Routine measurement of head circumference as a tool for detecting intracranial expansion in infants: what is the gain? A nationwide survey.

Zahl SM, Wester K. Pediatrics.2008; 121 (3).
OBJECTIVE. The aim of the present study was to investigate the importance of routine head circumference measurements in the detection of intracranial expansive conditions, because only fragmented evidence exists in favor of this routine.
METHODS. The study was a nationwide study based on the medical records of all Norwegian departments of pediatrics and neurosurgery. The study included all Norwegian children <5 years of age who were hospitalized because of intracranial expansion during a 4-year period (1999–2002). Information about diagnostic codes, symptoms, and ages at symptom onset and at admission was collected from the medical records.
RESULTS. The study included 298 patients. For 173 (58%), hydrocephalus was the primary diagnosis; 57 (19%) had intracranial tumors and 68 (23%) had other primary diagnoses. For 46% of the children, increased head circumference was the first and main symptom leading to diagnosis. Increased head circumference was much more common as the symptom that led to diagnosis for patients with hydrocephalus (72%), compared with patients with cysts (31%) or tumors (5%). Increasing head circumference seems important mainly in detecting hydrocephalus and cysts, especially during the first 10 months of life.
CONCLUSIONS. Routine measurements of head circumference during the first year of life mainly detect infants with hydrocephalus or cysts; other expansive conditions yield other symptoms. Most children with increased head circumference as a symptom of intracranial expansion are identified during the first 10 months of life.

LETTERS TO THE EDITOR
What We Gain by Measuring Head Circumference
Robin K. Wilson and Michael A. Williams
Pediatrics 2008; 122: 219-220.

What We Gain by Measuring Head Circumference: In Reply
Sverre Morten Zahl and Knut Wester
Pediatrics 2008; 122: 220-221.

Pediatricians and the US Preventive Services Task Force: A Natural Partnership to Enhance the Health of Children

Virginia A. Moyer and David Nelson
Pediatrics 2008; 122: 174-176.
Comentario para informar a los lectores acerca de USPSTF: qué es, quien está involucrado, cómo funciona y qué pueden esperar los lectores de estas publicaciones.
Resulta interesante conocer la metodología de trabajo de uno de los grupos que más está marcando en la actualidad el rumbo de las actividades preventivas en la infancia.

A Critique of Criteria for Evaluating Vaccines for Inclusion in Mandatory School Immunization Programs

Douglas J. Opel, MDa,b, Douglas S. Diekema, MD, MPHa,b and Edgar K. Marcuse, MD, MPHb,c

Pediatrics. 2008 Aug;122(2):e504-10

Several new vaccines for children and young adults have been introduced recently and now appear on the Advisory Committee on Immunization Practices’ recommended childhood and adolescent immunization schedule (meningococcal, rotavirus, human papillomavirus). As new vaccines are introduced, states face complex decisions regarding which vaccines to fund and which vaccines to require for school or child care entry. This complexity is evidenced by the current debate surrounding the human papillomavirus vaccine. We present a critique to the approach and criteria for evaluating vaccines for inclusion in mandatory school immunization programs that have been adopted by the Washington State Board of Health by illustrating how these criteria might be applied to the human papillomavirus vaccine. We conclude that these 9 criteria can help ensure a deliberate and informed approach to important public policy decisions, but we argue that several clarifications of the review process are needed along with the addition of a 10th criterion that ensures that a new vaccine mandate relates in some manner to increasing safety in the school environment.

Body mass index in adolescence in relation to cause-specific mortality: a follow-up of 230,000 Norwegian adolescents

Bjorge T, et al. Body mass index in adolescence in relation to cause-specific mortality: a follow-up of 230,000 Norwegian adolescents. Am J Epidemiol. 2008 Jul 1;168(1):30-7

Abstract

The prevalence of obesity in childhood and adolescence has increased worldwide. Long-term effects of adolescent obesity on cause-specific mortality are not well specified. The authors studied 227,000 adolescents (aged 14-19 years) measured (height and weight) in Norwegian health surveys in 1963-1975. During follow-up (8 million person-years), 9,650 deaths were observed. Cox proportional hazards regression was used to compare cause-specific mortality among individuals whose baseline body mass index (BMI) was below the 25th percentile, between the 75th and 84th percentiles, and above the 85th percentile in a US reference population with that of individuals whose BMI was between the 25th and 75th percentiles. Risk of death from endocrine, nutritional, and metabolic diseases and from circulatory system diseases was increased in the two highest BMI categories for both sexes. Relative risks of ischemic heart disease death were 2.9 (95% confidence interval (CI): 2.3, 3.6) for males and 3.7 (95% CI: 2.3, 5.7) for females in the highest BMI category compared with the reference. There was also an increased risk of death from colon cancer (males: 2.1, 95% CI: 1.1, 4.1; females: 2.0, 95% CI: 1.2, 3.5), respiratory system diseases (males: 2.7, 95% CI: 1.4, 5.2; females: 2.5, 95% CI: 1.4, 4.8), and sudden death (males: 2.2, 95% CI: 1.2, 4.3; females: 2.7, 95% CI: 1.1, 6.6). Adolescent obesity was related to increased mortality in middle age from several important causes.
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Pues eso, que los gorditos adolescentes mueren más en los años medios de la vida adulta... si son noruegos ;-)