Pediatrics
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Data were collected from parents bringing children to selected pediatric practices in Maryland using questionnaires and focus group discussions. Gun ownership ranged from 27% in the suburban practice to 53% in the rural practice. Unrealistic perceptions of children's capabilities and behavioral tendencies with regard to guns were common among gun owners. ⋯ Nearly all gun owners indicated a willingness to follow their pediatrician's advice about gun storage, but only 19% of the mothers and 10% of the fathers said they would follow advice to remove guns from the home. Among parents who did not have a gun in the home, 40% said they would consider obtaining one if they felt threatened; however, 73% of these parents indicated they would be dissuaded from doing so by a pediatrician's advice about the risks of keeping guns in the home. Results suggested that pediatricians will be most effective if they recommend passive strategies (eg, removing guns from the home or storing guns unloaded and locked) on the basis of children's developmental capabilities and behavioral tendencies and make their recommendations part of general counseling about child safety.
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Comparative Study
American Academy of Pediatrics. Preventive health care for young children: Findings from a 10-country study and directions for United States policy.
Infant health and survival in the US compare unfavorably with other Western industrial democracies. Circumstances that contribute to favorable pregnancy outcomes in other countries include nearly complete participation of pregnant women in early prenatal care and linkage of care to extensive support benefits. ⋯ This report looks at the condition of children in 10 European countries: Belgium, Denmark, France, the Federal Republic of Germany, Ireland, the Netherlands, Norway, Spain, Switzerland, and the United Kingdom. All of these countries have better infant survival rates than the US, and they all share elements of pluralism in their systems of health care.
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Standard recommendations for evaluating and treating jaundice in term babies include following all babies closely for jaundice, obtaining several laboratory tests in those with early jaundice or bilirubin levels more than 12 to 13 mg/dL (205 to 222 mumol/L), using phototherapy to try to keep bilirubin levels below 20 mg/dL (342 mumol/L), and doing exchange transfusions if phototherapy fails, regardless of the cause of the jaundice. These recommendations are likely to lead to unnecessary testing and treatment of many jaundiced term infants. Because most jaundiced infants have no underlying illness, and the generally recommended laboratory tests lack sensitivity and specificity, they are seldom useful. ⋯ Babies with hemolytic disease should be followed more closely, and their bilirubin levels kept below 300 to 400 mumol/L (17.5 to 23.4 mg/dL). These recommendations should be reevaluated as new data become available. In the meantime, currently available data justify an approach to the jaundiced term infant that is less aggressive than previously recommended.