Identifying pediatric age groups for influenza vaccination using a real-time regional surveillance system.

Evidence is accumulating that universal vaccination of schoolchildren would reduce the transmission of influenza. The authors sought to identify target age groups within the pediatric population that develop influenza the earliest and are most strongly linked with mortality in the population. Patient visits for respiratory illness were monitored, using real-time syndromic surveillance systems, in six Massachusetts health-care settings, including ambulatory care sites and emergency departments at tertiary-care and community hospitals.

A growth curve model of learning acquisition among cognitively normal older adults.

The objective of this study was to model recall and learning on the Auditory Verbal Learning Test using latent growth curve techniques. Participants were older adults recruited for the ACTIVE cognitive intervention pilot. A series of nested models revealed that an approximately logarithmic growth curve model provided optimal fit to the data.

A model-adjusted space-time scan statistic with an application to syndromic surveillance.

The space-time scan statistic is often used to identify incident disease clusters. We introduce a method to adjust for naturally occurring temporal trends or geographical patterns in illness. The space-time scan statistic was applied to reports of lower respiratory complaints in a large group practice.

Group versus individual academic detailing to improve the use of antihypertensive medications in primary care: a cluster-randomized controlled trial.

Purpose: To compare group versus individual academic detailing to increase diuretic or beta-blocker use in hypertension.

Methods: We conducted a cluster-randomized controlled trial in a large health maintenance organization. Subjects (N=9820) were patients with newly treated hypertension in the year preceding the intervention (N=3692), the 9 months following the intervention (N=3556), and the second year following intervention (N=2572).

Longitudinal study of birth weight and adult body mass index in predicting risk of coronary heart disease and stroke in women.

Objectives: To determine whether birth weight and adult body size interact to predict coronary heart disease in women, as has been observed for men. To determine whether birth weight and adult body size interact to predict risk of stroke.

Design: Longitudinal cohort study.

Preterm delivery in Boston before and after September 11th, 2001.

Background: We hypothesized that stress induced by the terrorist attacks of September 11, 2001 might shorten pregnancy. To test this hypothesis, we compared gestational duration and risk of preterm delivery among women who were pregnant on September 11 with women who had delivered before that date.

Study Design: We conducted a matched cohort study among pregnant women enrolled in the Boston-based cohort study Project Viva between 1999 and 2001.

Effects of race, insurance status, and hospital volume on perforated appendicitis in children.

Objective: Previous research suggests that perforated appendicitis is more common in Medicaid patients, but the roles of minority race and hospital volume remain largely unstudied. We sought to investigate the association of perforated appendicitis in children with minority race, insurance status, and hospital volume.

Methods: We conducted a retrospective, population-based cohort study of 33184 children who had an International Classification of Diseases, Ninth Revision diagnosis code for acute appendicitis in The Kids' Inpatient Database, a pediatric database from 22 states in 1997.

Immigration, race/ethnicity, and social and economic factors as predictors of breastfeeding initiation.

Objective: To determine the impact of immigration status as well as race/ethnicity and social and economic factors on breastfeeding initiation.

Design: Cohort.

Setting: Multisite group practice in eastern Massachusetts.

National Bioterrorism Syndromic Surveillance Demonstration Program.

The National Bioterrorism Syndromic Surveillance Demonstration Program identifies new cases of illness from electronic ambulatory patient records. Its goals are to use data from health plans and practice groups to detect localized outbreaks and to facilitate rapid public health follow-up. Data are extracted nightly on patient encounters occurring during the previous 24 hours.

Maternal protein intake is not associated with infant blood pressure.

Background: Animal data show that low protein intake in pregnancy programs higher offspring blood pressure, but similar data in humans are limited. We examined the associations of first and second trimester maternal protein intake with offspring blood pressure (BP) at the age of six months.

Methods: In a prospective US cohort study, called Project Viva, pregnant women completed validated semi-quantitative food-frequency questionnaires (FFQ) to measure gestational protein intake.

Associations of seafood and elongated n-3 fatty acid intake with fetal growth and length of gestation: results from a US pregnancy cohort.

Previous studies, mainly among populations with high consumption of seafood, have suggested that increased marine n-3 polyunsaturated fatty acid (PUFA) intake during pregnancy promotes longer gestation and higher birth weight. Few studies have isolated the contribution of fetal growth to birth weight. Using data from 2,109 pregnant women in Massachusetts enrolled in Project Viva from 1999 to 2002, the authors examined associations of marine n-3 PUFA and seafood intake with birth weight and birth-weight-for-gestational-age z value (fetal growth) using linear regression; length of gestation using median regression; and low birth weight, preterm delivery, and being small for gestational age using logistic regression.

Maternal calcium intake and offspring blood pressure.

Background: Few data exist on the intergenerational influence of calcium intake during pregnancy on offspring blood pressure.

Methods And Results: As part of the ongoing US prospective cohort study Project Viva, we analyzed 4091 Dinamap blood pressure measurements from 936 six-month-old infants whose mothers had completed food frequency questionnaires during the second trimester of pregnancy. We used mixed models to estimate effects of maternal calcium intake on offspring systolic blood pressure.

Child care center policies and practices for management of ill children.

Objectives: The objectives of this study were to 1) describe child care staff knowledge and beliefs regarding upper respiratory tract infections and antibiotic indications and 2) evaluate child care staff reported reasons for a) exclusion from child care, b) referral to a health care provider, and c) recommending antibiotics for an ill child.

Methods: A longitudinal study based in randomly selected child care centers in Massachusetts. Staff completed a survey to assess knowledge regarding common infections.

Differential association of modifiable health behaviors with hot flashes in perimenopausal and postmenopausal women.

Objective: To determine the association of modifiable factors, such as smoking, body mass index, and alcohol use, with hot flashes, and to ascertain whether the association with hot flashes varies by menopausal stage.

Design: A written survey completed by perimenopausal and postmenopausal women enrolling in a randomized, controlled trial of a menopause risk management program in 1999. Survey items included questions on demographics, health status, and health behaviors.

Decreasing women's anxieties after abnormal mammograms: a controlled trial.

Background: Few studies have evaluated interventions to decrease a woman's anxiety after she receives an abnormal mammogram (i.e., one with a recommendation for follow-up).

Community-level predictors of pneumococcal carriage and resistance in young children.

Pneumococcal carriage and resistance vary markedly among communities and are not fully explained by individual predictors. Community risk factors may explain this variation. The authors geocoded addresses from a multicommunity sample of 710 Massachusetts children previously swabbed for pneumococcal carriage in 2001.

Incidence of outpatient visits and hospitalizations related to influenza in infants and young children.

Objective: The Advisory Committee on Immunization Practices currently encourages influenza vaccination for all children aged 6 to 23 months when feasible, based on studies that have demonstrated that young children have high hospitalization rates attributable to influenza. The Advisory Committee on Immunization Practices recently voted to recommend influenza vaccination for all children beginning during the 2004-2005 influenza season; information on the rate of outpatient visits due to influenza is needed to better evaluate the potential health impact and cost-effectiveness of the recommendation. We estimated the incidence of outpatient visits as well as hospitalizations for specific acute respiratory illnesses and for influenza-associated outpatient-visit and hospitalization rates among healthy infants and children in a Massachusetts health maintenance organization.

Perinatal predictors of atopic dermatitis occurring in the first six months of life.

Objective: Previous studies of predictors of atopic dermatitis have had limited sample size, small numbers of variables, or retrospective data collection. The purpose of this prospective study was to investigate several perinatal predictors of atopic dermatitis occurring in the first 6 months of life.

Design: We report findings from 1005 mothers and their infants participating in Project Viva, a US cohort study of pregnant women and their offspring.

Maternal age and other predictors of newborn blood pressure.

Objective: To investigate perinatal predictors of newborn blood pressure.

Study Design: Among 1059 mothers and their newborn infants participating in Project Viva, a US cohort study of pregnant women and their offspring, we obtained five systolic blood pressure readings on a single occasion in the first few days of life. Using multivariate linear regression models, we examined the extent to which maternal age and other pre- and perinatal factors predicted newborn blood pressure level.

Preferences and willingness to pay for health states prevented by pneumococcal conjugate vaccine.

Objective: To measure parents' and other adults' values for preventing disease associated with pneumococcal infection and to evaluate how including these values changes the economic appraisal of pneumococcal conjugate vaccine.

Methods: Data on preferences and willingness to pay to reduce risk of illness were collected for 6 illnesses that are preventable by pneumococcal conjugate vaccine (simple otitis media, complex otitis media, moderate pneumonia, severe pneumonia, bacteremia, and meningitis) and 1 vaccine-related adverse event (fever and fussiness after vaccine). Interviews were conducted with 2 groups of respondents: 1) parents of children who had experienced 1 or more of the outcomes described in the survey (n = 101) and 2) a US community sample (n = 109).

A generalized linear mixed models approach for detecting incident clusters of disease in small areas, with an application to biological terrorism.

Since the intentional dissemination of anthrax through the US postal system in the fall of 2001, there has been increased interest in surveillance for detection of biological terrorism. More generally, this could be described as the detection of incident disease clusters. In addition, the advent of affordable and quick geocoding allows for surveillance on a finer spatial scale than has been possible in the past.

The effect of hospital volume of pediatric appendectomies on the misdiagnosis of appendicitis in children.

Background: Although appendicitis is a common pediatric surgical condition, it is often misdiagnosed. Because higher hospital volume has been associated with improved outcome for many surgical procedures, the current study investigates whether hospital volume of pediatric appendectomies is associated with misdiagnosis of appendicitis in children.

Methods: The Kids' Inpatient Database is a national sample of pediatric discharges from 2521 hospitals in 22 states in 1997.

Leaving the practice: effects of primary care physician departure on patient care.

Background: Recent changes in the organization of health care services, coupled with rising rates of primary care physician (PCP) turnover, pose threats to the maintenance of a continuous patient-physician relationship. Little is known, however, about how PCP departure may affect patients' quality of health care.

Methods: Participants were adult patients whose PCPs left a large, multispecialty group practice from July 1, 1994, to June 30, 1996 (n = 3931), and adult patients of a set of matched PCPs who remained in the practice at least 2 years beyond the index PCPs departure dates (n = 8009).

Antibiotic-resistant Streptococcus pneumoniae in the heptavalent pneumococcal conjugate vaccine era: predictors of carriage in a multicommunity sample.

Objective: Despite immunization with heptavalent pneumococcal conjugate vaccine (PCV7), the rising prevalence of antibiotic resistance makes Streptococcus pneumoniae a continuing threat to child health. Data on carriage of resistant organisms by healthy children in communities in which immunization with PCV7 has been implemented will help to define and decrease these risks further.

Methods: Children who were <7 years old, resided in a study community, and presented for routine well care or a "sick" visit between March 13 and May 11, 2001, at 31 primary care practices in 16 geographically distinct Massachusetts communities were studied.