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This Month in Archives of Pediatrics & Adolescent Medicine
July 2011

This Month in Archives of Pediatrics & Adolescent Medicine

Arch Pediatr Adolesc Med. 2011;165(7):588. doi:10.1001/archpediatrics.2011.103

Although video gaming has been one aspect of screen time that has been at least partially blamed for the rapid increase in overweight among children and adolescents, there has recently been increased interest in activity-promoting video gaming or video games that require physical movement. In this study of 39 children, energy expenditure was elevated to a moderate to vigorous intensity level for all of the 6 activities evaluated. Exergaming compared favorably with walking on a treadmill at 3 miles per hour, with 4 of the 6 activities resulting in higher energy expenditure. This level of intensity is consistent with current physical activity recommendations for children and can be used to alter energy balance. While exergaming is most likely not the solution to the epidemic of reduced physical activity in children, it appears to be a potentially innovative strategy that can be used to reduce sedentary time, increase adherence to exercise programs, and promote enjoyment of physical activity.

Metabolic equivalent task (MET) values for rest, walking, and exergaming for 39 children recruited from local schools and after-school programs in Boston, Massachusetts.

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Following a lawsuit, Massachusetts implemented new regulations requiring primary care providers to screen for developmental and behavioral problems at all well-child visits or at parent request for all MassHealth members younger than 21 years. Kuhlthau and colleagues examined rates of screening and identification of behavioral problems for children with Medicaid coverage in Massachusetts during the months immediately following the ruling and report on the combined impact of a court order, thoughtful implementation efforts, and distinct reimbursements for psychosocial screening services. There was a remarkable 3-fold increase in the number of pediatric screens and the percentage of well-child visits with screens following implementation of a small payment and a comprehensive statewide program supporting routine behavioral health screening as a part of pediatric well-child visits covered by the Early Periodic Screening, Diagnosis, and Treatment statute in Massachusetts. These data suggest that a small payment and a well-supported mandate for use of a formal screening tool can substantially improve the identification of children at behavioral health risk.

Percentage of Medicaid-enrolled children with screens for mental health, percentage of “modified” screens with behavioral health (BH) problems identified, and number of children with a mental health evaluation.

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Although school-based health centers (SBHCs) were not initially developed to expressly address student academic needs, SBHCs are now widely proposed as a mechanism to manage physical and mental health barriers to academic success. In this study of more than 3000 high school students, there were strong and inverse relationships between SBHC use and dropout for the majority of youth using SBHCs, particularly among youth at higher relative risk for dropout. These SBHCs may have a role in dropout prevention through influencing student health status. Unplanned pregnancies, untreated sexually transmitted diseases, and undiagnosed minor acute illness (eg, strep infections) have the potential to create significant barriers to learning, yet can be effectively addressed within brief, time-limited care.

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Approaches to end-of-life decisions have changed over time and vary among neonatal intensive care units. This study examined whether the trends in the 1990s toward decreasing use of cardiopulmonary resuscitation (CPR) at the time of neonatal death had continued. In this study of 1400 neonatal deaths during a 10-year period, 61.6% of infant deaths followed withdrawal of therapy, 20.8% followed withholding of therapy, and 17.6% occurred despite attempted CPR. During the 10-year period, the percentage of deaths that followed withholding of life-sustaining treatment increased. During the same period, use of CPR at death tended to decrease.

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