Hospitalizations for childhood asthma in Athens, Greece, from 1978 to 2000

Trends in rates of asthma admissions among children have shown a variety of patterns in different countries in the last decades. We undertook the present study to determine the time trends in asthma admissions and readmissions of children in Athens, Greece. Data were obtained retrospectively from hospital registries of the three main children's hospitals in Athens from 1978 to 2000. Children admitted with the diagnoses of asthma, asthmatic bronchitis or wheezy bronchitis were included. Hospital admission rate for asthma among children 0-14 yr from 1978 to 2000 rose by 271% (p <0.001). The rise in rates among those aged 0-4 and 5-15 yr were 250% and 276%, respectively. The mean annual increase in admission rate was 12.2% for 1978-1987, 4.7% for 1988-1993 and 0.6% for 1994-2000. The readmission rate among children 0-14 yr was increased from 15.3% to 23.3%. A positive correlation between admission and readmission rates in all age groups was observed. In conclusion, our findings show an increase in the childhood asthma admission rate in Athens in late 1970's and during the 1980's, which has decelerated in the 1990's, particularly in the second-half of the decade. The readmission rate paralleled that of admissions over the entire study period.     

2000～2004年《小儿急救医学》被引分析研究

目的从文献引证的角度透视《小儿急救医学》的学术水平和期刊质量。方法依据《中国生物医学期刊引文数据库》(ChineseMedicalCitationIndex,CMCI),采用文献计量方法对《小儿急救医学》载文被CMCI来源期刊引用的情况进行统计分析及评价。结果单篇论文平均被引次数为2.39次,被引频次较高的论文数量较多,被引作者群的地域分布27个省(直辖市),辽宁、广东和北京在小儿急救医学研究领域居于前列。有242种期刊引用该刊,自引率为7.43%。结论《小儿急救医学》所载文献质量较高,形成具有独自风格和特色且相对稳定的研究体系。该刊不仅是我国小儿急救医学研究领域最重要的信息源之一,也是我国儿科医学领域的主要核心期刊。     

Hospitalizations during a measles epidemic in the Netherlands, 1999 to 2000

BACKGROUND: A measles epidemic occurred in the Netherlands in 1999 to 2000. We collected data on hospitalized and deceased cases to inform the public about the risks associated with measles infection. METHODS: From the National Medical Registration we extracted hospital discharge diagnoses for measles-related hospitalizations (International Classification of Diseases, 9th revision, Clinical Modification Code 055) during the measles epidemic (April 1999 to May 2000). We also reviewed hospital records to assess reasons for hospitalization and severity of disease as a result of measles infection during this epidemic. In addition we estimated the total number of hospitalized cases by a capture-recapture approach using two surveillance sources. RESULTS: Measles without mention of complication (39%) and postmeasles pneumonia (33%) were most often registered as main discharge diagnoses for the 130 cases in the National Medical Registration. Forty-seven (96%) of the 49 patients whose hospital charts were reviewed were not vaccinated. Median admission period was 5 (range, 1 to 26) days, 19 (38%) required mechanical ventilation and 14 (29%) had sequelae at the time of discharge but none was permanent. Three patients died as a result of complications. No association was observed between preexisting illness and either reason for admission (P = 0.5) or residual symptoms at discharge (P = 0.5). The estimated total number of hospitalized measles patients was 157 (95% confidence interval, 145 to 179), leading to an estimated 825 admission days during an epidemic in which 3,292 cases were reported. CONCLUSIONS: Measles infection can still run a severe course even in a prosperous country.     

Hospital admissions for childhood asthma in Rogaland,Norway, from 1984 to 2000

AIM: The prevalence of childhood asthma is increasing, and it is important to monitor factors related to hospital admissions in order to understand the different aspects of the disease. The aim of this study was to investigate admissions for childhood asthma to Rogaland Central Hospital, Norway, in order to elucidate time trends related to rates of admissions and treatment modalities. METHODS: A population-based study was conducted in which data extracted from the medical records, including number of admissions, length of hospitalization, medication and symptom scores, were recorded for children aged 1 to 14 y admitted to hospital for asthma during four periods, of two years each, from 1984/1985 to 1999/2000. RESULTS: For all the children there was an increase in annual admission rates for asthma from 1984/1985 to 1989/1990 and stabilization thereafter, but there were substantial differences between age groups. For children of 1 or 2 y of age the annual admission rate increased from 43/10000 in the first period to 104/10000 in the last period (p < 0.001), with an increase in both primary admissions and re-admissions. For children aged 3 and 4 y, the admission rates increased from the first to the second period, and then declined to an annual admission rate of 40/10000 in 1999/2000. For older children, the admission rate was low and stable. There was a gradual increase in the use of inhaled corticosteroids both prior to admission and at discharge, and the percentage of children receiving systemic corticosteroids at admission increased from 19% to 45% (p < 0.001). The average hospital in-days decreased from 3.4 to 1.9 (p < 0.001). CONCLUSION: A disturbingly high and increasing rate of both primary admissions and re-admissions for asthma has been observed in children aged 1 and 2 y, which seemed to be unaffected by changes in treatment modalities during the period. The decrease in admissions for children aged 3 and 4 y may have been influenced by the increased use of inhaled corticosteroids.     

Pediatric Hospitalizations Associated with 2009 Pandemic Influenza A (H1N1): An Experience from a Tertiary Care Center in North India

Objectives  

To describe our experience in children hospitalized with the pandemic Influenza A (H1N1) from Northern India.     

Pediatric central nervous system tumors: a single-center experience from 1989 to 2009

The objective of this study was to determine the epidemiology of primary tumors of the central nervous system (CNS) in pediatric patients from a Brazilian oncology institute. We retrospectively analyzed 741 charts (415 males and 326 females) of patients under 21 years of age who were diagnosed with a CNS tumor. The analysis included patients from 1989 to 2009 and was performed using the World Health Organization criteria. We evaluated the distribution of age, sex, topography, clinical symptoms, symptom intervals, and classification of the tumors. Patients with clinical/radiologic diagnoses were included. Seven hundred forty-one patients with tumors in the CNS were reviewed, and 83% of the patients presented a histologic diagnosis. Males (56%) were more prevalent than females. In children under the age of 1 year, the supratentorial compartment was the predominant region involved (62.0%). Astrocytoma was the most frequent tumor type (37.0%), followed by medulloblastoma (13.6%), craniopharyngioma (10.5%), and ependymoma (6.8%). Headaches were the most common symptom, and the symptom intervals varied from 1 to 5010 days. Approximately 4% of the patients had associated genetic syndromes. Although it was not a population study and selection bias may have occurred, this study supplies important epidemiologic data from an emerging country in which population studies are rare.     

Hospital and Community Characteristics Associated With Pediatric Direct Admission to Hospital

Objectives

One quarter of pediatric hospitalizations begin as direct admissions, defined as hospitalization without receiving care in the hospital's emergency department (ED). Direct admission rates are highly variable across hospitals, yet previous studies have not examined reasons for this variation. We aimed to determine the relationships between hospital and community factors and pediatric direct admission rates, and to evaluate the degree to which these characteristics explain variation in risk-adjusted direct admission rates.

Neighborhood Poverty and Distance to Pediatric Hospital Care

ObjectiveTo describe the relationship between neighborhood poverty and geographic access to pediatric inpatient care.MethodsThis is a retrospective, cross-sectional study using 2017–18 hospital and demographic data, as well as geographic data from the 2010 census. Acute care hospitals in 17 states were included, comprising approximately one-third of the national population. The main outcome was distance to capable pediatric hospital care by neighborhood Area Deprivation Index (ADI), both overall and by urbanicity.ResultsMedian distance to pediatric hospital care increased linearly with poverty across ADI national deciles (Pearson coefficient of 0.986; P < .001). The most advantaged neighborhoods were a median of 2.5 miles from the nearest pediatric capable hospital (interquartile range [IQR] 1.2–5.6) while those in the most disadvantaged were a median of 13.8 miles away (IQR 3.3–35.9; P < .001). The nearest hospital admitted children in 51.17% (7927) of advantaged neighborhoods (lowest national ADI quintile) and only 26.02% (3729) of disadvantaged neighborhoods (highest national ADI quintile). The association between poverty and median distance to care was observed in rural, suburban, and urban census block groups (P < .001 for all trends). In suburban neighborhoods, children from the most disadvantaged neighborhoods were 3 times as likely as children from the most advantaged neighborhoods to live more than 20 miles from pediatric inpatient care (27.85%, 456,533 of children from bottom quintile neighborhoods vs 9.24%, 259,787 of children from top quintile neighborhoods, P < .001).ConclusionsDistances to capable pediatric hospital care are greater from poor than affluent neighborhoods. This carries potential implications for disparities in pediatric health outcomes.     

News media framing of childhood obesity in the United States from 2000 to 2009

The American public holds mixed views about the desirability of government action to combat childhood obesity. The framing of coverage by news media may affect citizens' views about the causes of childhood obesity and the most appropriate strategies for addressing the problem. We analyzed the content of a 20% random sample of news stories on childhood obesity published in 18 national and regional news sources in the United States over a 10-year period (2000-2009). News media coverage patterns indicated that by 2003, childhood obesity was firmly on the news media's agenda and remained so until 2007, after which coverage decreased. We identified changes in news media framing over time and significant differences according to news source. News coverage of causes of childhood obesity that were linked to the food and beverage industry increased in the early years of the study but then decreased markedly in later years. Similarly, mention of solutions to the problem of childhood obesity that involved restrictions on the food and beverage industry followed a reverse U-shaped pattern over the 10-year study period. News stories consistently mentioned individual behavioral changes most often as a solution to the problem of childhood obesity. Television news was more likely than other news sources to focus on behavior change as a solution, whereas newspapers were more likely to identify system-level solutions such as changes that would affect neighborhoods, schools, and the food and beverage industry.     

Opportunities for Restructuring Hospital Transfer Networks for Pediatric Asthma

ObjectiveTo describe the current system of pediatric asthma care and identify potential options for unloading tertiary centers.MethodsRetrospective, cross-sectional study using 2014 inpatient and emergency department all-encounter administrative datasets from Arkansas, Florida, Kentucky, Maryland, Massachusetts, and New York. Study participants included children <18 with primary diagnosis of asthma.ResultsThere were 174,239 encounters for pediatric asthma, with 26,316 admissions and 3101 transfers. About 94.4% of transfers were admitted, with median stay length 2 days (interquartile range [IQR] 1.0–3.0). About 637 hospitals saw pediatric asthma, but 58.7% never admitted these patients. Fifty-four hospitals (8.5%) regularly received transfers; these hospitals were broadly capable pediatric centers (mean pediatric hospital capability indices = 0.82, IQR: 0.64–0.89). Two hundred nine facilities (32.8%) did not regularly receive transfers but were highly capable of caring for pediatric asthma (mean condition-specific capability = 0.92, IQR: 0.85–1.00). Median distance from transferring hospitals to the nearest pediatric center was 25.7 miles (IQR: 6.45–50.15) vs 18.0 miles (IQR: 8.35–29.25) to the nearest potential receiving hospital. Mean cost of a 2-day asthma admission in receiving hospitals was $3927 (IQR: $3083–$4894) versus $3427 (IQR: $2485–$4102) in potential receivers.ConclusionsWhile nearly all acute care hospitals encounter children with asthma, more than half never admit them. Children are primarily transferred to a small subset of specialized centers, despite the existence, in many regions, of closer community hospitals with high pediatric asthma capability. In settings with long transfer distances and tertiary center crowding, a tiered system of hospital care for pediatric asthma may be feasible.     

Impact of Palivizumab on RSV Hospitalizations for Children with Hemodynamically Significant Congenital Heart Disease

The objective of this study was to evaluate the impact of palivizumab prophylaxis on respiratory syncytial virus (RSV) hospitalizations among children with hemodynamically significant congenital heart disease (CHD). In 2003, the American Academy of Pediatrics (AAP) revised the bronchiolitis policy statement and recommended the use of palivizumab in children <24 months old with hemodynamically significant CHD (HS-CHD). California statewide hospital discharge data from years 2000–2002 (pre-AAP policy revision) were compared to those from years 2004–2006 (post-AAP policy revision). Hospitalizations due to RSV bronchiolitis for children <2 years of age were identified by IDC-9 CM codes 4661.1, 480.1, and 079.6 as the Principal Diagnosis. Children with CHD and children with HS-CHD were identified by the codiagnoses. The overall RSV hospitalization rate was 71 per 10,000 children <2 years of age. Of all RSV hospitalizations, 3.0% were among children with CHD, and 0.50% among children with HS-CHD. HS-CHD patients accounted for 0.56% of RSV hospitalizations in 2000–2002, compared to 0.46% RSV hospitalizations in 2004–2006. That represents a 19% reduction in RSV hospitalizations among HS-CHD patients after 2003. The 19% decrease in RSV hospitalizations equates to seven fewer hospitalizations (76 hospital days) per year among HS-CHD patients. We conclude that, since the recommendation of palivizumab for children with HS-CHD in 2003, the impact on RSV hospitalizations in California among HS-CHD patients has been limited. Considering the high cost of palivizumab administration, the cost-benefit of RSV prophylaxis with palivizumab warrants further investigation.     

Association Between Outdoor Air Pollution Levels and Inpatient Outcomes in Pediatric Pneumonia Hospitalizations, 2007 to 2008

ObjectivePneumonia is a leading cause of pediatric admissions. Although air pollutants are associated with poor outcomes, few national studies have examined associations between pollutant levels and inpatient pediatric pneumonia outcomes. We examined the relationship between ozone (O₃) and fine particulate matter with a diameter ≤2.5 µm (PM_2.5) and outcomes related to disease severity.MethodsIn this cross-sectional study, we obtained discharge data from the 2007 to 2008 Nationwide Inpatient Sample and pollution data from the Air Quality System. Patients ≤18years with a principal diagnosis of pneumonia were included. Discharge data were linked to O₃ and PM_2.5 levels (predictors) from the patient's ZIP Code (not publicly available) from day of admission. Outcomes were mortality, intubation, length of stay (LOS), and total costs. We calculated weighted national estimates and performed multivariable analyses adjusting for sociodemographic and hospital factors.ResultsThere were a total of 57,972 (278,871 weighted) subjects. Median PM_2.5 level was 9.5 (interquartile range [IQR] 6.8–13.4) µg/m³. Median O₃ level was 35.6 (IQR 28.2–45.2) parts per billion. Mortality was 0.1%; 0.75% of patients were intubated. Median LOS was 2 (IQR 2–4) days. Median costs were $3089 (IQR $2023–$5177). Greater levels of PM_2.5 and O₃ were associated with mortality, longer LOS, and greater costs. Greater O₃ levels were associated with increased odds of intubation.ConclusionsGreater levels of O₃ and PM_2.5 were associated with more severe presentations of pneumonia. Future work should examine these relationships in more recent years and over a longer time period.     

Pediatric tick-borne encephalitis in 371 cases from an endemic region in Slovenia, 1959 to 2000

BACKGROUND: With the exception of Lyme borreliosis, tick-borne encephalitis (TBE) is the most prevalent tick-transmitted disease in Europe. Here we report clinical and epidemiologic features of the largest number of children with TBE reported to date and the longest (i.e. 42-year) retrospective survey of pediatric TBE cases from one geographic region. METHODS: Case records of 371 patients, age 0 to 15 years, with serologically confirmed TBE and hospitalized between 1959 and 2000 at the Department of Infectious Diseases of the General Hospital Celje, Slovenia were reviewed and analyzed. RESULTS: Children represented 23.5% of 1578 confirmed TBE cases in the study period. Children were admitted to hospital throughout the year, but the majority were treated during summer months. In 178 (47.9%) children, a tick bite was noticed before admission. A biphasic course of illness occurred in 249 (67.1%) patients. The most common symptoms and signs of TBE were raised body temperature [>38 degrees C (n = 371)], headache and meningeal signs (n = 346), fatigue (n = 337) and vomiting (n = 327). Meningitis was diagnosed in 232 (62.5%) children, and meningoencephalitis was diagnosed in 139 (37.5%). There was a tendency for greater severity of TBE with increasing age. None of the children with TBE died, and none had permanent sequelae. CONCLUSIONS: The results of our study indicate that pediatric TBE is relatively mild disease with favorable outcome.