RESUMO

OBJECTIVE: To validate externally the UTICalc, a popular clinical decision support tool used to determine the risk of urinary tract infections (UTIs) in febrile children, and compare its performance with and without the inclusion of race and at differing risk thresholds. METHODS: We performed a retrospective, singlecenter case-control study of febrile children (2-24 months) in an emergency department. Cases with culture-confirmed UTI were matched 1:1 to controls. We compared the performance of the original model which included race (version 1.0) to a revised model which did not consider race (version 3.0). We evaluated model performance at risk thresholds between 2% and 5%. RESULTS: We included 185 cases and 197 controls (median age 8.4 months; IQR, 4.4-13.0 months; 60.5% girls). When using UTICalc version 1.0, the model area under the receiver operator characteristic curve (AUROC) was 73.4% (95% CI 68.4%-78.5%), which was similar to the version 3.0 model (73.8%; 95% CI 68.7%-78.8%). When using a 2% risk threshold, the version 3.0 model demonstrated a sensitivity of 96.7% and a specificity of 25.0%, with declines in sensitivity and gains in specificity at higher risk thresholds. Version 1.0 of the UTICalc had 12 false negatives, of whom 10 were Black (83%); whereas version 3.0 had 6 false negatives, of whom 2 were Black (33%). CONCLUSIONS: Versions of the UTICalc with and without race had similar performance to each other with a slight decline from the original derivation sample. The removal of race did not adversely affect the accuracy of the UTICalc.

Assuntos

Infecções Urinárias , Feminino , Criança , Humanos , Lactente , Masculino , Estudos Retrospectivos , Estudos de Casos e Controles , Infecções Urinárias/diagnóstico

RESUMO

OBJECTIVE: To characterize children who experienced interfacility emergency department (ED) transfers with discharge home, and identify care potentially amenable to telemedicine in lieu of transfer. STUDY DESIGN: Retrospective cohort study (July 2016 to June 2017) of patients transferred from general EDs to an academic pediatric ED and discharged home. The primary outcome was care potentially amenable to telemedicine defined as pediatric emergency medicine (PEM) provider assessment without other in-person subspecialty evaluation, diagnostic evaluation available in a general ED (electrocardiogram, point-of-care, or urine tests), and/or referrals and medications available in a general ED. Analysis included descriptive and χ2 statistics. RESULTS: Of the 1733 patients transferred, 529 (31%) were discharged home and 22% of those discharged home had care potentially amenable to telemedicine. Patients amenable to telemedicine were more likely to be <2 years old (32% vs 17%; P = .002) and to have neurologic (29% vs 17%; P = .005), respiratory (16% vs 4%; P < .001), or urinary (5% vs 1%; P = .004) diagnoses than those whose care was not. Eight in 10 patients received their entire diagnostic evaluation before transfer and one-half received only a PEM provider assessment. An additional 281 cases were evaluated by a subspecialist in person, received routine imaging, or routine interventions. CONCLUSIONS: Children receiving care potentially amenable to telemedicine in lieu of transfer often received their entire diagnostic evaluation before transfer; PEM provider assessment was the mainstay of care after transfer. These findings have implications for informing telemedicine to improve access to PEM expertise and potentially decrease some interfacility transfers.

Assuntos

Serviço Hospitalar de Emergência , Transferência de Pacientes/organização & administração , Pediatria , Telemedicina , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Departamentos Hospitalares , Humanos , Lactente , Masculino , Estudos Retrospectivos

RESUMO

OBJECTIVE: To identify and quantify public preferences for attributes of newborn screening conditions. STUDY DESIGN: We conducted an online national survey of the public (n = 502) to evaluate preferences for attributes of candidate newborn screening conditions. Respondents were presented with hypothetical condition profiles that were defined using 10 attributes with 2-6 levels per attribute. Participants indicated whether they would recommend screening for a condition and which condition attributes were most and least important when making this decision (best-worst scaling). Difference scores were calculated and stratified by condition recommendation (recommend or not recommend for screening). Regression analyses were used to evaluate the effect of attributes on choice to screen or not screen. RESULTS: The number of babies diagnosed was important to those who would recommend newborn screening for a profile, and age at which the treatment would start was important to those who would not recommend newborn screening. Cost was considered to be a key attribute, and treatment effectiveness and impact of making the diagnosis through newborn screening were of low importance for both groups. CONCLUSION: Public preferences identified through survey methods that provide an adequate baseline understanding of newborn screening can be used to inform newborn screening decisions.

Assuntos

Triagem Neonatal , Preferência do Paciente , Opinião Pública , Adolescente , Adulto , Tomada de Decisões , Feminino , Humanos , Recém-Nascido , Doenças do Recém-Nascido/diagnóstico , Doenças do Recém-Nascido/terapia , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Tempo para o Tratamento , Adulto Jovem

RESUMO

The Mexico-US border region is a transit point in the trajectory of Mexican migrants travelling to and from the USA and a final destination for domestic migrants from other regions in Mexico. This region also represents a high-risk environment that may increase risk for HIV among migrants and the communities they connect. We conducted a cross-sectional, population-based survey, in Tijuana, Mexico, and compared Mexican migrants with a recent stay on the Mexico-US border region (Border, n = 553) with migrants arriving at the border from Mexican sending communities (Northbound, n = 1077). After controlling for demographics and migration history, border migrants were more likely to perceive their risk for HIV infection as high in this region and regard this area as a liberal place for sexual behaviours compared to Northbound migrants reporting on their perceptions of the sending communities (p < .05). Male border migrants were more likely to engage in sex, and have unprotected sex, with female sex workers during their recent stay on the border compared to other contexts (rate ratio = 3.0 and 6.6, respectively, p < .05). Binational and intensified interventions targeting Mexican migrants should be deployed in the Mexican border region to address migration related HIV transmission in Mexico and the USA.

Assuntos

Infecções por HIV/transmissão , Acessibilidade aos Serviços de Saúde/economia , Comportamento Sexual/estatística & dados numéricos , Normas Sociais/etnologia , Transtornos Relacionados ao Uso de Substâncias/etnologia , Migrantes/estatística & dados numéricos , Sorodiagnóstico da AIDS/estatística & dados numéricos , Adulto , Estudos Transversais , Escolaridade , Feminino , Infecções por HIV/epidemiologia , Infecções por HIV/etnologia , Humanos , Incidência , Seguro Saúde/economia , Seguro Saúde/estatística & dados numéricos , Masculino , México/etnologia , Prevalência , Assunção de Riscos , Profissionais do Sexo/estatística & dados numéricos , Comportamento Sexual/etnologia , Comportamento Sexual/psicologia , Parceiros Sexuais , Fatores Socioeconômicos , Transtornos Relacionados ao Uso de Substâncias/economia , Transtornos Relacionados ao Uso de Substâncias/psicologia , Inquéritos e Questionários , Migrantes/psicologia , Estados Unidos/epidemiologia

RESUMO

Mobile populations are at increased risk for HIV infection. Exposure to HIV prevention messages at all phases of the migration process may help decrease im/migrants' HIV risk. We investigated levels of exposure to HIV prevention messages, factors associated with message exposure, and the association between exposure to prevention messages and HIV testing behavior among Mexican im/migrants at different phases of the migration process. We conducted a cross-sectional, probability survey of Mexican im/migrants (N = 3,149) traveling through the border city of Tijuana, Mexico. The results indicate limited exposure to prevention messages (57-75%) and suboptimal last 12-month HIV testing rates (14-25%) across five migration phases. Compared to pre-departure levels (75%), exposure to messages decreases at all post-departure migration phases (57-63%, p < .001). In general, exposure to prevention messages is positively associated with greater odds of HIV testing at the pre-departure, destination, and interception phases. Binational efforts need to be intensified to reach and deliver HIV prevention to Mexican im/migrants across the migration continuum.

Assuntos

Infecções por HIV/prevenção & controle , Conhecimentos, Atitudes e Prática em Saúde , Americanos Mexicanos , Migrantes , Adolescente , Adulto , Estudos Transversais , Feminino , Infecções por HIV/diagnóstico , Infecções por HIV/epidemiologia , Humanos , Entrevistas como Assunto , Masculino , Programas de Rastreamento , México/etnologia , Pessoa de Meia-Idade , Vigilância da População , Fatores de Risco , Fatores Socioeconômicos , Inquéritos e Questionários , Estados Unidos/epidemiologia

RESUMO

BACKGROUND: Temporary and unauthorized migrants may face unique obstacles to access health care services in the U.S. OBJECTIVE: This study estimated levels of health care access among Mexican migrants returning to Mexico from the U.S. and factors associated with access to health care, with emphasis on the role of modifiable, enabling factors. METHODS: We conducted a pilot probability health care survey of migrants in the border city of Tijuana, Mexico (N=186). RESULTS: Approximately 42% of migrants reported having used health care services in the U.S. during the past year. Only 38% had a usual source of care and approximately 11% went without needed medical care in the U.S. About 71% of migrants did not have health insurance in the U.S. Lack of health insurance and transportation limitations were significantly related to various access indicators. CONCLUSION: These results have implications for future policies and programs aimed to address modifiable health care access barriers faced by these vulnerable and underserved segments of the Mexican migrant population.