- Email: [email protected]
Access to healthcare improves the quality of life of children
This Month in
THE JOURNAL OF
PEDIATRICS September 2006 • Volume 149 • Number 3 Copyright © 2006 by Mosby, Inc.
THE EDITORS’ PERSPECTIVES Children should not be treated as little adults. . . unless. . .
Access to healthcare improves the quality of life of children
It is not uncommon to hear a pediatrician say that children should not be treated as if they were simply small adults. There may be a few exceptions to this train of thought. As the obesity epidemic continues, overweight children are beginning to suffer associated disorders at an alarming rate including, but not limited to, elevated cholesterol, hypertension, diabetes, sleep apnea, and depression. These disorders were once thought to only be common only in adults. Kershnar et al report that a substantial proportion of young patients with diabetes have abnormal lipids and, furthermore, the prevalence is even higher in children with type 2 diabetes. These patients also tended to be either overweight or at risk for being overweight. Most were not being treated for elevated lipids. Children with diabetes should have their lipids and weight evaluated and treated as necessary to help avoid the complications that used to be seen only in adults.
Seid et al have prospectively studied a cohort of children in the California State Children’s Health Insurance Program (SCHIP). Over a 2-year period of follow-up, they showed that access to healthcare was positively related to health-related quality of life (HRQOL). Episodes of not receiving care were reduced following enrolment in SCHIP but were associated with significantly reduced HRQOL by both parent and child report. The results of this study have important implications for health policy.
—Reginald L. Washington, MD page 314
Graf et al at the University of Zurich assessed quality of life (QOL) and psychological adjustment in 40 children and adolescents with neurofibromatosis type I. The questionnaires were completed by both parents and children. The results show that many dimensions of QOL deviated from reference values and psychological adjustment was also impaired. The deviations correlated with family-related and illness-related factors but not with social and demographic factors. Good family relationships and cohesion were associated with a significant improvement in both QOL and psychological adjustment.
Excess RSV hospitalization is associated more with poverty than with race or ethnicity Using a 5-year California data base of hospitalizations associated with respiratory syncytial virus infection and population statistics, investigators found the expected two-fold higher rates of hospitalizations for RSV infection in MediCal (the national Medicaid program) users and minority populations. However, less expected analyses adjusted for payer source were that non-Hispanic Whites had the highest rates of RSV hospitalization among MediCal users, and Hispanics had the highest rates of RSV hospitalization among non-MediCal users. African Americans and non-Hispanic Whites who did not have a MediCal payer had similar rates of hospitalization. One important shortcoming of the database is lack of information about gestational age at birth. Findings suggest that environmental factors associated with poverty may be more important risks than genetic susceptibility to severe infection.
—Robert W. Wilmott, MD page 354
Quality of life in children and adolescents with neurofibromatosis type I
—Robert W. Wilmott, MD page 348
—Sarah S. Long, MD page 373 The Journal of Pediatrics (ISSN 0022-3476) is published monthly by Elsevier Inc., 360 Park Avenue South, New York, NY 10010. Business and Editorial Offices: 1600 John F. Kennedy Blvd., Suite 1800, Philadelphia, PA 19103-2899. Accounting and Circulation Offices: 6277 Sea Harbor Drive, Orlando, FL 32887-4800. Periodicals postage paid at New York, NY, and additional mailing offices. POSTMASTER: Send address changes to The Journal of Pediatrics, Elsevier Periodicals Customer Service, 6277 Sea Harbor Drive, Orlando, FL 32887-4800.
The Journal of Pediatrics
September 2006
1A
THE JOURNAL OF
PEDIATRICS September 2006 • Volume 149 • Number 3 Copyright © 2006 by Mosby, Inc.
THE EDITORS’ PERSPECTIVES Children should not be treated as little adults. . . unless. . .
Access to healthcare improves the quality of life of children
It is not uncommon to hear a pediatrician say that children should not be treated as if they were simply small adults. There may be a few exceptions to this train of thought. As the obesity epidemic continues, overweight children are beginning to suffer associated disorders at an alarming rate including, but not limited to, elevated cholesterol, hypertension, diabetes, sleep apnea, and depression. These disorders were once thought to only be common only in adults. Kershnar et al report that a substantial proportion of young patients with diabetes have abnormal lipids and, furthermore, the prevalence is even higher in children with type 2 diabetes. These patients also tended to be either overweight or at risk for being overweight. Most were not being treated for elevated lipids. Children with diabetes should have their lipids and weight evaluated and treated as necessary to help avoid the complications that used to be seen only in adults.
Seid et al have prospectively studied a cohort of children in the California State Children’s Health Insurance Program (SCHIP). Over a 2-year period of follow-up, they showed that access to healthcare was positively related to health-related quality of life (HRQOL). Episodes of not receiving care were reduced following enrolment in SCHIP but were associated with significantly reduced HRQOL by both parent and child report. The results of this study have important implications for health policy.
—Reginald L. Washington, MD page 314
Graf et al at the University of Zurich assessed quality of life (QOL) and psychological adjustment in 40 children and adolescents with neurofibromatosis type I. The questionnaires were completed by both parents and children. The results show that many dimensions of QOL deviated from reference values and psychological adjustment was also impaired. The deviations correlated with family-related and illness-related factors but not with social and demographic factors. Good family relationships and cohesion were associated with a significant improvement in both QOL and psychological adjustment.
Excess RSV hospitalization is associated more with poverty than with race or ethnicity Using a 5-year California data base of hospitalizations associated with respiratory syncytial virus infection and population statistics, investigators found the expected two-fold higher rates of hospitalizations for RSV infection in MediCal (the national Medicaid program) users and minority populations. However, less expected analyses adjusted for payer source were that non-Hispanic Whites had the highest rates of RSV hospitalization among MediCal users, and Hispanics had the highest rates of RSV hospitalization among non-MediCal users. African Americans and non-Hispanic Whites who did not have a MediCal payer had similar rates of hospitalization. One important shortcoming of the database is lack of information about gestational age at birth. Findings suggest that environmental factors associated with poverty may be more important risks than genetic susceptibility to severe infection.
—Robert W. Wilmott, MD page 354
Quality of life in children and adolescents with neurofibromatosis type I
—Robert W. Wilmott, MD page 348
—Sarah S. Long, MD page 373 The Journal of Pediatrics (ISSN 0022-3476) is published monthly by Elsevier Inc., 360 Park Avenue South, New York, NY 10010. Business and Editorial Offices: 1600 John F. Kennedy Blvd., Suite 1800, Philadelphia, PA 19103-2899. Accounting and Circulation Offices: 6277 Sea Harbor Drive, Orlando, FL 32887-4800. Periodicals postage paid at New York, NY, and additional mailing offices. POSTMASTER: Send address changes to The Journal of Pediatrics, Elsevier Periodicals Customer Service, 6277 Sea Harbor Drive, Orlando, FL 32887-4800.
The Journal of Pediatrics
September 2006
1A