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In This Issue of JAMA Pediatrics
June 2017


JAMA Pediatr. 2017;171(6):501. doi:10.1001/jamapediatrics.2016.3111

Bedside monitor alarms alert nurses to life-threatening physiologic changes among patients, but the response times of nurses are slow. In this prospective cohort study, Bonafide et al used 551 hours of video-recorded care administered by 38 nurses to 100 children in a children’s hospital medical unit to identify factors associated with monitor alarm response times. The median response time among nurses was 10.4 minutes, and only 0.5% of alarms were actionable. Longer response times were found for nurses who had worked for less than 1 year, were at a later point in their shift, and were caring for children with families present. The accompanying Editorial discusses the system-level care processes needed to improve alarm response times.


Continuing Medical Education

Approximately 60% of youths who have a human immunodeficiency virus infection (HIV) are unaware of their serostatus and are therefore not linked to HIV medical or prevention services. Testing strategies, including targeted testing, universal testing, or a combination of both testing approaches, were evaluated using an observational design in 12 adolescent medicine HIV primary care programs. Compared with universal screenings, targeted testing directed specifically toward at-risk males who were sexual minorities identified more youths with previously undiagnosed infections and was more successful in linking those with negative test results to behavioral and biomedical prevention services. The Editorial by Agwu and Quinn discusses the likely need for a combination of targeted and universal testing, depending on venue and community acceptance.


Several studies have examined the links between prenatal exposure to antidepressants and autism spectrum disorders in children with inconsistent results, especially regarding the effect of the trimester of exposure. This meta-analysis of 6 case-control studies (117 737 patients) found a positive association between antidepressant exposure and autism spectrum disorders, which decreased after controlling for past maternal mental illness. This association is more consistent during the preconception period than during each trimester. Treatment for maternal psychiatric disorders before a pregnancy rather than antenatal exposure to antidepressants could have a major role in the risk for autism spectrum disorders in children.

The comprehensive and timely monitoring of disease burden among all age groups, including children and adolescents, is essential for improving population health. This report from the Global Burden of Diseases, Injuries, and Risk Factors 2015 Study focuses on children and adolescents who were 19 years or younger from 1990 to 2015 in 195 countries and territories. Global child and adolescent mortality rates decreased from 14.18 million (95% uncertainty interval [UI], 14.09 million to 14.28 million) deaths in 1990 to 7.26 million (95% UI, 7.14 million to 7.39 million) deaths in 2015, but progress has been uneven. In 2015, a greater share of global mortality burden was concentrated in the lowest–sociodemographic index countries than in 1990, and there has been an increase in the global proportion of nonfatal disease burden. The Editorial by Sudfeld and Fawzi highlights the need for continued investment in reducing stillbirths and neonatal deaths and improving adolescent health.