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.
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.
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.
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.
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.
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.
This Month in Archives of Pediatrics & Adolescent Medicine. Arch Pediatr Adolesc Med. 2001;155(8):873. doi:10-1001/pubs.Pediatr Adolesc Med.-ISSN-1072-4710-155-8-ptm0801