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  • Rubella Vaccine—A Tale of Appropriate Caution and Remarkable Success
    JAMA Pediatr. (IF 10.251) Pub Date : 2017-11-20
    Laura A. Zimmerman, Susan E. Reef, Walter A. Orenstein

    To the Editor Lyerly et al1 refer to historical aspects of the rubella vaccination program as “a cautionary tale about caution” with lessons pertinent to ongoing Zika vaccine research. However, the US rubella vaccination program has been a tale of appropriate caution and remarkable success in the elimination of rubella and congenital rubella syndrome.2 We concur with the authors in their assertions that safety studies in pregnant women are important and that these could have overcome the initial reluctance to give rubella vaccine to women of childbearing age (WCBA). However, further points within the article warrant comment.

    更新日期:2017-11-20
  • Rubella Vaccine—Reply
    JAMA Pediatr. (IF 10.251) Pub Date : 2017-11-20
    Anne Drapkin Lyerly, Elana Jaffe, Samantha G. Robin

    In Reply We appreciate the opportunity to respond to Zimmerman and colleagues. While we recognize the ultimate success of the rubella campaign, we believe its lessons inform an approach that will better serve women and children in the context of Zika vaccination. First, the authors argue that caution was an “appropriate” means to avoid the theoretical possibility of vaccine-induced teratogenesis, given limited safety data. We do not contest the relevance of this consideration, but offer that the narrow focus on it came at a cost. Ramifications included the unanticipated paradoxical effect, but also the ongoing exposure of unvaccinated pregnant women to a known teratogen, wild-type rubella virus. Infection before 12 weeks’ gestation is associated with a 90% risk of congenital rubella syndrome.1 This reflects a tendency—common in pregnancy—to notice the risks of medical intervention over the risks of nonintervention.2 Rubella reminds us that what we fear most may not be the only, nor the greatest, threat.

    更新日期:2017-11-20
  • Association of Salivary MicroRNA Changes With Prolonged Concussion Symptoms
    JAMA Pediatr. (IF 10.251) Pub Date : 2017-11-20
    Jeremiah J. Johnson, Andrea C. Loeffert, Jennifer Stokes, Robert P. Olympia, Harry Bramley, Steven D. Hicks
    更新日期:2017-11-20
  • Variation in the 12-Month Treatment Trajectories of Children and Adolescents After a Diagnosis of Depression
    JAMA Pediatr. (IF 10.251) Pub Date : 2017-11-20
    Nina R. Joyce, Megan S. Schuler, Scott E. Hadland, Laura A. Hatfield
    更新日期:2017-11-20
  • Promise of Salivary MicroRNA for Assessing Concussion
    JAMA Pediatr. (IF 10.251) Pub Date : 2017-11-20
    William P. Meehan, Rebekah Mannix

    Despite the marked increase in clinical and basic scientific investigation into concussive brain injury in recent years,1 the diagnosis and assessment of a concussion remains largely based on the reporting of symptoms.2 The symptoms of a concussion are nonspecific and can be caused by many etiologies. The biological basis of concussion symptoms has not been well-characterized and concussion symptoms do not always correlate with more objective measures of injury, such as neurocognitive testing. It therefore remains unclear whether persistent symptoms represent the continuation of concussion pathophysiology, are due to other contributing etiologies, or are the result of concussion management strategies that involve restricting activity.3 However, most children demonstrate persistent symptoms of a concussion 1 month after their injury.4,5 Given this large disease burden, objective measures of injury would be highly useful for making the diagnosis of a concussion, monitoring recovery, and identifying those at risk for prolonged symptoms after an injury.

    更新日期:2017-11-20
  • Long-Acting Reversible Contraceptives for AdolescentsMore Complex Than “First-Line”
    JAMA Pediatr. (IF 10.251) Pub Date : 2017-11-20
    Maya Michelle Kumar

    Rates of adolescent pregnancy in the United States are the highest in the developed world,1 and most pregnancies in adolescence are unplanned.2 Long-acting reversible contraceptives (LARCs), including subdermal implants and intrauterine systems, are recommended as first-line contraceptives for adolescents by the American Academy of Pediatrics, as they have the highest continuation rates (78%-84% after 1 year of use) and lowest failure rates (<1% per year with typical use) of all contraceptive methods.3 Health care professionals are encouraged to mention LARCs first and strongly recommend them when reviewing contraceptive options with adolescents. The goal of this well-intentioned recommendation was to reduce reluctance among health care professionals to offer LARCs to adolescents, thus improving young women’s access to and uptake of highly effective and convenient contraceptive options. However, health care professionals should remember that LARCs may not be the best choice for every adolescent girl.

    更新日期:2017-11-20
  • Errors in Data Input in Results, Figure, and Table
    JAMA Pediatr. (IF 10.251) Pub Date : 2017-11-13

    There were pervasive errors in the Original Investigation titled “Association Between Initial Use of e-Cigarettes and Subsequent Cigarette Smoking Among Adolescents and Young Adults: A Systematic Review and Meta-analysis,”1 published online on June 26, 2017, and in the August issue of JAMA Pediatrics. The errors in data input affected unadjusted odds ratios and adjusted odds ratios in the Results section of the Abstract and main article, as well as in Figure 2 and Table 2.2 The conclusions and interpretations of the article were not affected by these errors or the corrections. In addition, the authors updated the Supplement with a new eTable that identifies sources of specific input data. This article was corrected onlin$L̫VxnLE$L̫Vxn

    更新日期:2017-11-13
  • Errors in Data Input in Meta-analysis on Association Between Initial Use of e-Cigarettes and Subsequent Cigarette Smoking Among Adolescents and Young Adults
    JAMA Pediatr. (IF 10.251) Pub Date : 2017-11-13
    Samir Soneji

    To the Editor I write on behalf of my coauthors to report errors in our article, “Association Between Initial Use of e-Cigarettes and Subsequent Cigarette Smoking Among Adolescents and Young Adults: A Systematic Review and Meta-analysis,” that was published online on June 26, 2017, and in the August issue of JAMA Pediatrics.1 First, we had inadvertently input incorrect transition probabilities of cigarette smoking initiation by e-cigarette use status and, as a result, the wrong unadjusted odds ratio of this initiation from the study by Leventhal et al.2 After using the correct data, the correct pooled transition probabilities for cigarette smoking initiation equaled 23.2% for ever e-cigarette users and 7.2% for never e-cigarette users across all studies (not the originally reported 30.4% for ever e-cigarette users and 7.9% for never e-cigarette users). In addition, the correct pooled unadjusted odds ratio of cigarette smoking initiation by ever e-cigarette use equaled 3.83 (95% CI, 3.74-3.91) across all studies (not the originally reported 5.12 [95% CI, 4.41-5.95]).

    更新日期:2017-11-13
  • Time to Appendectomy and Risk of Complicated Appendicitis and Adverse Outcomes in Children
    JAMA Pediatr. (IF 10.251) Pub Date : 2017-11-13
    William Bonadio

    To the Editor I read with interest the study1 analyzing the effect of in-hospital duration of time to appendectomy on risk for developing appendiceal perforation in children who present with uncomplicated appendicitis. The authors report that relatively shorter in-hospital delay (<24 hours) was not associated with a significantly increased risk for developing perforation.

    更新日期:2017-11-13
  • Time to Appendectomy and Risk of Complicated Appendicitis and Adverse Outcomes in Children—Reply
    JAMA Pediatr. (IF 10.251) Pub Date : 2017-11-13
    Shawn J. Rangel

    In Reply We read with interest the concerns raised by Bonadio in response to our study1 examining the relationship between treatment delay and complicated appendicitis. First and foremost, we would disagree with the premise that a lack of knowledge regarding perforation status at presentation undermines the study’s validity. Use of mixed-effects hierarchical regression modeling to control for differences (ie, clustering) in perforation rates within hospitals allows for the assessment of postpresentation treatment delay across hospitals without knowledge of each hospitals’ specific baseline rate. Furthermore, we explored the relationship between treatment delay and adverse outcomes at the level of 23 individual hospitals, collectively representing a broad range of diagnostic practices and time-to-appendectomy profiles. The results were no different with the hospital-level analyses, and no increased risk of complicated disease was found even at hospitals with relatively long treatment delays.

    更新日期:2017-11-13
  • Median Time to Antiretroviral Therapy Initiation in a Cohort of Chinese Infants Born With HIV
    JAMA Pediatr. (IF 10.251) Pub Date : 2017-11-13
    Yan Zhao, Yuexin Wang, Ailing Wang, Jennifer M. McGoogan, Zunyou Wu
    更新日期:2017-11-13
  • Effect of an Intervention to Promote Breastfeeding on Asthma, Lung Function, and Atopic Eczema at Age 16 YearsFollow-up of the PROBIT Randomized Trial
    JAMA Pediatr. (IF 10.251) Pub Date : 2017-11-13
    Carsten Flohr, A. John Henderson, Michael S. Kramer, Rita Patel, Jennifer Thompson, Sheryl L. Rifas-Shiman, Seungmi Yang, Konstantin Vilchuck, Natalia Bogdanovich, Mikhail Hameza, Richard M. Martin, Emily Oken
    更新日期:2017-11-13
  • Association of Maternal Obesity With Longitudinal Ultrasonographic Measures of Fetal GrowthFindings From the NICHD Fetal Growth Studies–Singletons
    JAMA Pediatr. (IF 10.251) Pub Date : 2017-11-13
    Cuilin Zhang, Mary L. Hediger, Paul S. Albert, Jagteshwar Grewal, Anthony Sciscione, William A. Grobman, Deborah A. Wing, Roger B. Newman, Ronald Wapner, Mary E. D’Alton, Daniel Skupski, Michael P. Nageotte, Angela C. Ranzini, John Owen, Edward K. Chien, Sabrina Craigo, Sungduk Kim, Katherine L. Grantz, Germaine M. Buck Louis
    更新日期:2017-11-13
  • Association Between Inhaled Corticosteroid Use and Bone Fracture in Children With Asthma
    JAMA Pediatr. (IF 10.251) Pub Date : 2017-11-13
    Natasha Gray, Andrew Howard, Jingqin Zhu, Laura Y. Feldman, Teresa To
    更新日期:2017-11-13
  • Improving the Study of New Medicines for Children With Rare Diseases
    JAMA Pediatr. (IF 10.251) Pub Date : 2017-11-13
    Florence T. Bourgeois, Thomas J. Hwang

    While orphan diseases, which by definition affect less than 200 000 people in the United States,1 are individually rare, they are not rare in aggregate. Rather, they affect as many as 30 million people nationwide.1 Most rare diseases are genetic in origin,1 and as many as 50% of the people affected are children.1 Historically, there have been limited therapies available for treatment of these conditions, largely owing to the market disincentives pharmaceutical companies face in developing products for small, geographically dispersed populations. To counter this, Congress passed the Orphan Drug Act in 19831 to provide a number of financial incentives to sponsors developing drugs intended to treat orphan diseases. The act has been credited with successfully stimulating orphan drug development—38 orphan drugs were approved in the United States prior to 1983, and 365 have been approved from 1984 through 2016.2

    更新日期:2017-11-13
  • Error in Table Data
    JAMA Pediatr. (IF 10.251) Pub Date : 2017-11-01

    In the Original Investigation titled “Association of Serum Soluble Urokinase Receptor Levels With Progression of Kidney Disease in Children,”1 published online September 5, 2017, there was an error in Table 1. The data in row 3, “Male, No. (%)” were erroneously duplicated in row 10, “Other,” causing the data for rows 4 to 10 to be shifted up. All data from rows 4 to 9, “Diagnosis, No. (%),” “CAKUT, refluxive/obstructive,” “CAKUT, other,” “Glomerulopathies,” “Tubulointerstitial disease,” and“Post-AKI,” should be shifted down 1 row, leaving row 4, “Diagnosis, No. (%),” blank. This article was corrected online.

    更新日期:2017-11-10
  • JAMA Pediatrics
    JAMA Pediatr. (IF 10.251) Pub Date : 2017-11-01

    Vision: JAMA Pediatrics will be the most respected source of information for investigators, providers, and policy makers seeking the highest quality evidence to guide decision making. Mission Statement: JAMA Pediatrics seeks to provide state-of-the-art information to individuals and organizations working to advance the health and well-being of infants, children, and adolescents. The Journal also provides a forum for discussion of the most important issues and policies affecting child and adolescent health and health care. JAMA Pediatrics will use the most current technology to make timely information available to readers wherever and whenever it is needed.

    更新日期:2017-11-06
  • New Approaches for Appendicitis in Children
    JAMA Pediatr. (IF 10.251) Pub Date : 2017-11-01
    Megan A. Moreno
    更新日期:2017-11-06
  • Error in Group Information
    JAMA Pediatr. (IF 10.251) Pub Date : 2017-11-01

    In the Original Investigation titled “Effect of Inhaled Nitric Oxide on Survival Without Bronchopulmonary Dysplasia in Preterm Infants: A Randomized Clinical Trial,”1 published online September 25, 2017, there was an error in the Group Information portion of Article Information. In the list of members of the Newborns Treated With Nitric Oxide (NEWNO) Trial Group, Lewis P. Rubin, MD, was mistakenly identified as deceased. This article was corrected online.

    更新日期:2017-11-06
  • Descriptive Error
    JAMA Pediatr. (IF 10.251) Pub Date : 2017-11-01

    In the Original Investigation titled “Effects of Exposure to Gun Violence in Movies on Children’s Interest in Real Guns,”1 published online September 25, 2017, the caliber of the gun used in the study was changed from 38 caliber to semiautomatic 9 mm. This article has been corrected online.

    更新日期:2017-11-06
  • Nonoperative Treatment of Appendicitis—Reply
    JAMA Pediatr. (IF 10.251) Pub Date : 2017-11-01
    Monica E. Lopez, David E. Wesson

    In Reply We thank Minneci and Deans for their comment on our Editorial. We agree that the two 2017 meta-analyses of nonoperative treatment of pediatric appendicitis indeed have demonstrated the feasibility and initial success of this approach. While Huang et al1 did not report a pooled estimate for risk of treatment failure at 1 year, Georgiou et al2 found an overall nonoperative treatment efficacy of 82% at final reported follow-up, with both studies yielding similar histopathological appendicitis recurrence rates of 14% to 16%.1,2 In comparison, two 2017 meta-analyses of adult data, demonstrated an overall treatment effectiveness at 1 year of 64%3 and 73%,4 with Harnoss et al4 reporting a complication-free treatment success for nonoperative treatment at 1 year of 68% vs 90% for the operative treatment.4 The conclusions drawn from the pediatric meta-analyses published to date generate consensus that nonoperative treatment is “feasible and effective,” albeit a higher risk for treatment failure compared with appendectomy, especially in the setting of acute appendicitis with appendicolith,1 and that further evaluation by means of large randomized trials is needed with regard to longer-term clinical outcomes and cost-effectiveness.2 In fact, Georgiou et al2 recommend that nonoperative treatment of children with acute uncomplicated appendicitis “be reserved for those participating in carefully designed research studies.” We regret that Minneci and Deans have focused their contention on only 1 aspect of our conclusion in which we state that “nonoperative treatment remains an experimental proposition meriting ongoing consideration as a treatment strategy” for this condition and that “this therapeutic option should only be offered to pediatric patients under protocol in the setting of a clinical trial.”5 We stand by our recommendation that future studies should have attention “to longer follow-up and patient-centered outcomes, cost utility, and shared decision making.”5 This last area is essential as we attempt to understand how to align patients’ wishes, values, and their particular circumstances with their treatment plan. We commend Minneci and Deans on their ongoing work with preference-based trials and look forward to their long-term results. Their findings will provide critical information as we build a repository of evidence addressing all the previously mentioned categories so that we can provide patients’ families complete information to aid in their decision making. In spite of ongoing debates as to what the best study design is to establish superiority and to balance internal vs external validity, the current available evidence does not support routine nonoperative treatment of uncomplicated acute appendicitis in general practice.

    更新日期:2017-11-06
  • Nonoperative Treatment of Appendicitis
    JAMA Pediatr. (IF 10.251) Pub Date : 2017-11-01
    Peter C. Minneci, Katherine J. Deans

    To the Editor We appreciate the meta-analysis1 and Editorial2 evaluating nonoperative treatment of uncomplicated appendicitis in children in this issue of JAMA Pediatrics. However, we propose an alternative interpretation of the evidence and future direction of this work.1,2

    更新日期:2017-11-06
  • Nonoperative Treatment of Appendicitis—Reply
    JAMA Pediatr. (IF 10.251) Pub Date : 2017-11-01
    Libin Huang, Yuan Li, Zongguang Zhou

    In Reply We appreciate the attention, comments, and questions on our article1 in JAMA Pediatrics. Regarding Bonadio’s first question, we would agree that criteria for adults are not always applicable for children. The references Bonadio cited, which showed nonappendicitis had a normal measured appendiceal diameter of greater than 6 mm, were adult-based studies. For children, 6 mm is a critical diagnostic criterion for acute appendicitis (AA).2 Meanwhile, diagnosis for AA is mainly based on clinical findings combined with imaging examination. The inclusion criteria of studies were comprehensive; appendiceal dilation as 6 to 11 mm is part of the criteria, which was defined to exclude either complicated appendicitis or normal appendix. But it could be possible that nearly normal or milder appendicitis be included in nonoperative treatment (NOT) group, so risk-stratified scoring system3,4 should be used for ultrasonography examination, providing more detailed information for the precision diagnosis of AA.

    更新日期:2017-11-06
  • Nonoperative Treatment of Appendicitis
    JAMA Pediatr. (IF 10.251) Pub Date : 2017-11-01
    William A. Bonadio

    To the Editor I read with interest the meta-analysis by Huang et al1 combining results of 5 studies (n = 404 patients) with uncomplicated appendicitis (AUA) evaluating efficacy of nonoperative treatment (NOT). They found NOT was successful in 90% of cases and concluded that antibiotics as the initial treatment for pediatric patients with AUA may be feasible and effective without increasing the risk for complications.

    更新日期:2017-11-06
  • Infantile-Onset Fever and Urticaria
    JAMA Pediatr. (IF 10.251) Pub Date : 2017-11-01
    Sukesh Sukumaran, Vini Vijayan
    更新日期:2017-11-06
  • Truth Telling in the Setting of Cultural Differences and Incurable Pediatric IllnessA Review
    JAMA Pediatr. (IF 10.251) Pub Date : 2017-11-01
    Abby R. Rosenberg, Helene Starks, Yoram Unguru, Chris Feudtner, Douglas Diekema
    更新日期:2017-11-06
  • Accuracy of Complete Blood Cell Counts to Identify Febrile Infants 60 Days or Younger With Invasive Bacterial Infections
    JAMA Pediatr. (IF 10.251) Pub Date : 2017-11-01
    Andrea T. Cruz, Prashant Mahajan, Bema K. Bonsu, Jonathan E. Bennett, Deborah A. Levine, Elizabeth R. Alpern, Lise E. Nigrovic, Shireen M. Atabaki, Daniel M. Cohen, John M. VanBuren, Octavio Ramilo, Nathan Kuppermann
    更新日期:2017-11-06
  • Association of Serum Soluble Urokinase Receptor Levels With Progression of Kidney Disease in Children
    JAMA Pediatr. (IF 10.251) Pub Date : 2017-11-01
    Franz Schaefer, Howard Trachtman, Elke Wühl, Marietta Kirchner, Salim S. Hayek, Ali Anarat, Ali Duzova, Sevgi Mir, Dusan Paripovic, Alev Yilmaz, Francesca Lugani, Klaus Arbeiter, Mieczyslaw Litwin, Jun Oh, Maria Chiara Matteucci, Jutta Gellermann, Simone Wygoda, Augustina Jankauskiene, Günter Klaus, Jiri Dusek, Sara Testa, Aleksandra Zurowska, Alberto Caldas Afonso, Melissa Tracy, Changli Wei, Sanja Sever, William Smoyer, Jochen Reiser
    更新日期:2017-11-06
  • Association of Sex With Recurrence of Autism Spectrum Disorder Among Siblings
    JAMA Pediatr. (IF 10.251) Pub Date : 2017-11-01
    Nathan Palmer, Andrew Beam, Denis Agniel, Alal Eran, Arjun Manrai, Claire Spettell, Gregory Steinberg, Kenneth Mandl, Kathe Fox, Stanley F. Nelson, Isaac Kohane
    更新日期:2017-11-06
  • Association of Cigarette Price Differentials With Infant Mortality in 23 European Union Countries
    JAMA Pediatr. (IF 10.251) Pub Date : 2017-11-01
    Filippos T. Filippidis, Anthony A. Laverty, Thomas Hone, Jasper V. Been, Christopher Millett
    更新日期:2017-11-06
  • Association of Guideline-Adherent Antibiotic Treatment With Readmission of Children With Sickle Cell Disease Hospitalized With Acute Chest Syndrome
    JAMA Pediatr. (IF 10.251) Pub Date : 2017-11-01
    David G. Bundy, Troy E. Richardson, Matthew Hall, Jean L. Raphael, David C. Brousseau, Staci D. Arnold, Ram V. Kalpatthi, Angela M. Ellison, Suzette O. Oyeku, Samir S. Shah
    更新日期:2017-11-06
  • Effect of Inhaled Nitric Oxide on Survival Without Bronchopulmonary Dysplasia in Preterm InfantsA Randomized Clinical Trial
    JAMA Pediatr. (IF 10.251) Pub Date : 2017-11-01
    Shabih U. Hasan, Jim Potenziano, Girija G. Konduri, Jose A. Perez, Krisa P. Van Meurs, M. Whit Walker, Bradley A. Yoder
    更新日期:2017-11-06
  • Association of an Asthma Improvement Collaborative With Health Care Utilization in Medicaid-Insured Pediatric Patients in an Urban Community
    JAMA Pediatr. (IF 10.251) Pub Date : 2017-11-01
    Carolyn M. Kercsmar, Andrew F. Beck, Hadley Sauers-Ford, Jeffrey Simmons, Brandy Wiener, Lisa Crosby, Susan Wade-Murphy, Pamela J. Schoettker, Pavan K. Chundi, Zeina Samaan, Mona Mansour
    更新日期:2017-11-06
  • Safety and Feasibility of Antiretroviral Preexposure Prophylaxis for Adolescent Men Who Have Sex With Men Aged 15 to 17 Years in the United States
    JAMA Pediatr. (IF 10.251) Pub Date : 2017-11-01
    Sybil G. Hosek, Raphael J. Landovitz, Bill Kapogiannis, George K. Siberry, Bret Rudy, Brandy Rutledge, Nancy Liu, D. Robert Harris, Kathleen Mulligan, Gregory Zimet, Kenneth H. Mayer, Peter Anderson, Jennifer J. Kiser, Michelle Lally, Jennifer Brothers, Kelly Bojan, Jim Rooney, Craig M. Wilson
    更新日期:2017-11-06
  • Effects of Exposure to Gun Violence in Movies on Children’s Interest in Real Guns
    JAMA Pediatr. (IF 10.251) Pub Date : 2017-11-01
    Kelly P. Dillon, Brad J. Bushman
    更新日期:2017-11-06
  • Comparative Effectiveness and Safety of Cognitive Behavioral Therapy and Pharmacotherapy for Childhood Anxiety DisordersA Systematic Review and Meta-analysis
    JAMA Pediatr. (IF 10.251) Pub Date : 2017-11-01
    Zhen Wang, Stephen P. H. Whiteside, Leslie Sim, Wigdan Farah, Allison S. Morrow, Mouaz Alsawas, Patricia Barrionuevo, Mouaffaa Tello, Noor Asi, Bradley Beuschel, Lubna Daraz, Jehad Almasri, Feras Zaiem, Laura Larrea-Mantilla, Oscar J. Ponce, Annie LeBlanc, Larry J. Prokop, Mohammad Hassan Murad
    更新日期:2017-11-06
  • White Blood Cell Count in the Evaluation of the Febrile InfantTime to Revisit the Dogma?
    JAMA Pediatr. (IF 10.251) Pub Date : 2017-11-01
    Matthew Mischler, Francis McBee Orzulak, Jessica Hanks

    The diagnostic challenge of the infant younger than 60 days presenting to medical attention with fever has been the source of numerous publications, clinical scoring systems, and, more importantly, a high level of clinical uncertainty for caregivers evaluating this population.1- 3 The rate of serious bacterial infection is high enough in this age group to warrant evaluation, but it is unclear how much or how little evaluation is warranted.4 Clinical signs and symptoms have been shown to be unreliable at best, and as a result, there is a high level of clinical variability in emergency departments and clinical wards nationwide.5,6 The true impetus behind the evaluation of infants in this age group presenting with fever is the early recognition and diagnosis of invasive bacterial infections (IBI), thereby preventing the potential morbidity and mortality that comes with these infections.

    更新日期:2017-11-06
  • Vision Screening in Very Young Children—Making Sense of an Inexorable Diagnostic Process
    JAMA Pediatr. (IF 10.251) Pub Date : 2017-11-01
    William V. Good

    The current issue of JAMA includes guidelines for vision screening in young children.1,2 The guidelines are thorough and evidence-based. Simply condensed, vision screening is recommended for children older than 3 years; however, the evidence was insufficient to recommend for or against screening for children aged 6 months to 3 years. Screening offers detection of amblyopia (child has eyes with different refractive powers and/or strabismus), high refractive errors, and even anisocoria (unequal size pupils) in patients often unable to self-identify a problem. The proliferation of screening tools underscores the importance, both medical and financial, of screening.

    更新日期:2017-11-06
  • Navigating Nondisclosure Requests in PediatricsHonesty and Sensitivity Are Transcultural Practices
    JAMA Pediatr. (IF 10.251) Pub Date : 2017-11-01
    Deena R. Levine, Liza-Marie Johnson, Justin N. Baker

    In a world rich with diversity, practicing culturally sensitive medicine is a unique challenge. Western medical ethical principles do not always translate well to other cultures. This is especially the case with regard to disclosure of prognosis in patients with terminal illness, particularly pediatric patients. In the review by Rosenberg and colleagues,1 the authors discuss the issue of request for nondisclosure of terminal prognosis using a hypothetical case example of Sara, a 15-year-old girl from the Middle East. A review of Western and Middle Eastern literature reveals great variability by country, medical specialty, and individual preference.2 The diversity of preferences underscores the importance of not making assumptions regarding patient and family values and beliefs and stresses the importance of individual assessments by the health care professional.

    更新日期:2017-11-06
  • Improving Asthma Care by Building Bridges Across Inpatient, Outpatient, and Community Settings
    JAMA Pediatr. (IF 10.251) Pub Date : 2017-11-01
    Sean M. Frey, Jill S. Halterman

    Pediatric asthma continues to pose a significant challenge to population health. Despite more than 25 years of management guidelines1 from the National Heart, Lung, and Blood Institute and the wide availability of effective controller medications, asthma morbidity rates in the United States have stagnated.2 In this issue of JAMA Pediatrics, Kercsmar et al3 detail the influence of a triphasic quality improvement initiative on asthma outcomes in a population of Medicaid-insured children and adolescents (aged 2-17 years) in Hamilton County, Ohio. The 3 domains of bundled quality improvement (QI) interventions (inpatient, outpatient, and community) were sequentially implemented during a 5-year period and engaged a multidisciplinary team grounded in the chronic care model.

    更新日期:2017-11-06
  • Human Immunodeficiency Virus Preexposure Prophylaxis for Adolescent MenHow Do We Ensure Health Equity for At-Risk Young Men?
    JAMA Pediatr. (IF 10.251) Pub Date : 2017-11-01
    Renata Arrington-Sanders

    Preexposure prophylaxis (PrEP), coformulated as tenofovir (TFV), disoproxil fumarate (TDF), and emtricitabine (FTC), is a biomedical intervention that has demonstrated a reduction of human immunodeficiency virus (HIV) transmission rates by as much as 75% in heterosexual serodiscordant partnerships and up to 99% among men having sex with men (MSM) and transgender women when taken daily.1,2 It was approved by the US Food and Drug Administration in 2012 for adults 18 years and older, but approval for adolescents younger than 18 years has stalled because of limited data on the efficacy, acceptability, and safety among adolescents younger than 18 years.

    更新日期:2017-11-06
  • Guns and Violent Media—A Toxic Mix With an Available Antidote
    JAMA Pediatr. (IF 10.251) Pub Date : 2017-11-01
    Dimitri A. Christakis, Frederick P. Rivara

    There are few proverbial “third rails” in academic medicine. In this issue of JAMA Pediatrics, we published an article that touches 2 of them: media violence and guns. Given the stakes, we accepted the article only after multiple iterative reviews and careful attention to the rigor of the science and data analysis. Still, we are aware that critics will seek flaws in the science and take issue with the conclusions. Before delving into the implications of the article, we start by revisiting some unassailable statistics. First, the US population owns more guns per capita than any other country in the world.1 More people die per capita from guns in the United States than in any other country.2 And, most germane to this article, 7 children and adolescents die every day in the United States from guns. Second, media violence is pervasive. The last time a comprehensive review of movies was done, 100% of G-rated films contained violence.3 That assessment, made in 2000, surely underestimates the situation today given the increase in media violence4 and the advent of newer forms, including virtual and augmented reality games as well as social media posts of real-world violence.

    更新日期:2017-11-06
  • Medication and Cognitive Behavioral Therapy for Pediatric Anxiety DisordersNo Need for Anxiety in Treating Anxiety
    JAMA Pediatr. (IF 10.251) Pub Date : 2017-11-01
    Joan Rosenbaum Asarnow, Michelle S. Rozenman, Gabrielle A. Carlson

    Anxiety disorders are among the most prevalent pediatric behavioral health conditions, affecting roughly 32% of youths prior to adulthood, and associated with impaired functioning that can continue into adulthood and increase in severity.1,2 In this issue of JAMA Pediatrics, Wang et al3 report an updated meta-analysis evaluating the comparative efficacy of cognitive behavioral therapy (CBT) and pharmacotherapy for pediatric anxiety disorders. Results supported the efficacy of CBT, selective serotonin reuptake inhibitors (SSRIs), and their combination; limited support was provided for serotonin-norepinephrine reuptake inhibitors (SNRIs). We briefly review the evidence followed by implementation issues.

    更新日期:2017-11-06
  • Medicine’s Firsts
    JAMA Pediatr. (IF 10.251) Pub Date : 2017-11-01
    Lauren Rissman

    Practicing medicine is full of firsts: the first time someone calls you “doctor” and the first time a patient thanks you for saving their life. After those moments, you leave the hospital remembering why you went into medicine. You like to help people. Sometimes that means curing or easing someone’s suffering. Sometimes that means helping families cope with terminal conditions. You want to save the world 1 person at a time. And then, of course, there’s the first time you call time of death.

    更新日期:2017-11-06
  • BB Guns That Look Like Real GunsA Clinical Vignette and Policy Review
    JAMA Pediatr. (IF 10.251) Pub Date : 2017-11-01
    Katherine E. M. Hoops, Stephen P. Teret
    更新日期:2017-11-06
  • Deception in Schools—When Crisis Preparedness Efforts Go Too Far
    JAMA Pediatr. (IF 10.251) Pub Date : 2017-11-01
    David J. Schonfeld, Eric Rossen, Diann Woodard

    Without warning, police burst into classrooms in a middle school, sparking panic among seventh graders as they point loaded weapons at students, aiming to protect them from an active shooter. The panic spreads to parents as students send text messages to them during the attack. Highway patrol officers go classroom to classroom in a high school notifying students that several classmates died in motor vehicle crashes over the weekend, sparking grief as peers first learn that students missing from the class that morning had died.

    更新日期:2017-11-06
  • Health Care Workforce Development to Enhance Mental and Behavioral Health of Children and Youths
    JAMA Pediatr. (IF 10.251) Pub Date : 2017-11-01
    Thomas F. Boat, Marshall L. Land, Laurel K. Leslie

    Mental and behavioral disorder diagnoses in children and youths are increasing at a concerning rate and are antecedent to many lifetime physical and behavioral health disorders.1 The cost to individuals, families, communities, and the American public is enormous. Comprehensive attention to the risks of all children, starting early in life, through behavioral health promotion, risk prevention, early detection of concerning behaviors, and effective treatment of behavioral disorders is an unmet need.

    更新日期:2017-11-06
  • Children’s Health Must Remain a Focus in the Recovery From Hurricane Harvey
    JAMA Pediatr. (IF 10.251) Pub Date : 2017-11-01
    Aaron E. Carroll, Austin B. Frakt

    The United States has been consumed by the news about the flooding in Texas that accompanied and followed Hurricane Harvey. Many have been comforted by the relatively low levels of morbidity and mortality seen so far compared with disasters such as Hurricane Katrina. However, we should resist complacency. Unfortunately, most of the potential harm from the storm is yet to come, and much of it will fall on children. Although flooding is one of the most deadly types of natural disasters in the United States and worldwide, floods’ full physical and mental health effects, particularly in the long term, are still not well understood. However, some data do exist and have been summarized in a 2012 systematic review on floods and human health.1 Overall, mortality rates nearly double in the year after floods. Increases in disease outbreaks of hepatitis E and gastrointestinal infections are common, fueled by breakdowns in sanitation services and the contamination of potable water with sewage. The incidence of injuries is usually focused on the short term, driven by wounds from contact with debris. However, physical and mental effects of floods on children can be especially acute and worthy of dedicated, long-term attention.

    更新日期:2017-11-06
  • Highlights
    JAMA Pediatr. (IF 10.251) Pub Date : 2017-11-01

    Childhood anxiety disorders are the most common mental health diagnoses, with prevalence rates of 15% to 20%. This systematic review and meta-analysis examined 115 studies to determine the efficacy and safety of behavioral and pharmacological treatment of anxiety disorders in children. Evidence supports the effectiveness of cognitive behavioral therapy, selective serotonin reuptake inhibitors, and serotonin-norepinephrine reuptake inhibitors for reducing childhood anxiety symptoms. In an Editorial, Asarnow and colleagues discuss the challenges in implementing evidence-based mental health care in practice and the need for further research to improve the outcomes for children who are resistant to current therapies.

    更新日期:2017-11-06
  • The Well-Child Visit
    JAMA Pediatr. (IF 10.251) Pub Date : 2017-11-06
    Megan A. Moreno
    更新日期:2017-11-06
  • Hypertonic Saline and Acute BronchiolitisThe Debate Is Still On
    JAMA Pediatr. (IF 10.251) Pub Date : 2017-11-06
    Xavier Tanguay-Rioux, Anali Maneshi, Hajar Al Hoqani

    To the Editor We read with interest the study “Effect of Nebulized Hypertonic Saline Treatment in Emergency Departments on the Hospitalization Rate for Acute Bronchiolitis: A Randomized Clinical Trial” by Angoulvant et al and the Efficacy of 3% Hypertonic Saline in Acute Viral Bronchiolitis (GUERANDE) Study Group.1 We thank the authors for this well-designed and clinically important randomized clinical trial. The authors concluded that hypertonic saline administration for bronchiolitis does not reduce hospital admission.

    更新日期:2017-11-06
  • Hypertonic Saline and Acute Bronchiolitis—Reply
    JAMA Pediatr. (IF 10.251) Pub Date : 2017-11-06
    François Angoulvant, Karen Milcent, Vincent Gajdos

    In Reply We thank Tanguay-Rioux et al for their careful reading and response, which allows us to clarify some points of our study. First, given the burden of acute bronchiolitis in infants, a treatment reducing hospital admission even by few percentage points should not be neglected. However, as stated by Ralston,1 demonstrating a slight efficacy in the experimental conditions of a randomized clinical trial does not imply a clinical pertinence in daily practice. For example, in a randomized clinical trial, patients are enrolled based on rigorous criteria, while a much larger phenotype of patients will be met in daily practice. The same applies to where and how the treatment is delivered. This point associated with adverse effects, and the cost of hypertonic saline (HS) nebulizations makes the clinical utility of such treatment very unlikely.

    更新日期:2017-11-06
  • Cost-effectiveness of Strategies for Offering Influenza Vaccine in the Pediatric Emergency Department
    JAMA Pediatr. (IF 10.251) Pub Date : 2017-11-06
    Rebecca J. Hart, Michelle D. Stevenson, Michael J. Smith, A. Scott LaJoie, Keith Cross
    更新日期:2017-11-06
  • Association Between Adolescent Preventive Care and the Role of the Affordable Care Act
    JAMA Pediatr. (IF 10.251) Pub Date : 2017-11-06
    Sally H. Adams, M. Jane Park, Lauren Twietmeyer, Claire D. Brindis, Charles E. Irwin
    更新日期:2017-11-06
  • Ensuring Access to Preventive Services for AdolescentsHistorical Roots, Current Progress, and Future Challenges
    JAMA Pediatr. (IF 10.251) Pub Date : 2017-11-06
    Abigail English, Jane Perkins

    The value of preventive health services for adolescents is supported by a strong evidence base1 and broad professional consensus.2 These services play an important role in addressing preventable causes of morbidity and mortality in the adolescent years: substance use, obesity, sexually transmitted infections and other sexual health issues, motor vehicle crashes, violence, and suicide.3 Public and private insurance coverage for preventive health care exists as a result of requirements in Medicaid, the Children’s Health Insurance Program (CHIP), and the Patient Protection and Affordable Care Act (ACA). Nevertheless, adolescents receive preventive services at low levels, despite some recent noteworthy increases.4

    更新日期:2017-11-06
  • The Lost Art of DoctoringReflections of a Pediatric Resident
    JAMA Pediatr. (IF 10.251) Pub Date : 2017-11-06
    Sarah M. Mitchell

    As I finish residency, I have been reflecting on my view of what it means to be a physician. This has been a conflict between past experiences and recently discovered expectations. Medicine is an art that even the brightest people have difficulty grasping, and my past experiences have revealed a side of the profession that cannot be learned in textbooks nor reflected on board scores. I had had a long-standing curiosity about pediatric cardiology, and in college, through shadowing and volunteering, I solidified this interest. When I was in medical school, my mother died unexpectedly, and my bereavement strengthened my desire to hold onto qualities I had developed, including empathy and humility. In my final year of residency, I participated in a medical mission trip that performed cardiac surgical procedures on children in geographic areas of high need. I quickly bonded with an infant whose echocardiogram revealed defects too extensive for repair on the mission. The plan was to send him home to spend time with his family, where he would eventually die. I could not provide hospice care or analgesia for this child, since there was none to give. The nearest hospital was hours away. I felt helpless. The more I thought about it, however, the more obvious it became that while this was the only option, this was also the best option.

    更新日期:2017-11-06
  • Mild Neonatal Encephalopathy—How, When, and How Much to Treat?
    JAMA Pediatr. (IF 10.251) Pub Date : 2017-11-06
    Gregory A. Lodygensky, Malcolm R. Battin, Alistair J. Gunn

    There is compelling evidence from randomized clinical trials that therapeutic hypothermia for full term or near-term neonates with moderate to severe hypoxic-ischemic encephalopathy (HIE) improves survival without disability.1 However, more than half of all infants with HIE have mild encephalopathy,2 as shown by hyperalertness, agitation and hypertonia. These infants were not enrolled in the clinical trials because of their apparently lower risk for adverse outcomes, and so they do not meet current criteria for treatment. However, there is increasing evidence that infants who have mild encephalopathy in the first 6 hours of life may still have a high risk for brain injury. For example, in a level 3 cohort, 54% of 48 cases of mild HIE had cerebral abnormalities on magnetic resonance imaging.3 Consistent with this, in a prospective cohort study of infants who were not treated with therapeutic hypothermia, cases with mild HIE determined by both early electroencephalography and clinical examination had adverse cognitive and neuromotor outcomes at 5 years of age compared with healthy control infants.2 Although intact survival was greater after mild than moderate or severe HIE, among survivors, there was no significant difference in the cognitive outcomes of infants who had mild or moderate HIE. This finding contrasts with historical observations that infants with mild encephalopathy had normal neurodevelopmental outcomes.4

    更新日期:2017-11-06
  • Effectiveness of β-Lactam Monotherapy vs Macrolide Combination Therapy for Children Hospitalized With Pneumonia
    JAMA Pediatr. (IF 10.251) Pub Date : 2017-10-30
    Derek J. Williams, Kathryn M. Edwards, Wesley H. Self, Yuwei Zhu, Sandra R. Arnold, Jonathan A. McCullers, Krow Ampofo, Andrew T. Pavia, Evan J. Anderson, Lauri A. Hicks, Anna M. Bramley, Seema Jain, Carlos G. Grijalva
    更新日期:2017-10-30
  • Association Between Early Life Adversity and Risk for Poor Emotional and Physical Health in AdolescenceA Putative Mechanistic Neurodevelopmental Pathway
    JAMA Pediatr. (IF 10.251) Pub Date : 2017-10-30
    Joan L. Luby, Deanna Barch, Diana Whalen, Rebecca Tillman, Andy Belden
    更新日期:2017-10-30
  • Dose, Content, and Mediators of Family-Based Treatment for Childhood ObesityA Multisite Randomized Clinical Trial
    JAMA Pediatr. (IF 10.251) Pub Date : 2017-10-30
    Denise E. Wilfley, Brian E. Saelens, Richard I. Stein, John R. Best, Rachel P. Kolko, Kenneth B. Schechtman, Michael Wallendorf, R. Robinson Welch, Michael G. Perri, Leonard H. Epstein
    更新日期:2017-10-30
Some contents have been Reproduced with permission of the American Chemical Society.
Some contents have been Reproduced by permission of The Royal Society of Chemistry.
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