The results of this meta-analysis suggest that Lactobacillus is safe and effective as a treatment for children with acute infectious diarrhea.

To test the hypothesis that audible television is associated with decreased parent and child interactions.

No abstract

WHAT'S KNOWN ON THIS SUBJECT:Media use has been shown to negatively affect child sleep, especially in the context of evening use or with a television in the child's bedroom. WHAT THIS STUDY ADDS:Increased sleep problems were observed in preschool-aged children for each additional hour of daytime violent media content or evening media use. No such effect was observed with nonviolent daytime use. abstract BACKGROUND: Media use has been shown to negatively affect a child's sleep, especially in the context of evening use or with a television in the child's bedroom. However, little is known about how content choices and adult co-use affect this relationship. OBJECTIVE:To describe the impact of media content, timing, and use behaviors on child sleep. METHODS:These data were collected in the baseline survey and media diary of a randomized controlled trial on media use in children aged 3 to 5 years. Sleep measures were derived from the Children's Sleep Habits Questionnaire. Media diaries captured time, content title, and co-use of television, video-game, and computer usage; titles were coded for ratings, violence, scariness, and pacing. Nested linear regression models were built to examine the impact of timing, content, and co-use on the sleep problem score. RESULTS:On average, children consumed 72.9 minutes of media screen time daily, with 14.1 minutes occurring after 7:00 PM. Eighteen percent of parents reported at least 1 sleep problem; children with a bedroom television consumed more media and were more likely to have a sleep problem. In regression models, each additional hour of evening media use was associated with a significant increase in the sleep problem score (0.743 [95% confidence interval: 0.373-1.114]), as was daytime use with violent content (0.398 [95% confidence interval: 0.121-0.676]). There was a trend toward greater impact of daytime violent use in the context of a bedroom television (P ϭ .098) and in low-income children (P ϭ .07). CONCLUSIONS:Violent content and evening media use were associated with increased sleep problems. However, no such effects were observed with nonviolent daytime media use. Pediatrics 2011;128:29-35 AUTHORS:

The dangers of accidental freezing of vaccines in the cold chain have prompted studies throughout the globe to better characterize the risk. To date, there has been no systematic review of these studies. This analysis highlights that accidental freezing is pervasive and occurs across all segments of the cold chain. Between 14% and 35% of refrigerators or transport shipments were found to have exposed vaccine to freezing temperatures, while in studies that examined all segments of distribution, between 75% and 100% of the vaccine shipments were exposed. More rigorous study designs were associated with higher levels of freeze exposure. As more expensive, freeze-sensitive vaccines are introduced into immunization schedules, freeze prevention will become increasingly critical for ensuring that the world's children are receiving fully potent vaccine.

Considerable, unexplained variation exists in the inpatient management of bronchiolitis. The development of national guidelines and controlled trials of new therapies and different management approaches are indicated.

Problem drinking during adolescence is associated with problem drinking in early adulthood. Efforts to prevent and treat adolescent problem drinking could have an impact on the progression of alcohol-related disease.

ABSTRACT. Context. Prescribing practices for otitis media are not consistent with current evidence-based recommendations.Objective. To determine whether point-of-care evidence delivery regarding the use and duration of antibiotics for otitis media decreases the duration of therapy from 10 days and decreases the frequency of prescriptions written.Design. Randomized, controlled trial. Setting. Primary care pediatric clinic affiliated with university training program.Intervention. A point-of-care evidence-based message system presenting real time evidence to providers based on their prescribing practice for otitis media.Main Outcome Measures. Proportion of prescriptions for otitis media that were for <10 days and frequency with which antibiotics were prescribed.Results. Intervention providers had a 34% greater reduction in the proportion of time they prescribed antibiotics for <10 days. Intervention providers were less likely to prescribe antibiotics than were control providers.Conclusions. A point-of-care information system integrated into outpatient pediatric care can significantly influence provider behavior for a common condition. Pediatrics 2001;107(2). URL: http://www.pediatrics.org/ cgi/content/full/107/2/e15; evidence-based medicine, antibiotics, otitis media, informatics, prescriptions.ABBREVIATION. PCC, pediatric care center. K eeping current and applying the best evidence in the care of patients remains a problem for physicians. Recent studies suggest that providers do not prescribe the appropriate or optimal medications for their patients. 1,2 Among other consequences, this has led to significant unnecessary use of antibiotics and a growing problem of microbial resistance. 3,4 For pediatricians, the most common indication for prescribing antibiotics is otitis media. 5 Data suggest that this practice could be improved in several ways including delaying the initiation of therapy for 2 to 3 days from the start of symptoms and a shorter course than the frequently used 10 days. 6 -8 Both reducing therapy duration and the frequency of antibiotic prescriptions for otitis media are important because they are cost-saving and reduce the spread of penicillin-resistant pneumococcus. 9,10 Many past attempts to change physician behavior have been unsatisfactory or yielded mixed results. 11 Clinical practice guidelines have not been well received by pediatricians, 12 and their dissemination alone has not proven an effective means of improving the quality of care. 13,14 Passive information retrieval systems that rely on providers to actively seek answers to their questions are also primarily ineffective. 15 Embedding explicit recommendations into the flow of care has been demonstrated to improve the care of surgery patients and health care workers. 16,17 We hypothesized that a system that did not make explicit recommendations but rather attempted to make providers aware of the most recent advances in medicine could also be effective even for conditions for which providers were unlikely to seek assistance. Therefore, we...