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Childhood Gender Nonconformity: A Risk Indicator
for Childhood Abuse and Posttraumatic Stress in
Youth
Childhood gender nonconformity has been associated with poorer relationships with parents, but it is unknown if child-hood gender nonconformity is associated with childchild-hood abuse or with posttraumatic stress disorder.
We identify gender nonconformity before age 11 years as a risk indicator for physical, sexual, and psychological abuse in childhood and lifetime probable posttraumatic stress disorder in youth.
Children and Adolescents With Gender Identity
Disorder Referred to a Pediatric Medical Center
Studies in the Netherlands show that pubertal blockade at Tanner 2/3 prevents unwanted sex characteristics and improves psychological functioning. Endocrine Society guide-lines (2009) recommend pubertal suppression for adolescents with gender identity disorder until approximately age 16.
This is thefirst study of a US cohort of children and adolescents with gender identity disorder. Patients were referred for medical treatment to a pediatric center that supports a mul-tidisciplinary Gender Management Service.
Impact of State Laws That Extend Eligibility for
Parents
’
Health Insurance Coverage to Young
Adults
Prior to the Affordable Care Act of 2010, 34 states enacted laws extending eligibility for parents’health insurance to adult
children. Few studies have examined their impact; a single study found no change in insurance 1 year after enactment.
States that expanded parents’insurance eligibility to young adults were associated with higher rates of insurance cover-age, identification of a personal clinician, physical exams, and lower forgone care due to cost. The Affordable Care Act may similarly improve access to care.
Quality Measures for Primary Care of Complex
Pediatric Patients
There are known gaps in quality measures for children. More clinical effectiveness research is needed. The patient-centered medical home may serve as a model to guide the development of quality measures, particularly for children with complex medical conditions.
This study combined systematic literature review and the Rand/ University of California Los Angeles appropriateness method to develop quality measures for children with complex medical conditions. These are valid and feasible quality measures based on the patient-centered medical home framework that may be used to assess care.
Secondhand Smoke Exposure in Cars Among
Middle and High School Students
—
United States,
2000
–
2009
Secondhand smoke exposure poses a significant health risk to nonsmokers. With the proliferation of comprehensive smoke-free laws prohibiting smoking in worksites and public areas, private areas have become the primary source of secondhand smoke exposure for many individuals, particularly youth.
Requirements and Sociodemographics
Most states require driver education (DE) for novice drivers, and several recent substantial efforts have sought to realign DE with the aim of producing safer drivers. However, teen par-ticipation rates and how they differ among relevant subgroups remain unknown.
This study provides national estimates of teen driver partici-pation in formal DE, a recognized gap in the literature, and identifies disparities in behind-the-wheel training among cer-tain racial/ethnic, socioeconomic, and gender groups, partic-ularly in jurisdictions without a DE requirement.
Using US Data to Estimate the Incidence of Serious
Physical Abuse in Children
Limited data exist about the frequency and incidence of serious injuries due to physical abuse of children. Data from Child Protective Services, which are published yearly, do not have information about severity.
This is thefirst study to provide US estimates on the occurrence of serious injuries due to physical abuse. The incidence was highest in infants on Medicaid. Such data can be used to track changes due to prevention.
Community Asthma Initiative: Evaluation of
a Quality Improvement Program for Comprehensive
Asthma Care
Comprehensive home visits conducted by Community Health Workers including environmental remediation and office-based nurse case management improve asthma outcomes.
Implementation of a comprehensive quality improvement program as part of enhanced care of pediatric asthma patients with a history of hospitalizations or emergency department visits can improve health outcomes and be cost-effective as well as reduce health disparities.
Longitudinal Follow-up of Poor Inner-city Youth
Between Ages 8 and 18: Intentions Versus Reality
Adolescence is a time of risk taking, with poor inner-city youth at greater risk than the general population for drug use, school failure, adjudication, and teen parenthood. Little is known regarding these youths’perceptions and intentions in early childhood.
a Clinical Research Study May Not Be
Representative
The demographics of trials that use antenatal consent may not be representative of the populations that they are intended to study.
This study analyzes the difference in clinical outcomes between the enrolled and eligible but not enrolled populations of a trial that required antenatal consent.
Maternal Serum Vitamin D Levels During Pregnancy
and Offspring Neurocognitive Development
Vitamin D levels in the general population have decreased considerably over the past decade. The implications of ma-ternal vitamin D insufficiency during pregnancy for offspring neurocognitive development remain unclear.
Studying a large sample and using a prospective longitudinal design, this study demonstrates a link between maternal vi-tamin D insufficiency during pregnancy and offspring language impairment. There was no association with childhood behav-ioral or emotional problems.
Antenatal Antecedents of Cognitive Impairment at
24 Months In Extremely Low Gestational Age
Newborns
Among extremely premature infants, survival has improved, but the rate of cognitive impairment has not. Impaired cognition is the most frequent developmental problem identified in survi-vors. Several antenatal factors have been associated with cognitive impairment, mostly related to social disadvantage.
In addition to social disadvantage, antenatal characteristics associated with cognitive impairment include maternal obesity and thrombosis of fetal stem vessels. Prenatal infection and inflammation were not associated with impaired early cognitive function among extremely preterm infants.
Stability of Cognitive Outcome From 2 to 5 Years of
Age in Very Low Birth Weight Children
been questioned because of the divergent data on the prog-nostic value of early measures.
Good stability of cognitive development was found between the ages of 2 and 5 years. Well-conducted assessment of cognitive development in infancy is both reliable to anticipate later development and clinically valuable to identify those children who need developmental support.
A Statewide Trial of the SafeCare Home-based
Services Model With Parents in Child Protective
Services
Neglect cases in Child Protective Services often receive home-based interventions, but their success in preventing mal-treatment recidivism has been elusive. Structured, behavioral skills models, such as SafeCare, are promising but have not been tested in full-scale implementation trials.
This cluster trial experiment demonstrates significant mal-treatment recidivism reduction due to implementing the SafeCare model in a fully scaled-up statewide system. The findings support adopting the SafeCare model for these types of services.
What the Orphan Drug Act Has Done Lately for
Children With Rare Diseases: A 10-Year Analysis
Rare diseases in childhood can be debilitating and require lifelong care. Since 1983, the Orphan Drug Act incentives have stimulated the development and significantly improved the availability of treatment products for patients with rare diseases.
We report an increasing pediatric orphan product designations and approvals from 2000 to 2009. The trend indicates that the Orphan Drug Act has continued to address this important unmet need.
Pediatric Training and Career Intentions,
2003
–
2009
In the previous decade, graduating pediatric residents gen-erally experienced success infinding desired jobs, but they also experienced increased debt andflat starting salaries.
This study highlights trends over the past several years (2003– 2009) including high levels of satisfaction among graduating pediatric residents, increasing ease in obtaining post-residency positions, and a modest decline in interest in pri-mary care practice.
Changing Epidemiology of Bacteremia in Infants
Aged 1 Week to 3 Months
Approximately 1.1% to 5.9% of febrile infants aged,90 days have bacteremia, but the incidence of bacteremia in this age is
unknown.Escherichia coli, group BStreptococcus, and
Staphylococcus aureusare the leading causes of bacteremia. Bacteremia occurs in 2.2% of infants who have a blood culture drawn. The incidence rate of true bacteremia was 0.57 in 1000 full-term births. The most common pathogens wereEscherichia
coli(56%), group BStreptococcus(21%), andStaphylococcus
aureus(8%).
Impact of a Guideline on Management of
Children Hospitalized With Community-Acquired
Pneumonia
Community-acquired pneumonia (CAP) is a common pediatric illness caused byStreptococcus pneumoniae. New pediatric Infectious Diseases Society of America CAP guidelines are now available recommending ampicillin as empirical treatment of children hospitalized with uncomplicated CAP.
This study found that a CAP guideline led to an increase in the narrow-spectrum antibiotic ampicillin. Additionally, an increase in the use of amoxicillin at discharge was observed. Further-more, change in therapy did not lead to increased adverse outcomes.
Discharged on Supplemental Oxygen From an
Emergency Department in Patients With
Bronchiolitis
Bronchiolitis is the most common cause for hospital admission in patients aged,1 year. Hypoxia is a common reason for admission. Despite a multitude of studies looking at various treatment strategies, no clear benefit has been found.
With oxygen therapy being the main therapeutic option, home oxygen offers a novel way to manage bronchiolitis. This study shows that home oxygen is a safe and effective way to decrease hospital admissions in a select group of patients.
A Primary Care
–
Based, Multicomponent Lifestyle
Intervention for Overweight Adolescent Females
Clinic-based weight control treatments for youth have largely been designed for preadolescent children and their families by using family-based care, a strategy that may be less appealing to adolescents as they become increasingly motivated by peer acceptance rather than parental influence.
To our knowledge, this is the first study to demonstrate the efficacy of a primary care–based, multicomponent life-style intervention specifically tailored for overweight ado-lescent females and demonstrating a sustained effect (at 12 months) extending beyond the active 5-month intervention.
ARTICLE SUMMARIES
–
MARCH 2012
P E D I AT R I C S
ÒS U M M A RY
Among youth at high risk for obesity based on income, minority status, and child behavior problems, early intervention that promotes effective parenting led to meaningful differences in obesity in preadolescence. Early family intervention is an in-novative and promising approach.
Prevalence of Autism Spectrum Disorders in
Hispanic and Non-Hispanic White Children
The number of individuals diagnosed with autism spectrum disorders (ASDs) continues to increase in the United States and other developed countries. Most prevalence estimates indicate that ASD is diagnosed less commonly in Hispanic individuals in comparison with the non-Hispanic (NH) white population.
Prevalence of ASD in Arizona’s population-based cohort is higher than reported previously. Prevalence in both the His-panic population and NH white population increased signifi -cantly over time, with a significant decrease in the gap between Hispanic and NH white prevalence.
Impact of an Active Video Game on Healthy
Children
’
s Physical Activity
Active video games can enable children under laboratory conditions to participate in moderate, and even vigorous, physical activity. There are inconsistencies in the literature, however, about whether active video games enable children to increase physical activity under more naturalistic circum-stances.
This study tests whether children receiving a new active video game spontaneously engaged in more physical activity, and whether commercially available active video games have a public health benefit. No additional physical activity was detected, suggesting no public health benefit.
Self-Referral and Serious Illness in Children With
Fever
General measures discourage all self-referrals to the emer-gency department. For adults, self-referral to the emeremer-gency department has been associated with nonsevere disease, whereas severity of illness of self-referred children is still unknown.
and Infantile Colic in the Offspring
Infantile colic affects almost 10% of all infants and is char-acterized by crying and fussing in an otherwise healthy and well-fed infant. Prenatal exposure to tobacco smoking is a risk factor, but it is unclear whether nicotine causes the association.
Infants exposed to nicotine replacement therapy during pregnancy had elevated infantile colic risk of the same mag-nitude as infants exposed to tobacco smoking. Intrauterine exposure to nicotine may play a causal role in the pathogenesis of infantile colic.
The Effect of Simulated Ostracism on Physical
Activity Behavior in Children
The social and emotional burdens of ostracism are well known, but few studies have tested whether ostracism adversely alters physical activity behaviors that may result in maintenance of childhood obesity.
This is the first study to experimentally assess the effect of simulated ostracism, or social exclusion, on physical activity behavior in children. Ostracism reduced accelerometer counts by 22% and increased time allocated to sedentary behaviors by 41%.
Hemodynamic Effects of Delayed Cord Clamping in
Premature Infants
Delayed umbilical cord clamping in premature infants has been associated with decreased rates of intraventricular hemor-rhage; however, the mechanisms that explain thisfinding have not been described.
Premature infants with delayed umbilical cord clamping have improved superior vena cava bloodflow over thefirst days of life. This may provide one of the mechanism(s) by which this technique reduces the incidence in intraventricular hemor-rhage in this at-risk population.
Bed- and Sofa-Sharing Practices in a UK Biethnic
Population
sudden infant death. Blanket prohibitions against bed-sharing conflict with breastfeeding promotion and inhibit safe bed-sharing discussion.
Bed-sharing and sofa-sharing were almost mutually exclusive. Pakistani families avoided sofa-sharing and hazardous bed-sharing, and have a very low rate of sudden infant death syndrome. White British families were more likely to smoke, drink alcohol, and sofa-share with their infants.
Prospective Analysis of Pulmonary Hypertension in
Extremely Low Birth Weight Infants
Pulmonary hypertension is associated with bronchopulmonary dysplasia in extremely low birth weight infants and contributes to morbidity and mortality.
Pulmonary hypertension affects at least 1 in 6 extremely low birth weight infants and persists to discharge in most survi-vors. Routine screening of these infants with echocardiography at 4 weeks of age identifies only one-third of those affected.
Trends in Computed Tomography Utilization in the
Pediatric Emergency Department
Recent studies report that overall computed tomography uti-lization in the emergency department has continued to rise. Increased computed tomography use is concerning because of the association with radiation exposure and the potential risk of radiation-induced malignancy, which is highest in children.
Our data showed no overall increase in computed tomography utilization through 2010. In areas where alternative non– radiation-based modalities were options, there were de-creased trends in computed tomography use and inde-creased use of potential alternative non–radiation-based modalities.
Impaired Fetal Growth and Arterial Wall Thickening:
A Randomized Trial of Omega-3 Supplementation
Impaired fetal growth is an independent risk factor for cdiovascular diseases in adulthood and is associated with ar-terial wall thickening, a noninvasive measure of subclinical atherosclerosis, in early childhood. No preventive strategy has been identified.
Dietary omega-3 fatty acid supplementation in early childhood prevented the association of impaired fetal growth with arterial wall thickening, suggesting that this early-life intervention may mitigate the risk of cardiovascular disease in those with im-paired fetal growth.
Effect of Repeated Dietary Counseling on Serum
Lipoproteins From Infancy to Adulthood
Atherosclerotic cardiovascular diseases have roots in child-hood. Modification of dietary fat intake influences serum lipid
and lipoprotein concentrations. Reduction of saturated fat in-take is recommended to promote cardiovascular health.
Dietary counseling had a beneficial effect on saturated fat intake from ages 7 months to 19 years. The counseling reduced serum low-density lipoprotein cholesterol concentrations in both genders. It also decreased computationally estimated concentrations of intermediate-density lipoprotein cholesterol, very low-density lipoprotein–triglycerides and apolipoprotein B in boys.
Functional Dif
fi
culties and Health Conditions Among
Children With Special Health Needs
Children with special health care needs present clinically with varied functional difficulties across an array of health con-ditions. Little attention has been given to the interaction of these descriptors at a population level, thereby not addressing the complexity of functional difficulties and their impact on the health of CSHCN.
The data demonstrate the relationships among functional difficulties and health conditions, which then improve our understanding of CSHCN and their needs. Functional difficulties contribute significantly to outcomes, such as emergency room visits, parental work patterns, and limitations in daily activities, and have implications for practice, training, policy, and research.
The Population Cost-effectiveness of Interventions
Designed to Prevent Childhood Depression
There are a number of effective interventions designed to prevent childhood/adolescent depression. Such interventions tend to comprise screening and the subsequent provision of psychological therapy. However, the cost-effectiveness of rou-tinely providing such interventions at a population level is not known.
By using economic modeling techniques, this study shows that the population cost-effectiveness of such preventive inter-ventions for childhood/adolescent depression is very favorable, although implementation issues, particularly around the ac-ceptability to providers, need to be addressed before wide-spread adoption.
Morbidity and Mortality of Neonatal Respiratory
Failure in China: Surfactant Treatment in Very
Immature Infants
Although China has the largest birth population in the world and a number of multicenter studies of neonatal respiratory failure are reported, there is a paucity of data regarding
ARTICLE SUMMARIES
–
MARCH 2012
P E D I AT R I C S
ÒS U M M A RY
Discomfort and Pain in Newborns With
Myelomeningocele: A Prospective Evaluation
Active termination of life in newborns with myelomeningocele because of assumed suffering in these newborns has been extensively discussed. However, the level of discomfort and pain in these newborns has never been substantially assessed.
This is thefirst study presenting quantitative data on dis-comfort and pain in newborns with myelomeningocele. Therefore, it can be of guidance in the choice of treatment: either active treatment or palliative care in the context of end-of-life decisions.
Nonconvulsive Status Epilepticus: The
Encephalopathic Pediatric Patient
Nonconvulsive status epilepticus (NCSE) is the diagnosis for encephalopathy caused by continuous epileptic activity on EEG. It is a well-known cause of morbidity and mortality in critically ill adults and neonates. NCSE is increasingly reported in critically ill children.
We show that NCSE is common in all inpatient settings, not only in the critically ill. Key risk factors that should dramatically
in which serotonergic and noradrenergic neurons are involved. Monoamine oxidase A is the enzyme that degrades both neu-rotransmitters, and genetic variation of this gene might con-tribute to SIDS.
Alleles with weak effect on the monoamine oxidase A gene activity (*2/*3) appear to be associated with sudden infant death syndrome in boys. This association is strongest in infants who died at the age with the highest SIDS prevalence.
Resilience in Children Undergoing Stem Cell
Transplantation: Results of a Complementary
Intervention Trial
Children undergoing stem cell transplantation are thought to be at risk for increased distress, adjustment difficulties, and impaired health-related quality of life. Few interventions to improve adjustment and quality-of-life outcomes in this setting have been tested.
The excellent outcomes observed in all patient groups, in-cluding controls, may be a result of improvements in standard supportive care. Stem cell transplantation may not be as de-manding as previously thought to be, and children undergoing this procedure appear resilient to the challenge.
DOI: 10.1542/peds.digest1293
2012;129;D1
Pediatrics
Pediatrics Digest
Services
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