Does a short symptom checklist accurately diagnose ADHD?

Several abbreviated checklists perform well in distinguishing children with attention deficit/ hyperactivity disorder (ADHD) from those without ADHD under ideal conditions and in research settings. While many guidelines and experts recommend using these checklists as an efficient method to collect data from multiple sources (strength of recommendation: B, based on extrapolation from cohort studies to define test characteristics and consensus opinion), experts point out the subjective nature of responses on behavior rating scales, and the limitations in using checklists as the sole source of information

Parenting of children under two: severe physical punishment and psychological aggression

Severe physical discipline and psychological aggression towards children have well documented consequences and are along spectrum of parenting that can be part of, or lead to, child maltreatment. Some research has focused on the particular vulnerabilities of young children and suggests an even more pressing need to understand and prevent such victimization. To date, there have been few studies with sufficient samples to report on severe physical discipline and psychological aggression towards children under two. This study uses data from the largest reported population-based study of child victimization of children under two. Mothers were surveyed regarding parenting behaviors of themselves and their partners over the previous year using the Parent-Child Conflicts Tactics Scale as a core instrument with project developed items to learn more about shaking as a behavior. Nearly 3000 mothers (n=2946) completed this anonymous telephone survey. Nearly two percent (1.8%) of mothers reported using one or more types of severe physical discipline in the last year. One percent self-reported shaking by themselves or their partner. Of these, 90% reported shaking occurred in the context of anger, frustration, potential harm, or aversive stimulus (i.e., crying). Nearly four times as many mothers reported observing someone else (not self or partner) shake a child under two in the last year. Yelling was endorsed by 39% of mothers, with 11% reporting frequent yelling ([greater than or equal to] 12 times in the last year). One or more types of severe psychological aggression were reported by 7% of mothers. Increasing child age, use of alcohol or tobacco during pregnancy, and spanking are salient risk factors for reported use of psychological aggression. Psychological aggression was endorsed by nearly two-fifths of mothers of children under two with yelling being a prevalent strategy. Given current understanding of the consequences of psychological aggression, more attention should be paid to this and other forms of psychological aggression. Parent educators and primary care clinicians should discourage this type of negative, coercive, and potentially destructive type of discipline

Does group prenatal care improve pregnancy outcomes?

It may decrease preterm births, especially among higher-risk women--minority women, women of low socioeconomic status, and adolescents (strength of recommendation [SOR]: B, 1 randomized, controlled trial [RCT] and 1 matched cohort study)

Do intercontraction intervals predict when a woman at term should seek evaluation of labor?

A reduction in the intercontraction interval is associated with active labor (strength of recommendation [SOR]: B, cohort study). Most primigravidas who have had regular contractions for 2 hours and multigravidas who have had regular contractions for 1 hour haven't transitioned into the active phase of labor (SOR: B, cohort study)

What are the benfits and risks of IUDs in adolescents?

Little available evidence specifically addresses the benefits and risks of intrauterine devices (IUDs) in adolescents. Most studies have evaluated IUD use in nulliparous adults. Levonorgestrel IUDs cause less menstrual bleeding than oral contraceptive pills (OCPs) in adult nulliparous women without differences in complications or pregnancy rates (strength of recommendation [SOR]: B, one RCT). Levonorgestrel IUDs appear to have similar expulsion and continuation rates in adolescents and adults (SOR: B, one prospective study). Adult nulliparous women who discontinue IUDs have subsequent birth rates similar to women who stop using OCPs or barrier methods. (SOR: B, limited quality evidence)

Glucose control: How low should you go with the critically ill?

For hyperglycemic patients admitted to an intensive care unit (ICU), the target blood glucose level should be [less than or equal to] 180 mg/dL, not 81 to 108 mg/dL. More aggressive glucose lowering is associated with a higher mortality rate. Strength of recommendation: B: Based on a single, high-quality randomized clinical trial

Which women should we screen for gestational diabetes mellitus?

It's unclear which women we should screen. No randomized controlled trials (RCTs) demonstrate that either universal screening or risk factor screening for gestational diabetes mellitus (GDM) prevents maternal and fetal adverse outcomes. That said, the common practice of universal screening is more sensitive than screening based on risk factors (strength of recommendation [SOR]: B, 1 randomized trial and 3 retrospective cohort studies without patient-oriented outcomes). Historic risk factors are poor predictors of GDM in a current pregnancy (SOR: C, 1 retrospective cohort study without patient-oriented outcomes)

Intracranial Pressure Monitoring in Infants and Young Children With Traumatic Brain Injury

OBJECTIVE: To examine the use of intracranial pressure monitors and treatment for elevated intracranial pressure in children 24 months old or younger with traumatic brain injury in North Carolina between April 2009 and March 2012 and compare this with a similar cohort recruited 2000-2001. DESIGN: Prospective, observational cohort study. SETTING: Twelve PICUs in North Carolina. PATIENTS: All children 24 months old or younger with traumatic brain injury, admitted to an included PICU. INTERVENTIONS: None. MEASUREMENT AND MAIN RESULTS: The use of intracranial pressure monitors and treatments for elevated intracranial pressure were evaluated in 238 children with traumatic brain injury. Intracranial pressure monitoring (risk ratio, 3.7; 95% CI, 1.5-9.3) and intracranial pressure therapies were more common in children with Glasgow Coma Scale less than or equal to 8 compared with Glasgow Coma Scale greater than 8. However, only 17% of children with Glasgow Coma Scale less than or equal to 8 received a monitoring device. Treatments for elevated intracranial pressure were more common in children with monitors; yet, some children without monitors received therapies traditionally used to lower intracranial pressure. Unadjusted predictors of monitoring were Glasgow Coma Scale less than or equal to 8, receipt of cardiopulmonary resuscitation, nonwhite race. Logistic regression showed no strong predictors of intracranial pressure monitor use. Compared with the 2000 cohort, children in the 2010 cohort with Glasgow Coma Scale less than or equal to 8 were less likely to receive monitoring (risk ratio, 0.5; 95% CI, 0.3-1.0), although the estimate was not precise, or intracranial pressure management therapies. CONCLUSION: Children in the 2010 cohort with a Glasgow Coma Scale less than or equal to 8 were less likely to receive an intracranial pressure monitor or hyperosmolar therapy than children in the 2000 cohort; however, about 10% of children without monitors received therapies to decrease intracranial pressure. This suggests treatment heterogeneity in children 24 months old or younger with traumatic brain injury and a need for better evidence to support treatment recommendations for this group of children

The Emergence of Spanking Among a Representative Sample of Children Under 2 Years of Age in North Carolina

Spanking is common in the United States but less common in many European countries in which it has been outlawed. Being spanked has been associated with child abuse victimization, poor self-esteem, impaired parent–child relationships, and child and adult mental health, substance abuse, and behavioral consequences. Being spanked as a child has also been shown to increase the likelihood of abusing one's own children or spouse as an adult. Spanking of very young children less than two is almost never recommended even among experts that consider spanking as reasonable in some circumstances. Using a cross-sectional anonymous telephone survey, we describe spanking rates among a representative sample of North Carolina mothers of children less than 2 years old and the association of spanking with demographic characteristics. A substantial proportion of mothers admit to spanking their very young children. The rate of spanking in the last year among all maternal respondents was 30%. Over 5% of the mothers of 3-month olds reported spanking. Over 70% of the mothers of 23-month olds reported spanking. Increased spanking was associated with higher age of the child and lower maternal age. With every month of age, a child had 27% increased odds of being spanked. Early spanking has been shown to be associated with poor cognitive development in early childhood. Further, early trauma has been shown to have significant effects on the early developing brain. It is therefore critical that health and human services professionals address the risk of corporal punishment as a method of discipline early in the life of the child. The spanking of very young children may be an appropriate locus for policy and legislative debates regarding corporal punishment

Internalizing Problems: A Potential Pathway From Childhood Maltreatment to Adolescent Smoking

This study examines the association between child maltreatment and adolescent smoking and the extent to which internalizing behavior problems mediate this hypothesized link