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This Month in Archives of Pediatrics and Adolescent Medicine
March 1, 2010

This Month in Archives of Pediatrics & Adolescent Medicine

Arch Pediatr Adolesc Med. 2010;164(3):213. doi:10.1001/archpediatrics.2009.298
Trends in Childhood Violence and Abuse Exposure: Evidence From 2 National Surveys

The exposure of children to violence has potentially far-reaching effects on future mental, emotional, and behavioral health. Using 2 large national surveys, Finkelhor and colleagues examined trends in violence victimization and exposure between 2003 and 2008. There was a decrease in the annual prevalence of physical assault, psychological and emotional abuse, sexual assault, and exposure to community violence. There was no change in the prevalence of physical abuse or neglect, dating violence, witnessing domestic violence, or exposures to shootings. However, the prevalence of robbery and witnessing physical abuse of a sibling did increase during this period. These declines are consistent with trends apparent in the National Crime Victimization Survey, which since 2003 have shown marked drops in 12- to 17-year-old adolescents reporting assaults, sexual assault, and property crime.

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Adolescent Screen Time and Attachment to Parents and Peers

During the last 20 years, there has been a marked expansion in screen-based communication and entertainment options available to adolescents. One area of interest is how screen time may impact the quality of relationships with family and friends. This study examined associations between adolescent screen time and attachment to parents and peers using 2 cohorts of adolescents, 16 years apart. Adolescents who spent more time watching television had a greater risk of low parental attachment and low peer attachment. Spending more time reading and doing homework was associated with higher parental attachment. For every extra hour spent watching television, there was a 4% to 13% increase in risk of having low parental attachment and a 24% increase in risk of having low peer attachment. Among the later cohort, spending more time playing on a computer (not for homework) was also associated with poorer parental attachment, while greater time spent playing on the computer or with video games was associated with poorer peer attachment. Given the importance of parental and peer attachment to adolescent health and development, concern about high levels of screen time among adolescents is warranted.

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No Evidence of a Trial Effect in Newly Diagnosed Pediatric Acute Lymphoblastic Leukemia

There is a common belief that, by itself, participation in a trial improves the outcome of patients with cancer. To determine the survival advantage of enrollment in a clinical trial among children with newly diagnosed acute lymphoblastic leukemia (ALL), Koschmann and colleagues evaluated outcomes in 322 children with ALL who were treated at a single large pediatric oncology center between 1997 and 2005. After minimizing the potential for participation effect, patient selection bias, and treatment effect, the study failed to show a trial effect in the treatment of pediatric ALL. It is important that families and providers are aware that a patient's outcome is unlikely to be improved simply by enrolling in a trial.

Event-free survival of patients with acute lymphoblastic leukemia comparing study participation and nonparticipation.

Event-free survival of patients with acute lymphoblastic leukemia comparing study participation and nonparticipation.

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Association Between Child Immunization and Availability of Health Infrastructure in Slums in India

Despite immunization being one of the most cost-effective public health interventions, the latest national survey in India shows that only 44% of children younger than 5 years were completely immunized. An examination of the relationship between availability of health infrastructure and childhood immunization outcomes in low-income countries remains limited. This study examined whether availability and proximity to health centers that provide immunization services were associated with the probability of being immunized among 1728 children aged 10 to 23 months living in slums in India. Only 13% were found to be completely immunized. The presence of an urban health center within 2 km of a slum was associated with more than twice the likelihood of children being completely or partially immunized. The existing urban health delivery systems remain inadequate to respond to needs of poor urban populations in many countries. With the shift in locus of poverty from rural to urban areas, improving health services for the urban poor cannot be neglected to meet the global health challenges.

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