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  • Citation Errors in Figure 2
    JAMA Pediatr. (IF 10.251) Pub Date : 2018-01-16

    In the Original Investigation titled “Mobile Health Interventions for Improving Health Outcomes in Youth: A Meta-analysis,”1 published online March 30, 2017, and in the May 2017 issue of JAMA Pediatrics, many of the cited references in the Source column in Figure 2 were incorrectly numbered. The reference numbers in the Source column have been updated. This article was corrected online.

    更新日期:2018-01-16
  • 更新日期:2018-01-16
  • The Fragile State of the National Institutes of Health Pediatric Research Portfolio, 1992-2015Doing More With Less?
    JAMA Pediatr. (IF 10.251) Pub Date : 2018-01-16
    Daniel P. Gitterman, W. Scott Langford, William W. Hay
    更新日期:2018-01-16
  • Association of National Institute of Child Health and Human Development Career Development Awards With Subsequent Research Project Grant Funding
    JAMA Pediatr. (IF 10.251) Pub Date : 2018-01-16
    Dennis A. Twombly, Sarah L. Glavin, Jennifer Guimond, Susan Taymans, Catherine Y. Spong, Diana W. Bianchi
    更新日期:2018-01-16
  • Challenges for Today’s Pediatric Physician-Scientists
    JAMA Pediatr. (IF 10.251) Pub Date : 2018-01-16
    Barbara J. Stoll, Heinrich Taegtmeyer

    This issue of JAMA Pediatrics features 2 articles1,2 addressing the diminishing workforce of pediatric physician-scientists and the worrisome state of the federally funded pediatric research portfolio in the United States, challenging fewer pediatric researchers to do more with less. The article by Good et al1 suggests that the pool of qualified physician-scientists in pediatrics is decreasing. They raise concerns that a small group of research-intensive universities are home to the vast majority of National Institutes of Health (NIH)–funded pediatric scientists (15 institutions supported 63% of R01-equivalent grants) and that most funded investigators are full professors (or hold other senior leadership roles), suggesting that pediatric physician-scientists reflect an aging workforce.

    更新日期:2018-01-16
  • Physician-Scientist Career Awards and a DilemmaNational Institute of Child Health and Human Development K Awards—Individual, Institutional, or National?
    JAMA Pediatr. (IF 10.251) Pub Date : 2018-01-16
    Alan L. Schwartz

    Despite the critical role that physician-scientists play in the biomedical work force, often from bedside to bench and back, concern for the health of this enterprise was apparent to James Wyngaarden1 40 years ago when he described this “endangered species.” Former National Institutes of Health (NIH) director, Elias Zerhouni, in 2008, said of the young scientist conundrum, “I think anybody who thinks this is not the number one issue in American science probably doesn’t understand the long-term issues.” The myriad challenges this presents have been addressed recently by many (see Schafer2). In 2 striking articles, Alberts et al3,4 have focused attention on what they term “rescuing US biomedical research from its systemic flaws.” Among the key areas identified is the next generation of biomedical scientists (including both fundamental and clinician scientists), wherein 18% of NIH R01-funded investigators were aged 36 years or younger in 1980, yet only 3% were in that age group in 2010. Furthermore, the percent of R01 principal investigators older than 65 years increased more than 10-fold during this same period: the aging of the workforce. Daniels5 dissected many of the causes for this current young generation at risk and noted that the average age for an MD investigator to receive her or his first R01 was 38 years in 1980 and rose to more than 45 years in 2010. To address this, he suggested 4 areas for potential action: strategic reinvestment in scientific research, reform of external peer review, rebalancing the compact between universities and the government, and developing sustainable career paths for young scientists. Indeed, the 2014 NIH Physician-Scientist Workforce (PSW) Report (https://acd.od.nih.gov/), noted that there are approximately 9000 physician scientists in the NIH-funded workforce and discussed the challenges confronting them: the cost of medical education with resultant debt, prolonged training required in both clinical medicine and research, funding challenges, shifting finances of schools of medicine and academic health centers, funding mentors for guidance, work-life balance, and increasing as well as demanding compliance, among others.

    更新日期:2018-01-16
  • Early Detection of Scoliosis—What the USPSTF “I” Means for Us
    JAMA Pediatr. (IF 10.251) Pub Date : 2018-01-09
    M. Timothy Hresko, Richard M. Schwend, Richard A. Hostin

    In the current issue of JAMA is the latest recommendation statement by the US Preventive Services Task Force (USPSTF),1 and accompanying evidence report,2 on the value of screening asymptomatic adolescents for adolescent idiopathic scoliosis. Since the topic was last reviewed in 2004, important new evidence has emerged that potentially supports scoliosis screening. In this update, the USPSTF changed its grade of the evidence from a “D” (discourage the use of screening programs) to an “I” (uncertainty about the balance of benefits and harms of the service).1 The recommendation highlights the high sensitivity, specificity, and predictive value and the low false-positive rate of screening programs when the Adams forward bend test is paired with scoliometer measurements and Moiré topography. It is important to recognize that a properly implemented screening program will identify potential patients who can benefit from brace treatment, possibly avoiding surgery. In addition, spinal deformity may be the presenting sign of a variety of conditions, including heritable collagen disease, neurological conditions, or skeletal dysplasia unrecognized until adolescence. Even if surgery cannot be averted, early diagnosis of progressive curves allows for surgical intervention at the most opportune time.

    更新日期:2018-01-09
  • Error in Key Points
    JAMA Pediatr. (IF 10.251) Pub Date : 2018-01-08

    In the Original Investigation titled “Accuracy of Complete Blood Cell Counts to Identify Febrile Infants 60 Days or Younger With Invasive Bacterial Infections,”1 published online September 11, 2017, and printed in the November 2017 issue of JAMA Pediatrics, there was an error in the second paragraph of the Key Points. The numerical value for the absolute neutrophil count should be ≥10 000/µL. This article was corrected online.

    更新日期:2018-01-08
  • Error in Author Name
    JAMA Pediatr. (IF 10.251) Pub Date : 2018-01-08

    In the Original Investigation titled “Families as Partners in Hospital Error and Adverse Event Surveillance,”1 published online February 27, 2017, and printed in the April 2017 issue of JAMA Pediatrics, there was an error in the spelling of an author’s name. Rebecca L. Blankenburg’s name was corrected. This article was corrected online.

    更新日期:2018-01-08
  • Charlie Gard and the Limits of the Harm Principle
    JAMA Pediatr. (IF 10.251) Pub Date : 2018-01-08
    Johan Christiaan Bester

    To the Editor An article by Shah et al1 published in JAMA Pediatrics argues that the best interest standard is too vague and indeterminate to be the appropriate decision-making standard in cases such as that of Charlie Gard.1 The authors favor the harm principle advanced by Diekema2 as a clearer, more understandable standard. Indeed, the best interest standard requires the complex work of identifying and weighing interests and values. However, the harm principle does not avoid this, nor is it less vague and indeterminate.

    更新日期:2018-01-08
  • Charlie Gard and the Limits of the Harm Principle—Reply
    JAMA Pediatr. (IF 10.251) Pub Date : 2018-01-08
    Seema K. Shah, Abby R. Rosenberg, Douglas S. Diekema

    In Reply We appreciate Bester’s comments regarding the complexity of applying the harm principle to cases such as Charlie Gard’s.1 Specifically, he argues that (1) the harm principle is intended for parental refusals of treatment (in contrast to Charlie Gard’s parents’ request for investigational therapy) and (2) our criticism of the best interest standard for vagueness applies equally to the harm principle. We take this opportunity to clarify our views.

    更新日期:2018-01-08
  • Effect of the School-Based Telemedicine Enhanced Asthma Management (SB-TEAM) Program on Asthma MorbidityA Randomized Clinical Trial
    JAMA Pediatr. (IF 10.251) Pub Date : 2018-01-08
    Jill S. Halterman, Maria Fagnano, Reynaldo S. Tajon, Paul Tremblay, Hongyue Wang, Arlene Butz, Tamara T. Perry, Kenneth M. McConnochie
    更新日期:2018-01-08
  • Comparing Alternative Ranibizumab Dosages for Safety and Efficacy in Retinopathy of PrematurityA Randomized Clinical Trial
    JAMA Pediatr. (IF 10.251) Pub Date : 2018-01-08
    Andreas Stahl, Tim U. Krohne, Nicole Eter, Isabel Oberacher-Velten, Rainer Guthoff, Synke Meltendorf, Oliver Ehrt, Sabine Aisenbrey, Johann Roider, Heinrich Gerding, Claudia Jandeck, Lois E. H. Smith, Johanna M. Walz
    更新日期:2018-01-08
  • 更新日期:2018-01-08
  • I Thought You Said This Was Confidential?—Challenges to Protecting Privacy for Teens and Young Adults
    JAMA Pediatr. (IF 10.251) Pub Date : 2018-01-08
    Lauren E. Wisk, Susan H. Gray, Holly C. Gooding

    A 19-year-old woman taking immunomodulatory therapy presents to her primary care physician for a routine physical examination. She receives a diagnosis of Chlamydia trachomatis during screening for sexually transmitted infections (STIs) and returns to the clinic for directly observed treatment with azithromycin. She later calls the practice to express dismay that her parents questioned her about her sexual activity after they received an explanation of benefits for services rendered.

    更新日期:2018-01-08
  • Core Quality and Outcome Measures for Pediatric Health—Reply
    JAMA Pediatr. (IF 10.251) Pub Date : 2018-01-02
    William Gardner, Kelly J. Kelleher

    In Reply We thank Webbe et al for their thoughtful comments on our brief article.1 We are glad they concur with the primary points, in particular, the need for a global set of concise pediatric measures, a focus on outcomes, and the early and frequent inclusion of child, family, and other stakeholder perspectives. Webbe et al go on to underscore examples from arthritis and neonatology among others. These are exemplary cases of large-scale collaborative work. As such, they represent the best in class for specialty outcomes measurement development.

    更新日期:2018-01-02
  • Core Quality and Outcome Measures for Pediatric Health
    JAMA Pediatr. (IF 10.251) Pub Date : 2018-01-02
    James Webbe, Neena Modi, Chris Gale

    To the Editor We read with interest the call from members of the Vital Signs project for national initiatives to improve measures of quality of care and outcomes in children.1 Problems caused by a lack of consistent measures are well recognized in research2 and quality improvement.3 We agree that work to develop clinically meaningful, standardized outcomes and other measures in pediatrics is overdue.

    更新日期:2018-01-02
  • Association of Long-term Exposure to Airborne Particulate Matter of 1 μm or Less With Preterm Birth in China
    JAMA Pediatr. (IF 10.251) Pub Date : 2018-01-02
    Yuan-yuan Wang, Qin Li, Yuming Guo, Hong Zhou, Xiaobin Wang, Qiaomei Wang, Haiping Shen, Yiping Zhang, Donghai Yan, Ya Zhang, Hongguang Zhang, Shanshan Li, Gongbo Chen, Jun Zhao, Yuan He, Ying Yang, Jihong Xu, Yan Wang, Zuoqi Peng, Hai-Jun Wang, Xu Ma
    更新日期:2018-01-02
  • Differences in Morbidity and Mortality Rates in Black, White, and Hispanic Very Preterm Infants Among New York City Hospitals
    JAMA Pediatr. (IF 10.251) Pub Date : 2018-01-02
    Elizabeth A. Howell, Teresa Janevic, Paul L. Hebert, Natalia N. Egorova, Amy Balbierz, Jennifer Zeitlin
    更新日期:2018-01-02
  • 更新日期:2018-01-02
  • Choice of Hospital as a Source of Racial/Ethnic Disparities in Neonatal Mortality and Morbidity Rates
    JAMA Pediatr. (IF 10.251) Pub Date : 2018-01-02
    Ciaran S. Phibbs, Scott A. Lorch

    The study by Howell et al1 in this issue of JAMA Pediatrics is a carefully done, methodologically sound examination of the racial/ethnic disparities in the outcomes for very preterm infants in New York City. The authors partitioned the racial/ethnic differences in a combined morbidity and mortality index into those attributable to maternal and infant factors present at delivery, those attributable to which hospital cared for each infant, and other unexplained factors. Not surprisingly, infant health risks, such as gestational age at delivery, explained most of the large racial/ethnic disparities in neonatal outcomes. What is concerning about the results is that differences in where care was provided explained 40% of the black-white disparity and 30% of the Hispanic-white disparity in mortality/morbidity rates. In these New York City data there was a very large range in risk-adjusted mortality/morbidity rates across the study hospitals (9.7% to 57.7%). Looking at the results (see eFigure 1 in the article’s Supplement1) shows there were no racial/ethnic differences in access to the best-performing hospitals (the top 2 quintiles). However, black and Hispanic patients were, on average, more likely to receive care at hospitals within the lower 3 quintiles. It was notable that almost no white patients were cared for in the lowest performing quintile of hospitals. One encouraging finding from this article is that the authors did not find any within-hospital disparities in outcomes. Previous studies looking at this topic in perinatal medicine yielded mixed results, with some studies finding no difference in hospital care between infants of different racial/ethnic status while others found significant differences in access to high-quality hospitals.2- 5 Similar to this work, racial/ethnic disparities in access to high-quality care have been noted in the hospitalized care of adult patients6 and access to outpatient services.7 Because the data are only from New York City, we cannot assume that the disparity patterns found by Howell et al1 apply to the rest of the country. But, if it were to apply to the rest of the country, these results would point to an alarming driver of disparities in perinatal outcomes by race/ethnicity.

    更新日期:2018-01-02
  • JAMA Pediatrics 2018 and Beyond
    JAMA Pediatr. (IF 10.251) Pub Date : 2018-01-02
    Dimitri A. Christakis

    With this issue, I officially assume the role of editor in chief of JAMA Pediatrics. It is a daunting and humbling task, especially as I take over from one of the true giants in academic pediatrics. Fred Rivara, MD, MPH, has edited the journal for almost 18 years, shepherding it from Archives of Pediatrics & Adolescent Medicine to JAMA Pediatrics and tirelessly working to increase the quality of the journal. JAMA Pediatrics now has by far the highest impact factor (10.25) of all pediatric journals in the world. Of course, impact factor is but one—albeit important—metric of a journal’s contribution to society. The most important metric—how a journal’s science impacts population health—is considerably more knotty to measure. Frequent citations, which drive impact factor results, mean that other scientists consider the work to be notable, but so much of child health relies on the actions of nonscientists, including clinicians in all specialties, policy makers, day care workers, teachers, and, perhaps most importantly, parents themselves. Publishing research that has clear implications and actionable strategies for these constituents is essential to making meaningful changes that affect child health.

    更新日期:2018-01-02
  • A Lesson in Balancing Education and Empathy
    JAMA Pediatr. (IF 10.251) Pub Date : 2018-01-02
    Stephanie Sophie Lee

    Prior to residency, my exposure to infants was limited to holding newborns, so the neonatal intensive care unit was fascinating to me as a resident. The infants were medically complicated and academically interesting, but because of their fragile health, they were often on the brink of death. It was during my first encounter with a dying infant that I realized what a struggle it can be to maintain the balance between medical curiosity and the moral obligation to express empathy for all patients.

    更新日期:2018-01-02
  • JAMA Pediatrics
    JAMA Pediatr. (IF 10.251) Pub Date : 2018-01-01

    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:2018-01-02
  • The Well-Child Visit
    JAMA Pediatr. (IF 10.251) Pub Date : 2018-01-01
    Megan A. Moreno
    更新日期:2018-01-02
  • Error in Introduction
    JAMA Pediatr. (IF 10.251) Pub Date : 2018-01-01

    In the Original Investigation titled “Association Between Adolescent Preventive Care and the Role of the Affordable Care Act,”1 published online November 6, 2017, there was an error in the Introduction section. The US Preventive Services Task Force recommendation for chlamydia should have been listed as grade B instead of grade A. The third sentence of the Introduction’s second paragraph should have read as follows: “Chlamydia screening, a US Preventive Services Task Force grade B recommendation, also remains low (47%-55% in 2014) among sexually active females ages 16 to 24 years.” This article was corrected online.

    更新日期:2018-01-02
  • Errors in Data Input in Results, Figure, and Table
    JAMA Pediatr. (IF 10.251) Pub Date : 2018-01-01

    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 online.

    更新日期:2018-01-02
  • Traumatic Brain Injury and Cases of Abnormal Menstrual Pattern—Reply
    JAMA Pediatr. (IF 10.251) Pub Date : 2018-01-01
    Meredith L. Snook, Anthony P. Kontos

    In Reply We thank Benvenga et al for their thoughtful commentary on our article1 examining abnormal menstrual patterns in adolescents and young women after sport-related concussion. These authors discuss several key issues related to our article including references, mechanisms for our findings, and future research. The references2,3 noted by the authors and not included in our article represent significant contributions to the literature detailing the association of severe traumatic brain injury (TBI) and hypopituitarism. However, we noted differences between the patients in these case series and those from our study. Specifically, approximately half of the patients2,3 were male, most were either prepubertal or adult, and experienced severe, non–sport-related TBI. Yet the results from these studies are applicable to our study. By demonstrating pituitary dysfunction using hormonal assessment, Acerini et al2 reported gonadotropin deficiencies in 80% (n = 16 of 20) of pediatric patients following severe TBI. All 3 of the female adolescents with severe TBI (skull fractures) in these series2,3 exhibited gonadotropin deficiencies 2 to 5 years after injury, and at least one reported amenorrhea. These findings suggest that gonadotropin deficiencies may be a long-term consequence of TBI. Perhaps, as we stated in our article, “more subtle forms of brain injury, such as concussion, may adversely affect HPO [hypothalamic-pituitary-ovarian] axis function…leading to disrupted gonadotropin secretion.”1

    更新日期:2018-01-02
  • Traumatic Brain Injury and Cases of Abnormal Menstrual Pattern
    JAMA Pediatr. (IF 10.251) Pub Date : 2018-01-01
    Salvatore Benvenga, Alessandro Sindoni, Fausto Fama

    To the Editor We read with interest the article1 on frequency of abnormal menstrual patterns in adolescents and young women after a sport-related concussion.1 Authors used self-reported menstrual bleeding patterns during the 120 days after injury as a proxy for hypothalamic-pituitary-ovarian axis function.1 This study follows an uncited position statement on concussion sequelae in both young and adult athletes,2 where words such as “hypopituitarism” or “menstrual disorders” are absent.

    更新日期:2018-01-02
  • Rubella Vaccine—Reply
    JAMA Pediatr. (IF 10.251) Pub Date : 2018-01-01
    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:2018-01-02
  • Rubella Vaccine—A Tale of Appropriate Caution and Remarkable Success
    JAMA Pediatr. (IF 10.251) Pub Date : 2018-01-01
    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:2018-01-02
  • Time to Appendectomy and Risk of Complicated Appendicitis and Adverse Outcomes in Children
    JAMA Pediatr. (IF 10.251) Pub Date : 2018-01-01
    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:2018-01-02
  • Time to Appendectomy and Risk of Complicated Appendicitis and Adverse Outcomes in Children—Reply
    JAMA Pediatr. (IF 10.251) Pub Date : 2018-01-01
    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:2018-01-02
  • Hypertonic Saline and Acute BronchiolitisThe Debate Is Still On
    JAMA Pediatr. (IF 10.251) Pub Date : 2018-01-01
    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:2018-01-02
  • Hypertonic Saline and Acute Bronchiolitis—Reply
    JAMA Pediatr. (IF 10.251) Pub Date : 2018-01-01
    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:2018-01-02
  • 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 : 2018-01-01
    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:2018-01-02
  • Median Time to Antiretroviral Therapy Initiation in a Cohort of Chinese Infants Born With HIV
    JAMA Pediatr. (IF 10.251) Pub Date : 2018-01-01
    Yan Zhao, Yuexin Wang, Ailing Wang, Jennifer M. McGoogan, Zunyou Wu
    更新日期:2018-01-02
  • Rapidly Changing Skin Lesion in a Teenage Boy
    JAMA Pediatr. (IF 10.251) Pub Date : 2018-01-01
    Hannah Song, Patricia Todd, Jennifer T. Huang
    更新日期:2018-01-02
  • Perinatal Diagnosis, Management, and Follow-up of Cystic Renal DiseasesA Clinical Practice Recommendation With Systematic Literature Reviews
    JAMA Pediatr. (IF 10.251) Pub Date : 2018-01-01
    Charlotte Gimpel, Fred E. Avni, Carsten Bergmann, Metin Cetiner, Sandra Habbig, Dieter Haffner, Jens König, Martin Konrad, Max C. Liebau, Lars Pape, Georg Rellensmann, Andrea Titieni, Constantin von Kaisenberg, Stefanie Weber, Paul J. D. Winyard, Franz Schaefer
    更新日期:2018-01-02
  • 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 : 2018-01-01
    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:2018-01-02
  • Cost-effectiveness of Strategies for Offering Influenza Vaccine in the Pediatric Emergency Department
    JAMA Pediatr. (IF 10.251) Pub Date : 2018-01-01
    Rebecca J. Hart, Michelle D. Stevenson, Michael J. Smith, A. Scott LaJoie, Keith Cross
    更新日期:2018-01-02
  • Association of Salivary MicroRNA Changes With Prolonged Concussion Symptoms
    JAMA Pediatr. (IF 10.251) Pub Date : 2018-01-01
    Jeremiah J. Johnson, Andrea C. Loeffert, Jennifer Stokes, Robert P. Olympia, Harry Bramley, Steven D. Hicks
    更新日期:2018-01-02
  • Association Between Inhaled Corticosteroid Use and Bone Fracture in Children With Asthma
    JAMA Pediatr. (IF 10.251) Pub Date : 2018-01-01
    Natasha Gray, Andrew Howard, Jingqin Zhu, Laura Y. Feldman, Teresa To
    更新日期:2018-01-02
  • Variation in the 12-Month Treatment Trajectories of Children and Adolescents After a Diagnosis of Depression
    JAMA Pediatr. (IF 10.251) Pub Date : 2018-01-01
    Nina R. Joyce, Megan S. Schuler, Scott E. Hadland, Laura A. Hatfield
    更新日期:2018-01-02
  • Association Between Adolescent Preventive Care and the Role of the Affordable Care Act
    JAMA Pediatr. (IF 10.251) Pub Date : 2018-01-01
    Sally H. Adams, M. Jane Park, Lauren Twietmeyer, Claire D. Brindis, Charles E. Irwin
    更新日期:2018-01-02
  • Neurodevelopmental and Behavioral Outcomes in Extremely Premature Neonates With Ventriculomegaly in the Absence of Periventricular-Intraventricular Hemorrhage
    JAMA Pediatr. (IF 10.251) Pub Date : 2018-01-01
    Athina Pappas, Ira Adams-Chapman, Seetha Shankaran, Scott A. McDonald, Barbara J. Stoll, Abbot R. Laptook, Waldemar A. Carlo, Krisa P. Van Meurs, Susan R. Hintz, Martha D. Carlson, Jane E. Brumbaugh, Michele C. Walsh, Myra H. Wyckoff, Abhik Das, Rosemary D. Higgins
    更新日期:2018-01-02
  • 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 : 2018-01-01
    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:2018-01-02
  • Association Between Neonatal Intensive Care Unit Admission Rates and Illness Acuity
    JAMA Pediatr. (IF 10.251) Pub Date : 2018-01-01
    Joseph Schulman, David Braun, Henry C. Lee, Jochen Profit, Grace Duenas, Mihoko V. Bennett, Robert J. Dimand, Maria Jocson, Jeffrey B. Gould
    更新日期:2018-01-02
  • Promise of Salivary MicroRNA for Assessing Concussion
    JAMA Pediatr. (IF 10.251) Pub Date : 2018-01-01
    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:2018-01-02
  • Ensuring Access to Preventive Services for AdolescentsHistorical Roots, Current Progress, and Future Challenges
    JAMA Pediatr. (IF 10.251) Pub Date : 2018-01-01
    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:2018-01-02
  • Data Deficiency in an Era of Expanding Neonatal Intensive Care Unit Care
    JAMA Pediatr. (IF 10.251) Pub Date : 2018-01-01
    David C. Goodman, George A. Little

    Despite longstanding efforts to improve newborn care, the ability of neonatology and the public to monitor and influence the quality, outcomes, and efficiency of care has been mixed. On the bright side, the Vermont-Oxford Network has pioneered the comparative measurement of care processes and outcomes primarily for very low-birth-weight newborns through benchmarking, research, and quality improvement initiatives. Statewide perinatal collaborative efforts, most notably the California Perinatal Quality Care Collaborative and the California Children’s Services (CPQCC/CCS), have expanded the range of newborn care data and provided further stimulus to improvement activities. While these efforts remain important, the growth of neonatal intensive care unit (NICU) care has overtaken these data used by these initiatives, leaving the care and outcomes of most newborns in the dark. Currently, to our knowledge, no entity is responsible or has the means to monitor medical care for the total birth cohort in the United States, and only limited data sets are available at the state level.

    更新日期:2018-01-02
  • The Lost Art of DoctoringReflections of a Pediatric Resident
    JAMA Pediatr. (IF 10.251) Pub Date : 2018-01-01
    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:2018-01-02
  • Improving the Study of New Medicines for Children With Rare Diseases
    JAMA Pediatr. (IF 10.251) Pub Date : 2018-01-01
    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:2018-01-02
  • Long-Acting Reversible Contraceptives for AdolescentsMore Complex Than “First-Line”
    JAMA Pediatr. (IF 10.251) Pub Date : 2018-01-01
    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:2018-01-02
  • 更新日期:2018-01-02
  • Mild Neonatal Encephalopathy—How, When, and How Much to Treat?
    JAMA Pediatr. (IF 10.251) Pub Date : 2018-01-01
    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:2018-01-02
  • Highlights
    JAMA Pediatr. (IF 10.251) Pub Date : 2018-01-01

    Recent work has raised questions about the uniformity of criteria for admission to a neonatal intensive care unit (NICU) and possible overuse of this resource. In this large study in California, 10% of infants born at 34 or more weeks were admitted to a NICU, accounting for 79% of all NICU admissions. Admission rates varied 34-fold across NICUs and there was a 40-fold variation in the reported percentage of high illness acuity. The accompanying Editorial by Goodman and Little discusses the implications of this variation and the need for appropriate population-based data to track variations in care.

    更新日期:2018-01-02
  • 更新日期:2017-12-27
  • Are Structural Magnetic Resonance Imaging and General Movements Assessment Sufficient for Early, Accurate Diagnosis of Cerebral Palsy?—Reply
    JAMA Pediatr. (IF 10.251) Pub Date : 2017-12-26
    Iona Novak, Catherine Morgan

    In Reply We thank Parikh for his excellent points and deeply appreciate his efforts to refine advanced magnetic resonance imaging (MRI) biomarkers toward multivariable prediction models in high-income contexts. Our clinical practice guideline1 was developed from the combined body of best-available evidence, sourced using a systematic review method, and organized by panel consensus using the GRADE framework. We did not review single articles in isolation to avoid selection and reporting bias. Furthermore, we examined multiple causal pathways to cerebral palsy, not just the preterm population as cited by Parikh, which affects the denominator value used for interpreting data.

    更新日期:2017-12-27
  • Are Structural Magnetic Resonance Imaging and General Movements Assessment Sufficient for Early, Accurate Diagnosis of Cerebral Palsy?
    JAMA Pediatr. (IF 10.251) Pub Date : 2017-12-26
    Nehal A. Parikh

    To the Editor A systematic review and clinical practice guideline on early, accurate diagnosis and early intervention in cerebral palsy (CP), as undertaken by Novak et al,1 is a timely addition to the literature. However, it is unclear why the authors restricted their search criteria to only systematic reviews/meta-analyses and CPGs. By doing so, they overlooked several relevant, well-conducted prognostic studies.2- 5 Unfortunately, this casts significant doubt on their recommendation to combine structural brain magnetic resonance imaging (MRI) with general movements assessment (GMA) for accurate diagnosis of CP before age 5 months. They report MRI to possess a sensitivity of 86% to 89%. However, these data were derived from a clinical practice guideline that examined cross-sectional MRI studies (reference 27 in the Novak et al article),1 which are unable to determine prognostic test properties, and from a systematic review that found only 1 eligible cohort study of 61 preterm infants (reference 21 in the Novak et al article).1 They excluded the largest MRI study in preterm infants (N = 445),2 which yielded a sensitivity of 48% and likelihood ratio for a positive test result (LR+) of 2.8 for CP prediction. A 2015 meta-analysis,3 also excluded, reported a similarly low LR+ of 3.7 for MRI. When applied to a very preterm infant (assuming 10% CP prevalence) with an abnormal MRI, a LR+ of 3.7 only increases this infant’s probability of developing CP to 29%.

    更新日期:2017-12-27
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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