Hearing Assessment in Infants, Children, and Adolescents: Recommendations Beyond Neonatal Screening.

Children who are deaf or hard of hearing (D/HH) are at high risk for permanent deficits in language acquisition and downstream effects such as poor academic performance, personal-social maladjustments, and emotional difficulties. Identification of children born D/HH through newborn hearing screening and subsequent timely early intervention can prevent or reduce many of these adverse consequences. Ongoing surveillance for changes in hearing thresholds after infancy is also important and should be accomplished by subjective assessment for signs of atypical hearing and with objective screening tests.

Responsibility in the Current Epidemic of Language Deprivation (1990-Present).

Language deprivation syndrome (LDS) is a permanent and preventable disability affecting language, cognition, and behavior that is epidemic in the deaf population. Since 1990, systemic and technological changes in the health care of deaf children have created a new paradigm that perpetuates this crisis. Physicians and other professionals have been largely unaware of their roles in this recent epidemic.

Extreme RNA editing in coding islands and abundant microsatellites in repeat sequences of Selaginella moellendorffii mitochondria: the root of frequent plant mtDNA recombination in early tracheophytes.

Using an independent fosmid cloning approach and comprehensive transcriptome analysis to complement data from the Selaginella moellendorffii genome project, we determined the complete mitochondrial genome structure of this spikemoss. Numerous recombination events mediated mainly via long sequence repeats extending up to 7 kbp result in a complex mtDNA network structure. Peculiar features associated with the repeat sequences are more than 80 different microsatellite sites (predominantly trinucleotide motifs).

Patient use of secure electronic messaging within a shared medical record: a cross-sectional study.

Background: Most patients would like to be able to exchange electronic messages with personal physicians. Few patients and providers are exchanging electronic communications.

Objective: To evaluate patient characteristics associated with the use of secure electronic messaging between patients and health care providers.

Evaluation of the group health cooperative access initiative: study design challenges in estimating the impact of a large-scale organizational transformation.

The Institute of Medicine argues that poorly designed delivery systems are a major cause of low-quality care in the United States but does not present methods for evaluating whether its recommendations, when implemented by a health care organization, actually improve quality of care. We describe how time-series study designs using individual-level longitudinal data can be applied to address methodological challenges in our evaluation of the impact of the Group Health Cooperative "Access Initiative," an integrated set of 7 "patient-centered" reforms in its integrated delivery system that are consistent with the Institute of Medicine's recommendations. The methods may be generalizable to evaluating similar reforms in other integrated delivery systems with representative patient and physician data sources.

Potential medication dosing errors in outpatient pediatrics.

Objective: To determine the prevalence of potential dosing errors of medication dispensed to children for 22 common medications.

Study Design: Using automated pharmacy data from 3 health maintenance organizations (HMOs), we randomly selected up to 120 children with a new dispensing prescription for each drug of interest, giving 1933 study subjects. Errors were defined as potential overdoses or potential underdoses.

Depression and health status in elderly patients with heart failure: a 6-month prospective study in primary care.

To determine the prevalence and effects of depression on health status among elderly outpatients with heart failure, the authors conducted a 6-month prospective cohort study of 139 older outpatients with heart failure managed in primary care and 80 of their spouses. Primary care heart failure diagnosis was confirmed through chart review. The Primary Care Evaluation of Mental Disorders psychiatric diagnostic interview and Hamilton Depression Rating Scale were administered by phone.

Variability in asthma care and services for low-income populations among practice sites in managed Medicaid systems.

Objective: To characterize and describe variability in processes of asthma care and services tailored for low-income populations in practice sites participating in Medicaid managed care (MMC).

Study Setting: Eighty-five practice sites affiliated with five not-for-profit organizations participating in managed Medicaid (three group-model health maintenance organizations [HMOs] and two Medicaid managed care organizations [MCOs]).

Study Design/data Collection: We conducted a mail survey of managed care practice site informants using a conceptual model that included chronic illness care and services targeting low-income populations.

Depression predicts revascularization procedures for 5 years after coronary angiography.

Objective: Depression has been reported to increase cardiac event rates and functional impairment in patients with coronary disease. This article describes the impact of depression on subsequent healthcare utilization for such patients.

Methods: One hundred ninety-eight health maintenance organization patients with stable coronary disease were interviewed after elective angiography using a structured psychiatric diagnostic scale.

Asthma medication use and disease burden in children in a primary care population.

Background: Children with persistent asthma underuse controller medications and overuse relievers. A better understanding of the appropriateness of regimens, medication adherence, and adequacy of asthma control is needed.

Objectives: To describe use of asthma medications and disease burden in children with persistent asthma, to determine whether use of controllers and relievers is consistent with national guidelines, and to estimate adequacy of asthma control.