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This Month in Archives of Pediatrics and Adolescent Medicine
Octomber 4, 2010

This Month in Archives of Pediatrics & Adolescent Medicine

Author Affiliations

Copyright 2010 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2010

Arch Pediatr Adolesc Med. 2010;164(10):897. doi:10.1001/archpediatrics.2010.183
Effect of Pathological Use of the Internet on Adolescent Mental Health

This prospective study aimed to examine the effect of the pathological use of the Internet on adolescent mental health. Of the 1618 students aged 13 to 18 years in the survey, 6.4% were at moderate or high risk of pathological Internet use. Those with pathological use were 2.5-fold more likely to have depression at the 9-month follow-up compared with those with normal Internet use. This result suggests that young people who are initially free of mental health problems but use the Internet pathologically could develop depression as a consequence. However, such a relationship was not demonstrated for anxiety.

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Household, Family, and Child Risk Factors After an Investigation for Suspected Child Maltreatment

In 2007, Child Protective Services (CPS) in the United States investigated 3.2 million children for suspected child maltreatment. While a CPS investigation grants unique access into high-risk households to provide services that may reduce repeated maltreatment and improve outcomes, it is not clear that we are taking advantage of this opportunity to help families. This study was undertaken to determine how often positive changes occur following a CPS investigation. In this cohort study, a CPS investigation when a child was 4 to 8 years of age predicted higher maternal depressive symptoms at age 8 years. Maternal depressive symptoms were worse in households with a CPS investigation compared with those without an investigation. The lack of change in household characteristics known to be associated with repeated abuse suggests that CPS intervention represents a missed opportunity to improve outcomes for children at high risk for future maltreatment and medical and behavioral problems.

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Recurrent Wheezing in the Third Year of Life Among Children Born at 32 Weeks' Gestation or Later

Respiratory syncytial virus (RSV) bronchiolitis during infancy is associated with subsequent development of recurrent wheezing and early childhood asthma. This study examined the long-term impact of RSV bronchiolitis during infancy in a cohort of 71 102 moderately preterm and term infants. The rate of recurrent wheezing in the third year of life was 16.2% among premature infants with prior RSV infection and 6.2% among those without a history of RSV infection. The risk of recurrent wheezing increased 2-fold among infants having an RSV outpatient encounter and more than 4-fold in those with an uncomplicated RSV hospitalization. Supplemental oxygen exposure in the neonatal period was associated with increased risk of recurrent wheezing. Infants with gestational ages of 37 weeks or less were also at increased risk of recurrent wheezing.

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Adjusted odds ratios (OR) and 95% confidence intervals for respiratory syncytial virus (RSV) exposure during the first year of life . Adjusted ORs and 95% confidence intervals were calculated for each individual week of gestational age (using 40 weeks as the reference), controlling for all other factors. Note that RSV infection that only involved an outpatient visit has a significantly elevated adjusted OR compared with no infection but that this is lower than the adjusted ORs for RSV infection in which hospitalization occurred. * P < .001. The No. (%) of patients with recurrent wheezing that involved no visit was 3144 (4.5); outpatient visit, 69 (9.6); uncomplicated hospitalization, 68 (19.3); and prolonged hospitalization, 17 (15.9).

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Improving Evidence-Based Care in Cystic Fibrosis Through Quality Improvement

Poor clinician adherence to prescribing guidelines is a common barrier in health care delivery, including care of patients with cystic fibrosis (CF). In this study, McPhail et al evaluate a generally applicable model to improve adherence to prescribing guidelines. The goal of the intervention was to shift the clinician-family relationship from a relationship in which the clinician made treatment recommendations to the family and was solely responsible for prescribing guidelines to a relationship in which the family advocated for guideline-recommended therapies from their CF clinician. At the start of the project, only 62% of appropriate medications for 134 patients with CF were prescribed. After 3 months of the project, the rate of clinical adherence to prescribing guidelines increased to 87%, and these improvements were maintained during the 21 months of follow-up.

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Bar chart demonstrating changes in clinician adherence to prescribing guidelines in our cystic fibrosis center for oral azithromycin, nebulized dornase alfa, and inhaled tobramycin sulfate during the first 3 months of the project.

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