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Ebola Virus Disease and Children What Pediatric Health Care Professionals Need to Know

from ArchPedi - 01 Dec 14

This Viewpoint discusses what pediatric health care professionals should consider when treating children presenting with signs and symptoms similar to Ebola virus disease.



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Comparative Effectiveness Research Ethical and Regulatory Guidance

from ArchPedi - 01 Dec 14

This Viewpoint addresses questions raised in the debate over whether the current US regulatory framework for governing protection of human research participants is an impediment to comparative effectiveness research.



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Using the Placebo Effect to Treat Cold Symptoms in Children

from ArchPedi - 01 Dec 14

Although it has been recognized for centuries, the concept of the placebo effect was brought to professional consciousness with the 1955 publication of “The Powerful Placebo.” In this seminal work, Beecher used a quasi–meta-analysis approach to estimate that 35.2% of patients had a satisfactory response to placebo for relief of pain. Despite limitations in design and more recent analyses calling these results into question, the study by Beecher is largely responsible for the commonly held percep



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Exercise and Depressive Symptoms in Adolescents A Longitudinal Cohort Study

from ArchPedi - 01 Dec 14

ImportancePhysical activity (PA) may have a positive effect on depressed mood. However, whether it can act as a protective factor against developing depressive symptoms in adolescence is largely unknown.ObjectiveTo investigate the association between objectively measured PA and depressive symptoms during 3 years of adolescence.Design, Setting, and ParticipantsWe performed a longitudinal study between November 1, 2005, and January 31, 2010, of a community-based sample from Cambridgeshire and Suff



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Improvement in Preventive Care of Young Adults After the Affordable Care Act The Affordable Care Act Is Helping

from ArchPedi - 01 Dec 14

ImportanceThe 2010 Affordable Care Act (ACA) included expansion of insurance coverage for young adults and improved access to preventive care.ObjectiveTo examine the ACA’s initial effects on young adults’ receipt of preventive care.Design, Setting, and ParticipantsSecondary data analysis using a pre-post design that compared health care use by young adults (aged 18 to 25 years) from 2009 and 2011 Medical Expenditure Panel Surveys. Data were collected through computer-assisted personal interviews



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Placebo Effect in the Treatment of Acute Cough in Infants and Toddlers A Randomized Clinical Trial

from ArchPedi - 01 Dec 14

ImportanceCough is one of the most common reasons why children visit a health care professional.ObjectivesTo compare the effect of a novel formulation of pasteurized agave nectar vs placebo and no treatment on nocturnal cough and the sleep difficulty associated with nonspecific acute cough in infants and toddlers.Design, Setting, and ParticipantsIn this randomized clinical trial performed in 2 university-affiliated outpatient, general pediatric practices from January 28, 2013, through February 2



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Validity and Responsiveness of the Pediatric Quality of Life Inventory (PedsQL) 4.0 Generic Core Scales in the Pediatric Inpatient Setting

from ArchPedi - 01 Dec 14

ImportanceValidated patient-reported outcomes responsive to clinical change are needed to evaluate the effectiveness of quality improvement interventions.ObjectivesTo evaluate responsiveness, construct validity, and predictive validity of the Pediatric Quality of Life Inventory (PedsQL) 4.0 Generic Core Scales in the pediatric inpatient setting.Design, Setting, and ParticipantsProspective, cohort study of parents and caregivers of patients 1 month to 18 years old (n?=?4637) and patients 13 to 18



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Associations Between Genetic Obesity Susceptibility and Early Postnatal Fat and Lean Mass An Individual Participant Meta-analysis

from ArchPedi - 01 Dec 14

ImportancePatterns of body size and body composition associated with genetic obesity susceptibility inform the mechanisms that increase obesity risk.ObjectiveTo test associations between genetic obesity susceptibility, represented by a combined obesity risk-allele score, and body size or body composition at birth to age 5 years.Design, Setting, and ParticipantsA total of 3031 children from 4 birth cohort studies in England, France, and Spain were included in a meta-analysis.ExposuresA combined o



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Bisphenol A Exposure and the Development of Wheeze and Lung Function in Children Through Age 5 Years

from ArchPedi - 01 Dec 14

ImportanceBisphenol A (BPA), a prevalent endocrine-disrupting chemical, has been associated with wheezing in children, but few studies have examined its effect on lung function or wheeze in older children.ObjectivesTo test whether BPA exposure is associated with lung function, with wheeze, and with pattern of wheeze in children during their first 5 years.Design, Setting, and ParticipantsA birth cohort study, enrolled during early pregnancy in the greater Cincinnati, Ohio, area among 398 mother-i



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Influence of Age at Virologic Control on Peripheral Blood Human Immunodeficiency Virus Reservoir Size and Serostatus in Perinatally Infected Adolescents

from ArchPedi - 01 Dec 14

ImportanceCombination antiretroviral therapy initiated within several weeks of human immunodeficiency virus (HIV) infection in adults limits proviral reservoirs that preclude HIV cure. Biomarkers of restricted proviral reservoirs may aid in the monitoring of HIV remission or cure.ObjectivesTo quantify peripheral blood proviral reservoir size in perinatally HIV-infected (PHIV+) adolescents and to identify correlates of limited proviral reservoirs.Design, Setting, and ParticipantsA cross-sectional



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Accuracy of the MacArthur Competence Assessment Tool for Clinical Research (MacCAT-CR) for Measuring Children’s Competence to Consent to Clinical Research

from ArchPedi - 01 Dec 14

ImportanceAn objective assessment of children’s competence to consent to research participation is currently not possible. Age limits for asking children’s consent vary considerably between countries, and, to our knowledge, the correlation between competence and children’s age has never been systematically investigated.ObjectivesTo test a standardized competence assessment instrument for children by modifying the MacArthur Competence Assessment Tool for Clinical Research (MacCAT-CR), to investig



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Missed Opportunities for Pregnancy Prevention Among Insured Adolescents

from ArchPedi - 01 Dec 14

ImportanceBirth to a teenaged mother is associated with adverse health and social outcomes. Adolescents at risk for pregnancy may not receive needed reproductive health services at primary care visits.ObjectiveTo review services provided at outpatient visits in the year prior to pregnancy among adolescents in a US Midwestern integrated health care delivery system.Design, Setting, and ParticipantsRetrospective medical record review of continuously insured adolescents aged 15 to 19 years experienc



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Retinal Vessel Alterations and Cerebral White Matter Microstructural Damage in Obese Adolescents With Metabolic Syndrome

from ArchPedi - 01 Dec 14

ImportanceCerebral white matter (WM) damage has been reported in childhood obesity and in metabolic syndrome (MetS) but mechanisms remain unclear.ObjectivesTo ascertain whether adolescents with MetS have retinal vessel alterations and if the anticipated reductions in retinal arteriolar diameter are associated with diminished cerebral WM microstructural integrity and to test a model for vascular etiology of the WM abnormalities.Design, Setting, and ParticipantsCross-sectional study of the brain c



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Children and US Federal Policy on Health and Health Care Seen but Not Heard

from ArchPedi - 01 Dec 14

Children account for 73.5 million Americans (24%), but 8% of federal expenditures. Data on health and health care indicate that child well-being in the United States has been in decline since the most recent recession. Childhood poverty has reached its highest level in 20 years, 1 in 4 children lives in a food-insecure household, 7 million children lack health insurance, a child is abused or neglected every 47 seconds, and 1 in 3 children is overweight or obese. Five children are killed daily by




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Pain Terminology

from ArchPedi - 01 Dec 14

To the Editor I read with interest the Viewpoint recently published in JAMA Pediatrics expressing frustration with the term functional pain to describe the common scenario of chronic pain from unidentified causes. However, I question the author’s recommendation to change the name to primary pain disorder. Just because the cause of a symptom is unknown does not mean that it has no cause; absence of proof is not proof of absence. Diagnostic delay is common in complex illnesses and not all patients



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Pain Terminology

from ArchPedi - 01 Dec 14

To the Editor I concur with Dr Schechter’s appeal recently published in JAMA Pediatrics to discontinue the use of the term functional pain but find his proposed new term, primary pain disorder, equally unsatisfying. It is akin to telling someone with a fast heart rate they have tachycardia. Although he dismisses the term amplified pain, interpreted by patients as implying they are amplifying or exaggerating their pain, it is not so interpreted by my patients. Strumming a guitar string is a rathe



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Pain Terminology—Reply

from ArchPedi - 01 Dec 14

In Reply I appreciate the responses of Drs Oaklander and Sherry. Both of them agree with me in abandoning the term functional pain, which I perceive to be inappropriately burdened by the mantle of psychogenesis. Although they both disagree with the term that I have proposed as an alternative, primary pain disorders, they state opposing grounds for their objections. Dr Oaklander suggests the term implies too much, intimating an understanding of these entities that may be premature, and offers med



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Surgery and Neurodevelopmental Impairment Need for Time-Dependent Covariates to Correct for Confounding by Indication

from ArchPedi - 01 Dec 14

To the Editor We read with interest the study by Morriss et al and the accompanying editorial recently published in JAMA Pediatrics. We applaud their use of a propensity score modeling approach to answer the following question facing neonatologists and surgeons: is it the surgery or the underlying condition/status of the infant that is associated with neurodevelopmental impairment? However, we wish to highlight an important shortcoming in the authors’ attempt to reduce bias owing to confounding



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Surgery and Neurodevelopmental Impairment—Reply

from ArchPedi - 01 Dec 14

In Reply We appreciate the careful reading of our article by Weisz et al recently published in JAMA Pediatrics, who point out that our propensity score calculations omit consideration of the timing of surgery, an important variable in adjusting for selection bias. While we have dates of occurrence for some of the morbidities that we adjusted for, the Neonatal Research Network Generic Database does not contain information on the timing of surgery for the birth years 1998 to 2009. Consequently, th



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Texting and Driving

from ArchPedi - 01 Dec 14

Adolescents are generally a healthy age group. The major cause of injury and death in this population is unintentional injury, particularly motor vehicle crashes. In recent years, texting has become a new behavior that has impacted teen driving.



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JAMA Pediatrics

from ArchPedi - 01 Dec 14

JAMA Pediatrics Vision: JAMA Pediatrics will be the most respected source of information for investigators, providers, and policy makers seeking the highest quality evidence to guide decision-making.



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Associations of Tobacco Control Policies With Birth Outcomes

from ArchPedi - 03 Nov 14

ImportanceIt is unclear whether the benefits of tobacco control policies extend to pregnant women and infants, especially among racial/ethnic minority and low socioeconomic populations that are at highest risk for adverse birth outcomes.ObjectiveTo examine the associations of state cigarette taxes and the enactment of smoke-free legislation with US birth outcomes according to maternal race/ethnicity and education.Design, Setting, and ParticipantsUsing a quasi-experimental approach, we analyzed r



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Folic Acid Supplements During Pregnancy and Child Psychomotor Development After the First Year of Life

from ArchPedi - 03 Nov 14

ImportanceFolate intake during pregnancy has been associated with improved neuropsychological development in children, although the effects of high dosages of folic acid (FA) supplements are unclear.ObjectiveTo examine the association between the use of high dosages of FA supplements during pregnancy and child neuropsychological development after the first year of life.Design, Setting, and PatientsThe multicenter prospective mother-child cohort Infancia y Medio Ambiente (INMA) Project recruited


 

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