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This Month in Archives of Pediatrics and Adolescent Medicine
February 2006

This Month in Archives of Pediatrics & Adolescent Medicine

Arch Pediatr Adolesc Med. 2006;160(2):127. doi:10.1001/archpedi.160.2.127
Randomized Controlled Trial of a Primary Care and Home-Based Intervention for Physical Activity and Nutrition Behaviors: PACE+ for Adolescents

While there has been increasing attention paid to the problem of obesity, poor nutrition, and physical inactivity among youth, few interventions have been developed that are effective in addressing these problems. Patrick and colleagues conducted a randomized controlled trial in 878 adolescents, examining the effectiveness of a multifaceted school and home-based intervention. The program significantly improved physical activity and diet although it had no effect on body mass index. Even more intensive interventions, however, may be necessary to have long-term effects on the prevalence of obesity.

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Neonatal Abstinence Syndrome After In Utero Exposure to Selective Serotonin Reuptake Inhibitors in Term Infants

The use of selective serotonin reuptake inhibitors (SSRIs) to treat depression during pregnancy has become more common. While there is no evidence that such use is teratogenic, there have been reports of neonatal abstinence syndrome in infants born to mothers taking SSRIs. This study examined the incidence and clinical characteristics of the neonatal abstinence syndrome of 60 term infants who had prolonged in utero exposure to SSRIs. Of these infants, 1 in 7 exhibited signs of severe withdrawal and 1 in 6 had mild withdrawal symptoms. The maximum symptoms usually occurred within 2 days of birth. The long-term effects of SSRIs on infants are unknown.

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Association of Condom Use, Sexual Behaviors, and Sexually Transmitted Infections With the Duration of Genital Human Papillomavirus Infection Among Adolescent Women

Persistent human papillomavirus (HPV) infection appears to be necessary for the development of neoplasia. Little is known about the factors associated with HPV persistence in adolescent women. The authors of this study observed adolescent women over a period of 27 months to determine the duration of persistence. The cumulative prevalence of HPV infection was 82% in this patient population, and 45% had coinfection with Chlamydia trachomatis and 25% with Neisseria gonorrhoeae. Half of all HPV infections were no longer detectable by 210 days after initial detection. Prolonged HPV infection was associated with oncogenic viral types, lower condom use, and coinfection with C trachomatis. Having fewer sexual partners was associated with a shorter duration of HPV infection. These findings have important public health implications.

Kaplan-Meier estimates of the survival of human papillomavirus (HPV) infection (A-F). CT indicates Chlamydia trachomatis; TV, Trichomonas vaginalis; Pr, probability.

Kaplan-Meier estimates of the survival of human papillomavirus (HPV) infection (A-F). CT indicates Chlamydia trachomatis; TV, Trichomonas vaginalis; Pr, probability.

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Simulating Cost-effectiveness of Fluoride Varnish During Well-Child Visits for Medicaid-Enrolled Children

Disparities in children's oral health are large, in part owing to limited access to dental services for high-risk children. Only a minority of poor children receive regular routine prophylactic dental care. Fluoride varnish is an effective topical medication that can be applied by primary care physicians. This study examined the cost-effectiveness of routine fluoride varnish by primary care practitioners during routine well-child care visits. Providing universal routine fluoride varnish at ages 9, 18, 24, and 36 months resulted in an additional 1.5 cavity-free months by 42 months of age. The net cost was $10.93 over the entire intervention period. Fluoride varnish would cost $203 per restorative treatment averted.

Results illustrate changing incremental cost-effectiveness ratio over simulation time by quarter discounted.

Results illustrate changing incremental cost-effectiveness ratio over simulation time by quarter discounted.

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