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This Month in Archives of Pediatrics and Adolescent Medicine
February 2008

This Month in Archives of Pediatrics & Adolescent Medicine

Arch Pediatr Adolesc Med. 2008;162(2):103. doi:10.1001/archpediatrics.2007.42
Effect of Transition to a Medical Emergency Team and Categorization of Cardiopulmonary Arrests

The outcome of cardiopulmonary arrests, even if occurring in a hospital, is poor. Pediatric rapid response teams have been developed to evaluate and intervene before children sustain arrests. This study documents the effect of such a team on respiratory and cardiopulmonary arrests. Following introduction of the team, there was a 68% increase in the number of calls and a 73% decrease in the incidence of respiratory arrests, though the incidence of cardiopulmonary arrests did not change. Most cardiopulmonary arrests were considered nonpreventable.

Impact of Cost-Sharing on Asthma Medication Use

In this Canadian study, 49% of asthma medications involved sharing 0% to 20% of their cost. For 18% of the medications, cost-sharing was more than 20%. The high cost-sharing group was 24% less likely to purchase bronchodilators, anti-inflammatory medications, or leukotriene receptor antagonists. There was a 30% decreased purchase of combined long-acting β-agonists and inhaled corticosteroids in the high cost-sharing group. There was no effect of cost-sharing on the use of oral steroids. Drug plan managers should consider the effect that medication cost-sharing may have on heath outcomes in children with asthma and other chronic illnesses. Ideally, providing drug benefits to children should be integrated with asthma disease management programs to promote optimal asthma control.

World Trade Center Attacks and Preschool Children's Behavioral Problems

In this study, conducted an average of 35 months after the World Trade Center attacks, Chemtob and colleagues interviewed families of 116 children who lived or attended preschool in lower Manhattan at the time of the attacks. About one-fourth of the children were exposed to high-intensity events associated with the attack, and about half had been previously exposed to other traumatic events in their lives. The combination of these exposures was additive and increased the odds of behavioral problems 18- to 26-fold. This study indicates the preschool children's vulnerability to the synergistic effects of repeated trauma and the need for identification and treatment with effective interventions in this group.

Figure.
Effect of conjoined exposure to high-intensity World Trade Center (WTC) attack–related events and to other lifetime trauma exposure on child symptoms. Logistic regression analysis was used, with adjustment for child age, maternal educational level, and time between the WTC attacks and the assessment.
*P < .05. †P < .01. ‡P < .10.

Effect of conjoined exposure to high-intensity World Trade Center (WTC) attack–related events and to other lifetime trauma exposure on child symptoms. Logistic regression analysis was used, with adjustment for child age, maternal educational level, and time between the WTC attacks and the assessment. *P < .05. †P < .01. ‡P < .10.

New Clinical Patterns in the Presentation of Celiac Disease

With the advent of effective screening tests and knowledge of high-risk patients, the number of children with diagnosed celiac disease in southeastern Wisconsin has risen in recent years, increasing from 1 in 1986 to 93 in 2003. Telega and colleagues discuss changes in the clinical presentation of patients with this disorder. With this increase in frequency of diagnosis, the mean age at diagnosis rose from 5 to nearly 9 years. In children older than 3 years, most presented with extraintestinal manifestations; in this group, 60% had no gastrointestinal symptoms and 11% were overweight. Pediatricians should be aware of the more typical presentation of celiac disease and screen all high-risk children, including those who have Down or Turner syndrome, type 1 diabetes, short stature, thyroiditis, and a first-degree relatives with celiac disease.

Figure.
Age distribution of patients diagnosed with celiac disease by type of presentation. The difference was significant as evaluated by χ2 test (P < .001).

Age distribution of patients diagnosed with celiac disease by type of presentation. The difference was significant as evaluated by χ2 test (P < .001).

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