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The Role of Syndromic Surveillance in Directing the Public Health Response to the Enterovirus D68 Epidemic

from ArchPedi - 01 Nov 14

This Viewpoint discusses how early detection of enterovirus D68 can inform decisions to activate hospital preparedness and emergency response teams and promote proactive community and physician education.



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Global Child Health A Call to Collaborative Action for Academic Health Centers

from ArchPedi - 01 Nov 14

This Viewpoint calls for collaborative action in order for academic health centers to improve global child health.



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Social Impact Bonds Behavioral Health Opportunities

from ArchPedi - 01 Nov 14

The past 2 decades have seen remarkable growth in the development of cost-beneficial, evidence-based programs in pediatric health, behavioral health, youth juvenile justice, and child welfare. Despite the economic and system constraints that have slowed broad dissemination, research-proven approaches have exceptional potential to improve population-level well-being while simultaneously protecting society from the burdensome costs of failing to treat the problems they target.



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Pediatric Pain Management and Opioids The Baby and the Bathwater

from ArchPedi - 01 Nov 14

In the past 30 years, a major shift has occurred in the way that pediatric pain is conceptualized and treated. Although pain management was widely viewed as inadequate in adults in the 1970s, the classic report by Eland and Anderson documented that children’s pain management was far worse, with an almost total disregard of procedural and postoperative pain. The emerging recognition that, in addition to being inhumane, inadequate pain treatment had short- and long-term negative consequences in ch



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Morningtown

from ArchPedi - 01 Nov 14

I love working nights. I’m a pediatrician at a county hospital, and it’s a great job. The work is interesting, and the daytime hassles seem distant (even hospital administrators sleep sometimes!). I love spending the day with my kids; then, just as their activities and their activity levels are winding down, I hand them off and off I go.



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Insulin Therapy for the Management of Diabetic Ketoacidosis Time for a Paradigm Shift?

from ArchPedi - 01 Nov 14

Diabetic ketoacidosis (DKA) and cerebral edema are major causes of morbidity and mortality in children with diabetes mellitus. Despite greater awareness and reports of earlier detection, approximately one-third of US children with new-onset diabetes at the time of diagnosis present with DKA, which is defined by the presence of hyperglycemia (blood glucose [BG] level >200 mg/dL [to convert to millimoles per liter, multiply by 0.0555]), a venous pH less than 7.3 or a bicarbonate level less than 15



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The Role of Families in Preventing and Buffering the Effects of Bullying

from ArchPedi - 01 Nov 14

Bullying is a significant public health concern that has garnered considerable attention by the media, policy makers, educators, parents, and researchers. In some ways, its increased visibility has followed a similar trajectory to the issue of child maltreatment, whereby research on short- and long-term impacts of maltreatment, high-profile case examples, and court cases came to the attention of the media, which in turn led policy makers to pass legislation related to identification and reportin



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Uncovering Reservoirs of Methicillin-Resistant Staphylococcus aureus Children Contaminating Households or Households Contaminating Children?

from ArchPedi - 01 Nov 14

Methicillin-resistant Staphylococcus aureus (MRSA) emerged in the late 1980s and is a leading cause of skin and soft-tissue infections (SSTIs) in the United States. Unlike hospital-associated MRSA strains, community-associated MRSA strains, commonly designated USA300 by use of pulsed-field gel electrophoresis, initially were found in children without health care exposure. These strains of community-associated MRSA now cause infections in community and hospital settings. Recent data from the Cent



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Vitamin A Shortage and Risk of Bronchopulmonary Dysplasia

from ArchPedi - 01 Nov 14

Bronchopulmonary dysplasia is the most common serious pulmonary morbidity in premature infants. Premature infants with bronchopulmonary dysplasia are at increased risk of death, and survivors have life-long morbidities. Despite the increased survival of extremely premature infants, bronchopulmonary dysplasia remains a major morbidity. Approximately 40% of infants born between 22 and 28 weeks’ gestation are diagnosed with bronchopulmonary dysplasia, defined as requiring oxygen supplementation at



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Single vs Multiple Embryo Transfer Comparative Costs and a Call for Change

from ArchPedi - 01 Nov 14

The equivalent efficacy and superior safety of elective single embryo transfer (SET) compared with elective multiple embryo transfer (MET) after in vitro fertilization (IVF) has been established in recent medical literature. The transfer of a single high-quality embryo selected from a larger number of available embryos after IVF does not decrease implantation rates compared with MET and decreases the rate of twins from 30% to between 1% and 2%.



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Effects of Aerobic Training, Resistance Training, or Both on Percentage Body Fat and Cardiometabolic Risk Markers in Obese Adolescents The Healthy Eating Aerobic and Resistance Training in Youth Rando

from ArchPedi - 01 Nov 14

ImportanceLittle evidence exists on which exercise modality is optimal for obese adolescents.ObjectiveTo determine the effects of aerobic training, resistance training, and combined training on percentage body fat in overweight and obese adolescents.Design, Setting, and ParticipantsRandomized, parallel-group clinical trial at community-based exercise facilities in Ottawa (Ontario) and Gatineau (Quebec), Canada, among previously inactive postpubertal adolescents aged 14 to 18 years (Tanner stage



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Cyberbullying Victimization and Mental Health in Adolescents and the Moderating Role of Family Dinners

from ArchPedi - 01 Nov 14

ImportanceThis study presents evidence that cyberbullying victimization relates to internalizing, externalizing, and substance use problems in adolescents and that the frequency of family dinners attenuate these associations.ObjectivesTo examine the unique association between cyberbullying victimization and adolescent mental health (after controlling differences in involvement in traditional, face-to-face bullying) and to explore the potential moderating role of family contact in this associatio



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Limited Impact on Health and Access to Care for 19- to 25-Year-Olds Following the Patient Protection and Affordable Care Act

from ArchPedi - 01 Nov 14

ImportanceThe Patient Protection and Affordable Care Act (PPACA) allowed young adults to remain on their parents’ insurance until 26 years of age. Reports indicate that this has expanded health coverage.ObjectiveTo evaluate coverage, access to care, and health care use among 19- to 25-year-olds compared with 26- to 34-year-olds following PPACA implementation.Design, Setting, and ParticipantsData from the Behavior Risk Factor Surveillance System and the National Health Interview Survey, which pro



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Contamination of Environmental Surfaces With Staphylococcus aureus in Households With Children Infected With Methicillin-Resistant S aureus

from ArchPedi - 01 Nov 14

ImportanceHousehold environmental surfaces may serve as vectors for the acquisition and spread of methicillin-resistant Staphylococcus aureus (MRSA) among household members, although few studies have evaluated which objects are important reservoirs of MRSA.ObjectivesTo determine the prevalence of environmental MRSA contamination in households of children with MRSA infection; define the molecular epidemiology of environmental, pet, and human MRSA strains within households; and identify factors as



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The Effect of the National Shortage of Vitamin A on Death or Chronic Lung Disease in Extremely Low-Birth-Weight Infants

from ArchPedi - 01 Nov 14

ImportanceProphylactic vitamin A supplementation has been shown to reduce the incidence of chronic lung disease or death in extremely low-birth-weight infants. Beginning in 2010, a national shortage reduced the supply of vitamin A available.ObjectiveTo estimate the association between vitamin A supplementation and death or chronic lung disease in the context of the recent drug shortage. Intercenter variability in vitamin A use was assessed secondarily.Design, Setting, and ParticipantsRetrospecti



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Hospital Costs of Multiple-Birth and Singleton-Birth Children During the First 5 Years of Life and the Role of Assisted Reproductive Technology

from ArchPedi - 01 Nov 14

ImportanceThe unprecedented increase in multiple births during the past 3 decades is a major public health concern and parallels the uptake of medically assisted conception. The economic implications of such births are not well understood.ObjectivesTo conduct a comprehensive economic and health services assessment of the frequency, duration, and cost of hospital admissions during the first 5 years of life for singleton, twin, and higher-order multiple (HOM) children and to examine the contributi



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Blood Transfusion and Breast Milk Transmission of Cytomegalovirus in Very Low-Birth-Weight Infants A Prospective Cohort Study

from ArchPedi - 01 Nov 14

ImportancePostnatal cytomegalovirus (CMV) infection can cause serious morbidity and mortality in very low-birth-weight (VLBW) infants. The primary sources of postnatal CMV infection in this population are breast milk and blood transfusion. The current risks attributable to these vectors, as well as the efficacy of approaches to prevent CMV transmission, are poorly characterized.ObjectiveTo estimate the risk of postnatal CMV transmission from 2 sources: (1) transfusion of CMV-seronegative and leu



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Association of Antibiotics in Infancy With Early Childhood Obesity

from ArchPedi - 01 Nov 14

ImportanceObesity in children and adults is associated with significant health burdens, making prevention a public health imperative. Infancy may be a critical period when environmental factors exert a lasting effect on the risk for obesity; identifying modifiable factors may help to reduce this risk.ObjectiveTo assess the impact of antibiotics prescribed in infancy (ages 0-23 months) on obesity in early childhood (ages 24-59 months).Design, Setting, and ParticipantsWe conducted a cohort study s



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Low-Dose vs Standard-Dose Insulin in Pediatric Diabetic Ketoacidosis A Randomized Clinical Trial

from ArchPedi - 01 Nov 14

ImportanceThe standard recommended dose (0.1 U/kg per hour) of insulin in diabetic ketoacidosis (DKA) guidelines is not backed by strong clinical evidence. Physiologic dose-effect studies have found that even lower doses could adequately normalize ketonemia and acidosis. Lowering the insulin dose may be advantageous in the initial hours of therapy when a gradual decrease in glucose, electrolytes, and resultant osmolality is desired.ObjectiveTo compare the efficacy and safety of low-dose insulin




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Overprescribing and Inappropriate Antibiotic Selection for Children With Pharyngitis in the United States, 1997-2010

from ArchPedi - 01 Nov 14

Pharyngitis is a common reason for pediatric health care visits. While viral infections account for the majority of pharyngitis episodes, group A Streptococcus (GAS) is implicated in approximately 37% of episodes among children. Antimicrobial treatment of GAS pharyngitis can shorten illness duration, prevent complications, and minimize transmission to others. Evidence-based guidelines for GAS pharyngitis recommend narrow-spectrum penicillins (amoxicillin or penicillin) as first-line therapy; the



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Geographic Variation in Receipt of Psychotherapy in Children Receiving Attention-Deficit/Hyperactivity Disorder Medications

from ArchPedi - 01 Nov 14

Attention-deficit/hyperactivity disorder (ADHD) is one of the most common childhood disorders, affecting an estimated 11% of boys and 4% of girls in the United States. Stimulant medications manage ADHD symptoms in most children. However, many parents prefer that treatment include some nonpharmacologic therapy, and combination behavioral therapy and pharmacotherapy may improve outcomes over either modality alone for many youth.



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Undertreated and Untreated Pain Should Be Considered an Adverse Event of Neonatal Circumcision

from ArchPedi - 01 Nov 14

To the Editor We read with great interest the article by El Bcheraoui et al recently published in JAMA Pediatrics. We believe that the rates of adverse events of male circumcision may have been underestimated. As a matter of fact, the authors did not mention intraoperative and postoperative pain as an adverse effect, especially in neonates. Nonetheless, authors in other studies consider undertreating or untreating procedural pain to be an actual adverse event.



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Undertreated and Untreated Pain Should Be Considered an Adverse Event of Neonatal Circumcision—Reply

from ArchPedi - 01 Nov 14

In Reply We thank Bisogni et al for their comments recently published in JAMA Pediatrics about intraoperative and postoperative pain as an adverse event (AE) to male circumcision (MC). Use of appropriate analgesia for pain management is a good practice that should be the standard of care during and after any surgical procedure because it can substantially control pain. In a prospective study of 583 neonatal circumcisions performed between December 1, 2005, and December 1, 2008, when appropriate


 

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