Issues in studying the effectiveness of health services for children.

Objectives: To discuss issues in studying the effectiveness of health services for children, suggest areas in which more research is needed, and recommend strategies for future research.

Principal Findings: Issues that should be considered include the choice of perspective, which will help determine the interventions studied and the measures of effectiveness and cost-effectiveness chosen. Unique challenges in this area include the fact that serious measurable morbidity is relatively uncommon in children, that causal relationships between services and outcomes may be difficult to establish, and that standard measures of cost-effectiveness may fail to accurately measure important benefits, such as reduced parental anxiety.

Parent reports on willingness to accept childhood immunizations during urgent care visits.

Objectives: To 1) describe whether parents would be willing to accept childhood immunizations at urgent care visits; and 2) identify predictors of parents' willingness to accept childhood immunizations at urgent care visits.

Design And Participants: Cross-sectional telephone survey of parents of children aged 18 to 24 months who were underimmunized according to a computerized immunization tracking system and who had recently made an urgent care visit in a regional group-model health maintenance organization in Northern California. Chart review was conducted to confirm immunization status and to identify contraindications to vaccination.

Neonatal group B streptococcal infection in a managed care population. Perinatal Group B Streptococcal Infection Study Group.

Objective: In a health maintenance organization population, we determined the incidence of early-onset (at less than or equal to 7 days) neonatal group B streptococcal (GBS) disease, the sensitivity and prevalence of labor risk factors, the adherence to a protocol for intrapartum antibiotics, and the costs for care of and outcomes of affected infants.

Methods: Mothers and infants at four health maintenance organization hospitals in northern California in 1989 to 1995 were studied retrospectively using computerized databases and chart review. In 1994, two of the four hospitals had adopted protocols similar to the ACOG recommendations for intrapartum antibiotics for women with labor risk factors (preterm, temperature 100.

Computer-based models to identify high-risk children with asthma.

Effective management of populations with asthma requires methods for identifying patients at high risk for adverse outcomes. The aim of this study was to develop and validate prediction models that used computerized utilization data from a large health-maintenance organization (HMO) to predict asthma-related hospitalization and emergency department (ED) visits. In this retrospective cohort design with split-sample validation, variables from the baseline year were used to predict asthma-related adverse outcomes during the follow-up year for 16,520 children with asthma-related utilization.

Effectiveness and cost-effectiveness of letters, automated telephone messages, or both for underimmunized children in a health maintenance organization.

Background: Immunization rates have improved in the United States, but are still far from the national 90% goal for the year 2000. There is scant evidence about the effectiveness and costs of automated telephone messages to improve immunization rates among privately insured children.

Objective: To evaluate the effectiveness and cost-effectiveness of sending letters, automated telephone messages, or both to families of underimmunized 20-month-olds in a health maintenance organization (HMO).

Varicella serology among school age children with a negative or uncertain history of chickenpox.

Background: Clinicians who offer varicella vaccination to school age children face the dilemma of whether to serotest or vaccinate presumptively. Varicella seroprevalence among 7- to 12-year-old children with negative or uncertain histories has not previously been studied. Our main objective was to describe varicella seroprevalence among children ages 7 to 12 years with a negative or uncertain history of chickenpox.

Projected cost-effectiveness of primary angioplasty for acute myocardial infarction.

Objectives: This study sought to evaluate the cost-effectiveness of primary angioplasty for acute myocardial infarction under varying assumptions about effectiveness, existing facilities and staffing and volume of services.

Background: Primary angioplasty for acute myocardial infarction has reduced mortality in some studies, but its actual effectiveness may vary, and most U.S.

Rising HIV infection rates in Ho Chi Minh City herald emerging AIDS epidemic in Vietnam.

Objective: To describe the epidemiology of HIV in Ho Chi Minh City in the context of current surveillance data from Vietnam.

Methods: Since the late 1980s, HIV surveillance data have been collected in Ho Chi Minh City from centers for the treatment of venereal disease and tuberculosis, centers for the rehabilitation of injecting drug users and sex workers, prenatal clinics, blood banks and other sites.

Results: The first case of HIV infection in Vietnam was identified in 1990 in Ho Chi Minh City.

Outpatient management practices associated with reduced risk of pediatric asthma hospitalization and emergency department visits.

Objectives: 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.

Methods: This case-control study included children aged 0 to 14 years with asthma who were members of a regional health maintenance organization.

Blood lead testing by pediatricians: practice, attitudes, and demographics.

Objectives: This study aimed to evaluate adherence and identify ways to improve concordance between blood lead testing guidelines and practice.

Methods: One hundred fifty-five pediatricians responded to a questionnaire assessing demographic, knowledge, and attitudinal factors relating to lead testing.

Results: Only 27% of the respondents adhered to the guidelines, and less than half knew all of the answers to three factual questions about the recommendations.

A subpopulation of WIL-2 cell calreticulin molecules is associated with RO/SS-A ribonucleoprotein particles.

A subpopulation of human calreticulin (CR) molecules that is reactive with human Ro/SS-A autoimmune sera was identified in a nucleic acid- enriched Wil-2 cell fraction derived by anion exchange column chromatography. Further resolution of this fraction by gel filtration size separation demonstrated that the appearance of CR (true mol. weight 46 kD) coincided with the emergence of Ro/SS-A ribonucleoprotein (mol.

Computer-generated recall letters for underimmunized children: how cost-effective?

Objective: To evaluate the effectiveness and cost effectiveness of computer-generated recall letters to parents of children overdue for immunizations.

Methods: This randomized controlled trial included children of two facilities in a regional health maintenance organization. Parents of 20-month-olds who had not yet received a measles-mumps-rubella (MMR) immunization were identified via a computerized immunization tracking system.

ParaSight-F test to diagnose malaria in hypo-endemic and epidemic prone regions of Vietnam.

The antigen capture ParaSight-F test was evaluated during a drug sensitivity survey in a hypoendemic region of northern Vietnam. When only asexual blood forms of P. falciparum were considered, sensitivity of ParaSight-F was 100%, specificity 88% (95% CI 95-80%), positive predictive value 68% (95% CI 85-50%) and negative predictive value 100%.

Would better adherence to guidelines improve childhood immunization rates?

Objective: To evaluate the contribution of three provider practices to underimmunization of children with financial coverage for vaccines.

Design: Retrospective cohort study of children in a large health maintenance organization, based on computerized databases and chart review.

Setting: Large health maintenance organization in northern California.

Initial cost of primary angioplasty for acute myocardial infarction.

Objectives: We sought to evaluate the initial economic cost of primary angioplasty for acute myocardial infarction under varying assumptions about whether a cardiac catheterization laboratory exists, whether services are provided during night and weekend hours and how cardiovascular surgical backup is arranged.

Background: Primary angioplasty for acute myocardial infarction has resulted in clinical outcomes superior or equal to those obtained with thrombolysis in recent studies, but its future implementation depends greatly on its cost and cost-effectiveness. There is a gap in knowledge about the true economic costs of this procedure, and understanding costs under a variety of hypothetic scenarios is important in planning whether and how the procedure should be offered to broad groups of patients.

Primary angioplasty and thrombolysis for acute myocardial infarction: an evidence summary.

Coronary angioplasty is being increasingly used as the primary treatment for patients with acute myocardial infarction, but controversy remains over its potential adoption in preference to thrombolysis as standard care. This report summarizes the published evidence on health outcomes after primary angioplasty compared with thrombolysis or no intervention for patients with acute myocardial infarction. The data tables presented provide the scientific groundwork to assist physicians and other policy-makers in deciding which interventions to provide for broad populations of patients.

Facilitation of olfactory learning by a modulator of AMPA receptors.

The effects of a benzoyl-piperidine drug (BDP) that facilitates AMPA receptor-mediated synaptic responses were tested on the acquisition and retention of long-term memory at dosages that had no detectable effects on a variety of performance measures. BDP-12 produced a dose-dependent suppression of exploratory activity in rats with statistically reliable effects occurring at 50 mg/kg (i.p.

Studies on the expression and immunogenicity of the B50 melanoma antigen and its relationship with calreticulin.

B50 is a 50 kDa protein antigen originally identified and isolated from cultured B16 murine melanoma cells; it is found in close association with a melanoma-specific antigen termed B700. Using a specific rabbit antiserum, B50 (or B50 cross-reactive molecules) has been shown to be expressed by 35 out of 36 cell lines, including melanomas, sarcomas, fibrosarcomas, carcinomas, gliomas, immortalized and primary fibroblasts, melanocyte and keratinocyte cell lines obtained from murine, human, hamster, swine, and canine donors. B50 expression is localized on the cellular membrane and in the cytoplasm in varying amounts in seven of the nine cell lines tested.

Cost-effectiveness of varicella serotesting versus presumptive vaccination of school-age children and adolescents.

Objective: To evaluate the cost-effectiveness of presumptive vaccination versus serological testing of school-age children (6 to 12 years) and adolescents (13 to 17 years) with a negative or uncertain history of varicella.

Design: Decision analysis model based on published and unpublished probabilities and costs.

Patients: Hypothetical cohorts of 10,000 school-age children and 10,000 adolescents.

The cost-effectiveness of prenatal carrier screening for cystic fibrosis.

Objective: To evaluate the economic consequences of routinely offering cystic fibrosis-carrier screening to pregnant white women under 35 years of age.

Methods: Decision analysis was used to evaluate the health outcomes and medical costs of a screening program from the health care payer's perspective. Probabilities were taken from the literature; cost data were based on consultations with laboratory and hospital administrators.

Impact of ultraviolet irradiation on expression of SSA/Ro autoantigenic polypeptides in transformed human epidermal keratinocytes.

SSA/Ro autoantibodies are frequently found in various autoimmune disorders including subacute cutaneous and neonatal lupus erythematosus. SSA/Ro patient sera precipitate a ribonucleoprotein complex consisting of multiple polypeptides and small RNA molecules (hY RNA). Such sera react in Western blot with at least four antigenically distinct proteins having molecular weights of 52-60 kD.

Risk factors for delayed immunization among children in an HMO.

Objectives: Improving the timely delivery of childhood immunizations has become a national imperative. This study aimed to identify nonfinancial predictors of delayed immunization among patients with good financial access to preventive care.

Methods: This prospective cohort study used telephone interviews and a computerized immunization tracking system to evaluate 13-month-old children (n = 530) in a regional group-model health maintenance organization.

Effects of vaccine information pamphlets on parents' attitudes.

Objectives: To describe how parents actually use federally mandated vaccine information pamphlets and to evaluate the pamphlets' effects on parents' opinions about vaccination.

Design: A controlled trial of vaccine information pamphlets based on a survey mailed to parents who either received (n = 140) or did not receive (n = 167) the pamphlets.

Study Population: Parents of infants aged 2 to 8 months in a suburban, mainly upper-middle class private group practice in northern California.