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Despite improvements in vehicles and driver training programs, some teens appear to still be at high risk for a motor vehicle crash. In this longitudinal study of newly licensed teenage drivers, Ouimet and colleagues studied the driving behavior and cortisol responses to stress in 40 teens driving instrumented vehicles that could detect crashes and near-crash maneuvers. Teens with higher baseline cortisol response had lower crash and near-crash rates during the follow-up period, and their driving improved at a more rapid rate. The implications of this study for clinicians and for future research are discussed by Durbin and colleagues in their accompanying editorial.
Editorial and Patient Page
Violence and injury risk behaviors, alcohol and drug use problems, and posttraumatic stress disorder (PTSD) and depressive symptoms occur frequently among adolescents presenting to acute care medical settings after traumatic physical injury. Zatzick and colleagues randomized injured adolescents to receive care as usual or stepped collaborative care for 12 months after hospitalization. Weapon carrying by intervention patients was reduced by 69% compared with the control group; there were no significant effects on PTSD, depressive symptoms, or substance use at 12 months. If the finding is replicated, orchestrated investigative and policy efforts could systematically implement and evaluate screening and intervention procedures targeting youth violence prevention at US trauma centers.
The rates of children’s exposure to violence and abuse are of interest to all of us. Finkelhor and colleagues presented the results of comprehensive national surveys in 2003, 2008, and 2011 for children 2 to 17 years of age. There was a 33% decline in assault rates over this time, with particularly large declines for assault victimization, bullying, and sexual victimization, as well as declines in youth perpetration. The accompanying editorial by Lutzker and colleagues discussed the possible reasons for this decline including the broad application of multi-faceted, evidence-based prevention programs.
Author Audio Interview
Iron deficiency has a known adverse effect on infants’ neurodevelopment. In this randomized clinical trial, Andersson and colleagues assessed the effects of early cord clamping or clamping at 180 seconds after birth. Delayed cord clamping did not affect iron status or neurodevelopmental outcomes at age 12 months in healthy term-born infants, although sex may have influenced the effects on development. The implementation of the study in a population in which iron deficiency is rare may be partly responsible for the absence of an effect.
Journal Club and Continuing Medical Education
Highlights. JAMA Pediatr. 2014;168(6):501. doi:10.1001/jamapediatrics.2013.3345