 |
|
This Month in Archives of Pediatrics & Adolescent Medicine
Arch Pediatr Adolesc Med. 2001;155:873.
Advocating for Children's Health at the State Level:
Lessons Learned
Three years ago, the country was shaken to its roots by the shooting
of 4 elementary school students and their teacher in Jonesboro, Ark. The authors
describe how this school shooting was used as the impetus to galvanize community
action to develop long-term violence prevention programs. The group was successful
in creating and promoting a bill to fund a nurse home visitation program for
high-risk mothers in Arkansas using the successful model of David Olds. This
article provides a wonderful example of effective community advocacy by pediatricians.
(SEE ARTICLE)
Serious Injuries and Deaths of Adolescent Girls Resulting From Interpersonal
Violence: Characteristics and Trends From the United States, 1989-1998
Adolescent and young adult males have been the focus of most of the
attention paid to violent victimization during the last decade. While rates
are higher in males, adolescent females are nevertheless frequently the victims
of interpersonal violence. Data from 91 trauma centers reporting to the National
Pediatric Trauma Registry indicate that females were more likely to have been
stabbed while males were more likely to have been shot. Females were also
more likely to have been injured at home while males were more likely to have
been injured in public places. The proportion of injures due to assaults declined
for males and females during the last decade.
(SEE ARTICLE)
Pediatric Length of Stay Guidelines and Routine Practice: The Case of Milliman and Robertson
In efforts to control health care costs, many health plans have begun
to use clinical practice guidelines to limit use of health services. Although
the guidelines developed by Milliman and Robertson (M&R) have been widely
disseminated and adopted, there have been few reports examining their validity.
Statewide data from Pennsylvania for 1996 to 1998 found that the median length
of stay was very similar to the M&R guidelines for most conditions examined.
However, 30% to 83% of children had stays longer than the guidelines recommended,
indicating the need for careful application of the guidelines to practice.
(SEE ARTICLE)
Hepatitis B Vaccination Practices in Hospital Newborn Nurseries Before
and After Changes in Vaccination Recommendations
The suspension of newborn hepatitis B vaccination in July 1999 for low-risk
infants was a controversial policy, related to a theoretical risk of mercury
exposure. This national study reports on interviews with 773 hospitals across
the country to document changes in policies as a result of this suspension.
After July 1999, there was a 6-fold increase in the number of hospitals that
were not vaccinating all high-risk infants, thereby placing these children
at risk of hepatitis B. After the introduction of thimerosal-free vaccines,
only 39% of hospitals reported vaccinating all low-risk infants. This study
points out the need for a more thoughtful balance between theoretical risk
and actual risk related to inconsistent implementation.
(SEE ARTICLE)
When Parents Reject Interventions to Reduce Postnatal Human Immunodeficiency
Virus Transmission
As more women infected with the human immunodeficiency virus give birth,
pediatricians may increasingly face dilemmas when parents reject medical recommendations
to forgo breastfeeding and to administer antiretroviral prophylaxis to the
infant. Pediatricians have an obligation to protect the infant and also to
respect parental decision making. The authors analyze the legal and ethical
issues around such dilemmas and provide an approach for addressing these disagreements.
They provide very practical advice on when a pediatrician should, may, and
should not seek a court order to intervene on behalf of the child.
(SEE ARTICLE)
Subsequent Sexually Transmitted Infection in Urban Adolescents and
Young Adults
Current recommendations are to conduct annual screening for sexually
transmitted infections in sexually active adolescents. Among 444 unmarried
individuals aged 13 to 25 years, the rates of new infection among those who
were not infected previously were 40% in men and 53% in women 7 months later.
Rates of reinfection were even higher in those treated for an infection at
baseline. These data support screening high-risk youth every 6 months for Chlamydia trachomatis, Neisseria gonorrheae, and Trichomonas vaginalis.
(SEE ARTICLE)
|
