Publications by authors named "Lawrence C Kleinman"
Article Synopsis
- Research highlights a critical gap in understanding long COVID (PASC) in children and emphasizes the need for studies that define its characteristics in this age group.
- The objective is to identify common prolonged symptoms in children aged 6 to 17 post-SARS-CoV-2 infection, examining differences between school-age kids and adolescents, as well as potential symptom clusters for future research.
- A multicenter study involved nearly 5,000 participants, revealing that certain symptoms were significantly more prevalent in those with a history of COVID-19 compared to those without.
Article Synopsis
- Behavioral and mental health disorders are prevalent among children, adolescents, and young adults, leading to increased use of medications, but there’s limited research on the combinations of these drugs in outpatient settings, particularly in New York Medicaid.
- In a study of over 2.4 million Medicaid enrollees under 21 from 2014, about 5.8% were prescribed BMH medications, with 37.8% of those engaged in polypharmacy, resulting in thousands of distinct drug combinations.
- Although contraindicated drug pairs were relatively rare among those prescribed BMH medications, the study identified risks, particularly related to prolonged QT intervals and serotonin syndrome, emphasizing the need for clinicians to carefully
Importance: The prevalence, pathophysiology, and long-term outcomes of COVID-19 (post-acute sequelae of SARS-CoV-2 [PASC] or "Long COVID") in children and young adults remain unknown. Studies must address the urgent need to define PASC, its mechanisms, and potential treatment targets in children and young adults.
Observations: We describe the protocol for the Pediatric Observational Cohort Study of the NIH's REsearching COVID to Enhance Recovery (RECOVER) Initiative.
Dysregulated innate immune responses contribute to multisystem inflammatory syndrome in children (MIS-C), characterized by gastrointestinal, mucocutaneous, and/or cardiovascular injury occurring weeks after SARS-CoV-2 exposure. To investigate innate immune functions in MIS-C, we stimulated peripheral blood cells from MIS-C patients with agonists of Toll-like receptors (TLR), key innate immune response initiators. We found severely dampened cytokine responses and elevated gene expression of negative regulators of TLR signaling.
View Article and Find Full Text PDFArticle Synopsis
- - The RECOVER-Pediatrics study aims to investigate the prevalence and long-term effects of Long COVID (PASC) in children and young adults, addressing the need for more research in this area.
- - The study recruits caregiver-child pairs and young adults across 100+ sites in the U.S., focusing on a diverse group of participants with and without prior SARS-CoV-2 infections, and will collect data over several years through various tiers of assessments.
- - The ultimate goal of the study is to understand the clinical trajectory, mechanisms, and sociodemographic factors related to pediatric PASC, thereby contributing to potential treatments and public health responses.
Article Synopsis
- - The study investigates whether disparities in hospital utilization, specifically length of stay (LOS) and costs, are linked to ZIP codes in children with traumatic brain injury (TBI) using the Child Opportunity Index (COI).
- - Conducted as a multicenter retrospective cohort study using data from the Pediatric Health Information System (PHIS), it analyzed 8,055 children aged 0-18 years with TBI admitted to PICUs between 2016 and 2020.
- - Results showed that children from very low COI ZIP codes had a 10.2% longer average hospital stay compared to those from very high COI areas, but COI did not correlate with hospital costs and was not predictive for children with
Trends in Disease Severity Among Critically Ill Children With Severe Acute Respiratory Syndrome Coronavirus 2: A Retrospective Multicenter Cohort Study in the United States.
Pediatr Crit Care Med
January 2023
Article Synopsis
- This study assessed trends in pediatric critical illness due to SARS-CoV-2 during the COVID-19 pandemic, focusing on differences between the Omicron wave in January 2022 and the original outbreak in March 2020.
- It found that while PICU admissions were seven times higher during the Omicron period, the need for endotracheal intubation was either reduced or unchanged, suggesting that younger patients may have been affected differently.
- The study included 267 patients, highlighting the importance of ongoing research into the varying impacts of COVID-19 on children throughout different phases of the pandemic.
Purpose: Explore factors associated with flourishing and family resilience among children aged 6 months to 5 years old in the 2016 National Survey of Children's Health (NSCH).
Design And Methods: Cross-sectional analysis of the 2016 NSCH was conducted using Kleinman and Norton's Regression Risk Analysis method to derive adjusted risk measures for logistic regression models to assess factors contributing to (1) child flourishing and (2) child flourishing stratified between resilient and non-resilient families.
Results: In multivariable models, resilient families less often reported a child with two or more lifetime ACE exposures (ARD -0.
Objective: To assess variation in asthma-related emergency department (ED) use between weekends and weekdays.
Methods: Cross-sectional administrative claims-based analysis using California 2016 Medicaid data and Vermont 2016 and Massachusetts 2015 all-payer claims databases. We defined ED use as the rate of asthma-related ED visits per 100 child-years.
Importance: Multisystem inflammatory syndrome in children (MIS-C) is associated with recent or current SARS-CoV-2 infection. Information on MIS-C incidence is limited.
Objective: To estimate population-based MIS-C incidence per 1 000 000 person-months and to estimate MIS-C incidence per 1 000 000 SARS-CoV-2 infections in persons younger than 21 years.
Importance: Coronavirus disease 2019 (COVID-19) affects the nervous system in adult patients. The spectrum of neurologic involvement in children and adolescents is unclear.
Objective: To understand the range and severity of neurologic involvement among children and adolescents associated with COVID-19.
Objective: Improvement efforts in pediatric primary care would benefit from measures that capture families' holistic experience of the practice. We sought to assess the reliability and validity of the new Person-Centered Primary Care Measure (PCPCM) in a pediatric resident continuity clinic serving low-income families.
Methods: We incorporated the 11-item PCPCM, stems adapted to reflect a parent responding about their child's visit, into a telephone survey of 194 parents presenting for care in October 2019 at a pediatric resident continuity clinic in Cleveland Ohio (64% response rate).
Background: Understanding the epidemiology and clinical course of multisystem inflammatory syndrome in children (MIS-C) and its temporal association with coronavirus disease 2019 (Covid-19) is important, given the clinical and public health implications of the syndrome.
Methods: We conducted targeted surveillance for MIS-C from March 15 to May 20, 2020, in pediatric health centers across the United States. The case definition included six criteria: serious illness leading to hospitalization, an age of less than 21 years, fever that lasted for at least 24 hours, laboratory evidence of inflammation, multisystem organ involvement, and evidence of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) based on reverse-transcriptase polymerase chain reaction (RT-PCR), antibody testing, or exposure to persons with Covid-19 in the past month.
Video-electroencephalogram (EEG) monitoring in the epilepsy monitoring unit (EMU) is essential for managing epilepsy and seizure mimics. Evaluation of care in the EMU would benefit from a validated code set capable of identifying EMU admissions from administrative databases comprised of large, diverse cohorts. We assessed the ability of code-based queries to parse EMU admissions from administrative billing records in a large academic medical center over a four-year period, 2016-2019.
View Article and Find Full Text PDFImportance: The recent and ongoing coronavirus disease 2019 (COVID-19) pandemic has taken an unprecedented toll on adults critically ill with COVID-19 infection. While there is evidence that the burden of COVID-19 infection in hospitalized children is lesser than in their adult counterparts, to date, there are only limited reports describing COVID-19 in pediatric intensive care units (PICUs).
Objective: To provide an early description and characterization of COVID-19 infection in North American PICUs, focusing on mode of presentation, presence of comorbidities, severity of disease, therapeutic interventions, clinical trajectory, and early outcomes.
Introduction: Various methods have been used to interpret the reports of pediatric polypharmacy across the literature. This is the first scoping review that explores outcome measures in pediatric polypharmacy research.
Objectives: The aim of our study was to describe outcome measures assessed in pediatric polypharmacy research.
Background And Objectives: Asthma is responsible for ∼1.7 million emergency department (ED) visits annually in the United States. Studies in adults have shown that anxiety and depression are associated with increased asthma-related ED use.
View Article and Find Full Text PDFThe Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit is a key component of Medicaid policy intended to define an essential set of services provided to patients younger than age 21. Given increasing attention to social determinants of health in pediatric health care, this qualitative review examines the extent to which EPSDT might be used to implement structured screening to identify environmental and social factors affecting children's health. Themes derived from semistructured interviews conducted in 2017 were triangulated with a review of the recent literature to describe how states currently consider the EPSDT benefit with respect to social determinants of health screening.
View Article and Find Full Text PDFArticle Synopsis
- Shared decision-making is important for good health care, especially for kids, but it's hard to do well and measure in practice.
- Current methods don't fully consider everyone involved, like parents and doctors, or how small decisions might impact patients later.
- The proposed model focuses on teamwork between kids, parents, and doctors, learning from past decisions to improve future ones, especially for children with special health care needs.
Variation of the prevalence of pediatric polypharmacy: A scoping review.
Pharmacoepidemiol Drug Saf
March 2019
Purpose: To examine the range of prevalence of pediatric polypharmacy in literature through a scoping review, focusing on factors that contribute to its heterogeneity in order to improve the design and reporting of quality improvement, pharmacovigilance, and research studies.
Methods: We searched Ovid Medline, PubMed, EMBASE, CINAHL, Ovid PsycINFO, Cochrane CENTRAL, and Web of Science Core Collection databases for studies with concepts of children and polypharmacy, along with a hand search of the bibliographies of six reviews and 30 included studies. We extracted information regarding study design, disease conditions, and prevalence of polypharmacy.
Unlabelled: : media-1vid110.1542/5852348672001PEDS-VA_2017-3562 BACKGROUND AND OBJECTIVES: Multidisciplinary care teams may improve health and control total cost for children with medical complexity (CMC). We aim to quantify the time required to perform nonreimbursed care coordination activities by a multidisciplinary care coordination program for CMC and to estimate the direct salary costs of that time.
View Article and Find Full Text PDFObjectives: Lack of consensus regarding the semantics and definitions of pediatric polypharmacy challenges researchers and clinicians alike. We conducted a scoping review to describe definitions and terminology of pediatric polypharmacy.
Methods: Medline, PubMed, EMBASE, CINAHL, PsycINFO, Cochrane CENTRAL, and the Web of Science Core Collection databases were searched for English language articles with the concepts of "polypharmacy" and "children".