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A New Opportunity to Define Health Care Reform for Children

from ArchPedi - 01 Jun 14

The magic year for the Affordable Care Act (ACA), 2014, is now upon us. The transition of millions of uninsured individuals into new insurance exchange markets has not been smooth, but as the challenges are addressed, our collective attention should turn to ensuring that the law meets the needs of the people it was intended to serve. This is especially true for children.



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Children’s Health Care and the Patient Protection and Affordable Care Act What’s at Stake?

from ArchPedi - 01 Jun 14

Although the Patient Protection and Affordable Care Act (hereafter referred to as the ACA) of 2010 does not explicitly target the health care needs of children, its significant reforms and cascading effects throughout our complex health system are likely to directly and indirectly affect children’s health care. The ACA increases insurance coverage for children and their families by covering comprehensive preventive services with no cost sharing, eliminating exclusions for preexisting conditions,



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Antenatal Glucocorticoids Prior to Cesarean Delivery at Term

from ArchPedi - 01 Jun 14

Administration of glucocorticoids to pregnant women to accelerate fetal lung maturation prior to preterm birth is one of the most effective interventions in perinatal medicine. Its success led to the evaluation of glucocorticoid administration prior to prelabor cesarean delivery between 37 weeks 0 days and 38 weeks 6 days of gestational age. The Antenatal Steroids for Term Elective Caesarean Section (ASTECS) trial demonstrated that antenatal glucocorticoids reduced short-term respiratory morbidi



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The Descent

from ArchPedi - 01 Jun 14

The glum 16-year-old girl sat disconsolately looking at her shoes, while her mother unfurled their story. Two years ago, seemingly out of the blue, her daughter reported that her abdomen hurt. She could not identify an antecedent event that triggered her pain nor could she discern a pattern to the variation in its intensity. Yet, her daughter’s pain was unremitting and disabling. Over time, the abdominal pain was further complicated by the development of a crushing headache, profound dizziness,



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Enhancing Our Understanding of Teen-Driver Crashes

from ArchPedi - 01 Jun 14

While progress has been made in reducing the number of teens killed in motor vehicle crashes, crashes continue to be the leading cause of death for teens in the United States. The high crash rate for teens is owing in large part to their lack of driving experience. Continued identification of specific characteristics of teens that lead to elevated crash risk can inform interventions for high-risk subgroups. This month’s issue of JAMA Pediatrics includes a study by Ouimet et al that examined the



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More Work Needed to Protect Children but Promising Trend Data on Exposure to Violence

from ArchPedi - 01 Jun 14

Finkelhor and colleagues continue their leadership in providing trend data on maltreatment of children. Their previous work has shown that within child maltreatment there has been a 20-year decline in emotional child abuse and sexual abuse but not child neglect. Their current study, based on 3 large representative samples of national random digit dialing surveys, finds encouraging data on exposure to violence among children defined more broadly, with 27 significant declines in child maltreatment



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Role of Celiac Disease Screening for Children With Functional Gastrointestinal Disorders

from ArchPedi - 01 Jun 14

Almost any pediatric health care provider will substantiate the significant disease burden of “abdominal pain.” Although an understanding of a patient’s medical history and a careful physical examination can guide a clinician, in many cases, there persists the difficult task of deciding who and how to test when the etiology remains uncertain. One important resource is the Rome criteria and classification system to diagnose symptoms and to treat and manage children with suspected functional gastr



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The Value of Time in Assessing the Effectiveness of Newborn Screening for Congenital Adrenal Hyperplasia

from ArchPedi - 01 Jun 14

Time is precious. In newborn screening (NBS), more time is often associated with increased risk—risk to a child’s health that comes with the passing of time between NBS and diagnosis of a disorder. In their article titled “Nationwide Neonatal Screening for Congenital Adrenal Hyperplasia in Sweden: A 26-Year Longitudinal Prospective Population-Based Study,” Gidlöf et al show that for assessment of a program’s screening performance, more time is exceedingly valuable. By assessing the program durin



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Higher Crash and Near-Crash Rates in Teenaged Drivers With Lower Cortisol Response An 18-Month Longitudinal, Naturalistic Study

from ArchPedi - 01 Jun 14

ImportanceRoad traffic crashes are one of the leading causes of injury and death among teenagers worldwide. Better understanding of the individual pathways to driving risk may lead to better-targeted intervention in this vulnerable group.ObjectiveTo examine the relationship between cortisol, a neurobiological marker of stress regulation linked to risky behavior, and driving risk.Design, Setting, and ParticipantsThe Naturalistic Teenage Driving Study was designed to continuously monitor the drivi



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Long-term Benefits of an Early Online Problem-Solving Intervention for Executive Dysfunction After Traumatic Brain Injury in Children A Randomized Clinical Trial

from ArchPedi - 01 Jun 14

ImportanceExecutive dysfunction after traumatic brain injury (TBI) in children is common and leads to significant short- and long-term problems in functioning across multiple settings. We hypothesized that improvements in short-term executive function would be maintained to 24 months after injury and that improvements would increase over time in a counselor-assisted problem-solving (CAPS) intervention.ObjectiveTo evaluate the efficacy of a CAPS intervention administered within 7 months of compli



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Collaborative Care Intervention Targeting Violence Risk Behaviors, Substance Use, and Posttraumatic Stress and Depressive Symptoms in Injured Adolescents A Randomized Clinical Trial

from ArchPedi - 01 Jun 14

ImportanceViolence and injury risk behaviors, alcohol and drug use problems, and posttraumatic stress disorder (PTSD) and depressive symptoms occur frequently among adolescents presenting to acute care medical settings after traumatic physical injury.ObjectiveTo test the effectiveness of a stepped collaborative care intervention targeting this constellation of risk behaviors and symptoms in randomly sampled hospitalized adolescents with and without traumatic brain injury.Design, Setting, and Par



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Trends in Children’s Exposure to Violence, 2003 to 2011

from ArchPedi - 01 Jun 14

ImportanceThe study suggests that years of public policy designed to reduce the burden of violence and victimization among youths is having some success.ObjectiveTo identify trends in children’s exposure to violence, crime, and abuse from 2003 through 2011.Design, Setting, and ParticipantsThree national telephone surveys of representative samples of children and caregivers from 2003, 2008, and 2011 were compared, all obtained using the Juvenile Victimization Questionnaire; samples included paren



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Effect of Delayed vs Early Umbilical Cord Clamping on Iron Status and Neurodevelopment at Age 12 Months A Randomized Clinical Trial

from ArchPedi - 01 Jun 14

ImportancePrevention of iron deficiency in infancy may promote neurodevelopment. Delayed cord clamping (DCC) can prevent iron deficiency during the first 6 months of life. However, no data are available on long-term effects on infant outcomes in relation to time for umbilical cord clamping.ObjectiveTo investigate effects of DCC, as compared with early cord clamping (ECC), on infant iron status and neurodevelopment at age 12 months in a European setting.Design, Setting, and ParticipantsRandomized



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Increased Prevalence of Celiac Disease Among Pediatric Patients With Irritable Bowel Syndrome A 6-Year Prospective Cohort Study

from ArchPedi - 01 Jun 14

ImportanceRecurrent abdominal pain is a prevalent health issue in childhood. Clinical criteria (ie, the Rome criteria) have been established to aid diagnosis. Studies of adults have shown an increased prevalence of celiac disease among patients with irritable bowel syndrome (IBS); few data are available with regard to children.ObjectiveTo assess the prevalence of celiac disease among children with abdominal pain–related functional gastrointestinal disorders classified according to the Rome crite



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Prevalence and Trends in Obesity and Severe Obesity Among Children in the United States, 1999-2012

from ArchPedi - 01 Jun 14

ImportanceChildhood obesity is the focus of public health efforts and accurate estimates of the prevalence and severity of obesity are needed for policy decisions and directions for future research.ObjectiveTo examine the prevalence of obesity and severe obesity over time for 14 years of the continuous National Health and Nutrition Examination Survey, 1999 to 2012, and to examine differences in the trends by age, race/ethnicity, and sex.Design, Setting, and ParticipantsRepresentative sample (N?=



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Nationwide Neonatal Screening for Congenital Adrenal Hyperplasia in Sweden A 26-Year Longitudinal Prospective Population-Based Study

from ArchPedi - 01 Jun 14

ImportanceRecent reports have questioned the rationale for neonatal screening for congenital adrenal hyperplasia (CAH) owing to low sensitivity in salt-wasting forms and a high rate of recall (ie, a positive finding resulting in a visit to a pediatrician and a second test) in preterm infants.ObjectiveTo determine the efficiency of the neonatal screening program for CAH in Sweden over time.Design, Setting, and ParticipantsLongitudinal prospective population-based study in Sweden. We assessed neon




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Potential Use of Pulse Oximetry for the Diagnosis of Testicular Torsion

from ArchPedi - 01 Jun 14

Scrotal Doppler ultrasonography (scrotal US) has been commonly used for evaluating patients with suspected testicular torsion (TT). However, scrotal US is not available in all medical facilities. Comparatively, pulse oximetry is easily available at all institutions; it is used for monitoring pulse oximeter saturation (SpO2) with an accuracy equivalent to that of conventional arterial oxygen saturation (Sao2) and is the standard for noninvasive Sao2 monitoring in most medical facilities. We evalu



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Weight Labeling and Obesity A Longitudinal Study of Girls Aged 10 to 19 Years

from ArchPedi - 01 Jun 14

Anti-obesity efforts that rely on stigmatizing weight (eg, using harsh language or stereotypical portrayals of overweight individuals) may impede health promotion efforts, as weight stigma is often negatively related to behavior change and thus seems unlikely to result in weight loss. Indeed, considerable research underscores the detrimental effects of weight stigma on the physical health and well-being of children and adolescents, and nationally representative, longitudinal data show weight-bas



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Understanding Sexual Violence Perpetration

from ArchPedi - 01 Jun 14

To the Editor It seems unlikely that the 9% of adolescents reported by Ybarra and Mitchell to have coerced sex, or to have attempted or completed rape, made a conscious decision to commit a felony. It is more likely that they made excuses for their behavior because they had not fully understood the lesson that any penetration of the body of a girl (or boy) without free consent is rape—consent being valid only if she or he is capable of giving consent. Somehow, they convinced themselves that the



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Understanding Sexual Violence Perpetration

from ArchPedi - 01 Jun 14

To the Editor The article “Prevalence Rates of Male and Female Sexual Violence Perpetrators in a National Sample of Adolescents” recently published in JAMA Pediatrics documents that both males and females can be perpetrators or victims of sexual violence; however, both the methods used and the interpretation of the findings ignore the important influence of gender, particularly in the etiology underlying sexual violence perpetration.



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Understanding Sexual Violence Perpetration—Reply

from ArchPedi - 01 Jun 14

In Reply We agree with Reed et al that sexual violence perpetration is gendered. Indeed, this is the story that emerges from our study: although females and males perpetrate sexual assaults at equivalent rates, males are overrepresented in coercive sex and in attempted and completed rapes. Among those who have attempted or completed rape, female perpetrators tend to initiate this behavior at an older age than male perpetrators. Accordingly, there are some differences in the type of victims femal



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Survival at a Gestational Age of 24 Weeks in the Netherlands

from ArchPedi - 01 Jun 14

To the Editor Verhagen and Janvier have described the processes involved in the medical care of neonates who died. Although their article is highly relevant, we would like to comment on one aspect of it.



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Survival at a Gestational Age of 24 Weeks in the Netherlands—Reply

from ArchPedi - 01 Jun 14

In Reply In their letter, Groenendaal and coauthors inform us about recent changes in attitudes and practice regarding the care of extremely preterm babies in the Netherlands resulting in optional active resuscitation for neonates from a gestational age of 24 weeks onwards. That is important news. We hope that they will soon publish these data internationally in a detailed manner and include the descriptions of medical care and the decisions that preceded the death or survival of the babies stud


 

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