Infancia en blanco y negro: La experiencia de la crianza en Estados Unidos a principios del siglo XX

In this paper, I am going to discuss children’s agency, but will also consider the ways that national discourses regarding mothering, gender roles, race, hygiene and healthcare, shaped the everyday experience of childhood in the early 20th century. My archaeological evidence will be drawn from four early twentieth- century American house sites. Despite the diversity of economic, employment and ethnoracial experiences of these families, each family found their nurturing and rearing of children shaped by discourses debated outside of the home.En este artículo se analiza la capacidad de los niños para actuar en su mundo, pero también las maneras en que los discursos nacionales relativos a la maternidad, roles de género, raza, higiene y salud, modelaron las experiencias cotidianas de la infancia en los inicios del siglo XX. La evidencia arqueológica que voy a analizar proviene de cuatro viviendas norteamericanas de principios del siglo XX. A pesar de la diversidad de experiencias económicas, etno-raciales y de subsistencia de estas familias, todas vieron la alimentación y la crianza de sus hijos modeladas por discursos creados fuera del ámbito doméstico

Pediatric Cellulitis: A Red-Hot Concern

Cellulitis and other skin and soft tissue infections are a common reason for children to seek care, both in the primary care setting and the emergency department. Cellulitis is a common skin and soft-tissue infection that is usually caused by streptococci bacteria or, less commonly, Staphylococcus aureus. Most children recover quickly from cellulitis, but a small subset will require hospitalization. Practitioners need to be skilled in the diagnosis and treatment of cellulitis, including recognition of the need for inpatient treatment. However, diagnosis of cellulitis, and exclusion of complicated or other more serious infections, can be challenging. Management of these infections has also been highly variable, resulting in some difficulty identifying the ideal treatment regimen. The goal is to use the antibiotic with the narrowest spectrum for the shortest duration necessary to provide clinical improvement. Research to identify the best treatment for pediatric cellulitis will be important moving forward

Comparison of Macrolide Use in Hospitalized Children with Community Acquired Pneumonia (CAP) Before and After the Publication of Clinical Practice Guidelines

poster abstractIntroduction The 2011 Pediatric Infectious Disease Society (PIDS) and Infectious Diseases Society of America (IDSA) guidelines for treatment of community-acquired pneumonia (CAP) in children recommend the addition of a macrolide to a beta-lactam antibiotic for hospitalized children in whom atypical pneumonia is a concern. Studies have demonstrated shorter lengths of stay for school-aged children treated with combination therapy versus those treated with a beta-lactam alone. In light of the emerging benefits of combination therapy, we sought to determine if use of macrolides for children hospitalized with CAP had changed after the publication of the PIDS/IDSA guidelines. Methods Administrative records for children with a primary discharge diagnosis of pneumonia from January 1, 2009 through June 30, 2013, were collected from the Pediatric Health Information System (PHIS) database. The number of children who received macrolides prior to (pre-guideline group) and after (post-guideline group) publication of the guidelines were compared using Chi Square test. Groups were further analyzed based on age to determine if macrolides had been used more frequently in school-aged children. Results There was not a significant overall difference in the use of macrolides before and after publication of the IDSA guidelines (p0.18). Of the pre-guideline group (n=6496), 31.1% received a macrolide, compared to 32.4% of the post-guideline group (n=3527). There was also not a significant change in the use of macrolides by age: infant/preschool (0-5yrs), p0.12; young school-aged (6-10yrs), p0.33; older school-aged (≥11yrs) p0.98. Discussion The lack of a significant increase in the use of macrolides after publication of the guidelines may be due to many factors, including a time lag between publication and adoption into clinical practice. Further studies using data collected after publication of the guidelines will provide insight into clinical practice changes. Of particular interest will be whether use of macrolides in school-aged children will increase given the demonstrated benefits in length of hospitalization for this age group. Infant and pre-school-aged children treated with combination therapy have not been shown to benefit from the addition of a macrolide, and costs of hospitalization in this group have also been higher. Thus, further studies examining the use of macrolides for CAP in this age group would also be valuable

Spirometry use in patientswith sickle cell disease with and without asthma and acute chest syndrome: Amulticenter study

A de‐identified data repository of electronic medical record data, i2b2 (Informatics for Integrating Biology and the Bedside), including four geographically diverse academic medical centers, was queried to determine the use of diagnostic spirometry testing in African American children and young adults 5‐34 years of age with sickle cell disease (SCD) with or without a documented history of asthma and/or acute chest syndrome (ACS). A total of 2749 patients were identified with SCD, of these 577 had asthma and 409 had ACS. Cross‐referencing the CPT code for diagnostic spirometry showed that for patients identified as having SCD, a history of ACS, and a diagnosis of asthma, only 31% across all four centers had spirometry. Having an asthma diagnosis was associated with ACS. Among SCD patients with asthma, the proportion with ACS for the four centers was 47%, 75%, 38%, and 36% respectively. The bivariate association between asthma and ACS for each Center was significant for each (P < .001). To summarize, only one third of patients with co‐morbid SCD, ACS, and asthma received the spirometry procedure as recommended in evidence‐based guidelines, suggesting limited testing for changes in pulmonary function. Future studies to determine barriers and facilitators to implementation of pulmonary testing in SCD are warranted