In New Jersey, physicians were not consulted by home maintenance organizations (HMOs) before early discharge began. There was only the assurance that early discharge had gone well in California. In New Jersey it was quite different, for a spectrum of health problems soon became apparent. Moreover, obstetricians and pediatricians were repeatedly confronted by unhappy mothers who complained that they had been sent home uncomfortably soon. Anthony Caggiano, MD, President of the Obstetrical and Gynecological Society of New Jersey, points out that in 24 hours after delivery, many mothers are still in pain and are not ready to go home, physically or psychologically.
Almost since the emergence of the First Ride—Safe Ride concept some 15 years ago, loan or rental programs for child car seats in maternity hospitals and community centers have been a popular method of promoting child restraint use. Today there must be hundreds of such programs throughout the United States. The Dunedin rental program (Pediatrics 1986;77:167-172) is certainly a unique approach, but some aspects of it may lack practical application, at least in the United States. For example, it would be unlikely that we could saturate a community with free car seats or have available so broad a staff support system.
The review of the epidemiologic and clinical pattern of adolescent morbidity and mortality from the "highway epidemic," which appears in this issue of Pediatrics (1986;77:603-607), will be educational for those pediatricians who underestimate the awesome toll of this major pediatric health threat. The multifactorial causes of adolescent disruptive behavior the authors describe, however, will come as no surprise to pediatricians practicing adolescent medicine. Those of us who treat adolescents are accustomed to the instability of the exchange between the adolescent's immaturity and his or her environment which is capable of producing unpredictable crises.
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