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Context: The process of epiphyseal fusion during puberty is regulated by estrogen, even in males., Objective: Our objective was to investigate whether anastrozole, a potent aromatase inhibitor, could delay bone age acceleration and increase predicted adult height in adolescent boys with GH deficiency., Methods: Fifty-two adolescent males with GH deficiency treated with GH were randomized to cotreatment with anastrozole or placebo daily for up to 36 months., Results: Fifty subjects completed 12 months, 41 completed 24 months, and 28 completed 36 months. Linear growth was comparable between groups; however, there was a significantly slower increase in bone age advancement from baseline in the anastrozole group vs. placebo group after 2 yr (+1.8+/-0.1 vs. +2.7+/-0.1 yr, P<0.0001) and after 3 yr (+2.5+/-0.2 vs. +4.1+/-0.1 yr, P<0.0001). This resulted in a net increase in predicted adult height of +4.5+/-1.2 cm in the anastrozole group at 24 months and +6.7+/-1.4 cm at 36 months as compared with a 1-cm gain at both time points in the placebo group. Estradiol and estrone concentrations increased less in the anastrozole group compared with placebo group. All boys on the aromatase inhibitor had normal tempo of virilization. Safety data, including glucose, and plasma lipid concentrations were comparable between groups., Conclusions: Anastrozole increases adult height potential of adolescent boys on GH therapy while maintaining normal pubertal progression after 2-3 yr. This treatment offers an alternative in promoting growth in GH-deficient boys in puberty. Long-term follow up is needed to elucidate fully the safety and efficacy of this approach.

Objective: To replicate an anomalous psychometric profile previously documented in children with Type 1 diabetes living in the mainland United States with a cross-cultural sample selected from Puerto Rico., Methods: Ninety-three Spanish-speaking children (M age = 12.8 years) with Type 1 diabetes living in Puerto Rico were administered the Puerto Rican version of the Wechsler Intelligence Scale for Children-Revised (WISC-R). The factor structure of the Puerto Rican sample's WISC-R was then compared to that of a United States sample (n = 95) in which an anomalous factor structure in children with diabetes was first documented., Results: As in the United States sample, a four-factor IQ structure was obtained. Instead of the traditional three-factor structure of the WISC-R, the Perceptual Organization factor split into a Spatial Conceptual factor and an anomalous Visual Discrimination factor., Conclusions: Results support previous findings and suggest anomalies in the psychometric profiles of children with Type 1 diabetes. Cross-cultural replication of the anomalous IQ factor structure, and atypical visual discrimination, suggests that differences are illness-related, and consideration may therefore be warranted when administering some subtests of the Wechsler scales to children with Type 1 diabetes.

Objective: To examine self-care behaviors among children and adolescents with type 1 diabetes living in Puerto Rico, to determine the relationship between self-care and demographic variables, and to investigate the utility of the 24-hour recall interview within a Hispanic population., Method: Forty-one children (M age = 12.6 years) with type 1 diabetes, and their mothers, were administered the 24-hour recall interview on three separate occasions to assess diabetes-related self-care behaviors., Results: Children reported self-care behaviors that included daily administration of an average of two insulin injections and two blood glucose tests, and consumption of 5.5 meals a day comprised of 52% carbohydrates and 29% fat. Younger age, female gender, longer illness duration, and better metabolic control were associated with higher rates of several self-care behaviors., Conclusions: Data provide a first look at self-care behaviors of children with type 1 diabetes living in Puerto Rico and suggest the utility of the 24-hour recall interview within this population.

Care coordination is a process that links children with special health care needs and their families to services and resources in a coordinated effort to maximize the potential of the children and provide them with optimal health care. Care coordination often is complicated because there is no single entry point to multiple systems of care, and complex criteria determine the availability of funding and services among public and private payers. Economic and sociocultural barriers to coordination of care exist and affect families and health care professionals. In their important role of providing a medical home for all children, primary care pediatricians have a vital role in the process of care coordination, in concert with the family.