Despite specific guidelines for optimizing asthma management, many children do not receive recommended care. One point for improving care is the provision of systemic steroids for children with acute asthma exacerbations. Copper and Hickson found that less than half of Tennessee children receiving Medicaid had prescriptions for oral steroids following an emergency department visit or hospitalization. This study documents the need to develop better methods of increasing physician compliance with guidelines for care of children with chronic illnesses.
Efforts to reduce high-risk behaviors can only be judged by their long-term effect. This randomized controlled study of 4000 middle and high school students found that a school-based educational intervention regarding high-risk sexual behaviors still had a positive effect an average of 41 weeks later. The effect was greatest among middle school girls and among those who were not yet sexually active at the time of the intervention. This supports the move to earlier implementation of school-based interventions.
Improvements in obstetrical and neonatal care have reduced the morbidity and mortality of very low-birth-weight infants. In this study of 1085 infants weighing 1500 g or less at birth, nosocomial infections increased by 41% between 1991 and 1995, and 1996 and 1997. During the same time, the duration of indwelling vascular access increased by 60%, and the duration of mechanical ventilation increased by 71%. Understanding the interaction between host and environmental factors that contributed to this increase in nosocomial infections is necessary to prevent a rise in mortality.
The problem of increasing prevalence of antibiotic resistance in acute otitis media has focused on the accuracy of the diagnosis of this common problem. Pichichero and Poole assessed the accuracy of 514 pediatricians and 199 otolaryngologists in diagnosing acute otitis media and otitis media with effusion using video-recorded pneumatic otoscopic examinations. The average correct diagnosis by pediatricians was 50% and by otolaryngologists, 73%. Pediatricians overdiagnosed otitis media 7% to 53% of the time, compared with 3% to 23% of the time by otolaryngologists. Improvment in physicians' ability to diagnose this common pediatric problem is clearly needed.
It has been commonly thought that children in families with low income were more likely to be both overweight as well as have food deprivation, compared with children in families with high income. Using data from the Third National Health and Nutrition Examination Survey of more than 9000 children, Alaimo et al found that food insufficiency was not associated with overweight, except in 8- to 16-year-old white, non-Hispanic girls. Thus, there seems to be only limited evidence for this "paradox."
This Month in Archives of Pediatrics & Adolescent Medicine. Arch Pediatr Adolesc Med. 2001;155(10):1089. doi:10.1001/archpedi.155.10.1089