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This Month in Archives of Pediatrics and Adolescent Medicine
October 6, 2008

This Month in Archives of Pediatrics & Adolescent Medicine

Arch Pediatr Adolesc Med. 2008;162(10):910. doi:10.1001/archpedi.162.10.910

Influenza Vaccine Effectiveness in Children 6 to 59 Months of Age

With the expansion of the child population recommended to receive the influenza vaccination, evidence of its effectiveness has become even more important. Szilagyi and colleagues studied vaccine effectiveness among children aged 6 to 59 months in 3 counties during 2 influenza seasons. After adjustment for potential confounding factors, significant vaccine effectiveness in preventing inpatient, emergency department, or outpatient visits could not be demonstrated for any season, age, or setting. A likely factor was the suboptimal match between vaccine and circulating influenza strains, with only 11% and 36% matching in the 2 seasons. Annual evaluation of the yearly effect of influenza vaccination programs for children are needed, particularly as higher rates of vaccination are achieved in this population.

See page 943

Use of a Fan During Sleep and the Risk of Sudden Infant Death Syndrome

Rebreathing exhaled carbon dioxide trapped by bedding near an infant's airway has been suggested as a possible mechanism for the occurrence of sudden infant death syndrome (SIDS). Increased air movement in the room of a sleeping infant may potentially decrease the accumulation of carbon dioxide around the infant's nose and mouth and decrease the likelihood of rebreathing exhaled gas. In this case-control study of 185 infants with confirmed SIDS, fan use during sleep was associated with a 72% reduction in the risk of SIDS. The reduction in the risk of SIDS appeared more pronounced in warmer rooms, for infants placed in a prone or side sleeping position, and for those who did not use a pacifier or who shared a bed. Use of a fan in the room of a sleeping infant is an easily available means of possibly further reducing SIDS risk.

See page 963

Four Recent Health Reform Initiatives: Implications for Pediatric Health Reform

In this commentary, Lantos examines 4 different health reform efforts to address the inequities in our uniquely expensive health care system. These are the National Vaccine Initiative of 1993, the creation of the State Children's Health Insurance Program in 1997, the expansion of federally qualified health centers in 2001, and the proposal to expand the State Children's Health Insurance Program in the past year. In his analysis, Lantos argues that a way to provide high-quality health care for all children would be to build on the current combined private-public program, using the federally qualified health center system, the system of private pediatric providers, and the current network of tertiary children's hospitals. Lantos envisions that such a system might harness our deeply ingrained political values in a way that creates an adequate safety net for poor individuals, an efficient public-private partnership, and a vibrant competitive marketplace for different styles of pediatric care.

See page 912

Medical Error Disclosure Among Pediatricians: Choosing Carefully What We Might Say to Parents

Patients wish to be told about medical errors that occur in their care. Recent studies have revealed that physicians' attitudes vary about when to disclose medical errors and how forthcoming they would be in their disclosure to patients. In this study, attending physicians and pediatric residents affiliated with 1 academic program were surveyed and randomly presented with 1 of 2 scenarios: an insulin overdose resulting in an intensive care unit admission or failure to follow up on a laboratory test resulting in symptomatic bacteremia and hospitalization. Among all respondents, only 53% reported that they would definitely disclose the error, 43% would probably disclose the error, and 7% would disclose only if asked by a parent. Approximately one-quarter of respondents would offer an explicit apology, and 51% would discuss detailed plans for preventing future recurrences of the error. This study demonstrated marked variation in when and how pediatricians might disclose an error. The implementation and monitoring of professional practice guidelines to improve care around error disclosure are warranted.

Respondents' answers to the question, “How likely would you be to disclose this error to the parents?” (P < .001).

Respondents' answers to the question, “How likely would you be to disclose this error to the parents?” (P < .001).

See page 922