Depressive symptoms occur frequently among adolescents and are often unrecognized. Efforts to increase awareness of depression among ED physicians, adolescents, and parents of adolescents may be beneficial.

Purpose: Asthma is a chronic inflammatory disorder of airways resulting in recurrent exacerbations of wheezing, breathlessness, chest tightness, excessive mucus production, and cough. We hypothesize that intravenous magnesium sulfate (IV MgSO 4 ) is an effective adjunctive therapy in the treatment of acute severe asthma. We propose that IV MgSO 4 at 75mg/kg improves the Clinical Asthma Severity Score (CASS) by 2 points at 3 hours in patients (pts) with acute severe asthma. Methods: Prospective, randomized, double-blind, placebo-controlled pilot study using a convenience sample presenting to an urban children's emergency department with an acute asthma exacerbation. Pts with a CASS Q 8 following 3 Albuterol/Ipatropium bromide nebs, a 1 hour 20mg Albuterol neb, and 2mg/kg of steroids were enrolled. Pts received either 75mg/kg (max 3 grams) IV MgSO 4 or saline infusion over 30 min. Baseline and serial assessments of CASS, PEFR, vital signs, O2 sat., and physical exam were performed every 20 min. for a total of 120 min. Results: 90 pts were enrolled, 74 had at least one measurement beyond baseline. Median age was 6.2 yrs (range 1.9 Y 15.5 yrs), 55.3% male, mean CASS at baseline (6 0 )= 10.7 T 2.3. Using a mixed model ANCOVA controlling for baseline covariates, the effect of time for both groups was F (6,74) = 13.71, P G 0.0001. The effect of treatment group was F (1,74) = 0.02, P = 0.89. Mean for placebo at time 0 (6 plac0 ) = 10.39 (T0.37) versus treatment mean at time 0 (6 mg0 ) = 10.95 (T0.37); 6 plac40 = 9.19 (T0.42) vs 6 mg40 = 9.14 (T0.42); 6 plac80 = 8.49 (T0.42) vs 6 mg80 = 8.39 (T0.42); 6 plac120 = 8.08 (T0.45) vs 6 mg120 = 8.12 (T0.49). 15 pts required NS bolus during med infusion, 3 pts required BIPAP, and 1 pt required intubation. Conclusion: Intravenous magnesium sulfate is not a useful adjunctive therapy in the treatment of acute severe asthma exacerbations in children.Purpose: Asthma is one of the leading causes of childhood emergency department (ED) utilization despite medical advances in the field. This study examined predictors of ED utilization for asthma that could help decrease ED utilization. Methods: Project S.T.A.R. (Support for Treatment of Asthma Research) is a 4-year prospective cohort study of 172 low-income, urban, predominantly African American children with persistent asthma. Participants were 6Y12 yrs old with controller medication prescriptions from their primary care physicians.Patients and their primary caregivers were assessed twice, at baseline and follow-up (mean = 60 wks, range = 52Y130 wks) for medication adherence, asthma symptoms, asthma knowledge, and certain psychosocial variables. Medication adherence was measured prospectively with electronic monitoring devices over a 14 day period. Medical records were reviewed for asthma related ED visits, hospitalizations, and primary care visits. Results: Analyses were conducted on 165 participants who had complete medical records and adherence data. The median age was 9 yrs, 62% were male; 34.5% of participants had one or more ED vis...

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