bluuebunny/crossref_metadata_2025_split huggingface dataset:
Emergency Department Utilization by Adolescents in the United States
Authors: Ziv Amitai , Boulet Jack R. , Slap Gail B. 
Published: August 2004

Background. Adolescents in the United States have been shown to underutilize primary care services and therefore may rely heavily on emergency service. Although several small studies have explored local emergency services for youth, there are no published reports of adolescent utilization of emergency services on a national scale. Furthermore, emergency services data have not been aggregated according to the age subgroups used by the current guidelines for adolescent care.Objective. To explore the utilization of emergency departments in the United States by early (11 to 14 years), middle (15 to 17 years), and late (18 to 21 years) adolescent subgroups.Design. Secondary analysis of the emergency department component of the 1994 National Hospital Ambulatory Medical Care Survey.Setting. Nationally representative sample of 418 emergency departments in the United States.Patients. Approximately 26 547 visits by patients of all ages, representing 93.4 million total visits in 1994 and 14.8 million adolescent visits.Outcome Measures. Number of visits, health insurance, reasons for visits, urgency of visits, resulting diagnoses, and hospitalization rates.Results. Adolescents accounted for 15.4% of the population and 15.8% of emergency department visits in 1994. Late adolescents were overrepresented in emergency department visits relative to their population proportion (6.8% of visits, 5.3% of population), whereas early adolescents were underrepresented (4.6% of visits, 5.9% of population). Lack of health insurance was more common among 11- to 21-year-olds (26.2%) than either children (13.6%) or adults (22.7%). By ages 18 to 21 years, 40.5% of male visits and 27.6% of female visits were uninsured. Injury-related visits were more common among adolescents (28.6%) than either children (23.1%) or adults (18.2%). Injury was the leading reason for visits among all adolescent age-sex subgroups (36.6% to 42.0% of male visits and 14.1% to 27.2% of female visits) except females aged 18 to 21 years for whom digestive reasons ranked first (18.8%). Injury was the leading diagnosis for all adolescent age-sex subgroups, with peaks at early adolescence of 61.6% for males and 45.8% for females. Across all adolescent age-sex subgroups, 3.1% to 5.3% of visits resulted in hospitalization, and 41.0% to 52.5% of visits were urgent. These rates did not differ from those of children but were lower than those of adults.Conclusions. Utilization of emergency departments increases and health insurance decreases during adolescence, suggesting that adolescents with inadequate health insurance may rely heavily on emergency departments for their health care needs. Most adolescent visits to emergency departments are not urgent and might be better treated through nonemergency, primary care sites.
Length of Stay, Jaundice, and Hospital Readmission
Authors: Maisels M. Jeffrey , Kring Elizabeth 
Published: August 2004

Objective. To evaluate the effect of postnatal age at the time of discharge on the risk of readmission to hospital with specific reference to readmission for hyperbilirubinemia.
Design. Case-control study based on chart review.
Setting. Large suburban community hospital in southeastern Michigan, delivering more than 5000 infants annually.
Patients. Newborn infants, born between December 1, 1988, and November 30, 1994, who were readmitted to hospital within 14 days of discharge, were compared with a randomly selected control group who were not readmitted.
Results. Of 29 934 infants discharged, 247 (0.8%) were readmitted by the age of 14 days. One hundred twenty-seven (51%) were admitted because of hyperbilirubinemia and 74 (30%) with the diagnosis of “rule out sepsis.” The factors associated with an increased risk of readmission to the hospital were: infant of diabetic mother [odds ratios (OR), 3.45; 95% confidence limits (CL), 1.39 to 8.60]; gestation ≤36 weeks (OR, 4.56; CL, 1.45 to 14.33), and 3717 to 38 weeks (OR, 2.95; CL, 1.63 to 5.35) versus ≥40 weeks; presence of jaundice in the nursery (OR, 1.73; CL, 1.14 to 2.63); breastfeeding (OR, 1.78; CL, 1.13 to 2.81); male sex (OR, 1.58; CL, 1.07 to 2.34); length of stay &lt;48 hours (OR, 1.91; CL, 1.15 to 3.16) and 48 to &lt;72 hours (OR, 2.09; CL, 1.25 to 3.50) versus ≥72 hours. Factors associated with readmission for jaundice were gestation ≤36 weeks (OR, 13.2; CL, 2.70 to 64.6), 3617 to 37 weeks (OR, 7.7; CL, 2.69 to 22.0), 3717 to 38 weeks (OR, 7.2; CL, 3.05 to 16.97) versus ≥40 weeks; jaundice during nursery stay (OR, 7.80; CL, 3.38 to 18.0); length of stay &lt;48 hours (OR, 2.40; CL, 1.09 to 5.30) and 48 to &lt;72 hours (OR, 3.15; CL, 1.40 to 7.09) versus ≥72 hours; male sex (OR, 2.89; CL, 1.46 to 5.74); and breastfeeding (OR, 4.21; CL, 1.80 to 9.87). Infants whose length of stay was &lt;48 hours were at no greater risk for readmission for jaundice or other causes than those whose length of stay was ≥48 hours to &lt;72 hours.
Conclusions. Discharge at any time &lt;72 hours significantly increases the risk for readmission to hospital and the risk for readmission with hyperbilirubinemia when compared with discharge after 72 hours. The American Academy of Pediatrics recommends that infants discharged &lt;48 hours should be seen by a health care professional within 2 to 3 days of discharge. Our observations, as well as those of others, suggest that this recommendation should also be extended to those discharged at &lt;72 hours after birth. One approach to decreasing the risk of morbidity and readmission, particularly from hyperbilirubinemia, would be to help mothers to nurse their infants more effectively from the moment of birth.
Screening for Urinary Tract Infection in Infants in the Emergency Department: Which Test Is Best?
Authors: Shaw Kathy N. , McGowan Karin L. , Gorelick Marc H. , Schwartz J. Sanford 
Published: August 2004

Objective. Comparison of rapid tests and screening strategies for detecting urinary tract infection (UTI) in infants.
Methods. Cross-sectional study conducted in an urban tertiary care children's hospital emergency department and clinical laboratories of 3873 infants &lt;2 years of age who had a urine culture obtained in the emergency department by urethral catheterization; results of urine dipstick tests for leukocyte esterase or nitrites, enhanced urinalysis (UA) (urine white blood cell count/mm3plus Gram stain), Gram stain alone, and dipstick plus microscopic UA (white blood cells and bacteria per high-powered field) compared with urine culture results (positive urine results defined as ≥104 colony-forming units per milliliter of urinary tract pathogen) for each sample. Cost comparison of 1) dipstick plus culture of all urine specimens versus 2) cell count ± Gram stain of urine, culture only those with positive results.
Results. The enhanced UA was most sensitive at detecting UTI (94%; 95% confidence interval: 83,99), but had more false-positive results (16%) than the urine dipstick or Gram stain (3%). The most cost-effective strategy was to perform cultures on all infants and begin presumptive treatment on those whose dipstick had at least moderate (+2) leukocyte esterase or positive nitrite at a cost of $3.70 per child. With this strategy, all infants with UTI were detected. If the enhanced UA was used to screen for when to send the urine for culture, 82% of cultures would be eliminated, but 4% to 6% of infants with UTI would be missed and the cost would be higher ($6.66 per child).
Conclusion. No rapid test can detect all infants with UTI. Physicians should send urine for culture from all infants and begin presumptive treatment only on those with a significantly positive dipstick result. The enhanced UA is most sensitive for detecting UTI, but is less specific and more costly, and should be reserved for the neonate for whom a UTI should not be missed at first visit.
Racial/Ethnic Differences in the Decision to Breastfeed Among Adolescent Mothers
Authors: Wiemann Constance M. , DuBois Jacqueline C. , Berenson Abbey B. 
Published: August 2004

Objective. To identify racial/ethnic differences in prevalence and the factors that influence decisions to breastfeed among adolescent mothers.Methods. A total of 696 Mexican-American, African-American, and Caucasian adolescent mothers ≤18 years of age were interviewed on the postpartum ward of university hospital within 48 hours of delivery. Self-reported factors associated with the decision to breastfeed were assessed.Results. The decision to breastfeed was reported by 55% of Mexican-American, 45% of Caucasian, and 15% of African-American adolescent mothers. With the exception of perceived benefits of breastfeeding and exposure to educational materials, most factors associated with breastfeeding differed by race/ethnicity. Among Mexican-Americans, important factors included having relied on feeding advice (adjusted odds ratio [AOR] = 7.6); the feeding preference of a partner (AOR = 7.0) or mother (AOR = 6.6); and feeding decisions made in early pregnancy (AOR = 4.7). Among African-Americans, important factors included living with a partner (AOR = 10.6); having a mother who breastfed (AOR = 5.9); the feeding preference of a partner (AOR = 5.6) or health care provider (AOR = 4.7); and low family support (AOR = 3.4). Among Caucasians, health care providers' feeding preference (AOR = 6.1); having two or more breastfeeding role models (AOR = 4.1); not being enrolled in Women, Infants, and Children's Supplemental Nutrition Program (AOR = 3.0); having relied on infant-feeding advice (AOR = 3.0); and prenatal alcohol use (AOR = 2.6) were associated with the decision to breastfeed.Conclusions. Prevalence and influences to breastfeed differ by patient race/ethnicity. We speculate that targeting the adolescent mother and members of her support system, educating them before and during pregnancy, and stressing benefits of this method while eliminating misinformation, especially among African-Americans, may be important intervention strategies to promote breastfeeding.
Childhood Caffeine Tic Syndrome
Authors: Davis Richard E. , Osorio Ivan 
Published: August 2004

Objective. To determine whether caffeine ingestion was temporally correlated with tics in 2 healthy children.
Methods. Two first-degree cousins were observed over a period of ∼3 years, and the presence and absence of tics was recorded and correlated with consumption of or abstinence from caffeinated foods or beverages.
Results. Appearance and disappearance of tics were closely and clearly temporally correlated with ingestion and elimination of caffeine in the cousins' diets.
Conclusions. Our observations suggest that caffeine may precipitate tics in susceptible children.
Circumcision Practice Patterns in the United States
Authors: Stang Howard J. , Snellman Leonard W. 
Published: August 2004

Objective. To determine 1) the performing of circumcision by medical specialty, gender, and years of practice; 2) the pattern of anesthetic use for this procedure; and 3) the reasons physicians cite for not using anesthesia.Design. A total of 3066 questionnaires were received from a mailing to a representative sampling of physicians stratified by specialty and geographic location.Results. Fifty-eight percent (1768) of the questionnaires were returned and interpretable from the following specialists: pediatricians (PEDs), 73% (n = 691); family practitioners (FPs), 52% (n = 464); and obstetricians (OBs), 51% (n = 623).Of the respondents, 956 (54%) perform at least one circumcision per month (35% of PEDs; 60% of FPs; 70% of OBs). Of the physicians performing circumcisions, 45% use anesthesia (71% of PEDs; 56% of FPs; 25% of OBs). Of physicians using anesthesia, 85% use dorsal penile nerve block.A significantly higher percentage of male physicians (57%) are performing circumcisions than are females (45%), but there was no difference in the percent using anesthesia. Recently trained PEDs and FPs were more likely to use anesthetics than were their older colleagues, but OB use of pain relief was independent of their practice longevity. Physicians in the western states were significantly more likely to use anesthesia than were other physicians from the rest of the United States.Respondents who did not use anesthesia cited “concern over adverse drug effects” (54%) followed by “procedure does not warrant anesthesia” (44%) as the most common explanations.Conclusions. A substantial number of PEDs are performing circumcisions, and they are most likely to use anesthesia (71%), followed by FPs (56%), then OBs (25%). With recent recognition of the importance of pain reduction in neonatal procedures and the lack of substantiated contraindications to newborn anesthetic use, additional education of current practitioners, residents, and parents is required to increase the use of anesthesia for circumcision.
Ifosfamide-induced Nephrotoxicity in Children: Critical Review of Predictive Risk Factors
Authors: Loebstein Ronen , Koren Gideon 
Published: August 2004

Ifosfamide is widely used in the treatment of pediatric solid tumors. Its main adverse effects are various forms of renal tubular and glomerular damage. Many risk factors have been proposed to play a role in the development and severity of nephrotoxicity in children receiving ifosfamide, among which are 1) patient's age, 2) cumulative ifosfamide dose, 3) concurrent administration of cis or carboplatinum, 4) unilateral nephrectomy, and 5) method of ifosfamide administration. However, presently there is no consensus regarding the weight of each one of them. Therefore, we critically reviewed the major studies that have evaluated the different risk factors in an attempt to determine the relative importance of each.
Cumulative ifosfamide doses of ≥60 g/m2 appears to be the most consistent independent predictor for both the development and the severity of nephrotoxicity, whereas a younger age (&lt;5 years of age) was associated primarily with the more severe and chronic forms of proximal tubulopathy. Comparable incidence and severity forms of proximal tubulopathy among children who had been treated with cis platinum in addition to ifosfamide and those who had not indicate that platinums probably potentiate ifosfamide-induced renal damage rather than act as a major independent risk factor. Finally, although unilateral nephrectomy has been proposed as a significant risk factor in different studies, the relatively small number of nephrectomized children in these cohorts limit the strength of this association.
To reduce the frequency and severity of ifosfamide-induced nephrotoxicity, it appears that cumulative doses of 60 g/m2should be considered carefully, especially in children &lt;5 years of age.
A Phase I/II Study of the Protease Inhibitor Indinavir in Children With HIV Infection
Authors: Mueller Brigitta U. , Sleasman John , Nelson Robert P. , Smith Sharon , Deutsch Paul J. , Ju William , Steinberg Seth M. , Balis Frank M. , Jarosinski Paul F. , Brouwers Pim , Mistry Goutam , Winchell Gregory , Zwerski Sheryl , Sei Shizuko , Wood Lauren V. , Zeichner Steve , Pizzo Philip A. 
Published: August 2004

Background. Indinavir, an inhibitor of the human immunodeficiency virus type 1 (HIV-1) protease, is approved for the treatment of HIV infection in adults when antiretroviral therapy is indicated. We evaluated the safety and pharmacokinetic profile of the indinavir free-base liquid suspension and the sulfate salt dry-filled capsules in HIV-infected children, and studied its preliminary antiviral and clinical activity in this patient population. In addition, we evaluated the pharmacokinetic profile of a jet-milled suspension after a single dose.
Methods. Previously untreated children or patients with progressive HIV disease despite antiretroviral therapy or with treatment-associated toxicity were eligible for this phase I/II study. Three dose levels (250 mg/m2, 350 mg/m2, and 500 mg/m2 per dose given orally every 8 h) were evaluated in 2 age groups (&lt;12 years and ≥12 years). Indinavir was initially administered as monotherapy and then in combination with zidovudine and lamivudine after 16 weeks.
Results. Fifty-four HIV-infected children (ages 3.1 to 18.9 years) were enrolled. The indinavir free-base suspension was less bioavailable than the dry-filled capsule formulation, and therapy was changed to capsules in all children. Hematuria was the most common side effect, occurring in 7 (13%) children, and associated with nephrolithiasis in 1 patient. The combination of indinavir, lamivudine, and zidovudine was well tolerated. The median CD4 cell count increased after 2 weeks of indinavir monotherapy by 64 cells/mm3, and this was sustained at all dose levels. Plasma ribonucleic acid levels decreased rapidly in a dose-dependent way, but increased toward baseline after a few weeks of indinavir monotherapy.
Conclusions. Indinavir dry-filled capsules are relatively well tolerated by children with HIV infection, although hematuria occurs at higher doses. Future studies need to evaluate the efficacy of indinavir when combined de novo with zidovudine and lamivudine.
An Epidemiologic Profile of Children With Special Health Care Needs
Authors: Newacheck Paul W. , Strickland Bonnie , Shonkoff Jack P. , Perrin James M. , McPherson Merle , McManus Margaret , Lauver Cassie , Fox Harriette , Arango Polly 
Published: August 2004

Objective. To present an epidemiologic profile of children with special health care needs using a new definition of the population developed by the federal Maternal and Child Health Bureau.Methods. We operationalized the new definition using the recently released 1994 National Health Interview Survey on Disability. Estimates are based on 30 032 completed interviews for children &lt;18 years old. The overall response rate was 87%.Results. Eighteen percent of US children &lt;18 years old in 1994, or 12.6 million children nationally, had a chronic physical, developmental, behavioral, or emotional condition and required health and related services of a type or amount beyond that required by children generally. This estimate includes children with existing special health care needs but excludes the at-risk population. Prevalence was higher for older children, boys, African-Americans, and children from low-income and single-parent households. Children with existing special health care needs had three times as many bed days and school absence days as other children. An estimated 11% of children with existing special health care needs were uninsured, 6% were without a usual source of health care, 18% were reported as dissatisfied with one or more aspects of care received at their usual source of care, and 13% had one or more unmet health needs in the past year.Conclusions. A substantial minority of US children were identified as having an existing special health care need using national survey data. Children with existing special health care needs are disproportionately poor and socially disadvantaged. Moreover, many of these children face significant barriers to health care.
Decreasing Nonurgent Emergency Department Utilization by Medicaid Children
Authors: Grossman Lindsey K. , Rich Leslie N. , Johnson Catherine 
Published: August 2004

Objective. To test interventions to decrease the utilization of hospital emergency departments (EDs) for routine, nonemergent health care among Medicaid recipients.Methods. Families of a Medicaid-recipient child presenting to a children's hospital ED for nonurgent problems received information from either a health professional or a clerical employee about the importance of a primary care provider and assistance with making an appointment to the provider of their choice. The health professional continued to work with her assigned families in eliminating barriers to appropriate utilization of a primary care provider for up to 3 months after the index ED visit. A third (comparison) group received no intervention. Subsequent health care utilization for each enrollee was tracked via Ohio Medicaid claims data throughout the four subsequent 6-month periods after the index ED visit.Results. Children in the intervention groups had 11.1% and 14.5% fewer nonurgent ED visits in the 6 months after the index ED visit with a concomitant decrease in cost for this type of care when compared with the comparison group during the same time period. No difference in the number of preventive or ill-child primary care visits was seen. There was no difference in health care cost or utilization in the time period 6 to 24 months after the intervention.Conclusions. Interventions in pediatric EDs aimed at decreasing subsequent ED utilization for nonurgent care can be effective, resulting in modest decreases in the cost of health care for a Medicaid population.
Cost-effectiveness of Care for Very Low Birth Weight Infants
Authors: Rogowski Jeannette 
Published: August 2004

Objective. Very low birth weight (VLBW)infants (those with birth weights &lt;1500 g) account for only 1.2% of births but 46% of infant deaths. Large improvements in neonatal technology in the last 2 decades have significantly improved survival prospects for infants with low birth weights, but at a high cost. Due largely to a lack of data, the costs of medical care during the period in which infant mortality is measured (the first year of life), as well as the cost-effectiveness of that care for VLBW infants, have not been quantified. Despite this fact, public policies both toward providing insurance coverage for their care, as well as denying payment for their treatment, have either been proposed or implemented on cost-effectiveness grounds.Patients. The study includes all VLBW single live births in the state of California during 1986 and 1987 that were continuously eligible (through traditional channels) for the state's Medicaid program.Main Outcome Measures. Treatment costs were measured for all medical care received during the first year of life, including all inpatient and outpatient care received. The cost-effectiveness of care is measured by aggregate treatment costs for all singleton VLBW liveborns divided by the number of first-year survivors.Results. Average treatment costs per first-year survivor for infants &lt;1500 g was $93 800 (in 1987 constant dollars). Treatment costs per survivor were twice as high for infants &lt;750 g ($273 900) as for the next highest birth weight group 750 to 999 g ($138 800) which was itself almost twice as high as for the 1000 to 1249 g group ($75 100). The gradient in cost-effectiveness with birth weight then drops off to $58 000 per survivor for infants with birth weights between 1250 and 1499 g.Conclusion. Public policies aimed at improving birth outcomes by providing insurance coverage for pregnant women and children, such as the recent Medicaid expansions, can potentially be very cost-effective. Although maternal interventions such as prenatal care are relatively inexpensive, each normal birth that results instead in a VLBW birth saves $59 700 in first year medical expenses. However, cost savings attributable to increased birth weights depend on where in the birth weight distribution the increase occurs as well as the size of the birth weight increase. For infants with birth weights &gt;750 g, significant gains can accrue from even a small shift in the birth weight distribution. A shift of 250 g at birth saves an average of $12 000 to $16 000 in first year medical costs and a shift of 500 g generates $28 000 in savings. However, there is a threshold effect on birth weight. For infants &lt;750 g, increases in birth weight may increase medical expenditures. For instance, a shift in birth weight to the 750 to 999 g range increases costs by $29 000.