Background: On January 20, 2020, the first documented case of novel severe acute respiratory syndrome coronavirus 2 (coronavirus disease 2019 [COVID-19]) was reported in the United States. The U.S. Centers for Disease Control and Prevention continues to report more morbidity
and mortality in adults than in children. Early in Pandemic, there was a concern that patients with asthma would be affected disproportionately from COVID-19, but this was not manifested. It is now recognized that angiotensin-converting enzyme 2 receptors that are used by the coronavirus
for infection have low expression in children with atopy that may contribute to decreased infectivity in children who are atopic. There are several early reports of decreased emergency department (ED) visits for children with asthma. The authors previously reported a decrease in pediatric
ED visits in the spring of 2020, which correlated with school closure. Objective: To determine if this trend of decreased ED visits for pediatric asthma was sustained throughout the first COVID-19 pandemic year. Methods: ED data from one inner city children's
hospital were collected by using standard medical claims codes. Conclusion: We reported a sustained year of decreased ED visits for children with asthma in one pediatric ED in an inner-city hospital; this seemed to be secondary to school closure and decreased exposure to
upper respiratory infections.
Problem analysis conducted by a university-based research partner can provide communities with data-driven options to address the local drivers of serious youth and gang violence. Situated in Worcester, Massachusetts, this article describes how subsequent to early childhood trauma being identified as a potential driver of adolescent and young adult violence; problem analysis using local data confirmed that being the victim or witness of a traumatic incident before the age of 12 years was significantly correlated with involvement in violence in adolescence or young adulthood. Although there is a robust literature on the relationship between early childhood trauma and later delinquency, local decision makers did not consider this knowledge actionable until the research partner used the city's own police records to demonstrate the extent of the problem in the city. Rigorous problem analysis, conducted collaboratively between practitioners and an academic research partner, helped to compel local change and ensured that strategies addressed the right risk factors and directed service to the appropriate target population.
Among the three medications approved for the treatment of opioid use disorder, methadone has been in use for the longest period and has the most extensive evidence base of effectiveness. Yet it remains underutilized as new insurance policies favor access to buprenorphine and neglect to dismantle barriers to obtaining methadone. In the absence of wholesale regulatory change, private insurance carriers should take the lead in expanding access to this medication. We offer several solutions for private payers, including expanding coverage, removing prior authorization, addressing out-of-pocket costs, increasing provider reimbursement, and incentivizing system integration.
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