Are epinephrine auto-injector needles too short for kids?
The length of the needles on epinephrine auto-injectors may be too short to deliver epinephrine intramuscularly in a significant number of children, according to a study in Pediatrics. Researchers at Phoenix Children's Hospital used a convenience sample of 256 children 1 to 12 years old who presented to the hospital, measuring depth from the skin to the vastus lateralis muscle via ultrasound. They also assessed the children’s body mass index, or BMI, and used that data to help predict whether the needle length would reach the vastus lateralis muscle. Of the 158 children who weighed less than 30 kg and would be prescribed the 0.15-mg auto-injector, 12 percent had a skin-to-muscle surface depth exceeding one-half inch and would not receive epinephrine intramuscularly from current auto-injectors. Of the 98 children weighing 30 kg or more who would receive the 0.3-mg auto-injector, 30 percent had a skin-to-muscle surface depth exceeding five-eighths of an inch and would not receive epinephrine intramuscularly.

CDC releases H1N1 vaccine recommendations
The Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP) recently announced recommendations for influenza A (H1N1) vaccine use. To help reduce the impact and spread of H1N1, the committee recommended vaccination efforts focus on five key populations:

• pregnant women
• people who live with or care for children younger than 6 months old
• health care and emergency services personnel
• people 6 months to 24 years old
• people 25 to 64 years old who are at higher risk for novel H1N1 because of chronic health disorders or compromised immune systems.

Should the vaccine initially be limited, the group also developed a separate priority list.

Adding Web-based care may help patients better manage asthma
Interactive Web-based resources may help people with asthma better manage their symptoms, according to a study in Annals of Internal Medicine. Researchers at Leiden University Medical Center in the Netherlands studied 200 adults with asthma and Internet access, who were treated with inhaled corticosteroids for three months or more during the previous year at 37 general practices and one academic outpatient department in the Netherlands. Subjects were randomly assigned to either the usual care group or a group that received the addition of Internet-based consultations to help them better control their day-to-day symptoms. Internet subjects could access a Web site that provided education and allowed them to monitor their symptoms. An asthma care nurse helped patients interpret their symptom shifts and change their medications, as needed. Compared with the usual care subjects, those who received online help showed greater improvements in symptom control during the year and were more likely to report symptom-free days in recent weeks. However, there was no significant difference in asthma attack frequency between the two groups.

Parental stress may increase kids’ asthma risk
For children exposed either to smoking while in the womb or pollution from cars, parental stress increases their odds for developing asthma, according to a study in Proceedings of the National Academy of Sciences. Scientists at the Centre for Research on Inner City Health at the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, enrolled 2,497 southern California children, from 5 to 9 years old, with no history of asthma or wheeze. Over three years, they collected data about the children's exposure to traffic-related pollution and whether they were exposed to tobacco smoke before birth. They also tracked whether the children developed asthma and collected parent questionnaires that included questions measuring stress. Alone, neither stress nor socioeconomic status increased the risk of developing asthma. But when either was combined with parental stress, asthma risk climbed more than for children exposed only to pollution or smoke.

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