OBJECTIVE -We sought to examine the distribution of insulin and homeostasis model assessment of insulin resistance (HOMA-IR) and associations of HOMA-IR with sex, race/ ethnicity, age, and weight status, as measured by BMI, among U.S. adolescents. Health and Nutrition Examination Survey 1999 -2002, analysis was performed for a nationally representative subsample of 1,802 adolescents without diabetes who had fasting laboratory measurements. The main outcome measure was HOMA-IR, calculated from fasting insulin and glucose and log transformed for multiple linear regression analyses. RESEARCH DESIGN AND METHODS -Of 4,902 adolescents aged 12-19 years who participated in the NationalRESULTS -In adjusted regression models that included age and weight status, girls had higher HOMA-IR than boys and Mexican-American children had higher HOMA-IR levels than white children. There were no significant differences in adjusted HOMA-IR between black and white children. Obese children (BMI Ն95th percentile) had significantly higher levels of HOMA-IR compared with children of normal weight (BMI CONCLUSIONS -Obesity in U.S. adolescents represents the most important risk factor for insulin resistance, independent of sex, age, or race/ethnicity. The prevalence of insulin resistance in obese children foreshadows a worrisome trend for the burden of type 2 diabetes in the U.S. Diabetes Care 29:2427-2432, 2006T he pathogenesis of type 2 diabetes in children is hypothesized to be related to two principal factors: insulin resistance and impaired insulin secretion (1). Insulin resistance represents an insensitivity of the peripheral tissues (e.g., muscle, liver, adipose tissue) to the effects of insulin. To maintain glucose homeostasis, pancreatic ␤-cells compensate for insulin resistance by augmenting insulin secretion, leading to a state of chronic hyperinsulinemia. However, the progressive failure of the ␤-cells to maintain adequate insulin secretion is believed to result in the development of type 2 diabetes (2). Longitudinal studies in adults have demonstrated that insulin resistance is strongly predictive of the development of type 2 diabetes (3). Furthermore, studies in obese children have shown that insulin resistance is associated with abnormalities in glucose metabolism, such as impaired glucose tolerance or type 2 diabetes (4). Therefore, there is increasing recognition of the important role of insulin resistance in the pathogenesis of type 2 diabetes in children (1,2,5).Given that insulin resistance represents an important risk factor for development of type 2 diabetes, identification of children with insulin resistance has been proposed as a strategy for identifying high-risk children for targeted diabetes prevention interventions (6). The goldstandard test for insulin resistance includes the hyperinsulinemic-euglycemic clamp (7), and another accepted method is the minimal-model analysis frequently sampled intravenous glucose tolerance test (FSIVGTT) (8). These tests are invasive, labor intensive, and expensive, which discourage...

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Approximately 24% of families with CSHCN have experienced work loss to meet the medical needs of their child. Availability of a system of care support, such as the medical home, is associated with lower work loss reported by families. Therefore, improved systems of care for CSHCN may have the potential to optimize work productivity for families.

General pediatricians and internists report multiple barriers to providing care for adults with childhood-onset chronic diseases. Improvements in office-based support seem to be most associated with perceived quality of care delivery.

Background Youth and young adults with special healthcare needs (YASHCN) experience challenges during transition from pediatric to adult care. Prior studies have not examined how community and healthcare resources can work together to assist YASHCN in transitioning from child-focused care and services to adult-oriented providers. Objective To develop a theoretical understanding of how family, healthcare providers and community supports can assist YASHCN during the transition from pediatric to adult healthcare and services. Design/Methods We conducted 41 semi-structured interviews with YASHCN aged 16-25, their family members and healthcare and community providers. We focused our interviews on support mechanisms, both within the traditional healthcare system, and those available in the community. Using grounded theory methods, we performed a multi-step analysis process. Results The theoretical code “Transition Advocacy” was developed from the data. This theoretical perspective arose from three major categories, which were developed in the analysis: “Fighting for healthcare”, “Obtaining resources”, and “Getting ready to transition”. Transition Advocacy consists of the presence of, or need for, a healthcare ”advocate”’ who did or can assist the YASHCN with the healthcare transition, particularly to navigate complex health or community services. The ”advocate” role was performed by family members, healthcare or agency professionals, or sometimes the YASHCN themselves. If advocates were identified, youth were more likely to obtain needed services. Conclusions Parents, health providers, and community agencies are potentially well-poised to assist transitioning YASHCN. Efforts to encourage development of strong advocacy skills will facilitate better transitions for YASHCN.

The vast majority of persons who have survived to adulthood with complex congenital heart disease, cystic fibrosis, spina bifida, or sickle cell disease are hospitalized in hospitals that predominantly care for adults, where charges for care appear to be lower than in pediatric hospitals.

Thottapalayam virus (TPMV), a member of the genus Hantavirus in the family Bunyaviridae, was isolated from an insectivore, Suncus murinus (musk shrew), captured in southern India in 1964. While the isolation of TPMV predates the discovery of the prototype Hantaan virus, little is known about its genetics and biology. To date, preliminary evidence suggests that TPMV differs significantly, both antigenically and genetically, from all known rodent-borne hantaviruses. However, since detailed epizootiological studies have not been conducted, it is unclear if TPMV is naturally harbored by an insectivore host or if TPMV represents a "spillover" from its natural rodent reservoir host. Moreover, to what extent TPMV causes infection and/or disease in humans is not known. To address these issues, we first studied the antigenic profile of TPMV using monoclonal antibodies against Hantaan and Seoul viruses and polyclonal immune sera against Puumala virus and TPMV. Armed with this newfound information, we developed an enzymelinked immunosorbent assay system for the diagnosis of TPMV infections in shrews and humans, using a recombinant TPMV N antigen manipulated to have an E5/G6 epitope to be captured by monoclonal antibody clone E5/G6. Using this assay, we found anti-TPMV antibodies in sera from a patient with high fever of unknown etiology in Thailand and from two shrews captured in Indonesia. Seropositivity was verified by the indirect immunofluorescence antibody test, Western blotting analysis, and focus reduction neutralization test. Collectively, our data indicate that TPMV is harbored by Suncus murinus as its host in nature and is capable of infecting humans.

Handgrip strength is decreased in the RASopathies. The etiology of the reduced muscle force is unknown, but likely multifactorial.