Firearms Screening in the Pediatric Inpatient Setting.

OBJECTIVES: Firearm-related deaths remain a top cause of mortality in American children and adolescents. In a 2012 policy statement, the American Academy of Pediatrics urged pediatricians to incorporate questions about the availability of firearms into their patient history taking. We aim to evaluate the frequency of screening for home firearms in an academic tertiary-care hospital inpatient setting. METHODS: This retrospective chart review examined patients with the following pediatric diagnoses admitted to a tertiary-care pediatric hospital from 2006 to 2015: asthma, bronchiolitis, cellulitis, jaundice, single liveborn infant, bacterial and viral pneumonia, and all mood disorders. Data analysts then searched the patient charts that met these inclusion criteria for documentation of firearm screening as indicated by use of the terms "firearm," "pistol," "gun," "handgun," "bullet," "ammunition," or "rifle" in the admissions history and physical. RESULTS: Evidence of screening for firearms in the home was found in 1196 of the 40 658 charts included in the study (2.94%). The most frequently screened diagnosis and admitting service were mood disorders and child psychiatry, respectively (1159 of 3107; 37.3%). Only 19.8% of identified gun-owning families received specific anticipatory guidance. CONCLUSIONS: Firearm screening and gun safety education occurred infrequently in the inpatient setting. Inpatient encounters may provide an opportunity for increased screening and education because the hospital environment also includes additional resources, exposure to a greater number of providers, and the presence of more family members or caregivers. Further studies are warranted to explore barriers to inpatient screening and possible mechanisms for improvement.

A retrospective review of patients with atypical femoral fractures while on long-term bisphosphonates: including pertinent biochemical and imaging studies.

OBJECTIVE: To elucidate the effects of prolonged bisphosphonate (BP) exposure on the development of atypical fragility fractures, and to define the associated risk factors. METHODS: Approval was obtained from the institutional review board, and a retrospective chart analysis was performed on 51 patients who had been on BPs for at least 3 years and had complete subtrochanteric or diaphyseal femoral fracture(s) between January 2005 and April 2011. All relevant data were available for 25 patients (mean age, 67.52 years). All fractures included in the study were low- or no-energy. Relevant clinical and demographic data were collected regarding age, gender, ethnicity, height, weight, and comorbid medical conditions. Imaging and laboratory data collected on all patients included: calcium, alkaline phosphatase, 25-hydroxyvitamin D (25-OHD), intact parathyroid hormone, serum c-telopeptide, and urine n-telopeptide levels, bone mineral density, radiography, and magnetic resonance imaging. RESULTS: Most of the patients in this study were Caucasian, were on alendronate, had bilateral findings, and almost half had prodromal symptoms. The 25-OHD level was suboptimal (<30 ng/mL) in 45.8% of the patients. Mean BP duration was 9.84 years, and mean bone density was in the osteopenic, not osteoporotic, range. CONCLUSION: Characteristics of patients with atypical BP-related fracture include relatively young age, long duration of BP use, suboptimal 25-OHD level, and bone density in the nonosteoporotic range. All of these may be significant risk factors for insufficiency fracture development.

MR imaging findings of retinal hemorrhage in a case of nonaccidental trauma.

Retinal hemorrhage is a well-recognized manifestation of child abuse found in many babies with shaken baby syndrome. The presence of retinal hemorrhage is generally associated with more severe neurological damage and a worse clinical outcome. MR imaging findings of retinal hemorrhages are not well described in the pediatric literature. We present a 6-month-old boy with new-onset seizures, subdural hemorrhage and bilateral retinal hemorrhages that were detected by MRI and confirmed by indirect ophthalmoscopy. This case demonstrates the MR imaging findings of retinal hemorrhages and the importance of radiologists being able to recognize these specific imaging features.

The contribution of parenting to ethnic and racial gaps in school readiness.

The authors describe various parenting behaviors, such as nurturance, discipline, teaching, and language use, and explain how researchers measure them. They note racial and ethnic variations in several behaviors. Most striking are differences in language use. Black and Hispanic mothers talk less with their young children than do white mothers and are less likely to read to them daily. They also note some differences in harshness. When researchers measuring school readiness gaps control for parenting differences, the racial and ethnic gaps narrow by 25-50 percent. And it is possible to alter parenting behavior to improve readiness. The authors examine programs that serve poor families-and thus disproportionately serve minority families--and find that home- and center-based programs with a parenting component improve parental nurturance and discipline. Programs that target families with children with behavior problems improve parents' skills in dealing with such children. And certain family literacy programs improve parents' skills in talking with their children. Several interventions have significantly reduced gaps in the parenting behavior of black and white mothers. Not all improvements in parenting translate to improved school readiness. Home-based programs affect the mother but do not appear to affect the child, at least in the short term. But center-based programs with a parenting component enhance both parenting and school readiness. And some family literacy programs also improve readiness. Because these successful interventions serve a greater share of minority than nonminority families and have more positive effects for blacks than for whites, they offer promise for closing the ethnic and racial gaps in school readiness.