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The Big Bang Theory Adolescent Hairstyles and Sun Protection

from ArchPedi - 01 Jul 14

Several years ago, a teenaged mega celebrity appeared in public view with a hairstyle that should have made pediatric dermatologists and anyone involved in child skin care rejoice. While these hairstyles have since evolved, we continue to note the photoprotective effect of the big bangs that sweeps across the forehead protecting a portion of the face from sun damage. For the past few years, we have embraced this hairstyle in our teenage patient population to encourage discussion of sun protectiv



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God Was Born Prematurely

from ArchPedi - 01 Jul 14

A charming, refined, great lady, who incidentally was my wonderful philosophy teacher during high school (liceo in Italian) claimed that atheists secretly reprimand God because He did not create us like angels and because He made us feel both homesick for our true home, the Garden of Eden, and searing pain over having been cast out of it.



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Tobacco Control Policy and Electronic Cigarettes

from ArchPedi - 01 Jul 14

During the past few years, the use of electronic nicotine delivery systems (ENDS), commonly known as electronic cigarettes (e-cigarettes), has risen rapidly in the United States, with some analysts suggesting that ENDS sales could surpass sales of traditional cigarettes in the not-too-distant future. This rapid rise has stimulated a vigorous debate in the tobacco control community over the potential public health impact of ENDS and about how best to regulate them. The article by Dutra and Glantz



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Driving After Marijuana Use The Changing Face of “Impaired” Driving

from ArchPedi - 01 Jul 14

Whitehill et al share the findings of a survey of 315 first-year college students who report having driven after using marijuana and/or alcohol and being a passenger of a driver who had used these substances. They found that among first-year college students who had used marijuana in the past month, a substantial proportion reported driving after using marijuana (43.9% of male and 8.7% of female students). Of particular interest, although a higher proportion of students had drunk alcohol in the



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School Nursing Beyond Medications and Procedures

from ArchPedi - 01 Jul 14

Children spend 6 to 7 hours per day, 180 days per year in school in the United States. While education is the chief purpose, consideration for children’s health is a significant role of schools. Like math and reading, students need to be taught how to have an optimally healthy life. We want each student to return home at the end of the day at least as healthy as when he or she arrived. School-age children, especially adolescents, young students, and those developmentally immature, are more apt t



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The Downside of Increased Cost Sharing

from ArchPedi - 01 Jul 14

From 1971 through 1982, the RAND Corporation conducted the most comprehensive randomized clinical trial of health insurance ever performed. The investigators randomized more than 2700 families and 7700 individuals to 1 of 5 health insurance plans with different levels of cost sharing. The major finding of the study was that increased cost sharing, or making people pay more out-of-pocket for their care, led people to spend less on health care. They also found that increased cost sharing did not,



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The Tale of 2 Trials Disentangling Contradictory Evidence on Hypertonic Saline for Acute Bronchiolitis

from ArchPedi - 01 Jul 14

For pediatricians looking for answers on how best to provide treatment for their patients, nothing can be more frustrating than 2 randomized clinical trials (RCTs) with contradictory results. It may encourage nihilism and a throwing up of one’s hands, thinking clinical researchers have no idea what they are doing by producing data and gaining publications but not shedding light on the tough management issues that pediatricians face day to day. These 2 RCTs on the use of nebulized hypertonic sali



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Electronic Cigarettes and Conventional Cigarette Use Among US Adolescents A Cross-sectional Study

from ArchPedi - 01 Jul 14

ImportanceElectronic cigarette (e-cigarette) use is increasing rapidly among adolescents, and e-cigarettes are currently unregulated.ObjectiveTo examine e-cigarette use and conventional cigarette smoking.Design, Setting, and ParticipantsCross-sectional analyses of survey data from a representative sample of US middle and high school students in 2011 (n?=?17?353) and 2012 (n?=?22?529) who completed the 2011 and 2012 National Youth Tobacco Survey.ExposuresEver and current e-cigarette use.Main Outc



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Marijuana-Using Drivers, Alcohol-Using Drivers, and Their Passengers Prevalence and Risk Factors Among Underage College Students

from ArchPedi - 01 Jul 14

ImportanceDriving after marijuana use increases the risk of a motor vehicle crash. Understanding this behavior among young drivers and how it may differ from alcohol-related driving behaviors could inform prevention efforts.ObjectiveTo describe the prevalence, sex differences, and risk factors associated with underage college students’ driving after using marijuana, driving after drinking alcohol, or riding with a driver using these substances.Design, Setting, and ParticipantsCross-sectional tel



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Rates of Adverse Events Associated With Male Circumcision in US Medical Settings, 2001 to 2010

from ArchPedi - 01 Jul 14

ImportanceApproximately 1.4 million male circumcisions (MCs) are performed annually in US medical settings. However, population-based estimates of MC-associated adverse events (AEs) are lacking.ObjectivesTo estimate the incidence rate of MC-associated AEs and to assess whether AE rates differed by age at circumcision.DesignWe selected 41 possible MC AEs based on a literature review and on medical billing codes. We estimated a likely risk window for the incidence calculation for each MC AE based



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Effect of Antimicrobial Treatment of Acute Otitis Media on the Daily Disappearance of Middle Ear Effusion A Placebo-Controlled Trial

from ArchPedi - 01 Jul 14

ImportanceAntimicrobial treatment reduces the symptoms of acute otitis media (AOM). The effect of antimicrobial treatment on the duration of middle ear effusion (MEE) and concomitant hearing impairment is not known.ObjectiveTo determine whether the antimicrobial treatment of AOM reduces the duration of MEE.Design, Setting, and ParticipantsThis randomized, double-blind, placebo-controlled trial involved a total of 84 children with AOM between 6 months and 15 years of age. Participants were recrui



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Cost-Benefit Study of School Nursing Services

from ArchPedi - 01 Jul 14

ImportanceIn recent years, across the United States, many school districts have cut on-site delivery of health services by eliminating or reducing services provided by qualified school nurses. Providing cost-benefit information will help policy makers and decision makers better understand the value of school nursing services.ObjectiveTo conduct a case study of the Massachusetts Essential School Health Services (ESHS) program to demonstrate the cost-benefit of school health services delivered by



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Financial Barriers to Care Among Low-Income Children With Asthma Health Care Reform Implications

from ArchPedi - 01 Jul 14

ImportanceThe Patient Protection and Affordable Care Act (ACA) includes subsidies that reduce patient cost sharing for low-income families. Limited information on the effects of cost sharing among children is available to guide these efforts.ObjectiveTo examine the associations between cost sharing, income, and care seeking and financial stress among children with asthma.Design, Setting, and ParticipantsA telephone survey in 2012 about experiences during the prior year within an integrated healt



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Nebulized Hypertonic Saline for Bronchiolitis A Randomized Clinical Trial

from ArchPedi - 01 Jul 14

ImportanceBronchiolitis is one of the most common and costly respiratory diseases in infants and young children. Previous studies have shown a potential benefit of nebulized hypertonic saline; however, its effect in the emergency department (ED) setting is unclear.ObjectiveTo compare the effect of nebulized 3% hypertonic saline vs 0.9% normal saline on admission rate and length of stay in infants with bronchiolitis.Design, Setting, and ParticipantsWe conducted a double-blind, randomized clinical



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Nebulized Hypertonic Saline for Bronchiolitis in the Emergency Department A Randomized Clinical Trial

from ArchPedi - 01 Jul 14

ImportanceAcute bronchiolitis is the most frequent lower respiratory tract infection in infants, yet there are no effective therapies available. Current evidence is unclear about the role of hypertonic saline (HS) for the acute treatment of bronchiolitis.ObjectiveTo determine whether nebulized 3% HS compared with normal saline (NS) improves respiratory distress in infants with bronchiolitis not responding to standard treatments in the emergency department.Design, Setting, and ParticipantsA rando



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Relationship Between the Functional Status Scale and the Pediatric Overall Performance Category and Pediatric Cerebral Performance Category Scales

from ArchPedi - 01 Jul 14

ImportanceFunctional status assessment methods are important as outcome measures for pediatric critical care studies.ObjectiveTo investigate the relationships between the 2 functional status assessment methods appropriate for large-sample studies, the Functional Status Scale (FSS) and the Pediatric Overall Performance Category and Pediatric Cerebral Performance Category (POPC/PCPC) scales.Design, Setting, and ParticipantsProspective cohort study with random patient selection at 7 sites and 8 chi




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Metabolic Monitoring in Commercially Insured Pediatric Patients Newly Initiated to Take a Second-Generation Antipsychotic

from ArchPedi - 01 Jul 14

The use of second-generation antipsychotics (SGAs) in children and adolescents has increased amidst the concern for adverse effects (AEs) on overall health. The use of SGAs increases the risk for weight gain, elevated glucose, insulin resistance, hyperlipidemia, and development of type 2 diabetes mellitus. Despite these concerns, there has been a slow uptake performing recommended monitoring. To our knowledge, few studies have examined metabolic monitoring in pediatric patients receiving an SGA,



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The Natural History of Weight Percentile Changes in the First Year of Life

from ArchPedi - 01 Jul 14

The Centers for Disease Control and Prevention and the World Health Organization have published growth curves derived from the z scores of cross-sectional data in children who have become an integral part of pediatrics. Children whose growth curves fall below these curves are said to have failure to thrive. Growth curves may be useful to determine whether a patient’s values are within a normal range, but they do not capture the longitudinal perspective essential for determination of health. We



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Early-Life Milk and Late-Life Fracture

from ArchPedi - 01 Jul 14

To the Editor Feskanich et al report that early-life milk consumption does not protect against late-life hip fractures in 2 health professions cohorts and, if anything, increased fracture risk in men. In her Editorial, Weaver describes a strong mechanistic basis for fracture protection but offers no explanation as to why Feskanich et al seem not to have found it.



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Early-Life Milk and Late-Life Fracture

from ArchPedi - 01 Jul 14

To the Editor In their data analysis from 2 observational cohort studies, Feskanich et al found that greater milk consumption during adolescence was not significantly associated with a lower risk of hip fracture in older women, but was weakly and significantly associated with a greater risk of hip fracture in older men. They also reported that the weak positive association in men was partially mediated by greater height. Their data analysis is limited by not including many important confounding



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Early-Life Milk and Late-Life Fracture—Reply

from ArchPedi - 01 Jul 14

In Reply Dr Heaney questioned our adjustment for calcium intake during adult years, which was done because our primary question was the independent contribution of milk intake during adolescence to future risk of hip fracture. However, repeating the analysis without adjustment for adult milk consumption and supplemental calcium intake made little difference. In men, the relative risk associated with each additional glass per day of adolescent milk intake changed from 1.09 (95% CI, 1.01-1.17) to



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Error in Phthalate Metabolite Name

from ArchPedi - 01 Jul 14

In the article titled “Environmental Phthalate Exposure and Preterm Birth” published in the January 2014 issue of JAMA Pediatrics (2014;168[1]:61-67. doi:10.1001/jamapediatrics.2013.3699), incorrect information appeared. The phthalate metabolite for benzyl butyl phthalate appeared as “mono-benzyl-butyl phthalate.” It should have appeared as “mono-benzyl phthalate” in the top of the right column on page 63, in the top of the left column on page 64, in row 6 in the second column of Table 2, and i


 

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