial septal defects (AOR = 1.9; 95% CI, 1.1-3.4), and cleft lip with cleft palate (AOR = 2.1; 95% CI, 1.2-3.9). Other antibacterial agents that showed associations included erythromycins (2 defects), penicillins (1 defect), cephalosporins (1 defect), and quinolones (1 defect). Conclusions Reassuringly, penicillins, erythromycins, and cephalosporins, although used commonly by pregnant women, were not associated with many birth defects. Sulfonamides and nitrofurantoins were associated with several birth defects, indicating a need for additional scrutiny.

Parental Views on Withdrawing Life-Sustaining Therapies in Critically Ill Children [Article]

Objective To broaden existing knowledge of pediatric end-of-life decision making by exploring factors described by parents of patients in the pediatric intensive care unit (PICU) as important/influential if they were to consider withdrawing life-sustaining therapies. Design Quantitative and qualitative analysis of semi-structured one-on-one interviews. Setting The PICUs at 2 tertiary care hospitals. Participants English- or Spanish-speaking parents who were older than 17 years and whose child was admitted to the PICU for more than 24 hours to up to 1 week. Intervention Semi-structured one-on-one interviews. Results Forty of 70 parents (57%) interviewed said they could imagine a situation in which they would consider withdrawing life-sustaining therapies. When asked if specific factors might influence their decision making, 64% of parents said they would consider withdrawing life-sustaining therapies if their child were suffering; 51% would make such a decision based on quality-of-life considerations; 43% acknowledged the influence of physician-estimated prognosis in their decision; and 7% said financial burden would affect their consideration. Qualitative analysis of their subsequent comments identified 9 factors influential to parents when considering withdrawing life-sustaining therapies: quality of life, suffering, ineffective treatments, faith, time, financial considerations, general rejection of withdrawing life-sustaining therapies, mistrust/doubt toward physicians, and reliance on self/intuition. Conclusion Parents describe a broad range of views regarding possible consideration of withdrawing life-sustaining therapies for their children and what factors might influence such a decision.

Estimating the Risk of Food Stamp Use and Impoverishment During Childhood [Article]

Objective To estimate the lifetime risk that an American child will reside in a household receiving food stamps and, as a result, will encounter poverty and a heightened exposure to food insecurity. Design Thirty years of longitudinal data from the Panel Study of Income Dynamics survey data set. Setting Nationally representative sample of the US population. Participants Approximately 90 000 childhood years of information are pooled together to create a series of life tables that span the ages of 1 to 20 years. Main Outcome Measure Self-reporting measure of whether survey households received the Food Stamp Program during the prior year. Results Between the ages of 1 to 20 years, nearly half (49.2%) of all American children will, at some point, reside in a household that receives food stamps. Households in need of the program use it for relatively short periods but are also likely to return to the program at several points during the childhood years. Race, parental education, and head of household's marital status exert a strong influence on the proportion of children residing in a food stamp household. Conclusions American children are at a high risk of encountering a spell during which their families are in poverty and food insecure as indicated through their use of food stamps. Such events have the potential to seriously jeopardize a child's overall health.

Case-control Study of a Gastroschisis Cluster in Nevada [Article]

Objective To identify potential risk factors associated with a sudden increase in gastroschisis cases in northern Nevada. Design Case-control study. Setting Medical centers and a pregnancy care center in Reno, Nevada. Participants Participants (n = 14) were women who gave birth to infants with gastroschisis at either of the 2 medical centers in Reno, Nevada, from April 5, 2007, through April 4, 2008. Controls (n = 57) were selected from the same pregnancy center providing perinatal care to the cases and were matched 4:1 to the case mothers by maternal date of birth within 1 year. Main Exposures Environmental exposures and illnesses during pregnancy. Outcome Measures Association of gastroschisis with illnesses, medications, or environmental exposures. Results Gastroschisis was associated with the use of methamphetamine (odds ratio [OR], 7.15; 95% confidence interval [CI], 1.35-37.99) or any vasoconstrictive recreational drug (methamphetamine, amphetamine, cocaine, ecstasy) (OR, 4.46; 95% CI, 1.21-16.44) before pregnancy. When we limited self-reported illnesses to those occurring during the first trimester of pregnancy, chest colds (OR, 16.77; 95% CI, 1.88-150.27) and sore throats (OR, 12.72; 95% CI, 1.32-122.52) were associated with gastroschisis. Conclusions These findings add strength to the hypothesis that use of methamphetamine and related drugs is a risk factor for gastroschisis and raise questions about the risks associated with infections.

A Randomized Trial of Nebulized 3% Hypertonic Saline With Epinephrine in the Treatment of Acute Bronchiolitis in the Emergency Department [Article]

Objective To determine whether nebulized 3% hypertonic saline with epinephrine is more effective than nebulized 0.9% saline with epinephrine in the treatment of bronchiolitis in the emergency department. Design Randomized, double-blind, controlled trial. Setting Single-center urban pediatric emergency department. Participants Infants younger than 12 months with mild to moderate bronchiolitis. Interventions Patients were randomized to receive nebulized racemic epinephrine in either hypertonic or normal saline. Outcome Measures The primary outcome measure was the change in respiratory distress, as measured by the Respiratory Assessment Change Score (RACS) from baseline to 120 minutes. The change in oxygen saturation was also determined. Secondary outcome measures included the rates of hospital admission and return to the emergency department. Results Forty-six patients were enrolled and evaluated. The 2 study groups had similar baseline characteristics. The RACS from baseline to 120 minutes demonstrated no improvement in respiratory distress in the hypertonic saline group compared with the normal saline control group. The change in oxygen saturation in the hypertonic saline group was not significant when compared with the control group. Rates of admission and return to the emergency department were not different between the 2 groups. Conclusions In the treatment of acute bronchiolitis, hypertonic saline and epinephrine did not improve clinical outcome any more than normal saline and epinephrine in the emergency setting. This differs from previously published results of outpatient and inpatient populations and merits further evaluation. Trial Registration isrctn.org Identifier: ISRCTN66632312

Physical Activity Opportunities Associated With Fitness and Weight Status Among Adolescents in Low-Income Communities [Article]

Objective To identify physical activity opportunities linked to fitness and weight status among adolescents in low-income communities. Design, Setting, and Participants Cross-sectional, ecological analysis of 9268 seventh- and ninth-grade students in 19 public schools participating in The California Endowment's Healthy Eating Active Communities program. Main Outcome Measures Cardiorespiratory fitness (mile time) and body mass index. Independent variables included students' perceptions and behaviors related to daily physical activity opportunities, assessed via anonymous survey. Ecological analysis was used to link survey data with fitness and body mass index data within each school. Linear regression identified associations between youths' perceptions/behaviors and fitness/body mass index. Results As the proportion of students reporting enjoying physical education, walking to school, and spending 20 minutes or longer in exercise during physical education increased from 0% to 100%, mile time decreased overall (–2.7 minutes; P = .03), mile time decreased among seventh graders (–3.3 minutes; P = .02), and body mass index z scores decreased among ninth graders (–0.7; P = .045), respectively. Each additional day students reported being active on school grounds outside school hours was associated with decreased mile time (–0.5 minute; P = .02). Active transport to school was associated with poorer weight status and greater odds of purchasing food while in transit (odds ratio = 1.5; P < .001). Conclusions Physical education is a valuable policy opportunity to improve student health. Promoting active transport may improve fitness but must be done in conjunction with community partnerships to improve the food environment in the vicinity of schools. Promoting the use of school grounds outside school hours (such as after-school programs) should also be prioritized in response to youth obesity.

Obesity in the Transition to Adulthood: Predictions Across Race/Ethnicity, Immigrant Generation, and Sex [Article]

Objective To trace how racial/ethnic and immigrant disparities in body mass index (BMI) change over time as adolescents (age, 11-19 years) transition to young adulthood (age, 20-28 years). Design We used growth curve modeling to estimate the pattern of change in BMI from adolescence through the transition to adulthood. Setting All participants in the study were residents of the United States enrolled in junior high school or high school during the 1994-1995 school year. Participants More than 20 000 adolescents from nationally representative data interviewed at wave I (1994-1995) and followed up in wave II (1996) and III (2001-2002) of the National Longitudinal Study of Adolescent Health when the sample was in early adulthood. Main Exposures Race/ethnicity, immigrant generation, and sex. Outcome Measure Body mass index. Results Findings indicate significant differences in both the level and change in BMI across age by sex, race/ethnicity, and immigrant generation. Females, second- and third-generation immigrants, and Hispanic and black individuals experience more rapidly increasing BMIs from adolescence into young adulthood. Increases in BMI are relatively lower for males, first-generation immigrants, and white and Asian individuals. Conclusion Disparities in BMI and prevalence of overweight and obesity widen with age as adolescents leave home and begin independent lives as young adults in their 20s.

Lipid Profile in Portuguese Obese Children and Adolescents: Interaction of Apolipoprotein E Polymorphism With Adiponectin Levels [Article]

Objective To evaluate how the lipid profile associates with apolipoprotein (apo) E gene polymorphism, plasma adiponectin level, and body mass index (BMI) z score in Portuguese youth. Design Transversal cohort study. Setting Hospital de São João and Hospital de Crianças Maria Pia, Porto, Portugal, between May 2006 and March 2007. Participants One hundred thirty-eight obese children and adolescents (62 boys; mean age, 10.8 years [range, 4-16 years]). Participants were grouped according to (1) apo E polymorphism: presence of the apo E alleles 2 or 4 in E2 (n = 11) and E4 (n = 31) carriers, respectively, or as E3/E3 (n = 94) (carriers of E2/E4 [n = 2] were excluded from apo E analysis because they carry both alleles) and (2) BMI z score: group 1, BMI z score less than 2 (n = 31); group 2, BMI z score of 2 or more and less than 2.5 (n = 65); and group 3, BMI z score of 2.5 or more (n = 42). Main Outcome Measures Lipid variable comparisons between apo E polymorphism and BMI z score groups and influence of BMI z score and adiponectin level, adjusted for apo E polymorphism, on total cholesterol to high-density lipoprotein cholesterol and apo A-I to apo B ratios. Results E4 carriers presented with a worse lipid profile when compared with E2 and E3/E3 carriers. There was also a clear risk of worsening for the group with the highest BMI z score. Apolipoprotein E polymorphism, BMI z score, and adiponectin level were significantly associated with total cholesterol to high-density lipoprotein cholesterol (standardized β coefficient = 0.283, 0.354, and –0.292, respectively; P < .001 for all) and apo A-I to apo B (standardized β coefficient = –0.372, –0.284, and 0.327, respectively; P < .001 for all) ratios. Conclusion Our data suggest a more atherogenic lipid profile for some apo E genotypes and for increasing BMI z score, whereas adiponectin level seems to play a protective role.

Television Exposure as a Risk Factor for Aggressive Behavior Among 3-Year-Old Children [Article]

Objective To examine associations of child television (TV) exposure and household TV use with aggressive behavior among 3-year-old children while controlling for demographic characteristics and risk and protective factors for aggression. Design The Fragile Families and Child Wellbeing Study, a prospective cohort study. Setting Data collected at home and by telephone from parents of children born from 1998 to 2000 from 20 cities. Participants Mothers who completed a 36-month in-home survey and met inclusion criteria (n = 3128). Main Exposure Direct child TV exposure and household TV use were the primary explanatory variables. Additional risk factors included neighborhood disorder and maternal factors like depression. Outcome Measures Childhood aggression was assessed with the Child Behavior Checklist/2-3. Multivariate linear regression models were used to examine associations between TV measures, additional risk factors, and childhood aggression. Results Children who were spanked in the past month (β = 1.24, P < .001), lived in a disorderly neighborhood (β = 2.07, P < .001), and had a mother reporting depression (β = 0.92, P < .001) and parenting stress (β = 0.16, P < .001) were significantly more likely to exhibit aggressive behavior. Direct child TV exposure (β = 0.16, P < .001) and household TV use (β = 0.09, P < .001) were also significantly associated with childhood aggression, even when controlling for other factors. Conclusions Three-year-old children exposed to more TV, both directly and indirectly, are at increased risk for exhibiting aggressive behavior. Further research is essential to determine whether pediatric recommendations concerning TV and children should include limits for general household TV use.

Effect of Early Intervention on 8-Year Growth Status of Low-Birth-Weight Preterm Infants [Article]

Objective To examine the impact of early educational experience at age 8 years on child growth status. The Infant Health and Development Program has shown positive impacts to age 8 years on intelligence and adaptive functioning of larger preterm infants. Design Randomized controlled trial. Setting Home and center based. Participants Three hundred seventy-seven intervention (INT) and 608 nonintervention (NI) children, stratified by birth-weight categories 2001 to 2500 g and 2000 g or less. Intervention Educational intervention from nursery discharge until age 3 years. Main Outcome Measures Eight-year weight, height, head circumference, and body mass index. Results Complete data were available for 313 INT children and 491 NI children. Adjusting for child birth weight, birth-weight category, treatment group x birth-weight category interaction, sex, race, and Neonatal Health Index; maternal education and preconception weight; and site, the INT children at age 8 years were significantly taller (127.6 vs 126.6 cm; P = .02) and had a larger head circumference (52.5 vs 52.1 cm; P < .001) than the NI children. The prevalence of both overweight (9%) and underweight (4.5%) was the same in both treatment groups. Lighter low-birth-weight INT children had greater 8-year weight (28.0 vs 26.8 kg; P = .02), larger head circumference (52.6 vs 52.1 cm; P < .001), and larger height (127.6 vs 126.5 cm; P = .05) compared with their counterparts in the NI group. Conclusion Low-birth-weight preterm children, specifically the lighter low-birth-weight group, who received the Infant Health and Development Program educational intervention were heavier and taller and had greater head circumference compared with NI children in the same birth-weight category.

Transcutaneous Bilirubin Nomograms: A Systematic Review of Population Differences and Analysis of Bilirubin Kinetics [Review Article]

Objectives To compare available nomograms in the literature defining trends in bilirubin levels across populations with different risk factor profiles and to study a mathematical bilirubin kinetics model describing the natural course of jaundice and the bilirubin rate of rise needed to cross percentile curves. Data Sources We searched PubMed for publications between March 1999 and March 2009 that created transcutaneous nomograms. We performed the same search among abstracts presented in the past 2 years at meetings of the Pediatric Academic Societies or the European Society for Paediatric Research. Study Selection Inclusion criteria were gestational age of at least 35 weeks among study subjects, the use of an electronic transcutaneous bilirubinometer, and creation of a nomogram based on hour-specific bilirubin values. Four articles met the selection criteria. Data Extraction Jaundice risk factors were analyzed, and raw data were analyzed using nonlinear regression to describe trends in bilirubin levels and kinetics. The bilirubin exaggerated rate of rise needed to cross percentile curves was calculated. Data Synthesis Significant differences in bilirubin values exist across populations, and there is substantial variability in rates of rise. Hispanic neonates demonstrate higher rates of rise and later plateaus. Bilirubin rates of rise tend to plateau and become null (equilibrium between bilirubin production and elimination) at about 96 hours of life. Rates of rise needed to cross percentile curves decrease over time but are lower (approximately 0.11 mg/dL/h [to convert bilirubin level to micromoles per liter, multiply by 17.104]) in the first 48 hours of life than previously thought. Conclusions Transcutaneous bilirubin levels plateau and then decrease after about 96 hours of life in healthy neonates, with some differences across populations. A bilirubin rate of rise higher than in the previous period implies that bilirubin production exceeds elimination and indicates high risk for subsequent hyperbilirubinemia in neonates.

Picture of the Month--Quiz Case [Special Feature]

Picture of the Month--Diagnosis [Special Feature]

Children of the Recession [Editorial]

The Ethics of Hematopoietic Stem Cell Donation by Minors [The Pediatric Forum]

The Ethics of Hematopoietic Stem Cell Donation by Minors--Reply [The Pediatric Forum]

Actual vs Preferred Sources of Human Papillomavirus Information Among Black, White, and Hispanic Parents [The Pediatric Forum]

Take Me Home: Protecting America's Vulnerable Children and Families [Book Reviews and Other Media]

Bronchiolitis and Respiratory Syncytial Virus [Advice for Patients]