Pediatrics
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Comparative Study
Outpatient management practices associated with reduced risk of pediatric asthma hospitalization and emergency department visits.
Effective outpatient care is believed to prevent hospitalization and emergency department (ED) visits resulting from childhood asthma. The aim of this study was to suggest priority areas for intervention by identifying outpatient management practices associated with the risk of these adverse outcomes in a large population. ⋯ Practices that support early intervention for asthma flare-ups by parents at home, particularly written management plans, are strongly associated with reduced risk of adverse outcomes among children with asthma.
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Randomized Controlled Trial Clinical Trial
Health care utilization and health status in high-risk children randomized to receive group or individual well child care.
To determine if health care utilization and health status among high-risk children is modified by the use of group well child care (GWCC) as compared with traditional one-to-one individual well child care (IWCC). ⋯ Health care utilization and health status was similar in high-risk children whether they received GWCC or IWCC. GWCC is a viable format for health supervision visits in this population.
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To study the association between maternal/infant characteristics and mortality from injury for children 0 through 4 years of age. ⋯ For young children, maternal education, age, and parity are strongly and independently associated with injury mortality. These factors define a steep gradient of risk, suggesting that many injury deaths could be prevented.
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To assess sexually active adolescents' knowledge, attitudes, and behaviors associated with human immunodeficiency virus (HIV) testing and to determine the factors important in their decision to obtain voluntary HIV testing. ⋯ Among sexually active Massachusetts adolescents, voluntary HIV testing is uncommon. Teens who have had multiple sexual partners and who do not believe condoms are effective in preventing transmission were most likely to have been tested. Issues requiring clearer communication to patients include the testing process, its availability, and confidentiality. Physicians can play an influential role in the promotion of HIV testing by discussing HIV risk behaviors with patients and offering those at risk voluntary HIV counseling and testing.
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Comparative Study
Apnea frequently persists beyond term gestation in infants delivered at 24 to 28 weeks.
Apnea of prematurity remains among the most commonly diagnosed conditions in the Newborn Intensive Care Unit and may prolong hospital stays in some infants. Because survival of extremely premature infants has improved markedly, the natural history of apnea in this population needs to be reassessed. ⋯ Apnea of prematurity frequently persists beyond term gestation in infants delivered at 24 to 28 weeks' gestational age. These persistent apnea and/or bradycardia events may contribute to prolonged hospitalization. Programs to promote earlier discharge of premature infants should take into account the variability in resolution of apnea and specifically address management of persistent apnea.