Cost-effectiveness of serotesting compared with universal immunization for varicella in refugee children from six geographic regions

BACKGROUND: It is unknown whether it is more cost-effective to test for varicella antibody or to immunize without testing in immigrant populations. The reliability of history of varicella disease is also unclear. METHODS: The prevalences of varicella antibody in immigrant children from six regions of the world were used in a cost-effectiveness model to calculate the antibody prevalence above which it is more cost-effective to test rather than to immunize. History of varicella disease was obtained from chart review. We calculated the positive and negative predictive values of varicella history by age group and region. RESULTS: The prevalence of varicella antibody above which it is more cost-effective to test than to immunize was 34% for children less than 13 years old and 17% for those aged 13 years and older. Overall, the positive predictive value of varicella history was 93-100% and the negative predictive value of varicella history was 28-66% among the six geographic regions. CONCLUSION: Immunization without serotesting was cost-effective in children <5 years of age. Testing prior to immunization was cost-effective in children 5 years of age and older. History of varicella was a good predictor of the presence of antibody to varicella, whereas a negative history was a poor predictor of the absence of antibody to varicella.     

Missed Opportunities for Prevention: Failure to Identify Smoking in the Parents of Adolescent Patients

Smoking is an addiction that often begins in childhood or adolescence. Factors associated with early smoking initiation include parental smoking and socialization about smoking with their children. Previous studies evaluating the history obtained during routine pediatric appointments have not focused on parental smoking history and counseling. In this study, seventy-three (73) adolescents (mean age: 15.2 years; 77% female; 64% African-American) seen for medical care in a primary care clinic and their accompanying parent(s) (mean age: 43.5 years; 91% female) were surveyed about smoking followed by a review of each chart measuring documentation of adolescent and parent smoking history and counseling. Although the majority of adolescents were questioned about smoking (92%), parents were rarely questioned (1%) (p < 0.05). Adolescents were counseled about smoking (7%) and other risk-taking behaviors (44%); however, no parents were counseled about smoking or smoking socialization. Physicians frequently overlook an important factor in the prevention of smoking initiation at a young age, parental smoking history and counseling.     

Parental Threatening Behaviors and Offspring Substance Use: The Moderating Role of Anxiety Sensitivity

ABSTRACT

Despite extensive evidence linking childhood exposure to adverse parenting and subsequent substance use, the extant research literature is more limited regarding individual difference factors that may moderate this association. This study examines the moderating role of anxiety sensitivity (AS) in the association between childhood exposure to parental threatening behaviors and substance use in a sample of late adolescents with clinical anxiety. One hundred fifty-one late adolescents with clinical levels of anxiety (18.61 years old; SD = 0.91) completed measures assessing childhood exposure to parental threatening behaviors, AS, alcohol/tobacco and illicit substance use frequency, negative affect, and history of negative life events. A significant moderating effect of AS in the association between childhood exposure to parental threatening behaviors and both average and illicit drug use was found—even after controlling for participants' age and history of negative life events. Specifically, for individuals with high AS, as childhood exposure to parental threatening behaviors increased so too did average and illicit substance use frequency; however, for individuals with low AS, childhood exposure to parental threatening behaviors was not significantly associated with either substance use frequency. Findings underscore the profound impact that early negative experiences have on substance use outcomes, particularly for individuals with high AS who have difficulty coping with and regulating physiological arousal. Limitations and clinical implications of these findings are discussed.     

Natural history of cow's milk allergy. An eight-year follow-up study in 115 atopic children

BACKGROUND: Cow's milk allergy (CMA) is a disease of infancy and usually appears in the first few months of life. The evaluation of infants for possible CMA is one of the more common problems shared by pediatricians. The role of foods in determining and/or aggravating the clinical features of atopic dermatitis (AD) has been stressed in the last decades. OBJECTIVE: The aim of the present study was to investigate, in children with food related AD, the development of tolerance to the offending food(s), clinical or laboratory data to predict the development of food tolerance, and whether there are clinical or laboratory data to predict the onset of respiratory allergy. MATERIALS AND METHODS: In this prospective study we report on 115 babies, first examined at a median age of 6 months, and followed-up for 8 years. We have investigated several factors as predictive of the outcome, as follows: early onset; widespread or not-typical (reverse pattern) skin lesions, family history positive for atopy; persisting FA, high levels of total and specific IgE antibodies, association with CMA and asthma. RESULTS: All these parameters were significantly predictive of a long-term morbidity of AD children with CMA. The median age for tolerance to cow's milk was 7 years + 11 months, to egg 6 years + 6 months, and to wheat 7 years + 2 months. However a great number of both tolerant and intolerant children developed multiple sensitizations. Only 66 children (57%) acquired food tolerance, but there was the onset of asthma in 54% of cases. CONCLUSION: The natural history of CMA is not well-known, since not many related studies have been done in children. The several predictive factors, all in a negative sense, may be the norm in atopic children. We suggest possible areas of intervention in children at risk due to parental atopy. Preventive measures may induce a dramatic improvement in children with food allergy, but we stress that the long-term prognosis is challenging, since asthma prevalence may increase up to 54% during a long follow-up. Therefore, the natural history of IgE-mediated AD in atopic children sensitized to several allergens may be less optimistic than generally reported.     

利钠肽对老年人非心脏手术心血管事件的预测价值

目的探讨B型利钠肽(BNP)预测老年非心脏手术心血管事件的价值。方法依据术前血浆BNP浓度将62例择期行非心脏手术患者分为两组,A组(42例):BNP浓度≤100ng/L;B组(20例):BNP浓度>100ng/L。比较两组患者术后心脏事件并计算敏感性、特异性、假阳性率、假阴性率、阳性预测值、阴性预测值、准确率等指标。结果A组无心脏事件发生,B组中有14例(70%)发生心脏事件,两组比较差异有统计学意义(P<0.05),BNP浓度>100ng/L预测心脏事件敏感性100%、特异性87.5%、假阳性率12.5%、假阴性率0、阳性预测值70%、阴性预测值100%、准确率90.3%。结论术前血浆BNP浓度>100ng/L对老年非心脏手术心血管事件有较好的预测价值。     

Correspondence between proxy and self-reports on smoking in a full family study

OBJECTIVES: The present study investigated the reliability of proxy reports obtained from family members with self-reports on adolescent and parental lifetime and current smoking status. METHODS: Data were assessed from 416 families, consisting of both biological parents and two adolescent siblings aged 13-17 years. These families were assessed at baseline and 1 year later. Sensitivity, specificity, positive predictive value and negative predictive value were calculated to test whether proxy reports corresponded with self-reports. RESULTS: Mothers scored higher than fathers on most measures on lifetime and current smoking status of both children. The sensitivity was low for parental reports, but moderate to high for children's reports. Specificity and positive predictive value were high in all proxy reports. The negative predictive value was moderate (parents as proxy reporters) to low (children as proxy reporters) on lifetime smoking, but high on current smoking. CONCLUSIONS: Adolescents, aged 13-17 years, can be used as a reliable source to assess the smoking status of their mothers and fathers. Parents, however, appeared to accurately identify the smoking status of their adolescent children less reliably.     

尿沉渣分析仪检测白细胞和细菌对尿路感染的筛查价值

目的 评估Uf-1000i尿沉渣分析仪检测白细胞和细菌的基本性能及对尿路感染的筛查价值. 方法 收集304例疑是尿路感染做尿培养的患者的中段尿,用尿沉渣分析仪Uf-1000i检测尿白细胞(WBC)和细菌(BACT).分析两项参数的精密度、线性和携带污染率.以尿细菌培养阳性为金标准,绘制尿白细胞和细菌计数的ROC曲线,并评价其诊断尿路感染的敏感度、特异度、假阳性率、假阴性率、阳性预期值、阴性预期值. 结果 Uf-1000i检测白细胞和细菌的批内精密度、日间精密度、携带污染率和线性范围均符合厂家标准;Uf-1000i尿沉渣分析仪用于诊断尿路感染的阈值,为白细胞计数173.5个/μL和细菌计数513.5个/μL.若以白细胞或细菌任意一项阳性来判断尿路感染,敏感度、特异度、假阳性率、假阴性率、阳性预期值、阴性预期值分别为83.3%、73.0%、27.0%、16.7%、62.9%、88.8%.以白细胞和细菌双阳性来判断尿路感染,敏感度、特异度、假阳性率、假阴性率、阳性预期值、阴性预期值分别为54.6%、93.9%、6.1%、45.4%、83.1%、79.0%.结论 Uf-1000i尿沉渣分析仪检测白细胞和细菌的性能符合厂家标准,对尿路感染能早期筛查,便于临床医师决定是否需要培养及选择早期用药.     

Universal varicella vaccination: efficacy trends and effect on herpes zoster

In 1995, the Varicella Active Surveillance Project (VASP) was established in Antelope Valley (California), a geographically distinct high-desert community of 300,000 residents, as one of three sites in the nation in a cooperative agreement with the Centers for Disease Control and Prevention (CDC) to collect baseline demographic and clinical data and to monitor trends in varicella (chickenpox) following introduction of varicella vaccine. Herpes zoster (shingles) was added to the active surveillance January 1, 2000. The universal varicella program has proven effective in terms of reducing the number of reported verified varicella cases by 85%, from 2,934 in 1995 to 412 in 2002. Prior to this dramatic reduction, immunologic boosting due to exogenous exposures to wild-type varicella-zoster virus (VZV) in the community (1) caused mean serum anti-VZV levels among vaccines to increase with time after vaccination and (2) served as a mechanism that helped suppress the reactivation of herpes zoster (HZ), especially among individuals with a previous history of wild-type varicella.That immunologic boosting might play a significant role in both varicella and the closely related HZ epidemiology is evidenced by (1) a decline in vaccine efficacy by over 20%, from 95.7% (95% C.I., 82.7% to 98.9%) in 1999 to 73.9% (95% C.I., 57.9% to 83.8%) in 2001 and (2) an unexpectedly high cumulative (2000 to 2003) true incidence rate of 223 (95% C.I. 180-273) per 100,000 person-years (p-y) among children <10 years old with a previous history of varicella. Because capture-recapture methods demonstrate a likely lower bound of 50% underreporting, the actual rate is likely double or 446 per 100,000 p-y, approaching the HZ rate reported among older adults. Other recent studies based on VASP data have mitigated against discovery of the above trends that challenge several initial assumptions inherent to the universal varicella program, namely, (1) a single dose confers long-term immunity and (2) there is no immunologically mediated link between varicella and HZ incidence. As vaccinated children replace those with a prior history of wild-type varicella in the <10 age group, increasing HZ incidence among this cohort will be of less concern in the near future. However, previous scientific studies, including the present preliminary results from active surveillance indicate that HZ may be increasing among adults. It may be difficult to design booster interventions that are cost-effective and meet or exceed the level of protection provided by immunologic boosting that existed naturally in the community in the prelicensure era.     

Reduced-antigen, combined diphtheria, tetanus and acellular pertussis vaccine, adsorbed (Boostrix®): a review of its properties and use as a single-dose booster immunization

Reduced-antigen, combined diphtheria, tetanus and three-component acellular pertussis vaccine (Tdap; Boostrix?) is indicated for booster vaccination against diphtheria, tetanus and pertussis in individuals from age four years onwards in Europe and from age 10 years onwards in the US. Compared with infant formulations used for primary vaccination, Tdap contains reduced quantities (10-50%) of all toxoids and antigens, which are adsorbed to either ≤0.39?mg/dose (US licensed formulation) or 0.5?mg/dose (rest-of-world formulation) of aluminium adjuvant. The reduced antigen content is designed to avoid the increasing reactogenicity historically seen with the fourth and fifth doses of infant vaccine. This article reviews the immunogenicity, protective efficacy and reactogenicity of Tdap booster administered to children, adolescents and adults, including those aged ≥65 years. In clinical trials, a single booster dose of Tdap induced seroprotective levels of antibodies to diphtheria and tetanus toxoids in virtually all children and adolescents, and in a high proportion of adults and elderly individuals at approximately 1 month post-vaccination irrespective of their vaccination history. In all age groups, seropositivity rates for antibodies against pertussis antigens were ≥90% (including in unvaccinated adolescents), and booster response rates were high. Tdap was safely co-administered with other common vaccines without significantly affecting the immune responses. The immunogenicity and reactogenicity profiles of booster doses of Tdap were generally similar to those of infant diphtheria-tetanus-whole-cell pertussis vaccine and infant diphtheria-tetanus-acellular pertussis vaccine in children aged 4-6 years, and infant diphtheria-tetanus vaccine in older children. In adolescents and adults, the immunogenicity and reactogenicity of Tdap were generally similar to those of reduced-antigen diphtheria-tetanus vaccine, reduced-antigen diphtheria-tetanus-five-component acellular pertussis vaccine and reduced-antigen acellular pertussis vaccine. Therefore, Tdap is suitable as a booster in place of these vaccines, including tetanus toxoid vaccine in the management of tetanus-prone wounds in adults. The quantity of aluminium adjuvant in Tdap did not markedly affect the immunogenicity or reactogenicity of the vaccine. Seropositivity rates for antibodies against pertussis toxin had begun to decline by 5 years after a booster dose of Tdap in adolescents/adults, and a subsequent booster dose 10 years later was generally as immunogenic as the initial booster and was well tolerated. Tdap was safe and well tolerated in all age groups. Local injection-site reactions were the most common adverse events. Most adverse events were of mild or moderate intensity and transient; there were few serious vaccination-related adverse events. Thus, Tdap is highly immunogenic, with low reactogenicity, in all age groups and appears suitable for targeted and/or repeat Tdap boosters in children, adolescents, adults and elderly individuals as part of immunization strategies that may prove beneficial in further limiting the burden of pertussis.     

计算机辅助阅片系统在宫颈癌筛查应用中的有效性观察

目的探讨计算机辅助阅片系统（Thin Prep imaging system,TIS）在宫颈癌筛查应用中的有效性。方法分别采用单纯人工阅片（Manual Screening,MS）和TIS辅助阅片对同一个宫颈细胞学检查标本进行初筛,结果不一致的由两名高年资的医生复核做出最终诊断。比较MS与TIS的诊断结果,计算ASC＋的检出率、假阴性率、假阳性率,阳性预测值、阴性预测值,敏感性和特异性。结果MS与TIS共同筛查925例,结果为ASC＋的MS75例（8．1％）,TIS86例（9．3％）;假阴性MS23例（2．5％）,TIS10例（1．1％）;假阳性MS15例（1．6％）,TIS13例（1．4％）;阴性预测值MS97．3％,TIS98．8％;阳性预测值Ms72．3％,TIS88．0％;敏感性MS72．3％,TIS88．0％;特异性MS98．2％,TIS98．5％。结论初步数据表明,TIS敏感性好于MS,明显降低了假阴性率,而特异性没有受影响,在采纳新的技术后,有必要对医生进行适当的培训以适应新的筛查方法。     

The utility of the history and clinical signs of poisoning in childhood: a prospective study

The authors aimed to evaluate the utility of the history and clinical signs for predicting ingestion of poisons in children. A prospective cohort study was performed of all patients presenting with suspected poisoning to a pediatric emergency department over a 13-month period. Clinical data were collected on a preformatted consultation sheet. Urine drug screens (UDS) were analyzed by gas chromatography/mass spectrometry (GC/MS). Serum toxicologic tests were performed when clinically indicated. The sensitivity, specificity, positive predictive values (PPV), and negative predictive values (NPV) of the history and clinical signs were calculated, first using UDS and, second, using all available toxicologic tests as the gold standards. Of 249 patients, 110 (46%) had a UDS performed. The purported poison ingested was potentially identifiable by GC/MS in 57 (52%) of these UDS. Only the results from these 57 UDS were included in our statistical analysis. Overall, the suspected poison was identified in 33 (58%) of the 57 UDS. Similarly, in the less than 5 years age subgroup, 28 (56%) of 50 UDS were positive. Odor on the breath (PPV 100%), followed by symptoms consistent with poisoning (PPV 92%) and presence of poison on clothes (PPV 86%) were the most useful predictors of a positive UDS. Similar results were obtained when all available toxicologic tests were used as the gold standard. The best clinical predictors of poisonous ingestion in children were found to be odor on the breath, symptoms consistent with poisoning, and presence of poison on the patient's clothes. Approximately 40% of children who present with poisoning have not been exposed to the putative toxin.     

Predictive values of metabolic syndrome in children

Metabolic syndrome is a clinical term encompassing risk factors (obesity, insulin resistance, dyslipidemia and hypertension), which yield an increased risk for the development of diabetes mellitus type 2 and cardiovascular disorders in adolescence. Two sets of criteria for diagnosing metabolic syndrome were applied, the criteria for adults, specifically adapted for children, and the criteria defined by the International Diabetes Federation (IDF). A reliability analysis was conducted; sensitivity (SE), specificity (SP), positive predictive value (PPV) and negative predictive value (NPV) of applying certain criteria of both definitions of metabolic syndrome. Metabolic syndrome in adolescents was diagnosed much more frequently using the specific criteria (41%) in comparison to the IDF criteria (22%). Using the specific criteria for children and adolescents, it was established that the HDL cholesterol was the most specific and had the largest PPV. Using the IDF criteria for diagnosing metabolic syndrome, the reliability analysis established that the highest PPV was recorded with the elevated level of triglycerides. The specific criteria have been found to be more efficient in diagnosing metabolic syndrome in adolescents. The highest predictive value was displayed by dyslipidemic disorders, hypertriglyceridemia and hypo HDL cholesterolemia.     

UF-500i尿沉渣分析仪与显微镜检查尿沉渣中管型的结果对比分析

目的比较UF-500i尿沉渣分析仪与尿沉渣显微镜检查两种方法对尿液中管型检测的敏感性及其影响因素。方法对1226例患者的尿液分别用UF-500i尿沉渣分析仪分析和显微镜检查尿沉渣中管型。结果 UF-500i尿沉渣分析仪检测尿中管型阳性率为12.9%,灵敏度为36.8%,特异度为95.2%,假阳性率3.6%,假阴性率16.0%,符合率80.4%,阳性预测值72.2%,阴性预测值81.6%;尿沉渣显微镜检查尿中管型阳性率为25.3%。结论 UF-500i尿沉渣分析仪检测尿中管型存在较多的假阴性和假阳性,联合应用显微镜检查尿沉渣可提高管型检测的准确率。     

Economic evaluations of varicella vaccination programmes: a review of the literature

Chickenpox infections are generally mild but due to their very high incidence among healthy children they give rise to considerable morbidity and occasional mortality. With the development of a varicella vaccine in the early 1970s and its progressive licensing in many countries, interest in the efficiency of varicella immunisation programmes grew. The objective of this review was to discuss the methodological aspects and results of published economic evaluations of varicella vaccination. From this, we attempted to make recommendations. A computerised search was carried out; 17 full economic evaluations of varicella vaccination were retrieved. The review identified the methodological divergences and similarities between the articles in four areas: study design, epidemiological data, economic data and model characteristics. We assessed to what extent the applied methods conform to general guidelines for the economic evaluation of healthcare interventions and compared the studies' results. The desirability of a universal vaccination programme depends on whose perspective is taken. Despite variability in data and model assumptions, the studies suggest that universal vaccination of infants is attractive to society because large savings occur from averted unproductive days for parents. For the healthcare payer, universal vaccination of infants does not generate savings. Vaccination of susceptible adolescents has been proposed by some authors as a viable alternative; the attractiveness of this is highly dependent on the negative predictive value of anamnestic screening. Targeted vaccination of healthcare workers and immunocompromised individuals appears relatively cost effective. Findings for other target groups are either contradictory or provide insufficient evidence for any unequivocal recommendations to be made. High sensitivity to vaccine price was reported in most studies. This review highlights that some aspects of these studies need to be further improved before final recommendations can be made. First, more transparency, completeness and compliance to general methodological guidelines are required. Second, because of the increasing severity of varicella with age, it is preferable and in some cases essential to use dynamic models for the assessment of universal vaccination strategies. Third, most studies focused on the strategy of vaccinating children only while their results depended heavily on disputable assumptions (regarding vaccine effectiveness and impact on herpes zoster). Since violation of these assumptions could have important adverse public health effects, we suggest pre-adolescent vaccination as a more secure alternative. This option deserves more attention in future analyses.     

Comparison between Dutch and Norwegian parents regarding their perceptions on parental measures to prevent substance use among adolescents

This study investigated whether Dutch and Norwegian parents differ in their perceptions on parental measures and how parents view governmental responsibility to prevent adolescents from substance use. Data were derived from a cross-sectional internet survey conducted in the Netherlands and Norway. A subsample of Dutch (n?=?2017) and Norwegian parents (n?=?844) was selected. Parents were asked about their perceptions on different parental measures in relation to substance use, e.g. setting the right example, setting rules, parental behavior in the presence of adolescents, and how they view governmental responsibility compared with parental responsibility in relation to substance use among adolescents. The parental responsibility for taking parental measures against adolescents’ substance use was emphasized by both the Dutch and Norwegian parents. Compared to Dutch parents, Norwegian parents were slightly more positive about taking parental measures. Dutch frequent and heavy drinkers and Norwegian men were the most negative about parental perceptions on alcohol measures. Regarding perceptions on parental measures on drug use, Dutch and Norwegian lifetime cannabis users and current cannabis users supported parental measures to a lesser extent. Overall, the results suggest that both Dutch and Norwegian parents feel the responsibility to provide measures to prevent children from alcohol and drug use, irrespective of the alcohol and drug policy in their own country. Both the Dutch and Norwegian supported parental measures to prevent adolescents from substance use.     

输血前检查交叉配血不合的分析及处理

目的：分析交叉配血不合的原因以解决临床输血问题。方法：采用DiaMed血型配血（微桂凝胶）系统，进行交叉配血，手工聚凝胺法作为交叉配血对照。对交叉配血不合者经抗体筛查作直接抗人球蛋白试验（DAT），放散试验和青霉索药物试验，并结合病史分析。结果：2360例次交叉配血MGT法检出56例交叉配血不合。其中假阳性2l例（37．5％），DAT阳性28例（50．0％），青霉素试验阳性7例f12．5％）；有输血史29例，妊娠史18例，相关药物史15例。结论：本组影响交叉配血不合的实验因素有标本因素、温度因素、疾病因素以及输血史、妊娠史、大剂量的抗菌药物史等因素；发现交叉配血不合，要分析病史，严格按照实验操作规程，重复试验．并控制实验条件，选择适宜的配血方法。     

16层螺旋CT肺动脉造影对肺栓塞诊断价值及对栓子显示情况的研究

目的探讨16层螺旋CT肺动脉造影对肺栓塞（PE）的诊断价值,并研究其对栓子的显示情况,以提高对PE的诊断水平。方法 2010年1月~2014年4月接收的127例PE疑似患者为研究对象,所有病例均行16层螺旋CT肺动脉造影、肺动脉造影、肺部CT平扫、胸部X线平片,比较4种检测方法的诊断结果,并比较16层螺旋CT肺动脉造影、肺部CT平扫、胸部X线平片的灵敏度、特异度、阳性预测值、阴性预测值、诊断准确率。观察、记录16层螺旋CT肺动脉造影对主肺动脉、肺动脉干,叶、段、亚段肺动脉的分支数及栓子的类型、数量显示情况。结果 127例PE疑似患者经肺动脉造影确诊89例,除外38例;16层螺旋CT肺动脉造影阳性85例,阴性42例（其中假阴性4例）;肺部CT平扫阳性69例（其中假阳性16例）,阴性58例（其中假阴性36例）;胸部X线平片阳性50例（其中假阳性13例）,阴性77例（其中假阴性52例）。16层螺旋CT肺动脉造影对肺栓塞的灵敏度、特异度、阳性预测值、阴性预测值及诊断准确率均显著高于肺部CT平扫、胸部X线平片（P〈0.05）。16层螺旋CT肺动脉造影共显示肺动脉干、左/右肺动脉,叶、段、亚段肺动脉3588支,肺动脉栓塞940支,栓塞率为26.2%。各动脉栓塞率从大到小依次为：亚段肺动脉（30.0%）〉叶肺动脉（29.4%）〉段肺动脉（26.8%）〉左/右肺动脉（12.2%）〉肺动脉干（8.1%）。栓子类型从大到小依次为：偏心型（497）〉附壁型（155）〉中心型（154）〉完全堵塞型（134）。结论16层螺旋CT肺动脉造影诊断PE具有较高的灵敏度、特异度和准确度,能清晰地显示栓子的类型和数量,值得临床推广应用。     

Predictors of involvement in the juvenile justice system among psychiatric hospitalized adolescents

OBJECTIVE: Several risk factors for juvenile justice involvement have been identified in previous research among delinquents and include mental illness, substance use, trauma and abuse, family dysfunction, poor parenting, school problems, and aggressive behavior. However, most of these predictors resulted from studies among adolescents incarcerated in the juvenile justice system. We were interested in finding out the prevalence rates of juvenile justice involvement among psychiatric inpatient adolescents and determining predictors of juvenile justice involvement in this high-risk group. METHODS: Six hundred and thirty-six medical records from adolescents ages 12-17 years who were consecutively admitted to one of two psychiatric inpatient units between July 1, 2003 and June 30, 2004 were examined. RESULTS: Almost half (43.6%) of hospitalized adolescents had a history of juvenile justice involvement. Logistic regression analysis was conducted to determine predictors of juvenile justice involvement. Significant predictors of juvenile justice involvement included being male, parental legal history, family substance abuse history, disruptive disorder, cocaine use, being sexually active, and having a history of aggressive behavior. CONCLUSIONS: Adolescents in mental health or substance abuse treatment settings should be screened for juvenile justice involvement and appropriate referrals made to prevent worsening problems for at-risk youth.