Children hospitalized in pediatric intensive care units (PICUs) are subjected to highly invasive interventions necessary in overcoming the critical period of their illness, yet little is known about their subsequent psychological adjustment. The purposes of this study were to compare the psychological responses of children hospitalized in a PICU with those of children hospitalized on a general ward and to identify clinically relevant factors that might be associated with psychological outcome. A prospective cohort design was used to follow 120 children for 6 months after PICU and ward discharge. Groups were compared on the children's sense of control over their health, their medical fears, posttraumatic stress, and changes in behavior. Relationships between children's responses and their age, the invasive procedures to which they were exposed, severity of illness, and length of hospital stay were also examined. No significant group differences were found. However, children who were younger, more severely ill, and who endured more invasive procedures had significantly more medical fears, a lower sense of control over their health, and ongoing posttraumatic stress responses for 6 months postdischarge. Findings indicate that regardless of the hospital setting, invasiveness coupled with length of stay and severity of illness in young children may have adverse long-term effects.

Screening infants for neuroblastoma does not appear to reduce mortality due to this disease.

Newcomer mothers have an increased risk for PPD symptoms. Social support interventions should be tested for their ability to prevent or alleviate this risk.

Objectives: Clinical scoring systems attempt to improve the diagnostic accuracy of pediatric appendicitis. The Pediatric Appendicitis Score (PAS) was the first score created specifically for children and showed excellent performance in the derivation study when administered by pediatric surgeons. The objective was to validate the score in a nonreferred population by emergency physicians (EPs).Methods: A convenience sample of children, 4-18 years old presenting to a pediatric emergency department (ED) with abdominal pain of less than 3 days' duration and in whom the treating physician suspected appendicitis, was prospectively evaluated. Children who were nonverbal, had a previous appendectomy, or had chronic abdominal pathology were excluded. Score components (right lower quadrant and hop tenderness, anorexia, pyrexia, emesis, pain migration, leukocytosis, and neutrophilia) were collected on standardized forms by EPs who were blinded to the scoring system. Interobserver assessments were completed when possible. Appendicitis was defined as appendectomy with positive histology. Outcomes were ascertained by review of the pathology reports from the surgery specimens for children undergoing surgery and by telephone follow-up for children who were discharged home. Sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) were calculated. The overall performance of the score was assessed by a receiver operator characteristic (ROC) curve.Results: Of the enrolled children who met inclusion criteria (n = 246), 83 (34%) had pathology-proven appendicitis. Using the single cut-point suggested in the derivation study (PAS 5) resulted in an unacceptably high number of false positives (37.6%). The score's performance improved when two cut-points were used. When children with a PAS of £4 were discharged home without further investigations, the sensitivity was 97.6% with a NPV of 97.7%. When a PAS of ‡8 determined the need for appendectomy, the score's specificity was 95.1% with a PPV of 85.2%. Using this strategy, the negative appendectomy rate would have been 8.8%, the missed appendicitis rate would have been 2.4%, and 41% of imaging investigations would have been avoided. Conclusions:The PAS is a useful tool in the evaluation of children with possible appendicitis. Scores of £4 help rule out appendicitis, while scores of ‡8 help predict appendicitis. Patients with a PAS of 5-7 may need further radiologic evaluation.ACADEMIC EMERGENCY MEDICINE 2009; 16:591-596 ª

Findings suggest there is a group of children in the pediatric intensive care unit who are at higher risk for developing persistent psychological sequelae postdischarge. Exposure to high numbers of invasive procedures may be the driving force behind group differences, particularly at 6 wks postdischarge. These children warrant closer observation and follow-up.

Introduction: Structural racism has attracted increasing interest as an explanation for racial disparities in health, including differences in adiposity. Structural racism has been measured most often with single-indicator proxies (e.g., housing discrimination), which may leave important aspects of structural racism unaccounted for. This paper develops a multi-indicator scale measuring county structural racism in the U.S. and evaluates its association with BMI. Methods: County structural racism was estimated with a confirmatory factor model including indicators reflecting education, housing, employment, criminal justice, and health care. Using Behavioral Risk Factor Surveillance Survey data (2011−2012) and a mixed-effects model, individual BMI was regressed on county structural racism, controlling for county characteristics (mean age, percentage black, percentage female, percentage rural, median income, and region). Analysis occurred 2017−2019. Results: The study included 324,572 U.S. adults. A 7-indicator county structural racism model demonstrated acceptable fit. County structural racism was associated with lower BMI. Structural racism and black race exhibited a qualitative interaction with BMI, such that racism was associated with lower BMI in whites and higher BMI in blacks. In a further interaction analysis, county structural racism was associated with larger increases in BMI among black men than black women. County structural racism was associated with reduced BMI for white men and no change for white women. Conclusions: The results confirm structural racism as a latent construct and demonstrate that structural racism can be measured in U.S. counties using publicly available data with methods offering a strong conceptual underpinning and content validity. Further study is necessary to determine whether addressing structural racism may reduce BMI among blacks.

There are over 214 million international migrants worldwide, half of whom are women, and all of them assigned by the receiving country to an immigration class. Immigration classes are associated with certain health risks and regulatory restrictions related to eligibility for health care. Prior to this study, reports of international migrant post-birth health had not been compared between immigration classes, with the exception of our earlier, smaller study in which we found asylum-seekers to be at greatest risk for health concerns. In order to determine whether refugee or asylum-seeking women or their infants experience a greater number or a different distribution of professionally-identified health concerns after birth than immigrant or Canadian-born women, we recruited 1127 migrant (and in Canada <5 years) women-infant pairs, defined by immigration class (refugee, asylum-seeker, immigrant, or Canadian-born). Between February 2006 and May 2009, we followed them from childbirth (in one of eleven birthing centres in Montreal or Toronto) to four months and found that at one week postpartum, asylum-seeking and immigrant women had greater rates of professionally-identified health concerns than Canadian-born women; and at four months, all three migrant groups had greater rates of professionally-identified concerns. Further, international migrants were at greater risk of not having these concerns addressed by the Canadian health care system. The current study supports our earlier findings and highlights the need for case-finding and services for international migrant women, particularly for psychosocial difficulties. Policy and program mechanisms to address migrants' needs would best be developed within the various immigration classes.

Home-based management for newly diagnosed diabetic children can result in better metabolic control and similar psychosocial outcomes compared with traditional hospital- and clinic-based care without notable effects on social (total) costs.