Factors associated with toilet training in the 1990s.

CONTEXT: Few studies have systematically evaluated the factors influencing toilet training in children with normal development. OBJECTIVES: To determine those child, parent, and environmental factors associated with toilet training completion, focusing on the influence of the child's temperament and development. DESIGN AND SETTING: Cross-sectional descriptive study of normal children, ages 15-42 months, attending 1 of 4 pediatric clinics in Milwaukee in 1995 and 1996. METHODS: Demographics for child, parents, and household were surveyed. Temperament was assessed using the Toddler Temperament Scale and the Behavioral Style Questionnaire. Child development was measured using the Bayley Scales of Infant Development II. MAIN OUTCOME MEASURE: Toilet training status was by parental report and was categorized as not trained, not currently training, in training, or training complete. RESULTS: The study population included 496 children, comprising 219 that had not started training, 70 that were not currently training, 148 that were in training, and 59 that were completely trained. The ages at which 50% of the children were predicted to be toilet trained were 35 and 39 months for girls and boys, respectively. In the multivariate regression model, statistically significant factors best predicting toilet training completion were older age, non-Caucasian race, female gender, and single parenthood. Temperament, development, maternal employment, or use of day care were not statistically significant factors. CONCLUSION: Innate factors such as older age, non-Caucasian race, and female gender are the best predictors of completing toilet training (rather than a child's temperament and developmental stage). Day care and maternal employment appear to be unimportant variables. Parents should not be discouraged, because children are completing toilet training at older ages. Research is needed to discover why single parents are more successful at toilet training.

Relationship between systematic feedback to faculty and ratings of clinical teaching.

PURPOSE: To examine whether frequent written feedback to faculty would improve their teaching in clinical settings. METHOD: Forty-four pediatrics faculty at the Medical College of Wisconsin participated in 1987 and 1988 in a prospective randomized trial of feedback about clinical teaching. During a six-month baseline period all the faculty were rated on ten teaching traits by residents and students using a seven-point Likert scale; evaluation summaries were placed in the teaching folders of the faculty. During a 12-month treatment period, 21 faculty were randomly selected to be given directed feedback every two months in the form of mailed computer-generated summaries that contained the most recent and cumulative mean ratings for the individual faculty member and the department, as well as written comments. Mean ratings were compared within the feedback and control groups and between the two groups by using two-tailed paired t-tests and Student's t-tests, respectively. RESULTS: The faculty receiving feedback showed significantly increased ratings over time for the traits of knowledge (p = .025), demonstrates skill(s) (p = .001), provides feedback to trainee (p = .006), and sets reasonable expectations (p = .03). The faculty receiving feedback had an average increase in ratings across all ten traits that was significantly greater than the average increase of their control-group peers (p < .05). Those in the feedback group who had received mean ratings for overall teaching effectiveness that were below the department mean at baseline showed the greatest improvement by the end of the treatment period (p < .05). CONCLUSION: The provision of written feedback improved the ratings of teaching effectiveness, especially among the faculty who had been rated below average.

Increasing rubella seronegativity despite a compulsory school law.

To determine if lower rubella susceptibility persisted five to seven years after immunization legislation, we retrospectively reviewed the serologic status of 341 outpatients from 1985 to 1987 in an inner-city school age population. Seronegative rates increased significantly during the two-year study period from 4.2 to 24.5 percent (17 percent overall). (Beta = 6.8%, 95% CI = 3.3, 10.3). Charts were reviewed for 57 of 58 seronegative and 114 seropositive controls. Estimates were then made to the population of 341 subjects. Those with documented rubella immunization had a seronegative rate of 13 percent compared to 19 percent if the immunization status was unknown. For patients who received care in our clinic for less than two years, 32 percent were seronegative compared to 10 percent for those treated greater than or equal to 2 years (odds ratio = 0.31, 95% CI = 0.16, 0.60). Among patients immunized in 1977 or 1978, 33 percent were seronegative compared to 7 percent immunized at other times (OR = 0.21, 95% CI = 0.07, 0.63). Factors associated with increased rubella seronegativity include immunization in 1977 or 1978 and lack of continuity of care in our clinic. Much of the increase remains unexplained.

Effects of hospitalization derived from a family diary. Review of the literature.

Management of psychosocial issues associated with hospitalization are essential to the practice of pediatrics. The personal experience of our son's prolonged hospitalization due to osteomyelitis (23 days) was detailed by an ongoing diary. The impact of this hospitalization on our family is presented, including: 1) normal but bothersome behavioral changes in the patient and his sibling; 2) the effects of excessive parental stress; 3) the development of parental coping strategies; and 4) stresses and coping strategies specific to a physician-father. Specific recommendations are presented to assist health professionals in addressing psychosocial issues.

Hemoglobin New Mexico: beta 100 (G2) Pro----Arg. A variant hemoglobin associated with erythrocytosis.

Hemoglobin New Mexico beta 100 Pro----Arg was found in a 4-year-old black male and represents a new mutation. The propositus is also heterozygous for Hb S. The variant shows high oxygen affinity, reduced cooperatively, and a lowered alkaline Bohr effect. Addition of allosteric effectors leads to improved cooperativity and a Bohr effect that is similar to that of Hb A. The high percentage of the variant (53.5%) and its increased oxygen affinity result in erythrocytosis in this patient. The hemoglobin level and packed cell volume values are elevated. In spite of these factors the patient appears healthy and shows no discomfort. The altered oxygen-linked properties of this variant can be related to the fact that the substituted residue contributes to the alpha 2 beta 1/alpha 1 beta 2 subunit interface, an area that is critical not only to the allosteric transitions between the oxy and deoxy states but also to stabilizing the hemoglobin tetrameer.

Effects of packaging and appearance on childhood poisoning. Vacor rat poison.

Over a 13-month period, 14 patients were hospitalized at Milwaukee Children's Hospital for rodenticide ingestions. Ten of the 14 patients ingested Vacor Rat Poison (N-3-pyridylmethyl N'-p-nitrophenyl urea). Small children could easily mistake Vacor, which resembles corn meal, for breakfast cereal. To intervene for safer packaging of toxic substances, pediatricians need to be aware of the health hazard posed to children by attractive packaging.

Neonatal intraventricular hemorrhage due to an intracranial arteriovenous malformation: a case report.

A full-term newborn infant with intraventricular hemorrhage due to a small arteriovenous malformation draining into the vein of Galen is presented. Other reported series are reviewed, and differences between this case and the usual pattern of morbidity are discussed. The use of computerized tomography is demonstrated.