bluuebunny/crossref_metadata_2025_split huggingface dataset:
Medicaid Participation by Private and Safety Net Pediatricians, 1993 and 2000
Authors: Tang Suk-fong S. , Yudkowsky Beth K. , Davis Jean C. 
Published: August 2004

Background. Eligibility expansions and managed care growth were 2 major forces shaping the Medicaid program during the 1990s. Although Medicaid managed care was introduced to contain rising costs of growing enrollment and expenditures, it also offered states an opportunity to improve enrollees’ access to mainstream health care providers. By enrolling in commercial managed care plans, they could gain access to private office-based physicians, thus eliminating a 2-tiered health care system.Objectives. To investigate changes in private and safety net pediatricians’ participation in Medicaid between 1993 and 2000, a period noted for eligibility expansion for children and rapid managed care growth.Design. Survey data collected from private and safety net pediatricians in 1993 and 2000 were analyzed to investigate how pediatricians’ Medicaid caseloads were affected by 1) their practice setting, and 2) whether they accepted all Medicaid patients.Results. Pediatricians’ Medicaid caseloads increased significantly between 1993 and 2000, with those in private practice settings reporting greater increases. More pediatricians accepted all Medicaid patients in 2000, but Medicaid caseloads remained twice as high for safety net pediatricians. Medicaid caseloads increased dramatically for those accepting all Medicaid patients, except in safety net settings, where pediatricians who were turning away some Medicaid patients had heavier Medicaid caseloads than those who accepted all Medicaid patients.Conclusions. Although Medicaid children were still disproportionately served in the safety net in 2000, their access to private pediatricians had improved since 1993. But a ceiling in the safety net’s capacity to absorb more Medicaid patients was suggested by the finding that safety net pediatricians turned away Medicaid patients as their Medicaid caseloads increased. Combined with decreasing participation by commercial plans in the Medicaid managed care market, increasing hospital emergency department overloads, and growing Title XXI Medicaid enrollments, interventions may be needed to avert a looming pediatric provider shortage for publicly insured low-income children.
Treating Exacerbations of Asthma in Children: The Role of Systemic Corticosteroids
Authors: Rachelefsky Gary 
Published: August 2004

Objective. To review the use of systemic corticosteroids to treat recurrent, acute asthma episodes in children, with a focus on the role of oral corticosteroids.Methods. A comprehensive review of the literature was performed using the Medline database (January 1966–October 2002) and the Embase database (January 1980–August 2002).Results. The significant findings of 17 selected, controlled clinical trials of oral corticosteroids (OCSs) for acute exacerbations of asthma in children, compared with placebo or with other formulations of corticosteroids, can be summarized as follows: 1) OCSs are effective for the outpatient treatment of acute asthma, 2) pulmonary function tests may not be the best means of assessing the efficacy of OCSs for acute asthma, 3) early administration of OCSs for acute asthma reduces hospitalizations, 4) the critical factor for a positive outcome is early administration of the corticosteroid, and 5) OCSs are preferred for the outpatient treatment of acute asthma.Conclusions. Early treatment of acute asthma symptoms with OCSs in children with a pattern of recurrent acute asthma may decrease the severity of acute asthma episodes and reduce the likelihood of subsequent relapses. Attention should be given to identifying these children and standardizing a treatment approach based on accepted, consistent definitions of what constitutes an asthma exacerbation and recurrence. A suggested protocol is described.
Prevention of Medication Errors in the Pediatric Inpatient Setting
Authors:   Committee on Drugs and Committee on Hospital Care
Published: August 2004

This Policy Statement was retired May 2011.
Although medication errors in hospitals are common, medication errors that result in death or serious injury occur rarely. Even before the Institute of Medicine reported on medical errors in 1999, the American Academy of Pediatrics and its members had been committed to improving the health care system to provide the best and safest health care for infants, children, adolescents, and young adults. This commitment includes designing health care systems to prevent errors and emphasizing the pediatrician’s role in this system. Human and device errors can lead to preventable morbidity and mortality. National and state legislative actions have heightened public awareness of these events. All involved persons, beginning with the physician and including every member of the health care team, must be better educated about and engaged in the several steps recommended to decrease these errors. The safe administration of medications to hospitalized infants and children requires additional specific safeguards that are above and beyond those for adult patients. Pediatricians should help hospitals develop effective programs for safely providing medications, reporting medication errors, and creating an environment of medication safety for all hospitalized pediatric patients.
Uninsured Children: How We Count Matters
Authors: Tang Suk-fong S. , Olson Lynn M. , Yudkowsky Beth K. 
Published: August 2004

Background. Because children uninsured for less than a full year are often reported as insured, they receive less attention in health policy debates than do the full-year uninsured and are underrecognized as potential users of public insurance programs.
Objective. The purpose of this study is to assess the impact on estimates of how many US children are uninsured when alternatives to the full-year uninsured definition are used.
Methods. Monthly health insurance coverage data collected from children through age 18 in the 1999 Medical Expenditure Panel Survey were analyzed to estimate prevalence of health insurance gaps among children in terms of the size of part-year and full-year uninsured child population, duration of uninsured gaps, and aggregate uninsured spells.
Results. Although 6.6 million ([M] 8.4%) children in the United States were uninsured throughout 1999, an additional 11.4M (14.4%) were uninsured for part of the year. Part-year uninsured gaps accounted for 41.7% of a total of 130M months of missing coverage experienced by all children.
Conclusions. Different definitions and measures of who are uninsured can project radically different pictures of the magnitude of the problem. As this study shows, including the part-year uninsured more than doubled the estimated uninsured child population for 1999, and increased the estimated aggregate uninsured months by 71%. As potential users of public coverage, children who have no insurance for part of the year should be included when evaluating challenges to and accomplishments by the State Children’s Health Insurance Program and other public programs. Their significant numbers and the potential burden they place on the health care delivery system argue for them to be counted and for the causes and consequences of short-term uninsured spells to be better understood.
Long-Term Neuropsychologic and Health Outcomes of Children With Facial Nerve Palsy Attributable to Lyme Disease
Authors: Vázquez Marietta , Sparrow Sara S. , Shapiro Eugene D. 
Published: August 2004

Background. There is little information about the long-term outcomes of children with facial nerve palsy attributable to Lyme disease, a group putatively at high risk for poor neurologic outcomes.Objective. The purpose of this study is to assess the long-term neuropsychologic and health outcomes of children with facial nerve palsy attributable to Lyme disease.Methods. We conducted a matched cross-sectional study of children with facial nerve palsy in Connecticut who met the Centers for Disease Control and Prevention national surveillance case definition for Lyme disease. We identified children with facial nerve palsy attributable to Lyme disease from population-based data for the state of Connecticut from 1984 to 1991 as well as from selected clinical practices from 1984 to 1998. For each case, 2 controls without Lyme disease, matched by age, were selected by sequential digit dialing technique. Both patients and controls (or their parents) were interviewed using structured questionnaires. Outcomes included self/parents’ reports both of symptoms and of abilities to perform normal daily activities since the diagnosis was made (or for an equivalent period of time for controls). In addition, the patients with facial nerve palsy attributable to Lyme disease were evaluated with a battery of neuropsychologic tests.Results. Of the 43 patients, 30% were female and 93% were white. Median age at diagnosis was 8 years (range: 2–18 years). Mean time to follow-up was 49 months (range: 7–161 months). Of the patients, 16% had been treated parenterally with ceftriaxone and 84% had been treated orally with either doxycycline or amoxicillin. Overall, 79% believed they were cured of Lyme disease, 9% believed they were not cured, and 12% did not know. The proportions of patients and of matched controls that reported increased problems with normal daily activities (eg, exercise, academic performance, word recall, sleeping) were similar. Patients with facial nerve palsy attributable to Lyme disease were more likely than matched controls to report symptoms of neck pain, changes in behavior, pains in joints or muscles, numbness or funny sensations in nerves, and problems with memory, but three quarters of them did not attribute these problems to Lyme disease. Twenty patients agreed to undergo neuropsychologic testing; all had average to above average scores on tests of IQ (eg, mean IQ was 110.2), memory, learning, attention, concentration, math, reading and spelling performance, executive functioning, abstract thinking, sequential processing, visuospatial scanning, and motor speed. There were no apparent differences in outcomes between children who received oral versus parenteral treatment.Conclusions. The neuropsychologic and health outcomes of children with facial nerve palsy attributable to Lyme disease 7 to 161 months earlier are comparable to those who did not have Lyme disease.
A Retrospective Cohort Study of the Association of Varicella Vaccine Failure With Asthma, Steroid Use, Age at Vaccination, and Measles-Mumps-Rubella Vaccination
Authors: Verstraeten Thomas , Jumaan Aisha O. , Mullooly John P. , Seward Jane F. , Izurieta Hector S. , DeStefano Frank , Black Steven B. , Chen Robert T. ,   the Vaccine Safety Datalink Research Group
Published: August 2004

Objective. Varicella breakthrough, the occurrence of varicella disease &gt;42 days after vaccination, is indicative of vaccination failure. A sevenfold increased risk of breakthrough among vaccinated children with asthma was observed in a 1996 varicella outbreak in a child care center. More recent outbreak investigations have also identified age at vaccination as a potential risk factor for breakthrough. We assessed the association of varicella breakthrough with asthma, steroids, age at varicella vaccination, and timing of measles-mumps-rubella (MMR) vaccination.Methods. We performed a retrospective cohort study among children born after 1993 and followed up through 1999 at 2 health maintenance organizations ([HMOs] A and B) in the United States. Information was obtained from automated vaccination, clinic, hospital discharge, and pharmacy records.Results. We identified 268 and 97 breakthrough cases among 80 584 and 8181 children vaccinated against varicella at HMOs A and B, respectively. Varicella breakthrough was not associated with asthma, inhaled steroids prescribed at any time, and oral steroids prescribed before vaccination. An increased risk of varicella breakthrough was found in the 3 months immediately after prescription for oral steroids at HMO A (adjusted relative risk [aRR]: 2.4; 95% confidence interval [CI]: 1.3–4.4) and HMO B (aRR: 2.8; 95% CI: 1.0–7.8), when varicella vaccine was given before 15 months of age at HMO A (aRR: 1.4; 95% CI: 1.1–1.9), and when varicella vaccination followed MMR vaccine within 28 days at HMO A (aRR: 3.1; 95% CI: 1.5–6.4).Conclusions. Varicella vaccine failure in children was not associated with asthma or the use of inhaled steroids, but with the use of oral steroids. Administration of varicella vaccine before the age of 15 months may be associated with a slightly increased risk of breakthrough disease. As currently recommended, varicella vaccination should not be administered for 28 days after MMR vaccination.
Kawasaki Syndrome Hospitalizations in the United States, 1997 and 2000
Authors: Holman Robert C. , Curns Aaron T. , Belay Ermias D. , Steiner Claudia A. , Schonberger Lawrence B. 
Published: August 2004

Objective. To estimate the incidence and describe the epidemiologic characteristics of Kawasaki syndrome (KS) among children in the United States.Methods. Hospital discharge records with a KS diagnosis among patients &lt;18 years of age were obtained from the 1997 and 2000 Kids’ Inpatient Database and weighted to estimate the number and rate of KS-associated hospitalizations for the United States.Results. In 2000, ∼4248 hospitalizations associated with KS occurred in the United States, and the median age of patients at admission was 2 years. Children &lt;5 years of age accounted for 3277 of these KS hospitalizations (77%) and had a KS hospitalization rate of 17.1 per 100 000 children. This rate was similar to the 1997 rate of 17.6 per 100 000 children. The KS hospitalization rate was significantly higher for infants &lt;1 year of age than for children 1 to 4 years of age (19.8 and 16.4 per 100 000 children, respectively). The rate of KS hospitalizations among children aged &lt;5 years was highest among Asian and Pacific Islander children and was followed by the rate for black children (39.0 and 19.7 per 100 000 children, respectively). No deaths associated with KS were reported among hospitalized children. The median charge for a KS hospitalization was $7779 (mean $10 725) and the total annual charges for KS hospitalizations in 2000 were approximately $35 million among children &lt;5 years of age.Conclusions. Among children &lt;5 years of age, the annual KS-associated hospitalization rates were similar for 1997 and 2000. The epidemiologic characteristics and hospitalization rates for KS at a national level were consistent with those reported from earlier studies, suggesting that the incidence for KS has not markedly changed in the United States during the past decade.
Guiding Medical Students Through the Match: Perspectives From Recent Graduates
Authors: Englander Robert , Carraccio Carol , Zalneraitis Edwin , Sarkin Richard , Morgenstern Bruce 
Published: August 2004

Objective. Little has been written about the counseling of medical students as they go through the process of selecting and ranking residency programs for the National Resident Matching Program. The Association of Pediatric Program Directors (APPD) and the Council on Medical Student Education in Pediatrics jointly sought to evaluate the current status of advice and counseling for students going through the Match, and to elicit suggestions for improvement.
Methods. Surveys evaluating satisfaction with aspects of and advice received regarding the Match were sent to each of the 199 Accreditation Council for Graduate Medical Education accredited member programs of the APPD with a request that they be distributed to all first-year pediatric residents during the orientation process for the 2001–2002 academic year. Surveys were both voluntary and anonymous. Results were compiled by the administration of the APPD.
Results. We received responses from 42% of all US pediatric categorical or combined residents entering pediatric residency in July of 2001. Respondents included at least 1 representative from every US medical school. Ninety-seven percent of respondents were either very satisfied (88%) or somewhat satisfied (9%) with where they matched, whereas 82% were either very (42%) or somewhat (40%) satisfied with the advice they received regarding the match. The Fellowship and Residency Interactive Database, the faculty advisor, and resident-to-student counseling were the top 3 resources identified by the respondents. Of 12 resources listed in the survey, only the Green Book was rated as unhelpful. Four areas for improvement regarding the advising process were identified: timing, standardization, and quantity of advice and accuracy of online information resources, with specific suggestions given for each.
Conclusions. Overall, recent medical school graduates are quite satisfied with both where they matched in pediatrics and the process that got them there. However, several areas for improvement in the advising/counseling system were identified. Potential approaches to these concerns or resources to develop approaches to them were identified.
Influence of Insurance Status and Vaccine Cost on Physicians’ Administration of Pneumococcal Conjugate Vaccine
Authors: Davis Matthew M. , Ndiaye Serigne M. , Freed Gary L. , Kim Christopher S. , Clark Sarah J. 
Published: August 2004

Objective. In 2000, heptavalent pneumococcal conjugate vaccine (PCV7) was recommended for children younger than 2 years, but its high cost relative to other universally recommended childhood immunizations and variability in insurance coverage for the vaccine raised concerns. We investigated the influence of PCV7 cost and insurance coverage on physician recommendation of PCV7 to their patients and administration of PCV7 in their practices.Methods. We conducted a mail survey from April to July 2001 of a random sample of 833 pediatricians and 788 family physicians in 24 states with different vaccine financing strategies (Vaccines for Children [VFC]-only; enhanced VFC; universal purchase). Physicians specified the proportion of children in their practice with insurance coverage for PCV7, where they recommend administering PCV7, and whether they have concerns about the cost of PCV7.Results. The response rate was 60%. Overall, 87% of physicians recommend PCV7 for children younger than 2 years (99% pediatricians; 68% family physicians). Among physicians who recommend PCV7, 98% said that they would administer the vaccine in their own practices for children whose insurance covers the vaccine. However, only 56% of physicians who recommend PCV7 reported that all children in their practices had insurance coverage for the vaccine, whereas 24% of physicians reported 86% to 99% of children with coverage and 20% reported ≤85% of children with coverage. Among physicians in the last group with the lowest PCV7 insurance coverage rates in their practices, only 44% said that they would administer the vaccine in their own practices to children without PCV7 coverage, compared with 62% of physicians who provide care to children with higher rates of PCV7 coverage. Physicians in states with VFC-only vaccine financing strategies for PCV7 are less likely to administer PCV7 in their own practices to children without coverage than physicians in states with enhanced VFC and universal purchase strategies (48% vs 64% vs 74%). Almost one third of physicians who recommend PCV7 are concerned about the cost of PCV7; those with cost concerns are more likely to recommend that children without insurance coverage for PCV7 receive the vaccine at a public health clinic rather than in their own practices (45% vs 29%). Physicians with cost concerns are also more likely to say that they now screen children for insurance coverage more than for previously recommended vaccines (52% vs 21% for physicians without cost concerns).Conclusions. Nationwide, physician adoption of PCV7 recommendations is high, but where physicians recommend that PCV7 be administered differs significantly by children’s variable insurance coverage for the vaccine and by state vaccine financing strategies. Physicians’ concerns about the cost of PCV7 may foreshadow their responses to future children’s vaccines that may be even more expensive.
Treatment of Otitis Media With Observation and a Safety-Net Antibiotic Prescription
Authors: Siegel Robert M. , Kiely Michele , Bien James P. , Joseph Evelyn C. , Davis James B. , Mendel Sandra G. , Pestian John P. , DeWitt Thomas G. 
Published: August 2004

Objective. Several studies have demonstrated that acute otitis media (AOM) in children can be managed without antibiotics. Because children with AOM have traditionally been treated with antibiotics in the United States, there are concerns that parents may not be comfortable with their children being treated with pain control alone. Recently, Cates in England showed that antibiotic usage for AOM could be decreased by prescribing a safety-net antibiotic prescription (SNAP) to be filled if symptoms do not resolve with observation after 48 hours. It is not clear whether a SNAP will be acceptable to parents in other settings such as the United States. The objective of our study was to determine whether parents in the United States find a SNAP for AOM acceptable and whether antibiotic usage could be decreased by its use.
Methods. A pediatric practice-based research network in a midwestern community of 1.8 million was the setting for this study. The Cincinnati Pediatric Research Group (CPRG) includes practices in Ohio, Kentucky, and Indiana. Children who were between 1 and 12 years of age and presented to the offices of the CPRG with uncomplicated AOM were eligible for the study. Children were excluded when they had temperature &gt;101.5°F, had an ear infection in the past 3 months, showed signs of another bacterial infection, or were toxic appearing. Families were given acetaminophen, ibuprofen, or topical otic anesthetic drops for pain control. They were also given a prescription for an antibiotic and instructed not to fill it unless symptoms either increased or did not resolve after 48 hours. The data were entered directly by investigators via an Internet site.
Results. A total of 194 children were enrolled in 11 offices over 12 months; 175 (90%) completed the follow-up interview. The average child’s age was 5.0 years. Only 55 (31%) of the 175 who were contacted for follow-up had filled their antibiotic prescription. Compared with their previous experience, parents were overwhelmingly willing to treat AOM with pain medication alone (χ2 = 111). Seventy-eight percent (95% confidence interval: 71%–84%) of parents reported that the pain medication was effective. Sixty-three percent (95% confidence interval: 55%–70%) of parents reported that they would be willing to treat future AOM episodes without antibiotics and with pain medication alone.
Conclusions. A subset of parents find a safety-net prescription and pain control acceptable in the treatment of AOM, and antibiotic usage can be lowered with this strategy.