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This Month in Archives of Pediatrics and Adolescent Medicine
December 2005

This Month in Archives of Pediatrics & Adolescent Medicine

Arch Pediatr Adolesc Med. 2005;159(12):1099. doi:10.1001/archpedi.159.12.1099

Headache is a common problem in pediatric practice. While the short-term prognosis in nearly all children is excellent, little data are available on the long-term outcome of children and adolescents with headache. In a 20-year follow-up of children with headache, only one quarter were headache free. Having more than 1 type of headache was common, and the type of headache varied over time. Most described their headaches as moderate to severe. While the amount of medications use to treat their headaches increased over the prior decade, nearly half felt that nonpharmacologic therapies were most effective.

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There is increasing demand for physicians in practice to address not only the physical but also the psychological and behavioral health of their patients. Brief interventions, and in particular motivational interviewing, offer an efficient means of targeting behavioral, developmental, and social problems within the context of pediatric practice. Erickson and her colleagues review the patient-centered foundation of, and empirical support for, brief pediatric interventions including motivational interviewing for prevention and intervention for high-risk behaviors such as smoking and drinking, and adherence to treatment recommendations. These represent powerful techniques which should be part of every physician’s therapeutic armamentarium.

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With the current epidemic of obesity among children and adolescents, more attention is being paid to the regular physical activity of patients. A key to increasing physical activity is to understand the motivation of adolescents to be physically active. This study of 202 adolescents in middle school found that personal fulfillment was the strongest motivating factor for physical activity, followed by desire to lose weight or socialize with peers; parent pressure was the least important factor associated with adolescents’ physical activity. Adolescents who perceived themselves as not being particularly competent in sports reported lower personal fulfillment motivation for being physically active. This study indicates that adolescents’ personal fulfillment must be taken into consideration when designing physical exercise programs.

Figure.
Mean scores for each source of activity motivation for adolescents at high risk (gray bars) vs low risk (black bars) for physical inactivity. Means are significantly (P<.05) different for risk groups.

Mean scores for each source of activity motivation for adolescents at high risk (gray bars) vs low risk (black bars) for physical inactivity. Means are significantly (P<.05) different for risk groups.

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While prior studies have examined the cost savings of individual childhood vaccines, Zhou and colleagues examined the benefits and costs of routine childhood immunization. The study showed that routine childhood immunizations for the 2001 birth cohort of 3.8 million children would save $9.9 billion in medical costs alone and $43.3 billion when examined from a societal perspective. Every dollar spent in vaccinating children against diphtheria, pertussis, tetanus, poliomyelitis, varicella, H influenzae type b, hepatitis B, measles, mumps, and rubella would save $5.30 in direct medical costs and $16.50 in societal costs. The remarkable public health benefits from vaccines occur at considerable cost savings to the public.

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