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This Month in Archives of Pediatrics and Adolescent Medicine
November 2005

This Month in Archives of Pediatrics & Adolescent Medicine

Author Affiliations

Copyright 2005 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2005

Arch Pediatr Adolesc Med. 2005;159(11):1005. doi:10.1001/archpedi.159.11.1005

While a number of recent studies have documented that acute stress disorder and posttraumatic stress disorder are common in children and adults after injuries, little information is available on the prevalence of stress disorders after involvement in motor vehicle crashes per se. Winston and colleagues contacted parents of 1483 children ages 5 to 15 years involved in motor vehicle crashes. Nearly 2% of children and 5% of parents reported significant acute stress disorder symptoms after the crash. Those who were injured and required medical care were more likely to develop symptoms of stress. While most demonstrate resilience, a significant proportion of children and their parents demonstrate impaired acute psychological responses to involvement in a car crash.

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Hepatitis C infection is a major public health concern in the United States and appears to be especially prevalent among adult prisoners. This study examined the prevalence and risk factors for infection among adolescents incarcerated in a juvenile detention center. The overall prevalence of hepatitis C infection was 2%. Injection drug use was a strong risk factor for infection, while tattooing and body piercing were not. Targeted screening for hepatitis C infection in adolescents appears to be indicated.

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Access to guns in the home is associated with an increased risk of homicide, suicide, and unintentional shooting deaths in children and adolescents. Recent studies indicate that safe storage of guns is an effective method to decrease the risk of suicide and unintentional shooting deaths in children and adolescents. However, prior programs to promote safe storage of guns have been unsuccessful. This study tested the effectiveness of an intervention consisting of counseling, information, and provision of a gun lock. At follow-up, families in the intervention group were 4 times as likely to improve their storage of guns compared with the control group. However, the intervention did not significantly influence the removal of guns from the home. This study supports recommendations to discuss gun safety with families.

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The burden of disease and the economic impact of influenza infection is enormous. Early treatment can potentially shorten the course of the disease, but it is unknown whether the benefits of antiviral medication in healthy children justify the costs and side effects. This analysis examined the cost-effectiveness from a societal perspective of rapid testing and antiviral therapy on children ages 2, 7, and 15 years. In young children, antiviral therapy saved up to $120 per child, mostly by avoiding parental work loss. Antiviral therapy resulted in a cost of $800 to $1800 per quality-adjusted life-year saved. This compares favorably with other interventions such as varicella vaccination or hepatitis B vaccination. Rapid viral testing was only cost-effective when the probability of influenza infection was below 60%. This model offers a framework for decision making.

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Monte Carlo probabilistic sensitivity analysis for a 15-year-old with influenza illness during a local epidemic in a mixed influenza A and B season. Each line shows the proportion of simulations in which a particular strategy would be favored for willingness-to-pay values per quality-adjusted life-year (QALY) saved.

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