BACKGROUND AND OBJECTIVE: Controversy remains concerning the optimal treatment approach for cryptorchidism. The objective of this study was to assess effectiveness of hormone therapy or surgery for cryptorchidism. METHODS: We searched Medline and other databases from 1980 to February 2012. Two reviewers independently assessed studies against predetermined criteria. Two reviewers independently extracted data and assigned overall quality and strength of evidence ratings using predetermined criteria. RESULTS: Fourteen studies addressed effectiveness of hormonal treatments, and 26 studies addressed surgical intervention outcomes. Hormonal treatment is associated with testicular descent in some children, but rates generally do not exceed those seen with placebo by >10%. Surgical treatment is associated with success rates of testicular descent ranging from 33% to 100%, depending on surgery. Weighted success averages were 78.7% for 1-stage Fowler-Stephens (FS), 86% for 2-stage FS, and 96.4% for primary orchiopexy. Descent rates were similar among studies comparing laparoscopic and open surgeries. Reported harms of hormonal treatments were mild and transient. Adverse effects specifically associated with surgical repair were rare. CONCLUSIONS: The body of the reviewed literature comprises primarily fair- and poor-quality studies, limiting our ability to draw definitive conclusions. Hormonal treatment is marginally effective relative to placebo but is successful in some children and with minimal harms, suggesting that it may be an appropriate trial of care for some patients. Surgical options are effective, with high rates of testicular descent (moderate strength of evidence for FS procedures, high for primary orchiopexy). Comparable outcomes occur with laparoscopic and open approaches.

BACKGROUND AND OBJECTIVES: In the United States, recommendations for annual influenza vaccination gradually expanded from 2004 to 2008, to include all children aged $6 months. The effects of these policies on vaccine uptake and influenza-associated health care encounters are unclear. The objectives of the study were to examine the annual incidence of influenza-related health care encounters and vaccine uptake among children age 6 to 59 months from 2000-2001 through 2010-2011 in Davidson County, TN. METHODS:We estimated the proportion of laboratory-confirmed influenza-related hospitalizations and emergency department (ED) visits by enrolling and testing children with acute respiratory illness or fever. We estimated influenza-related health care encounters by multiplying these proportions by the number of acute respiratory illness/fever hospitalizations and ED visits for county residents. We assessed temporal trends in vaccination coverage, and influenza-associated hospitalizations and ED visit rates. RESULTS:The proportion of fully vaccinated children increased from 6% in 2000-2001 to 38% in 2010-2011 (P , .05). Influenza-related hospitalizations ranged from 1.9 to 16.0 per 10 000 children (median 4.5) per year. Influenza-related ED visits ranged from 89 to 620 per 10 000 children (median 143) per year. Significant decreases in hospitalizations (P , .05) and increases in ED visits (P , .05) over time were not clearly related to vaccination trends. Influenza-related encounters were greater when influenza A(H3N2) circulated than during other years with median rates of 8.2 vs 3.2 hospitalizations and 307 vs 143 ED visits per 10 000 children, respectively.CONCLUSIONS: Influenza vaccination increased over time; however, the proportion of fully vaccinated children remained ,50%. Influenza was associated with a substantial illness burden particularly when influenza A(H3N2) predominated.

Background In April 2009, a pandemic caused by a novel influenza strain, the A(H1N1)pdm09 virus, started. Few age-specific estimates of hospitalizations associated with the first year of circulation of the pandemic virus are available. Objectives To estimate age-specific hospitalization rates associated with laboratory-confirmed A(H1N1)pdm09 virus in Davidson County, TN, from May 2009 to March 2010. Patients/methods Two separate strategies were applied: capture–recapture and surveillance-sampling methods. For the capture–recapture estimates, we linked data collected via two independent prospective population-based surveillance systems: The Influenza Vaccine Effectiveness Network (Flu-VE) tested consenting county patients hospitalized with respiratory symptoms at selected hospitals using real-time reverse transcriptase polymerase chain reaction (rRT-PCR); the Emerging Infections Program identified county patients with positive influenza tests in all area hospitals. For the surveillance-sampling estimates, we applied the agespecific proportions of influenza-positive patients (from Flu-VE) to the number of acute respiratory illness hospitalizations obtained from the Tennessee Hospital Discharge Data system. Results With capture–recapture, we estimated 0.89 (95% CI, 0.72–1.49), 0.62 (0.42–1.11), 1.78 (0.99–3.63), and 0.76 (0.50–1.76) hospitalizations per 1000 residents aged <5, 5–17, 18–49, and ≥50 years, respectively. Surveillance-sampling estimated rates were 0.78 (0.46–1.22), 0.32 (0.14–0.69), 0.99 (0.64–1.52), and 1.43 (0.80–2.48) hospitalizations per 1000 residents aged <5, 5–17, 18–49, and ≥50 years, respectively. In all age-groups combined, we estimated approximately 1 influenza-related hospitalization per 1000 residents. Conclusions Two independent methods provided consistent results on the burden of pandemic virus in Davidson County and suggested that the overall incidence of A(H1N1)pdm09-associated hospitalization was 1 per 1000 county residents.

To determine the number of emergency department visits attributable to influenza A(H1N1)pdm09 in Davidson County, Tennessee, USA, we used active, population-based surveillance and laboratory-confirmed influenza data. We estimated ≈10 visits per 1,000 residents during the pandemic period. This estimate should help emergency departments prepare for future pandemics.

Background: During the 2009Y2010 influenza A(H1N1)pdm09 pandemic, influenza-associated encounters had an unusual age distribution, with relative sparing of older adults. In postpandemic 2010Y2011, influenza A(H3N2), A(H1N1)pdm09, and B cocirculated.Purpose: To compare influenza-associated encounter rates in pandemic and postpandemic years.Methods: We enrolled and tested patients with acute respiratory illness (ARI) at selected Middle Tennessee hospitals. Age-specific proportions of influenza-positive patients were multiplied by the number of ARI encounters during influenza season to estimate the numbers of influenza encounters. These were divided by the respective populations to estimate rates.Results: In pandemic and postpandemic years, overall influenzaassociated emergency department (ED) visits, 10.2 (95% confidence interval [CI], 7.6 Y14.0) and 10.3 (CI, 8.0 Y13.4) per 1000 residents, were similar. Overall hospitalizations increased from 0.9 (CI, 0.6 Y1.4) to 1.2 (CI, 0.8Y1.6) per 1000 residents. For residents 0.5 to 17 years, influenza encounter rates declined, 13.2 (CI, 9.0 Y19.1) versus 11.9 (CI, 9.6 Y14.5) ED visits and 0.3 (CI, 0.2Y 0.5) versus 0.2 (CI, 0.1Y0.3) hospitalizations. For residents 65 years or older influenza encounter rates increased, 1.6 (CI, 0.3Y8.7) versus 6.7 (CI, 2.4Y16.5) ED visits and 1.0 (CI, 0.3Y2.7) versus 4.5 (CI, 3.1Y6.5) hospitalizations. During 2010Y2011, influenza A(H1N1)pdm09 accounted for 26%, 55%, and 13% of influenza-associated ARI in those aged 0.5 to 17, 18 to 64, and 65 years or older, respectively; influenza B accounted for 62%, 33%, and 54% and influenza A(H3N2) accounted for 12%, 12%, and 33%, respectively.Conclusions: Overall influenza-associated ED rates were similar in both years, but hospitalizations increased modestly in the postpandemicyear. Higher encounter rates in older adults in the postpandemic year were associated with the circulation of 2 nonpandemic influenza viruses.

Background Use of antiretroviral (ARV) drugs during pregnancy has been associated with an increased risk of birth defects, but the evidence remains inconclusive. Methods We identified infants born to human immunodeficiency virus (HIV)-infected mothers between 1994 and 2009 using Tennessee Medicaid data linked to vital records. Maternal HIV status was based on diagnosis codes, prescriptions for ARVs, and HIV-related laboratory testing. ARV exposure was identified from pharmacy claims. Birth defects diagnoses during the first year of life were identified from maternal and infant claims, and from vital records, and were confirmed through medical record review. Multivariate logistic regression models were used to evaluate associations between first trimester ARV dispensing and birth defects. Results Of 806 infants included in the study, 32 (4.0%) had at least 1 major birth defect, most (44%) in the cardiac system. There was no increased risk for infants exposed in the first trimester to ARVs compared to unexposed infants (odds ratio = 1.07; 95% confidence interval (CI): 0.50 – 2.31). Of the 20 infants exposed to efavirenz (EFV), none had a birth defect (0%; 95% CI: 0.0 – 13.2). Conclusions There was no significant association between first trimester ARV dispensing and the risk of birth defects in this Medicaid cohort of HIV positive women.

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