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Biomedical subjects

A Gadomski

Publications and source records attributed to A Gadomski.

At least 19 recordsLinked to original sources
PubMed2001

Ruptured appendicitis among children as an indicator of access to care.

OBJECTIVE: To determine factors associated with ruptured appendicitis among children, using administrative databases. Insurance-related differences in the risk of ruptured appendix among adults in California have previously been described (Braveman, Schaaf, Egerter, et al. 1994). DATA SOURCES/STUDY SETTING: State of Maryland Medicaid claims data for children < or = 18 years of age from 1989 to 1993 and hospital discharge data for children < or = 19 years of age from 1989 to 1994 were analyzed. STUDY DESIGN: Administrative data analysis pre- and post-implementation of a Medicaid managed care program called Maryland Access to Care. DATA COLLECTION/EXTRACTION METHODS: Medicaid claims and hospital discharge ICD-9-CM codes were used to define hospitalization for ruptured and nonruptured appendicitis. Linear regression was used to model trends. Logistic regression was used to model the probability of ruptured appendicitis. PRINCIPAL FINDINGS: Among the 374 Medicaid inpatient claims for appendicitis, 37 percent were for ruptured appendicitis. Among the 5,141 hospital discharges for appendicitis, 30 percent were for ruptured appendicitis. Using Medicaid claims data, the probability of ruptured appendicitis was inversely related to age (OR = 0.86, 95% CI 0.81-0.91), white race (OR = 0.35, 95% CI 0.17-0.71) and preventive care visits (OR = 0.19, 95% CI 0.05-0.77). Using hospital discharge data, age (OR = 0.91, 95% CI 0.90-0.93) and female gender (OR = 0.87, 95% CI 0.77-0.99) were significant covariates. Insurance-related covariates were not significant in multivariate models addressing the probability of ruptured appendicitis. CONCLUSIONS: During a period of rapid managed care growth, insurance type was not associated with an increased risk of ruptured appendicitis among children in this geographic area. Age, female gender, and the number of preventive care visits are inversely related to the risk of ruptured appendix among children. The protective effect of preventive care visits suggests that a primary care relationship facilitates access to care, thus reducing delay in the management of appendicitis.

Adolescent↗
PubMed2000

Insights from a large rural population laboratory. Health census '89 and '99.

PURPOSE: Data are limited on health status behaviors and use of health services for rural residents. Yet rural areas now have higher rates of chronic diseases, such as coronary heart disease, than urban areas.METHODS: A population laboratory (Health Census) was established in rural Central NY (Otsego County) to study these variables in this population. HC '89 was a door-to-door enumeration of all permanent households in the country. In 1989, 44,500 adults in 18,000 households provided data on individual health screenings, cancer and cardiovascular risk factors, health behaviors, chronic disease, access to care, preventive services use, health insurance and emergency department utilization. Data collection for HC '99 will identify 10-year trends; it also includes baseline data for children. Also, households in six surrounding rural counties (N = 10,000) were sampled; cost benefits of different survey methods were assessed. Questions about perceived health status, and special health and pediatric preventive care needs were included. After 10 years of social change, many limitations of traditional survey methods became apparent; much more varied and frequent types of follow-up were needed to achieve adequate response rates.RESULTS: The HC '89 final response rate was 86%. There were significant socioeconomic gradients in use of preventive services (blood pressure screening, rectal exams, mammograms and Pap smears). Adults without health insurance or Medicaid had much lower utilization rates of screening tests and higher rates of cigarette smoking and obesity. Several community intervention programs were implemented as a result of HC '89. HC '99 provides additional analyses to examine change in preventive service use, self-reported chronic disease, and health services use; it will likely verify the persistence of socioeconomic gradients. Response rates are similar to '89, but achieved only with more intensive reinforcement.CONCLUSIONS: HC '89 confirmed a lag in positive health indices in rural populations in Central NY. Both newer methodologies now needed and results of HC '99 will serve as guides for smaller rural counties to develop affordable local health surveys and plan intervention strategies.

Journal Article↗
PubMed2000

Children's mental health: recommendations for research, practice and policy.

A recent study documented a large increase in prescriptions of stimulants and antidepressants among preschoolers, and has prompted public and professional concern about the effects of mood-altering drugs on young children. In response, the White House announced a broad initiative on children's mental health, including more government money for research, new labels on drugs for pediatric use, educational materials for parents, and a fall White House conference. To place these events in their larger context, this Issue Brief summarizes the findings of the Children's Mental Health Alliance Project, which conducted a multidisciplinary consensus conference in November 1998 followed by a year-long dialogue with clinicians, researchers, and families.

Child↗
PubMed1999

Polymorphic phase transitions in systems evolving in a two-dimensional discrete space.

Polymorphic phase transitions in systems evolving in a two-dimensional discrete space have been studied. The driving force of the transitions appears to be a difference between two main energetic contributions: one, related to the thermal activation of the process, and another, being of quantum nature. The former (high temperature limit) is naturally assigned to the expansion (melting) part of the transition, while the latter (low temperature limit) has much in common with the contraction (solidification) part. Between the two main physical states distinguished, there exists a certain state, corresponding to a discontinuity point (pole) in the morphological phase diagram, represented by the well-known Bose-Einstein (Planck) formula, in which the system blows up. This point is related to an expected situation in which the contour of the object under investigation stands for the Brownian or purely diffusional path, with the fractal dimension dw=2, and the situation can be interpreted as some emergence of an intermediate "tetratic" phase. This, in turn, recalls a certain analogy to the equilibrium (order-disorder) phase transition of Kosterlitz-Thouless type, characteristic of, e.g., rough vs rigid interfaces in a two-dimensional space, with some disappearance of interface correlation length at dw=2. Otherwise, the contours of the objects are equivalent to fractional Brownian paths either in superlinear or "turbulent" (dw<2; the expansion case), or sublinear, viz., anomalously slow (dw>2; the contraction case) regimes, respectively. It is hoped that the description offered will serve to reflect properly the main subtleties of the dynamics of the polymorphic transitions in complex "soft-matter" systems, like formation of lipid mesomorphs or diffusional patterns, with nonzero line tension effect.

Journal Article↗
PubMed1998

The rational clinical examination. Does this infant have pneumonia?

Acute lower respiratory tract illness is common among children seen in primary care. We reviewed the accuracy and precision of the clinical examination in detecting pneumonia in children. Although most cases are viral, it is important to identify bacterial pneumonia to provide appropriate therapy. Studies were identified by searching MEDLINE from 1982 to 1995, reviewing reference lists, reviewing a published compendium of studies of the clinical examination, and consulting experts. Observer agreement is good for most signs on the clinical examination. Each study was reviewed by 2 observers and graded for methodologic quality. There is better agreement about signs that can be observed (eg, use of accessory muscles, color, attentiveness; kappa, 0.48-0.66) than signs that require auscultation of the chest (eg, adventitious sounds; kappa, 0.3). Measurements of the respiratory rate are enhanced by counting for 60 seconds. The best individual finding for ruling out pneumonia is the absence of tachypnea. Chest indrawing, and other signs of increased work of breathing, increases the likelihood of pneumonia. If all clinical signs (respiratory rate, auscultation, and work of breathing) are negative, the chest x-ray findings are unlikely to be positive. Studies are needed to assess the value of clinical findings when they are used together.

Cough↗
PubMed1998

Impact of a Medicaid primary care provider and preventive care on pediatric hospitalization.

OBJECTIVE: This study evaluates the impact that a Medicaid managed care program had on avoidable hospitalization, a form of health care misuse that we hypothesize can be reduced by improved access to and quality of primary care in the context of a managed care program. Ambulatory care sensitive (ACS) hospitalizations, a previously defined categorization of hospitalization, as well as all pediatric hospitalizations were also studied. INTERVENTION: The Maryland Access to Care (MAC) was a fee-for-service, gatekeeper, Medicaid managed care program with assigned primary medical providers and required Early Periodic Screening, Diagnosis, and Treatment (EPSDT) examinations. Medicaid managed care elements include: 1) assignment to primary medical provider (PMP) either by voluntary choice or mandatory enrollment of eligible Aid to Families With Dependent Children (AFDC), Medical Assistance (medical needy), and Supplemental Security Income; 2) a medical home accessible 24 hours a day, 7 days a week; 2) PMP must authorize emergency department (ED), inpatient, and specialty care but there were no disincentives to PMP for referral; 3) fee-for-services reimbursement (with a physician rate increase) for primary care, authorized specialist care, and hospitalization; and 4) an on-line eligibility verification system was available to all medical providers. Pre-enrollment as well as publicity allowed MAC to be phased in rapidly, resulting in 70% to 80% enrollment by the end of the first program year. DESIGN: The design of this study is that of a pre- and postevaluation of the MAC program using Medicaid claims analysis of data 3 years pre-MAC and 2 years post-MAC. In multivariate analyses, this study also compares MAC-enrolled children to non-MAC-enrolled children (before and after MAC began) to estimate the impact of MAC enrollment while controlling for potential confounders. SETTING: State of Maryland from 1989 to 1993. PATIENTS: MAC-eligible children 18 years of age. OUTCOME MEASURES: Claims data were used to define avoidable hospitalization (based on ambulatory care received before hospitalization), to define ACS hospitalizations (based on the International Classification of Diseases-Clinical Modification, Ninth Revision [ICD-9-CM] codes), and to summarize use of ambulatory and inpatient care. ACS hospitalizations have been defined as those conditions for which timely and effective primary care can help to reduce the risk of hospitalizations. These are based solely on ICD-9-CM discharge codes that were studied by Billings and Teicholz in 1990 and used by an Institute of Medicine report in 1993. Examples include hospital discharge diagnoses of asthma (ICD-9-CM = 493), gastroenteritis (ICD-9-CM = 558.9), and dehydration (ICD-9-CM = 276.5). Usage measures, such as preventive care visits or ED visits, were created using Maryland Medicaid codes, Current Procedural Terminology codes, and ICD-9-CM codes. Linear regression was used to model trend. Logistic regression was used to model the probability of ambulatory and inpatient care given MAC enrollment and other covariates. First, logistic regression was used to predict the probability of any ambulatory care use among all MAC-eligible children during a quarter to model changes in access that may have occurred during MAC. Then, among users of ambulatory care or inpatient care, logistic regression was used to predict the probability of hospitalization. RESULTS: Most of the children studied were in the AFDC program, about half were African-American, one third resided in Baltimore City, and 9% of children had ICD-9-CMs reflecting chronic disease. The mean percentage of time children were MAC-eligible per quarter was 91%. Only 5% of children were continuously enrolled for all 20 quarters included in this study. Per-capita ambulatory care visits, especially per-capita preventive care visits, increased significantly during the study period (b = 0.003) whereas per-capita ED visits did not change. The mean n

Adolescent↗
PubMed1998

[Right atrial thrombus complicating chemotherapy by central venous catheterization in a child with Hodgkin's disease].

The atrial catheter (subcutaneous port) was used in a 5 year old boy with Hodgkin's disease for the administration of antineoplastic agents and other drugs. Catheter was flushed daily or every 2 weeks with heparin solution (5 U/ml)). The complications including infection and occlusion were not observed in this patient during observation time. Routine echocardiography performed after eight months of usage of the catheter showed right atrial thrombus. Because of the failure of 14 days fibrinolytic therapy (Actylise) surgical thrombectomy was performed. Bacteriological culture of the surgical specimen was positive for Pseudomonas aeruginosa. The post-operative period passed without complications. Follow-up echocardiography findings were normal. The probable reason of thrombus formation could be damage of the right atrium by stream of drugs or balloting ending of the catheter.

Antineoplastic Agents↗
PubMed1998

[Cyst of lower mediastinum in a 14-year-old boy with tumor of mediastinum in the course of Hodgkin's disease].

Bilateral enlarged lymph nodes in supraclavian regions, bilateral large tumour of mediastinum and enlarged lymph nodes of hiluses of the lungs were detected in a boy with stage III of Hodgkin's disease. After chemotherapy (MVPP/B-DOPA) and radiotherapy partial remission was achieved. However abnormal mass in the lower mediastinum on the right side of the heart was still present. Results of USG and CT studies showed solid character of this mass. MRI revealed a mediastinal cyst at the place of this mass. The boy has been in the first remission for eight months.

Adolescent↗
PubMed1994

[Use of filgrastim (RHU G-CSF) in supplemental treatment of non Hodgkin's lymphoma (NHL) in children].

Clinical application of glycoproteins stimulating the growth (G-CSF), differentiation and activity of the cells of granulocyte line has become a landmark in the treatment of patients with neutropenia. It has been proved that filgrastim (rHU G-CSF) applied after intensive chemotherapy shortens the duration of neutropenia and decreases the frequency of occurrence of infections. The paper discusses the efficiency and tolerance of filgrastim in children treated for NHL. Filgrastim was applied in children with NHL T cell and B cell treated according to BFM 86 protocols. It was given in a dose of 5 micrograms/kg daily i.v. The duration of therapy ranged from 5-20 days. Altogether 47 cycles were performed. 25 cycles were performed in 12 children during granulocytopenia (< 1 x 10(9)/l). The median time of neutropenia recovery, the frequency of severe infection and chemotherapy retardation were significantly lower in the examined than in the control group (p < 0.05). In 6 children 22 courses of filgrastim were given prophylactically after the cycles of intensive chemotherapy of NHL. Only during two courses due to neutropenia the chemotherapy retardation was necessary. Toleration of filgrastim was good. Application of filgrastim right after the intensive chemotherapy in children with NHL has considerably improved persistent realization of treatment programmes. Tolerance of the drug was good.

Adolescent↗
PubMed1987

Acute illnesses in the 2 weeks after hospitalization for bacterial meningitis.

The hospital records of 118 2-month-old to 3-year-old children who had been treated for bacterial meningitis were reviewed. Within 2 weeks after hospitalization, one fourth of the patients sought medical attention for an acute illness, but only one was treated for the possible relapse or recurrence of meningitis. Because only five of the 113 patients with available follow-up information required a diagnostic lumbar puncture procedure, it is not recommended that a lumbar puncture be performed following treatment of bacterial meningitis to provide end-of-treatment baseline information.

Acute Disease↗
PubMed1983

Control of poliomyelitis by pulse immunisation in Vellore, India.

In a simple study into the control of polio in the Third World a town was divided into 16 zones and pulses or oral polio vaccine given at one station in each zone, after extensive publicity about the campaign. Some 62% of children received three doses of the vaccine and the incidence of polio fell dramatically over the study period. It is suggested that this method is applicable to similar communities because it is cheap, effective, and able to be extended to unimmunised communities when resources allow.

Child, Preschool↗