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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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Incorrect Footnote in Table

from ArchPedi - 01 Jul 14

In the Original Investigation titled “Electronic Cigarettes and Conventional Cigarette Use Among US Adolescents: A Cross-sectional Study” published online March 6, 2014, in JAMA Pediatrics (doi:10.1001/jamapediatrics.2013.5488), an incorrect footnote appeared in Table 2. In the row “Ever cigarette smokers (n?=?1832),” footnote b should have been used.



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Electronic Cigarettes

from ArchPedi - 01 Jul 14

Electronic cigarettes, also called e-cigarettes, are battery-operated devices that deliver nicotine without smoke. The nicotine is delivered to the lungs but without burning tobacco like a regular cigarette. Electronic cigarettes are made to look like traditional cigarettes or cigars or everyday items such as pens.



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JAMA Pediatrics

from ArchPedi - 01 Jul 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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Analysis of a New York Times Article on the Public’s Perception of Dermatologists

from ArchDerm - 01 Jul 14

The American Academy of Dermatology (AAD) formally responded on January 21, 2014, to the New York Times article “Patients’ Costs Skyrocket; Specialists’ Incomes Soar,” by Elisabeth Rosenthal published on January 19, 2014 (part 6 of the “Paying Till it Hurts” series). The AAD’s statement was certainly sensible, and defending one’s specialty from potentially misleading and biased information is a worthy pursuit.



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Low-Dose Interleukin 2 to Reverse Alopecia Areata

from ArchDerm - 01 Jul 14

Cytokines have long been postulated to play a role in alopecia areata (AA), and antigen-specific scalp T cells from patients with extensive AA have been found to have an intrinsic defect in the production of TH1 cytokines such as interferon gamma and interleukin 2 (IL-2). In the interesting study presented by Castela et al, 5 patients with extensive AA were treated with low-dose IL-2, and 4 of the 5 patients attained considerable hair regrowth. This was accompanied by an increase in regulatory



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Durable Remission of Pemphigus With a Fixed-Dose Rituximab Protocol

from ArchDerm - 01 Jul 14

ImportanceRituximab induces B-lymphocyte apoptosis by targeting CD20 antigen and has shown efficacy in antibody-mediated autoimmune disease. Rituximab is increasingly being acknowledged as an effective and safe treatment option for pemphigus.ObjectiveTo assess the clinical response of patients with pemphigus to rituximab using a modified fixed-dose rheumatoid arthritis protocol (1 g intravenously on days 1 and 15, followed by 500 mg intravenously if clinically warranted at 6-month intervals or r



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Outcomes After Diagnosis of Mycosis Fungoides and Sézary Syndrome Before 30 Years of Age A Population-Based Study

from ArchDerm - 01 Jul 14

ImportanceMycosis fungoides and Sézary syndrome (MF/SS) are rare in children and young adults, and thus the incidence and outcomes in this patient population are not well studied.ObjectiveTo assess the incidence and outcomes of MF/SS in patients diagnosed before 30 years of age.Design, Setting, and ParticipantsRetrospective study of 2 population-based cancer registries—the California Cancer Registry (n = 204) and 9 US cancer registries of the Surveillance, Epidemiology, and End Results program (



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Effect of Host, Tumor, Diagnostic, and Treatment Variables on Outcomes in a Large Cohort With Merkel Cell Carcinoma

from ArchDerm - 01 Jul 14

ImportanceMerkel cell carcinoma (MCC) is a rare, aggressive, neuroendocrine-derived skin cancer with high rates of recurrence and associated mortality. Few published studies have used comprehensive patient data and long-term follow-up to examine factors that predict MCC outcomes.ObjectiveTo characterize MCC in a large defined-population cohort and analyze predictors of disease recurrence and survival.Setting, Design, and ParticipantsRetrospective cohort study of 218 patients with MCC from the ca



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Identification of Clinical Features and Autoantibodies Associated With Calcinosis in Dermatomyositis

from ArchDerm - 01 Jul 14

ImportancePrior studies have estimated that up to 20% of adults with dermatomyositis (DM) have calcinosis, which can lead to significant morbidity. Identification of risk factors may provide a better understanding of the pathogenesis and ultimately therapy for this difficult clinical problem. Risk factors for calcinosis in adults with DM have not been extensively studied.ObjectivesTo determine the prevalence of calcinosis and to identify associated clinical features in a cohort of extensively ph



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Delivery of Compression Therapy for Venous Leg Ulcers

from ArchDerm - 01 Jul 14

ImportanceDespite the documented effect of compression therapy in clinical studies and its widespread prescription, treatment of venous leg ulcers is often prolonged and recurrence rates high. Data on provided compression therapy are limited.ObjectiveTo assess whether home care nurses achieve adequate subbandage pressure when treating patients with venous leg ulcers and the factors that predict the ability to achieve optimal pressure.Design, Setting, and ParticipantsWe performed a cross-sectiona


 

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