Archives of pediatrics & adolescent medicine最新文献

Objective: To evaluate the expected change in the prevalence of male circumcision (MC)-reduced infections and resulting health care costs associated with continued decreases in MC rates. During the past 20 years, MC rates have declined from 79% to 55%, alongside reduced insurance coverage.

Design: We used Markov-based Monte Carlo simulations to track men and women throughout their lifetimes as they experienced MC procedure-related events and MC-reduced infections and accumulated associated costs. One-way and probabilistic sensitivity analyses were used to evaluate the impact of uncertainty.

Setting: United States.

Participants: Birth cohort of men and women.

Intervention: Decreased MC rates (10% reflects the MC rate in Europe, where insurance coverage is limited).

Outcomes measured: Lifetime direct medical cost (2011 US$) and prevalence of MC-reduced infections.

Results: Reducing the MC rate to 10% will increase lifetime health care costs by $407 per male and $43 per female. Net expenditure per annual birth cohort (including procedure and complication costs) is expected to increase by $505 million, reflecting an increase of $313 per forgone MC. Over 10 annual cohorts, net present value of additional costs would exceed $4.4 billion. Lifetime prevalence of human immunodeficiency virus infection among males is expected to increase by 12.2% (4843 cases), high- and low-risk human papillomavirus by 29.1% (57 124 cases), herpes simplex virus type 2 by 19.8% (124 767 cases), and infant urinary tract infections by 211.8% (26 876 cases). Among females, lifetime prevalence of bacterial vaginosis is expected to increase by 51.2% (538 865 cases), trichomoniasis by 51.2% (64 585 cases), high-risk human papillomavirus by 18.3% (33 148 cases), and low-risk human papillomavirus by 12.9% (25 837 cases). Increased prevalence of human immunodeficiency virus infection among males represents 78.9% of increased expenses.

Conclusion: Continued decreases in MC rates are associated with increased infection prevalence, thereby increasing medical expenditures for men and women.

Objectives: To estimate the prevalence of positive screens for social-emotional problems among preschool-aged children in a low-income clinical population and to explore the family context and receptivity to referrals to help guide development of interventions.

Design: Observational, cross-sectional study.

Setting: Two urban primary care clinics.

Participants: A total of 254 parents of 3- and 4-year-old children at 2 urban primary care clinics.

Main outcome measures: Score on a standardized screen for social-emotional problems (Ages and Stages Questionnaire: Social-Emotional) and answers to additional survey questions about child care arrangements, parental depressive symptoms, and attitudes toward preschool and behavioral health referrals.

Results: Twenty-four percent (95% CI, 16.5%-31.5%) of children screened positive for social-emotional problems. Among those screening positive, 45% had a parent with depressive symptoms, and 27% had no nonparental child care. Among parents of children who screened positive for social-emotional problems, 79% reported they would welcome or would not mind a referral to a counselor or psychologist; only 16% reported a prior referral.

Conclusions: In a clinical sample, 1 in 4 low-income preschool-aged children screened positive for social-emotional problems, and most parents were amenable to referrals to preschool or early childhood mental health. This represents an opportunity for improvement in primary prevention and early intervention for social-emotional problems.

Objective: To determine whether correction of anemia of prematurity by packed red blood cell transfusion improves sucking.

Design: Nonexperimental intervention study.

Setting: Neonatal intensive care unit of Shaare Zedek Medical Center, Jerusalem, Israel, between July 23, 2006, and December 16, 2007.

Patients: Thirty-six neonates at a gestational age of 34 weeks or younger, feeding orally, who developed anemia of prematurity.

Intervention: Packed red blood cell transfusion, 15 mL/kg.

Main outcome measures: Change in sucking parameters recorded with the Kron Nutritive Sucking Apparatus for 5 minutes and ingested volume, prior to and 1 to 2 days after intervention.

Results: The mean (SD) gestational age was 30.1 (2.1) weeks, and the mean (SD) birth weight was 1436 (45) g. At the time of the study, the mean (SD) postnatal age was 46 (26) days, the mean (SD) weight was 2311 (36) g, and the mean (SD) hematocrit was 26.7% (2.6%). Overall, there was no change in the number of sucks, number of bursts, or maximum negative pressure generated. Daily weight gain increased after transfusion (mean [SD] weight gain, 30.9 [10.0] g before transfusion vs 36.5 [13.0] g after transfusion; P=.02). The babies were then stratified into those below the median number of sucks (109 sucks) before transfusion (poor feeders) and those at or above the median (better feeders). In the former subgroup only, changes from before transfusion to after transfusion were found in the number of sucks (mean [SD] sucks, 73.4 [29.5] vs 108.9 [53.3], respectively; P=.006; mean [SD] sucks per burst, 3.4 [1.4] vs 4.9 [2.8], respectively; P=.01) and volume consumed (mean [SD] volume, 17.1 [9.8] mL vs 23.2 [12.8] mL, respectively; P=.004).

Conclusions: Correction of anemia of prematurity with blood transfusion improved sucking and volume ingested in premature infants who were poor feeders prior to the transfusion. It also enhanced overall weight gain.

Object: To assess whether younger siblings of participants in an early (preschool) educational program would benefit in terms of developmental and educational outcomes.

Design: Assessment of a cohort of siblings of intervention participants at a mean age of 13.5 years.

Setting: The Infant Health and Development Program (IHDP), an 8-site randomized trial of 3 years of early education for premature low-birth-weight infants who were followed up through 18 years of age.

Participants: Siblings born within 5 years of the IHDP study participants.

Main exposure: A sibling born no more than 5 years earlier who participated in the IHDP.

Main outcome measures: Observed IQ; youth report of behavioral problems, their expectations of future success, and their relationship with their parents; and the caregiver's report on the youth's school progress and their expectations of the youth's educational attainment.

Results: Of 878 IHDP participants who were followed up, 466 (53.1%) had an eligible younger sibling, and 229 of those siblings (49.1%) agreed to participate. No differences were seen between the siblings of those who did and did not receive the IHDP intervention on any of the outcome measures. Adjusting for maternal race/ethnicity, age, and educational attainment at the birth of the study participant; study site; sex of the sibling; and losses to the cohort did not alter the results.

Conclusion: Participation in an early educational program confers no apparent benefit on younger siblings in their early adolescent years.