Prevention of the early onset of disease is an important strategy for confronting America's co-occurring problems of increasing health care spending and increasing burden of disease as the population ages. Communities That Care is a prevention system created to provide training and materials that mobilize and empower coalitions of diverse community stakeholders to prevent adolescent drug use and delinquency. This report is the first randomized trial of Communities That Care, conducted in 24 communities in 7 states. Students in intervention communities were less likely to initiate use of alcohol, cigarettes, and smokeless tobacco than those in the control communities and were less likely to initiate delinquent behavior. This study indicates that public health can be promoted and risky behaviors in early adolescence can be prevented by coalitions of community stakeholders.
Predicted hazard of initiating delinquent behaviors, adjusted for student age, sex, race/ethnicity, parental educational achievement level, religious attendance, and rebelliousness; student population of the community; percent change in student population, 2001 to 2004; and percentage of students in the community receiving free or reduced-price school lunch.
Shared decision making between parents and physicians is essential in the care of critically ill newborns. While communication skills are among the core competencies for neonatology fellowship training, it is not clear how this training is operationalized. This survey of graduating neonatology fellows sought to determine the type and extent of training in communication and decision making that neonatology fellows receive and their perceived preparedness to lead family discussions. Alarmingly, graduating fellows reported little formal training in communication skills targeted to guiding family decision making and perceive this topic to be less important to the faculty than it is to them. Fellows felt inadequately trained to address the more emotional and social issues, such as palliative care, addressing conflicting goals among staff or between staff and families, and discussing families' spiritual and religious needs. Training programs in neonatology appear to fall short of their obligations.
Cognitive home environments have critical effects on child development from infancy to adolescence, including early development, emergent literacy, school readiness, grade retention, and high school graduation rates. Green and colleagues studied low-income mothers of 6-month-old infants to determine the degree to which maternal literacy accounts for associations between education and the cognitive home environment in low-income households. Maternal literacy, and not education alone, was associated with a wide range of parenting behaviors important for child development, including provision of toys and learning materials, shared reading activities, teaching activities, and verbal responsiveness in the home. These findings suggest that literacy may account for the well-established impact of education on parenting and has important implications for both research and clinical practice. Pediatricians should consider developing strategies to identify mothers with low literacy to support their childrens' cognitive home environments. An ethics curriculum that addresses these issues would help meet the professionalism goals, better serve trainees' current educational needs, and likely better prepare trainees, especially those entering primary care, for their future roles as pediatricians.
Medicine involves moral obligations and inevitably conflicts between those obligations. Competent pediatricians must be able to identify the moral issues that arise in clinical care and apply analytic skills toward their resolution. The goal of this study was to identify real-life ethics issues that pediatric residents encounter as they care for patients in an outpatient clinical setting. Observations of residents in the clinic identified 5 major themes of ethical challenges: (1) promoting the child's best interests in complex and resource-poor home and social settings, (2) managing the therapeutic alliance with parents and caretakers, (3) protecting patient privacy and confidentiality, (4) balancing the dual roles of learner and provider, and (5) using professional authority appropriately.
This Month in Archives of Pediatrics & Adolescent Medicine. Arch Pediatr Adolesc Med. 2009;163(9):780. doi:10.1001/archpediatrics.2009.168