A regional pediatric approach to the epidemic of social ills within our cities

Article Abstract:

The regional approach to providing health care would function on the basis of need and the availability of services. Rather than being limited by geographic boundaries, it would reflect the growth and development of urban centers and extends into neighboring rural communities. According to this approach, medical facilities would include complete primary services with private practice physicians, nurse practitioners and their counterparts in community and tertiary hospitals; neighborhood hospitals as a secondary level of services; and tertiary care consisting of hospitals associated with medical schools. Facilities offering specialized services would accept all referrals. Interplay and communication between physicians and facilities would be necessary for the success of this program. Competitive professional advertising would be eliminated. The regional approach would also favor and encourage an open door of communication between local practitioners and those in academia. Physicians' concerns should extend beyond the care of their own patients into the community, and include providing services to those who would otherwise be underserved or unserved. Who pays for this system of care is an issue. Voluntary services should be offered, and financial support would be sought from local businesses, corporations, foundations, labor unions and their members, and private citizens. A major revision of the health insurance policies currently in place, which exclude almost as many persons as are included, would be critical to success. Insurance premiums would be dependent on need and use of services. Children and the community would benefit from the regional approach to providing health care. Pediatricians are especially qualified to advocate for children's health care services and can play a significant role in reversing the devastating effects of poverty on the health of American children. (Consumer Summary produced by Reliance Medical Information, Inc.)

Social aspects, Innovations, Community health services, Child health services, Regional medical programs, Community health services for children

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Pediatric cardiac rehabilitation

Article Abstract:

Cardiac rehabilitation programs (CRPs) have been valuable in treating adult patients with heart disease. Similar programs have been developed for children with heart disease, those at high risk of coronary artery disease, and children with chronic illnesses who would benefit from graded exercise programs. These programs may help children and parents overcome anxiety about exercise following treatment of heart defects or diseases. The goals of one program, similar to others, are to assist patients in attaining the best possible physiologic and psychological function; to reverse the deconditioning effects of sedentary habits; to use education in facilitating adoption of life-styles with low cardiovascular risks; to improve emotional health; and to reduce the need for medical care. The evaluations and treatments used in the program are described. Sixteen patients enrolled in the program, all of whom were ignorant about exercise principles and had exercise-related anxiety. Six patients finished the program, which was shortened from six to three months. Three of the six patients had been surgically treated for congenital heart defects. After the CRP, the six patient's resting blood pressure decreased, but there was no change in heart rate. The amount of time that exercise was tolerated increased, as did maximal cardiovascular work. No complications developed. Ways in which the program were modified and improved are discussed. (Consumer Summary produced by Reliance Medical Information, Inc.)

Methods, Children, Exercise therapy, Cardiac patients, Chronically ill children, Exercise therapy for children

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