Objectives. To identify and describe disparities in the provision of Emergency Department (ED) care in pediatric patients presenting with chest pain (CP). Patients and Methods. Nationally representative data were drawn from the National Hospital Ambulatory Medical Care Survey (NHAMCS). All ED visits with a chief complaint of CP and age <19 years from 2002 to 2006 were analyzed. The primary outcome variable was "Anytest" performed (defined as any combination of complete blood count, electrocardiogram, and/or chest x-ray). Univariable analyses were performed with "Anytest" as the dependent variable and patient characteristics as independent variables. Multivariable analysis was performed using logistic regression with the same independent patient characteristics. Results. Eight hundred eighteen pediatric CP visits representing 2 552 193 such visits nationwide were analyzed. Gender and metro/non-metro location were not associated with "Anytest." However, Caucasian patients (p = 0.01) and those with private insurance (p < 0.01) were significantly more likely to receive testing despite otherwise similar demographics and severity of illness. Multivariate analysis revealed race (p = 0.03), expected payer (p = 0.003), and triage level (p = 0.009) were significantly and independently associated with the frequency of testing performed. Conclusion. Disparities exist in the ED care of pediatric patients with CP. Identification of such variations is important and provides an opportunity for targeted interventions that ensure delivery of high-quality, cost-effective health care for children.

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Development of a vaccine for prevention of congenital cytomegalovirus (CMV) disease is a priority. This study evaluated a "prime-boost" strategy by comparing the safety and immunogenicity of 3 doses of subunit CMV glycoprotein B (gB) vaccine plus MF59 (a squalene-in-water emulsion), 2 doses of a canarypox recombinant vaccine expressing CMVgB (ALVAC-CMVgB) followed by 2 doses of the subunit gB vaccine, 3 doses of both vaccines administered concomitantly, and placebo in 105 healthy, CMV-seronegative adults. Systemic adverse events were rare, but local reactions were common in all groups. After the first subunit vaccination, neutralizing antibody titers in the prime-boost group were comparable to those in subjects receiving 2 subunit vaccinations, indicating a priming effect of ALVAC-CMVgB. However, after the final dose, antibody and cell-mediated immune responses were not significantly different among the groups. All 3 vaccine regimens induced high-titer antibody and lymphoproliferative responses, but no benefit for priming or simultaneous vaccination was detected.

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Using the geographically and socioeconomjcally varied collaborative Lipid Research Clinics Prevalence Study data, this report focuses upon relationships between dietary intake and plasma lipids and lipoproteins in 1234 white children, 661 boys and 573 girls, aged 6-19 years who were sampled in a random recall (Visit 2) from large populations in six Lipid Research Clinics. Using multiple regression analysis, we found that in 6-to 12-year-old boys the dietary polyunsaturated-to-saturated fat ratio was inversely associated with plasma total and low density lipoprotein cholesterol and dietary cholesterol was positively associated with plasma high density lipoprotein cholesterol. In 13-to 19-year-old boys, high density lipoprotein cholesterol and the ratio of high density lipoprotein cholesterol to total cholesterol were inversely related to sucrose intake. In 6-to 12-year-old girls, plasma triglycerides were positively related to dietary sucrose. Using analysis of covariance in children having the lowest, middle, and top decile nutrient intakes, we found that higher carbohydrate intakes were associated with lower plasma total cholesterol in boys. The highest polyunsaturated fat intake (in 6-to 12-year-old girls) was associated with the lowest plasma cholesterol and very low density lipoprotein cholesterol. The highest cholesterol intake (in 6-to 12-year-old boys) was associated with the highest high density lipoprotein cholesterol levels. In girls, the highest sucrose intakes were associated with the highest plasma triglyceride levels. We conclude that the weak, but statistically significant, associations that we observed were meaningful relative to etiologies of nutrient-lipoprotein interrelationships, and should be useful in forming new hypotheses for focused metabolic ward studies. (Arteriosclerosis