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This Month in Archives of Pediatrics and Adolescent Medicine
October 2006

This Month in Archives of Pediatrics & Adolescent Medicine

Arch Pediatr Adolesc Med. 2006;160(10):1002. doi:10.1001/archpedi.160.10.1002

Cardiorespiratory Fitness Levels Among US Youth 12 to 19 Years of Age

Increasing scrutiny on the problem of obesity in children and youth involves analysis of the levels of physical activity and concomitant cardiorespiratory fitness of youth. This study presents data on 3287 youth aged 12 to 19 years who had fitness measured as part of the National Health and Nutrition Examination Survey. Youth who reported higher levels of physical activity had higher levels of cardiorespiratory fitness. On the treadmill test, males and females in the overweight and at risk for overweight groups had lower cardiorespiratory fitness than their peers in the normal weight group. Approximately one third of youth aged 12 to 19 years in the United States fail to meet the levels of cardiorespiratory fitness deemed appropriate by experts. This is an important public health problem because low physical fitness during adolescence tracks into adulthood, increasing the risk for later chronic morbidity and early mortality.

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Attention-Deficit/Hyperactivity Disorder in Children: Excess Costs Before and After Initial Diagnosis and Treatment Cost Differences by Ethnicity

Ray and his colleagues at Kaiser Permanente of Northern California compared the health care costs among 3122 children with attention-deficit/hyperactivity disorder (ADHD) with those among 15 899 children without ADHD. Children with ADHD had health care costs that were nearly twice that of children without ADHD in the year prior to their initial diagnosis of ADHD and nearly 3 times as costly in the year after their initial diagnosis. Health care for children with ADHD and coexisting mental health disorders was much costlier than that for children without such comorbidities. The higher costs were due primarily to increased psychiatric and pediatric care as well as increased costs for medication. Nonwhite children were less likely to use ADHD medication in the year after their diagnosis than were white children, and among users, less medication was used.

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Improved Preventive Care for Asthma: A Randomized Trial of Clinician Prompting in Pediatric Offices

Despite the availability of effective medications to treat asthma, many providers do not follow established guidelines for their use. Halterman and colleagues conducted a randomized controlled trial in 2 inner-city pediatric practices among children aged 2 to 12 years with persistent asthma. Clinicians who received a written prompt including the child's symptoms and guideline recommendations at the time of the child's visit were more likely to deliver an asthma action plan, perform smoking-reduction counseling, discuss asthma with the family, and recommend a follow-up visit than clinicians who did not receive the prompt. Children in the clinician-prompting group had a 3-fold greater odds of receiving any preventive action than children in the control group. Because guidelines-based asthma care can improve outcomes, the implications of this study are great.

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Adolescent Bone Health

Pediatric and adolescent health care providers have increasingly recognized the importance of understanding the skeletal health of their patients. At least one fourth of adult total bone mineral is acquired during the 4-year period surrounding peak height velocity with up to 60% during the remaining peripubertal years. This review outlines the known conditions that are associated with impaired bone mineral accrual and clinical settings in which the evaluation of the “at-risk” adolescents should be considered. The article provides current recommendations regarding physical activity and nutrition for all adolescents as well as therapeutic options for patients identified as having low bone mineral density.

Factors affecting bone health. Reprinted with permission.

Factors affecting bone health. Reprinted with permission.

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