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This Month in Archives of Pediatrics & Adolescent Medicine
Arch Pediatr Adolesc Med. 2001;155:1192.
Limits of the Genetic Revolution
Medical and lay publications give increasing, and sometimes overwhelming,
coverage of genetic discoveries. Concrete progress in therapy, however, has
been and will likely continue to be slow. Dr Scheuerle discusses the molecular,
economic, and behavioral barriers to the development of genetic treatments.
The economic disincentives to develop orphan drugs may hinder therapy for
truly rare diseases. The lack of uniform compliance with existing effective
therapies will limit the adoption of new treatments. While the genetic revolution
had much potential, the complexity of genetics itself is great. Advancements
will be made, but they are likely to occur only at a measured pace.
(SEE ARTICLE)
Foster Care Placement Improves Children's Functioning
More than 500 000 children are currently in foster care in the
United States, and the average stay in care is 33 months. There have been
limited data on the effect of foster care on children's health and functioning.
In this prospective, longitudinal study of 120 children in foster care, Horwitz
and colleagues examined the improvement in children's functioning at 6 and
12 months after placement. After 12 months of care, children's functioning
significantly improved, with mean scores well within the range of normal.
Children who were older at placement and spent more time in care were the
group most likely to show improvement. The results argue for a careful examination
of the foster care environment to better understand the factors that most
contribute to improved functioning.
(SEE ARTICLE)
The Influence of Grandmothers and Other Senior Caregivers on Sleep
Position Used by African American Infants
In the United States, rates of sudden infant death syndrome continue
to be higher in African American infants. This is potentially related to a
higher rate of prone sleeping in these infants. Flick and colleagues conducted
a randomized controlled trial among pregnant women and their mothers during
the third trimester, during which education about sleep position was given.
Including grandmothers in the education did not increase the rate of supine
sleeping postnatally, though it did decrease the amount that the grandmothers
worried about sudden infant death syndrome. It is clear that the Back-to-Sleep
campaign must include all caregivers for the child.
(SEE ARTICLE)
Effects of 2 Inhaled Corticosteroids on Growth: Results of a Randomized
Controlled Trial
While inhaled corticosteroids are widely recommended for the treatment
of asthma, little is known about the effects of different inhaled steroids
on growth rates. This randomized controlled trial compared twice-daily fluticasone
proprionate with beclomethasone diproprionate in 4- to 11-year-old children
during a 12-month period. The adjusted mean growth velocity in the fluticasone
group was significantly higher than in the beclomethasone group. The fluticasone
group also had greater improvement in lung function. The more favorable risk-benefit
ratio for fluticasone that indicates that it may be preferable for the long-term
treatment of children with asthma.
(SEE ARTICLE)
Overrestriction of Dietary Fat Intake Before Formal Nutritional Counseling
in Children With Hyperlipidemia
Previous reports have suggested that parent-imposed low-fat diets in
the absence of nutritional counseling may have a negative effect on the growth
and development of children. In this study of children referred by their primary
care pediatricians for hyperlipidemia, parent-imposed diets resulted in lower
energy intake and lower fat intake than the diets of control children. These
children had lower vitamin E and zinc intake as well. The study indicates
that overzealous dietary fat restriction can occur in parent-initiated diets.
(SEE ARTICLE)
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