Adjustment Among Area Youth After the Boston Marathon Bombing and Subsequent Manhunt
Research in the aftermath of large-scale terrorist attacks shows that exposed children experience numerous negative psychological sequelae, including increased emotional difficulties, posttraumatic stress, and significant attack-related life disruptions.
Most research on terrorism-exposed youth examines large-scale terrorism. Limited work examines reactions to terrorism of the scope of the marathon attack, and the extraordinary manhunt and shelter-in-place warning was an unprecedented experience. Understanding adjustment after these events is critical.
Rotavirus Vaccines and Health Care Utilization for Diarrhea in the United States (2007–2011)
Since the introduction of rotavirus vaccines, diarrhea-associated health care utilization among US children has decreased substantially. Moreover, indirect benefits from rotavirus vaccination have been observed in unvaccinated children and in adults.
With increasing rotavirus vaccine coverage during 2009–2011, we observed continued reductions in diarrhea-associated health care utilization and cost. Both rotavirus vaccines conferred high protection against rotavirus hospitalizations; pentavalent rotavirus vaccine provided durable protection through the fourth year of life.
Impact of Vaccination on the Epidemiology of Varicella: 1995–2009
Varicella vaccine is effective, but there is concern that widespread use in young children may lead to a shift in the age of infection, with potentially more severe disease later in childhood and adolescence.
This study documents that varicella vaccine resulted in a decline of varicella incidence and hospitalization in all age groups, with no shift to older age groups.
The Transition to ICD-10-CM: Challenges for Pediatric Practice
The US health care system transition to the ICD-10-CM will occur in October 2015. The logistical and financial impact of the transition for billing codes frequently used by pediatricians has not been studied.
The findings of this study evaluate the government-provided mappings from ICD-9-CM to ICD-10-CM for accuracy and provide the diagnostic codes used by pediatricians, which may be adversely affected by the transition to ICD-10-CM.
Effectiveness of Anti-TNFα for Crohn Disease: Research in a Pediatric Learning Health System
Studies on adult patients who have Crohn disease have shown a comparative benefit of anti-TNFα versus placebo and thiopurines. These same studies have not been done in children, because of time, cost, and ethical (withholding an efficacious treatment) challenges.
Anti-TNFα therapy administered in routine practice to children with Crohn disease was more effective than usual care at achieving clinical and corticosteroid-free remission. Using data from the ImproveCareNow learning health system for observational research is feasible and produces valuable evidence.
Development of Guidelines for Skeletal Survey in Young Children With Fractures
Rates of performing skeletal survey (SS) for young children presenting with fractures and at risk for abuse vary substantially across providers, with disparities associated with patients’ characteristics. Lack of consensus regarding indications for SS also contributes to this variation.
The results of this study provide a set of explicit consensus guidelines, based on the literature and on the knowledge of experts from several medical specialties, for identifying children with fractures who should undergo an initial SS.
Acute Concussion Symptom Severity and Delayed Symptom Resolution
Children are often evaluated in the emergency department after a concussion. Although prolonged symptoms are associated with higher initial symptom severity when measured 2 to 3 weeks after injury, a similar association with acute symptom severity has not been demonstrated.
Higher acute symptom severity is not associated with development of persistent post-concussion symptoms 1 month after injury, but persistent post-concussive symptoms affect a significant number of children after concussion. Outpatient follow-up is essential to identify children who develop persistent symptoms.
Firearm Homicide and Other Causes of Death in Delinquents: A 16-Year Prospective Study
Homicide is the third leading cause of mortality in general population youth aged 15 to 29 years. Groups at greatest risk for early violent death (racial/ethnic minorities, males, poor persons, and urban youth) are overrepresented in the juvenile justice system.
We examined rates of and risk factors for firearm homicide and other causes of death in delinquents 16 years after detention. Our study analyzes gender differences; compares Hispanics, African Americans, and non-Hispanic whites; and includes a representative sample of delinquents.
Baby-MONITOR: A Composite Indicator of NICU Quality
The traditional process-focused approach to quality improvement has not remedied NICUs’ inconsistency in quality of care delivery across clinically important measures. Global measurement of quality may induce broad, systems-based improvement, but must be formally studied.
We present a systematically developed and robust composite indicator, the Baby-MONITOR, to assess the quality of care delivered to very low birth weight infants in the NICU setting.
Five-Year Follow-up of Community Pediatrics Training Initiative
Compared with their peers, pediatric residents who report exposure to community settings anticipate greater future community involvement at the end of training. The impact of community pediatrics training on actual future community involvement is not known.
Pediatricians exposed to enhanced community pediatrics training during residency report greater participation in community activities and greater related skills than their peers nationally.
The Medical Cost of Abusive Head Trauma in the United States
Children with shaken-baby syndrome, or abusive head trauma (AHT), have lasting health and development problems. The long-term medical cost of AHT is unknown.
Patients with AHT had higher inpatient, outpatient, and drug costs compared with other children for 4 years after their abuse diagnosis, amounting to tens of thousands of dollars in excess and preventable medical care per patient with AHT.
Readmissions Among Children Previously Hospitalized With Pneumonia
Pneumonia is a leading cause of hospitalization among children, and readmissions after discharge are common.
Eight percent of children experience a readmission within 30 days after hospital discharge for pneumonia. Readmissions are most common among young children and those with chronic medical conditions, and are associated with substantial costs.
Early-Onset Basal Cell Carcinoma and Indoor Tanning: A Population-Based Study
Indoor tanning has gained widespread popularity among adolescents and young adults. Incidence rates of early-onset basal cell carcinoma also appear to be rising. Scant evidence exists on the impacts of early exposure and whether it leads to early occurrence of this malignancy.
In a US population-based study, indoor tanning was associated with an elevated risk of basal cell carcinomas occurring at or before the age of 50 years, with an increasing trend in risk with younger age at exposure among adolescents and young adults.
Adverse Childhood Experiences of Low-Income Urban Youth
Adverse childhood experiences have been shown to have long-term impacts on health and well-being. However, little work has been done to incorporate the voices of youth in understanding the range of adverse experiences that low-income urban children face.
Study participants cited a broad range of adverse experiences beyond those listed in the initial adverse childhood experience studies. Domains of adverse experiences included family relationships, community stressors, personal victimization, economic hardship, peer relationships, discrimination, school, health, and child welfare/juvenile justice systems.
Sexting and Sexual Behavior Among Middle School Students
Sending and receiving sexually explicit picture and text messages (sexting) is related to sexual activity and risk behavior among some high school populations, yet little is known about sexting associations with sexual activity and risk behavior among middle school students.
This study is the first to examine sexting among a probability sample of middle school students and found that middle school students who text excessively and send and receive sexts are more likely to report being sexually active.
Exposure to Electronic Cigarette Television Advertisements Among Youth and Young Adults
Electronic cigarettes have unknown health risks and youth and young adults increasingly use them. E-cigarette companies are marketing e-cigarettes using television ads. The content of these ads may appeal to young people because they emphasize themes of independence and maturity.
E-cigarette companies advertise to a broad television audience that includes 24 million youth. The reach and frequency of these ads increased dramatically between 2011 and 2013. If current trends continue, youth awareness and use of e-cigarettes are likely to increase.
Gestational Age and Age at Sampling Influence Metabolic Profiles in Premature Infants
Prematurely born infants commonly have abnormal metabolic screens.
Both gestational and chronological age influence metabolic profiles used to screen for inborn errors of metabolism.
Comparison of Rapid Cranial MRI to CT for Ventricular Shunt Malfunction
Rapid cranial MRI is a radiation-free method to assess children with possible ventricular shunt malfunction. However, the test performance of rapid cranial MRI has never been compared with that of cranial CT, the current reference standard.
The accuracy of rapid cranial MRI was not inferior to that of CT for diagnosing ventricular shunt malfunction. Rapid cranial MRI is an important radiation-sparing diagnostic alternative for children presenting emergently with possible ventricular shunt malfunction.
A Parent Questionnaire for Developmental Screening in Infants Born Late and Moderately Preterm
Children born late and moderately preterm are at increased risk of developmental problems compared with term-born peers. Screening for developmental problems in the early years may thus aid in the early identification of children at risk for adverse outcomes.
The Parent Report of Children’s Abilities-Revised has good concurrent validity and 90% sensitivity and 76% specificity for identifying moderate/severe cognitive developmental delay in infants born late and moderately preterm. This parent questionnaire may be used as a clinical screening tool.
Autism Spectrum Disorders and Race, Ethnicity, and Nativity: A Population-Based Study
Autism prevalence is reported to be highest among non-Hispanic white children, lower in Hispanic and African American/black children, and highly variable in Asian/Pacific Islanders. More comorbid intellectual disability and delays in expressive language have been observed among Hispanic and African American children.
Maternal nativity is a risk factor for childhood autism in US populations. We observed higher risk of severe autism phenotypes in children of foreign-born black, Central/South American, Filipino, and Vietnamese mothers and US-born African Americans and Hispanics compared with US-born whites.
Caregiver-Mediated Intervention for Low-Resourced Preschoolers With Autism: An RCT
Mixed results exist regarding the efficacy of caregiver-mediated interventions for children who have ASD. To date, randomized controlled studies have rarely compared 2 active interventions; none have focused on targeting families who are low-resourced in the community.
Significant improvements were found in social communication of children who have autism when caregivers received a hands-on caregiver training intervention in the home. These are the first data from a low-intensity, short-term intervention with low-resourced families.
Rate of Spending on Chronic Conditions Among Medicaid and CHIP Recipients
Previous analyses have documented that the prevalence of children with chronic conditions is growing and is responsible for increased growth in hospital charges; however, such utilization trends have not been documented in Medicaid and the Children’s Health Insurance Program.
From 2007 through 2010 in Illinois, children with chronic conditions became Medicaid and Children’s Health Insurance Program recipients at a higher rate than healthy children. In contrast to studies of hospital data, this analysis found per-member spending decreases in most chronic condition groups.
Parental Injury and Psychological Health of Children
Injuries sustained by parents in combat can also have a variety of psychological effects on children in the family. However, there has been little research on the effect of parental injury on children in the civilian setting.
The effects of injury of parents impacted children’s functioning by negatively affecting the health-related quality of life of the injured children, over and above the effect of any injury itself to the child. Injury to the parent also increased the likelihood of his or her uninjured children having PTSD symptoms 5 months after the parent’s injury.
Age at Referral and Mortality From Critical Congenital Heart Disease
Early referral of infants with critical congenital heart disease (CCHD) is recommended to reduce mortality. However, few population-based data have been published showing the relationship between CCHD neonatal mortality and timing of cardiac evaluation at a specialty center.
In neonates with CCHD, 35% were not evaluated at a cardiac center by 4 days of age. These cases accounted for a significant number of CCHD deaths. This information enhances the rationale for pulse oximetry screening of neonates for CCHD.
Hypertension Screening Using Blood Pressure to Height Ratio
The definition of hypertension in children is complex because of the age-, gender-, and height-specific blood pressure algorithm. Blood pressure to height ratio was reported to easily identify hypertension in Chinese children living in a local area (Hebei Province).
Blood pressure to height ratio index is simple and accurate for screening for prehypertension and hypertension in Chinese children aged 6 to 17 years and can be used for early screening or treating Chinese children with hypertension.
Cardiovascular Responses to Caffeine by Gender and Pubertal Stage
Caffeine has predictable effects on cardiovascular function in both adults and children. Our previous work has shown that there are gender differences in this cardiovascular response, with boys having a greater change in heart rate and blood pressure than girls.
This study shows that the gender differences in cardiovascular response to caffeine emerge after puberty and there are some differences in postpubertal girls across the menstrual cycle.
Emergency Department and Urgent Care for Children Excluded From Child Care
Previous studies have revealed that children in child care are frequently ill with mild illness and are unnecessarily excluded from child care at high rates.
Parent race/ethnicity, single parents, and work-related concerns are associated with increased emergent/urgent care use for a sick child excluded from child care, even for mild illnesses.
The Association of Telomere Length With Family Violence and Disruption
Poor health in children is associated with exposure to family violence and disruption. Telomere length has been hypothesized to be a lasting biological indicator of exposure to early adversity and potentially predictive of negative health outcomes throughout the life course.
Telomere length reflects exposure to family violence and disruption and may be an early indicator of the biological impact of early adversity. Children exposed to interpersonal violence and family disruptions had significantly shorter telomeres. Gender moderated these associations.
Cognitive Deficit and Mental Health in Homeless Transition-Age Youth
Neurocognitive deficits, academic delays, and behavioral and emotional problems are well documented in school-age children in relation to socioeconomic disadvantage and residential instability. Despite adversity, early intervention can facilitate healthy cognitive, emotional, and social development.
Homeless youth demonstrated elevated rates of untreated psychiatric disorders, low academic achievement, and impaired neurocognition. Mental health and neurocognitive symptoms were associated with vocational outcome. Intervention beyond employment services alone is needed to improve functioning.
Assessment of Musculoskeletal Toxicity 5 Years After Therapy With Levofloxacin
Animal studies document dose-dependent and duration-of-therapy-dependent fluoroquinolone cartilage toxicity in weight-bearing joints. Preliminary pediatric data collected after fluoroquinolone treatment and up to 1 year posttreatment in blinded and unblinded studies suggest the possibility of cartilage toxicity in children.
These are the first prospectively collected data on fluoroquinolone musculoskeletal safety collected posttherapy from randomized, comparative studies of respiratory tract infections and analyzed at 5 years. Long-term musculoskeletal adverse events occurred with equal frequency in both levofloxacin and comparator groups.
Association of Maternal Hypertension and Chorioamnionitis With Preterm Outcomes
In very preterm infants, outcomes depend not only on the degree of immaturity, but also on the underlying pathologies that trigger preterm delivery. Studies that have addressed this issue have provided unclear results.
Patterns of outcomes differ between maternal hypertension and chorioamnionitis: hypertension is associated with greater risks for bronchopulmonary dysplasia and retinopathy of prematurity, and lower risks for brain injury, necrotizing enterocolitis, early-onset sepsis. For mortality, the effect changes across gestational age weeks.
Disparities in Early Exposure to Book Sharing Within Immigrant Families
Parents in disadvantaged households are less likely to book share with their children during early childhood. These children are more likely to enter school with delays in emergent literacy and language skills, apparent as early as the age of 3.
This study examines the effect of parental immigrant status as a predictor of reading and sharing books with children. This research disentangles immigrant status from other variables thought to explain disparities in familial practices related to emergent literacy.
Videoconferencing to Reduce Stress Among Hospitalized Children
Previous research has demonstrated that family presence alongside hospitalized patients is associated with improvements in physiologic responses, reductions in anxiety, and expedited recovery. Recently, videoconferencing has been increasingly used for virtual visits to pediatric patients and their parents during hospitalization.
Our study demonstrates that in some cases, the use of videoconferencing by children and their parents for virtual visits is associated with greater reductions in stress during hospitalization compared with children and parents who do not use videoconferencing.
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- Copyright © 2014 by the American Academy of Pediatrics