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This Month in Archives of Pediatrics and Adolescent Medicine
February 2003

This Month in Archives of Pediatrics & Adolescent Medicine

Arch Pediatr Adolesc Med. 2003;157(2):117. doi:10.1001/archpedi.157.2.117
Parental Decision Making and the Choice of Communication Modality for the Child Who Is Deaf

As many as 1 in 200 infants are born with a hearing deficit, making this a common problem facing pediatricians. One of the earliest decisions for parents is the choice of communication modality: speech, sign language, or a combination of the 2. This survey of 83 parents of children with hearing loss examined the relative importance of different factors in this decision process. The most important influences on the decision to choose the oral-only approach was the child having less than a profound hearing loss and the preferences of the parents for the child to communicate orally. Technology such as cochlear implants had no significant effect on the decision to choose "oral only."

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A Randomized Controlled Trial of the Middle and Junior High School D.A.R.E. and D.A.R.E. Plus Programs

Drug Abuse Resistance Education (D.A.R.E.) is the most widely used drug use prevention program for elementary schools in the United States. This randomized controlled trial was conducted in 24 middle and junior high schools to evaluate the effect of the standard middle school curriculum or an extended program on substance use among 6237 seventh- and eighth-grade students. The study found no effect of either curriculum on girls and no effect of the D.A.R.E. only curriculum on boys. The extended D.A.R.E. program had some effect on tobacco, alcohol, and multidrug use. This study emphasizes the ineffectiveness of the regular D.A.R.E. curriculum and the need to use a multiyear, multicomponent program to be effective.

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Child Care and Common Communicable Illnesses in Children Aged 37 to 54 Months

Out-of-home child care is a fact of life for most American families. Parents recognize the increased risk of illness of their child while in out-of-home care and seek advice on ways to minimize this risk. Data from the National Institutes of Health Study of Early Child Care indicate that rates of respiratory illness, gastrointestinal tract illness, and ear infections were 40% to 100% higher in children 37 months to 54 months of age attending centers with 6 or more children compared with children attending smaller centers or reared at home. Number of hours per week attending child care was not a risk factor for more illness.

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Burden of Asthma in Inner-city Elementary Schoolchildren: Do School-Based Health Centers Make a Difference?

School-based health centers have mushroomed as a source of care for children, especially those in the inner city. However, their effect on the health outcomes of children, particularly those with chronic illness, is poorly documented. This survey of 6400 parents of children in 6 inner city elementary schools found that, among children with asthma, the rate of hospitalization was 50% higher among children at schools without a health center. While there was no effect on emergency department utilization, children with asthma missed fewer days of school if they attended a school with a health center. These findings support the efficacy of school-based health centers for inner-city children with asthma and have implication for access to school-based primary care.

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Maternal Antibiotics and Decreased Periventricular Leukomalacia in Very Low-Birth-Weight Infants

Brain injury in preterm infants has been associated with antenatal conditions such as chorioamnionitis and prolonged rupture of membranes. Paul and colleagues examined the effect of maternal antibiotics on neonatal outcomes in 834 infants weighing less than 1500 g at birth. There was no effect of maternal antibiotics on infant mortality, grades 3 to 4 intraventicular hemorrhage, or sepsis. However, the use of maternal antibiotics was associated with a 91% decreased risk of developing cystic periventricular leukomalacia. If corroborated by future studies, these findings will have important implications for the prevention of brain injury in premature infants.

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