Below are news releases and briefs on articles appearing in the August issue of Pediatrics, the peer-reviewed, scientific journal of the American Academy of Pediatrics (AAP). To receive the full text of these articles, contact the AAP Department of Communications.
 
Note: Please attribute the source as the journal, Pediatrics, when covering information from this mailing.
 
AAP REPORTS
 
1.  MINORS AS LIVING SOLID-ORGAN DONORS
 
Although rare, children do serve as living solid-organ donors, and these donations raise serious ethical issues. In the clinical report, “Minors as Living Solid-Organ Donors,” the American Academy of Pediatrics (AAP) examines the exceptional circumstances under which minors younger than 18 can morally serve as living organ donors. Four of these criteria are suggested by the U.S. Live Organ Donor Consensus group and have the agreement of the AAP. First, both the donor and recipient must be highly likely to benefit. The psychological benefit for the donor is most likely to be high if donations are restricted to an immediate family member. Minors should never be considered as potential donors for strangers, or in cases where the likelihood of success is low.Second, the surgical risk for the donor should be extremely low. This suggests children should be restricted to serving as living kidney donors, which has lower risks than other types of living solid-organ donation. Third, a child should be the donor of last resort, and should not undergo donor evaluation until all other options are exhausted, including the potential for a deceased donor. Fourth, the child should freely agree to donate without coercion and with full understanding of the process. Children who are too young to fully understand should not be allowed to donate. The AAP adds a fifth criterion that the emotional and psychological risks to child donors be minimized. This may be accomplished through medical role playing, allowing them to ask questions and including them in the decision-making process. A donor-advocacy team to work with the child should be required for all transplants that involve living minor donors. Finally, more research should be conducted into the long-term benefits and risks of donation for children.  
 
2. ELECTROCARDIOGRAMS AND ADHD MEDICATIONS
 
This month, Pediatrics prints the previously released policy statement, “Cardiovascular Monitoring and Stimulant Drugs for Attention-Deficit/Hyperactivity Disorder.” The statement was electronically released in May.
 
STUDIES
 
3. DIVING-RELATED INJURIES IN THE U.S.
 
Every year there is a seasonal increase in the number of diving-related injuries to children. A new study, “Diving-Related Injuries in Children < 20 Years Old Treated in Emergency Departments in the United States:  1990-2006,” examined the types of injuries, how they occurred and what can be done to prevent them. Each year more than 6,500 diving-related injuries are reported. Boys and girls 10 to 14 years are the most frequent victims. Injuries to the head, neck, and face were the most common. The most frequent diagnoses were cuts and bruises. The most common cause of injury is collision with a diving board or platform. The authors assert that prevention efforts to reduce injury should include:  education to prevent young divers from jumping or diving into the shallow end of the pool, supervision by lifeguards, and visible depth indicators around the pool. They also suggest that due to the high number of cases involving diving board interference, the improvement of diving board safety could be beneficial. 
 
4. ACGME WORK HOUR LIMITS FOR RESIDENT PHYSICIANS FAIL TO REDUCE ERRORS
 
In 2003, the Accreditation Council for Graduate Medical Education (ACGME) implemented work hour limits for resident physicians. By limiting residents to no more than 30 consecutive hours and 80 to 88 hours per week, the ACGME hoped to reduce fatigue-related medical errors and injuries. The study, “Effects of the Accreditation Council for Graduate Medical Education Duty Hour Limits on Sleep, Work Hours, and Safety,” found the policy was ineffective in three pediatric centers. A total of 220 residents completed daily logs in the study. Under the new standards, the mean length of extended shifts decreased slightly, and rates of burnout decreased significantly, from 75.4 percent to 57 percent. However, 24- to 30-hour shifts remained common. There was no change in residents’ total work or sleep hours. The overall rate of medication errors did not change; nor did rates of motor vehicle crashes, occupational exposure, self-reported medical errors, or overall ratings of work and education experiences.According to the study authors, the fact that implementation of the ACGME standards did not improve total work hours or error rates is of considerable concern, given that residents’ traditional long work hours have been shown to endanger both themselves and their patients.  They suggest that effective implementation of evidence-based work hour limits - including the elimination of residents’ traditional 24-hour shifts - should be a high priority in academic hospitals. This study was funded in part by the U.S. Department of Health and Human Services’ Agency for Healthcare Research and Quality, as part of an ongoing body of research in the area of resident work hours and the effects on health care quality and safety.
 
5. SCARY STATISTICS ABOUT WHO IS WATCHING VIOLENT MOVIES
 
A nationwide survey documents widespread exposure of young teens to movies with extreme graphic violence, calling into question the effectiveness of the current movie rating system. In the study, “Exposure of U.S. Adolescents to Extremely Violent Movies,” researchers from Dartmouth Medical School surveyed 6,522 adolescents 10 to 14 years old from all regions of the U.S to determine what percentage had seen each of 534 recently released movies. They report results for 40 that were rated “R” for violence by the Motion Picture Association of American and “UK 18” by the British Board of Film Classification. The 40 violent movies were seen by a median of 12.5 percent of the teens surveyed. The most popular movie, “Scary Movie” was seen by 48.1 percent of children, and a million of those were age 10. In another example, 12.2 percent of the teens had seen “Gangs of New York,” in which a graphic scene portrays a character being beaten and tortured with a branding iron. Violent movie exposure was associated with measures of media parenting, such as having a TV in the bedroom and being allowed to watch R-rated movies. Exposure also was more prevalent among those with older age, male gender, nonwhite race, lower parental education and lower school performance. According to the authors, this widespread exposure raises important questions about the effectiveness of the movie rating system, and suggests that pediatricians should motivate and teach parents to impose restrictions on violent movie viewing.
 
6. ACCIDENTAL AND NONACCIDENTAL POISONINGS IN INFANTS AND OVER-THE-COUNTER COLD MEDICATIONS
 
Apparent life-threatening events (ALTEs) are relatively common occurrences in infants and children for which there may be a number of causes. Results of the study, “Accidental and Nonaccidental Poisonings as a Cause of Apparent Life-Threatening Events in Infants,” show that a significant number of infants under age 2 brought to the emergency department with an ALTE also had a positive toxicology screen report, and had been given an over-the-counter (OTC) cold medication. Of 274 toxicology screen results, 50 were positive and 23 were considered clinically significant. Thirteen toxicology results tested positive for an OTC medication, but no parents admitted to giving their children medicine. These medications are not recommended for young children, and U.S. Food and Drug Administration dosing guidelines do not exist for children under age 2. There is a real concern that giving OTC cold medications to very young infants can cause them to stop breathing. The authors suspect that infants are given OTCs inadvertently, through breastfeeding, or purposely, in order to treat cough and cold symptoms. Because of these findings, toxicology screens should be part of the routine evaluation for children with an apparent life-threatening event.
 
7. TEENS WITH SINGLE ELEVATED BLOOD PRESSURE READING AT RISK OF HYPERTENSION
 
Roughly 7 percent of adolescents who have prehypertension, or blood pressure readings over 120/80 mm Hg, will progress to hypertension a year later, according to the study, “Blood Pressure Variability and Classification of Prehypertension and Hypertension in Adolescence.” Researchers compared blood pressure readings of 8,535 adolescents ages 13 to 15 with repeated blood pressure measurements two and four years later. Of the 1,470 teenagers who had a single blood pressure reading in the prehypertensive range, 14 percent of boys and 12 percent of girls progressed to blood pressure levels that were considered hypertensive two years later. Of those with hypertension at the first measurement, 31 percent of boys and 26 percent of girls continued to have hypertension, and 47 percent of boys and 26 percent of girls had prehypertension two years later. A high body mass index contributed to progression to hypertension. The authors suggest that adolescents identified with prehypertension would benefit from treatments such as lifestyle changes.
 
8. VIDEO GAME IMPROVES TREATMENT ADHERENCE IN YOUNG CANCER PATIENTS
 
A significant challenge when managing a chronic illness such as cancer in adolescents is patient refusal to follow required treatment regimes. The study, “A Video Game Improves Behavioral Outcomes in Adolescents and Young Adults With Cancer: A Randomized Trail,” examines the effects of a video game titled “Re-Mission” that addresses issues of cancer treatment and care. The intervention group consisted of 375 patients ages 13 to 29 years who were diagnosed with malignancies including acute leukemia, lymphoma and soft-tissue sarcoma. After one hour of play a day for three months, the video game intervention group significantly improved treatment adherence, knowledge and self-awareness of their cancer. Analyses of study data suggest that patients’ increased sense of control over cancer (self-efficacy) was a major driver of the game’s effect on medical treatment untilization. Study authors believe that these results provide scientific evidence for a growing field of product development that taps into the positive potential of video games to improve human health.
 
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AAP NEWS RELEASES
 
 
9. AUGUST IS NATIONAL IMMUNIZATION AWARENESS MONTH
Are you up-to-date on your immunizations? While the majority of immunizations target infants and children under age 6, getting immunized is a lifelong effort and an important part of staying healthy and protecting yourself from life-threatening infections. Particular vaccines and booster shots are recommended for children, adolescents, adults and seniors. August, National Immunization Awareness Month, is a perfect time to remind people to catch up on their vaccinations. Parents are getting children ready to return to school, young adults are heading off to college, and health care providers are preparing for the flu season. Visit http://www.cispimmunize.org  for immunization schedules and other facts about vaccines.
                       
AAP President Renee R. Jenkins, MD, FAAP, will appear with actress Amanda Peet, former First Lady Rosalynn Carter and others at a news conference at 10:30 a.m. (ET) Tuesday, August 5.
 
10. SAVE THE DATE:
AAP 2008 NATIONAL CONFERENCE AND EXHIBITION IS OCT. 11-14
Members of the media are encouraged to attend the 2008 American Academy of Pediatrics’ National Conference & Exhibition (NCE), October 10-14 in Boston at the Hynes Convention Center. The meeting features more than 350 sessions on issues such as children’s brain development; detection of and treatments for autism; environmental hazards; adolescent substance abuse and more.  To access or research meeting sessions, visit http://www.aapexperience.org .  Media interested in attending can register online.  Just click on “Attendee” followed by “Media” at the NCE site listed above.  Check the NCE site or the AAP online press room at http://www.aap.org/pressroom regularly for conference updates, registration and newsworthy meeting presentations.  
 
11. AUGUST 1-7 IS WORLD BREASTFEEDING WEEK
More than 120 countries will celebrate World Breastfeeding Week August 1 - 7, 2008. This year's theme is “Mother Support: Going for the Gold” to coincide with this summer’s Olympic Games. Many activities including mass breastfeeding demonstrations, lectures, fairs and video and photo contests are planned worldwide to celebrate this event. For more information visit the World Alliance for Breastfeeding Action Web site at
http://www.worldbreastfeedingweek.org.