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Archives of Pediatrics & Adolescent Medicine

Publisher:
American Medical Association
American Medical Association
ISSN:
1072-4710
Scimago Journal Rank:
196
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Just Say No... Welfare

Joffe, Alain

1995 Archives of Pediatrics & Adolescent Medicine

doi: 10.1001/archpedi.1995.02170150015001pmid: 7858681

Abstract LIKE OTHER Pediatric journals, the Archives is not a politically charged journal. Its major goal is to report research findings that will ultimately help improve the health of children and adolescents, either by shedding light on how they come to be sick or stay healthy, or by helping pediatricians and others who care for young people improve the health care system. Still musing over last month's election results, however, I cannot help but wonder whether the health of our next generation will be jeopardized unless the Archives and other medical journals and their readership become more political. I use "political" in the sense "of relating to, or concerned with the making as distinguished from the administration of government policy" (as defined by Merriam Webster's Collegiate Dictionary). Within such a context, this Editorial is not about Democrats or Republicans, liberals or conservatives. It is, given the significant shift in the political References 1. Polaneczky M, Slap G, Forke C, Rappaport A, Sondheimer S. The use of levonorgestrel implants (Norplant) for contraception in adolescent mothers . N Engl J Med . 1994;331:1201-1206.Crossref 2. Kirby D, Barth RP, Leland N, Fetro JV. Reducing the risk: impact of a new curriculum on sexual risk-taking . Fam Plann Perspect . 1991;23:253-263.Crossref 3. Koo HP, Dunteman GH, George C, Green Y, Vincent M. Reducing adolescent pregnancy through a school- and community-based intervention: Denmark, South Carolina, revisited . Farn Plann Perspect . 1994;26:206-217.Crossref 4. Mann CC. Can meta-analysis make policy? Science . 1994;266:960-962.Crossref 5. Kellerman AL, Rivara FP, Rushforth NB, et al. Gun ownership as a risk factor for homicide in the home . N Engl J Med . 1993;329:1084-1091.Crossref 6. Fulginiti VA. Violence and children in the United States . AJDC . 1992;146:671-672.
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Problems With the Report of the Expert Panel on Blood Cholesterol Levels in Children and Adolescents

Newman, Thomas B.;Garber, Alan M.;Holtzman, Neil A.;Hulley, Stephen B.

1995 Archives of Pediatrics & Adolescent Medicine

doi: 10.1001/archpedi.1995.02170150021003pmid: 7858682

Abstract An Expert Panel convened by the National Cholesterol Education Program has recommended selective screening and treatment of children for high blood cholesterol levels, based on family history of cardiovascular disease or high blood cholesterol. This recommendation is problematic for several reasons. First, the recommended diets are likely to cause only a slight decrease in low-density lipoprotein cholesterol levels, the projected benefits of which will be offset by a similar decrease in high-density lipoprotein cholesterol levels. Lack of efficacy of the recommended diets could lead to use of more restrictive diets or to cholesterol lowering drugs. Second, even under optimistic assumptions, beneficial effects of cholesterol intervention will be small and delayed for many decades. As a result, childhood cholesterol-lowering efforts will not be cost-effective. Third, the Expert Panel's recommendations do not address important gender differences. Girls have higher average cholesterol levels than boys. They will therefore qualify for more dietary and drug treatment despite their lower age-adjusted risk of heart disease and the lack of association between cholesterol levels and cardiovascular mortality in women. Finally, recent evidence from randomized trials, cohort studies, and animal experiments suggests that cholesterol lowering may have serious adverse effects. This evidence was not discussed in the Expert Panel's report. Given current evidence, any screening and treatment of children for high blood cholesterol levels is, at best, premature. (Arch Pediatr Adolesc Med. 1995;149:241-247) References 1. Strong WB. You are a preventive cardiologist: the scope of pediatric preventive cardiology . AJDC . 1989:143:1145. 2. Garcia RE, Moodie DS. Routine cholesterol surveillance in childhood . Pediatrics . 1989;84:751-755. 3. Wynder E. An American Health Foundation monograph: coronary artery disease prevention: cholesterol, a pediatric perspective . Prev Med . 1989; 18:323-409.Crossref 4. Cresanta JL, Burke GL, Downey AM, Freedman DS, Berenson GS. Prevention of atherosclerosis in childhood . Pediatr Clin North Am . 1986;33: 835-858. 5. Holtzman NA. Hyperlipidemia screening: a search for heffalumps? Pediatrics . 1979:64:270-271. 6. Holtzman NA. Hyperlipidemia screening and Semmelweis re-visited . Pediatrics . 1980;66:838-839. 7. Newman TB, Browner WS, Hulley SB. The case against childhood cholesterol screening . JAMA . 1990;264:3039-3043.Crossref 8. Holtzman NA. The great god cholesterol . Pediatrics . 1991;87:943-945. 9. Gillman M, Lannon C. Screening for hypercholesterolemia in children: the missing links . Ann Epidemiol . 1991;1:559-565.Crossref 10. Newman TB, Browner WS, Hulley SB. Childhood cholesterol screening: contraindicated . JAMA . 1992;267:100-101.Crossref 11. Hulley SB, Newman TB. Position statement: cholesterol screening in children is not indicated, even with positive family history . JAm Coll Nutr . 1992;11S:20S-22S.Crossref 12. Hoekelman RA. Cholesterol mania . Pediatr Ann . 1992;21:215-216.Crossref 13. Frame PS. Screening and management of cholesterol levels in children and adolescents . J Am Board Fam Pract . 1993;6:582-587. 14. Hulley SB, Newman TB, Grady D, Garber AM, Baron RB, Browner WS. Should we be measuring blood cholesterol in young adults? JAMA . 1993;269:1416-1419.Crossref 15. Toronto Working Group on Cholesterol Policy. Asymptomatic hypercholesterolemia: a clinical policy review . J Clin Epidemiol . 1990:43:1028-1121. 16. Davey Smith G, Song F, Sheldon T. Cholesterol lowering and mortality: the importance of considering initial level of risk . BMJ . 1993;306:1367-1373.Crossref 17. Sox H. Screening for lipid disorders under health system reform . N Engl J Med . 1993;328:1269-1271.Crossref 18. Canadian Task Force on the Periodic Health Examination. Periodic health examination, 1993 update, II: lowering the blood total cholesterol level to prevent coronary heart disease . Can Med Assoc J . 1993;148:521-538. 19. National Cholesterol Education Program. Report of the Expert Panel on Blood Cholesterol Levels in Children and Adolescents . Pediatrics . 1992;89:515-584. 20. American Academy of Pediatrics Committee on Nutrition. Statement on cholesterol . Pediatrics . 1992;90:469-473. 21. Arneson T, Luepker R, Pirie P, Sinaiko A. Cholesterol screening by primary care pediatricians: a study of attitudes and practices in the Minneapolis–St Paul metropolitan area . Pediatrics . 1992;89:502-505. 22. Puska P, Vartiainen E, Pallonen U, et al. The North Karelia Youth Project: evaluation of 2 years of intervention on health behavior and CVD risk factors among 13- to 15-year-old children . Prev Med . 1982;11:550-570.Crossref 23. Walter HJ, Hofman A, Vaughan RD, Wynder EL. Modification of risk factors for coronary heart disease: 5-year results of a school-based intervention trial . N Engl J Med . 1988;318:1093-1100.Crossref 24. Ramsay LE, Yeo WW, Jackson PR. Dietary reduction of serum cholesterol concentration: time to think again . BMJ . 1991;303:953-957.Crossref 25. Hunninghake DB, Stein EA, Dujovne CA, et al. The efficacy of intensive dietary therapy alone or combined with lovastatin in outpatients with hypercholesterolemia . N Engl J Med . 1993;328: 1213-1219.Crossref 26. Ornish D, Brown SE, Scherwitz LW, et al. Can lifestyle changes reverse coronary heart disease?: the Lifestyle Heart Trial . Lancet . 1990; 336:129-133.Crossref 27. Hjermann I, Velve Byre K, Holme I, Leren P. Effect of diet and smoking intervention on the incidence of coronary heart disease: report from the Oslo Study Group of a randomised trial in healthy men . Lancet . 1981;2:1303-1310.Crossref 28. Henkin Y, Garber DW, Osterlund LC, Darnell BE. Saturated fats, cholesterol, and dietary compliance . Arch Intern Med . 1992;152:1167-1174.Crossref 29. Orchard TJ, Donahue RP, Kuller LH, Hodge PN, Drash AL. Cholesterol screening in childhood: does it predict adult hypercholesterolemia? the Beaver County experience . J Pediatr . 1983;103: 687-691.Crossref 30. Mensink RP, Katan MB. Effect of dietary fatty acids on serum lipids and lipoproteins: a metaanalysis of 27 trials . Arterioscler Thromb . 1992; 12:911-919.Crossref 31. Ehnholm C, Huttunen JK, Pietinen P, et al. Effect of diet on serum lipoproteins in a population with a high risk of coronary heart disease . N Engl J Med . 1982;307:850-855.Crossref 32. Schaefer EJ, Levy RI, Ernst ND, Van Sant FD, Brewer H Jr. The effects of low cholesterol, high polyunsaturated fat, and low fat diets on plasma lipid and lipoprotein cholesterol levels in normal and hypercholesterolemic subjects . Am J J Clin Nutr . 1981;34:1758-1763. 33. Nicklas TA, Webber LS, Koschak M, Berenson GS. Nutrient adequacy of low fat intakes for children: the Bogalusa Heart Study . Pediatrics . 1992; 89:221-228. 34. Lifshitz F. Children on adult diets: is it harmful? is it healthful? J Am Coll Nutr . 1992;11:84S-90S.Crossref 35. Lifshitz F, Moses N. Growth failure: a complication of dietary treatment of hypercholesterolemia . AJDC . 1989;143:537-542. 36. Stelmach WJ, Rush DR, Brucker PC, et al. Diet and exercise and gemfibrozil therapy for the management of dyslipidemia: a CEN study: clinical experience network . J Fam Pract . 1993;36:401-408. 37. Cholesterol and Kids: A Family Affair . Bethesda, Md: Citizens for Public Action on Blood Pressure and Cholesterol Inc; 1991. 38. Cholesterol in Children and Adolescents: A Physician's Handbook . Bethesda, Md: Citizens for Public Action on Blood Pressure and Cholesterol Inc; 1991. 39. Liacouras CA, Coates PM, Gallagher PR, Cortner JA. Use of cholestyramine in the treatment of children with familial combined hyperlipidemia . J Pediatr . 1993;122:477-482.Crossref 40. Ducobu J, Brasseur D, Chaudron JM, et al. Simvastatin use in children . Lancet . 1992;339: 1488.Crossref 41. Mold JW, Stein HF. The cascade effect in the clinical care of patients . N Engl J Med . 1986; 314:512-514.Crossref 42. Taylor WC, Pass TM, Shepard DS, Komaroff AL. Cholesterol reduction and life expectancy . Ann Intern Med . 1987;106:605-614.Crossref 43. Garber AM, Wagner JL. Practice guidelines and cholesterol policy . Health Aff (Millwood) . 1991; 10:52-66.Crossref 44. Goldman L, Weinstein MC, Goldman PA, Williams LW. Cost-effectiveness of HMG-CoA reductase inhibition for primary and secondary prevention of coronary heart disease . JAMA . 1991; 265:1145-1151.Crossref 45. Lipid Research Clinics Program. The Lipid Research Clinics Coronary Primary Prevention Trial results, II: the relationship of reduction in incidence of coronary heart disease to cholesterol lowering . JAMA . 1984;251:365-374.Crossref 46. Jacobs D, Blackburn H, Higgins M, et al. Report of the Conference on Low Blood Cholesterol: mortality associations . Circulation . 1992;86:1046-1060.Crossref 47. Hulley SB, Walsh JM, Newman TB. Health policy on blood cholesterol: time to change directions . Circulation . 1992;86:1026-1029.Crossref 48. Lowering blood cholesterol to prevent heart disease . JAMA . 1985;253:2080-2086.Crossref 49. American Academy of Pediatrics Committee on Nutrition. Indications for cholesterol testing in children . Pediatrics . 1989;83:141-142. 50. Erratum : Pediatrics . 1989:83:678. 51. Mason RP, Herbette LG, Silverman DI. Can altering serum cholesterol affect neurologic function? J Mol Cell Cardiol . 1991;23:1339-1342.Crossref 52. McMurchie EJ, Patten GS. Dietary cholesterol influences cardiac beta-adrenergic receptor adenylate cyclase activity in the marmoset monkey by changes in membrane cholesterol status . Biochim Biophys Acta . 1988;942:324-332.Crossref 53. Clandinin MT, Field CJ, Hargreaves K, Morson L, Zsigmond E. Role of diet fat in subcellular structure and function . Can J Physiol Pharmacol . 1985; 63:546-556.Crossref 54. Enslen M, Milon H, Malnoe A. Effect of low intake of n-3 fatty acids during development on brain phospholipid fatty acid composition and exploratory behavior in rats . Lipids . 1991;26: 203-208.Crossref 55. Geiser F. The effect of unsaturated and saturated dietary lipids on the pattern of daily torpor and the fatty acid composition of tissues and membranes of the deer mouse Peromyscus maniculatus . J Comp Physiol . 1991;161:590-597.Crossref 56. Aloia RC, Mlekusch W. The effect of a saturated fat diet on pentobarbital-induced sleeping time and phospholipid composition of mouse brain and liver . Pharmazie . 1988;43:496-498. 57. Yehuda S, Carasso RL. Effects of dietary fats on learning, pain threshold, thermoregulation and motor activity in rats: interaction with the length of feeding period . Int J Neurosci . 1987;32:919-925.Crossref 58. Coscina DV, Yehuda S, Dixon LM, Kish SJ, Leprohon-Greenwood CE. Learning is improved by a soybean oil diet in rats . Life Sci . 1986:38: 1789-1794.Crossref 59. Kaplan JR, Manuck SB, Shively C. The effects of fat and cholesterol on social behavior in monkeys . Psychosom Med . 1991;53:634-642.Crossref 60. Lindberg G, Rastam L, Gullberg B, Eklund GA. Low serum cholesterol concentration and short-term mortality from injuries in men and women . BMJ . 1992;305:277-279.Crossref 61. Neaton JD, Blackburn H, Jacobs D, et al. Serum cholesterol level and mortality findings for men screened in the Multiple Risk Factor Intervention Trial: Multiple Risk Factor Intervention Trial Research Group . Arch Intern Med . 1992;152: 1490-1500.Crossref 62. Cowan LD, O'Connell DL, Criqui MH, Barrett CE, Bush TL, Wallace RB. Cancer mortality and lipid and lipoprotein levels: Lipid Research Clinics Program Mortality Follow-up Study . Am J Epidemiol . 1990;131:468-482. 63. Schatzkin A, Taylor P, Carter C, et al. Serum cholesterol and cancer in the NHANES-1 Follow-up Study . Lancet . 1987;2:298-301.Crossref 64. Isles CG, Hole DJ, Gillis CR, Hawthorne VM, Lever AF. Plasma cholesterol, coronary heart disease, and cancer in the Renfrew and Paisley Survey . BMJ . 1989;298:920-924.Crossref 65. Chen Z, Peto R, Collins R, MacMahon S, Lu J, Li W. Serum cholesterol concentration and coronary heart disease in population with low cholesterol concentrations . BMJ . 1991;303:276-282.Crossref 66. Frank JW, Reed DM, Grove JS, Benfante R. Will lowering population levels of serum cholesterol affect total mortality? expectations from the Honolulu Heart Program . J Clin Epidemiol . 1992; 45:333-346.Crossref 67. Smith GD, Shipley MJ, Marmot MG, Rose G. Plasma cholesterol concentration and mortality: the Whitehall Study . JAMA . 1992;267:70-76.Crossref 68. Jacobs D Jr. Why is low blood cholesterol associated with risk of nonatherosclerotic disease death? Annu Rev Public Health . 1993;14:95-114.Crossref 69. Muldoon M, Rossouw J, Manuck S, Glueck C, Kaplan J, Kaufman P. Low or lowered cholesterol and risk of death from suicide and trauma . Metabolism . 1993;42( (suppl 1) ):45-56.Crossref 70. Feldman W. Routine cholesterol surveillance in childhood . Pediatrics . 1990;86:150-151. 71. Oliver MF. Might treatment of hypercholesterolaemia increase non-cardiac mortality? Lancet . 1991;337:1529-1531.Crossref 72. Muldoon MF, Manuck SB, Matthews KA. Lowering cholesterol concentrations and mortality: a quantitative review of primary prevention trials . BMJ . 1990;301:309-314.Crossref 73. Criqui MH. Cholesterol, primary and secondary prevention, and all-cause mortality . Ann Intern Med . 1991;115:973-976.Crossref 74. Ravnskov U. Cholesterol lowering trials in coronary heart disease: frequency of citation and outcome . BMJ . 1992;305:15-19.Crossref 75. Strandberg TE, Salomaa VV, Naukkarinen VA, Vanhanen HT, Sarna SJ, Miettinen TA. Long-term mortality after 5-year multifactorial primary prevention of cardiovascular diseases in middle-aged men . JAMA . 1991;266:1225-1229.Crossref 76. Zurich D, Duffy M. Physicians' Desk Reference . 47th ed. Montvale, NJ: Medical Economics Data; 1993. 77. Lipid Research Clinics Program. The Lipid Research Clinics Coronary Primary Prevention Trial results, I: reduction in incidence of coronary heart disease . JAMA . 1984;251:351-364.Crossref 78. Frick M, Elo O, Happa K, et al. Helsinki Heart Study: primary-prevention trial with gemfibrozil in middle-aged men with dyslipidemia . N Engl J Med . 1987;317:1237-1245.Crossref 79. Engelberg H. Low serum cholesterol and suicide . Lancet . 1992;339:727-729.Crossref 80. Heron DS, Shinitzky M, Hershkowitz M, Samuel D. Lipid fluidity markedly modulates the binding of serotonin to mouse brain membranes . Proc Natl Acad Sci U S A . 1980;77:7463-7467.Crossref 81. Asberg M, Thoren P, Traskman L, Bertilsson L, Ringberger V. 'Serotonin depression'—a biochemical subgroup within the affective disorders? Science . 1976;191:478-480.Crossref 82. Linnoila VM, Virkkunen M. Aggression, suicidality, and serotonin . J Clin Psychiatry . 1992;53 ( (suppl) ):46-51. 83. Mann JJ, Arango V, Marzuk PM, Theccanat S, Reis DJ. Evidence for the 5-HT hypothesis of suicide: a review of post-mortem studies . Br J Psychiatry Suppl . 1989;8:7-14. 84. Mann JJ, Marzuk PM, Arango V, McBride PA, Leon AC, Tierney H. Neurochemical studies of violent and nonviolent suicide . Psychopharmacol Bull . 1989;25:407-413. 85. Weidner G, Connor SL, Hollis JF, Connor WE. Improvements in hostility and depression in relation to dietary change and cholesterol lowering: the Family Heart Study . Ann Intern Med . 1992; 117:820-823.Crossref 86. Strandberg TE, Valvanne J, Tilvis RS. Serum lipids and depression . Lancet . 1993;341:433-434.Crossref 87. Pekkanen J, Nissinen A, Punsar S, Karvonen MJ. Serum cholesterol and risk of accidental or violent death in a 25-year follow-up: the Finnish cohorts of the Seven Countries Study . Arch Intern Med . 1989;149:1589-1591.Crossref 88. Kromhout D, Katan MB, Menotti A, Keys A, Bloemberg B. Serum cholesterol and long-term death rates from suicide, accidents, or violence: Seven Countries Study Group . Lancet . 1992;340:317.Crossref 89. Rao U, Carlson GA, Rapport MD. Serum cholesterol and aggressive behavior in psychiatrically hospitalized children . Acta Psychiatr Scand . 1991;83:77-78.Crossref 90. Morgan RE, Palinkas LA, Barrett-Connor EL, Wingard DL. Plasma cholesterol and depressive symptoms in older men . Lancet . 1993;341:75-79.Crossref 91. Dealberto MJ, Ducimetiere P, Mainard F, Alperovitch A. Serum lipids and depression . Lancet. 1993:341:435.Crossref 92. Virkkunen M, Penttinen H. Serum cholesterol in aggressive conduct disorder: a preliminary study . Biol Psychiatry . 1984;19:435-439. 93. Virkkunen M. Serum cholesterol levels in homicidal offenders: a low cholesterol level is connected with a habitually violent tendency under the influence of alcohol . Neuropsychobiology . 1983;10:65-69.Crossref 94. Schuit AJ, Dekker JM, Schouten EG, Kok FJ. Low serum cholesterol and death due to accidents, violence, or suicide . Lancet . 1993:341:827.Crossref 95. Young SN. Cholesterol, heart disease and the brain: an opportunity in research and a disaster in public health education? J Psychiatry Neurosci . 1993; 18:1-3. 96. Silberberg JS, Henry DA. The benefits of reducing cholesterol levels: the need to distinguish primary from secondary prevention, I: a metaanalysis of cholesterol-lowering trials . Med J Aust . 1991;155:665-666, 669-670. 97. McCormick J, Skrabanek P. Coronary heart disease is not preventable by population interventions . Lancet . 1988;2:839-841.Crossref 98. Berger M. Cholesterol non-consensus in primary prevention of coronary heart disease: methodologic problems in the interpretation of epidemiologic studies . Z Kardiol . 1993;82:399-405.
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Long-term Outcome After Severe Brain Injury in Preschoolers Is Worse Than Expected

Koskiniemi, Marjaleena;Kyykkä, Timo;Nybo, Taina;Jarho, Leo

1995 Archives of Pediatrics & Adolescent Medicine

doi: 10.1001/archpedi.1995.02170150029004pmid: 7532073

Abstract Objective: To determine the long-term outcome after severe brain injury at preschool age. Design: Follow-up until adult life. Setting: A centralized guidance center for all trafficassociated injuries. Patients: Children with severe brain injury at preschool age between January 1959 and December 1969. Main Outcome Measure: Final evaluation in adulthood was performed by our team. The capability to work and live independently was rated. Results: Twenty three (59%) of 39 children attended a typical school, eight (21%) attended a school for the physically disabled, and seven (18%) attended a school for the mentally retarded; information was not available for one child. In adulthood, nine patients (23%) were able to work full-time, 10 (26%) worked at sheltered workplaces, 14 (36%) lived independently at home, and six (15%) needed physical and/or psychotherapeutic support. The difference between normal school performance (59%) and capability to work full-time (23%) was significant (P<.05). In evaluating different aspects after the severe brain injury, the sense of identity was the best indicator of final outcome. Conclusions: The final evaluation of severe brain injury at preschool age should be performed in adulthood. Normal school performance or normal intelligence functioning is not a guarantee for good long-term prognosis. To let the child develop a firm identity is essential for good outcome.(Arch Pediatr Adolesc Med. 1995;149:249-254) References 1. Mahoney WJ, D'souza BJ, Haller JA, Rogers MC, Epstein MH, Freeman JM. Long-term outcome of children with severe head trauma and prolonged coma . Pediatrics . 1983;71:756-762. 2. Overgaard J, Christensen S, Hvid-Hansen O, et al. Prognosis after head injury based on early clinical examination . Lancet . 1973;2:631-635.Crossref 3. Levin HS. Head trauma . Curr Opin Neurol . 1993;6:841-846.Crossref 4. Heiskanen O, Kaste M. Late prognosis of severe brain injury in children . Dev Med Child Neurol . 1974;16:11-14.Crossref 5. Hennes H, Lee M, Smith D, Sty JR, Losek J. Clinical predictors of severe head trauma in children . AJDC . 1988;142:1045-1047. 6. Gurland JB, Yorkston NJ, Stone AR, Frank JD, Fleiss JL. The Structured and Scaled Interview to Assess Maladjustment (SSIAM), I: description, rationale, and development . Arch Gen Psychiatry . 1972;27:259-267.Crossref 7. Dobbing J: Davison AN, Dobbing J, eds. Applied Neurochemistry . Oxford, England: Basil Blackwell Publishing; 1968. 8. Kaufmann PM, Fletcher JM, Levin HS, Miner ME, Ewing-Cobbs L. Attentional disturbance after pediatric closed head injury . J Child Neurol . 1993;8: 348-353.Crossref 9. Asarnow RF, Satz P, Light R, Lewis R, Neumann E. Behavior problems and adaptive functioning in children with mild and severe closed head injury . J Pediatr Psychol . 1991;16:543-555.Crossref 10. Cohadon F, Richer E, Castel JP. Head injuries: incidence and outcome . J Neurol Sci . 1991;103:S27-S31.Crossref 11. Rivara F, Tanaguchi D, Parish RA, Stimac GK, Mueller B. Poor prediction of computed tomographic scans by clinical criteria in symptomatic pediatric head trauma . Pediatrics . 1987;80:579-584. 12. Lieh-Lai MW, Theodorou AA, Sarnaik AP, Meert KL, Moylan PM, Canady Al. Limitations of the Glasgow Coma Scale in predicting outcome in children with traumatic brain injury . J Pediatr . 1992;120:195-199.Crossref 13. Zimmerman RA, Bilaniuk LT, Gennarelli T, Bruce D, Dolinskas C, Uzzell B. Cranial computed tomography in diagnosis and management of acute head trauma . AJR Am J Roentgenol . 1978;131:27-34.Crossref 14. Jennett B, Snoek J, Bond MR, Brooks N. Disability after severe head injury: observations on the use of the Glasgow Outcome Scale . J Neurol Neurosurg Psychiatry . 1981;44:285-293.Crossref 15. Levin HS, Culhane KA, Mendelsohn D, et al. Cognition in relation to magnetic resonance imaging in head-injured children and adolescents . Arch Neurol . 1993; 50:897-905.Crossref 16. Newton MR, Greenwood RJ, Britton KE, et al. A study comparing SPECT with CT and MRI after closed head injury . J Neurol Neurosurg Psychiatry . 1992; 55:92-94.Crossref 17. Guyer B, Ellers B. Childhood injuries in the United States: mortality, morbidity, and cost . AJDC . 1990;144:649-652. 18. Kraus JF, Rock A, Hemyari P. Brain injuries among infants, children, adolescents, and young adults . AJDC . 1990;144:684-691. 19. Brink JD, Garrett AL, Hale WR, Woo-Sam J, Nickel VL. Recovery of motor and intellectual function in children sustaining severe head injuries . Devel Med Child Neurol . 1970;12:565-571.Crossref 20. Klonoff H, Clark C, Klonoff PS. Long-term outcome of head injuries: a 23 year follow up study of children with head injuries . J Neurol Neurosurg Psychiatry . 1993;56:410-415.Crossref 21. Costeff H, Abraham E, Brenner T, et al. Late neuropsychologic status after childhood head trauma . Brain Dev . 1988;10:371-374.Crossref 22. Fletcher JM, Ewing-Cobbs L, Miner ME, Levin HS, Eisenberg HM. Behavioral changes after closed head injury in children . J Consult Clin Psychol . 1990;58:93-98.Crossref 23. Dikmen S, Reitam RM. Emotional sequelae of head injury . Ann Neurol . 1977; 2:492-494.Crossref 24. Michaud LJ, Duhalme AC, Batshaw ML. Traumatic brain injury in children . Pediatr Clin North Am . 1993;40:553-565.
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Decision Rules for Roentgenography of Children With Acute Ankle Injuries

Chande, Vidya T.

1995 Archives of Pediatrics & Adolescent Medicine

doi: 10.1001/archpedi.1995.02170150035005pmid: 7858683

Abstract Objective: The Ottawa Ankle Rules (OAR) assist emergency physicians in the appropriate use of roentgenography in adults with acute ankle injuries. The OAR state that ankle roentgenograms are needed only if there is pain near the malleoli and one or more of the following exists: (1) age 55 years or older; (2) inability to bear weight; or (3) bone tenderness at the posterior edge or tip of either malleolus. This study assessed the utility of the OAR on pediatric patients with acute ankle injuries. Design: Prospective, consecutive survey of pediatric patients with acute ankle injuries. Setting: Pediatric emergency department of an urban university hospital. Participants: Seventy-one children with acute ankle injuries were enrolled from July 22, 1993, to December 1, 1993. Interventions: Twenty-four standardized clinical variables were assessed and recorded by physicians in the pediatric emergency department. The OAR were applied to each patient by the investigator to determine which ones would qualify for roentgenography. Main Outcome Measures: Sensitivity and specificity of the OAR were calculated, as was percent reduction in roentgenograms ordered. Results: Seventy-one of 73 eligible patients were enrolled. The two missed patients had open fractures of the tibia. Sixty-eight of 71 patients had ankle roentgenography during the visit. Fourteen patients (21%) (mean age, 11.8±4.0 years) had fractures noted on the roentgenograms. Fifty-four patients (79%) (mean age, 12.0±3.6 years) had no fracture. Application of the OAR would have reduced the number of roentgenograms ordered by 25% without missing any fractures. Sensitivity of OAR was 100% (95% confidence interval, 77% to 100%), specificity was 32% (95% confidence interval, 21% to 43%), negative predictive value was 100% (95% confidence interval, 80% to 100%), and positive predictive value was 28% (95% confidence interval, 17% to 39%). Conclusions: Initial testing suggests that the OAR may help determine which children with acute ankle injuries could safely forgo roentgenograms without risk of missing fractures.(Arch Pediatr Adolesc Med. 1995;149:255-258) References 1. McConnochie KM, Roghmann KJ, Pasternach J, Monroe DJ, Monaco LP. Prediction rules for selective radiographic assessment of extremity injuries in children and adolescents . Pediatrics . 1990;86:45-47. 2. Vargish T, Clarke WR, Young RA, Jensen A. The ankle injury: indications for the selective use of x-rays . Injury . 1983:14:507-512.Crossref 3. Stiell IG, Greenberg GH, McKnight RD, Nair RC, McDowell I, Worthington JR. A study to develop clinical decision rules for the use of radiography in acute ankle injuries . Ann Emerg Med . 1992;21:384-390.Crossref 4. Stiell IG, Mcknight RD, Greenberg GH, et al. A field trial to implement decision rules for radiography in ankle injuries . Ann Emerg Med . 1993:22:903. Abstract. 5. Stiell IG, Greenberg GH, McKnight RD, et al. Decision rules for the use of radiography in acute ankle injuries . JAMA . 1993;269:1127-1132.Crossref 6. Fleiss JL. Statistical Methods for Rates and Proportions . 2nd ed. New York, NY: John Wiley & Sons Inc; 1981. 7. Rosner BA. Fundamentals of Biostatistics . Boston, Mass: Duxbury Press; 1982. 8. Brand DA, Frazier WH, Kohlhepp WC, et al. A protocol for selecting patients with injured extremities who need x-rays . N Engl J Med . 1982;306:333-339.Crossref 9. Rivara FP, Parish RA, Mueller BA. Extremity injuries in children: predictive value of clinical findings . Pediatrics . 1986;78:803-807. 10. Brooks SC, Potter BT, Rainey JB. Inversion injuries of the ankle: clinical assessment and radiographic review . BMJ . 1981;282:607-608.Crossref 11. Cockshott WP, Jenkin JK, Pui M. Limiting the use of routine radiography for acute ankle injuries . Can Med Assoc J . 1983;129:129-131. 12. Dunlop MG, Beattie TF, White GK, Raab GM, Doull RI. Guidelines for selective radiological assessment of inversion ankle injuries . BMJ . 1986;293:603-605.Crossref 13. Diehr P, Highley R, Dehkondi F, et al. Prediction of fracture in patients with acute musculoskeletal ankle trauma . Med Decis Making . 1988;8:40-47.Crossref 14. Lloyd S. Selective radiographic assessment of acute ankle injuries in the emergency department: barriers to implementation . Can Med Assoc J . 1986;135:973-974.
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Urine Concentration and Enuresis in Healthy Preschool Children

Mevorach, Robert A.;Bogaert, Guy A.;Kogan, Barry A.

1995 Archives of Pediatrics & Adolescent Medicine

doi: 10.1001/archpedi.1995.02170150039006pmid: 7858684

Abstract Objectives: To determine whether children concentrate their urine overnight and to assess the correlation between specific gravity of a first morning urine specimen and the results of a questionnaire concerning bedwetting, voiding habits, and continence in 47 healthy children aged 3 to 6 years. Design: A prospective observer-blinded consecutive sample. Setting: Two San Francisco, Calif, preschools. Participants: Forty-seven children attending preschool during the study period. Measurements/Main Results: Forty of 47 children had a urine specific gravity greater than 1.020. None of these children wet the bed during this study, although four (11%) of 36 had a history of bedwetting. Furthermore, seven children with a urine specific gravity of 1.015 or lower had a history of bedwetting and wet the bed during this study. A voiding frequency of six or more times per day, by history, was associated with a 3:1 relative risk of bedwetting but did not segregate children with primary enuresis from those with secondary enuresis. Conclusions: Our results indicate that healthy children aged 3 to 6 years are able to concentrate their urine. In addition, urine specific gravity was an accurate predictor of the presence of nocturnal enuresis in this group of children. Our results suggest that a specific gravity of the first morning urine specimen should be correlated with appropriate history before extensive diagnostic evaluation or empiric therapy is performed in children with nocturnal enuresis.(Arch Pediatr Adolesc Med. 1995;149:259-262) References 1. Butler RJ, Redfern EJ, Forsythe I. The Maternal Tolerance Scale and nocturnal enuresis . Behav Res Ther . 1993;31:433-436.Crossref 2. Forsythe WI, Redmond A. Enuresis and the electric alarm: study of 200 cases . BMJ . 1970;1:211-213.Crossref 3. Shaffer D, Gardner A, Hedge B. Behavior and bladder disturbance of enuretic children: a rational classification of a common disorder . Dev Med Child Neurol . 1984;26:781-792.Crossref 4. Foxman B, Valdez RB, Brook RH. Childhood enuresis: prevalence, perceived impact, and prescribed treatments . Pediatrics . 1986;77:482-487. 5. Rushton HG. Nocturnal enuresis: epidemiology, evaluation, and currently available treatment options . J Pediatr . 1989;114:691-696.Crossref 6. Meadow SR, Evans JH. Desmopressin for enuresis . BMJ . 1989;298:1596-1597.Crossref 7. Forsythe WI, Merrett JD, Redmond A. Enuresis and psychoactive drugs . Br J Clin Pract . 1972;26:116-118. 8. Rittig S, Knudsen UB, Norgaard JP, Pedersen EB, Djurhuus JC. Abnormal diurnal rhythm of plasma vasopressin and urinary output in patients with enuresis . Am J Physiol . 1989;256( (pt 2) ):F664-F671. 9. Rittig S, Knudsen UB, Norgaard JP, Gregersen H, Pedersen EB, Djurhuus JC. Diurnal variation of plasma atrial natriuretic peptide in normals and patients with enuresis nocturna . Scand J Clin Lab Invest . 1991;51:209-217.Crossref 10. Fitzwater D, Macknin ML. Risk/benefit ratio in enuresis therapy . Clin Pediatr (Phila) . 199231:308-310.Crossref 11. Janknegt RA, Smans AJ. Treatment with desmopressin in severe nocturnal enuresis in childhood . Br J Urol . 1990;66:535-537.Crossref 12. Janknegt RA. Desmopressin and nocturnal enuresis. Originally published in Dutch . Ned Tijdschr Geneeskd . 1991;135:2451. 13. Dorner K, Campos R, Bornsen S. Further evaluation of the SG test strip for estimation of urinary osmolality . J Clin Chem Clin Biochem . 1984;22:419-425. 14. Deane AM, Capper V, Forsling ML, Hindmarsh JR, Wickham JEA. ADH levels and concentration abilities in adult enuresis . In: Proceedings of the Sixth European Association of Urology Meeting; Copenhagen , Demark; 1984:1. 15. Norgaard JP, Pedersen EB, Djurhuus JC. Diurnal antidiuretic hormone levels in enuretics . J Urol . 1985;134:1029-1031. 16. Norgaard JP, Hansen JH, Nielsen JB, Petersen BS, Knudsen N, Djurhuus JC. Simultaneous registration of sleep-stages and bladder activity in enuresis . Urology . 1985;26:316-319.Crossref 17. Tanguay S, Homsy Y. Role of desmopressin in nocturnal enuresis management . In: Ehrlick R, ed. Dialogues in Pediatric Urology . 1992;15:3-4. 18. Murayama K, Meeker RB, Murayama S, Greenwood RS. Developmental expression of vasopressin in the human hypothalamus: double-labeling with in situ hybridization and immunocytochemistry . Pediatr Res . 1993:33:152-158.Crossref 19. Godard C, Vallotton MB, Favre L. Urinary prostaglandins, vasopressin, and kallikrein excretion in healthy children from birth to adolescence . J Pediatr . 1982; 100:898-902.Crossref 20. Friedell A. A reversal of the normal concentration of the urine in children having enuresis . AJDC . 1926;31:717-721. 21. Mills JN. Diurnal rhythm in urine flow . J Physiol (Lond) . 1951;113:528-536. 22. Vulliamy D. The day and night output of urine in enuresis . Arch Dis Child . 1959;31:439-443.Crossref 23. Evans JHC, Meadow SR. Desmopressin for bed wetting: length of treatment, vasopressin secretion, and response . Arch Dis Child . 1992;67:184-188.Crossref 24. Steffens J, Netzer M, Isenberg E, Alloussi S, Ziegler M. Vasopressin deficiency in primary nocturnal enuresis: results of a controlled prospective study . Eur Urol . 1993;24:366-370. 25. Starfield B. Functional bladder capacity in enuretic and nonenuretic children . J Pediatr . 1967;70:777-781.Crossref 26. Starfield B, Mellits ED. Increase in functional bladder capacity and improvements in enuresis . J Pediatr . 1968;72:483-487.Crossref 27. Jarvelin MR, Huttunen NP, Seppanen J, Seppanen U, Moilanen I. Screening of urinary tract abnormalities among day and nightwetting children . Scand J Urol Nephrol . 1990;24:181-189.Crossref 28. Jarvelin MR, Moilanen I, Kangas P, et al. Aetiological and precipitating factors for childhood enuresis . Acta Paediatr Scand . 1991;80:361-369.Crossref 29. Mahony DT. Studies of enuresis, I: incidence of obstructive lesions and pathophysiology of enuresis . J Urol . 1971;106:951-958. 30. Mahony DT. Studies of enuresis, III: vesical hyperuropiresia as a hazardous side effect of sphincter repair surgery . J Urol . 1972;107:1059-1063. 31. Mahony DT. Studies of enuresis, II: a new valvotome for the endoscopic surgical treatment of congenital valvular obstructions of the urethra . J Urol . 1972; 107:318-319. 32. Fidas A, Galloway NT, McInnes A, Chisholm GD. Neurophysiological measurements in primary adult enuretics . Br J Urol . 1985;57:635-640.Crossref 33. Moffatt ME, Harlos S, Kirshen AJ, Burd L. Desmopressin acetate and nocturnal enuresis: how much do we know? Pediatrics . 1993;92:420-425. 34. Shaefer MS, Edmunds AL, Markin RS, Wood RP, Pillen TJ, Shaw BJ. Hepatic failure associated with imipramine therapy . Pharmacotherapy . 1990;10:66-69. 35. Evans J. Nocturnal enuresis . Practitioner . 1992;236:780-782. 36. Evans JH. Establishment of working definitions in nocturnal enuresis . Arch Dis Child . 1991;66:753.Crossref
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Omeprazole Treatment of Children With Peptic Esophagitis Refractory to Ranitidine Therapy

Karjoo, Manoochehr;Kane, Robert

1995 Archives of Pediatrics & Adolescent Medicine

doi: 10.1001/archpedi.1995.02170150047007pmid: 7858685

Abstract Objective: To evaluate the cause of chronic abdominal pain lasting more than 3 weeks in 153 patients aged 6 to 18 years (mean, 9.9 years) who had undergone endoscopy. Design: Those patients with peptic esophagitis as the cause of their chronic pain were treated with high-dose ranitidine hydrochloride, followed by the proton-pump inhibitor, omeprazole, for those who did not respond to a histamine2-receptor antagonist. Results: Eighty-four percent of patients had peptic esophagitis, 3% had Helicobacater pylori gastritis, and 3% had ulcer disease. Seventy percent of the patients with peptic esophagitis responded to an 8-week course of high-dose ranitidine hydrochloride (4 mg/kg per dose, twice a day or three times a day). Of the 30% of patients who failed to respond to ranitidine therapy, 87% responded to an 8-week course of omeprazole (20 mg/d). The grade of esophagitis at initial endoscopy was a predictive factor for response to ranitidine therapy. Ninety percent of patients with grade 1 esophagitis responded to ranitidine therapy vs only 43% of those with grade 3 or 4 esophagitis. Only five patients (4%) failed to respond to both therapies; three of these subsequently underwent Nissen fundoplications. There were no side effects of either ranitidine or omeprazole therapy. Conclusions: These findings indicate that (1) peptic esophagitis was a common cause of chronic abdominal pain in pediatric patients and (2) omeprazole was effective in the treatment of esophagitis in children and adolescents that was resistant to high-dose histamine2receptor antagonists.(Arch Pediatr Adolesc Med. 1995;149:267-271) References 1. Apley J, Naish N. Recurrent abdominal pains: a field survey of 1000 school children . Arch Dis Child . 1958;33:165-170.Crossref 2. Oster J. Recurrent abdominal pain, headaches, and limb pains in children and adolescents . Pediatrics . 1972;50:429-436. 3. Johanessen T. Symptoms of esophagitis in general practice . In: Sanberg N, Walen A, eds. Function and Disease of the Esophagus . Philadelphia, Pa: Smith Kline & French; 1985:77-78. 4. Feldman M, Burton ME. Histamine 2 receptor antagonist: standard therapy for acid-peptic disease . N Engl J Med . 1990;323:1672-1680.Crossref 5. Koelz HR. Treatment of reflux esophagitis with H2-blockers antacids and prokinetic drugs: an analysis of randomized clinical trials . Scand J Gastroenterol . 1989;24( (suppl 156) ):25-36. 6. Klinkenberg-Knol EC, Jansen KMBJ, Fosten HMP, Meuwissen SGM, Lamers CBHW. Double blind multicenter comparison of omeprazole and ranitidine in the treatment of reflux esophagitis . Lancet . 1987:1:349-351.Crossref 7. Vantrappen G, Rutgersts L, Schurmans P, Coenegrachts JL. Omeprazole (40 milligrams) is superior to ranitidine in short-term treatment of ulcerative reflux esophagitis . Dig Dis Sci . 1988;33:523-529.Crossref 8. Havelund T, Laursen L, Skoubo-Kristensen E, et al. Omeprazole and ranitidine in treatment of reflux esophagitis: double blind comparative trial . BMJ . 1988; 296:89-92.Crossref 9. Koop H, Hotz J, Pommer G, Kllein M, Arnold R. Prospective evaluation of omeprazole treatment in reflux esophagitis refractory to H2-receptor antagonists . Aliment Pharmacol Ther . 1990;4:593-599.Crossref 10. Lloyd-Davies KA, Rutgersson K, Solvell L. Omeprazole in the treatment of Zollinger-Ellison syndrome: a 4-year international study . Aliment Pharmacol Ther . 1988; 2:13-32.Crossref 11. Kato S, Shibuya H, Hayashi Y, Tseng SW, Nakagawa H, Ohi R. Effectiveness 12. Apley J, Naish N. Recurrent abdominal pains: a field survey of 1000 school children . Arch Dis Child . 1958;33:165-170.Crossref 13. Oster J. Recurrent abdominal pain, headaches, and limb pains in children and adolescents . Pediatrics . 1972;50:429-436. 14. Johanessen T. Symptoms of esophagitis in general practice . In: Sanberg N, Walen A, eds. Function and Disease of the Esophagus . Philadelphia, Pa: Smith Kline & French; 1985:77-78. 15. Feldman M, Burton ME. Histamine 2 receptor antagonist: standard therapy for acid-peptic disease . N Engl J Med . 1990;323:1672-1680.Crossref 16. Koelz HR. Treatment of reflux esophagitis with H2-blockers antacids and prokinetic drugs: an analysis of randomized clinical trials . Scand J Gastroenterol . 1989;24( (suppl 156) ):25-36. 17. Klinkenberg-Knol EC, Jansen KMBJ, Fosten HMP, Meuwissen SGM, Lamers CBHW. Double blind multicenter comparison of omeprazole and ranitidine in the treatment of reflux esophagitis . Lancet . 1987:1:349-351.Crossref 18. Vantrappen G, Rutgersts L, Schurmans P, Coenegrachts JL. Omeprazole (40 milligrams) is superior to ranitidine in short-term treatment of ulcerative reflux esophagitis . Dig Dis Sci . 1988;33:523-529.Crossref 19. Havelund T, Laursen L, Skoubo-Kristensen E, et al. Omeprazole and ranitidine in treatment of reflux esophagitis: double blind comparative trial . BMJ . 1988; 296:89-92.Crossref 20. Koop H, Hotz J, Pommer G, Kllein M, Arnold R. Prospective evaluation of omeprazole treatment in reflux esophagitis refractory to H2-receptor antagonists . Aliment Pharmacol Ther . 1990;4:593-599.Crossref 21. Lloyd-Davies KA, Rutgersson K, Solvell L. Omeprazole in the treatment of Zollinger-Ellison syndrome: a 4-year international study . Aliment Pharmacol Ther . 1988; 2:13-32.Crossref 22. Kato S, Shibuya H, Hayashi Y, Tseng SW, Nakagawa H, Ohi R. Effectiveness and pharmacokinetics of omeprazole in children with refractory duodenal ulcer . J Pediatr Gastroenterol Nutr . 1992;15:184-188.Crossref 23. Dalzell AM, Searle JW, Patrick MK. Treatment of refractory ulcerative esophagitis with omeprazole . Arch Dis Child . 1992;67:641-642.Crossref 24. Gunasekaran TS, Hassall EG. Efficacy and safety of omeprazole for severe gastroesophageal reflux in children . J Pediatr . 1993;123:148-154.Crossref 25. Kilbridge PM, Dahms BB, Czinn SJ. Campylobacter pylori-associated gastritis and peptic ulcer disease in children . AJDC . 1988;142:1149-1152. 26. Herbst JJ. Gastroesophageal reflux . J Pediatr . 1981;88:859-870.Crossref 27. Baslisteri WF, Ferrell MK. Gastroesophageal reflux in infants . N Engl J Med . 1983;309:790-792.Crossref 28. Hixson LJ, Kelley CL, Jones WN, Tuohy CD. Current trends in the pharmacotherapy of gastroesophageal reflux disease . Arch Intern Med . 1992;152:714-723.Crossref 29. Sontag SJ. Rolling review: gastro-esophageal reflux disease . Aliment Pharmacol Ther . 1993;7:293-312.Crossref 30. Colin-Jones DG. Histamine receptor antagonists in gastroesophageal reflux . Gut . 1989;30:1305-1308.Crossref 31. Collen MJ, Lewis JH, Benjamin SB. Gastric acid hypersecretion in refractory gastroesophageal reflux disease . Gastroenterology . 1990;98:654-661. 32. Somogyi A, Becker M, Gugler. Cimetidine pharmacokinetics and dosage requirements in children . Eur J Pediatr . 1985;144:72-76.Crossref 33. Blumer JL, Rothstein FC, Kaplan BS, et al. Pharmacokinetic determination of ranitidine pharmacodynamics in pediatric ulcer disease . J Pediatr . 1985:107: 301-306.Crossref 34. Lundell L, Backman L, Ekstrom P, et al. Omeprazole or high-dose ranitidine in the treatment of patients with reflux esophagitis not responding to standard doses of H2-receptor antagonists . Aliment Pharmacol Ther . 1990;4:145-155.Crossref 35. Wolf MM, Soil AH. The physiology of gastric acid secretion . N Engl J Med . 1988;319:1705-1715. 36. Fellenius E, Elander B, Wallmark B, Helander HF, Berglindh T. Inhibition of acid secretion in isolated gastric glands by substituted benzimidazoles . Am J Physiol . 1982;243:G505-G510. 37. Clissold SP, Campoli-Richards DM. Omeprazole . Drugs . 1986;32:15-47.Crossref 38. Olbe L, Lind T, Cederberg C, Ekenved G. Effect of omeprazole on gastric acid secretion in man . Scand J Gastroenterol . 1986;18( (suppl 21) ):105-107.Crossref 39. Gugler R, Fuchs G, Dieckmann M, Somogyi AA. Cimetidine plasma concentrations-response relationships . Clin Pharmacol Ther . 1981;29:744-748.Crossref 40. Lind T, Cederberg C, Ekvenved G, Haglund U, Olbe L. Effect of omeprazole—a gastric proton pump inhibitor—on pentagastrin stimulated acid secretion in man . Gut . 1983:24:270-276.Crossref 41. Bardham KD. Is there any acid peptic disease that is refractory to proton pump inhibitors? Aliment Pharmacol Ther . 1993;7( (suppl 1) ):13-24.Crossref 42. Farup PG. Compliance with anti-ulcer medication during short term healing phase clinical trials . Aliment Pharmacol Ther . 1992;6:179-186.Crossref 43. De Boer WA, Tytgat GNJ. Review article: drug therapy for reflux esophagitis . Aliment Pharmacol Ther . 1994;8:147-157.Crossref 44. Joelson S, Joelson IB, Lungdorg P, Walan A, Wallander MA. Safety experience from long-term treatment with omeprazole . Digestion . 1992;51( (suppl 1) ):93-101.Crossref 45. McTavish D, Buckley MM, Heel RC. Omeprazole. Drugs . 1991;42:138-170.Crossref
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Correction

1995 Archives of Pediatrics & Adolescent Medicine

doi: 10.1001/archpedi.1995.02170150051008

This article is only available in the PDF format. Download the PDF to view the article, as well as its associated figures and tables. Abstract Missing Information in Table. In the article entitled "Lidocaine as a Diluent for Ceftriaxone in the Treatment of Gonorrhea: Does It Reduce the Pain of the Injection?," published in the January 1994 issue of the Archives (1994;148:72-75), information was missing from Table 2 on page 74. The first cut-in head should have appeared as follows: "3 Time Periods (39 Patients)t."
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Gravid Students: Characteristics of Nongravid Classmates Who React With Positive and Negative Feelings About Conception

Stevens-Simon, Catherine;Boyle, Constance

1995 Archives of Pediatrics & Adolescent Medicine

doi: 10.1001/archpedi.1995.02170150052009pmid: 7858686

Abstract Objective: To determine whether gravid classmates affect nongravid students' feelings about conception. Method: Cross-sectional survey of a school-based clinic population. We asked 130 nulliparous high school students who were seeking routine health care at an urban school-based clinic to complete an anonymous questionnaire concerning risk factors for and attitudes about teen pregnancy. Results: The respondents were grouped according to the effect that contact with gravid classmates had on their desire for conception: increased desire (n=13), no change in desire (n=59), and decreased desire (n=49). The analysis disclosed no significant group differences for age (mean±SD, 16.3±1.2 years), sex (65% female), welfare use (20%), or living situation (85% lived with a parent). The increased-desire group had significantly more sociodemographic risk factors for teen pregnancy than did the groups with no change and decreased desire. The group with increased desire was significantly more likely than the other two groups to be failing in school (54% vs 44% and 12.2%; P<.001), to have low education goals (15.4% vs 3.4% and 0%; P=.02), to be unhappy with their family support (69.2% vs 27.1% and 29.8%; P=.01), to be concerned about sterility (30.8% vs 8.6% and 6.1%; P=.03), not to be using contraceptives (77% vs 35.6% and 30.6%; P<.01), to want a pregnancy within 2 years (61.5% vs 25.4% and 12.2%; P<.001), and to have a sexual partner who wanted a pregnancy within 2 years (61.5% vs 13.6% and 8.2%; P<.0001). Conclusions: Our findings support the study hypothesis that that never-pregnant students in the increased-desire group had more sociodemographic risk factors for teen pregnancy than did students in the groups with no change or decreased desire. The results of this study may help to ally concerns about the adverse effect that the increased prevalence of gravid students in American schools might have on the childbearing attitudes of never-pregnant students.(Arch Pediatr Adolesc Med. 1995;149:272-275) References 1. Stevens-Simon C, Beach RK. School-based prenatal and postpartum care: startegies for meeting the unique medical and educational needs of pregnant and parenting students . J School Health . 1992;62:304-309.Crossref 2. Stout JW, Rivara FP. Schools and sex education: does it work? Pediatrics . 1989;83:375-379. 3. Zellman GL. Public school programs for adolescent pregnancy and parent-hood: an assessment . Fam Plan Perspect . 1982;14:15-21.Crossref 4. Wolk LI, Kaplan DW. Frequent school-based clinic utilization: a comparative profile of problems and service needs . J Adolesc Health . 1993;14:458-463.Crossref 5. McAnarney ER, Hendee WR. The prevention of adolescent pregnancy . JAMA . 1989;262:78-82.Crossref 6. Stevens-Simon C, White M. Adolescent pregnancy . Pediatr Ann . 1991;20:322-331.Crossref 7. Elster AB, Ketterlinus R, Lamb ME. Association between parenthood and problem behavior in a national sample of adolescents . Pediatrics . 1990;85:1044-1050. 8. Abrahamse AF, Morrison PA, Waite LJ. Teenagers willing to consider single parenthood: who is at greatest risk? Fam Plan Perspect . 1988;20:13-18.Crossref 9. Rainey D, Stevens-Simon C, Kaplan DW. Self-perception of infertility among female adolescents . AJDC . 1993;147:1053-1056. 10. Zabin LS, Astone NM, Emerson MR. Do adolescents want babies? The relationship between attitudes and behavior . J Res Adolesc . 1993;3:67-86.Crossref 11. Stevens-Simon C, Beach R, Eagar R. Contraception after a negative pregnancy test during adolescence . Adolesc Pediatr Gynecol . 1993;6:83-85.Crossref 12. Klerman LV. Adolescent pregnancy and parenting controversies of the past and lessons for the future . J Adolesc Health . 1993;14:553-561.Crossref 13. Stevens-Simon C, Reichert S. Sexual abuse, adolescent pregnancy, and child abuse . Arch Pediatr Adolesc Med . 1994;148:23-27.Crossref 14. Norusis MJ. Statistical Package for the Social Sciences (SPSS/PC+) . Chicago, III: SPSS Inc; 1990. 15. Jones EF, Forrest JD, Goldman N, et al. Teenage pregnancy in developed countries: determinants and policy implications . Fam Plan Perspect . 1985;17:53-63.Crossref 16. Kirby D. School-based programs to reduce sexual risk-taking behavior . J School Health . 1992;62:280-287.Crossref 17. Howard M, McCabe JB. Helping teenagers postpone sexual involvement . Fam Plan Perspect. 1990;22:21-26.Crossref 18. Stevens-Simon C. Working with the personal fable . J Adolesc Health . 1993; 14:349.Crossref
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Factors Associated With Prolonged Hospitalization of Children With Asthma

Morray, Barbara;Redding, Gregory

1995 Archives of Pediatrics & Adolescent Medicine

doi: 10.1001/archpedi.1995.02170150056010pmid: 7858687

Abstract Objective: To identify clinical features of asthma present before arrival in the emergency department, at the time of emergency department treatment, and during hospitalization that differ between children with asthma hospitalized for a prolonged period and those hospitalized for an average duration. Design: Retrospective chart review. Patients and Setting: Hospital records of patients with asthma (International Classification of Diseases, Ninth Revision, code 493) admitted to Children's Hospital and Medical Center, Seattle, Wash, from October 1989 to September 1991. Results: The medical records of 23 children hospitalized from October 1989 to September 1991 for more than 4 days with acute asthma were compared with those of 62 sex- and age-matched children hospitalized for 2 days. Patients in the long-stay and short-stay groups had similar histories of home medication use. The presence of asthma symptoms before arrival in the emergency department was prolonged in the long-stay group (P<.001). Only one of the 23 patients in the long-stay group had augmented asthma treatment within 24 hours before hospitalization, compared with 39 of the 62 patients with short stays (P<.001). During hospitalization, a greater proportion of children in the long-stay group than the short-stay group received supplemental oxygen (P<.01). More children in the long-stay group than the short-stay group had residual hypoxemia (arterial oxygen saturation, <94%) in room air at discharge, suggesting that hospital stay was not prolonged to reach normal oxygen saturations. None of the children were readmitted within 1 month of their index admission. Conclusions: Early augmentation of home therapy for acute asthma is associated with a reduced duration of hospitalization for children admitted with asthma. In addition, hypoxemia in children with acute asthma on presentation and during hospitalization is associated with prolonged hospital stay.(Arch Pediatr Adolesc Med. 1995;149:276-279) References 1. Taylor WR, Newacheck PW. Impact of childhood asthma on health . Pediatrics . 1992;90:657-662. 2. Gergen PJ, Weiss KB. Changing patterns of asthma hospitalization among children: 1979 to 1987 . JAMA . 1990;264:1688-1692.Crossref 3. Weiss KB, Gergen PJ, Hodgson TA. An economic evaluation of asthma in the United States . N Engl J Med . 1992;326:862-866.Crossref 4. Sheffer AL, Bailey WC, Bleecker ER, et al. Guidelines for the Diagnosis and Management of Asthma . Bethesda, Md: National Institutes of Health; 1991. 5. Tal A, Levy N, Bearman JE. Methylprednisolone therapy for acute asthma in infants and toddlers: a controlled clinical trial . Pediatrics . 1990;86:350-356. 6. Harris JB, Weinberger MM, Nassif E, et al. Early intervention with short courses of prednisone to prevent progression of asthma in ambulatory patients incompletely responsive to bronchodilators . J Pediatr . 1987;110:627-633.Crossref 7. Ferrer A, Rosa J, Wagner PD, Rodriquez-Roisin R. Airway obstruction and ventilation-perfusion relationships in acute severe asthma . Am Rev Respir Dis . 1993;147:579-584.Crossref 8. Mihatsch W, Geelhoed GC, Landau LI, LeSouef PN. Time course of change in oxygen saturation and peak expiratory flow in children admitted to hospital with acute asthma . Thorax . 1990;45:438-441.Crossref
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