The diagnosis of occult bacteremia in children remains a challenging clinical problem. C-reactive protein (CRP) has been suggested as a useful diagnostic test for the detection of bacteremia in febrile children. In this prospective study of 256 febrile children aged 3 to 36 months, 11.3% had a bacterial infection, including 1.1% with bacteremia. Use of the CRP, in addition to the absolute neutrophil count, did not improve the sensitivity of laboratory tests in identifying bacterial infections, and the specificity of negative tests in this population was lowered. Given that the prevalence of bacteremia seems to be very low, the use of diagnostic screening tests may not be appropriate.
Hospitalists are caring for an increasing proportion of hospitalized children and adults in the United States. Hospitalists seem to decrease inpatient length of stay and costs, but their effects on training of residents are less clear. Landrigan and colleagues surveyed resident physicians before and following the introduction of a hospitalist system at an academic children's hospital. Interns reported that their satisfaction with the educational experience and supervision improved following use of the hospitalists. Hospitalists were rated by residents as more effective role models, more accessible and knowledgeable, and more involved in resident education.
The average child or adolescent in the United States watches an average of 3 hours of television per day, and prior studies have suggested that exposure to television violence is associated with aggressive behavior. This study assessed the effect of television watching on behavioral problems and social competency among second- and third-grade students. The amount of time spent watching television was found to be positively associated with social problems and delinquent and aggressive behavior. This study further underscores the negative effects of large amounts of time spent watching television.
For more than 30 years, the danger of serious abdominal and pelvic organ injuries posed by bicycle handlebars has been known. The US Consumer Product Safety Commission is considering regulating the performance of handlebars with regards to their energy dissipation capabilities. Winston and colleagues, using data from 19 states, estimated that 1147 children and adolescents sustain bicycle-related injuries annually in the United States, of whom 77% may have been injured because of handlebars. The estimated hospital charges associated with these injuries were $9.6 million and an additional estimated $10 million in lifetime medical costs. The scope and magnitude of the problem warrant serious consideration of alternative designs for handlebars.
Asthma and lead poisoning are common in urban areas, with both diseases having an environmental mechanism. Home repair and renovation have been practiced for prevention and intervention for both diseases. Determining the degree of comorbidity between lead poisoning and asthma may provide information to guide interventions aimed at preventing or reducing the effect of these diseases. This study of patients attending an inner-city clinic found no increased likelihood of asthma diagnosis or symptoms among children with elevated blood lead levels. The prevalence of asthma symptoms was high among both children with high and low blood lead levels.
This Month in Archives of Pediatrics & Adolescent Medicine. Arch Pediatr Adolesc Med. 2002;156(9):851. doi:10.1001/archpedi.156.9.851