Although individual IRB chairpersons and oncology investigators may have important differences of opinion concerning the ethics of phase I trials, these disagreements do not represent a widespread area of ethical conflict in clinical research.

OBJECTIVE. To assess primary care pediatricians' (PCPs') perceptions of caring for children and youth with special health care needs (CYSHCN). METHODS. Cross-sectional survey of Illinois pediatricians. RESULTS. Thirty-five percent of surveys were returned and 26% were analyzed. The top 3 perceived barriers were insufficient time (72%), insufficient reimbursement (68%), and lack of support services (59%). Insufficient interest was the least cited barrier (19%). Preparedness to perform tasks related to care of CYSHCN ranged from 89% for accessing early intervention services to 24% for billing and coding. The percentage of PCPs somewhat or very comfortable providing primary care to patients with technology dependence ranged from 75% for blood glucose monitoring to 12% for dialysis. CONCLUSIONS. The issues of time, reimbursement, billing, and coding are perceived as significant barriers to the care CYSHCN. There is substantial variation in PCPs' comfort in the care of CYSHCN who require the assistance of medical technologies.

About 60% of respondents were re-hospitalized at least once for diabetes-related reasons (n = 128). Half of those questioned had Medicaid or no health insurance at all; 23% fit criteria for a non-autoimmune, type 2 diabetic phenotype. Those who avoided re-hospitalization were more likely to have been seen initially at a tertiary care facility, to have private health insurance, and to be males. They had, on average, 2 yr shorter duration of diabetes at the time of interview. Risk for re-hospitalization was not associated with age at diagnosis, ethnicity, diabetic phenotype, or source of care during the past year. In multivariate analysis, predictors of re-hospitalization were gender [odds ratio (OR) 1.98 for females vs. males (95% confidence interval (CI) = 1.05-3.72)], duration of diabetes [OR = 1.46 per yr (95% CI = 1.36-1.57)], initial ascertainment at a community hospital [OR = 5.44 vs. tertiary care facility (95% CI = 2.61-11.29)] and having Medicaid or no insurance [OR = 2.73 (95% CI = 1.42-5.24)], compared with those with another type of health insurance. There is a high risk of re-hospitalization after the initial diagnosis of diabetes among insulin-treated minority children, particularly the uninsured and those on Medicaid, in part related to duration of disease and where the initial treatment occurred.

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Most PCPs did not want additional CYSHCN in their practices. Variation exists in PCP preparation to care for varying conditions and in familiarity with supportive programs.