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This Month in Archives of Pediatrics & Adolescent Medicine
Arch Pediatr Adolesc Med. 2003;157:616.
Does Telephone Triage Delay Significant Medical Treatment? Advice Nurse Service vs On-Call Pediatricians
Centralized advice nurse call centers are increasingly used by pediatricians to lessen the burden of being on call. This randomized controlled trial analyzed families' use of unadvised medical care by the nurse compared with the on-call physician. About 1 in 5 patients sought unadvised care; this did not differ among those who were randomized to the advice nurse call center compared with patients randomized to a pediatrician on call. This suggests that nurses do not delay significant medical treatment when compared with on-call pediatricians.
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Prospective Polysomnographic Analysis of Obstructive Sleep Apnea in Down Syndrome
Concerns about snoring and obstructive sleep apnea (OSA) are common when caring for children with Down syndrome. Among patients with a mean age of 9 years, (OSA) was found in 79%. Patients had a median of 3 apnea events per hour during sleep and a median oxygen saturation (SaO2) level of 88%. A higher body mass index was associated with greater apnea and lower SaO2) levels; older children were more likely to have low SaO2 levels. Children with OSA were more likely to have sleep-related symptoms and a higher movement arousal index during sleep. This study indicates that OSA should be more widely investigated in children with Down syndrome and that attention should be given to the development of better treatments.
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Analysis of Prevalence Trends of Autism Spectrum Disorder in Minnesota
Awareness and concern about autism spectrum disorder has grown among the lay public and the scientific community. This population-based study from the state of Minnesota used school data to determine the prevalence rates of autism spectrum disorder during the last 20 years. The prevalence of autism spectrum disorder appeared to be fairly stable from 1981 to 1990 but increased 16-fold between 1991 and 2001. The prevalence appeared to increase both for each successive birth cohort and within each birth cohort as the children aged. Whether this represents a true increase in prevalence or a change in case ascertainment is unknown.
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The Relationship Between Pediatric Residency Program Size and Inpatient Illness Severity and Diversity
To provide quality training for pediatric residents regardless of program size, exposure to a diverse group of patients is necessary. Jennings and colleagues examined a sample of pediatric residency programs within the University HealthSystems Consortium. There was no relationship between program sized and the severity of illness among patients discharged from the hospital. However, larger programs had less diagnostic diversity than small and medium-size programs as well as a greater number of patients discharged with asthma. Although there were variations in the diversity of exposure across programs, program size was a poor predictor of inpatient learning opportunities.
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Evaluating Adolescents in Juvenile Detention Facilities for Urogenital Chlamydial Infection: Costs and Effectiveness of Alternative Interventions
Adolescents in juvenile detention facilities typically exhibit many risky behaviors and represent a unique opportunity to diagnose and treat sexually transmitted diseases. This study examined the trade-offs between different strategies for the diagnosis and treatment of chlamydial infection in adolescents in juvenile detention. In males, treating on the basis of a positive urine leukocyte esterase test result was found to be the most cost-effective strategy. In females, empiric treatment based on either symptoms or results of urine ligase chain reaction tests for Chlamydia were the optimal strategies for treating urogenital chlamydial infection.
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