Archives of Pediatrics & Adolescent Medicine

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ISSN / EISSN : 1072-4710 / 1538-3628
Published by: Rockefeller University Press (10.1001)
Total articles ≅ 24,591
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, Jennifer R. O’Neill
Archives of Pediatrics & Adolescent Medicine, Volume 166, pp 1095-1096; https://doi.org/10.1001/archpediatrics.2012.1458

Abstract:
In 2008, the first federally approved PhysicalActivity Guidelines for Americans1 were released, and this action clearly demonstrated that promotion of physical activity is becoming a public health priority in the United States. The guidelines provide well-documented recommendations regarding the types and amounts of physical activity needed for health benefits. Separate sets of recommendations were provided for adults, older adults, and children and adolescents. The age range designated for children and adolescents was 6 years to 17 years. Notably, no recommendations were included in the Physical Activity Guidelines for children younger than 6 years.
Archives of Pediatrics & Adolescent Medicine, Volume 166, pp 1097-1098; https://doi.org/10.1001/archpediatrics.2012.1907

Abstract:
In a debate at a meeting of the Pediatric Academic Societies in May 2012, I reiterated arguments against universal pediatric lipid screening because instituting
Archives of Pediatrics & Adolescent Medicine, Volume 166, pp 1093-1094; https://doi.org/10.1001/archpediatrics.2012.806

Abstract:
Personal belief exemptions (PBEs) from school enrollment immunization requirements are permitted in 19 states. In the 2011-2012 legislative year, bills to tighten or eliminate PBEs have been introduced in 3 states while bills to expand or allow PBEs have been proposed in 8 states (D. Peterson, BS, written communication, March 2012). Bills expanding or allowing PBEs have often been introduced by those opposed to all immunization mandates, while those that tighten or eliminate PBEs are usually supported by immunization advocates. Too often the ensuing debates generate more heat than light. Prudent PBE policies have the potential to facilitate thoughtful, informed vaccine decision-making by parents, sustain public support for immunization programs, and, thereby, help to realize the full potential of modern vaccinology to improve both individual and public health. Seeking to eliminate PBEs will likely foster an adversarial relationship between immunization advocates and vaccine-hesitant parents, increase claims for religious or medical exemptions, and make for more challenging public discussion of the optimal balance between individual freedom of choice and protecting the public health.
, Jan Kowalski, , Claude Marcus
Archives of Pediatrics & Adolescent Medicine, Volume 166, pp 1103-1108; https://doi.org/10.1001/2013.jamapediatrics.319

Abstract:
ObjectivesTo investigate whether the degree of obesity predicts the efficacy of long-term behavioral treatment and to explore any interaction with age.DesignA 3-year longitudinal observational study. Obese children were divided into 3 age groups (6-9, 10-13, and 14-16 years) and also into 2 groups (moderately obese, with a body mass index [BMI]–standard deviation [SD] score [or z score] of 1.6 to <3.5, and severely obese, with a BMI-SD score of ≥3.5).SettingNational Childhood Obesity Center, Stockholm, Sweden.ParticipantsChildren 6 to 16 years of age who started treatment between 1998 and 2006.InterventionBehavioral treatment of obesity.Main Outcome MeasureChange in BMI-SD score during 3 years of treatment; a reduction in BMI-SD score of 0.5 units or more was defined as clinically significant.ResultsA total of 643 children (49% female children) met the inclusion criteria. Among the youngest moderately obese children, 44% had a clinically significant reduction in BMI-SD score (mean reduction, −0.4 [95% CI, −0.55 to −0.32]). Treatment was less effective for the older moderately obese children. Twenty percent of children who were 10 to 13 years of age and 8% of children who were 14 to 16 years of age had a reduction in BMI-SD score of 0.5 units or more; 58% of the severely obese young children showed a clinically significant reduction in BMI-SD score (mean reduction, −0.7 [95% CI, −0.80 to −0.54]). The severely obese adolescents showed no change in mean BMI-SD score after 3 years, and 2% experienced clinically significant weight loss. Age was found to be a predictor of a reduction in BMI-SD score (odds ratio, 0.68 units per year [95% CI, 0.60-0.77 units per year]).ConclusionsBehavioral treatment was successful for severely obese children but had almost no effect on severely obese adolescents.
, Nicholas A. Christakis,
Archives of Pediatrics & Adolescent Medicine, Volume 166, pp 1132-1139; https://doi.org/10.1001/archpediatrics.2012.1372

Abstract:
ObjectiveTo evaluate the relationship between the parenting style of an adolescent's peers' parents and an adolescent's substance use.DesignLongitudinal survey.SettingAdolescents across the United States were interviewed at school and at home.ParticipantsNationally representative sample of adolescents in the United States.Main ExposureAuthoritative vs neglectful parenting style of adolescent's parents and adolescent's friends' parents and adolescent substance use.Main Outcome MeasuresAdolescent alcohol abuse, smoking, marijuana use, and binge drinking.ResultsIf an adolescent had a friend whose mother was authoritative, that adolescent was 40% (95% CI, 12%-58%) less likely to drink to the point of drunkenness, 38% (95% CI, 5%-59%) less likely to binge drink, 39% (95% CI, 12%-58%) less likely to smoke cigarettes, and 43% (95% CI, 1%-67%) less likely to use marijuana than an adolescent whose friend's mother was neglectful, controlling for the parenting style of the adolescent's own mother, school-level fixed effects, and demographics. These results were only partially mediated by peer substance use.ConclusionsSocial network influences may extend beyond the homogeneous dimensions of own peer or own parent to include extradyadic influences of the wider network. The value of parenting interventions should be reassessed to take into account these spillover effects in the greater network.
Comment
Ron Keren
Archives of Pediatrics & Adolescent Medicine, Volume 166, pp 1181-1182; https://doi.org/10.1001/2013.jamapediatrics.175

Abstract:
There are few issues in pediatrics that have generated as much controversy as the importance of identifying and treating vesicoureteral reflux (VUR) in children who have been diagnosed with a urinary tract infection (UTI). Until recently, it was thought that bacterial seeding of the urine in the setting of VUR put children at risk of acute pyelonephritis (APN) and renal damage and that this renal damage could lead to renal insufficiency and/or hypertension later in life. Thus, prevention strategies were developed to screen children who have had a UTI for VUR and to prevent recurrent UTIs through antibiotic prophylaxis and/or surgical correction of VUR.1
, , Mika Venhola, Tytti Pokka, , Matti Uhari
Archives of Pediatrics & Adolescent Medicine, Volume 166, pp 1117-1122; https://doi.org/10.1001/archpediatrics.2012.1383

Abstract:
ObjectiveTo evaluate the long-term outcome of children with urinary tract infection (UTI).DesignFollow-up examination 6 to 17 years after childhood UTI.SettingSecondary to tertiary referral center.PatientsFrom an original population-based cohort of 1185 children with a history of UTI on whom both ultrasonography (US) and voiding cystourethrography had been performed between January 1, 1993, and December 31, 2003, we excluded 24 cases with major renal dysplasia or obstruction of the urinary tract to form a study cohort of 1161 patients. We took a stratified random sample of 228 patients for follow-up, and a total of 193 (85%) participated. Of the 193 participating patients, 103 (53%) had received antibiotic prophylaxis and 42 (22%) had undergone surgery.Main ExposureUrinary tract infection.Main Outcome MeasuresRenal growth and parenchymal damage in US examination, kidney function, and blood pressure.ResultsUnilateral renal parenchymal defect was found in 22 of the 150 patients (15%) studied with US at follow-up, and unilateral kidney growth retardation was found in 5 patients (3%). All but 1 of the renal parenchymal defects seen on US were in patients with grade III to V vesicoureteral reflux. Despite the parenchymal defects seen on US, the serum cystatin C concentration, estimated glomerular filtration rate, and blood pressure were within the normal ranges in all patients.ConclusionsThe risk of long-term consequences from childhood UTI seems to be very low. Owing to the observational nature of our study, we cannot exclude the effects of the given treatment on the outcome of our patients.
Comment
Jennifer A. Woo Baidal, Elsie M. Taveras
Archives of Pediatrics & Adolescent Medicine, Volume 166, pp 1179-1181; https://doi.org/10.1001/2013.jamapediatrics.358

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