RESUMO
OBJECTIVE: To prospectively validate the Pediatric Appendicitis Score (PAS), developed on a cohort of children with abdominal pain suggestive of appendicitis, in unselected children with abdominal pain who present to the emergency department. STUDY DESIGN: Over a 19-month period, we prospectively recruited children 1 to 17 years old who came to our tertiary pediatric emergency department, with a chief complaint of abdominal pain of duration less than 7 days. PAS components included fever >38 degrees C, anorexia, nausea/vomiting, cough/percussion/hopping tenderness (2 points), right-lower-quadrant tenderness (2 points), migration of pain, leukocytosis >10 000 cells/mm(3), and polymorphonuclear neutrophilia > 7500 cells/mm(3). A follow-up call was made to verify final outcome. Sensitivity, specificity, and the receiver operating characteristic curve of the PAS with respect to diagnosis of appendicitis were calculated. RESULTS: We collected data on 849 children. 123 (14.5%) had pathologic study-proven appendicitis. Mean (median, range) score for children with appendicitis and without appendicitis was 7.0 (7, 2-10) and 1.9 (1, 0-9), respectively. If a cutoff PAS of
Assuntos
Dor Abdominal/diagnóstico , Apendicite/diagnóstico , Apendicite/epidemiologia , Técnicas de Apoio para a Decisão , Dor Abdominal/etiologia , Adolescente , Apendicite/complicações , Criança , Pré-Escolar , Diagnóstico Diferencial , Humanos , Lactente , Estudos Prospectivos , Curva ROC , Reprodutibilidade dos TestesRESUMO
For Mexican migrants and recent immigrants, the impact of migration from Mexico to California has the potential to lead to an increased risk for HIV infection. Until recently, the prevalence of HIV in Mexico and among Mexican migrants in California appeared to be stable and relatively low. Recent studies have raised new concerns, however, that the HIV epidemic may expand more aggressively among this population in the coming years. Unfortunately, the insufficient amount of data available within recent years makes it difficult to fully assess the potential for rapid spread of the HIV epidemic among this population. Consequently, there is a critical need for an ongoing binational surveillance system to assess prevalence and trends in HIV/STD/TB disease and related risk behaviors among this population both in Calfornia and within this population's states of origin in Mexico. This enhanced epidemiologic surveillance system should provide improved data on the subpopulations at the highest risk for HIV/STD/TB, such as men who have sex with men, and should provide the opportunity to evaluate the impact of migration on the transmission dynamics, risk behaviors, and determinants of behavior on each side of the border. It is essential that this potential threat be assessed and that intervention programs are developed and implemented to combat this possible escalation in the HIV epidemic.
Assuntos
Infecções por HIV/epidemiologia , Migrantes , Agricultura , California/epidemiologia , Emigração e Imigração , Monitoramento Ambiental , Monitoramento Epidemiológico , Feminino , Infecções por HIV/complicações , Política de Saúde , Homossexualidade Masculina , Humanos , Masculino , México/epidemiologia , México/etnologia , Vigilância da População , Gravidez , Assunção de Riscos , Trabalho Sexual , Infecções Sexualmente Transmissíveis/complicações , Infecções Sexualmente Transmissíveis/epidemiologia , Abuso de Substâncias por Via Intravenosa/complicações , Tuberculose Pulmonar/complicações , Tuberculose Pulmonar/epidemiologiaRESUMO
The importance of immunization in protecting seniors against influenza and pneumonia has long been recognized. Nevertheless, immunization rates among Medicare beneficiaries continue to fall short of what is both desirable and achievable. The problem is even more acute among certain racial and ethnic groups in the United States within which rates are below the rate for the country as a whole. This is true in New Mexico where 40 percent of the population is estimated to be Hispanic. As part of its work on behalf of the Centers for Medicare & Medicaid Services (CMS), the New Mexico Medical Review Association (NMMRA) undertook a project aimed both at reducing the disparities that exist in immunization status between the Hispanic and non-Hispanic population in the state and attempting to increase overall rates in the state for all groups. Developing interventions to reduce disparaties in immunization rates between Hispanic seniors and the rest of the senior population requires more than a straightforward review of the literature and must take into account not only the cultural differences that exist between Hispanics and non-Hispanics but, certainly, in the case of New Mexico, it must attempt to understand the richness and diversity that exists within the Hispanic communities across the state. To do otherwise runs the risk of designing interventions that are at best ineffective and at worst culturally insensitive and potentially damaging to future efforts to improve health status. This article describes the process undertaken by NMMRA, a Medicare Quality Improvement Organization (QIO), to collect qualitative data from three culturally different groups of Hispanics in New Mexico. The data are used to design interventions that will increase immunization rates for all Hispanics in New Mexico.