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Problems like housing or food insecurity, violence, poor nutrition and substance use are often missed during adolescent primary care visits. Eric Fleegler, MD, MPH, Areej Hassan, MD, MPH, and colleagues at Children’s Hospital Boston surveyed 362 adolescents at an urban clinic, and found that 62 percent had more than one such problem needing a referral, and that 38 percent had an unmet referral need. To better capture those needs, the researchers created an interactive, user-friendly screening and referral tool called the Online Advocate, which gives users personalized feedback, lets them select problems they want help for and prints out referral information. In phone interviews one month later, 39 percent of users reported contacting an agency for their top problem, and almost half said their problem was “completely” or “mostly” resolved. This tool is now starting to be used by the Boston Public Schools and the Boston Public Health Commission.
A study of more than 40,000 children with minor blunt head trauma, presenting at 25 different emergency departments, found that clinical observation can reduce the use of head CT scans in many cases, without compromising care. Investigator Lise Nigrovic, MD, MPH, of Children’s Division of Emergency Medicine, notes that cranial CT itself presents risks because of radiation exposure, and that observation allows it to be used selectively, reserving it for children whose symptoms progress or don’t resolve.
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