Tanner stage 4 breast development in adults: forensic implications.

BACKGROUND AND OBJECTIVE: Forensic testimony in alleged child pornography cases commonly asserts that Tanner stage (TS) 4 breast development, characterized by secondary mounding of the areola that is obliterated in TS 5, is evidence of age <18 years. Clinical experience does not support this notion, but there are no relevant studies. We sought to estimate how frequently TS 4 might be interpreted from nonclinical images by individual forensic experts. METHOD: Published images of 547 adult women were independently examined by the authors and classified as having TS 4 or TS 5 breast development. RESULTS: There was concordance among all 4 of the examiners for 17 of the images, agreement of 3 of the examiners on another 36 images, of 2 examiners on 39 images, and 53 images were designated TS 4 by only 1 examiner, for a total of 153 (26.5%) images that could have been considered by a single forensic expert to represent TS 4. CONCLUSIONS: A substantial number of adults have persistent TS 4 breast development. This observation, and the frequent difficulty distinguishing TS 4 from TS 5, even by adolescent development specialists, especially in nonclinical images, renders testimony based on this distinction invalid. Without clinical relevance for distinguishing these advanced stages of breast development, they should both be considered indicative of full maturation. Testimony based on this inappropriate test of maturity should no longer be allowed.

Exploration of food addiction in pediatric patients: A preliminary investigation.

OBJECTIVES: The goals of the present study were to explore the possibility that symptoms of food addiction may exist for some children and to identify factors that may be associated with pediatric food addiction. METHODS: Participants were 50 children (aged 8-19), recruited from the Pediatric Lipid Clinic at a large southeastern teaching hospital, and their parent/guardian. Participants completed questionnaires to assess food- and eating-related attitudes and behaviors, as well as symptoms of food addiction. RESULTS: Parent- and child-reported behaviors and attitudes demonstrated similar patterns. Child BMI ratings were significantly correlated with overeating (r = .42, p = .02) and emotional eating (r = .33, p = .04). Of note, 15.2% of children indicated that they "Often," "Usually," or "Always" think that they are addicted to food, and an additional 17.4% reported that they "Sometimes" feel that way. Food addiction symptoms were significantly correlated with child overeating (r = .64, p < .001), uncontrolled eating (r = .60, p < .001), emotionol eating (r = .62, p < .001), food preoccupation (r = .58, p < .001), overconcern with body size (r = .54, p < .001), and caloric awareness and control (r = -.31, p = .04). CONCLUSIONS: Results of the present study suggest that "food addiction" may be a real problem for a subset of children who suffer from overweight/obesity. Identification of food addiction may improve obesity treatment efforts for this subset of patients.

Improved access to subspecialist diabetes care by telemedicine: cost savings and care measures in the first two years of the FITE diabetes project.

We have used telemedicine clinics supplemented by online education to provide effective care for children with diabetes. Before the programme began, the mean interval between visits was 149 days; in year 1 of the programme it was 98 days, and in year 2 it was 89 days. Before the programme, there were on average 13 hospitalizations a year (47 days) and this decreased to 3.5 hospitalizations a year (5.5 days). Emergency department visits decreased from 8 to 2.5 per year. On 10 occasions after the programme started, ketosis was managed by telephone intervention alone, relying on family-initiated calls. Over 90% of patients and family members expressed satisfaction with the telemedicine service and wished to continue using it. In all, 95% felt little self-consciousness. Over 90% felt their privacy was respected. The programme saved US dollar 27,860 per year. The present study demonstrated improved access to specialized health care via telemedicine in combination with online education improved health status and reduced costs by reducing hospitalizations and emergency department visits.

School nurse, family and provider connectivity in the FITE diabetes project.

The Florida Initiative in Telehealth and Education (FITE) diabetes project includes a system of remote blood glucose monitoring and online education for school personnel, families and providers. Forty-four patients with diabetes (100% of patients), six caregivers, six case managers and 18 school nurses were provided with secure email access, allowing blood glucose and other data transfer. In all, 50% of school nurses and 100% of case managers completed educational modules on the FITE Website. Over 90% of patients and all school nurses received equipment for transmitting blood glucose data to their computers. The data were discussed during clinic appointments. Inclusion of previously unavailable data from school nurses contributed to fine-tuning the diabetes management regimen. Those patients, families and school nurses who chose to transmit blood glucose data and participate in online education expressed satisfaction with the technology, the process and the improved communication.

Advances in telemedicine in the 21st century.

Increasing demands on practitioners' time and increasing complexity of patient education and management have created a demand for creative solutions to providing for those needs. Telemedicine can answer some of those needs. Further documentation of the efficacy and cost-effectiveness of telemedicine and education is important but should not hinder the provision of care that is required yet unavailable by traditional means.