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This Month in Archives of Pediatrics and Adolescent Medicine
January 2005

This Month in Archives of Pediatrics & Adolescent Medicine

Arch Pediatr Adolesc Med. 2005;159(1):7. doi:10.1001/archpedi.159.1.7

There has been widespread concern about the apparent dramatic increase in the prevalence of autism in the United States over the last decade. It remains unclear whether this represents a true increase in the number of children with the disorder, better case finding, or changes in diagnostic criteria. Olmsted County, Minnesota, provides a unique population-based laboratory to explore this question. Barbaresi and colleagues found that the incidence of autism, as defined using specific research criteria, increased among young children after the introduction of broader diagnostic criteria, increased availability of services, and increased awareness of autism. The timing of this increase suggests that the change in prevalence is at least partly due to these external factors.

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Prior research has indicated that interventions in early childhood for high-risk children can have important long-term effects. The Seattle Social Development Project is a well-known multicomponent intervention delivered to children in elementary school. At age 21 years, those who have received the full intervention were more likely to have graduated from high school, gone on to college, be more integrated into school or work, and have less criminal activity and substance abuse. These findings indicate that universal intervention during the elementary school years to strengthen teaching and parenting can have long-term effects on social functioning and mental health as these children become young adults.

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Home cardiorespiratory monitors continue to be used for a wide variety of indications. The utility of home monitoring to detect and record potentially pathologic data depends on the willingness of caregivers to adhere to recommendations for monitor use. By using monitors with memory, Silvestri et al were able to determine how well caregivers adhered to recommendations on monitor use. The monitors were used on average only about 48 h/wk. The most important predictor of use for the 5-week period was the amount of use during the first week. Low use during the first week was highly predictive of low use for the entire monitoring period.

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The infant mortality rates in the United States continue to be far worse than those in many countries, primarily because of our relatively high rate of premature births. Interventions during the prenatal period have, to date, been relatively ineffective in decreasing the incidence of prematurity. One possibility is that the focus needs to be earlier, before the woman is pregnant. This prospective cohort study examined the prepregnancy health status of 1619 women who delivered newborns. Risk factors before the pregnancy were found to contribute as much to the occurrence of prematurity as were risk factors during the prenatal period. Women who had poor physical health before conception were twice as likely to have a premature delivery compared with those with better physical function. Attention to the health of women before pregnancy may be necessary to improve the rates of preterm delivery in the United States.

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