Telemedicine in urban and suburban childcare and elementary schools lightens family burdens.

Background: Acute illness challenges all families with young children. The Health-e-Access Telemedicine Network in Rochester, NY, has enabled >7,000 telemedicine visits since 2001 among children in childcare or elementary schools, predominantly from Rochester's inner city. Large reductions in illness-related absence and emergency department use among Health-e-Access participants have occurred.

Acute illness care patterns change with use of telemedicine.

Objective: Health-e-Access, a telemedicine service providing care for acute illnesses in children, has delivered >6500 telemedicine visits from 10 primary care practices in Rochester, New York, by using telemedicine access at 22 child care and school sites. The goal was to assess the hypotheses that children served by Health-e-Access received health care more often for acute illnesses but had fewer emergency department (ED) visits and lower health care expenditures than did children without access through this service.

Methods: By using insurance claims, this case study compared utilization (starting in May 2001) of telemedicine, office, or ED care for children with versus without telemedicine access.

Acute illness utilization patterns before and after telemedicine in childcare for inner-city children: a cohort study.

The ready access provided by telemedicine benefits families and society but might increase total healthcare utilization with uncertain implications for costs. The objective of this study was to assess the net impact on healthcare utilization of introducing into inner-city childcare a telemedicine model designed to manage acute illness. A cohort study was done using comparable periods before and after introduction of telemedicine for all qualifying children (n = 112) using three innercity childcare centers.

Differences in diagnosis and treatment using telemedicine versus in-person evaluation of acute illness.

Objective: We designed a telemedicine model for diagnosis of common, acute illness to compare telemedicine and in-person evaluations on reproducibility of diagnosis and treatment.

Methods: Subjects were seen by usual physicians in ambulatory settings. Subjects were also evaluated separately by experienced general pediatricians (study physicians), either in person or via telemedicine, based on random assignment.

Effectiveness of telemedicine in replacing in-person evaluation for acute childhood illness in office settings.

For the purpose of reducing the social and economic burden imposed by common acute childhood illness, we developed a telemedicine model to enable diagnosis and treatment of illness episodes presenting in pediatric office settings. The study objective was to assess the effectiveness of this telemedicine model in replacing illness visits to traditional healthcare settings and to compare effectiveness of this model (base model) with that of alternative models including simple office laboratory tests and albuterol administration (simple model) or a complete complement of tests and procedures (extended model). Eligible subjects had an acute problem and were seen in the pediatric primary care practice or pediatric emergency department of the University of Rochester Medical Center.

Telemedicine reduces absence resulting from illness in urban child care: evaluation of an innovation.

Background: Common acute illness challenges everyone involved in child care. Impoverished inner-city families, whose children are most burdened by morbidity and whose reliance on child care is most important, are those least equipped to deal with this challenge.

Objective: To assess the impact of telemedicine on absence from child care due to illness (ADI).

Sexual behavior, contraception, and risk among college students.

Purpose: To characterize the differences and similarities among college freshmen, sophomores, juniors, and seniors regarding their sexual behavior including contraception choices and human immunodeficiency virus (HIV) risk.

Methods: A 41-item sexual behavior questionnaire designed for this study was administered to a convenience sample (N = 797) of a college population.

Results: Levels of sexual activity were found to be comparable to other college-based surveys.

Increase in admission threshold explains stable asthma hospitalization rates.

Background: Asthma morbidity and mortality has increased substantially in recent years, but asthma hospitalization rates among many geographic and sociodemographic groups have remained stable. Observations on asthma hospitalization rates and severity of acute episodes might provide valuable insight into the functioning of the health care system during this period of health care reform.

Objective: To analyze changes between 1991 and 1995 in childhood asthma hospitalization rates and severity of acute episodes.

Socioeconomic variation in asthma hospitalization: excess utilization or greater need?

Objective: To assess the hypothesis that higher incidence of severe acute asthma exacerbation, not lower severity threshold for admission, explains the difference between the asthma hospitalization rates of inner-city and suburban children.

Methods: All 2028 asthma hospitalizations between 1991 and 1995 for children (aged >1 month and <19 years) dwelling in Rochester, New York, were analyzed. ZIP codes defined residences as inner-city, other urban, or suburban.

Diagnostic clusters in infants as child health outcomes. Variation among socioeconomic areas in one community.

Objectives were to examine geographic variation in rates of infant hospitalization for diagnostic clusters in Monroe County (Rochester), New York and to assess these clusters as indexes of child health. ICD-9 codes were used to cluster all 7,883 hospitalizations of infants (< 24 months) between 1985 and 1991 on the basis of their avoidability. Environmentally sensitive clusters accounted for 63% of admissions.

How commonly are children hospitalized for asthma eligible for care in alternative settings?

Objective: To estimate the proportion of children hospitalized for acute asthma exacerbation who might be cared for successfully in alternative settings such as short-stay units or in-home nursing.

Design: Descriptive study based on analysis of hospital discharge files and on retrospective medical record review of a random sample of asthma hospitalizations.

Methods: The 2028 asthma hospitalizations between 1991 and 1995 for children (aged <19 years) dwelling in Rochester, NY, were studied.

Early effects of a school-based human immunodeficiency virus infection and sexual risk prevention intervention.

Objective: To determine the short-term effect of a middle and high school-based human immunodeficiency virus and sexuality intervention (Rochester AIDS Prevention Project for Youth [RAPP]) on knowledge, self-efficacy, and behavior intention.

Design: Nonrandomized intervention study with 2 intervention groups and 1 control group.

Setting: Middle and high school health classes in an urban, predominantly minority school district.

Estimating risk associated with care in alternative settings: deterioration among children hospitalized.

Background: Although managed care favors use of alternative settings in an attempt to avoid hospitalization, uncertainty about possible deterioration creates concern about their safety.

Objective: To derive preliminary estimates for the risk of adverse outcome in children hospitalized with acute illness who met criteria for admission to potentially less-expensive, alternative settings (eg, short-stay unit, home nursing).

Design: Description of hospitalization outcomes for a community-wide childhood population.

Self-reported honesty among middle and high school students responding to a sexual behavior questionnaire.

Purpose: To determine self-reported honesty in completing a sexual and other risk behavior questionnaire among middle and high school students, and to relate honesty scores to sexual behavior item responses as a method to detect bias in reporting.

Methods: A self-administered questionnaire measuring overall honesty (7-point rating scale), sexual honesty (5-category scale), and selected sex behaviors was used. Urban, predominantly minority middle and high schools (Grades 7-12) were examined, and participants were 3144 male and female students in middle (mean age = 13.

Sibling Adaptation to Childhood Cancer Collaborative Study: the association of sibling adaptation with maternal well-being, physical health, and resource use.

This multi-institutional study investigated the association of behavioral/emotional adaptation among siblings of children with cancer with maternal general well-being, physical health, and resource use. One hundred seventy siblings and mothers completed standardized interviews and self-report measures 6 to 42 months after the cancer was diagnosed. As a group, mothers of children with cancer reported significantly lower levels of well-being than matched controls.

Decline of pediatric admissions with Haemophilus influenzae type b in New York State, 1982 through 1993: relation to immunizations.

Objectives: To evaluate the impact of vaccination for Haemophilus influenzae type b (Hib) on pediatric hospital admissions in New York State, and to identify risk factors in children who continue to be admitted for Hib invasive disease.

Methods: Retrospective review of hospitalizations in New York state from 1982 through 1993 and a survey of immunization records from physician offices in Monroe Country, New York.

Results: In 1982, 769 children were admitted to New York state hospitals for Hib-related conditions; by 1993, this had decreased to 133.

Socioeconomic variation in discretionary and mandatory hospitalization of infants: an ecologic analysis.

Objectives: To examine geographic variation in rates of infant hospitalization for diagnoses classified by type of hospitalization decision in Monroe County (Rochester), New York.

Methods: Study design was cross-sectional and ecologic. International Classification of Diseases (ICD) codes were used to categorize all 7883 hospitalizations for infants (age, <24 months) beyond the newborn period between 1985 and 1991.

Ensuring high-quality alternatives while ending pediatric inpatient care as we know it.

Child advocates recognize pediatric hospitalization as an issue of great concern because of the serious morbidity it reflects and the adverse psychosocial effects of inpatient experience on children and families. Accounting for almost 50% of child health care costs, estimated at $49.8 billion in the United States in 1987, pediatric hospitalization also represents a substantial financial burden.

Composition of gestational weight gain in adolescent pregnancy.

The objective of this study was to test three hypotheses concerning age-related differences in the composition of the weight gained by pregnant adolescents. We studied the change in maternal body composition during gestation in relation to maternal age and infant birth weight in relation to change in maternal body composition in 108 consecutive, low-income, pregnant, black adolescents. Regardless of age, approximately 26% of adolescents' body weight and 38% of the weight adolescents gain during gestation is fat.

Avoidable morbidity in infants. A classification based on diagnoses in administrative databases.

Objectives: A hierarchical classification for avoidable morbidity in infants was developed based on a conceptual model for causes of morbidity. Experts rated the impact of risk factors and health services on diseases coded according to the International Classification of Diseases, 9th Revision, Classification Modification (ICD-9-CM). An etiologic framework was chosen for the classification because knowledge of etiology often suggests strategies for prevention.

Pathways of lead exposure in urban children.

A linear structural equation modeling procedure was used to explore the mechanisms and pathways for lead intake among urban children and the relative contribution of various lead sources to lead-contaminated house dust. Dust lead levels were significantly associated with children's blood lead levels, both indirectly and directly via hand lead. Both soil and paint lead contributed to dust lead levels, but paint contributed significantly more lead to house dust than soil (P < 0.

Effect of emergency department immunizations on immunization rates and subsequent primary care visits.

Background: The Standards for Pediatric Immunization Practices recommend the routine use of emergency department (ED) encounters for screening the immunization status of children and, if indicated, immunizing them.

Objective: To test the hypothesis that ED immunizations will improve immunization rates without decreasing subsequent primary care visits.

Design: A randomized controlled trial of 2 interventions.

Use of health services by urban youth: a school-based survey to assess differences by grade level, gender, and risk behavior.

Purpose: The purpose of this study was: (a) to describe reported access to health care among urban youth, and (b) to compare intention to seek care and risk behaviors for youth who did and did not seek care.

Methods: A cross-sectional survey measuring knowledge, attitudes, self-efficacy, and behavioral intentions related to sexuality and use of and access to health care was administered to 3,677 urban middle and high school students in health education classes.

Results: A total of 13% of students reported no established health care, whereas 25% reported no care within the past 6 months.

Sibling adaptation to childhood cancer collaborative study: health outcomes of siblings of children with cancer.

Objective: This seven-site study examined the overall health status, healthcare utilization, somatization, and health-risk behaviors of siblings of children with cancer compared to these factors in matched controls or normative data. The study also examined whether informants (i.e.

Sibling adaptation to childhood cancer collaborative study: siblings' perceptions of the cancer experience.

Investigated responses of siblings (N = 254) of children with cancer to structured interviews designed to elicit thoughts and feelings about effects of cancer on self and family. Siblings indicated distress about family separations and disruptions, lack of attention, focus of family on the ill child, negative feelings in themselves and family members, cancer treatments and their effects, and fear of death. Siblings also reported becoming more compassionate, families becoming closer, and having experiences they otherwise would not have had.