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This Month in Archives of Pediatrics & Adolescent Medicine
Arch Pediatr Adolesc Med. 2001;155:1089.
Corticosteroid Prescription Filling for Children Covered by Medicaid
Following an Emergency Department Visit or a Hospitalization for Asthma
Despite specific guidelines for optimizing asthma management, many children
do not receive recommended care. One point for improving care is the provision
of systemic steroids for children with acute asthma exacerbations. Copper
and Hickson found that less than half of Tennessee children receiving Medicaid
had prescriptions for oral steroids following an emergency department visit
or hospitalization. This study documents the need to develop better methods
of increasing physician compliance with guidelines for care of children with
chronic illnesses.
(SEE ARTICLE)
Long-term Effects of a Middle School– and High School–Based
Human Immunodeficiency Virus Sexual Risk Prevention Intervention
Efforts to reduce high-risk behaviors can only be judged by their long-term
effect. This randomized controlled study of 4000 middle and high school students
found that a school-based educational intervention regarding high-risk sexual
behaviors still had a positive effect an average of 41 weeks later. The effect
was greatest among middle school girls and among those who were not yet sexually
active at the time of the intervention. This supports the move to earlier
implementation of school-based interventions.
(SEE ARTICLE)
Improving Survival of Vulnerable Infants Increases Neonatal Intensive
Care Unit Nosocomial Infection Rate
Improvements in obstetrical and neonatal care have reduced the morbidity
and mortality of very low-birth-weight infants. In this study of 1085 infants
weighing 1500 g or less at birth, nosocomial infections increased by 41% between
1991 and 1995, and 1996 and 1997. During the same time, the duration of indwelling
vascular access increased by 60%, and the duration of mechanical ventilation
increased by 71%. Understanding the interaction between host and environmental
factors that contributed to this increase in nosocomial infections is necessary
to prevent a rise in mortality.
(SEE ARTICLE)
Assessing Diagnostic Accuracy and Tympanocentesis Skills in the Management
of Otitis Media
The problem of increasing prevalence of antibiotic resistance in acute
otitis media has focused on the accuracy of the diagnosis of this common problem.
Pichichero and Poole assessed the accuracy of 514 pediatricians and 199 otolaryngologists
in diagnosing acute otitis media and otitis media with effusion using video-recorded
pneumatic otoscopic examinations. The average correct diagnosis by pediatricians
was 50% and by otolaryngologists, 73%. Pediatricians overdiagnosed otitis
media 7% to 53% of the time, compared with 3% to 23% of the time by otolaryngologists.
Improvment in physicians' ability to diagnose this common pediatric problem
is clearly needed.
(SEE ARTICLE)
Low Family Income and Food Insufficiency in Relation to Overweight
in US Children: Is There a Paradox?
It has been commonly thought that children in families with low income
were more likely to be both overweight as well as have food deprivation, compared
with children in families with high income. Using data from the Third National
Health and Nutrition Examination Survey of more than 9000 children, Alaimo
et al found that food insufficiency was not associated with overweight, except
in 8- to 16-year-old white, non-Hispanic girls. Thus, there seems to be only
limited evidence for this "paradox."
(SEE ARTICLE)
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