Source: EFE Verde - La ex secretaria de cambio climático de la ONU que alcanzó el Acuerdo de París y actual directora del proyecto Misión 2020, Christiana Figueres, subraya que EE.UU. "se queda rezagado y pierde competitividad" abandonando el Acuerdo de París y cediendo a otros países el liderazgo de la economía baja en carbono.

While foreign language requirements have long been a core requirement for high school graduation--second language classes at an earlier age would improve overall fluency for most students.

Instead of fixating on the word gap and other false language-skills dilemmas, focus on what's really hurting students, writes Olivia Obeso.

There are five key values to consider when separating campaign rhetoric from how a candidate would actually govern, writes Robert Feirsen.

Little is known about the pharmacokinetics and required dosage of metronidazole in preterm neonates.

In this study the pharmacokinetics of metronidazole in preterm neonates was investigated by measurement of the drug in dried blood-spot samples. A dosage regimen is proposed that should result in more appropriate, less frequent dosing in the most preterm neonates. (Read the full article)

Over 500 000 children in the United States sustain a traumatic brain injury (TBI) each year. Headaches are commonly reported after TBI in adults, but little is known about the epidemiology of headache after pediatric TBI.

Headaches are more common 3 months after pediatric TBI than after arm injury. The frequency of headache after TBI is related to patient gender, age, and injury severity. Headaches after mild TBI were most common among girls and teenagers. (Read the full article)

Media reports suggest that adolescents are being charged with sex crimes and even placed on sex offender registries because of participating in the "sexting" of sexual images, but the nature and outcomes of such incidents have not been described empirically.

This is the first study to examine types of sexting cases handled by police. It informs clinicians by identifying characteristics of "aggravated" versus milder incidents and finding that most youth were not arrested. Sex offender registration was rare. (Read the full article)

Two UK models predict the risk of mortality in very preterm Western infants (1) alive at onset of labor and (2) admitted for neonatal intensive care. Prognostic models need temporal and geographic validation to evaluate their performance.

The 2 models showed very good performance in a recent large cohort of very preterm infants born in another Western country. The accurate performance of both models suggests application in clinical practice (Read the full article)

The prevalence of asthma and smoking among adolescents in Jordan is high. Well-designed, school-based, peer-led education programs can have a positive impact on asthma self-management in adolescents. Student peer leaders can be useful and responsible partners in health promotion programs.

A peer-led asthma education program —Adolescent Asthma Action—for adolescents developed in Australia was adapted to suit non–English-speaking cultures in the Middle East. Peer-led education led to improved self-management of asthma and motivated students to avoid smoking. (Read the full article)

Available clinical prediction rules to identify children with cerebrospinal fluid pleocytosis at low risk for Lyme meningitis include headache duration, cranial nerve palsy, and percent cerebrospinal fluid mononuclear cells. These rules require independent validation.

These clinical prediction rules accurately identify patients at low risk for Lyme meningitis in our large multicenter cohort. Children at low risk may be considered for outpatient management while awaiting Lyme serology. (Read the full article)

Smoking during pregnancy has been related to thicker carotid intima media thickness in young adults, and this was also shown in neonates.

This study is the first to show that the effect of smoking during pregnancy on the vasculature of children is (still) visible at the age of 5 years. Pregnancy appears to be the critical period for this damage to occur. (Read the full article)

Newborn screening (NBS) programs may store bloodspot samples and use them for secondary purposes, such as research. Recent public controversies and lawsuits over storage and secondary uses underscore the need to engage the public on these issues.

This public engagement study identifies values underlying citizens’ acceptance of and discomfort with research from NBS samples. Well-designed methods of public education and civic discourse on the risks and benefits of storage and secondary uses of NBS samples are required. (Read the full article)

Candidate genes involved in thrombophilia, inflammation, and preterm birth have previously been associated with cerebral palsy. Most studies to date have included small cohorts, did not allow for multiple testing, and require replication.

This study of children with cerebral palsy and their mothers did not confirm previously reported candidate gene associations. Prothrombin gene mutation was associated with hemiplegia in children born at term to mothers with a reported infection during pregnancy. (Read the full article)

Limited data exist about the frequency and incidence of serious injuries due to physical abuse of children. Data from Child Protective Services, which are published yearly, do not have information about severity.

This is the first study to provide US estimates on the occurrence of serious injuries due to physical abuse. The incidence was highest in infants on Medicaid. Such data can be used to track changes due to prevention. (Read the full article)

Survival takes precedence for adolescent patients with cancer and their families. Patients may not discuss their treatments’ potential to damage their reproductive capacity, which has significant psychological late effects in survivorship.

Strong reproductive concerns of adolescents with cancer may not be captured on current health-related quality of life instruments and may be neglected by parents’ unawareness. Parent-proxy reports of adolescent reproductive concerns are not suitable for capturing specific emotions and feelings. (Read the full article)

Cancer in a child may affect the quality of the parents’ relationship, but few studies have examined a potential effect on parental divorce, and no studies have accounted for the proportion of couples that live outside formal marriages.

In this nationwide registry-based study with up to 20 years of follow-up, we included both married and cohabiting couples, reflecting modern family structures. We found that experiencing cancer in a child is not a risk factor for the parents separating. (Read the full article)

Although all residents progressively assume responsibility for clinical skills under the teaching and supervision of attending physicians, senior residents also assume responsibility for teaching and supervising. This leads to a dynamic negotiation of responsibilities, particularly on clinical work rounds.

A better understanding of how attending physicians and senior residents negotiate shared responsibilities for teaching and supervising, and the context in which this negotiation occurs, may clarify assumptions and set expectations for resident training. (Read the full article)

We know that many evidence-based treatments for acute asthma are underused, and adherence with treatment guidelines is poor; however, studies have focused on β₂ agonists and corticosteroids, but little is known about intravenous magnesium, which has substantial evidence of benefit.

Magnesium is used infrequently in Canadian pediatric emergency departments in hospitalized children with acute asthma, with variation across sites. More than half of this population does not receive frequent bronchodilators and timely corticosteroids. (Read the full article)

Previous research has identified low rates of employment and postsecondary education for youth with autism, but generalizability has been limited by small samples.

Using national data, the authors of this study found that youth with autism are at high risk for no postsecondary education or employment, especially in the first 2 years after high school. Findings highlight the need for improved transition planning. (Read the full article)

The rapidly rising prevalence of overweight and obesity among children and adolescents over the past 4 decades is a significant public health concern. Experts urge pediatric health care providers to provide routine obesity screening and counseling.

We provide the first nationally representative estimates of the rate of screening and counseling for adolescent obesity by pediatric health professionals. We also examine how socioeconomic factors and access to health care affect whether adolescents receive these services. (Read the full article)

Known rates of nonsuicidal self-injury, hurting oneself without the intent to die, are between ~7% and 24% in samples of early adolescents and older adolescents, yet research has not reported rates for youth younger than 11 years old.

Children as young as 7 years old report engaging in nonsuicidal self-injury. There is a grade by gender interaction for nonsuicidal self-injury, such that ninth-grade girls report the greatest rates of engagement and do so by cutting themselves. (Read the full article)

Emphasis on preventing central line-associated bloodstream infections (CLABSIs) in US health care facilities and prophylactic antifungal medication use in neonates may impact incidence of Candida spp. CLABSIs. However, data on trends in incidence of neonatal Candida spp. CLABSIs are lacking.

Data from a large sample of US NICUs was analyzed to assess trends in incidence over time. This analysis provides a description of the epidemiology of Candida spp. CLABSIs in a national health care-associated infections surveillance system. (Read the full article)

Neonatal hyperbilirubinemia may progress to bilirubin encephalopathy. Findings from previous studies on long-term development of neonatal hyperbilirubinemia are conflicting.

Using Ages and Stages Questionnaire, we observed no association between bilirubin exposure and overall development in 1- to 5-year-old children who in the neonatal period had total serum bilirubin level ≥25 mg/dL and no or only minor neurologic symptoms. (Read the full article)

Adolescent dating violence has been studied from the perpetrators' and survivors' perspectives. The risk and protective factors have been explored, and the strength of the association of these factors with adolescent dating violence has been adequately described.

This study assessed the perceptions and practices of school counselors on adolescent dating violence. Knowing school personnel’s practices and perceptions may help researchers and practitioners gain insights into possible ways to alleviate the problem of dating violence in adolescents. (Read the full article)

Children’s mastery of fundamental movement skills is correlated with a number of health benefits, including higher levels of physical activity, cardiorespiratory fitness, perceived scholastic and athletic competence, and lower levels of overweight.

This is the first study to examine the associations between low skill competence (a new and novel way to report motor skills) and a range of health-related and sociodemographic factors in a large representative sample of children and youth. (Read the full article)

Ideal empirical antibiotic choices are based on local susceptibility data. These choices are important for ensuring positive patient outcomes, but pediatric-specific data may not be available.

Antibiotic susceptibilities differ by age group within a tertiary-care hospital. Knowing these differences, pediatricians chose empirical antibiotic therapy more likely to be successful. Children with infectious diseases would benefit from reporting of pediatric-specific susceptibility results. (Read the full article)

Childhood obesity occurs in 20% of children before they enter kindergarten. Treatment is difficult, making prevention desirable, but little is known about effective methods using anticipatory guidance to prevent obesity in pediatric primary care.

This study provides a comparison of 2 approaches versus usual care using anticipatory guidance to improve infant feeding during the first year of life, and demonstrates positive specific feeding behavior differences at 1 year in the intervention groups. (Read the full article)

Severe neonatal hyperbilirubinemia can lead to acute bilirubin encephalopathy and, subsequently, chronic bilirubin encephalopathy (CBE). This condition is preventable through routine identification and proper treatment; therefore, it is rare for permanent neurologic complications to occur.

This article describes the incidence of CBE in Canada, which is higher than previously reported in the literature. Furthermore, it describes the underlying causes of CBE and the spectrum of neurologic disease. (Read the full article)

Mortality of very low birth weight infants varies widely between regions and countries; however, the variation in morbidities after adjusting for confounders has not been adequately studied.

Composite outcome of mortality or short-term morbidity for very low birth weight infants was lower in Japan than in Canada. However, marked variations in mortality and individual morbidity exist, revealing areas for improvement in each country. (Read the full article)

Recent investigations of pubertal onset in US girls suggest earlier maturation. The situation for US boys is unknown, and existing investigations are outdated and lack information on a key physical marker of male puberty: testicular enlargement.

US boys appear to be developing secondary sexual characteristics and achieving testicular enlargement 6 months to 2 years earlier than commonly used norms, with African American boys entering Tanner stages 2 to 4 earlier than white or Hispanic boys. (Read the full article)

Social and environmental risks related to substandard housing contribute to adverse health outcomes. Partnerships between the health care and legal systems can help families address such risks and help clinicians understand the legal context of health.

A medical-legal partnership colocated in a pediatric primary care setting identified and treated a large cluster of poor quality, substandard housing. Housing improvements were possible because of strong collaboration between clinicians, attorneys, community partners, and families. (Read the full article)

Autism spectrum disorders are characterized by heterogeneous severity. Previous latent variable analyses of longitudinal data have focused on trajectories of related features such as IQ, and not on changes over time in standardized, observational measures of core autism symptoms.

Autism Diagnostic Observation Schedule–calibrated severity scores allow comparisons of observational data from toddlerhood to adolescence. This first report of latent autism severity trajectory classes indicates that most children show stability in core symptom severity over many years; small groups improved or worsened. (Read the full article)

Nationally representative surveys provide insight into overall childhood obesity trends and disparities but do not identify patterns specific to individual states. School-based surveillance is recommended, but it is unclear whether surveillance is helping to identify children at greatest risk.

This study includes 3 consecutive years of surveillance findings to describe within-state spatial and socioeconomic disparities in obesity among elementary-aged children. Implications for states using and considering school-based surveillance to plan preventive interventions are considered. (Read the full article)

Knowledge is limited regarding the epidemiology of persistent pulmonary hypertension of the newborn (PPHN). Previous work has implicated a host of perinatal risk factors and a few antenatal antecedents of PPHN, including maternal consumption during pregnancy of nonsteroidal antiinflammatory medications.

In contrast to results of previous studies, we found no association between PPHN and maternal consumption during late pregnancy of nonsteroidal antiinflammatory drugs in general or ibuprofen in particular. (Read the full article)

National asthma treatment guidelines include the recommendation that all asthma patients receive a written asthma action plan. No previous study has sought to examine the readability, suitability, and content of asthma action plans within a nationally representative sample.

Although variability was found across written asthma action plans, and improvements in readability, suitability, and content are needed, there were also many common elements that would support a move to a single universal standard action plan. (Read the full article)

Although a number of cross-sectional studies have documented associations between teen dating violence victimization and adverse health outcomes, including sexual risk behaviors, suicidality, substance use, and depression, longitudinal work examining the relationship between victimization and outcomes is limited.

This study is the first to demonstrate the longitudinal associations between teen dating violence victimization and multiple young adult health outcomes in a nationally representative sample. Findings emphasize the need for screening and intervention for both male and female victims. (Read the full article)

Childhood headache is a common medical condition and can negatively impact a child’s social and academic life in several ways. Early and accurate diagnoses of headache syndromes, including migraine, are essential to appropriate treatment and outcome for affected youth.

The Diagnostic Interview of Headache Syndromes–Child Version is a new tool for the assessment of pediatric migraine that can enhance the standardization of collection of diagnostic criteria in both clinical and community settings, leading to better recognition and treatment of this condition. (Read the full article)

In inverse proportion to the steadily declining under-5 mortality rate, prevalence of childhood disability has doubled in the past decade in Bangladesh. The Rapid Neurodevelopmental Assessment (RNDA) tool has been shown to be reliable and valid for assessment of a range of neurodevelopmental impairments (NDIs) and disabilities in children younger than 2 years. There is currently a lack of professional expertise for assessing NDIs in 2- to 5-year-old children in low- and middle-income countries.

We developed a set of instruments as part of the RNDA for administration by a single professional with experience in child development to assess >2- to 5-year-old children for a wide range of NDIs. The tool was acceptable to mothers, interrater reliability was high, and proportions of children with NDIs were elevated among the lowest income groups and in stunted children, demonstrating discriminant validity. The RNDA was valid for identifying >2- to 5-year-old children with a range of NDIs, especially in cognitive, behavior, and motor functions. Validity of the RNDA for vision, hearing, and seizure disorders needs further research. (Read the full article)

Many US children aged 6 to 24 months who would be classified as low weight-for-age by the Centers for Disease Control and Prevention 2000 reference will be classified as normal weight-for-age by the World Health Organization 2006 standard.

Children who will be reclassified from low to normal weight-for-age using the World Health Organization growth standard are at higher risk of adverse health outcomes than children who are not low weight-for-age by the Centers for Disease Control and Prevention reference. (Read the full article)

Sleep patterns of adult monozygotic twins are more similar than those of dizygotic twins, showing moderate heritability and little effects of environmental influences. There have been very few genetically informative studies of sleep in preschool children and results appear inconsistent.

From previous studies, we investigated daytime and nighttime continuous sleep duration longitudinally. This is the first time that the etiologies of daytime and nighttime continuous sleep duration trajectories were studied in early childhood. (Read the full article)

Infants aged <2 months are at highest risk for pertussis morbidity and mortality but are too young to receive pertussis vaccines. To protect young infants, the Advisory Committee on Immunization Practices recommends mothers receive 1 dose of Tdap during pregnancy.

This article evaluates the effect of Tdap during pregnancy compared with postpartum Tdap and cocooning in preventing infant pertussis cases, hospitalizations, and deaths, as well as their relative cost-effectiveness. (Read the full article)

Obesity is a growing concern for Mexican-American adolescents, with both behavioral and cultural variables that are related to the increasing trend.

These results highlight a patient-centered view of the emotional and physical burden of obesity in female Mexican-American adolescents, the families’ personal struggles with weight-related conditions, and the challenge of balancing family needs with those specific to the adolescent. (Read the full article)

Introduction of the pneumococcal conjugate vaccine was associated with decreased invasive pneumococcal disease (IPD) in children. Few data exist on the impact in infants aged 1 to 90 days, who are too young to be fully immunized.

The incidence and proportion of IPD in Utah infants aged 1–90 days remained stable after vaccine introduction. IPD caused by PCV7 serotypes decreased significantly in the post-vaccine period. Serotype 7F emerged as the predominant serotype and commonly resulted in meningitis. (Read the full article)

Preterm infants in the NICU receive the greatest number of transfusions of any patient population. The administration of the long-acting erythropoiesis stimulating agent (ESA) darbepoetin to reduce or eliminate transfusions in preterm infants has not been evaluated.

Infants receiving ESAs received half the number of transfusions and were exposed to approximately half the donors compared with the placebo group. More than half of the ESA recipients (59% darbepoetin recipients, 52% erythropoietin recipients) remained untransfused during their hospitalization. (Read the full article)

Several studies have investigated the prevalence of chronic daily headache (CDH) and analyzed the risk factors for its persistence. However, the etiologic factors that lead to new-onset CDH remain unsettled in adolescents.

This study was the first incidence study of CDH conducted in young adolescents. We reported the incidence rates and found that some risk factors for incident chronic migraine and chronic tension-type headache were different. (Read the full article)

Although unnecessary for children with headache and normal history, computed tomography (CT) scans are widely used. Fewer than 1% of pediatric brain abnormalities present with headache as the only symptom. Furthermore, repeated CT scans may increase lifetime risk of cancer.

CT scans continue to be used to diagnose isolated pediatric headaches despite existing practice parameters. Although emergency department visits were correlated with greater likelihood of CT scan use, these scans were widely used across a variety of clinical settings. (Read the full article)

The Faces Pain Scale–Revised and Color Analog Scale are self-report pain scales that are commonly used for children in the clinical and research settings.

The Faces Pain Scale–Revised and Color Analog Scale overall demonstrate strong psychometric properties in children 4 to 17 years of age, including within subgroups of age, sex, and ethnicity. Convergent validity, however, is questionable in children <7 years old. (Read the full article)

Rehabilitation of people with cerebral palsy aims to achieve and maintain optimal performance in mobility and daily activities. Although insight into the developmental trajectories of activities from childhood into adulthood is important, little is known about long-term development.

The gross motor function of children with cerebral palsy determines the developmental trajectories of mobility performance but not of daily activities, where intellectual disability was shown to be the determining factor. (Read the full article)

Although most US mothers initiate breastfeeding, half fail to achieve their breastfeeding intentions. In cross-sectional and retrospective surveys, early breastfeeding difficulties are often cited as reasons for stopping breastfeeding earlier than intended.

We characterized 4179 breastfeeding concerns/problems as reported by primiparas interviewed prospectively. Concerns were highly prevalent and associated with up to ninefold greater risk of stopping breastfeeding earlier than intended. Concerns at 3 to 7 days posed the greatest risk. (Read the full article)

Use of complementary and alternative medicine (CAM) is increasingly common among American youth; however, information on use of CAM among youth with recurrent headache (HA) is limited.

Youth across a range of chronic conditions experience HA. These youth are more likely to use CAM. Use and expenditures for conventional medical care, and increased difficulties in activity and functioning are greater for youth with HA who use CAM. (Read the full article)