Vitamin K Prophylaxis: Is There a Need for Policy Change?

Indian Journal of Pediatrics -     

Policy statement—Prevention of varicella: update of recommendations for use of quadrivalent and monovalent varicella vaccines in children

Two varicella-containing vaccines are licensed for use in the United States: monovalent varicella vaccine (Varivax [Merck & Co, Inc, West Point, PA]) and quadrivalent measles-mumps-rubella-varicella vaccine (MMRV) (ProQuad [Merck & Co, Inc]). It is estimated from postlicensure data that after vaccination at 12 through 23 months of age, 7 to 9 febrile seizures occur per 10,000 children who receive the MMRV, and 3 to 4 febrile seizures occur per 10,000 children who receive the measles-mumps-rubella (MMR) and varicella vaccines administered concurrently but at separate sites. Thus, 1 additional febrile seizure is expected to occur per approximately 2300 to 2600 children 12 to 23 months old vaccinated with the MMRV, when compared with separate MMR and varicella vaccine administration. The period of risk for febrile seizures is from 5 through 12 days after receipt of the vaccine(s). No increased risk of febrile seizures is seen among patients 4 to 6 years of age receiving MMRV. Febrile seizures do not predispose to epilepsy or neurodevelopmental delays later in life and are not associated with long-term health impairment. The American Academy of Pediatrics recommends that either MMR and varicella vaccines separately or the MMRV be used for the first dose of measles, mumps, rubella, and varicella vaccines administered at 12 through 47 months of age. For the first dose of measles, mumps, rubella, and varicella vaccines administered at ages 48 months and older, and for dose 2 at any age (15 months to 12 years), use of MMRV generally is preferred over separate injections of MMR and varicella vaccines.     

Child Personality–Adjustment Associations at the Transition from Kindergarten to School: Evaluating the Vulnerability and the Scar Model

The study investigated longitudinal relations between teacher-perceived children’s personality traits and teacher aide-assessed children’s adjustment. Questionnaire data on 5-year-old kindergarteners’ (N?=?240; 47 % boys) Extraversion, Neuroticism, Disagreeableness, Conscientiousness, Social Competence, Internalizing Problems, and Externalizing Problems were collected. One year later, the children’s schoolteachers and their aides completed identical assessments. Using a cross-lagged design, the results showed that the trait- and adjustment measures from age 5 to age 6 were moderately and modestly stable, respectively. Simultaneous testing of the vulnerability and the scar model provided support to the vulnerability model for Social Competence. The children’s Extraversion, Conscientiousness, and low Neuroticism predicted subsequent Social Competence, but not vice versa. Consistent with the vulnerability model, low Extraversion and low Conscientiousness also predicted later Internalizing Problems. Further results for problem behavior suggested bidirectional associations of Neuroticism and Disagreeableness with Internalizing and Externalizing Problems, respectively, supporting both the scar and the vulnerability model.     

Chlamydia Positivity in New Orleans Public High Schools, 1996–2005: Implications for Clinical and Public Health Practices

ObjectiveTo describe the trends in chlamydia positivity among New Orleans high school students tested in a schoolwide screening between 1996 and 2005, and to determine factors associated with chlamydia positivity among students during the 10-year period.MethodsBetween school years 1995–1996 and 2004–2005, students in New Orleans public high schools were tested for chlamydia using nucleic acid amplification tests (NAAT) in urine specimens (LCx assay until 1999–2000; BD assay from 2000–2001 to 2004–2005). For each year, we calculated chlamydia positivity by dividing the number of students testing positive by the total number of students tested. Data were analyzed separately by gender. Logistic regressions were performed to determine independent predictors of chlamydia positivity during the 10-year period.ResultsBetween 1996 and 2005, the average chlamydia positivity was 7.0% (95% confidence interval 6.6–7.4) in boys and 13.1% (95% confidence interval 12.6–13.7) in girls (P < .001). Chlamydia detection increased with the switch from LCx to BD assay. In multivariate analyses, chlamydia positivity among boys and girls was significantly associated with age, black race, and gonorrhea coinfection. Additionally, positivity was significantly different by school year among boys (P = .03) and by NAAT used among girls (P = .008).ConclusionsThe trends in chlamydia positivity observed between 1996 and 2005 more likely reflected a high and stable prevalence of chlamydia in the New Orleans school-age adolescent population. Any benefit of screening on individuals tested was likely to be mitigated by participants' uninterrupted social interactions with the dynamic forces that sustain the sexual transmission of chlamydia in the population.     

Child Health in Child Care: A Multi-state Survey of Head Start and Non–Head Start Child Care Directors

IntroductionDirectors of Head Start (HS) and non–Head Start (non-HS) child care centers were surveyed to compare health consultation and screening for and prevalence of health risks among enrolled children.MethodsDirectors of licensed centers from five states were surveyed from 2004 to 2005. Data were analyzed using cross-tabulation and logistic regression techniques.ResultsA total of 2753 surveys were completed. HS centers were more likely than non-HS centers to consult health professionals (P < .0001). More than 90% of HS centers screened for health problems compared with 64.9% of non-HS centers (P < .0001). Almost all HS centers provided parents with child health information. Children at HS centers were at high risk for dental problems. Less than 3% of HS center directors, versus 11.3% of non-HS directors (P < .0002), reported TV viewing for more than an hour a day.DiscussionChildren in HS centers were more likely to receive health consultations and screenings, were at higher risk for dental problems, and watched less TV compared with children in non-HS centers. HS centers promoted health significantly more frequently than did non-HS centers.     

Assessing Effective Practices and Barriers to Creating School and Community Partnerships for a Sudden Cardiac Death Prevention Program: A National Project ADAM® study

ObjectivesProject ADAM (Automated Defibrillators in Adam's Memory) is a national collaborative to improve outcomes for out-of-hospital sudden cardiac arrest. Given Project ADAM's expansion, we sought to identify effective methods to partner with community leaders and understand barriers to engagement. Our aim was to establish effective practices to guide affiliates and optimize site operations and partnerships.MethodsWe conducted a survey of all Project ADAM sites in 2020. Medical Directors and Program Coordinators were included for generalizability. The survey consisted of 20 questions covering the domains of communication, goals for partner organizations, partnership barriers, staff time commitments, and Project ADAM program needs.ResultsThirty-one members responded: 14 Medical Directors and 17 Program Coordinators. E-mail was the predominant method to initiate (58%) and maintain (87%) contact with partner organizations, though telephone (21%) and in-person visits (14%) were common for initiating contact. Presentations at school board, Emergency Medical Services, and athletic director meetings and student/family testimonials were powerful engagement tools. Barriers to partnership varied, revolving around limited school budgets, overburdened staff, and Covid-19. Limited time, difficulty coordinating schedules, and lack of dedicated resources were common challenges for Project ADAM sites. Only 36% of Medical Directors receive institutional recognition of Project ADAM effort.ConclusionsProject ADAM's partnership with community stakeholders creates unique opportunities and challenges. Optimal communication methods should be identified early for each school, with regular interaction for long-term success. Institutional recognition of Project ADAM efforts may boost success. Additionally, the Covid-19 pandemic created numerous challenges and may spur operational changes.     

The Chain of Relationships Among Gratitude,Prosocial Behavior and Elementary School Students’ School Satisfaction: The Role of School Affect

Based on Fredrickson’s Broaden-and-Build Theory of Positive Emotion, we explored the role of school affect (i.e., positive affect in school and negative affect in school) in connecting gratitude, prosocial behavior, and school satisfaction among a sample of 324 (176 males) elementary school students in grades 4 to 6 by using structural equation modeling. The participants completed a packet of questionnaires, including the Gratitude Questionnaire (GQ-6), the Elementary School Students’ Subjective Well-Being in School Scale (ESSSWBSS), and the Primary School Upper Grade Students’ Prosocial Behaviors Questionnaire (PSUGSPBQ). The results showed that elementary school students’ (1) positive affect in school and negative affect in school significantly related to school satisfaction; (2) prosocial behavior fully mediated the relation between gratitude and school satisfaction; (3) gratitude related to school satisfaction indirectly through positive affect in school and negative affect in school. As hypothesized, the effect was stronger for positive affect in school. Limitations and practical applications of the study were discussed.     

Social–Emotional Screening Protocol Implementation: A Trauma-Informed Response for Young Children in Child Welfare

Adverse childhood experiences in young children result in negative outcomes as trauma affects brain development. In child welfare services, early recognition of delayed social–emotional skills and treatment referral is essential in reducing the effects of trauma. This quality improvement pilot project implemented an evidence-based social–emotional screening protocol using the Ages and Stages Questionnaire: Social Emotional-2 screening tool for very young children placed in out-of-home care through the county's child welfare system. Findings showed significant improvement in identification of children younger than 3 years with social–emotional concerns (p < .0001) and significant improvement in referral of those children positively identified (p = .0130). Ongoing use of the protocol was recommended, because it showed improved identification and referral for young children in the child welfare system with social–emotional concerns that were potentially trauma related. Further collaboration between child protective services, pediatric medical systems, and pediatric mental health systems is needed to facilitate trauma-informed care for children in the child welfare system.     

School nurse knowledge and perceptions of recurrent abdominal pain: opportunity for therapeutic alliance?

Recurrent abdominal pain of childhood affects up to 15% of school-age children, who face significant psychosocial consequences, including school absence. Because assessment of recurrent abdominal pain is frequently made at the school nurse level, a questionnaire was sent to 425 school nurses to evaluate perceptions about recurrent abdominal pain. Among the responses, 47.1% believed children were taking or seeking attention; 3.6% considered it a serious disease, 77.9% stated that affected children should see a physician, 51.5% believed they should relax, and 25.0% believed they needed medicine. Results indicated that school nurses were unclear on epidemiologic and etiologic features of recurrent abdominal pain and had negative views that may inadvertently contribute to the anxiety felt by affected children. Education of school nurses and communication from physicians may advance strategies designed to reduce the fiscal and social costs associated with this common childhood condition.     

Gun carrying and conduct disorder: a highly combustible combination? Implications for juvenile justice and mental and public health

OBJECTIVES: To examine concealed gun carrying between the ages of 12 and 17 years in a population of clinic-referred boys, many of whom qualified for a disruptive behavior disorder, including conduct disorder (CD); to identify factors and diagnoses related to concealed gun carrying; and to examine the extent to which gun carrying is associated with crime in adulthood. DESIGN: Longitudinal follow-up study. SETTING: Pittsburgh, Pa, and Athens and Atlanta, Ga. PARTICIPANTS: One hundred seventy-seven clinic-referred boys, first assessed between the ages of 7 and 12 years and followed up yearly until the age of 19 years. MAIN OUTCOME MEASURES: Violence, property offenses, and drug charges in adulthood. RESULTS: Between the ages of 12 and 17 years, 1 in 5 participants carried a concealed gun, and the annual prevalence increased linearly with age. More than half (61.1%) carried a gun for 1 year only. Gun carrying was significantly (incident rate ratio, 3.93%; 95% confidence interval, 1.60-9.60) associated with CD. Conduct disorder, maternal psychopathy, victimization, and parental monitoring increased the risk of gun carrying by a factor of 8. Adult crime was best predicted by gun carrying, CD, and parental monitoring. Gun carrying predicted drug charges, but not violence or property offenses. CONCLUSIONS: Even though the carrying of handguns by juveniles is prohibited, young men with symptoms of CD are more likely to carry guns than young men without CD. The findings are discussed in terms of the need for the inclusion of gun carrying among the symptoms of CD.     

Causes of Child Deaths in India, 1985–2008: A Systematic Review of Literature

Objective  

To understand the causes of child deaths in order to implement appropriate child survival interventions in the country. We present a systematic review of studies reporting causes of child, infant, and neonatal deaths from India for 1985 to 2008.