Minding the gap: training in adolescent medicine when formal training programmes are not available.

There is a growing need for healthcare professionals to extend their knowledge in adolescent health care. Formal training curricula in adolescent medicine have been developed in only the United States, Canada and Australia. The Israeli experience in building an infrastructure that allows physicians to train in adolescent medicine is described. It includes the development of hospital-based and community-based multidisciplinary adolescent health services, a 3-year diploma course in adolescent medicine and a simulated patient-based programme regarding communication with adolescents. In the course of one decade an infrastructure has been developed to create a cadre of physicians who are able to operate adolescent clinics and to teach adolescent medicine. Consequently a formal fellowship training programme in adolescent medicine has been recently approved by the Scientific Council of the Israel Medical Association. This model can be applied in countries where formal training programmes in adolescent health care are not yet available.

Imaging after urinary tract infection in male neonates.

OBJECTIVE: To assess the frequency of urinary tract anomalies in male neonates <8 weeks old who presented with urinary tract infection (UTI), and to evaluate a suitable imaging approach after the initial infection. DESIGN: During a period of 4.5 years, from July 1994 through December 1998, 45 male neonates <8 weeks old (range: 5-56 days; mean: 23.77 days) with UTI were hospitalized. All patients had an ultrasound (US) and a voiding cystourethrogram (VCUG), except 1 neonate in whom VCUG was unsuccessful because of technical problems. A dimercaptosuccinic acid (DMSA) scan was recommended to all patients but was performed only in 30 of 45, most of them with an abnormal VCUG. The renal scan was performed at least 4 months after the UTI. RESULTS: Urinary tract abnormalities were observed in 22 of 45 male neonates. Nineteen had vesicoureteral reflux (VUR), 1 had VUR and a double collecting system, 1 had VUR and a posterior urethral valve, and 1 had an ureteropelvic junction stricture. Renal atrophy or scars, as demonstrated by DMSA scan, were detected almost exclusively in neonates with VUR grade 3 and above. Only 1 neonate with VUR grade 1 had a pathologic DMSA, and the US of this male also demonstrated renal atrophy. Escherichia coli was the pathogen in 62% (28 of 45), and 9 boys had bacteremia. CONCLUSION: We suggest that US and VCUG should be performed routinely after the initial UTI in male neonates. Renal scan should be reserved for those cases in which the US suggests renal parenchymal damage or when VCUG detects VUR grade 3 and above.