Paul H. Wise, MD, MPH

All Publications

• Strategies to promote sustainable care for children with cancer in Ukraine. The Lancet. Oncology Agulnik, A., Nogovitsyna, Y., Kizyma, R., Yakimkova, T., Vivtcharenko, V., Bhakta, N., Wise, P. H., Rodriguez-Galindo, C., Kacharian, A. 2024

  View details for DOI 10.1016/S1470-2045(23)00577-6

  View details for PubMedID 38307103

• The Preface DAEDALUS Kleinman, A. 2023; 152 (4): 6-7

  View details for DOI 10.1162/daed_e_02028

  View details for Web of Science ID 001112185900011

• EATING DISORDER CARE VIA TELEHEALTH: TELEHEALTH ACCESS AND QUALITY OF CARE AMONG YOUNG ADULTS AND ADOLESCENTS, 2018-2022 Meza, B. A., Wozniak, L., Goldstein, R., Saynina, O., Wise, P., Carlson, J., Chamberlain, L. ELSEVIER SCIENCE INC. 2023: S55

  View details for Web of Science ID 000995238000095

• Advocacy for Unaccompanied Migrant Children in US Detention. Pediatric clinics of North America Wise, P. H. 2023; 70 (1): 103-116

  Abstract

  During 2021, nearly 150,000 unaccompanied children (UCs) were apprehended at the US-Mexican border. Most are leaving Guatemala, Honduras, and El Salvador, motivated by poverty, climate change, and violence. UCs are most often apprehended by the Border Patrol and then transferred to the Office of Refugee Resettlement (ORR), the Department of Health and Human Services. ORR is responsible for ensuring that the child is released to a parent or sponsor in the United States capable of providing an adequate home. Advocacy must not only address a complex system of legal and custodial care but also confront a troubled political environment.

  View details for DOI 10.1016/j.pcl.2022.09.006

  View details for PubMedID 36402461

• The Conclusion DAEDALUS Wise, P. H., Welsh, J. M., Sepulveda, J. 2023; 152 (2): 210-215

  View details for DOI 10.1162/daed_a_02000

  View details for Web of Science ID 001000641600023

• The Preface DAEDALUS Welsh, J. M., Wise, P. H., Sepulveda, J. 2023; 152 (2): 6-12

  View details for DOI 10.1162/daed_e_01988

  View details for Web of Science ID 001000641600002

• Global effort to evacuate Ukrainian children with cancer and blood disorders who have been affected by war LANCET HAEMATOLOGY Agulnik, A., Kizyma, R., Salek, M., Wlodarski, M. W., Pogorelyy, M., Oszer, A., Yakimkova, T., Nogovitsyna, Y., Dutkiewicz, M., Dalle, J., Dirksen, U., Eggert, A., Fernandez-Teijeiro, A., Greiner, J., Kraal, K., Mueller, A., Sramkova, L., Zecca, M., Wise, P. H., Mlynarski, W. 2022; 9 (9): E645-E647

  View details for Web of Science ID 000876363200016

• Global effort to evacuate Ukrainian children with cancer and blood disorders who have been affected by war. The Lancet. Haematology Agulnik, A., Kizyma, R., Salek, M., Wlodarski, M. W., Pogorelyy, M., Oszer, A., Yakimkova, T., Nogovitsyna, Y., Dutkiewicz, M., Dalle, J., Dirksen, U., Eggert, A., Fernandez-Teijeiro, A., Greiner, J., Kraal, K., Mueller, A., Sramkova, L., Zecca, M., Wise, P. H., Mlynarski, W., SAFER Ukraine Collaborative, Avula, M., Adyrov, M. V., Berlanga, P., Blackwood, C. A., Bouffet, E., Czauderna, P. S., de Koning, L. A., Dos Reis Farinha, N. J., Foster, W. B., Graetz, D. E., Gupta, S., Holter, W., Hough, R. E., Kliuchkivska, K., Kolenova, A., Kolodrubiec, J., Moreira, D. C., Mukkada, S. T., Mykychak, I., Raciborska, A., Salman, Z. S., Sopilnyak, A., Tyupa, S., Vinitsky, A., Wobst, N. M., Miller, B. A., Rasul, S. S., Rodriguez-Galindo, C., Alanbousi, I., Alexander, S. W., Apel, A., Bal, W. A., Balwierz, W. A., Basset-Salom, L., Bastardo Blanco, D., Bauer, K. J., Bayazitov, I. T., Bhakta, N. H., Bien, E. I., Bieniek, K. A., Blair, S. J., Bodak, K. I., Bordeianu, I. M., Braganca, J. M., Bucurenci, M. S., Budny, E. B., Budzyn, A., Bumgardner, C. C., Burditt, R. N., Burnside Clapp, V. G., Bykov, V., Canete, A., Carnelli, M., Cela, E., Cepowska, Z. P., Chaber, R., Cherner-Drieux, A., Chubata, M., Clough, H. M., Czernicka-Siwecka, J., Czyzewski, K., Dashchakovska, O., Dembowska-Baginska, B. M., Derwich, K., Dommett, R., Dorosh, O., Drabko, K. A., Dragomir, M. D., Dworzak, M., Dyma, S., Earl, J. D., English, M. W., Evseev, D. A., Farren, B. S., Fedyk, N., Ferneza, S., Fox Irwin, L. E., Galazkowski, R. M., Ganieva, G., Garanzha, V., Gelman, M. S., Godzinski, J. K., Goeres, A. F., Golban, R., Griksaitis, M. J., Hampel, M. A., Hastings, S. G., Heenen, D. L., Hill, M. C., Holiuk, I., Hutnik, L. M., Irga-Jaworska, N., Istomin, O., Janczar, S. L., Kacharian, A., Kalwak, K., Karolczyk, G. M., Karpenko, N. M., Katsubo, H., Kaznowska, B. J., Kentsis, A., Ketteler, P., Kienesberger, A., Kiselev, R., Kizyma, Z., Klymniuk, H., Kostiuk, Y., Kowalik, T., Kozlova, O., Kozubenko, V., Kramar, T., Krawczuk-Rybak, M., Kulemzina, I., Kurkowska, P., Kuzyk, A. S., Ladenstein, R. L., Laguna, P. J., Lassaletta, A., Lehmberg, K., Leontieva, O., Liashenko, S., Loizou, L. G., Lucchetta, S. A., Lupo, M. W., Lysytsia, L., Lysytsia, O., Machnik, K. A., Mainland, J. A., Matczak, K. E., Matysiak, M. J., Mayeur, P., Minervina, A. A., Mishkova, V., Mizia-Malarz, A. J., Morales La Madrid, A., Moreno, L., Moskvin, V. P., Muszynska-Roslan, K. M., Nelson, A. J., Ociepa, T., Oltolini, S., Onipko, N., Pappas, A., Patel, A. B., Patrahau, A., Pauley, J. L., Pavlenko, Y., Pavlovych, A., Peregud-Pogorzelski, J., Perek-Polnik, M., Perez, V., Perez-Martinez, A., Pikman, Y., Pitozzi, G., Portugal, R. G., Posternak, V. V., Prete, A., Pritchard-Jones, K., Radaelli, A., Reeves, T., Reinhardt, D., Reshetnyak, A. V., Rider, A. J., Rizzari, C., Rizzi, D., Rodriguez Hermosillo, K. G., Ronenko, O., Rostowska, A. O., Rudko, L., Sakaan, F. M., Sakhar, N., Savva, N. N., Scaccaglia, D., Schaeffer, E. H., Schneider, C. U., Scobie, N., Semeniuk, O., Shevchyk, R., Shuler, A. I., Shvets, S., Skoczen, S. P., Smeal, W. J., Sokolowski, I., Sonkin, A. A., Stepanjuk, A. I., Spota, A., Sterba, J., Styczynski, J., Svintsova, O., Synyuta, A. V., Szczepanski, T., Szczucinski, P. K., Szmyd, B. M., Tasso Cereceda, M., Teliuk, A., Tomanek, I., Topping, P., Torrent, M., Trelinska, J., Troyanovska, O., Trubnikova, E., Tsurkan, L. G., Tsymbalyuk-Voloshyn, I., Urasinski, T. F., Urbanek-Dadela, A., Vasilieva, N., Vasilyeva, A., Verdu-Amoros, J., Vilcu-Bajurean, N., Vinitsky, L., Volpe, G., Vorobel, O., Wachowiak, J. T., Wasiak, M. S., Wiedower, L. A., Wuenschel, L. I., Wysocki, M. S., Yurieva, M., Zagurska, A., Zakharenko, S. S., Zakharenko, A. V., Zapotochna, K., Zawitkowska, J. E. 2022; 9 (9): e645-e647

  View details for DOI 10.1016/S2352-3026(22)00259-9

  View details for PubMedID 36055331

• Humanitarian aid must be allowed to enter the besieged Tigray region of Ethiopia. Nature medicine Kumar, W. M., Gebregziabher, B. A., Mengesha, R. E., Wise, P. H. 2022

  View details for DOI 10.1038/s41591-022-01921-0

  View details for PubMedID 35982308

• The Impact of Telehealth Adoption During COVID-19 Pandemic on Patterns of Pediatric Subspecialty Care Utilization. Academic pediatrics Cahan, E. M., Maturi, J., Bailey, P., Fernandes, S., Addala, A., Kibrom, S., Krissberg, J. R., Smith, S. M., Shah, S., Wang, E., Saynina, O., Wise, P. H., Chamberlain, L. J. 2022

  Abstract

  OBJECTIVE: The COVID-19 pandemic prompted health systems to rapidly adopt telehealth for clinical care. We examined the impact of demography, subspecialty characteristics, and broadband availability on the utilization of telehealth in pediatric populations before and after the early period of the COVID-19 pandemic.METHODS: Outpatients scheduled for subspecialty visits at sites affiliated with a single quaternary academic medical center between March - June 2019 and March - June 2020 were included. The contribution of demographic, socioeconomic, and broadband availability to visit completion and telehealth utilization were examined in multivariable regression analyses.RESULTS: Among visits scheduled in 2020 compared to 2019, in-person visits fell from 23,318 to 11,209, while telehealth visits increased from 150 to 7,675. Visits among established patients fell by 15% and new patients by 36% (p<.0001). Multivariable analysis revealed that completed visits were reduced for Hispanic patients and those with reduced broadband; high income, private non-HMO insurance, and those requesting an interpreter were more likely to complete visits. Of those with visits scheduled in 2020, established patients, those with reduced broadband, and patients older than 1 year were more likely to complete TH appointments. Cardiology, oncology, and pulmonology patients were less likely to complete scheduled TH appointments.CONCLUSIONS: Following COVID-19 onset, outpatient pediatric subspecialty visits shifted rapidly to telehealth. However, the impact of this shift on social disparities in outpatient utilization was mixed with variation among subspecialties. A growing reliance on telehealth will necessitate insights from other healthcare settings serving populations of diverse social and technological character.

  View details for DOI 10.1016/j.acap.2022.03.010

  View details for PubMedID 35318159

• Adversity and Opportunity-The Pandemic's Paradoxical Effect on Child Health and Well-being. JAMA pediatrics Wise, P. H., Chamberlain, L. J. 2022

  View details for DOI 10.1001/jamapediatrics.2022.0063

  View details for PubMedID 35285893

• Heterogeneity in the Impact of the COVID-19 Pandemic on Disparities in Pediatric Endocrine Care Addala, A., Shah, S., Saynina, O., Wise, P., Chamberlain, L. KARGER. 2021: 51-52

  View details for Web of Science ID 000696303300078

• Health seeking behavior after the 2013-16 Ebola epidemic: Lassa fever as a metric of persistent changes in Kenema District, Sierra Leone. PLoS neglected tropical diseases Koch, M. R., Kanneh, L., Wise, P. H., Kurina, L. M., Alhasan, F., Garry, R. F., Schieffelin, J. S., Shaffer, J. G., Grant, D. S. 2021; 15 (7): e0009576

  Abstract

  BACKGROUND: The West African Ebola epidemic of 2013-2016 killed nearly 4,000 Sierra Leoneans and devastated health infrastructure across West Africa. Changes in health seeking behavior (HSB) during the outbreak resulted in dramatic underreporting and substantial declines in hospital presentations to public health facilities, resulting in an estimated tens of thousands of additional maternal, infant, and adult deaths per year. Sierra Leone's Kenema District, a major Ebola hotspot, is also endemic for Lassa fever (LF), another often-fatal hemorrhagic disease. Here we assess the impact of the West African Ebola epidemic on health seeking behaviors with respect to presentations to the Kenema Government Hospital (KGH) Lassa Ward, which serves as the primary health care referral center for suspected Lassa fever cases in the Eastern Province of Sierra Leone.METHODOLOGY/PRINCIPAL FINDINGS: Presentation frequencies for suspected Lassa fever presenting to KGH or one of its referral centers from 2011-2019 were analyzed to consider the potential impact of the West African Ebola epidemic on presentation patterns. There was a significant decline in suspected LF cases presenting to KGH following the epidemic, and a lower percentage of subjects were admitted to the KGH Lassa Ward following the epidemic. To assess general HSB, a questionnaire was developed and administered to 200 residents from 8 villages in Kenema District. Among 194 completed interviews, 151 (78%) of respondents stated they felt hospitals were safer post-epidemic with no significant differences noted among subjects according to religious background, age, gender, or education. However, 37 (19%) subjects reported decreased attendance at hospitals since the epidemic, which suggests that trust in the healthcare system has not fully rebounded. Cost was identified as a major deterrent to seeking healthcare.CONCLUSIONS/SIGNIFICANCE: Analysis of patient demographic data suggests that fewer individuals sought care for Lassa fever and other febrile illnesses in Kenema District after the West African Ebola epidemic. Re-establishing trust in health care services will require efforts beyond rebuilding infrastructure and require concerted efforts to rebuild the trust of local residents who may be wary of seeking healthcare post epidemic.

  View details for DOI 10.1371/journal.pntd.0009576

  View details for PubMedID 34260615

• Gendered effects of COVID-19 on young girls in regions of conflict LANCET Nesamoney, S. N., Darmstadt, G. L., Wise, P. H. 2021; 397 (10288): 1880-1881

  View details for Web of Science ID 000652556000015

• Gendered effects of COVID-19 on young girls in regions of conflict. Lancet (London, England) Nesamoney, S. N., Darmstadt, G. L., Wise, P. H. 2021; 397 (10288): 1880-1881

  View details for DOI 10.1016/S0140-6736(21)00936-3

  View details for PubMedID 34022981

• Addressing the impacts of COVID-19 on gender equality and global health security in regions of violent conflict. Journal of global health Nesamoney, S. N., Darmstadt, G. L., Wise, P. H. 2021; 11: 03074

  View details for DOI 10.7189/jogh.11.03074

  View details for PubMedID 34055324

• Delivering health interventions to women, children, and adolescents in conflict settings: what have we learned from ten country case studies? Lancet (London, England) Singh, N. S., Ataullahjan, A. n., Ndiaye, K. n., Das, J. K., Wise, P. H., Altare, C. n., Ahmed, Z. n., Sami, S. n., Akik, C. n., Tappis, H. n., Mirzazada, S. n., Garcés-Palacio, I. C., Ghattas, H. n., Langer, A. n., Waldman, R. J., Spiegel, P. n., Bhutta, Z. A., Blanchet, K. n. 2021

  Abstract

  Armed conflict disproportionately affects the morbidity, mortality, and wellbeing of women, newborns, children, and adolescents. Our study presents insights from a collection of ten country case studies aiming to assess the provision of sexual, reproductive, maternal, newborn, child, and adolescent health and nutrition interventions in ten conflict-affected settings in Afghanistan, Colombia, Democratic Republic of the Congo, Mali, Nigeria, Pakistan, Somalia, South Sudan, Syria, and Yemen. We found that despite large variations in contexts and decision making processes, antenatal care, basic emergency obstetric and newborn care, comprehensive emergency obstetric and newborn care, immunisation, treatment of common childhood illnesses, infant and young child feeding, and malnutrition treatment and screening were prioritised in these ten conflict settings. Many lifesaving women's and children's health (WCH) services, including the majority of reproductive, newborn, and adolescent health services, are not reported as being delivered in the ten conflict settings, and interventions to address stillbirths are absent. International donors remain the primary drivers of influencing the what, where, and how of implementing WCH interventions. Interpretation of WCH outcomes in conflict settings are particularly context-dependent given the myriad of complex factors that constitute conflict and their interactions. Moreover, the comprehensiveness and quality of data remain limited in conflict settings. The dynamic nature of modern conflict and the expanding role of non-state armed groups in large geographic areas pose new challenges to delivering WCH services. However, the humanitarian system is creative and pluralistic and has developed some novel solutions to bring lifesaving WCH services closer to populations using new modes of delivery. These solutions, when rigorously evaluated, can represent concrete response to current implementation challenges to modern armed conflicts.

  View details for DOI 10.1016/S0140-6736(21)00132-X

  View details for PubMedID 33503459

• Explaining the Black-White Disparity in Preterm Birth: A Consensus Statement From a Multi-Disciplinary Scientific Work Group Convened by the March of Dimes. Frontiers in reproductive health Braveman, P., Dominguez, T. P., Burke, W., Dolan, S. M., Stevenson, D. K., Jackson, F. M., Collins, J. W., Driscoll, D. A., Haley, T., Acker, J., Shaw, G. M., McCabe, E. R., Hay, W. W., Thornburg, K., Acevedo-Garcia, D., Cordero, J. F., Wise, P. H., Legaz, G., Rashied-Henry, K., Frost, J., Verbiest, S., Waddell, L. 2021; 3: 684207

  Abstract

  In 2017-2019, the March of Dimes convened a workgroup with biomedical, clinical, and epidemiologic expertise to review knowledge of the causes of the persistent Black-White disparity in preterm birth (PTB). Multiple databases were searched to identify hypothesized causes examined in peer-reviewed literature, 33 hypothesized causes were reviewed for whether they plausibly affect PTB and either occur more/less frequently and/or have a larger/smaller effect size among Black women vs. White women. While definitive proof is lacking for most potential causes, most are biologically plausible. No single downstream or midstream factor explains the disparity or its social patterning, however, many likely play limited roles, e.g., while genetic factors likely contribute to PTB, they explain at most a small fraction of the disparity. Research links most hypothesized midstream causes, including socioeconomic factors and stress, with the disparity through their influence on the hypothesized downstream factors. Socioeconomic factors alone cannot explain the disparity's social patterning. Chronic stress could affect PTB through neuroendocrine and immune mechanisms leading to inflammation and immune dysfunction, stress could alter a woman's microbiota, immune response to infection, chronic disease risks, and behaviors, and trigger epigenetic changes influencing PTB risk. As an upstream factor, racism in multiple forms has repeatedly been linked with the plausible midstream/downstream factors, including socioeconomic disadvantage, stress, and toxic exposures. Racism is the only factor identified that directly or indirectly could explain the racial disparities in the plausible midstream/downstream causes and the observed social patterning. Historical and contemporary systemic racism can explain the racial disparities in socioeconomic opportunities that differentially expose African Americans to lifelong financial stress and associated health-harming conditions. Segregation places Black women in stressful surroundings and exposes them to environmental hazards. Race-based discriminatory treatment is a pervasive stressor for Black women of all socioeconomic levels, considering both incidents and the constant vigilance needed to prepare oneself for potential incidents. Racism is a highly plausible, major upstream contributor to the Black-White disparity in PTB through multiple pathways and biological mechanisms. While much is unknown, existing knowledge and core values (equity, justice) support addressing racism in efforts to eliminate the racial disparity in PTB.

  View details for DOI 10.3389/frph.2021.684207

  View details for PubMedID 36303973

• Doing better for women and children in armed conflict settings. Lancet (London, England) Bhutta, Z. A., Gaffey, M. F., Spiegel, P. B., Waldman, R. J., Wise, P. H., Blanchet, K. n., Boerma, T. n., Langer, A. n., Black, R. E. 2021

  View details for DOI 10.1016/S0140-6736(21)00127-6

  View details for PubMedID 33503454

• The effects of armed conflict on the health of women and children. Lancet (London, England) Bendavid, E. n., Boerma, T. n., Akseer, N. n., Langer, A. n., Malembaka, E. B., Okiro, E. A., Wise, P. H., Heft-Neal, S. n., Black, R. E., Bhutta, Z. A. 2021

  Abstract

  Women and children bear substantial morbidity and mortality as a result of armed conflicts. This Series paper focuses on the direct (due to violence) and indirect health effects of armed conflict on women and children (including adolescents) worldwide. We estimate that nearly 36 million children and 16 million women were displaced in 2017, on the basis of international databases of refugees and internally displaced populations. From geospatial analyses we estimate that the number of non-displaced women and children living dangerously close to armed conflict (within 50 km) increased from 185 million women and 250 million children in 2000, to 265 million women and 368 million children in 2017. Women's and children's mortality risk from non-violent causes increases substantially in response to nearby conflict, with more intense and more chronic conflicts leading to greater mortality increases. More than 10 million deaths in children younger than 5 years can be attributed to conflict between 1995 and 2015 globally. Women of reproductive ages living near high intensity conflicts have three times higher mortality than do women in peaceful settings. Current research provides fragmentary evidence about how armed conflict indirectly affects the survival chances of women and children through malnutrition, physical injuries, infectious diseases, poor mental health, and poor sexual and reproductive health, but major systematic evidence is sparse, hampering the design and implementation of essential interventions for mitigating the harms of armed conflicts.

  View details for DOI 10.1016/S0140-6736(21)00131-8

  View details for PubMedID 33503456

• The political and security dimensions of the humanitarian health response to violent conflict. Lancet (London, England) Wise, P. H., Shiel, A. n., Southard, N. n., Bendavid, E. n., Welsh, J. n., Stedman, S. n., Fazal, T. n., Felbab-Brown, V. n., Polatty, D. n., Waldman, R. J., Spiegel, P. B., Blanchet, K. n., Dayoub, R. n., Zakayo, A. n., Barry, M. n., Martinez Garcia, D. n., Pagano, H. n., Black, R. n., Gaffey, M. F., Bhutta, Z. A. 2021

  Abstract

  The nature of armed conflict throughout the world is intensely dynamic. Consequently, the protection of non-combatants and the provision of humanitarian services must continually adapt to this changing conflict environment. Complex political affiliations, the systematic use of explosive weapons and sexual violence, and the use of new communication technology, including social media, have created new challenges for humanitarian actors in negotiating access to affected populations and security for their own personnel. The nature of combatants has also evolved as armed, non-state actors might have varying motivations, use different forms of violence, and engage in a variety of criminal activities to generate requisite funds. New health threats, such as the COVID-19 pandemic, and new capabilities, such as modern trauma care, have also created new challenges and opportunities for humanitarian health provision. In response, humanitarian policies and practices must develop negotiation and safety capabilities, informed by political and security realities on the ground, and guidance from affected communities. More fundamentally, humanitarian policies will need to confront a changing geopolitical environment, in which traditional humanitarian norms and protections might encounter wavering support in the years to come.

  View details for DOI 10.1016/S0140-6736(21)00130-6

  View details for PubMedID 33503458

• Using Community Health Workers and a Smartphone Application to Improve Diabetes Control in Rural Guatemala. Global health, science and practice Duffy, S., Norton, D., Kelly, M., Chavez, A., Tun, R., Ramirez, M. N., Chen, G., Wise, P., Svenson, J. 2020; 8 (4): 699–720

  Abstract

  BACKGROUND: The global prevalence of diabetes has nearly doubled since 1980. Seventy-five percent of patients with diabetes live in low- and middle-income countries, such as Guatemala, where health care systems are often poorly equipped for chronic disease management. Community health workers (CHWs) and mobile health technology have increasingly been applied to the diabetes epidemic in these settings, although mostly in supportive rather than primary roles in diabetes management. We sought to improve diabetes care in rural Guatemala through the development of a CHW-led diabetes program and a smartphone application to provide CHWs with clinical decision support.METHODS: We worked with our local partners to develop a program model and the smartphone application (using the CommCare platform) and to train CHWs. We recruited patients with type 2 diabetes living in rural communities. Program evaluation used a single-group, pre-post design. Primary outcomes were hemoglobin A1c and the percentage of patients meeting A1c goals compared with baseline. We also followed a variety of process metrics, including application reliability.RESULTS: Eighty-nine patients enrolled during the study period. The hemoglobin A1c percentage decreased significantly at 3 months (-1.0; 95% CI=-1.7, -0.6), 6 months (-1.5; 95% CI=-2.2, -0.8), 9 months (-1.3; 95% CI=-2.0, -0.6), and 12 months (-1.0; 95% CI=-1.7, -0.4). The percentage of patients with A1c ≤ 8% increased significantly at 3 months (23.6% to 44.4%, P=.007), 6 months (22.0% to 44.0%, P=.015), and 9 months (23.9% to 45.7%, P=.03). CHWs and supervising physicians agreed with application medication recommendations >90% of the time.CONCLUSION: Our results suggest that CHWs can safely and effectively manage diabetes with the assistance of a smartphone application and remote physician supervision. This model should be evaluated versus other standards of care and could be adapted to other low-resource settings and chronic diseases.

  View details for DOI 10.9745/GHSP-D-20-00076

  View details for PubMedID 33361237

• Singleton preterm birth rates for racial and ethnic groups during the coronavirus disease 2019 pandemic in California. American journal of obstetrics and gynecology Main, E. K., Chang, S., Carpenter, A. M., Wise, P. H., Stevenson, D. K., Shaw, G. M., Gould, J. B. 2020

  View details for DOI 10.1016/j.ajog.2020.10.033

  View details for PubMedID 33203528

• Advancing Human Health in the Decade Ahead: Pregnancy as a Key Window for Discovery A Burroughs Wellcome Fund Pregnancy Think-Tank. American journal of obstetrics and gynecology Sadovsky, Y., Mesiano, S., Burton, G. J., Lampl, M., Murray, J. C., Freathy, R. M., Mahadevan-Jansen, A., Moffett, A., Price, N. D., Wise, P. H., Wildman, D. E., Snyderman, R., Paneth, N., Capra, J. A., Nobrega, M. A., Barak, Y., Muglia, L. J., Burroughs Wellcome Fund Pregnancy Think-Tank Working Group 2020

  Abstract

  Recent revolutionary advances at the intersection of medicine, omics, data sciences, computing, epidemiology and related technologies inspire us to ponder their impact on health. Their potential impact is particularly germane to the biology of pregnancy and perinatal medicine, where limited improvement in health outcomes for women and children has remained a global challenge. We assembled a group of experts to establish a Pregnancy Think Tank to discuss a broad spectrum of major gestational disorders and adverse pregnancy outcomes that impact maternal-infant lifelong health and that should serve as targets for leveraging the many recent advances. This report reflects avenues for future impact that hold great potential in three major areas: developmental genomics, including the application of methodologies designed to bridge genotypes, physiology and diseases addressing vexing questions in early human development; gestational physiology, from immune tolerance to growth and the timing of parturition; and personalized and population medicine, focusing on amalgamating health record data and deep phenotypes to create broad knowledge that can be integrated into health care systems and drive discovery to address pregnancy related disease and promote general health. We propose a series of questions reflecting development, systems biology, diseases, clinical approaches and tools, and population health and a call for scientific action. Clearly, transdisciplinary science must advance and accelerate in order to address adverse pregnancy outcomes. Disciplines not traditionally involved in the reproductive sciences, including computer science, engineering, mathematics, and pharmacology should be engaged at the study design phase to optimize the information gathered as well as to identify and further evaluate potentially actionable therapeutic targets. Information sources should include non-invasive, personalized sensors and monitors, alongside instructive "liquid biopsies" for non-invasive pregnancy assessment. Future research should also address the diversity of human cohorts in terms of geography, racial and ethnic distributions, as well as social and health disparities. Modern technologies, both for data-gathering and for data-analyzing, make this possible at a scale that was previously unachievable. Finally, the psychosocial and economic environment in which pregnancy takes place must be considered to promote the health and wellness of communities worldwide.

  View details for DOI 10.1016/j.ajog.2020.06.031

  View details for PubMedID 32565236

• Towards personalized medicine in maternal and child health: integrating biologic and social determinants. Pediatric research Stevenson, D. K., Wong, R. J., Aghaeepour, N., Maric, I., Angst, M. S., Contrepois, K., Darmstadt, G. L., Druzin, M. L., Eisenberg, M. L., Gaudilliere, B., Gibbs, R. S., Gotlib, I. H., Gould, J. B., Lee, H. C., Ling, X. B., Mayo, J. A., Moufarrej, M. N., Quaintance, C. C., Quake, S. R., Relman, D. A., Sirota, M., Snyder, M. P., Sylvester, K. G., Hao, S., Wise, P. H., Shaw, G. M., Katz, M. 2020

  View details for DOI 10.1038/s41390-020-0981-8

  View details for PubMedID 32454518

• Policy in pediatric nephrology: successes, failures, and the impact on disparities. Pediatric nephrology (Berlin, Germany) Krissberg, J. R., Sutherland, S. M., Chamberlain, L. J., Wise, P. H. 2020

  Abstract

  Pediatric nephrology has a history rooted in pediatric advocacy and has made numerous contributions to child health policy affecting pediatric kidney diseases. Despite this progress, profound social disparities remain for marginalized and socially vulnerable children with kidney disease. Different risk factors, such as genetic predisposition, environmental factors, social risk factors, or health care access influence the emergence and progression of pediatric kidney disease, as well as access to life-saving interventions, leading to disparate outcomes. This review will summarize the breadth of literature on social determinants of health in children with kidney disease worldwide and highlight policy-based initiatives that mitigate the adverse social factors to generate greater equity in pediatric kidney disease.

  View details for DOI 10.1007/s00467-020-04755-5

  View details for PubMedID 32968856

• Investigating the delivery of health and nutrition interventions for women and children in conflict settings: a collection of case studies from the BRANCH Consortium. Conflict and health Ataullahjan, A., Gaffey, M. F., Sami, S., Singh, N. S., Tappis, H., Black, R. E., Blanchet, K., Boerma, T., Langer, A., Spiegel, P. B., Waldman, R. J., Wise, P. H., Bhutta, Z. A. 2020; 14: 29

  Abstract

  Globally, the number of people affected by conflict is the highest in history, and continues to steadily increase. There is currently a pressing need to better understand how to deliver critical health interventions to women and children affected by conflict. The compendium of articles presented in this Conflict and Health Collection brings together a range of case studies recently undertaken by the BRANCH Consortium (Bridging Research & Action in Conflict Settings for the Health of Women and Children). These case studies describe how humanitarian actors navigate and negotiate the multiple obstacles and forces that challenge the delivery of health and nutrition interventions for women, children and adolescents in conflict-affected settings, and to ultimately provide some insight into how service delivery can be improved.

  View details for DOI 10.1186/s13031-020-00276-y

  View details for PubMedID 32514294

• Child Health and Telehealth in Global, Underresourced Settings. Pediatric clinics of North America Hsing, J. C., Wang, C. J., Wise, P. H. 2020; 67 (4): 773–81

  Abstract

  Telehealth has improved delivery of health care worldwide by improving access to and the quality of health care and by improving the global shortage of health professionals through collaboration and training. Although many telehealth efforts have been reported in adult health care settings, it is important to examine telehealth efforts in the pediatric setting. Children who are most commonly ill and malnourished are often those of underserved populations of the developing world. This article examines current uses of pediatric telehealth in a global setting and discusses key approaches to how telehealth may become successfully integrated and scaled in those settings.

  View details for DOI 10.1016/j.pcl.2020.04.014

  View details for PubMedID 32650872

• Applying trauma systems concepts to humanitarian battlefield care: a qualitative analysis of the Mosul trauma pathway. Conflict and health Garber, K. n., Kushner, A. L., Wren, S. M., Wise, P. H., Spiegel, P. B. 2020; 14: 5

  Abstract

  Trauma systems have been shown to save lives in military and civilian settings, but their use by humanitarians in conflict settings has been more limited. During the Battle of Mosul (October 2016-July 2017), trauma care for injured civilians was provided through a novel approach in which humanitarian actors were organized into a trauma pathway involving echelons of care, a key component of military trauma systems. A better understanding of this approach may help inform trauma care delivery in future humanitarian responses in conflicts.A qualitative study design was used to examine the Mosul civilian trauma response. From August-December 2017, in-depth semi-structured interviews were conducted with stakeholders (n = 54) representing nearly two dozen organizations that directly participated in or had first-hand knowledge of the response. Source document reviews were also conducted. Responses were analyzed in accordance with a published framework on civilian battlefield trauma systems, focusing on whether the response functioned as an integrated trauma system. Opportunities for improvement were identified.The Mosul civilian trauma pathway was implemented as a chain of care for civilian casualties with three successive echelons (trauma stabilization points, field hospitals, and referral hospitals). Coordinated by the World Health Organization, it comprised a variety of actors, including non-governmental organizations, civilian institutions, and at least one private medical company. Stakeholders generally felt that this approach improved access to trauma care for civilians injured near the frontlines compared to what would have been available. Several trauma systems elements such as transportation, data collection, field coordination, and post-operative rehabilitative care might have been further developed to support a more integrated system.The Mosul trauma pathway evolved to address critical gaps in trauma care during the Battle of Mosul. It adapted the concept of echelons of care from western military practice to push humanitarian actors closer to the frontlines and improve access to care for injured civilians. Although efforts were made to incorporate some of the integrative components (e.g. evidence-based pre-hospital care, transportation, and data collection) that have enabled recent achievements by military trauma systems, many of these proved difficult to implement in the Mosul context. Further discussion and research are needed to determine how trauma systems insights can be adapted in future humanitarian responses given resource, logistical, and security constraints, as well as to clarify the responsibilities of various actors.

  View details for DOI 10.1186/s13031-019-0249-2

  View details for PubMedID 32042308

  View details for PubMedCentralID PMC7001520

• Multiomics Characterization of Preterm Birth in Low- and Middle-Income Countries. JAMA network open Jehan, F. n., Sazawal, S. n., Baqui, A. H., Nisar, M. I., Dhingra, U. n., Khanam, R. n., Ilyas, M. n., Dutta, A. n., Mitra, D. K., Mehmood, U. n., Deb, S. n., Mahmud, A. n., Hotwani, A. n., Ali, S. M., Rahman, S. n., Nizar, A. n., Ame, S. M., Moin, M. I., Muhammad, S. n., Chauhan, A. n., Begum, N. n., Khan, W. n., Das, S. n., Ahmed, S. n., Hasan, T. n., Khalid, J. n., Rizvi, S. J., Juma, M. H., Chowdhury, N. H., Kabir, F. n., Aftab, F. n., Quaiyum, A. n., Manu, A. n., Yoshida, S. n., Bahl, R. n., Rahman, A. n., Pervin, J. n., Winston, J. n., Musonda, P. n., Stringer, J. S., Litch, J. A., Ghaemi, M. S., Moufarrej, M. N., Contrepois, K. n., Chen, S. n., Stelzer, I. A., Stanley, N. n., Chang, A. L., Hammad, G. B., Wong, R. J., Liu, C. n., Quaintance, C. C., Culos, A. n., Espinosa, C. n., Xenochristou, M. n., Becker, M. n., Fallahzadeh, R. n., Ganio, E. n., Tsai, A. S., Gaudilliere, D. n., Tsai, E. S., Han, X. n., Ando, K. n., Tingle, M. n., Maric, I. n., Wise, P. H., Winn, V. D., Druzin, M. L., Gibbs, R. S., Darmstadt, G. L., Murray, J. C., Shaw, G. M., Stevenson, D. K., Snyder, M. P., Quake, S. R., Angst, M. S., Gaudilliere, B. n., Aghaeepour, N. n. 2020; 3 (12): e2029655

  Abstract

  Worldwide, preterm birth (PTB) is the single largest cause of deaths in the perinatal and neonatal period and is associated with increased morbidity in young children. The cause of PTB is multifactorial, and the development of generalizable biological models may enable early detection and guide therapeutic studies.To investigate the ability of transcriptomics and proteomics profiling of plasma and metabolomics analysis of urine to identify early biological measurements associated with PTB.This diagnostic/prognostic study analyzed plasma and urine samples collected from May 2014 to June 2017 from pregnant women in 5 biorepository cohorts in low- and middle-income countries (LMICs; ie, Matlab, Bangladesh; Lusaka, Zambia; Sylhet, Bangladesh; Karachi, Pakistan; and Pemba, Tanzania). These cohorts were established to study maternal and fetal outcomes and were supported by the Alliance for Maternal and Newborn Health Improvement and the Global Alliance to Prevent Prematurity and Stillbirth biorepositories. Data were analyzed from December 2018 to July 2019.Blood and urine specimens that were collected early during pregnancy (median sampling time of 13.6 weeks of gestation, according to ultrasonography) were processed, stored, and shipped to the laboratories under uniform protocols. Plasma samples were assayed for targeted measurement of proteins and untargeted cell-free ribonucleic acid profiling; urine samples were assayed for metabolites.The PTB phenotype was defined as the delivery of a live infant before completing 37 weeks of gestation.Of the 81 pregnant women included in this study, 39 had PTBs (48.1%) and 42 had term pregnancies (51.9%) (mean [SD] age of 24.8 [5.3] years). Univariate analysis demonstrated functional biological differences across the 5 cohorts. A cohort-adjusted machine learning algorithm was applied to each biological data set, and then a higher-level machine learning modeling combined the results into a final integrative model. The integrated model was more accurate, with an area under the receiver operating characteristic curve (AUROC) of 0.83 (95% CI, 0.72-0.91) compared with the models derived for each independent biological modality (transcriptomics AUROC, 0.73 [95% CI, 0.61-0.83]; metabolomics AUROC, 0.59 [95% CI, 0.47-0.72]; and proteomics AUROC, 0.75 [95% CI, 0.64-0.85]). Primary features associated with PTB included an inflammatory module as well as a metabolomic module measured in urine associated with the glutamine and glutamate metabolism and valine, leucine, and isoleucine biosynthesis pathways.This study found that, in LMICs and high PTB settings, major biological adaptations during term pregnancy follow a generalizable model and the predictive accuracy for PTB was augmented by combining various omics data sets, suggesting that PTB is a condition that manifests within multiple biological systems. These data sets, with machine learning partnerships, may be a key step in developing valuable predictive tests and intervention candidates for preventing PTB.

  View details for DOI 10.1001/jamanetworkopen.2020.29655

  View details for PubMedID 33337494

• Understanding health disparities JOURNAL OF PERINATOLOGY Stevenson, D. K., Wong, R. J., Aghaeepour, N., Angst, M. S., Darmstadt, G. L., DiGiulio, D. B., Druzin, M. L., Gaudilliere, B., Gibbs, R. S., Gould, J. B., Katzl, M., Li, J., Moufarrej, M. N., Quaintancel, C. C., Quake, S. R., Reiman, D. A., Shawl, G. M., Snyder, M. P., Wang, X., Wisel, P. H. 2019; 39 (3): 354–58

  View details for DOI 10.1038/s41372-018-0298-1

  View details for Web of Science ID 000459549600003

• Empowering Community Health Workers With Mobile Technology to Treat Diabetes ANNALS OF FAMILY MEDICINE Duffy, S., Svenson, J., Chavez, A., Kelly, M., Wise, P. 2019; 17 (2): 176

  View details for DOI 10.1370/afm.2361

  View details for Web of Science ID 000460916800013

  View details for PubMedID 30858263

• The contributions of genetics to premature birth PEDIATRIC RESEARCH Stevenson, D. K., Wong, R. J., Shaw, G. M., Li, J., Wise, P. H., Davis, J. M. 2019; 85 (4): 416–17

  View details for DOI 10.1038/s41390-019-0292-0

  View details for Web of Science ID 000460127000003

• Prospective Biopsy-Based Study of CKD of Unknown Etiology in Sri Lanka CLINICAL JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY Anand, S., Montez-Rath, M. E., Adasooriya, D., Ratnatunga, N., Kambham, N., Wazil, A., Wijetunge, S., Badurdeen, Z., Ratnayake, C., Karunasena, N., Schensul, S. L., Valhos, P., Haider, L., Bhalla, V., Levin, A., Wise, P. H., Chertow, G. M., Barry, M., Fire, A. Z., Nanayakkara, N. 2019; 14 (2): 224–32

  View details for DOI 10.2215/CJN.07430618

  View details for Web of Science ID 000458400200011

• Prospective Biopsy-Based Study of Chronic Kidney Disease of Unknown Etiology in Sri Lanka. Clinical journal of the American Society of Nephrology : CJASN Anand, S., Montez-Rath, M. E., Adasooriya, D., Ratnatunga, N., Kambham, N., Wazil, A., Wijetunge, S., Badurdeen, Z., Ratnayake, C., Karunasena, N., Schensul, S. L., Valhos, P., Haider, L., Bhalla, V., Levin, A., Wise, P. H., Chertow, G. M., Barry, M., Fire, A. Z., Nanayakkara, N. 2019

  Abstract

  BACKGROUND AND OBJECTIVES: A kidney disease of unknown cause is common in Sri Lanka's lowland (dry) region. Detailed clinical characterizations of patients with biopsy-proven disease are limited, and there is no current consensus on criteria for a noninvasive diagnosis.DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We designed a prospective study in a major Sri Lankan hospital servicing endemic areas to ascertain pathologic and clinical characteristics of and assess risk factors for primary tubulointerstitial kidney disease. We used logistic regression to determine whether common clinical characteristics could be used to predict the presence of primary tubulointerstitial kidney disease on kidney biopsy.RESULTS: From 600 new patients presenting to a tertiary nephrology clinic over the course of 1 year, 87 underwent kidney biopsy, and 43 (49%) had a biopsy diagnosis of primary tubulointerstitial kidney disease. On detailed biopsy review, 13 (30%) had evidence of moderate to severe active kidney disease, and six (15%) had evidence of moderate to severe chronic tubulointerstitial kidney disease. Patients with tubulointerstitial kidney disease were exclusively born in endemic provinces; 91% spent a majority of their lifespan there. They were more likely men and farmers (risk ratio, 2.0; 95% confidence interval, 1.2 to 2.9), and they were more likely to have used tobacco (risk ratio, 1.7; 95% confidence interval, 1.0 to 2.3) and well water (risk ratio, 1.5; 95% confidence interval, 1.1 to 2.0). Three clinical characteristics-age, urine dipstick for protein, and serum albumin-could predict likelihood of tubulointerstitial kidney disease on biopsy (model sensitivity of 79% and specificity of 84%). Patients referred for kidney biopsy despite comorbid diabetes or hypertension did not experience lower odds of tubulointerstitial kidney disease.CONCLUSIONS: A primary tubulointerstitial kidney disease occurs commonly in specific regions of Sri Lanka with characteristic environmental and lifestyle exposures.PODCAST: This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2019_01_18_CJASNPodcast_19_02_.mp3.

  View details for PubMedID 30659059

• The contributions of genetics to premature birth. Pediatric research Stevenson, D. K., Wong, R. J., Shaw, G. M., Li, J., Wise, P. H., Davis, J. M. 2019

  View details for PubMedID 30644444

• Multiomics modeling of the immunome, transcriptome, microbiome, proteome and metabolome adaptations during human pregnancy. Bioinformatics (Oxford, England) Ghaemi, M. S., DiGiulio, D. B., Contrepois, K., Callahan, B., Ngo, T. T., Lee-McMullen, B., Lehallier, B., Robaczewska, A., Mcilwain, D., Rosenberg-Hasson, Y., Wong, R. J., Quaintance, C., Culos, A., Stanley, N., Tanada, A., Tsai, A., Gaudilliere, D., Ganio, E., Han, X., Ando, K., McNeil, L., Tingle, M., Wise, P., Maric, I., Sirota, M., Wyss-Coray, T., Winn, V. D., Druzin, M. L., Gibbs, R., Darmstadt, G. L., Lewis, D. B., Partovi Nia, V., Agard, B., Tibshirani, R., Nolan, G., Snyder, M. P., Relman, D. A., Quake, S. R., Shaw, G. M., Stevenson, D. K., Angst, M. S., Gaudilliere, B., Aghaeepour, N. 2019; 35 (1): 95–103

  Abstract

  Motivation: Multiple biological clocks govern a healthy pregnancy. These biological mechanisms produce immunologic, metabolomic, proteomic, genomic and microbiomic adaptations during the course of pregnancy. Modeling the chronology of these adaptations during full-term pregnancy provides the frameworks for future studies examining deviations implicated in pregnancy-related pathologies including preterm birth and preeclampsia.Results: We performed a multiomics analysis of 51 samples from 17 pregnant women, delivering at term. The datasets included measurements from the immunome, transcriptome, microbiome, proteome and metabolome of samples obtained simultaneously from the same patients. Multivariate predictive modeling using the Elastic Net (EN) algorithm was used to measure the ability of each dataset to predict gestational age. Using stacked generalization, these datasets were combined into a single model. This model not only significantly increased predictive power by combining all datasets, but also revealed novel interactions between different biological modalities. Future work includes expansion of the cohort to preterm-enriched populations and in vivo analysis of immune-modulating interventions based on the mechanisms identified.Availability and implementation: Datasets and scripts for reproduction of results are available through: https://nalab.stanford.edu/multiomics-pregnancy/.Supplementary information: Supplementary data are available at Bioinformatics online.

  View details for PubMedID 30561547

• Responding to epidemics in large-scale humanitarian crises: a case study of the cholera response in Yemen, 2016-2018. BMJ global health Spiegel, P., Ratnayake, R., Hellman, N., Ververs, M., Ngwa, M., Wise, P. H., Lantagne, D. 2019; 4 (4): e001709

  Abstract

  Background: Large epidemics frequently emerge in conflict-affected states. We examined the cholera response during the humanitarian crisis in Yemen to inform control strategies.Methods: We conducted interviews with practitioners and advisors on preparedness; surveillance; laboratory; case management; malnutrition; water, sanitation and hygiene (WASH); vaccination; coordination and insecurity. We undertook a literature review of global and Yemen-specific cholera guidance, examined surveillance data from the first and second waves (28 September 2016-12 March 2018) and reviewed reports on airstrikes on water systems and health facilities (April 2015-December 2017). We used the Global Task Force on Cholera Control's framework to examine intervention strategies and thematic analysis to understand decision making.Results: Yemen is water scarce, and repeated airstrikes damaged water systems, risking widespread infection. Since a cholera preparedness and response plan was absent, on detection, the humanitarian cluster system rapidly developed response plans. The initial plans did not prioritise key actions including community-directed WASH to reduce transmission, epidemiological analysis and laboratory monitoring. Coordination was not harmonised across the crisis-focused clusters and epidemic-focused incident management system. The health strategy was crisis focused and was centralised on functional health facilities, underemphasising less accessible areas. As vaccination was not incorporated into preparedness, consensus on its use remained slow. At the second wave peak, key actions including data management, community-directed WASH and oral rehydration and vaccination were scaled-up.Conclusion: Despite endemicity and conflict, Yemen was not prepared for the epidemic. To contain outbreaks, conflict-affected states, humanitarian agencies, and donors must emphasise preparedness planning and community-directed responses.

  View details for DOI 10.1136/bmjgh-2019-001709

  View details for PubMedID 31406596

• Epidemiology, molecular, and genetic methodologies to evaluate causes of CKDu around the world: report of the Working Group from the ISN International Consortium of Collaborators on CKDu. Kidney international Anand, S. n., Caplin, B. n., Gonzalez-Quiroz, M. n., Schensul, S. L., Bhalla, V. n., Parada, X. n., Nanayakkara, N. n., Fire, A. n., Levin, A. n., Friedman, D. J. 2019; 96 (6): 1254–60

  View details for DOI 10.1016/j.kint.2019.09.019

  View details for PubMedID 31759481

• Women and children living in areas of armed conflict in Africa: a geospatial analysis of mortality and orphanhood. The Lancet. Global health Wagner, Z. n., Heft-Neal, S. n., Wise, P. H., Black, R. E., Burke, M. n., Boerma, T. n., Bhutta, Z. A., Bendavid, E. n. 2019

  Abstract

  The population effects of armed conflict on non-combatant vulnerable populations are incompletely understood. We aimed to study the effects of conflict on mortality among women of childbearing age (15-49 years) and on orphanhood among children younger than 15 years in Africa.We tested the extent to which mortality among women aged 15-49 years, and orphanhood among children younger than 15 years, increased in response to nearby armed conflict in Africa. Data on location, timing, and intensity of armed conflicts were obtained from the Uppsala Conflict Data Program, and data on the location, timing, and outcomes of women and children from Demographic and Health Surveys done in 35 African countries from 1990 to 2016. Mortality among women was obtained from sibling survival data. We used cluster-area fixed-effects regression models to compare survival of women during periods of nearby conflict (within 50 km) to survival of women in the same area during times without conflict. We used similar methods to examine the extent to which children living near armed conflicts are at increased risk of becoming orphans. We examined the effects of varying conflict intensity using number of direct battle deaths and duration of consecutive conflict exposure.We analysed data on 1 629 352 women (19 286 387 person-years), of which 103 011 (6·3%) died (534·1 deaths per 100 000 women-years), and 2 354 041 children younger than 15 years, of which 204 276 (8·7%) had lost a parent. On average, conflict within 50 km increased women's mortality by 112 deaths per 100 000 person-years (95% CI 97-128; a 21% increase above baseline), and the probability that a child has lost at least one parent by 6·0% (95% CI 3-8). This effect was driven by high-intensity conflicts: exposure to the highest (tenth) decile conflict in terms of conflict-related deaths increased the probability of female mortality by 202% (187-218) and increased the likelihood of orphanhood by 42% compared with a conflict-free period. Among the conflict-attributed deaths, 10% were due to maternal mortality.African women of childbearing age are at a substantially increased risk of death from nearby high-intensity armed conflicts. Children exposed to conflict are analogously at increased risk of becoming orphans. This work fills gaps in literature on the harmful effects of armed conflict on non-combatants and highlights the need for humanitarian interventions to protect vulnerable populations.Bill & Melinda Gates Foundation to the BRANCH Consortium.

  View details for DOI 10.1016/S2214-109X(19)30407-3

  View details for PubMedID 31669039

• A Consensus Framework for the Humanitarian Surgical Response to Armed Conflict in 21st Century Warfare. JAMA surgery Wren, S. M., Wild, H. B., Gurney, J. n., Amirtharajah, M. n., Brown, Z. W., Bulger, E. M., Burkle, F. M., Elster, E. A., Forrester, J. D., Garber, K. n., Gosselin, R. A., Groen, R. S., Hsin, G. n., Joshipura, M. n., Kushner, A. L., Norton, I. n., Osmers, I. n., Pagano, H. n., Razek, T. n., Sáenz-Terrazas, J. M., Schussler, L. n., Stewart, B. T., Traboulsi, A. A., Trelles, M. n., Troke, J. n., VanFosson, C. A., Wise, P. H. 2019

  Abstract

  Armed conflict in the 21st century poses new challenges to a humanitarian surgical response, including changing security requirements, access to patients, and communities in need, limited deployable surgical assets, resource constraints, and the requirement to address both traumatic injuries as well as emergency surgical needs of the population. At the same time, recent improvements in trauma care and systems have reduced injury-related mortality. This combination of new challenges and medical capabilities warrants reconsideration of long-standing humanitarian surgery protocols.To describe a consensus framework for surgical care designed to respond to this emerging need.An international group of 35 representatives from humanitarian agencies, US military, and academic trauma programs was invited to the Stanford Humanitarian Surgical Response in Conflict Working Group to engage in a structured process to review extant trauma protocols and make recommendations for revision.The working group's method adapted core elements of a modified Delphi process combined with consensus development conference from August 3 to August 5, 2018.Lessons from civilian and military trauma systems as well as recent battlefield experiences in humanitarian settings were integrated into a tiered continuum of response from point of injury through rehabilitation. The framework addresses the security and medical requirements as well as ethical and legal principles that guide humanitarian action. The consensus framework includes trained, lay first responders; far-forward resuscitation/stabilization centers; rapid damage control surgical access; and definitive care facilities. The system also includes nontrauma surgical care, injury prevention, quality improvement, data collection, and predeployment training requirements.Evidence suggests that modern trauma systems save lives. However, the requirements of providing this standard of care in insecure conflict settings places new burdens on humanitarian systems that must provide both emergency and trauma surgical care. This consensus framework integrates advances in trauma care and surgical systems in response to a changing security environment. It is possible to reduce disparities and improve the standard of care in these settings.

  View details for DOI 10.1001/jamasurg.2019.4547

  View details for PubMedID 31722004

• Short interpregnancy interval as a risk factor for preterm birth in non-Hispanic Black and White women in California. Journal of perinatology : official journal of the California Perinatal Association Lonhart, J. A., Mayo, J. A., Padula, A. M., Wise, P. H., Stevenson, D. K., Shaw, G. M. 2019

  Abstract

  Short interpregnancy interval (IPI) is associated with adverse pregnancy outcomes, including preterm birth (PTB < 37 weeks GA). We investigated whether short IPI (< 6 months) contributes to the higher PTB frequency among non-Hispanic Blacks (NHB).Using a linked birth cohort > 1.5 million California live births, we examined frequencies of short IPI between racial/ethnic groups and estimated risks by multivariable logistic regression for spontaneous PTB. We expanded the study to births 1991-2012 and utilized a "within-mother" approach to permit methodologic inquiry about residual confounding.NHB women had higher frequency (7.6%) of short IPI than non-Hispanic White (NHW) women (4.4%). Adjusted odds ratios for PTB and short IPI were 1.64 (95% CI 1.54, 1.76) for NHW and 1.49 (1.34, 1.65) for NHB. Using within-mother analysis did not produce substantially different results.Short IPI is associated with PTB but does not explain risk disparity between NHWs and NHBs.

  View details for DOI 10.1038/s41372-019-0402-1

  View details for PubMedID 31209276

• Multiomics modeling of the immunome, transcriptome, microbiome, proteome and metabolome adaptations during human pregnancy BIOINFORMATICS Ghaemi, M., DiGiulio, D. B., Contrepois, K., Callahan, B., Ngo, T. M., Lee-McMullen, B., Lehallier, B., Robaczewska, A., Mcilwain, D., Rosenberg-Hasson, Y., Wong, R. J., Quaintance, C., Culos, A., Stanley, N., Tanada, A., Tsai, A., Gaudilliere, D., Ganio, E., Han, X., Ando, K., McNeil, L., Tingle, M., Wise, P., Maric, I., Sirota, M., Wyss-Coray, T., Winn, V. D., Druzin, M. L., Gibbs, R., Darmstadt, G. L., Lewis, D. B., Nia, V., Agard, B., Tibshirani, R., Nolan, G., Snyder, M. P., Relman, D. A., Quake, S. R., Shaw, G. M., Stevenson, D. K., Angst, M. S., Gaudilliere, B., Aghaeepour, N. 2019; 35 (1): 95–103

  View details for DOI 10.1093/bioinformatics/bty537

  View details for Web of Science ID 000459313900012

• Understanding health disparities. Journal of perinatology : official journal of the California Perinatal Association Stevenson, D. K., Wong, R. J., Aghaeepour, N., Angst, M. S., Darmstadt, G. L., DiGiulio, D. B., Druzin, M. L., Gaudilliere, B., Gibbs, R. S., B Gould, J., Katz, M., Li, J., Moufarrej, M. N., Quaintance, C. C., Quake, S. R., Relman, D. A., Shaw, G. M., Snyder, M. P., Wang, X., Wise, P. H. 2018

  Abstract

  Based upon our recent insights into the determinants of preterm birth, which is the leading cause of death in children under five years of age worldwide, we describe potential analytic frameworks that provides both a common understanding and, ultimately the basis for effective, ameliorative action. Our research on preterm birth serves as an example that the framing of any human health condition is a result of complex interactions between the genome and the exposome. New discoveries of the basic biology of pregnancy, such as the complex immunological and signaling processes that dictate the health and length of gestation, have revealed a complexity in the interactions (current and ancestral) between genetic and environmental forces. Understanding of these relationships may help reduce disparities in preterm birth and guide productive research endeavors and ultimately, effective clinical and public health interventions.

  View details for PubMedID 30560947

• Status Complexicus? The Emergence of Pediatric Complex Care PEDIATRICS Cohen, E., Berry, J. G., Sanders, L., Schor, E. L., Wise, P. H. 2018; 141: S202–S211

  Abstract

  Discourse about childhood chronic conditions has transitioned in the last decade from focusing primarily on broad groups of children with special health care needs to concentrating in large part on smaller groups of children with medical complexity (CMC). Although a variety of definitions have been applied, the term CMC has most commonly been defined as children and youth with serious chronic conditions, substantial functional limitations, increased health and other service needs, and increased health care costs. The increasing attention paid to CMC has occurred because these children are growing in impact, represent a disproportionate share of health system costs, and require policy and programmatic interventions that differ in many ways from broader groups of children with special health care needs. But will this change in focus lead to meaningful changes in outcomes for children with serious chronic diseases, or is the pediatric community simply adopting terminology with resonance in adult-focused health systems? In this article, we will explore the implications of the rapid emergence of pediatric complex care in child health services practice and research. As an emerging field, pediatric care systems should thoughtfully and rapidly develop evidence-based solutions to the new challenges of caring for CMC, including (1) clearer definitions of the target population, (2) a more appropriate incorporation of components of care that occur outside of hospitals, and (3) a more comprehensive outcomes measurement framework, including the recognition of potential limitations of cost containment as a target for improved care for CMC.

  View details for PubMedID 29496971

• The Patient Protection and Affordable Care Act dependent coverage expansion: Disparities in impact among young adult oncology patients CANCER Alvarez, E. M., Keegan, T. H., Johnston, E. E., Haile, R., Sanders, L., Wise, P. H., Saynina, O., Chamberlain, L. J. 2018; 124 (1): 110–17

  Abstract

  Private health insurance is associated with improved outcomes in patients with cancer. However, to the authors' knowledge, little is known regarding the impact of the Patient Protection and Affordable Care Act Dependent Coverage Expansion (ACA-DCE), which extended private insurance to young adults (to age 26 years) beginning in 2010, on the insurance status of young adults with cancer.The current study was a retrospective, population-based analysis of hospitalized young adult oncology patients (aged 22-30 years) in California during 2006 through 2014 (11,062 patients). Multivariable regression analyses examined factors associated with having private insurance. Results were presented as adjusted odds ratios and 95% confidence intervals. A difference-in-difference analysis examined the influence of the ACA-DCE on insurance coverage by race/ethnicity and federal poverty level.Multivariable regression demonstrated that patients of black and Hispanic race/ethnicity were less likely to have private insurance before and after the ACA-DCE, compared with white patients. Younger age (22-25 years) was associated with having private insurance after implementation of the ACA-DCE (odds ratio, 1.20; 95% confidence interval, 1.06-1.35). In the difference-in-difference analysis, private insurance increased among white patients aged 22 to 25 years who were living in medium-income (2006-2009: 64.6% vs 2011-2014: 69.1%; P = .003) and high-income (80.4% vs 82%; P = .043) zip codes and among Asians aged 22 to 25 years living in high-income zip codes (73.2 vs 85.7%; P = .022). Private insurance decreased for all Hispanic patients aged 22 to 25 years between the 2 time periods.The ACA-DCE provision increased insurance coverage, but not among all patients. Private insurance increased for white and Asian patients in higher income neighborhoods, potentially widening social disparities in private insurance coverage among young adults with cancer. Cancer 2018;124:110-7. © 2017 American Cancer Society.

  View details for PubMedID 28940423

• The Epidemiologic Challenge to the Conduct of Just War: Confronting Indirect Civilian Casualties of War DAEDALUS Wise, P. H. 2017; 146 (1): 139-154

  View details for DOI 10.1162/DAED_a_00428

  View details for Web of Science ID 000403207200011

• The relationship between burden of childhood disease and foreign aid for child health BMC HEALTH SERVICES RESEARCH Bavinger, J., Wise, P., Bendavid, E. 2017; 17: 655

  Abstract

  We sought to examine the relationship between child specific health aid (CHA) and burden of disease. Based on existing evidence, we hypothesized that foreign aid for child health would not be proportional to burden of disease.In order to examine CHA and burden of disease, we obtained estimates of these parameters from established sources. Estimates of disability adjusted life years (DALYs) in children (0-5 years) were obtained from the World Health Organization for 2000 and 2012. The 10 most burdensome disease categories in each continent, excluding high-income countries, were identified for study. Descriptions of all foreign aid commitments between 1996 and 2009 were obtained from AidData, and an algorithm to designate the target diseases of the commitments was constructed. Data were examined in scatterplots for trends.The most burdensome childhood diseases varied by continent. In all continents, newborn diseases, vaccine-preventable diseases (lower respiratory diseases, measles, meningitis, tetanus, and pertussis), and diarrheal diseases ranked within the four most burdensome diseases. Infectious diseases such as malaria, tuberculosis, and HIV were also among the ten most burdensome diseases in sub-Saharan Africa, and non-communicable diseases were associated with much of the burden in the other continents. CHA grew from $7.4 billion in 1996 to $17.7 billion in 2009 for our study diseases. Diarrheal diseases and malnutrition received the most CHA as well as the most CHA per DALY. CHA directed at HIV increased dramatically over our study period, from $227,000 in 1996 to $3.4 billion in 2008. Little aid was directed at injuries such as drowning, car accidents, and fires, as well as complex medical diseases such as leukemia and endocrine disorders.CHA has grown significantly over the last two decades. There is no clear relationship between CHA and burden of disease. This report provides a description of foreign aid for child health, and hopes to inform policy and decision-making regarding foreign aid.

  View details for PubMedID 28915813

• Civil War & the Global Threat of Pandemics DAEDALUS Wise, P. H., Barry, M. 2017; 146 (4): 71-84

  View details for DOI 10.1162/DAED_a_00460

  View details for Web of Science ID 000411503500006

• Social disadvantage and the black-white disparity in spontaneous preterm delivery among California births PLOS ONE Carmichael, S. L., Kan, P., Padula, A. M., Rehkopf, D. H., Oehlert, J. W., Mayo, J. A., Weber, A. M., Wise, P. H., Shaw, G. M., Stevenson, D. K. 2017; 12 (8): e0182862

  Abstract

  We examined the contribution of social disadvantage to the black-white disparity in preterm birth. Analyses included linked vital and hospital discharge records from 127,358 black and 615,721 white singleton California births from 2007-11. Odds ratios (OR) were estimated by 4 logistic regression models for 2 outcomes: early (<32 wks) and moderate (32-36 wks) spontaneous preterm birth (ePTB, mPTB), stratified by 2 race-ethnicity groups (blacks and whites). We then conducted a potential impact analysis. The OR for less than high school education (vs. college degree) was 1.8 (95% confidence interval 1.6, 2.1) for ePTB among whites but smaller for the other 3 outcome groups (ORs 1.3-1.4). For all 4 groups, higher census tract poverty was associated with increased odds (ORs 1.03-1.05 per 9% change in poverty). Associations were less noteworthy for the other variables (payer, and tract percent black and Gini index of income inequality). Setting 3 factors (education, poverty, payer) to 'favorable' values was associated with lower predicted probability of ePTB (25% lower among blacks, 31% among whites) but a 9% higher disparity, compared to probabilities based on observed values; for mPTB, respective percentages were 28% and 13% lower probability, and 17% lower disparity. Results suggest that social determinants contribute to preterm delivery and its disparities, and that future studies should focus on ePTB and more specific factors related to social circumstances.

  View details for PubMedID 28800643

• Childhood Illness and the Gender Gap in Adolescent Education in Low- and Middle-Income Countries PEDIATRICS Alsan, M., Xing, A., Wise, P., Darmstadt, G. L., Bendavid, E. 2017; 140 (1)

  Abstract

  Achieving gender equality in education is an important development goal. We tested the hypothesis that the gender gap in adolescent education is accentuated by illnesses among young children in the household.Using Demographic and Health Surveys on 41 821 households in 38 low- and middle-income countries, we used linear regression to estimate the difference in the probability adolescent girls and boys were in school, and how this gap responded to illness episodes among children <5 years old. To test the hypothesis that investments in child health are related to the gender gap in education, we assessed the relationship between the gender gap and national immunization coverage.In our sample of 120 708 adolescent boys and girls residing in 38 countries, girls were 5.08% less likely to attend school than boys in the absence of a recent illness among young children within the same household (95% confidence interval [CI], 5.50%-4.65%). This gap increased to 7.77% (95% CI, 8.24%-7.30%) and 8.53% (95% CI, 9.32%-7.74%) if the household reported 1 and 2 or more illness episodes, respectively. The gender gap in schooling in response to illness was larger in households with a working mother. Increases in child vaccination rates were associated with a closing of the gender gap in schooling (correlation coefficient = 0.34, P = .02).Illnesses among children strongly predict a widening of the gender gap in education. Investments in early childhood health may have important effects on schooling attainment for adolescent girls.

  View details for PubMedID 28759395

  View details for PubMedCentralID PMC5495535

• The Affordable Care Act Dependent Coverage Expansion (ACA-DCE): Disparities in impact in young adult oncology patients. Alvarez, E., Keegan, T., Johnston, E. E., Haile, R., Sanders, L., Wise, P., Saynina, O., Chamberlain, L. J. AMER SOC CLINICAL ONCOLOGY. 2017

  View details for DOI 10.1200/JCO.2017.35.15_suppl.6561

  View details for Web of Science ID 000411931706056

• Association Between the Birth of an Infant With Major Congenital Anomalies and Subsequent Risk of Mortality in Their Mothers OBSTETRICAL & GYNECOLOGICAL SURVEY Cohen, E., Horvath-Puho, E., Ray, J. G., Pedersen, L., Adler, N., Ording, A., Wise, P. H., Milstein, A., Sorensen, H. 2017; 72 (4): 205-207

  View details for DOI 10.1097/OGX.0000000000000435

  View details for Web of Science ID 000399467700001

• Integrated genomic characterization of oesophageal carcinoma NATURE Kim, J., Bowlby, R., Mungall, A. J., Robertson, A. G., Odze, R. D., Cherniack, A. D., Shih, J., Pedamallu, C. S., Cibulskis, C., Dunford, A., Meier, S. R., Kim, J., Raphael, B. J., Wu, H., Wong, A. M., Willis, J. E., Bass, A. J., Derks, S., Garman, K., McCall, S. J., Wiznerowicz, M., Pantazi, A., Parfenov, M., Thorsson, V., Shmulevich, I., Dhankani, V., Miller, M., Sakai, R., Wang, K., Schultz, N., Shen, R., Arora, A., Weinhold, N., Sanchez-Vega, F., Kelsen, D. P., Zhang, J., Felau, I., Demchok, J., Rabkin, C. S., Camargo, M. C., Zenklusen, J. C., Bowen, J., Leraas, K., Lichtenberg, T. M., Curtis, C., Seoane, J. A., Ojesina, A. I., Beer, D. G., Gulley, M. L., Pennathur, A., Luketich, J. D., Zhou, Z., Weisenberger, D. J., Akbani, R., Lee, J., Liu, W., Mills, G. B., Zhang, W., Reid, B. J., Hinoue, T., Laird, P. W., Shen, H., Piazuelo, M. B., Schneider, B. G., McLellan, M., Taylor-Weiner, A., Cibulskis, C., Lawrence, M., Cibulskis, K., Stewart, C., Getz, G., Lander, E., Gabriel, S. B., Ding, L., McLellan, M. D., Miller, C. A., Appelbaum, E. L., Cordes, M. G., Fronick, C. C., Fulton, L. A., Mardis, E. R., Wilson, R. K., Schmidt, H. K., Fulton, R. S., Ally, A., Balasundaram, M., Bowlby, R., Carlsen, R., Chuah, E., Dhalla, N., Holt, R. A., Jones, S. J., Kasaian, K., Brooks, D., Li, H. I., Ma, Y., Marra, M. A., Mayo, M., Moore, R. A., Mungall, A. J., Mungall, K. L., Robertson, A. G., Schein, J. E., Sipahimalani, P., Tam, A., Thiessen, N., Wong, T., Cherniack, A. D., Shih, J., Pedamallu, C. S., Beroukhim, R., Bullman, S., Cibulskis, C., Murray, B. A., Saksena, G., Schumacher, S. E., Gabriel, S., Meyerson, M., Hadjipanayis, A., Kucherlapati, R., Pantazi, A., Parfenov, M., Ren, X., Park, P. J., Lee, S., Kucherlapati, M., Yang, L., Baylin, S. B., Hoadley, K. A., Weisenberger, D. J., Bootwalla, M. S., Lai, P. H., Van den Berg, D. J., Berrios, M., Holbrook, A., Akbani, R., Hwang, J., Jang, H., Liu, W., Weinstein, J. N., Lee, J., Lu, Y., Sohn, B. H., Mills, G., Seth, S., Protopopov, A., Bristow, C. A., Mahadeshwar, H. S., Tang, J., Song, X., Zhang, J., Laird, P. W., Hinoue, T., Shen, H., Cho, J., Defrietas, T., Frazer, S., Gehlenborg, N., Heiman, D. I., Lawrence, M. S., Lin, P., Meier, S. R., Noble, M. S., Doug Voet, D., Zhang, H., Kim, J., Polak, P., Saksena, G., Chin, L., Getz, G., Wong, A. M., Raphael, B. J., Wu, H., Lee, S., Park, P. J., Yang, L., Thorsson, V., Bernard, B., Iype, L., Miller, M., Reynolds, S. M., Shmulevich, I., Dhankani, V., Abeshouse, A., Arora, A., Armenia, J., Kundra, R., Ladanyi, M., Kjong-Van Lehmann, Gao, J., Sander, C., Schultz, N., Sanchez-Vega, F., Shen, R., Weinhold, N., Chakravarty, D., Zhang, H., Radenbaugh, A., Hegde, A., Akbani, R., Liu, W., Weinstein, J. N., Chin, L., Bristow, C. A., Lu, Y., Penny, R., Crain, D., Gardner, J., Curley, E., Mallery, D., Morris, S., Paulauskis, J., Shelton, T., Shelton, C., Bowen, J., Frick, J., Gastier-Foster, J. M., Gerken, M., Leraas, K. M., Lichtenberg, T. M., Ramirez, N. C., Wise, L., Zmuda, E., Tarvin, K., Saller, C., Park, Y. S., Button, M., Carvalho, A. L., Reis, R. M., Matsushita, M. M., Lucchesi, F., de Oliveira, A. T., Le, X., Paklina, O., Setdikova, G., Lee, J., Bennett, J., Iacocca, M., Huelsenbeck-Dill, L., Potapova, C. O., Voronina, O., Liu, O., Fulidou, V., Cates, C., Sharp, A., Behera, M., Force, S., Khuri, F., Owonikoko, T., Pickens, A., Ramalingam, S., Sica, G., Dinjens, W., van Nistelrooij, A., Wijnhoven, B., Sandusky, G., Stepa, S., Crain, D., Paulauskis, J., Penny, R., Gardner, J., Mallery, D., Morris, S., Shelton, T., Shelton, C., Curley, E., Juhl, I. H., Zornig, C., Kwon, S. Y., Kelsen, D., Kim, G. H., Bartlett, J., Parfitt, J., Chetty, R., Darling, G., Knox, J., Wong, R., El-Zimaity, H., Liu, G., Boussioutas, A., Park, D. Y., Kemp, R., Carlotti, C. G., da Cunha Tirapelli, D. P., Saggioro, F. P., Sankarankutty, A. K., Noushmehr, H., dos Santos, J. S., Trevisan, F. A., Eschbacher, J., Eschbacher, J., Dubina, M., Mozgovoy, E., Carey, F., Chalmers, S., Forgie, I., Godwin, A., Reilly, C., Madan, R., Naima, Z., Ferrer-Torres, D., Rathmell, W. K., Dhir, R., Luketich, J., Pennathur, A., Ajani, J. A., McCall, S. J., Janjigian, Y., Kelsen, D., Ladanyi, M., Tang, L., Camargo, M. C., Ajani, J. A., Cheong, J., Chudamani, S., Liu, J., Lolla, L., Naresh, R., Pihl, T., Sun, Q., Wan, Y., Wu, Y., Demchok, J. A., Felau, I., Ferguson, M. L., Shaw, K. R., Sheth, M., Tarnuzzer, R., Wang, Z., Yang, L., Zenklusen, J. C., Hutter, C. M., Sofia, H. J., Zhang, J. 2017; 541 (7636): 169-?

  Abstract

  Oesophageal cancers are prominent worldwide; however, there are few targeted therapies and survival rates for these cancers remain dismal. Here we performed a comprehensive molecular analysis of 164 carcinomas of the oesophagus derived from Western and Eastern populations. Beyond known histopathological and epidemiologic distinctions, molecular features differentiated oesophageal squamous cell carcinomas from oesophageal adenocarcinomas. Oesophageal squamous cell carcinomas resembled squamous carcinomas of other organs more than they did oesophageal adenocarcinomas. Our analyses identified three molecular subclasses of oesophageal squamous cell carcinomas, but none showed evidence for an aetiological role of human papillomavirus. Squamous cell carcinomas showed frequent genomic amplifications of CCND1 and SOX2 and/or TP63, whereas ERBB2, VEGFA and GATA4 and GATA6 were more commonly amplified in adenocarcinomas. Oesophageal adenocarcinomas strongly resembled the chromosomally unstable variant of gastric adenocarcinoma, suggesting that these cancers could be considered a single disease entity. However, some molecular features, including DNA hypermethylation, occurred disproportionally in oesophageal adenocarcinomas. These data provide a framework to facilitate more rational categorization of these tumours and a foundation for new therapies.

  View details for DOI 10.1038/nature20805

  View details for Web of Science ID 000396125500030

  View details for PubMedID 28052061

• Risky Business: Meeting the Structural Needs of Transdisciplinary Science. The Journal of pediatrics Wise, P. H., Shaw, G. M., Druzin, M. L., Darmstadt, G. L., Quaintance, C. n., Mäkinen, E. n., Relman, D. A., Quake, S. R., Butte, A. J., Angst, M. S., Muglia, L. J., Macones, G. n., Driscoll, D. n., Ober, C. n., Simpson, J. L., Katz, M. n., Howse, J. n., Stevenson, D. K. 2017; 191: 255–58

  View details for PubMedID 29173314

• Pediatric Oncology Discharges With Febrile Neutropenia: Variation in Location of Care JOURNAL OF PEDIATRIC HEMATOLOGY ONCOLOGY Alvarez, E., Chamberlain, L. J., Aftandilian, C., Saynina, O., Wise, P. 2017; 39 (1): E1-E7

  Abstract

  We examined the use of Pediatric Cancer Specialty Centers (PCSCs) over time and the length of stay (LOS) in pediatric oncology patients with a diagnosis of febrile neutropenia. PCSCs were defined as Children's Oncology Group and California Children's Services designated centers. We performed a retrospective analysis on all discharges of pediatric (0 to 18) oncology patients with febrile neutropenia in California (1983 to 2011) using the private Office of Statewide Health Planning and Development database. We examined influence of age, sex, race/ethnicity, payer, income, distance, tumor type, and complications on utilization of PCSCs and LOS (SAS 9.2). Analysis of 24,559 pediatric oncology febrile neutropenia discharges showed hospitalizations in PCSCs increasing from 48% in 1983 to 94% in 2011. The adjusted regression analysis showed decreased PCSC utilization for ages 15 to 18, Hispanic patients, and those living >40 miles away. The median PCSC LOS was 9 days compared with 7 days at a non-PCSC (P<0.0001). Discharge from a PCSC was associated with a LOS >8 days after controlling for complications. Inpatient PCSC care for febrile neutropenia in California has increased since 1983. Receiving care at a PCSC is influenced by age, tumor type, ethnicity, geography, and complications.

  View details for DOI 10.1097/MPH.0000000000000716

  View details for Web of Science ID 000391634100001

  View details for PubMedID 27918351

• Association Between the Birth of an Infant With Major Congenital Anomalies and Subsequent Risk of Mortality in Their Mothers JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION Cohen, E., Horvath-Puho, E., Ray, J. G., Pedersen, L., Adler, N., Ording, A. G., Wise, P. H., Milstein, A., Sorensen, H. T. 2016; 316 (23): 2515-2524

  Abstract

  Giving birth to a child with a major birth defect is a serious life event for a woman, yet little is known about the long-term health consequences for the mother.To assess whether birth of an infant born with a major congenital anomaly was associated with higher maternal risk of mortality.This population-based cohort study (n = 455 250 women) used individual-level linked Danish registry data for mothers who gave birth to an infant with a major congenital anomaly (41 508) between 1979 and 2010, with follow-up until December 31, 2014. A comparison cohort (413 742) was constructed by randomly sampling, for each mother with an affected infant, up to 10 mothers matched on maternal age, parity, and year of infant's birth.Live birth of an infant with a major congenital anomaly as defined by the European Surveillance of Congenital Anomalies classification system.Primary outcome was all-cause mortality. Secondary outcomes included cause-specific mortality. Hazard ratios (HRs) were adjusted for marital status, immigration status, income quartile (since 1980), educational level (since 1981), diabetes mellitus, modified Charlson comorbidity index score, hypertension, depression, history of alcohol-related disease, previous spontaneous abortion, pregnancy complications, smoking (since 1991), and body mass index (since 2004).Mothers in both groups were a mean (SD) age of 28.9 (5.1) years at delivery. After a median (IQR) follow-up of 21 (12-28) years, there were 1275 deaths (1.60 per 1000 person-years) among 41 508 mothers of a child with a major congenital anomaly vs 10 112 deaths (1.27 per 1000 person-years) among 413 742 mothers in the comparison cohort, corresponding to an absolute mortality rate difference of 0.33 per 1000 person-years (95% CI, 0.24-0.42), an unadjusted HR of 1.27 (95% CI, 1.20-1.35), and an adjusted HR of 1.22 (95% CI, 1.15-1.29). Mothers with affected infants were more likely to die of cardiovascular disease (rate difference, 0.05 per 1000 person-years [95% CI, 0.02-0.08]; adjusted HR, 1.26 [95% CI, 1.04-1.53]), respiratory disease (rate difference, 0.02 per 1000 person-years [95% CI, 0.00-0.04]; adjusted HR, 1.45 [95% CI, 1.01-2.08]), and other natural causes (rate difference, 0.11 per 1000 person-years [95% CI, 0.07-0.15]; adjusted HR, 1.50 [95% CI, 1.27-1.76]).In Denmark, having a child with a major congenital anomaly was associated with a small but statistically significantly increased mortality risk in the mother compared with women without an affected child. However, the clinical importance of this association is uncertain.

  View details for DOI 10.1001/jama.2016.18425

  View details for Web of Science ID 000390959300019

  View details for PubMedID 27997654

• Costs of resistance and correlational selection in the multiple-herbivore community of Solanum carolinense EVOLUTION Wise, M. J., Rausher, M. D. 2016; 70 (10): 2411-2420

  View details for DOI 10.1111/evo.13035

  View details for Web of Science ID 000385550700019

  View details for PubMedID 27501350

• Relationship between paternal somatic health and assisted reproductive technology outcomes. Fertility and sterility Eisenberg, M. L., Li, S., Wise, L. A., Lynch, C. D., Nakajima, S., Meyers, S. A., Behr, B., Baker, V. L. 2016; 106 (3): 559-565

  Abstract

  To study the association between paternal medical comorbidities and the outcomes of assisted reproductive technology (ART).Retrospective cohort study.Academic reproductive medicine center.We analyzed fresh ART cycles uszing freshly ejaculated sperm from the male partner of couples undergoing ART cycles from 2004 until 2014. We recorded patient and partner demographic characteristics. The cohort was linked to hospital billing data to obtain information on selected male partners' comorbidities identified using ICD-9-CM codes.None.Fertilization, clinical pregnancy, miscarriage, implantation, and live-birth rates as well as birth weights and gestational ages.In all, we identified 2,690 men who underwent 5,037 fresh ART cycles. Twenty-seven percent of men had at least one medical diagnosis. Men with nervous system diseases had on average lower pregnancy rates (23% vs. 30%) and live-birth rates (15% vs. 23%) than men without nervous system diseases. Lower fertilization rates were also observed among men with respiratory diseases (61% vs. 64%) and musculoskeletal diseases (61% vs. 64%) relative to those without these diseases. In addition, men with diseases of the endocrine system had smaller children (2,970 vs. 3,210 g) than men without such diseases. Finally, men with mental disorders had children born at an earlier gestational age (36.5 vs. 38.0 weeks).The current report identified a possible relationship between a man's health history and IVF outcomes. As these are potentially modifiable factors, further research should determine whether treatment for men's health conditions may improve or impair IVF outcomes.

  View details for DOI 10.1016/j.fertnstert.2016.04.037

  View details for PubMedID 27179785

• Evaluating Outcomes Disparities in the Hispanic Cystic Fibrosis Population A Need for a National Analysis Response CHEST Buu, M. C., Milla, C. E., Wise, P. H. 2016; 150 (3): 753

  View details for PubMedID 27613985

• Persistent State-of-Charge Heterogeneity in Relaxed, Partially Charged Li1- x Ni1/3 Co1/3 Mn1/3 O2 Secondary Particles. Advanced materials Gent, W. E., Li, Y., Ahn, S., Lim, J., Liu, Y., Wise, A. M., Gopal, C. B., Mueller, D. N., Davis, R., Weker, J. N., Park, J., Doo, S., Chueh, W. C. 2016; 28 (31): 6631-6638

  Abstract

  Ex situ transmission X-ray microscopy reveals micrometer-scale state-of-charge heterogeneity in solid-solution Li1- x Ni1/3 Co1/3 Mn1/3 O2 secondary particles even after extensive relaxation. The heterogeneity generates overcharged domains at the cutoff voltage, which may accelerate capacity fading and increase impedance with extended cycling. It is proposed that optimized secondary structures can minimize the state-of-charge heterogeneity by mitigating the buildup of nonuniform internal stresses associated with volume changes during charge.

  View details for DOI 10.1002/adma.201601273

  View details for PubMedID 27187238

• Effects of bound states on dark matter annihilation PHYSICAL REVIEW D An, H., Wise, M. B., Zhang, Y. 2016; 93 (11)

  View details for DOI 10.1103/PhysRevD.93.115020

  View details for Web of Science ID 000377805100006

• Equal Improvement in Men and Women in the Treatment of Urologic Chronic Pelvic Pain Syndrome Using a Multi-modal Protocol with an Internal Myofascial Trigger Point Wand APPLIED PSYCHOPHYSIOLOGY AND BIOFEEDBACK Anderson, R. U., Wise, D., Sawyer, T., Nathanson, B. H., Smith, J. N. 2016; 41 (2): 215-224

  Abstract

  Both men and women require treatment for urologic chronic pelvic pain syndromes (UCPPS), which includes interstitial cystitis/painful bladder syndrome, pelvic floor dysfunction, and chronic prostatitis/chronic pelvic pain syndrome. However, it is unknown if men and women respond differently to a protocol that includes specific physical therapy self-treatment using an internal trigger point wand and training in paradoxical relaxation. We performed a retrospective analysis by gender in a single arm, open label, single center clinical trial designed to evaluate the safety and effectiveness of a protocol for the treatment of UCPPS from October, 2008 to May, 2011. 314 adult men (79.9 %) and 79 (20.1 %) women met inclusion criteria. The median duration of symptoms was 60 months. The protocol required an initial 6-day clinic for training followed by a 6-month self-treatment period. The treatment included self-administered pelvic floor trigger point release with an internal trigger point device for physical therapy along with paradoxical relaxation training. Notable gender differences in prior treatments were observed. Men had a lower median [Interquartile Range] NIH-CPSI score at baseline than women (27 [21, 31] vs. 29 [22, 33], p = 0.04). Using a 1-10 scale with 10 = Most Severe, the median reduction in trigger point sensitivity was 3 units for both men and women after 6 months therapy (p = 0.74). A modified Intention to Treat analysis and a multivariate regression analysis found similar results. We conclude that men and women have similar, significant reductions in trigger point sensitivity with this protocol.

  View details for DOI 10.1007/s10484-015-9325-6

  View details for PubMedID 26721470

• Postoperative Complications in Pediatric Tonsillectomy and Adenoidectomy in Ambulatory vs Inpatient Settings JAMA OTOLARYNGOLOGY-HEAD & NECK SURGERY Amoils, M., Chang, K. W., Saynina, O., Wise, P. H., Honkanen, A. 2016; 142 (4): 344-350

  Abstract

  A large-scale review is needed to characterize the rates of airway, respiratory, and cardiovascular complications after pediatric tonsillectomy and adenoidectomy (T&A) for inpatient and ambulatory cohorts.To identify risk factors for postoperative complications stratified by age and operative facility type among children undergoing T&A.This retrospective review included 115 214 children undergoing T&A in hospitals, hospital-based facilities (HBF), and free-standing facilities (FSF) in California from January 1, 2005, to December 31, 2010. The analysis used the State of California Office of Statewide Health Planning and Development private inpatient data and Emergency Department and Ambulatory Surgery public data. Inpatient (n = 18 622) and ambulatory (n = 96 592) cohorts were identified by codes from the International Classification of Diseases, Ninth Revision, and Current Procedural Terminology. Data were collected from September 2011 to March 2012 and analyzed from March through May 2012.Rates of airway, respiratory, and cardiovascular complications.A total of 18 622 inpatients (51% male; 49% female; mean age, 5.4 [range, 0-17] years) and 96 592 ambulatory patients (37% male; 35% female; 28%, masked; mean age, 7.6 [range, 0-17] years) underwent analysis. The ratio of ambulatory to inpatient procedures was 5:1. Inpatients demonstrated more comorbidities (≤8,compared with ≤4 for HBF and ≤3 for FSF patients) and, in general, their complication rates were 2 to 5 times higher (seen in 1% to 12% of patients) than those in HBFs (0.2% to 5%), and more than 10 times higher than those in the FSFs (0% to 0.38%), with rates varying markedly by age range and facility type. Tonsillectomy and adenoidectomy was associated with increased risk for all complication types in both settings, reaching an odds ratio of 8.5 (95% CI, 6.6-11.1) for respiratory complications in the ambulatory setting. Inpatients aged 0 to 9 years experienced higher rates of airway and respiratory complications, peaking at an odds ratio of 7.5 (95% CI, 3.1-18.2) for airway complications in the group aged 0 to 11 months.Large numbers of pediatric patients undergo T&A in ambulatory settings despite higher rates of complications in younger patients and patients with more comorbidities. Fortunately, a high percentage of these patients has been appropriately triaged to the inpatient setting. Further research is needed to elucidate the subgroups that warrant postoperative hospitalization.

  View details for DOI 10.1001/jamaoto.2015.3634

  View details for PubMedID 26915058

• Child Poverty and the Promise of Human Capacity: Childhood as a Foundation for Healthy Aging ACADEMIC PEDIATRICS Wise, P. H. 2016; 16 (3): S37-S45

  Abstract

  The effect of child poverty and related early life experiences on adult health outcomes and patterns of aging has become a central focus of child health research and advocacy. In this article a critical review of this proliferating literature and its relevance to child health programs and policy are presented. This literature review focused on evidence of the influence of child poverty on the major contributors to adult morbidity and mortality in the United States, the mechanisms by which these associations operate, and the implications for reforming child health programs and policies. Strong and varied evidence base documents the effect of child poverty and related early life experiences and exposures on the major threats to adult health and healthy aging. Studies using a variety of methodologies, including longitudinal and cross-sectional strategies, have reported significant findings regarding cardiovascular disorders, obesity and diabetes, certain cancers, mental health conditions, osteoporosis and fractures, and possibly dementia. These relationships can operate through alterations in fetal and infant development, stress reactivity and inflammation, the development of adverse health behaviors, the conveyance of child chronic illness into adulthood, and inadequate access to effective interventions in childhood. Although the reviewed studies document meaningful relationships between child poverty and adult outcomes, they also reveal that poverty, experiences, and behaviors in adulthood make important contributions to adult health and aging. There is strong evidence that poverty in childhood contributes significantly to adult health. Changes in the content, financing, and advocacy of current child health programs will be required to address the childhood influences on adult health and disease. Policy reforms that reduce child poverty and mitigate its developmental effects must be integrated into broader initiatives and advocacy that also attend to the health and well-being of adults.

  View details for Web of Science ID 000373417600010

  View details for PubMedID 27044700

• The Grand Divergence in Global Child Health: Confronting Data Requirements in Areas of Conflict and Chronic Political Instability. JAMA pediatrics Wise, P. H., Darmstadt, G. L. 2016; 170 (3): 195-197

  View details for DOI 10.1001/jamapediatrics.2015.4275

  View details for PubMedID 26809944

• Pharmacy Expenditures for Children With Serious Chronic Illness Reply JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION Chamberlain, L. J., Swenson, S. M., Wise, P. H. 2016; 315 (7): 706–7

  View details for PubMedID 26881379

• Assessing Differences in Mortality Rates and Risk Factors Between Hispanic and Non-Hispanic Patients With Cystic Fibrosis in California CHEST Buu, M. C., Sanders, L. M., Mayo, J. A., Milla, C. E., Wise, P. H. 2016; 149 (2): 380-389

  Abstract

  Over the past 30 years, therapeutic advances have extended the median life span of patients with cystic fibrosis (CF). Hispanic patients are a vulnerable subpopulation with high of prevalence of risk factors for worse health outcomes. The consequences of these differences on health outcomes have not been well described. The objective of this study is to characterize the difference in health outcomes, including mortality rate, between Hispanic and non-Hispanic patients with CF.Retrospective analysis of CF Foundation patient registry data of California residents with CF, diagnosed during or after 1991, from 1991-2010. Ethnicity was self-reported. Primary outcome was mortality. Hazard ratios were estimated from a Cox regression model, stratified by gender and adjusted for socioeconomic status, clinical risk factors, and year of diagnosis.Of 1719, 485 (28.2%) self-identified as Hispanic. Eighty-five deaths occurred, with an overall mortality rate of 4.9%. Unadjusted mortality rate was higher among Hispanic patients than non-Hispanic patients (9.1% vs. 3.3%, p<0.0001). Compared with non-Hispanic patients, Hispanic patients had lower survival rate 18 years post-diagnosis (75.9% vs. 91.5%, p<0.0001). Adjusted for socioeconomic status and clinical risk factors, Hispanic patients had increased rate of death compared to non-Hispanic patients (HR 2.81, 95% CI 1.70-4.63).Hispanic patients with CF have a higher mortality rate than non-Hispanic patients, even after adjusting for socioeconomic status and clinical severity. Further investigation of mechanism for the measured difference in lung function will help inform interventions and improve the health of all CF patients.

  View details for DOI 10.1378/chest.14-2189

  View details for Web of Science ID 000369660400021

• Association between gestational duration in first pregnancies and birth timing in second pregnancies Yang, J., Baer, R. J., Berghella, V., Chambers, C., Chung, P., Coker, T., Currier, R. J., Druzin, M. L., Kuppermann, M., Muglia, L. J., Norton, M. E., Rand, L., Ryckman, K., Shaw, G. M., Stevenson, D., Wise, P., Jelliffe-Pawlowski, L. L. MOSBY-ELSEVIER. 2016: S442

  View details for DOI 10.1016/j.ajog.2015.10.898

  View details for Web of Science ID 000367092800837

• Prevalence and Predictors of Malnutrition among Guatemalan Children at 2 Years of Age. PloS one Nagata, J. M., Gippetti, J., Wager, S., Chavez, A., Wise, P. H. 2016; 11 (11)

  Abstract

  To identify the prevalence and predictors of malnutrition among 2-year old children in the Western Highlands of Guatemala.Prospective cohort of 852 Guatemalan children in San Lucas Toliman, Guatemala followed from birth to age 2 from May 2008 to December 2013. Socio-demographic, anthropometric, and health data of children was collected at 2 month intervals.Among the 402 males and 450 females in the cohort, mean weight-for-age Z-score (WAZ) declined from -0.67 ± 1.01 at 1 year to -1.07 ± 0.87 at 2 years, while mean height-for-age Z-score (HAZ) declined from -1.88 ± 1.19 at 1 year to -2.37 ± 0.99 at 2 years. Using multiple linear regression modeling, number of children <5 years old, vomiting in the past week, fever in the past week, and WAZ at 1 year were significant predictors of WAZ at 2 years. Significant predictors of HAZ at 2 years included household size, number of children <5 years old, diarrhea in the past week, WAZ at 1 year, and HAZ at 1 year. Vomiting in the past week and WAZ at 1 year were significant predictors of weight-for-height z-score (WHZ) at 2 years.Number of children <5 years old, symptoms such as vomiting or diarrhea in the previous week, and prior nutritional status were the most significant predictors of malnutrition in this cohort. Future research may focus on the application of models to develop predictive algorithms for mobile device technology, as well as the identification of other predictors of malnutrition that are not well characterized such as the interaction of environmental exposures with protein consumption and epigenetics.

  View details for DOI 10.1371/journal.pone.0164772

  View details for PubMedID 27806066

  View details for PubMedCentralID PMC5091788

• Mental Illness Drives Hospitalizations for Detained California Youth. journal of adolescent health Anoshiravani, A., Saynina, O., Chamberlain, L., Goldstein, B. A., Huffman, L. C., Wang, N. E., Wise, P. H. 2015; 57 (5): 455-461

  Abstract

  The purpose of the study was to describe inpatient hospitalization patterns among detained and nondetained youth in a large, total population of hospitalized adolescents in California.We examined the unmasked California Office of Statewide Health Planning and Development Patient Discharge Dataset from 1997 to 2011. We considered hospitalized youth aged 11-18 years "detained" if admitted to California hospitals from detention, transferred from hospital to detention, or both. We compared discharge diagnoses and length of stay between detained youth and their nondetained counterparts in the general population.There were 11,367 hospitalizations for detained youth. Hospitalizations differed for detained versus nondetained youth: 63% of all detained youth had a primary diagnosis of mental health disorder (compared with 19.8% of nondetained youth). Detained girls were disproportionately affected, with 74% hospitalized for a primary mental health diagnosis. Detained youth hospitalized for mental health disorder had an increased median length of stay compared with nondetained inpatient youth with mental illness (≥ 6 days vs. 5 days, respectively). This group difference was heightened in the presence of minority status, public insurance, and concurrent substance abuse. Hospitalized detained youth discharged to chemical dependency treatment facilities had the longest hospital stays (≥ 43 days).Detained juvenile offenders are hospitalized for very different reasons than the general adolescent population. Mental illness, often with comorbid substance abuse, requiring long inpatient stays, represents the major cause for hospitalization. These findings underscore the urgent need for effective, well-coordinated mental health services for youth before, during, and after detention.

  View details for DOI 10.1016/j.jadohealth.2015.05.006

  View details for PubMedID 26208862

• New vector-like fermions and flavor physics JOURNAL OF HIGH ENERGY PHYSICS Ishiwata, K., Ligeti, Z., Wise, M. B. 2015

  View details for DOI 10.1007/JHEP10(2015)027

  View details for Web of Science ID 000362596800001

• Health Care Utilization and Costs of Publicly-Insured Children with Diabetes in California. journal of pediatrics Lee, J. M., Sundaram, V., Sanders, L., Chamberlain, L., Wise, P. 2015; 167 (2): 449-54 e6

  Abstract

  To examine diabetes-related health care utilization and costs for a population-based sample of children with presumed type 1 diabetes (T1D) enrolled in the California Children's Services program.Our data source was the California Children's Services claims data for the period July 1, 2009, to June 30, 2012. We studied a sample of 652 children aged 0-21 years who were continuously enrolled for at least 365 days, had an outpatient visit for T1D, and were taking insulin.Compared with the younger age groups, individuals in the 19-21 year age group had the highest rates of hospitalization, T1D-specific bed-days, and emergency department visits. The overall median cost for this population was $7654. The overall median costs per year (and proportion of total costs) were $5603 (59%) for hospitalizations, $58 (0.4%) for emergency department visits, $144 (1.3%) for outpatient utilization, $2930 (23%) for insulin, and $1579 (13%) for blood glucose monitoring supplies. For those who used them, the median cost of pumps was an additional $2162.Further studies are needed to provide more insight into patterns of care and adverse health outcomes for children with T1D as they transition into young adulthood. The costs of insulin, glucose monitoring supplies, and pump therapy for children with T1D is substantial and may factor into future policy considerations regarding coverage and cost-sharing with families.

  View details for DOI 10.1016/j.jpeds.2015.04.067

  View details for PubMedID 26028286

• Health Care Utilization and Costs of Publicly-Insured Children with Diabetes in California. journal of pediatrics Lee, J. M., Sundaram, V., Sanders, L., Chamberlain, L., Wise, P. 2015; 167 (2): 449-454 e6

  Abstract

  To examine diabetes-related health care utilization and costs for a population-based sample of children with presumed type 1 diabetes (T1D) enrolled in the California Children's Services program.Our data source was the California Children's Services claims data for the period July 1, 2009, to June 30, 2012. We studied a sample of 652 children aged 0-21 years who were continuously enrolled for at least 365 days, had an outpatient visit for T1D, and were taking insulin.Compared with the younger age groups, individuals in the 19-21 year age group had the highest rates of hospitalization, T1D-specific bed-days, and emergency department visits. The overall median cost for this population was $7654. The overall median costs per year (and proportion of total costs) were $5603 (59%) for hospitalizations, $58 (0.4%) for emergency department visits, $144 (1.3%) for outpatient utilization, $2930 (23%) for insulin, and $1579 (13%) for blood glucose monitoring supplies. For those who used them, the median cost of pumps was an additional $2162.Further studies are needed to provide more insight into patterns of care and adverse health outcomes for children with T1D as they transition into young adulthood. The costs of insulin, glucose monitoring supplies, and pump therapy for children with T1D is substantial and may factor into future policy considerations regarding coverage and cost-sharing with families.

  View details for DOI 10.1016/j.jpeds.2015.04.067

  View details for PubMedID 26028286

• Strategic governance: Addressing neonatal mortality in situations of political instability and weak governance SEMINARS IN PERINATOLOGY Wise, P. H., Darmstadt, G. L. 2015; 39 (5): 387-392

  Abstract

  Neonatal mortality is increasingly concentrated globally in situations of conflict and political instability. In 1991, countries with high levels of political instability accounted for approximately 10% of all neonatal deaths worldwide; in 2013, this figure had grown to 31%. This has generated a "grand divergence" between those countries showing progress in neonatal mortality reduction compared to those lagging behind. We present new analyses demonstrating associations of neonatal mortality with political instability (r = 0.55) and poor governance (r = 0.70). However, heterogeneity in these relationships suggests that progress is possible in addressing neonatal mortality even in the midst of political instability and poor governance. In order to address neonatal mortality more effectively in such situations, we must better understand how specific elements of "strategic governance"-the minimal conditions of political stability and governance required for health service implementation-can be leveraged for successful introduction of specific health services. Thus, a more strategic approach to policy and program implementation in situations of conflict and political instability could lead to major accelerations in neonatal mortality reduction globally. However, this will require new cross-disciplinary collaborations among public health professionals, political scientists, and country actors.

  View details for DOI 10.1053/j.semperi.2015.06.008

  View details for Web of Science ID 000359877300008

  View details for PubMedID 26166561

• Outpatient Pharmacy Expenditures for Children With Serious Chronic Illness in California, 2010-2012. JAMA Swenson, S. M., Chamberlain, L. J., Sanders, L. M., Sundaram, V., Wise, P. H. 2015; 314 (4): 405-407

  View details for DOI 10.1001/jama.2015.7169

  View details for PubMedID 26219060

• Variation in Use of Pediatric Cardiology Subspecialty Care A Total Population Study in California, 1983 to 2011 JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY Chamberlain, L. J., Fernandes, S. M., Saynina, O., Grady, S., Sanders, L., Staves, K., Wise, P. H. 2015; 66 (1): 37-44

  Abstract

  American Academy of Pediatrics guidelines emphasize regionalized systems of care for pediatric chronic illness. There remains a paucity of information on the status of regionalized systems of care for pediatric congenital heart disease (CHD).This study evaluated variations in use of pediatric cardiology specialty care centers (PCSCC) for pediatric patients with CHD in California between 1983 and 2011.We performed a retrospective, total population analysis of pediatric CHD patients using the California Office of Statewide Health Planning and Development unmasked database. PCSCCs were identified by California's Title V program.There were 164,310 discharges meeting inclusion criterion. Discharges from PCSCCs grew from 58% to 88% between 1983 and 2011. Regionalized care was highest for surgical (96%) versus nonsurgical (71%) admissions. Admissions with a public payer increased from 42% (1983) to 61% (2011). Total bed days nearly doubled, and median length of stay increased from 2 to 3 days (nonspecialty care) and from 4 to 5 days (specialty care). There was a decrease in the pediatric CHD in-hospital death rate from 5.1 to 2.3 per 100,000 between 1983 and 2011, and a shift toward a larger percent of deaths occurring in the newborn period.California's inpatient regionalized specialty care of pediatric CHD has increased substantially since 1983, especially for surgical CHD discharges. The death rate has decreased, the number of bed days has increased, and a large proportion of these discharges now have public payers. Health care reform efforts must consider these shifts while protecting advances in regionalization of pediatric CHD care.

  View details for DOI 10.1016/j.jacc.2015.04.053

  View details for PubMedID 26139056

• Assessing differences in mortality rates and risk factors between Hispanic and non-Hispanic patients with cystic fibrosis in California. Chest Buu, M. C., Sanders, L. M., Mayo, J., Milla, C. E., Wise, P. H. 2015

  Abstract

  Over the past 30 years, therapeutic advances have extended the median life span of patients with cystic fibrosis (CF). Hispanic patients are a vulnerable subpopulation with high of prevalence of risk factors for worse health outcomes. The consequences of these differences on health outcomes have not been well described. The objective of this study is to characterize the difference in health outcomes, including mortality rate, between Hispanic and non-Hispanic patients with CF.Retrospective analysis of CF Foundation patient registry data of California residents with CF, diagnosed during or after 1991, from 1991-2010. Ethnicity was self-reported. Primary outcome was mortality. Hazard ratios were estimated from a Cox regression model, stratified by gender and adjusted for socioeconomic status, clinical risk factors, and year of diagnosis.Of 1719, 485 (28.2%) self-identified as Hispanic. Eighty-five deaths occurred, with an overall mortality rate of 4.9%. Unadjusted mortality rate was higher among Hispanic patients than non-Hispanic patients (9.1% vs. 3.3%, p<0.0001). Compared with non-Hispanic patients, Hispanic patients had lower survival rate 18 years post-diagnosis (75.9% vs. 91.5%, p<0.0001). Adjusted for socioeconomic status and clinical risk factors, Hispanic patients had increased rate of death compared to non-Hispanic patients (HR 2.81, 95% CI 1.70-4.63).Hispanic patients with CF have a higher mortality rate than non-Hispanic patients, even after adjusting for socioeconomic status and clinical severity. Further investigation of mechanism for the measured difference in lung function will help inform interventions and improve the health of all CF patients.

  View details for DOI 10.1378/chest.14-2189

  View details for PubMedID 26086984

• Spatial and temporal patterns in preterm birth in the United States PEDIATRIC RESEARCH Byrnes, J., Mahoney, R., Quaintance, C., Gould, J. B., Carmichael, S., Shaw, G. M., Showen, A., Phibbs, C., Stevenson, D. K., Wise, P. H. 2015; 77 (6): 836-844

  Abstract

  Despite years of research, the etiologies of preterm birth remain unclear. In order to help generate new research hypotheses, this study explored spatial and temporal patterns of preterm birth in a large, total-population dataset.Data on 145 million US births in 3,000 counties from the Natality Files of the National Center for Health Statistics for 1971-2011 were examined. State trends in early (<34 wk) and late (34-36 wk) preterm birth rates were compared. K-means cluster analyses were conducted to identify gestational age distribution patterns for all US counties over time.A weak association was observed between state trends in <34 wk birth rates and the initial absolute <34 wk birth rate. Significant associations were observed between trends in <34 wk and 34-36 wk birth rates and between white and African American <34 wk births. Periodicity was observed in county-level trends in <34 wk birth rates. Cluster analyses identified periods of significant heterogeneity and homogeneity in gestational age distributional trends for US counties.The observed geographic and temporal patterns suggest periodicity and complex, shared influences among preterm birth rates in the United States. These patterns could provide insight into promising hypotheses for further research.

  View details for DOI 10.1038/pr.2015.55

  View details for PubMedID 25760546

• Trends in utilization of specialty care centers in california for adults with congenital heart disease. American journal of cardiology Fernandes, S. M., Chamberlain, L. J., Grady, S., Saynina, O., Opotowsky, A. R., Sanders, L., Wise, P. H. 2015; 115 (9): 1298-1304

  Abstract

  The American College of Cardiology and American Heart Association guidelines recommend that management of adult congenital heart disease (ACHD) be coordinated by specialty ACHD centers and that ACHD surgery for patients with moderate or complex congenital heart disease (CHD) be performed by surgeons with expertise and training in CHD. Given this, the aim of this study was to determine the proportion of ACHD surgery performed at specialty ACHD centers and to identify factors associated with ACHD surgery being performed outside of specialty centers. This retrospective population analysis used California's Office of Statewide Health Planning and Development's discharge database to analyze ACHD cardiac surgery (in patients 21 to 65 years of age) in California from 2000 to 2011. Designation as a "specialty ACHD center" was defined on the basis of a national ACHD directory. A total of 4,611 ACHD procedures were identified. The proportion of procedures in patients with moderate and complex CHD delivered at specialty centers increased from 46% to 71% from 2000 to 2011. In multivariate analysis among those discharges for ACHD surgery in patients with moderate or complex CHD, performance of surgery outside a specialty center was more likely to be associated with patients who were older, Hispanic, insured by health maintenance organizations, and living farther from a specialty center. In conclusion, although the proportion of ACHD surgery for moderate or complex CHD being performed at specialty ACHD centers has been increasing, 1 in 4 patients undergo surgery at nonspecialty centers. Increased awareness of ACHD care guidelines and of the patient characteristics associated with differential access to ACHD centers may help improve the delivery of appropriate care for all adults with CHD.

  View details for DOI 10.1016/j.amjcard.2015.02.013

  View details for PubMedID 25765587

• Variations in inpatient pediatric anesthesia in California from 2000 to 2009: a caseload and geographic analysis PEDIATRIC ANESTHESIA Mudumbai, S. C., Honkanen, A., Chan, J., Schmitt, S., Saynina, O., Hackel, A., Gregory, G., Phibbs, C. S., Wise, P. H. 2014; 24 (12): 1295-1301

  Abstract

  Regional referral systems are considered important for children hospitalized for surgery, but there is little information on existing systems.To examine geographic variations in anesthetic caseloads in California for surgical inpatients ≤6 years and to evaluate the feasibility of regionalizing anesthetic care.We reviewed California's unmasked patient discharge database between 2000 and 2009 to determine surgical procedures, dates, and inpatient anesthetic caseloads. Hospitals were classified as urban or rural and were further stratified as low, intermediate, high, and very high volume.We reviewed 257,541 anesthetic cases from 402 hospitals. Seventeen California Children's Services (CCS) hospitals conducted about two-thirds of all inpatient anesthetics; 385 non-CCS hospitals accounted for the rest. Urban hospitals comprised 82% of low- and intermediate-volume centers (n = 297) and 100% of the high- and very high-volume centers (n = 41). Ninety percent (n = 361) of hospitals performed <100 cases annually. Although potentially lower risk procedures such as appendectomies were the most frequent in urban low- and intermediate-volume hospitals, fairly complex neurosurgical and general surgeries were also performed. The median distance from urban lower-volume hospitals to the nearest high- or very high-volume center was 12 miles. Up to 98% (n = 40,316) of inpatient anesthetics at low- or intermediate-volume centers could have been transferred to higher-volume centers within 25 miles of smaller centers.Many urban California hospitals maintained low annual inpatient anesthetic caseloads for children ≤6 years while conducting potentially more complex procedures. Further efforts are necessary to define the scope of pediatric anesthetic care at urban low- and intermediate-volume hospitals in California.

  View details for DOI 10.1111/pan.12500

  View details for Web of Science ID 000345151700015

• Variations in inpatient pediatric anesthesia in California from 2000 to 2009: a caseload and geographic analysis. Paediatric anaesthesia Mudumbai, S. C., Honkanen, A., Chan, J., Schmitt, S., Saynina, O., Hackel, A., Gregory, G., Phibbs, C. S., Wise, P. H. 2014; 24 (12): 1295-1301

  Abstract

  Regional referral systems are considered important for children hospitalized for surgery, but there is little information on existing systems.To examine geographic variations in anesthetic caseloads in California for surgical inpatients ≤6 years and to evaluate the feasibility of regionalizing anesthetic care.We reviewed California's unmasked patient discharge database between 2000 and 2009 to determine surgical procedures, dates, and inpatient anesthetic caseloads. Hospitals were classified as urban or rural and were further stratified as low, intermediate, high, and very high volume.We reviewed 257,541 anesthetic cases from 402 hospitals. Seventeen California Children's Services (CCS) hospitals conducted about two-thirds of all inpatient anesthetics; 385 non-CCS hospitals accounted for the rest. Urban hospitals comprised 82% of low- and intermediate-volume centers (n = 297) and 100% of the high- and very high-volume centers (n = 41). Ninety percent (n = 361) of hospitals performed <100 cases annually. Although potentially lower risk procedures such as appendectomies were the most frequent in urban low- and intermediate-volume hospitals, fairly complex neurosurgical and general surgeries were also performed. The median distance from urban lower-volume hospitals to the nearest high- or very high-volume center was 12 miles. Up to 98% (n = 40,316) of inpatient anesthetics at low- or intermediate-volume centers could have been transferred to higher-volume centers within 25 miles of smaller centers.Many urban California hospitals maintained low annual inpatient anesthetic caseloads for children ≤6 years while conducting potentially more complex procedures. Further efforts are necessary to define the scope of pediatric anesthetic care at urban low- and intermediate-volume hospitals in California.

  View details for DOI 10.1111/pan.12500

  View details for PubMedID 25203670

• Maternal prepregnancy body mass index and risk of spontaneous preterm birth. Paediatric and perinatal epidemiology Shaw, G. M., Wise, P. H., Mayo, J., Carmichael, S. L., Ley, C., Lyell, D. J., Shachar, B. Z., Melsop, K., Phibbs, C. S., Stevenson, D. K., Parsonnet, J., Gould, J. B. 2014; 28 (4): 302-311

  Abstract

  Findings from studies examining risk of preterm birth associated with elevated prepregnancy body mass index (BMI) have been inconsistent.Within a large population-based cohort, we explored associations between prepregnancy BMI and spontaneous preterm birth across a spectrum of BMI, gestational age, and racial/ethnic categories. We analysed data for 989 687 singleton births in California, 2007-09. Preterm birth was grouped as 20-23, 24-27, 28-31, or 32-36 weeks gestation (compared with 37-41 weeks). BMI was categorised as <18.5 (underweight); 18.5-24.9 (normal); 25.0-29.9 (overweight); 30.0-34.9 (obese I); 35.0-39.9 (obese II); and ≥40.0 (obese III). We assessed associations between BMI and spontaneous preterm birth of varying severity among non-Hispanic White, Hispanic, and non-Hispanic Black women.Analyses of mothers without hypertension and diabetes, adjusted for age, education, height, and prenatal care initiation, showed obesity categories I-III to be associated with increased risk of spontaneous preterm birth at 20-23 and 24-27 weeks among those of parity 1 in each race/ethnic group. Relative risks for obese III and preterm birth at 20-23 weeks were 6.29 [95% confidence interval (CI) 3.06, 12.9], 4.34 [95% CI 2.30, 8.16], and 4.45 [95% CI 2.53, 7.82] for non-Hispanic Whites, non-Hispanic Blacks, and Hispanics, respectively. A similar, but lower risk, pattern was observed for women of parity ≥2 and preterm birth at 20-23 weeks. Underweight was associated with modest risks for preterm birth at ≥24 weeks among women in each racial/ethnic group regardless of parity.The association between women's prepregnancy BMI and risk of spontaneous preterm birth is complex and is influenced by race/ethnicity, gestational age, and parity.

  View details for DOI 10.1111/ppe.12125

  View details for PubMedID 24810721

• Quantifying and Exploiting the Age Dependence in the Effect of Supplementary Food for Child Undernutrition PLOS ONE Lakkam, M., Wager, S., Wise, P. H., Wein, L. M. 2014; 9 (6)

  Abstract

  Motivated by the lack of randomized controlled trials with an intervention-free control arm in the area of child undernutrition, we fit a trivariate model of weight-for-age z score (WAZ), height-for-age z score (HAZ) and diarrhea status to data from an observational study of supplementary feeding (100 kCal/day for children with WAZ [Formula: see text]) in 17 Guatemalan communities. Incorporating time lags, intention to treat (i.e., to give supplementary food), seasonality and age interactions, we estimate how the effect of supplementary food on WAZ, HAZ and diarrhea status varies with a child's age. We find that the effect of supplementary food on all 3 metrics decreases linearly with age from 6 to 20 mo and has little effect after 20 mo. We derive 2 food allocation policies that myopically (i.e., looking ahead 2 mo) minimize either the underweight or stunting severity - i.e., the sum of squared WAZ or HAZ scores for all children with WAZ or HAZ [Formula: see text]. A simulation study based on the statistical model predicts that the 2 derived policies reduce the underweight severity (averaged over all ages) by 13.6-14.1% and reduce the stunting severity at age 60 mo by 7.1-8.0% relative to the policy currently in use, where all policies have a budget that feeds [Formula: see text]% of children. While these findings need to be confirmed on additional data sets, it appears that in a low-dose (100 kCal/day) supplementary feeding setting in Guatemala, allocating food primarily to 6-12 mo infants can reduce the severity of underweight and stunting.

  View details for DOI 10.1371/journal.pone.0099632

  View details for Web of Science ID 000338280800017

  View details for PubMedCentralID PMC4072673

• Hospitalizations of Children with Autism Increased from 1999 to 2009 JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS Nayfack, A. M., Huffman, L. C., Feldman, H. M., Chan, J., Saynina, O., Wise, P. H. 2014; 44 (5): 1087-1094

  Abstract

  We performed a retrospective analysis of hospital discharges for children with autism, in comparison to children with cerebral palsy, Down syndrome, mental retardation/intellectual disability, and the general population. Hospitalizations for autism increased nearly threefold over 10 years, especially at the oldest ages, while hospitalizations for the other groups did not change. Leading discharge diagnoses for each age group in children with autism included mental health and nervous system disorders. Older age, Caucasian ethnicity, and living in a region with a high number of pediatric beds predicted hospitalizations associated with mental health diagnoses. These findings underscore the need for comprehensive clinical services that address the complex needs of children with autism to prevent costly hospitalizations.

  View details for DOI 10.1007/s10803-013-1965-x

  View details for Web of Science ID 000336330200009

  View details for PubMedID 24122446

• Increased utilization of pediatric specialty care: a population study of pediatric oncology inpatients in california. Journal of pediatric hematology/oncology Chamberlain, L. J., Pineda, N., Winestone, L., Saynina, O., Rangaswami, A., Link, M., Wise, P. H. 2014; 36 (2): 99-107

  Abstract

  To examine inpatient utilization of pediatric cancer specialty centers (PCSCs) by pediatric oncology patients.We performed a retrospective (1999 to 2010) population-based analysis of oncology hospitalizations for pediatric patients aged 0 through 18 years using the California Office of Statewide Health Planning and Development database. Logistic regression examined hospitalization at 29 PCSCs and variables of age, sex, tumor type, payer, race, income, and distance to admission site.Analysis of 103,961 pediatric oncology discharges revealed that 93% occurred at PCSCs. These sites experienced a 20% increase in pediatric oncology discharges, conversely non-PCSCs exhibited a 70% decrease (P<0.0001). Multivariate analyses revealed increased utilization with young age (odds ratio [OR], 4.58; 95% CI, 3.88-5.42), African American (OR, 1.26; 95% CI, 1.11-1.43), and middle income (OR, 1.36; 95% CI, 1.29-1.45). Decreased utilization was seen for females (OR, 0.88; 95% CI, 0.84-0.93) and Hispanics (OR, 0.72; 95% CI, 0.68-0.77). Payer and proximity were not significantly associated with change in utilization. Tumor types less likely to utilize a PCSC included germ cell, solid, and central nervous system tumors. Adolescents were >3 times less likely to be treated at a PCSC.Inpatient pediatric oncology care in California has become increasingly regionalized with the vast majority of patients accessing PCSCs. However, variability in hospitalizations of adolescent patients and children not treated in PCSCs deserve further evaluation.

  View details for DOI 10.1097/01.mph.0000438027.07467.f1

  View details for PubMedID 24517965

• Maternal Body Mass and Risk for Premature Birth among 1.2 Million California Births Shaw, G. M., Wise, P. H., Mayo, J., Carmichael, S. L., Ley, C., Lyell, D. J., Shachar, B., Melsop, K., Phibbs, C. S., Stevenson, D. K., Parsonnet, J., Gould, J. B. SAGE PUBLICATIONS INC. 2014: 340A

  View details for Web of Science ID 000333813003131

• Governance and health in the Arab world LANCET Batniji, R., Khatib, L., Cammett, M., Sweet, J., Basu, S., Jamal, A., Wise, P., Giacaman, R. 2014; 383 (9914): 343-355

  Abstract

  Since late 2010, the Arab world has entered a tumultuous period of change, with populations demanding more inclusive and accountable government. The region is characterised by weak political institutions, which exclude large proportions of their populations from political representation and government services. Building on work in political science and economics, we assess the extent to which the quality of governance, or the extent of electoral democracy, relates to adult, infant, and maternal mortality, and to the perceived accessibility and improvement of health services. We compiled a dataset from the World Bank, WHO, Institute for Health Metrics and Evaluation, Arab Barometer Survey, and other sources to measure changes in demographics, health status, and governance in the Arab World from 1980 to 2010. We suggest an association between more effective government and average reductions in mortality in this period; however, there does not seem to be any relation between the extent of democracy and mortality reductions. The movements for changing governance in the region threaten access to services in the short term, forcing migration and increasing the vulnerability of some populations. In view of the patterns observed in the available data, and the published literature, we suggest that efforts to improve government effectiveness and to reduce corruption are more plausibly linked to population health improvements than are efforts to democratise. However, these patterns are based on restricted mortality data, leaving out subjective health metrics, quality of life, and disease-specific data. To better guide efforts to transform political and economic institutions, more data are needed for health-care access, health-care quality, health status, and access to services of marginalised groups.

  View details for DOI 10.1016/S0140-6736(13)62185-6

  View details for Web of Science ID 000330212600034

  View details for PubMedID 24452043

• Population-Level Correlates of Preterm Delivery among Black and White Women in the U.S. PloS one Carmichael, S. L., Cullen, M. R., Mayo, J. A., Gould, J. B., Loftus, P., Stevenson, D. K., Wise, P. H., Shaw, G. M. 2014; 9 (4)

  View details for DOI 10.1371/journal.pone.0094153

  View details for PubMedID 24740117

• Consequences of the Affordable Care Act for Sick Newborns. Pediatrics Profit, J. n., Wise, P. H., Lee, H. C. 2014

  View details for PubMedID 25311609

• Quantifying and exploiting the age dependence in the effect of supplementary food for child undernutrition. PloS one Lakkam, M., Wager, S., Wise, P. H., Wein, L. M. 2014; 9 (6)

  Abstract

  Motivated by the lack of randomized controlled trials with an intervention-free control arm in the area of child undernutrition, we fit a trivariate model of weight-for-age z score (WAZ), height-for-age z score (HAZ) and diarrhea status to data from an observational study of supplementary feeding (100 kCal/day for children with WAZ [Formula: see text]) in 17 Guatemalan communities. Incorporating time lags, intention to treat (i.e., to give supplementary food), seasonality and age interactions, we estimate how the effect of supplementary food on WAZ, HAZ and diarrhea status varies with a child's age. We find that the effect of supplementary food on all 3 metrics decreases linearly with age from 6 to 20 mo and has little effect after 20 mo. We derive 2 food allocation policies that myopically (i.e., looking ahead 2 mo) minimize either the underweight or stunting severity - i.e., the sum of squared WAZ or HAZ scores for all children with WAZ or HAZ [Formula: see text]. A simulation study based on the statistical model predicts that the 2 derived policies reduce the underweight severity (averaged over all ages) by 13.6-14.1% and reduce the stunting severity at age 60 mo by 7.1-8.0% relative to the policy currently in use, where all policies have a budget that feeds [Formula: see text]% of children. While these findings need to be confirmed on additional data sets, it appears that in a low-dose (100 kCal/day) supplementary feeding setting in Guatemala, allocating food primarily to 6-12 mo infants can reduce the severity of underweight and stunting.

  View details for DOI 10.1371/journal.pone.0099632

  View details for PubMedID 24967745

• Quality health care for children and the Affordable Care Act: a voltage drop checklist. Pediatrics Cheng, T. L., Wise, P. H., Halfon, N. n. 2014; 134 (4): 794–802

  Abstract

  The Affordable Care Act (ACA) introduces enormous policy changes to the health care system with several anticipated benefits and a growing number of unanticipated challenges for child and adolescent health. Because the ACA gives each state and their payers substantial autonomy and discretion on implementation, understanding potential effects will require state-by-state monitoring of policies and their impact on children. The "voltage drop" framework is a useful interpretive guide for assessing the impact of insurance market change on the quality of care received. Using this framework we suggest a state-level checklist to examine ACA statewide implementation, assess its impact on health care delivery, and frame policy correctives to improve child health system performance. Although children's health care is a small part of US health care spending, child health provides the foundation for adult health and must be protected in ACA implementation.

  View details for PubMedID 25225140

  View details for PubMedCentralID PMC4179100

• Promise and perils of the Affordable Care Act for children. JAMA Cheng, T. L., Wise, P. H., Halfon, N. n. 2014; 311 (17): 1733–34

  View details for PubMedID 24794362

  View details for PubMedCentralID PMC4575119

• The changing nature of children's health development: new challenges require major policy solutions. Health affairs (Project Hope) Halfon, N. n., Wise, P. H., Forrest, C. B. 2014; 33 (12): 2116–24

  Abstract

  The epidemiology and social context of American childhood are rapidly changing. Adverse social, economic, and child-rearing conditions are loading children down with preventable illness, physical and behavioral disability, and dysfunction. This new epidemiology of childhood is swamping the capacity of the nation's health care system, schools, juvenile justice facilities, and child protective services to respond to the needs of those they serve. This low-performing system not only jeopardizes the health of children, it also jeopardizes the health of the adults they will become. In this article we review the science of life-course health development, a new field that provides a powerful explanatory framework for understanding how poor health and social adversity during childhood can affect lifelong health. We then present five ambitious policy recommendations to integrate educational, health, social, and economic initiatives designed to enhance health. Our bold but pragmatic goal is that by 2025, US children will have the highest levels of health among industrialized nations, instead of where US children currently rank-among the worst.

  View details for PubMedID 25489029

• Population-level correlates of preterm delivery among black and white women in the U.S. PloS one Carmichael, S. L., Cullen, M. R., Mayo, J. A., Gould, J. B., Loftus, P., Stevenson, D. K., Wise, P. H., Shaw, G. M. 2014; 9 (4)

  Abstract

  This study examined the ability of social, demographic, environmental and health-related factors to explain geographic variability in preterm delivery among black and white women in the US and whether these factors explain black-white disparities in preterm delivery.We examined county-level prevalence of preterm delivery (20-31 or 32-36 weeks gestation) among singletons born 1998-2002. We conducted multivariable linear regression analysis to estimate the association of selected variables with preterm delivery separately for each preterm/race-ethnicity group.The prevalence of preterm delivery varied two- to three-fold across U.S. counties, and the distributions were strikingly distinct for blacks and whites. Among births to blacks, regression models explained 46% of the variability in county-level risk of delivery at 20-31 weeks and 55% for delivery at 32-36 weeks (based on R-squared values). Respective percentages for whites were 67% and 71%. Models included socio-environmental/demographic and health-related variables and explained similar amounts of variability overall.Much of the geographic variability in preterm delivery in the US can be explained by socioeconomic, demographic and health-related characteristics of the population, but less so for blacks than whites.

  View details for DOI 10.1371/journal.pone.0094153

  View details for PubMedID 24740117

• Leveraging information technology to improve control of neglected tropical diseases. PLoS neglected tropical diseases Gupta, R., Wise, P. H. 2013; 7 (11)

  View details for DOI 10.1371/journal.pntd.0002353

  View details for PubMedID 24244759

  View details for PubMedCentralID PMC3820753

• Utilization of subspecialty care by Hispanic pediatric oncology patients, California 1983-2010. Alvarez, E., Chamberlain, L. J., Marina, N., Saynina, O., Wise, P. AMER SOC CLINICAL ONCOLOGY. 2013

  View details for Web of Science ID 000335419604381

• The Transformation of Child Health Research Innovation, Market Failure, and the Public Good JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION Stoll, B. J., Stevenson, D. K., Wise, P. H. 2013; 309 (17): 1779-1780

  View details for Web of Science ID 000318235600023

  View details for PubMedID 23632719

• Transdisciplinary translational science and the case of preterm birth JOURNAL OF PERINATOLOGY Stevenson, D. K., Shaw, G. M., Wise, P. H., Norton, M. E., Druzin, M. L., Valantine, H. A., McFarland, D. A. 2013; 33 (4): 251-258

  Abstract

  Medical researchers have called for new forms of translational science that can solve complex medical problems. Mainstream science has made complementary calls for heterogeneous teams of collaborators who conduct transdisciplinary research so as to solve complex social problems. Is transdisciplinary translational science what the medical community needs? What challenges must the medical community overcome to successfully implement this new form of translational science? This article makes several contributions. First, it clarifies the concept of transdisciplinary research and distinguishes it from other forms of collaboration. Second, it presents an example of a complex medical problem and a concrete effort to solve it through transdisciplinary collaboration: for example, the problem of preterm birth and the March of Dimes effort to form a transdisciplinary research center that synthesizes knowledge on it. The presentation of this example grounds discussion on new medical research models and reveals potential means by which they can be judged and evaluated. Third, this article identifies the challenges to forming transdisciplines and the practices that overcome them. Departments, universities and disciplines tend to form intellectual silos and adopt reductionist approaches. Forming a more integrated (or 'constructionist'), problem-based science reflective of transdisciplinary research requires the adoption of novel practices to overcome these obstacles.

  View details for DOI 10.1038/jp.2012.133

  View details for PubMedID 23079774

• The Utility of Childhood and Adolescent Obesity Assessment in Relation to Adult MEDICAL DECISION MAKING Goldhaber-Fiebert, J. D., Rubinfeld, R. E., Bhattacharya, J., Robinson, T. N., Wise, P. H. 2013; 33 (2): 163-175

  Abstract

  High childhood obesity prevalence has raised concerns about future adult health, generating calls for obesity screening of young children.To estimate how well childhood obesity predicts adult obesity and to forecast obesity-related health of future US adults.Longitudinal statistical analyses; microsimulations combining multiple data sets.National Longitudinal Survey of Youth, Population Study of Income Dynamics, and National Health and Nutrition Evaluation Surveys.The authors estimated test characteristics and predictive values of childhood body mass index to identify 2-, 5-, 10-, and 15 year-olds who will become obese adults. The authors constructed models relating childhood body mass index to obesity-related diseases through middle age stratified by sex and race.Twelve percent of 18-year-olds were obese. While screening at age 5 would miss 50% of those who become obese adults, screening at age 15 would miss 9%. The predictive value of obesity screening below age 10 was low even when maternal obesity was included as a predictor. Obesity at age 5 was a substantially worse predictor of health in middle age than was obesity at age 15. For example, the relative risk of developing diabetes as adults for obese white male 15-year-olds was 4.5 versus otherwise similar nonobese 15-year-olds. For obese 5-year-olds, the relative risk was 1.6.Main results do not include Hispanics due to sample size. Past relationships between childhood and adult obesity and health may change in the future.Early childhood obesity assessment adds limited information to later childhood assessment. Targeted later childhood approaches or universal strategies to prevent unhealthy weight gain should be considered.

  View details for DOI 10.1177/0272989X12447240

  View details for Web of Science ID 000316684200006

  View details for PubMedID 22647830

• Public Policy Implications of Promoting Growth 71st Nestle-Nutrition-InstituteWorkshop Wise, P. H. KARGER. 2013: 199–206

  Abstract

  Translating the new science of growth into constructive policy will not happen naturally. Rather, the emerging science will need to be reframed to address certain core policy requirements. First, the complexity of early genetic and environmental interactions should be respected as their impact may vary in different, real-world settings. Second, the scale of impact is important to gauge as early-life interactions, while real, may not account for a large portion of later outcomes. Third, judgments regarding critical periods and the amenability of early-life influences to later intervention should be made cautiously as the etiologic nature or timing of early-life interactions do not, per se, determine if their life course effects are amenable to later interventions. Fourth, there is a need for incremental efficacy, such that the new science significantly enhances the impact of extant policy-based interventions. Finally, the translation of the new developmental science into policy should be viewed in a historical context and responsive to social and cultural needs. This provides a basis for reframing the new science of growth in a manner that best ensures that the science receives the constructive policy response it so urgently demands.

  View details for PubMedID 23502155

• Leveraging information technology to improve control of neglected tropical diseases. PLoS neglected tropical diseases Gupta, R., Wise, P. H. 2013; 7 (11)

  View details for DOI 10.1371/journal.pntd.0002353

  View details for PubMedID 24244759

  View details for PubMedCentralID PMC3820753

• Predictors of Hospitalization After an Emergency Department Visit for California Youths With Psychiatric Disorders PSYCHIATRIC SERVICES Huffman, L. C., Wang, N. E., Saynina, O., Wren, F. J., Wise, P. H., Horwitz, S. M. 2012; 63 (9): 896-905

  Abstract

  This study examined patient, hospital, and county characteristics associated with hospitalization after emergency department visits for pediatric mental health problems.Retrospective analysis of emergency department encounters (N=324,997) of youths age five years to 17 years with psychiatric diagnoses was conducted with 2005-2009 California Office of Statewide Health Planning and Development emergency department statewide data.For youths with any psychiatric diagnosis, 23.4% of emergency department encounters resulted in hospitalization. In these cases, hospitalization largely was predicted by clinical need. Nonclinical factors that decreased the likelihood of hospitalization included demographic characteristics (such as younger age, lack of insurance, and rural residence) and resource characteristics (private hospital ownership, lack of psychiatric consultation in the emergency department, and lack of pediatric psychiatric beds). For youths with a significant psychiatric diagnosis plus a suicide attempt, 53.8% of emergency department encounters resulted in hospitalization. In these presumably more life-threatening cases, nonclinical factors that decreased the likelihood of hospitalization persisted: demographic characteristics (lack of insurance and rural residence) and resource characteristics (public hospital ownership, lack of psychiatric consultation, and lack of pediatric psychiatric beds).Mental health service delivery can improve only by addressing nonclinical demographic and resource obstacles that independently decrease the likelihood of hospitalization after an emergency department visit for a mental health issue; this is true even for the most severely ill youths-those with a suicide attempt as well as a serious psychiatric diagnosis.

  View details for DOI 10.1176/appi.ps.201000482

  View details for PubMedID 22710574

• [Investigation on prevalence of soil-transmitted nematode infections and influencing factors for children in southwest areas of China]. Zhongguo xue xi chong bing fang zhi za zhi = Chinese journal of schistosomiasis control Wang, X., Wang, G., Zhang, L., Luo, R., Tian, H., Tang, L., Wang, J., Medina, A., Wise, P., Rozelle, S. 2012; 24 (3): 268–93

  Abstract

  OBJECTIVE: To understand the infection status and main risk factors of soil-transmitted nematodes in southwest China so as to provide the evidence for making the control programs for soil-transmitted nematodiasis.METHODS: The prevalence of soil-transmitted nematode infections was determined by Kato-Katz technique and influencing factors were surveyed by using a standardized questionnaire, and in part of the children, the examination of Enterobius vermicularis eggs was performed by using the cellophane swab method. The relationship between soil-transmitted nematode infections and influencing factors was analyzed by the multiple probit estimated method.RESULTS: A total of 1 707 children were examined, with a soil-transmitted nematode infection rate of 22.2%, the crowd infection rates ofAscaris lumbricoides, hookworm, and Trichuris trichiura were 16.0%, 3.8% and 6.6% respectively and 495 children were examined on Enterobius vermicularis eggs, with the infection rate of 5.1%. The results of probit estimated analysis suggested that the effects of 4 factors on soil-transmitted nematode infections were significant (all P values were less than 0.05), namely the number of sib, educational level of mother, drinking unboiled water and raising livestock and poultry. Among the factors above, the educational level of mother could reduce the probability of infection (ME = -0.074), while the number of sib, drinking unboiled water and raising livestock and poultry could increase the probability of the infections (with ME of 0.028, -0.112 and 0.080, respectively).CONCLUSIONS: Soil-transmitted nematode infection rates are still in a high level for children in southwest poor areas of China, with Ascaris lumbricoides as a priority. The changes of children's bad health habits, raising livestock and poultry habits, and implementing the health education about parasitic diseases in mothers would be of great significance for the prevention and control of soil-transmitted nematodiasis.

  View details for PubMedID 23012947

• The association between insurance status and emergency department disposition of injured California children. Academic emergency medicine Arroyo, A. C., Ewen Wang, N., Saynina, O., Bhattacharya, J., Wise, P. H. 2012; 19 (5): 541-551

  Abstract

  This study examined the relationship between insurance status and emergency department (ED) disposition of injured California children.Multivariate regression models were built using data obtained from the 2005 through 2009 California Office of Statewide Health Planning and Development (OSHPD) data sets for all ED visits by injured children younger than 19 years of age.Of 3,519,530 injury-related ED visits, 52% were insured by private, and 36% were insured by public insurance, while 11% of visits were not insured. After adjustment for injury characteristics and demographic variables, publicly insured children had a higher likelihood of admission for mild, moderate, and severe injuries compared to privately insured children (mild injury adjusted odds ratio [AOR] = 1.36, 95% confidence interval [CI] = 1.34 to 1.39; moderate and severe injury AOR = 1.34, 95% CI = 1.28 to 1.41). However, uninsured children were less likely to be admitted for mild, moderate, and severe injuries compared to privately insured children (mild injury AOR = 0.63, 95% CI = 0.61 to 0.66; moderate and severe injury AOR = 0.50, 95% CI = 0.46 to 0.55). While publicly insured children with moderate and severe injuries were as likely as privately insured children to experience an ED death (AOR = 0.91, 95% CI = 0.70 to 1.18), uninsured children with moderate and severe injuries were more likely to die in the ED compared to privately insured children (AOR = 3.11, 95% CI = 2.38 to 4.06).Privately insured, publicly insured, and uninsured injured children have disparate patterns of ED disposition. Policy and clinical efforts are needed to ensure that all injured children receive equitable emergency care.

  View details for DOI 10.1111/j.1553-2712.2012.01356.x

  View details for PubMedID 22594358

  View details for PubMedCentralID PMC3443629

• The Association Between Insurance Status and Emergency Department Disposition of Injured California Children ACADEMIC EMERGENCY MEDICINE Arroyo, A. C., Wang, N. E., Saynina, O., Bhattacharya, J., Wise, P. H. 2012; 19 (5): 541-551

  Abstract

  This study examined the relationship between insurance status and emergency department (ED) disposition of injured California children.Multivariate regression models were built using data obtained from the 2005 through 2009 California Office of Statewide Health Planning and Development (OSHPD) data sets for all ED visits by injured children younger than 19 years of age.Of 3,519,530 injury-related ED visits, 52% were insured by private, and 36% were insured by public insurance, while 11% of visits were not insured. After adjustment for injury characteristics and demographic variables, publicly insured children had a higher likelihood of admission for mild, moderate, and severe injuries compared to privately insured children (mild injury adjusted odds ratio [AOR] = 1.36, 95% confidence interval [CI] = 1.34 to 1.39; moderate and severe injury AOR = 1.34, 95% CI = 1.28 to 1.41). However, uninsured children were less likely to be admitted for mild, moderate, and severe injuries compared to privately insured children (mild injury AOR = 0.63, 95% CI = 0.61 to 0.66; moderate and severe injury AOR = 0.50, 95% CI = 0.46 to 0.55). While publicly insured children with moderate and severe injuries were as likely as privately insured children to experience an ED death (AOR = 0.91, 95% CI = 0.70 to 1.18), uninsured children with moderate and severe injuries were more likely to die in the ED compared to privately insured children (AOR = 3.11, 95% CI = 2.38 to 4.06).Privately insured, publicly insured, and uninsured injured children have disparate patterns of ED disposition. Policy and clinical efforts are needed to ensure that all injured children receive equitable emergency care.

  View details for DOI 10.1111/j.1553-2712.2012.01356.x

  View details for Web of Science ID 000304133300009

  View details for PubMedCentralID PMC3443629

• Emerging Technologies and Their Impact on Disability FUTURE OF CHILDREN Wise, P. H. 2012; 22 (1): 169-191

  Abstract

  Technological innovation is transforming the prevalence and functional impact of child disability, the scale of social disparities in child disability, and perhaps the essential meaning of disability in an increasingly technology-dominated world. In this article, Paul Wise investigates several specific facets of this transformation. He begins by showing how technological change influences the definition of disability, noting that all technology attempts to address some deficiency in human capacity or in the human condition. Wise then looks at the impact of technology on childhood disabilities. Technical improvements in the physical environment, such as better housing, safer roads, and poison-prevention packaging, have significantly reduced childhood injury and disability. Other technological breakthroughs, such as those that identify genetic disorders that may lead to pregnancy termination, raise difficult moral and ethical issues. Technologies that identify potential health risks are also problematic in the absence of any efficient treatment. Wise stresses the imbalance in the existing health care delivery system, which is geared toward treating childhood physical illnesses that are declining in prevalence at a time when mental and emotional conditions, many of which are not yet well understood, are on the rise. This mismatch, Wise says, poses complex challenges to caring for disabled children, particularly in providing them with highly coordinated and integrated systems of care. Technology can also widen social disparities in health care for people, including children with disabilities. As Wise observes, efficacy--the ability of a technology to change health outcomes--is key to understanding the relationship of technology to social disparities. As technological innovation enhances efficacy, access to that technology becomes more important. Health outcomes may improve for those who can afford the technology, for example, but not for others. Hence, as efficacy grows, so too does the burden on society to provide access to technology equitably to all those in need. Without such access, technological innovation will likely expand disparities in child outcomes rather than reduce them.

  View details for Web of Science ID 000303139700008

  View details for PubMedID 22550690

• The Morality of Saved Lives AMERICAN JOURNAL OF BIOETHICS Batniji, R., Wise, P. H. 2012; 12 (12): 1-2

  View details for DOI 10.1080/15265161.2012.739388

  View details for Web of Science ID 000312338300004

  View details for PubMedID 23215917

• The genus zero Gromov-Witten invariants of the symmetric square of the plane COMMUNICATIONS IN ANALYSIS AND GEOMETRY Wise, J. 2011; 19 (5): 923-974

  View details for Web of Science ID 000300355600005

• Access to Pediatric Subspecialty Care: A Population Study of Pediatric Rheumatology Inpatients in California ARTHRITIS CARE & RESEARCH Pineda, N., Chamberlain, L. J., Chan, J., Cidon, M. J., Wise, P. H. 2011; 63 (7): 998-1005

  Abstract

  To examine trends in the specialty care hospitalization of pediatric rheumatology patients and determine how nonclinical factors influence access.This study used California's Office of Statewide Health Planning and Development discharge database to perform a retrospective population analysis of pediatric rheumatology hospitalizations in California between 1999 and 2007. We used logistic regression to examine the relationship between hospitalization in specialty care centers with a pediatric rheumatologist and nonclinical patient characteristics.A total of 18,641 pediatric discharges revealed that 57% were discharged from a specialty care center with a pediatric rheumatologist. Multivariate analysis showed that the factors associated with increased utilization of specialty care centers with a pediatric rheumatologist were public insurance (odds ratio [OR] 1.62, 95% confidence interval [95% CI] 1.51-1.74; P < 0.0001), being Hispanic (OR 1.29, 95% CI 1.19-1.40; P < 0.0001) or Asian non-Hispanic (OR 1.39, 95% CI 1.26-1.54; P < 0.0001), and high pediatric rheumatology specialty care bed supply (OR 2.79, 95% CI 2.49-3.14; P < 0.0001). A decreased utilization of specialty care centers with a pediatric rheumatologist was seen for patients ages <1 year (OR 0.45, 95% CI 0.40-0.52; P < 0.0001), ages 1-4 years (OR 0.50, 95% CI 0.46-0.55; P < 0.0001), ages 5-9 years (OR 0.68, 95% CI 0.62-0.75; P < 0.0001), ages 15-18 years (OR 0.51, 95% CI 0.47-0.56; P < 0.0001), males (OR 0.75, 95% CI 0.70-0.80; P < 0.0001), and patients residing farther away from a specialty care center with a pediatric rheumatologist (OR 0.57, 95% CI 0.51-0.63; P < 0.0001).Nonclinical factors play an increasingly important role in the hospitalization patterns of pediatric rheumatology patients in California. Understanding these factors is crucial if we are to ensure that the variation in access to care reflects clinical need.

  View details for DOI 10.1002/acr.20458

  View details for Web of Science ID 000292809200011

  View details for PubMedID 21360697

• Factors Associated With Trauma Center Use for Elderly Patients With Trauma A Statewide Analysis, 1999-2008 ARCHIVES OF SURGERY Hsia, R. Y., Wang, E., Saynina, O., Wise, P., Perez-Stable, E. J., Auerbach, A. 2011; 146 (5): 585-592

  Abstract

  To estimate the likelihood of trauma center admission for injured elderly patients with trauma, determine trends in trauma center admissions, and identify factors associated with trauma center use for elderly patients with trauma.Retrospective analysis.Acute care hospitals in California.All patients hospitalized for acute traumatic injuries during the period from January 1, 1999, to December 31, 2008 (n = 430,081). Patients who had scheduled admissions for nonacute or minor trauma were excluded.Likelihood of admission to level I or II trauma center was calculated according to age categories after adjusting for patient and system factors.Of 430,081 patients admitted to California acute care hospitals for trauma-related diagnoses, 27% were older than 65 years. After adjusting for demographic, clinical, and system factors, compared with trauma patients aged 18-25 years, the odds of admission to a trauma center decreased with increasing age; patients aged 26-45 years had lower odds (odds ratio [OR], 0.75; 95% confidence interval [CI], 0.71-0.80) of being admitted to a trauma center for their injuries than did patients 46-65 years of age (OR, 0.57; 95% CI, 0.54-0.60), patients 66-85 years of age (OR, 0.35; 95% CI, 0.30-0.41), and patients older than 85 years (OR, 0.30; 95% CI, 0.25-0.36). Similar patterns were found when stratifying the analysis by trauma type and severity. Living more than 50 miles away from a trauma center (OR, 0.03; 95% CI, 0.01-0.06) and lack of county trauma center (OR, 0.17; 95% CI, 0.09-0.35) were also predictors of not receiving trauma care.Age and likelihood of admission to a trauma center for injured patients were observed to be inversely proportional after controlling for other factors. System-level factors play a major role in determining which injured patients receive trauma care.

  View details for DOI 10.1001/archsurg.2010.311

  View details for Web of Science ID 000290633100024

  View details for PubMedID 21242421

  View details for PubMedCentralID PMC3121677

• Integrity Matters: Recapturing the Relevance of General Academic Pediatrics ACADEMIC PEDIATRICS Wise, P. H. 2011; 11 (2): 123-127

  View details for Web of Science ID 000288525900010

  View details for PubMedID 21282084

• Child Health Policy: Where Are You When We Need You? ACADEMIC PEDIATRICS Wise, P. H. 2010; 10 (5): 285-286

  View details for Web of Science ID 000282109700002

  View details for PubMedID 20816651

• Can State Early Intervention Programs Meet the Increased Demand of Children Suspected of Having Autism Spectrum Disorders? JOURNAL OF DEVELOPMENTAL AND BEHAVIORAL PEDIATRICS Wise, M. D., Little, A. A., Holliman, J. B., Wise, P. H., Wang, C. J. 2010; 31 (6): 469-476

  Abstract

  To determine whether Early Intervention programs have the capacity to accommodate the expected increase in referrals following the American Academy of Pediatrics' 2007 recommendation for universal screening of 18- and 24-month-old children for Autism Spectrum Disorders (ASD).We conducted a telephone survey of all state and territory early. Intervention coordinators about the demand for ASD evaluations, services, and program capacity. We used multivariate models to examine state-level factors associated with the capacity to serve children with ASD.Fifty-two of the 57 coordinators (91%) responded to the survey. Most states reported an increase in demand for ASD-related evaluations (65%) and services (58%) since 2007. In addition, 46% reported that their current capacity poses a challenge to meeting the 45-day time limit for creating the Individualized Family Service Plan. Many states reported that they have shortages of ASD-related personnel, including behavioral therapists (89%), speech-language pathologists (82%), and occupational therapists (79%). Among states that reported the number of service hours (n = 34) 44% indicated that children with ASD receive 5 or fewer weekly service hours. Multivariate models showed that states with a higher percentage of African-American and Latino children were more likely to have provider shortages whereas states with higher population densities were more likely to offer a greater number of service hours.Many Early Intervention programs may not have the capability to address the expected increase in demand for ASD services. Early Intervention programs will likely need enhanced resources to provide all children with suspected ASD with appropriate evaluations and services.

  View details for DOI 10.1097/DBP.0b013e3181e56db2

  View details for Web of Science ID 000279648300002

  View details for PubMedID 20585267

• Children with Special Health Care Needs: How Immigrant Status is Related to Health Care Access, Health Care Utilization, and Health Status MATERNAL AND CHILD HEALTH JOURNAL Javier, J. R., Huffman, L. C., Mendoza, F. S., Wise, P. H. 2010; 14 (4): 567-579

  Abstract

  To compare health care access, utilization, and perceived health status for children with SHCN in immigrant and nonimmigrant families. This cross-sectional study used data from the 2003 California Health Interview Survey to identify 1404 children (ages 0-11) with a special health care need. Chi-square and logistic regression analyses were used to examine relations between immigrant status and health access, utilization, and health status variables. Compared to children with special health care needs (CSHCN) in nonimmigrant families, CSHCN in immigrant families are more likely to be uninsured (10.4 vs. 4.8%), lack a usual source of care (5.9 vs. 1.9%), report a delay in medical care (13.0 vs. 8.1%), and report no visit to the doctor in the past year (6.8 vs. 2.6%). They are less likely to report an emergency room visit in the past year (30.0 vs. 44.0%), yet more likely to report fair or poor perceived health status (33.0 vs. 16.0%). Multivariate analyses suggested that the bivariate findings for children with SHCN in immigrant families largely reflected differences in family socioeconomic status, parent's language, parental education, ethnicity, and children's insurance status. Limited resources, non-English language, and limited health-care use are some of the barriers to staying healthy for CSHCN in immigrant families. Public policies that improve access to existing insurance programs and provide culturally and linguistically appropriate care will likely decrease health and health care disparities for this population.

  View details for DOI 10.1007/s10995-009-0487-9

  View details for Web of Science ID 000279477400010

  View details for PubMedID 19554437

• Variation in Specialty Care Hospitalization for Children With Chronic Conditions in California PEDIATRICS Chamberlain, L. J., Chan, J., Mahlow, P., Huffman, L. C., Chan, K., Wise, P. H. 2010; 125 (6): 1190-1199

  Abstract

  Despite the documented utility of regionalized systems of pediatric specialty care, little is known about the actual use of such systems in total populations of chronically ill children. The objective of this study was to evaluate variations and trends in regional patterns of specialty care hospitalization for children with chronic illness in California.Using California's Office of Statewide Health Planning and Development unmasked discharge data set between 1999 and 2007, we performed a retrospective, total-population analysis of variations in specialty care hospitalization for children with chronic illness in California. The main outcome measure was the use of pediatric specialty care centers for hospitalization of children with a chronic condition in California.Analysis of 2 170 102 pediatric discharges revealed that 41% had a chronic condition, and 44% of these were discharged from specialty care centers. Specialty care hospitalization varied by county and type of condition. Multivariate analyses associated increased specialty care center use with public insurance and high pediatric specialty care bed supply. Decreased use of regionalized care was seen for adolescent patients, black, non-Hispanic children, and children who resided in zip codes of low income or were located farther from a regional center of care.Significant variation exists in specialty care hospitalization among chronically ill children in California. These findings suggest a need for greater scrutiny of clinical practices and child health policies that shape patterns of hospitalization of children with serious chronic disease.

  View details for DOI 10.1542/peds.2009-1109

  View details for PubMedID 20439593

• Impact of Managed Care on Publicly Insured Children with Special Health Care Needs ACADEMIC PEDIATRICS Huffman, L. C., Brat, G. A., Chamberlain, L. J., Wise, P. H. 2010; 10 (1): 48-55

  Abstract

  The aim of this review was to evaluate the impact of managed care on publicly insured children with special health care needs (CSHCN).We conducted a review of the extant literature. Using a formal computerized search, with search terms reflecting 7 specific outcome categories, we summarized study findings and study quality.We identified 13 peer-reviewed articles that evaluated the impact of Medicaid and State Children's Health Insurance program (SCHIP) Managed Care (MSMC) on health services delivery to populations of CSHCN, with all studies observational in design. Considered in total, the available scientific evidence is varied. Findings concerning care access demonstrate a positive effect of MSMC; findings concerning care utilization were mixed. Little information was identified concerning health care quality, satisfaction, costs, or health status, whereas no study yielded evidence on family impact.The available studies suggest that the evaluated record of MSMC for CSHCN has been mixed, with considerable heterogeneity in the definition of CSHCN, program design, and measured outcomes. These findings suggest caution should be exercised in implementing MSMC for CSHCN and that greater emphasis on health outcomes and cost evaluations is warranted.

  View details for PubMedID 20129481

• Disparities in Trauma Center Access Despite Increasing Utilization: Data From California, 1999 to 2006 JOURNAL OF TRAUMA-INJURY INFECTION AND CRITICAL CARE Hsia, R. Y., Wang, E., Torres, H., Saynina, O., Wise, P. H. 2010; 68 (1): 217-224

  Abstract

  Although efforts have been made to address disparities in access to trauma care in the past decade, there is little evidence to show if utilization has changed. We use patient-level data to describe the changes in utilization of trauma centers (TCs) in an 8-year period in California.We analyzed all statewide trauma admissions (n = 752,706) using the California Office of Statewide Health Planning and Discharge Patient Discharge Database from the period of 1999 to 2006, and determined the trends in admissions and place of care.The proportion of severe injuries admitted increased by 3.6% (p < 0.05), with a concomitant rise in the proportion of patients with trauma to TCs, from 39.3% (95% CI: 39.0%-39.7%) to 49.7% (49.4%-50.0%). Within the severely injured with injury severity scores (ISS) >15, 82.4% were treated in a TC if they resided in a county with a TC, compared with 30.8% of patients who did not live in a county with a TC. After adjustment, patients living greater than 50 miles away from a TC still had a likelihood ratio of 0.11 (p < 0.0001) of receiving care in a TC compared with those less than 10 miles away. Similarly, even severely injured patients not living in a county with a TC had a likelihood ratio of 0.35 (p < 0.0001) of being admitted to a TC compared with those residing in counties with TCs.Admissions to TCs for all categories of injury severity are increasing. There remains, however, a large disparity in TC care depending on geographical distance and availability of a TC within county.

  View details for DOI 10.1097/TA.0b013e3181a0e66d

  View details for Web of Science ID 000273585800043

  View details for PubMedID 19901854

• Confronting social disparities in child health: a critical appraisal of life-course science and research. Pediatrics Wise, P. H. 2009; 124: S203-11

  Abstract

  The utility of the life-course framework to address disparities in child health is based on its ability to integrate the science of child development with the requirements of effective and just public policy. I argue that the life-course framework is best assessed in a historical context and through 4 essential observations. First, early genetic and environmental interactions are complex and influence outcomes in different settings in very different ways. Second, these early-life interactions are themselves subject to considerable later influences and, therefore, may not be highly predictive of later outcomes. Third, the etiologic nature or timing of early-life interactions does not, per se, determine if their life-course effects are amenable to later interventions. Fourth, a highly deterministic view of early-life interactions is not supported by the science and can generate counterproductive approaches to research and policy development. Finally, an alternative approach is proposed on the basis of a "human-capacity" model of the life course that connects the search for underlying basic mechanisms with a policy-based examination of the comparative effectiveness of influences at different developmental stages. This approach suggests an expanded research and policy agenda that might be more capable of generating urgently needed strategies for reducing disparities in child health. Such an approach could ultimately define more comprehensively the power and limits of life-course effects in shaping the social distribution of health outcomes in the real world.

  View details for DOI 10.1542/peds.2009-1100H

  View details for PubMedID 19861471

• Children of the Recession ARCHIVES OF PEDIATRICS & ADOLESCENT MEDICINE Wise, P. H. 2009; 163 (11): 1063-1064

  View details for Web of Science ID 000271427700014

  View details for PubMedID 19884599

• Quality Improvement Strategies for Children With Asthma A Systematic Review ARCHIVES OF PEDIATRICS & ADOLESCENT MEDICINE Bravata, D. M., Gienger, A. L., Holty, J. C., Sundaram, V., Khazeni, N., Wise, P. H., McDonald, K. M., Owens, D. K. 2009; 163 (6): 572-581

  Abstract

  To evaluate the evidence that quality improvement (QI) strategies can improve the processes and outcomes of outpatient pediatric asthma care.Cochrane Effective Practice and Organisation of Care Group database (January 1966 to April 2006), MEDLINE (January 1966 to April 2006), Cochrane Consumers and Communication Group database (January 1966 to May 2006), and bibliographies of retrieved articles.Randomized controlled trials, controlled before-after trials, or interrupted time series trials of English-language QI evaluations.Must have included 1 or more QI strategies for the outpatient management of children with asthma.Clinical status (eg, spirometric measures); functional status (eg, days lost from school); and health services use (eg, hospital admissions).Seventy-nine studies met inclusion criteria: 69 included at least some component of patient education, self-monitoring, or self-management; 13 included some component of organizational change; and 7 included provider education. Self-management interventions increased symptom-free days by approximately 10 days/y (P = .02) and reduced school absenteeism by about 0.1 day/mo (P = .03). Interventions of provider education and those that incorporated organizational changes were likely to report improvements in medication use. Quality improvement interventions that provided multiple educational sessions, had longer durations, and used combinations of instructional modalities were more likely to result in improvements for patients than interventions lacking these characteristics.A variety of QI interventions improve the outcomes and processes of care for children with asthma. Use of similar outcome measures and thorough descriptions of interventions would advance the study of QI for pediatric asthma care.

  View details for Web of Science ID 000266566700011

  View details for PubMedID 19487615

• Quality Improvement Strategies for Children With Asthma A Systematic Review ARCHIVES OF PEDIATRICS & ADOLESCENT MEDICINE Bravata, D. M., Gienger, A. L., Holty, J. C., Sundaram, V., Khazeni, N., Wise, P. H., McDonald, K. M., Owens, D. K. 2009; 163 (6): E1-E5

  View details for Web of Science ID 000266566700016

• Competition among herbivores of Solanum carolinense as a constraint on the evolution of host-plant resistance EVOLUTIONARY ECOLOGY Wise, M. J. 2009; 23 (3): 347-361

  View details for DOI 10.1007/s10682-007-9230-4

  View details for Web of Science ID 000265788600002

• The Effect of Medicaid Managed Care on Prenatal Care: The Case of Puerto Rico MATERNAL AND CHILD HEALTH JOURNAL Marin, H. A., Ramirez, R., Wise, P. H., Pena, M., Sanchez, Y., Torres, R. 2009; 13 (2): 187-197

  Abstract

  From 1994 to the year 2000 the government of Puerto Rico implemented a health care reform which included the mandatory enrollment of the entire Medicaid eligible population under Medicaid managed care (MMC) plans. This study assessed the effect of MMC on the use, initiation, utilization, and adequacy of prenatal care services over the reform period.Using the vital records of all infants born alive in Puerto Rico from the year 1995-2000, a series of bivariate and multivariate analyses were conducted to assess the effect of insurance status (traditional Medicaid, MMC, private insurance and uninsured) on prenatal care utilization patterns. In order to assess the potential influence of selection bias in generating the health insurance assignments, propensity scores (PS) were estimated and entered into the multivariate regressions.MMC had a generally positive effect on the frequency and adequacy of prenatal care when compared with the experience of women covered by traditional Medicaid. However, the PS analyses suggested that self-selection may have generated part of the observed beneficial effects. Also, MMC reduced but did not eliminate the gap in the amount and adequacy of prenatal care received by pregnant women covered by Medicaid when compared to their counterparts covered by private insurance.The Puerto Rico Health Reform to implement MMC for pregnant women was associated with a general improvement in prenatal care utilization. However, continued progress will be necessary for women covered by Medicaid to reach prenatal care utilization levels experienced by privately insured women.

  View details for DOI 10.1007/s10995-008-0345-1

  View details for Web of Science ID 000263081300004

  View details for PubMedID 18484174

• The "etiome": identification and clustering of human disease etiological factors 1st Summit on Translational Bioinformatics Liu, Y. I., Wise, P. H., Butte, A. J. BIOMED CENTRAL LTD. 2009

  Abstract

  Both genetic and environmental factors contribute to human diseases. Most common diseases are influenced by a large number of genetic and environmental factors, most of which individually have only a modest effect on the disease. Though genetic contributions are relatively well characterized for some monogenetic diseases, there has been no effort at curating the extensive list of environmental etiological factors.From a comprehensive search of the MeSH annotation of MEDLINE articles, we identified 3,342 environmental etiological factors associated with 3,159 diseases. We also identified 1,100 genes associated with 1,034 complex diseases from the NIH Genetic Association Database (GAD), a database of genetic association studies. 863 diseases have both genetic and environmental etiological factors available. Integrating genetic and environmental factors results in the "etiome", which we define as the comprehensive compendium of disease etiology. Clustering of environmental factors may alert clinicians of the risks of added exposures, or synergy in interventions to alter these factors. Clustering of both genetic and environmental etiological factors puts genes in the context of environment in a quantitative manner.In this paper, we obtained a comprehensive list of associations between disease and environmental factors using MeSH annotation of MEDLINE articles. It serves as a summary of current knowledge between etiological factors and diseases. By combining the environmental etiological factors and genetic factors from GAD, we computed the "etiome" profile for 863 diseases. Comparing diseases across these profiles may have utility for clinical medicine, basic science research, and population-based science.

  View details for PubMedID 19208189

• The Rebirth of Pediatrics PEDIATRICS Wise, P. H. 2009; 123 (1): 413-416

  View details for DOI 10.1542/peds.2008-3254

  View details for Web of Science ID 000262046400060

  View details for PubMedID 19117909

• Variability in Pediatric Utilization of Trauma Facilities in California: 1999 to 2005 ANNALS OF EMERGENCY MEDICINE Wang, N. E., Saynina, O., Kuntz-Duriseti, K., Mahlow, P., Wise, P. H. 2008; 52 (6): 607-615

  Abstract

  We identify geographic, system, and socioeconomic differences between injured children cared for within and outside of state-designated trauma centers.This was a nonconcurrent observational study of a population-based sample from the California Office of Statewide Health Planning and Development Public Patient Discharge Database 1999 to 2005. Patients were 1 to 14 years of age, with International Classification of Diseases, Ninth Revision (ICD-9) diagnostic codes indicative of trauma. Injury Severity Scores were calculated from ICD-9 codes and categorized into severity categories. Outcomes were hospitalization in a trauma or nontrauma center.Children with severe injury who resided 0 to 10, 11 to 25, 26 to 50, and more than 50 miles from a trauma center were hospitalized in these centers at rates of 80.0%, 71.2%, 51.4%, and 28.5%, respectively. Children with severe injury who were living in a county with a trauma center were hospitalized in these centers at rates of 78.8%, whereas children living in a county without a trauma center were hospitalized in trauma centers at rates of 39.0%. Children with severe injury and public, private non-health maintenance organization (HMO), and HMO insurance were hospitalized in trauma centers at rates of 77.7%, 68.0%, and 55.4%, respectively. Age, injury severity, insurance type, residence in a county with a trauma center, and proximity to a trauma center were identified as predictors of trauma center utilization by logistic regression.We demonstrate considerable variation in the utilization pattern of trauma specialty care for children with moderate and severe injuries. Children with HMO and private insurance are cared for less often in trauma centers than those with public insurance, even after adjustment for other variables. Increased distance to a trauma center, as well as lack of trauma center within a county, also decreases trauma center utilization. These results suggest that assessing trauma center utilization patterns in total populations of children may identify opportunities for improved referral policies and practices as part of a larger effort to ensure high-quality trauma care for all children in need.

  View details for DOI 10.1016/j.annemergmed.2008.05.011

  View details for Web of Science ID 000261540200002

  View details for PubMedID 18562043

• TRANSFORMING PRECONCEPTIONAL, PRENATAL, AND INTERCONCEPTIONAL CARE INTO A COMPREHENSIVE COMMITMENT TO WOMEN'S HEALTH WOMENS HEALTH ISSUES Wise, P. H. 2008; 18 (6): S13-S18

  Abstract

  Preconception and interconception care respond to the growing body of evidence that many of the most important determinants of birth outcomes may exist before pregnancy occurs. In this sense, the strategy of extending prenatal care into the preconception and interconception periods marks a useful step in reforming the public health approach to improving birth outcomes. However, although helpful in underscoring the continuity of risk that can ultimately find expression in adverse birth outcomes, the concern is that without greater critical attention these relatively new care constructs have the potential to undermine rather than strengthen a comprehensive system of women's health care.

  View details for DOI 10.1016/j.whi.2008.07.014

  View details for Web of Science ID 000262091300004

  View details for PubMedID 18951817

• Flavor changing neutral currents in the Lee-Wick standard model PHYSICS LETTERS B Dulaney, T. R., Wise, M. B. 2008; 658 (5): 230-235

  View details for DOI 10.1016/j.physletb.2007.08.049

  View details for Web of Science ID 000252612500009

• Using linked data to assess patterns of Early Intervention (EI) referral among very low birth weight infants 10th Annual Maternal and Child Health Epidemiology Conference Barfield, W. D., Clements, K. M., Lee, K. G., Kotelchuck, M., Wilber, N., Wise, P. H. SPRINGER/PLENUM PUBLISHERS. 2008: 24–33

  Abstract

  Access to Early Intervention (EI) services may improve cognitive and behavioral outcomes in very low birth weight infants, but few states have population-based data to evaluate EI outreach efforts. We analyzed Massachusetts (MA) infants born weighing <1,200 g to identify maternal and birth characteristics that predicted EI referral and timing of referral.MA birth and hospital discharge records (Jan. 1998-Sept. 2000) were linked to EI referral records (Jan. 1998-Sept. 2003) via probabilistic and deterministic methods (88% linkage). Timing of EI referral among infants weighing <1,200 g was examined by infant and maternal characteristics using categorical (0-12 months, 12-36 months, or no referral) time comparisons in the crude analysis. Survival functions calculating median time to referral, and adjusted hazard ratios (HR) with 95% confidence intervals (CI) were calculated for continuous time comparisons of EI referral from birth to 36 months.Of 1,233 infants weighing <1,200 g, 93.2% were referred to EI. After risk adjustment, referral was more likely among multiple-birth infants (HR = 1.17, 95%CI 1.06-1.30) and less likely among infants <28 weeks (HR = 0.70; 95%CI 0.64-0.77) or with low Apgar scores (<5 at 5 min; HR = 0.75; 95%CI 0.62-0.92). EI referrals were lower for infants of black non-Hispanic mothers, and mothers without private insurance (HR = 0.85; 95%CI 0.74-0.98 and HR = 0.77; 95%CI 0.68-0.86, respectively).In MA, most infants born <1,200 g are referred to EI, but disparities exist. Analysis of linked population-based health and developmental services can inform programs in order to reduce disparities and improve access for all high-risk infants.

  View details for DOI 10.1007/s10995-007-0227-y

  View details for Web of Science ID 000251867600003

  View details for PubMedID 17562149

• Herbivory as an agent of natural selection for floral-sex ratio in horsenettle (Solanum carolinense) EVOLUTIONARY ECOLOGY RESEARCH Wise, M. J., Cummins, J. J. 2007; 9 (8): 1319-1328

  View details for Web of Science ID 000252652600007

• The future pediatrician: The challenge of chronic illness JOURNAL OF PEDIATRICS Wise, P. H. 2007; 151 (5): S6-S10

  Abstract

  To relate the changing epidemiology of childhood to current patterns of pediatric practice in the United States, a critical literature review and selected analyses of national datasets, including the National Health Interview Survey, the National Hospital Discharge Survey, and National Vital Statistics System, were conducted. Trends over the past several decades suggest that the incidence of serious acute illness in children has fallen while the prevalence of chronic disease has risen. These trends have resulted in a growing concentration of serious childhood morbidity and mortality into chronic disorders. Current pediatric practice structures appear to be poorly suited to meet the growing demands of chronic disease in children and likely will require major reform in organization, financing, and training.

  View details for DOI 10.1016/Jpeds.2007.08.013

  View details for Web of Science ID 000250915000003

  View details for PubMedID 17950322

• The relationship of immigrant status with access, utilization, and health status for children with asthma AMBULATORY PEDIATRICS Javier, J. R., Wise, P. H., Mendoza, F. S. 2007; 7 (6): 421-430

  Abstract

  Despite their high levels of poverty and less access to health care, children in immigrant families have better than expected health outcomes compared with children in nonimmigrant families. However, this observation has not been confirmed in children with chronic illness. The objective of this study was to determine whether children with asthma in immigrant families have better than expected health status than children with asthma in nonimmigrant families.Data from the 2001 and 2003 California Health Interview Survey (CHIS) were used to identify 2600 children, aged 1 to 11, with physician-diagnosed asthma. Bivariate analyses and logistic regression were performed to examine health care access, utilization, and health status measures by our primary independent variable, immigrant family status.Compared with children with asthma in nonimmigrant families, children with asthma in immigrant families are more likely to lack a usual source of care (2.6% vs 1.0%; P < .05), report a delay in medical care (8.9% vs 5.2%; P < .01), and report no visit to the doctor in the past year (7.0% vs 3.8%; P < .05). They are less likely to report asthma symptoms (60.8% vs 74.4%; P < .01) and an emergency room visit in the past year (14.1% vs 21.1%; P < .01), yet more likely to report fair or poor perceived health status (25.0% vs 10.5%; P < .01). Multivariate models revealed that the relationship of immigrant status with health measures was complex. These models suggested that lack of insurance and poverty was associated with reduced access and utilization. Children in immigrant families were less likely to visit the emergency room for asthma in the past year (odds ratio 0.58, confidence interval, 0.36-0.93). Poverty was associated with having a limitation in function and fair or poor perceived health, whereas non-English interview language was associated with less limitation in function but greater levels of fair or poor perceived health.Clinicians should be aware of important barriers to care that may exist for immigrant families who are poor, uninsured, and non-English speakers. Reduced health care access and utilization by children with asthma in immigrant families requires policy attention. Further research should examine barriers to care as well as parental perceptions of health for children with asthma in immigrant families.

  View details for PubMedID 17996835

• Inhalational, gastrointestinal, and cutaneous anthrax in children ARCHIVES OF PEDIATRICS & ADOLESCENT MEDICINE Bravata, D. M., Holty, J. C., Wang, E., Lewis, R., Wise, P. H., McDonald, K. M., Owens, D. K. 2007; 161 (9): 896-905

  Abstract

  To systematically review all published case reports of children with anthrax to evaluate the predictors of disease progression and mortality.Fourteen selected journal indexes (1900-1966), MEDLINE (1966-2005), and the bibliographies of all retrieved articles.Case reports (any language) of anthrax in persons younger than 18 years published between January 1, 1900, and December 31, 2005. Main Exposures Cases with symptoms and culture or Gram stain or autopsy evidence of anthrax infection.Disease progression, treatment responses, and mortality.Of 2499 potentially relevant articles, 73 case reports of pediatric anthrax (5 inhalational cases, 22 gastrointestinal cases, 37 cutaneous cases, 6 cases of primary meningoencephalitis, and 3 atypical cases) met the inclusion criteria. Only 10% of the patients were younger than 2 years, and 24% were girls. Of the few children with inhalational anthrax, none had nonheadache neurologic symptoms, a key finding that distinguishes adult inhalational anthrax from more common illnesses, such as influenza. Overall, observed mortality was 60% (3 of 5) for inhalational anthrax, 65% (13 of 20) for gastrointestinal anthrax, 14% (5 of 37) for cutaneous anthrax, and 100% (6 of 6) for primary meningoencephalitis. Nineteen of the 30 children (63%) who received penicillin-based antibiotics survived, and 9 of the 11 children (82%) who received anthrax antiserum survived.The clinical presentation of children with anthrax is varied. The mortality rate is high in children with inhalational anthrax, gastrointestinal anthrax, and anthrax meningoencephalitis. Rapid diagnosis and effective treatment of anthrax in children requires recognition of the broad spectrum of clinical presentations of pediatric anthrax.

  View details for PubMedID 17768291

• Resolving the formation of protogalaxies. I. virialization ASTROPHYSICAL JOURNAL Wise, J. H., Abel, T. 2007; 665 (2): 899-910

  View details for Web of Science ID 000248676200002

• The UNICEF report on child well-being AMBULATORY PEDIATRICS Wise, P. H., Blair, M. E. 2007; 7 (4): 265-266

  View details for Web of Science ID 000248501100001

  View details for PubMedID 17660094

• Families' health-related social problems and missed referral opportunities PEDIATRICS Fleegler, E. W., Lieu, T. A., Wise, P. H., Muret-Wagstaff, S. 2007; 119 (6): E1332-E1341

  Abstract

  The objectives of this study were to characterize (1) families' cumulative burden of health-related social problems regarding access to health care, housing, food security, income security, and intimate partner violence; (2) families' experiences regarding screening and referral for social problems; and (3) parental acceptability of screening and referral.We surveyed 205 parents of children who were 0 to 6 years of age and attended 2 urban pediatric clinics for a well-child visit using a self-administered, computer-based questionnaire. The questionnaire included previously validated questions about health-related social problems and new questions about screening and referral in the past 12 months.A total of 205 (79%) of 260 eligible families participated. Eighty-two percent of families reported > or = 1 health-related social problem; 54% experienced problems in > or = 2 social domains. Families experienced similar types and frequencies of problems despite demographic differences between clinics. One third of families reported no screening in any domain in the previous 12 months. Of 205 families, 143 (70%) identified at least 1 need for a referral; 101 (49%) expressed > or = 1 unmet referral need. Of families who reported receiving referrals, 115 referrals were received by 79 families; of the referrals made, 63% (73 of 115) led to contact with the referral agency, and 82% (60 of 73) of the referral agencies were considered helpful. A computer-based system in a pediatrician's office for future screening and referral for health-related social problems was deemed acceptable by 92% of parents.Urban children and families reported a significant burden of health-related social problems yet infrequent pediatric screening or referral for these problems. Of families who reported receiving referrals, a majority contacted the recommended agencies and found them helpful. This study also demonstrates the feasibility of using a computer-based questionnaire to identify health-related social problems in a routine outpatient clinic setting.

  View details for DOI 10.1542/peds.2006-1505

  View details for Web of Science ID 000246948900078

  View details for PubMedID 17545363

• Effects of resource availability on tolerance of herbivory: A review and assessment of three opposing models AMERICAN NATURALIST Wise, M. J., Abrahamson, W. G. 2007; 169 (4): 443-454

  Abstract

  Although it is widely acknowledged that a plant's tolerance of herbivore damage depends on resource availability in the plant's environment, there is no consensus on whether higher resource levels lead to greater or to lower tolerance. The prevailing model, the compensatory continuum hypothesis (CCH), predicts that tolerance of herbivory should be greater in high-resource or low-competition conditions. The main rival hypothesis, the growth rate model (GRM), makes the opposite prediction: tolerance of herbivory should be greater in more stressful conditions. The tolerance predictions of a recently introduced model, the limiting resource model (LRM), are more flexible and depend on the type of resource and herbivore under consideration. We reviewed 48 studies (from 40 published articles) of plant tolerance of leaf damage in conditions differing in levels of light, inorganic nutrients, water stress, or competition. The results of 31%, 48%, and 95% of the studies were consistent with the predictions of the CCH, GRM, and LRM, respectively. Thus, by considering which resource is primarily affected by herbivory and which resource is limiting a plant's fitness, the LRM offers a substantial advance in predicting how tolerance will be affected by environmental differences in resource availability.

  View details for Web of Science ID 000245028000005

  View details for PubMedID 17253430

• Modeling the impacts of climate policy on the deployment of carbon dioxide capture and geologic storage across electric power regions in the United States 8th International Conference on Greenhouse Gas Control Technologies Wise, M., Dooley, J., Dahowski, R., Dauidson, C. ELSEVIER SCI LTD. 2007: 261–70

  View details for DOI 10.1016/S1750-5836(07)00017-5

  View details for Web of Science ID 000256440700014

• Trauma center utilization for children in California 1998-2004: Trends and areas for further analysis ACADEMIC EMERGENCY MEDICINE Wang, N. E., Chan, J., Mahlow, P., Wise, P. H. 2007; 14 (4): 309-315

  Abstract

  While it is known that trauma systems improve the outcome of injury in children, there is a paucity of information regarding trauma system function amid changes in policies and health care financing that affect emergency medical systems for children.To describe the trends in the proportion of pediatric trauma patients acutely hospitalized in trauma-designated versus non-trauma-designated hospitals.This was a retrospective observational study of a population-based cohort obtained by secondary analysis of a publicly available data set: the California Office of Statewide Health Planning and Development Patient Discharge Database from 1998 to 2004. Patients were included in the analysis if they were 0-19 years old, had International Classification of Disease, Ninth Revision (ICD-9) diagnostic codes and E-codes indicative of trauma, had an unscheduled admission, and were discharged from a general acute care hospital (N = 111,566). Proportions of patients hospitalized in trauma-designated hospitals versus non-trauma-designated hospitals were calculated for Injury Severity Score and death. Injury Severity Scores were calculated from ICD-9 codes. Primary outcomes were hospitalization in a trauma center and death two or more days after hospitalization.Over the study period, the proportion of children aged 0-14 years with acute trauma requiring hospitalization and who were cared for in trauma-designated hospitals increased from 55% (95% confidence interval [CI] = 54% to 56%) in 1998 to 66% (95% CI = 65% to 67%) in 2004 (p < 0.01). For children aged 15-19 years, the proportion increased from 55% (95% CI = 54% to 57%) in 1998 to 74% (95% CI = 72% to 75%) in 2004 (p < 0.0001). When trauma discharges were stratified by injury severity, the proportion of children with severe injury who were hospitalized in trauma-designated hospitals increased from 69% (95% CI = 66% to 72%) in 1998 to 84% (95% CI = 82% to 87%) in 2004, a rate higher than in children with moderate injury (59% [95% CI = 58% to 61%] in 1998 and 75% [95% CI = 74% to 76%] in 2004) and mild injury (51% [95% CI = 50% to 52%] in 1998 and 63% [95% CI = 62% to 64%] in 2004) (p < 0.0001 for each injury severity category and both age groups). Of the hospitalized children who died two or more days after injury (n = 502), 18.1% died in non-trauma-designated hospitals (p < 0.002 for children aged 0-14 years; p = 0.346 for children aged 15-19 years).An increasing majority of children with trauma were cared for in trauma-designated hospitals over the study period. However, 23% of children with severe injuries, and 18.1% of pediatric deaths more than two days after injury, were cared for in non-trauma-designated hospitals. These findings demonstrate an important opportunity for improvement. If we can characterize those children who do not access the trauma system despite severe injury or death, we will be able to design clinical protocols and implement policies that ensure access to appropriate regional trauma care for all children in need.

  View details for DOI 10.1197/j.aem.2006.11.012

  View details for Web of Science ID 000245579300003

  View details for PubMedID 17296799

• Crossing the Medicaid-private insurance divide: The case of EPSDT HEALTH AFFAIRS Rosenbaum, S., Wise, P. H. 2007; 26 (2): 382-393

  Abstract

  Contained in the Deficit Reduction Act of 2005 is a provision that could greatly affect Medicaid's signature child health coverage standard, embodied since 1967 in the Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) benefit. Whether the core child health and developmental principles that have been EPSDT's touchstone for four decades will continue to guide Medicaid depends on whether and how these principles will be incorporated into states' coverage reforms.

  View details for DOI 10.1377/hlthaff.26.2.382

  View details for Web of Science ID 000244763500009

  View details for PubMedID 17339664

• Radio properties of cavities in the ICM: Imprints of AGN activity MPA/ESO/MPE/USM Joint Astronomy Conference Birzan, L., McNamara, B. R., Carilli, C. L., Nulsen, P. E., Wise, M. W. SPRINGER-VERLAG BERLIN. 2007: 115–120

  View details for Web of Science ID 000251794500022

• The XMM-Newton view of MS0735+7421: the most energetic AGN outburst in a galaxy cluster MPA/ESO/MPE/USM Joint Astronomy Conference Gitti, M., McNamara, B. R., Nulsen, P. E., Wise, M. W. SPRINGER-VERLAG BERLIN. 2007: 90–94

  View details for Web of Science ID 000251794500017

• Pediatric anthrax: implications for bioterrorism preparedness. Evidence report/technology assessment Bravata, D. M., Wang, E., Holty, J., Lewis, R., Wise, P. H., Nayak, S., Liu, H., McDonald, K. M., Owens, D. K. 2006: 1-48

  Abstract

  To systematically review the literature about children with anthrax to describe their clinical course, treatment responses, and the predictors of disease progression and mortality.MEDLINE (1966-2005), 14 selected journal indexes (1900-1966) and bibliographies of all retrieved articles.We sought case reports of pediatric anthrax published between 1900 and 2005 meeting predefined criteria. We abstracted three types of data from the English-language reports: (1) Patient information (e.g., age, gender, nationality), (2) symptom and disease progression information (e.g., whether the patient developed meningitis); (3) treatment information (e.g., treatments received, year of treatment). We compared the clinical symptoms and disease progression variables for the pediatric cases with data on adult anthrax cases reviewed previously.We identified 246 titles of potentially relevant articles from our MEDLINE(R) search and 2253 additional references from our manual search of the bibliographies of retrieved articles and the indexes of the 14 selected journals. We included 62 case reports of pediatric anthrax including two inhalational cases, 20 gastrointestinal cases, 37 cutaneous cases, and three atypical cases. Anthrax is a relatively common and historically well-recognized disease and yet rarely reported among children, suggesting the possibility of significant under-diagnosis, underreporting, and/or publication bias. Children with anthrax present with a wide range of clinical signs and symptoms, which differ somewhat from the presenting features of adults with anthrax. Like adults, children with gastrointestinal anthrax have two distinct clinical presentations: Upper tract disease characterized by dysphagia and oropharyngeal findings and lower tract disease characterized by fever, abdominal pain, and nausea and vomiting. Additionally, children with inhalational disease may have "atypical" presentations including primary meningoencephalitis. Children with inhalational anthrax have abnormal chest roentgenograms; however, children with other forms of anthrax usually have normal roentgenograms. Nineteen of the 30 children (63%) who received penicillin-based antibiotics survived; whereas nine of 11 children (82%) who received anthrax antiserum survived.There is a broad spectrum of clinical signs and symptoms associated with pediatric anthrax. The limited data available regarding disease progression and treatment responses for children infected with anthrax suggest some differences from adult populations. Preparedness planning efforts should specifically address the needs of pediatric victims.

  View details for PubMedID 17764208

• Intergenerational health disparities: Socioeconomic status, women's health conditions, and child behavior problems PUBLIC HEALTH REPORTS Kahn, R. S., Wilson, K. X., Wise, P. H. 2005; 120 (4): 399-408

  Abstract

  Relatively little is known about the intergenerational mechanisms that lead to social disparities in child health. We examined whether the association between low socioeconomic status (SES) and child behavior problems is mediated by maternal health conditions and behavior.Prospective cohort data (1979-1998) on 2,677 children and their mothers were obtained from the National Longitudinal Survey of Youth. SES, the Child Behavior Problems Index (BPI), and maternal smoking, depressive symptoms, and alcohol use before, during, and after pregnancy were examined.Lower income and lower maternal education were associated with increased child BPI scores. Adjustment for maternal smoking, depressive symptoms, and alcohol use attenuated the associations between SES and child BPI by 26% to 49%. These maternal health conditions often occurred together, persisted over time, and were associated with the mother's own childhood SES and pre-pregnancy health.Social disparities in women's health conditions may help shape the likelihood of behavior problems in the subsequent generation. Improved public health programs and services for disadvantaged women across the lifecourse may not only address their own urgent health needs, but reduce social disparities in the health and well-being of their children.

  View details for Web of Science ID 000230046800007

  View details for PubMedID 16025720

  View details for PubMedCentralID PMC1497739

• The "Lost boys of Sudan" - Functional and behavioral health of unaccompanied refugee minors resettled in the United States Annual Meeting of the Pediatric-Academic-Societies/Society-for-Pediatric-Research Geltman, P. L., Grant-Knight, W., Meht, S. D., Lloyd-Travaglini, C., Lustig, S., Landgraf, M. M., Wise, P. H. AMER MEDICAL ASSOC. 2005: 585–91

  Abstract

  To assess the functional and behavioral health of unaccompanied Sudanese refugee minors approximately 1 year after resettlement in the United States.A descriptive survey.Local refugee foster care programs affiliated with the US Unaccompanied Refugee Minors Program.A total of 304 Sudanese refugee minors enrolled in the US Unaccompanied Refugee Minors Program.Health outcomes were assessed using the Harvard Trauma Questionnaire and the Child Health Questionnaire. Outcomes included the diagnosis of posttraumatic stress disorder and scores on all Child Health Questionnaire subscales and global single-item assessments.Twenty percent of the minors had a diagnosis of posttraumatic stress disorder and were more likely to have lower (worse) scores on all the Child Health Questionnaire subscales. Low functional and behavioral health scores were seen mainly in functioning in the home and in subjective health ratings. Social isolation and history of personal injury were associated with posttraumatic stress disorder.Unaccompanied Sudanese minors have done well in general. The minors function well in school and in activities; however, behavioral and emotional problems manifest in their home lives and emotional states. The subset of children with traumatic symptoms had characteristics that may distinguish them from their peers and that may inform future resettlement services for unaccompanied minors in the United States.

  View details for Web of Science ID 000229448300013

  View details for PubMedID 15939860

• Hepatitis A-related mortality in California, 1989-2000: Analysis of multiple cause-coded death data AMERICAN JOURNAL OF PUBLIC HEALTH Wise, M. E., Sorvillo, F. 2005; 95 (5): 900-905

  Abstract

  We estimated the hepatitis A (HA) mortality rate in California, assessed demographic differences in HA-related mortality, and examined comorbidities listed on death certificates in order to provide information for health policy and planning related to HA vaccination.We identified HA-related deaths in California from 1989 to 2000 with multiple-cause-of-death files and calculated mortality rates and rate ratios.We identified 402 HA-related deaths between 1989 and 2000; the annual age-adjusted HA-related mortality rate was 1.20 deaths per 1 million persons. Older individuals, men, Latinos, and American Indians/Alaska Natives had elevated mortality rates. Liver conditions and non-A viral hepatitis infections were more common among HA-related deaths than among all other deaths.Current immunization practices should be reevaluated and the expansion of current vaccination guidelines for groups that have elevated HA-related mortality rates should be considered.

  View details for DOI 10.2105/AJPH.2003.035485

  View details for Web of Science ID 000228826000029

  View details for PubMedID 15855472

• Creating an analytic voice in the policy storm AMBULATORY PEDIATRICS Wise, P. H., Chamberlain, L. 2005; 5 (1): 45-46

  View details for Web of Science ID 000226460500004

  View details for PubMedID 15656704

• The transformation of child health in the United States Conference on the Future of Pediatric Training Wise, P. H. PROJECT HOPE. 2004: 9–25

  Abstract

  Social trends and medical progress have fueled major changes in the epidemiology of child health in the United States. Injuries remain a major contributor to childhood illness and death. However, among noninjury causes, chronic illness now accounts for the majority of children's hospital days and deaths. Although mortality rates for all children have fallen dramatically, social disparities persist. Approximately half of all excess deaths among African American children occur during infancy, primarily from extremely premature births, and the remaining portion, primarily from homicide and serious chronic conditions. These challenges may require changes in today's child health practices and policies.

  View details for DOI 10.1377/hlthaff.23.5.9

  View details for Web of Science ID 000224027800002

  View details for PubMedID 15495347

• Low-income mothers' experience with poor health, hardship, work, and violence - Implications for policy VIOLENCE AGAINST WOMEN Romero, D., Chavkin, W., Wise, P. H., Smith, L. A. 2003; 9 (10): 1231-1244

  View details for DOI 10.1177/1077801203255862

  View details for Web of Science ID 000185208900005

• Framework as metaphor: the promise and peril of MCH life-course perspectives. Maternal and child health journal Wise, P. H. 2003; 7 (3): 151-156

  Abstract

  Life-course analytic frameworks expressly link the determinants of health and illness across the lifespan. Such frameworks could serve as a foundation for integrating child and adult health policies by emphasizing the potential that social and biologic processes early in life can find clinical expression as adult-onset disease. However, there are elements of these frameworks that can be misinterpreted in ways that obscure scientific processes and fragment rather than integrate health policies. First, casting early life influences as determining rather than merely influencing adult health obscures the complexity of social and biologic etiologies over a lifetime and diminishes the impact of events in adolescence and adult life. Second, oversimplifying the impact of early influences on adult disease tends to imply that such processes are particularly unamenable to clinical and public health interventions, a suggestion without an empirical basis and likely to undermine pleas for enhanced access to such interventions. Third, exaggerating early life events as being highly deterministic of adult illness in order to shift societal resources from the elderly towards children can generate unnecessary antagonisms between potentially allied constituencies. Together, these considerations suggest that the utility of life-course frameworks will depend upon cautious interpretation and an ongoing process of active refinement.

  View details for PubMedID 14509410

• The anatomy of a disparity in infant mortality ANNUAL REVIEW OF PUBLIC HEALTH Wise, P. H. 2003; 24: 341-362

  Abstract

  This article suggests that while disparities in infant mortality have been longstanding, the mechanisms of disparity creation are undergoing intense change. This dynamic character is explored by first developing an analytic model that examines the interaction between social factors and the public health and clinical capacity to intervene. Disparities in infant mortality are then broken down into their component parts and linked to specific arenas of intervention. Disparities in postneonatal mortality are being shaped by differential access to interventions designed to prevent infant death from congenital anomalies and the Sudden Infant Death Syndrome. Disparities in neonatal mortality are primarily determined by factors that influence the birthrate of extremely premature infants and access to specialized obstetrical and pediatric care. This analysis suggests that the epidemiology and social meaning of disparities in infant mortality are intensely dynamic and increasingly reflect the interaction between social forces and technical innovation.

  View details for DOI 10.1146/annurev.publhealth.24.100901.140816

  View details for Web of Science ID 000185094600018

  View details for PubMedID 12471271

• The State Children's Health Insurance Program - Effective but vulnerable ARCHIVES OF PEDIATRICS & ADOLESCENT MEDICINE Wise, P. H. 2002; 156 (12): 1175-1176

  View details for Web of Science ID 000179661400002

  View details for PubMedID 12444823

• The data are in: Health matters in welfare policy AMERICAN JOURNAL OF PUBLIC HEALTH Chavkin, W. 2002; 92 (9): 1392-1395

  View details for Web of Science ID 000177661900009

  View details for PubMedID 12197962

• Welfare to work? Impact of maternal health on employment AMERICAN JOURNAL OF PUBLIC HEALTH Romero, D., Chavkin, W., Wise, P. H., Smith, L. A., Wood, P. R. 2002; 92 (9): 1462-1468

  Abstract

  This study investigated whether health problems among poor mothers of chronically ill children affect their ability to obtain and maintain employment.Mothers of children with chronic illnesses were surveyed at clinical and welfare agency sites in San Antonio, Tex.There were distinct health differences according to mothers' TANF and employment status. Mothers without TANF experience reported better physical and mental health and less domestic violence and substance use than did those who had TANF experience. Those not currently working had higher rates of physical and mental health problems.Poor maternal health is associated with need for cash assistance and health insurance. Policymakers must recognize that social policies promoting employment will fail if they do not address the health needs of poor women and children.

  View details for Web of Science ID 000177661900021

  View details for PubMedID 12197974

• Relationships between welfare status, health insurance status, and health and medical care among children with asthma AMERICAN JOURNAL OF PUBLIC HEALTH Wood, P. R., Smith, L. A., Romero, D., Bradshaw, P., Wise, P. H., Chavkin, W. 2002; 92 (9): 1446-1452

  Abstract

  This study evaluated the relationships between health insurance and welfare status and the health and medical care of children with asthma.Parents of children with asthma aged 2 to 12 years were interviewed at 6 urban clinical sites and 2 welfare offices.Children whose families had applied for but were denied welfare had more asthma symptoms than did children whose families had had no contact with the welfare system. Poorer mental health in parents was associated with more asthma symptoms and higher rates of health care use in their children. Parents of uninsured and transiently insured children identified more barriers to health care than did parents whose children were insured.Children whose families have applied for welfare and children who are uninsured are at high risk medically and may require additional services to improve health outcomes.

  View details for Web of Science ID 000177661900018

  View details for PubMedID 12197971

• Employment barriers among welfare recipients and applicants with chronically ill children AMERICAN JOURNAL OF PUBLIC HEALTH Smith, L. A., Romero, D., Wood, P. R., Wampler, N. S., Chavkin, W., Wise, P. H. 2002; 92 (9): 1453-1457

  Abstract

  This study evaluated the association of chronic child illness with parental employment among individuals who have had contact with the welfare system.Parents of children with chronic illnesses were interviewed.Current and former welfare recipients and welfare applicants were more likely than those with no contact with the welfare system to report that their children's illnesses adversely affected their employment. Logistic regression analyses showed that current and former receipt of welfare, pending welfare application, and high rates of child health care use were predictors of unemployment.Welfare recipients and applicants with chronically ill children face substantial barriers to employment, including high child health care use rates and missed work. The welfare reform reauthorization scheduled to occur later in 2002 should address the implications of chronic child illness for parental employment.

  View details for Web of Science ID 000177661900019

  View details for PubMedID 12197972

• Chronic illness among poor children enrolled in the temporary assistance for needy families program AMERICAN JOURNAL OF PUBLIC HEALTH Wise, P. H., Wampler, N. S., Chavkin, W., Romero, D. 2002; 92 (9): 1458-1461

  Abstract

  This study assessed chronic child illness among recipients of Temporary Assistance for Needy Families (TANF) benefits and poor families not receiving benefits.Data from the 1998 National Health Interview Survey were used to examine chronic child illness, enrollment in TANF, health insurance status, and selected access indicators.One quarter of TANF-enrolled children had chronic illnesses. Unenrolled children were 3 times as likely as TANF-enrolled children to be uninsured. Among the chronically ill, 31.7% of unenrolled and 14.3% of enrolled children experienced gaps in insurance coverage that were associated with access barriers.Welfare policies should consider the effects of chronic illness and gaps in insurance coverage on the health of poor children.

  View details for Web of Science ID 000177661900020

  View details for PubMedID 12197973

• Women's health after pregnancy and child outcomes at age 3 years: A prospective cohort study AMERICAN JOURNAL OF PUBLIC HEALTH Kahn, R. S., Zuckerman, B., Bauchner, H., Homer, C. J., Wise, P. H. 2002; 92 (8): 1312-1318

  Abstract

  This study examined the persistence and comorbidity of women's physical and mental health conditions after pregnancy and the association of these conditions with child outcomes.A national cohort of women who recently gave birth were surveyed in 1988 and again in 1991. We examined longitudinal data on maternal poor physical health, depressive symptoms, and smoking, and maternal report of child outcomes (at age approximately 3 years).Women's poor physical health and smoking had strong, graded associations with children's physical health and behavior problems, whereas women's depressive symptoms were associated with children's delayed language and behavior problems.Substantial persistence and comorbidity of women's health conditions exist after pregnancy with adverse effects on early child outcomes. Child health professionals should support services and policies that promote women's health outside the context of pregnancy.

  View details for Web of Science ID 000177109800028

  View details for PubMedID 12144990

• Knowledge of welfare reform program provisions among families of children with chronic conditions AMERICAN JOURNAL OF PUBLIC HEALTH Smith, L. A., Wise, P. H., Wampler, N. S. 2002; 92 (2): 228-230

  Abstract

  This study examined the knowledge of and application for health-related welfare program provisions among beneficiaries with children who have chronic conditions.We administered a survey to 143 parents of children aged 3 to 16 years with asthma or sickle cell anemia in 2 clinical settings.Respondents indicated incomplete knowledge of work requirements (69.9%) and work exemptions (50.3%). Applications for work exemptions were rare, even among Supplemental Security Income recipients (30%).Welfare beneficiaries with children who have chronic conditions show limited knowledge and use of program provisions, placing them at risk for penalties or benefit termination.

  View details for Web of Science ID 000173558000021

  View details for PubMedID 11818296

• Maternal cigarette smoking, metabolic gene polymorphism, and infant birth weight JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION Wang, X. B., Zuckerman, B., Pearson, C., Kaufman, G., Chen, C. Z., Wang, G. Y., Niu, T. H., Wise, P. H., Bauchner, H., Xu, X. P. 2002; 287 (2): 195-202

  Abstract

  Little is known about genetic susceptibility to cigarette smoke in relation to adverse pregnancy outcomes.To investigate whether the association between maternal cigarette smoking and infant birth weight differs by polymorphisms of 2 maternal metabolic genes: CYP1A1 and GSTT1.Case-control study conducted in 1998-2000 among 741 mothers (174 ever smokers and 567 never smokers) who delivered singleton live births at Boston Medical Center. A total of 207 cases were preterm or low-birth-weight infants and 534 were non-low-birth-weight, full-term infants (control).Birth weight, gestation, fetal growth by smoking status and CYP1A1 MspI (AA vs Aa and aa, where Aa and aa were combined because of small numbers of aa and similar results), and GSTT1 (present vs absent) genotypes.Without consideration of genotype, continuous maternal smoking during pregnancy was associated with a mean reduction of 377 g (SE, 89 g) in birth weight (odds ratio [OR], 2.1; 95% confidence interval [CI], 1.2-3.7). When CYP1A1 genotype was considered, the estimated reduction in birth weight was 252 g (SE, 111 g) for the AA genotype group (n = 75; OR, 1.3; 95% CI, 0.6-2.6), but was 520 g (SE, 124 g) for the Aa/aa genotype group (n = 43 for Aa, n = 6 for aa; OR, 3.2; 95% CI, 1.6-6.4). When GSTT1 genotype was considered, the estimated reduction in birth weight was 285 g (SE, 99 g) (OR, 1.7; 95% CI, 0.9-3.2) and 642 g (SE, 154 g) (OR, 3.5; 95% CI, 1.5-8.3) for the present and absent genotype groups, respectively. When both CYP1A1 and GSTT1 genotypes were considered, the greatest reduction in birth weight was found among smoking mothers with the CYP1A1 Aa/aa and GSTT1 absent genotypes (-1285 g; SE, 234 g; P<.001). Among never smokers, genotype did not independently confer an adverse effect. A similar pattern emerged in analyses stratified by maternal ethnicity and in analyses for gestation.In our study, maternal CYP1A1 and GSTT1 genotypes modified the association between maternal cigarette smoking and infant birth weight, suggesting an interaction between metabolic genes and cigarette smoking.

  View details for Web of Science ID 000173114900021

  View details for PubMedID 11779261

• Welfare, women, and children: it's time for doctors to speak out. Journal of the American Medical Women's Association (1972) Chavkin, W., Wise, P. H., Romero, D. 2002; 57 (1): 3-?

  View details for PubMedID 11905487

• State welfare reform policies and maternal and child health services: a national study. Maternal and child health journal Romero, D., Chavkin, W., Wise, P. H., Hess, C. A., Vanlandeghem, K. 2001; 5 (3): 199-206

  Abstract

  Welfare reform (Personal Responsibility and Work Opportunity Reconciliation Act of 1996) resulted in dramatic policy changes, including health-related requirements and the administrative separation of cash assistance from Medicaid. We were interested in determining if changes in welfare and health policies had had an impact on state MCH services and programs.We conducted a survey in fall 1999 of state MCH Title V directors. Trained interviewers administered the telephone survey over a 3-month period. MCH directors from all 50 states, Washington, DC, and Puerto Rico participated (n = 52; response rate = 100%).Among the most noteworthy findings is that similar proportions of respondents reported that welfare policy changes had either helped (46%) or hindered (42%) the agency's work, with most of the positive impact attributed to increased funding. MCH data linkages with welfare and other social programs were low. Despite welfare reform's emphasis on work, limited services and exemptions were available for mothers with CSHCN. Almost no efforts have been undertaken to specifically address the needs of substance abusers in the context of new welfare policies.Few MCH agencies have developed programs to address the special needs of women receiving TANF who either have health problems themselves or have children with health problems. Recommendations including increased MCH and family planning funding and improved coordination between TANF and MCH to facilitate linkages and services are put forth in light of reauthorization of PRWORA.

  View details for PubMedID 11605725

• Molecular epidemiology of preterm delivery: methodology and challenges PAEDIATRIC AND PERINATAL EPIDEMIOLOGY Wang, X. B., Zuckerman, B., Kaufman, G., Wise, P., Hill, M., Niu, T. H., Ryan, L., Wu, D., Xu, X. P. 2001; 15: 63-77

  Abstract

  Preterm delivery (PTD) appears to be a complex trait determined by both genetic and environmental factors. Few studies have examined genetic influence on PTD. The overall goal of our study is to examine major candidate genes of PTD and to test gene-environment interactions. Our study includes 500 preterm trios, including 500 preterm babies and their parents and 500 maternal age-matched term controls. We will perform the transmission/disequilibrium test (TDT) on candidate genes thought to be important in each of the four biological pathways of PTD: (1) decidual chorioamionotic inflammation: interleukin 1 (IL-1), IL-6, and tumour necrosis factor (TNF); (2) maternal and fetal stress: corticotropin-releasing hormone (CRH); (3) uteroplacental vascular lesions: methylenetereahydrofolate reductase (MTHFR); and (4) susceptibility to environmental toxins: GSTM1, GSTT1, CYP1A1, CYP2D6, CYP2E1, NAT2, NQO1, ALDH2, and EPHX. We will also perform standard case-control analyses on the 500 preterm cases and 500 term controls to examine gene-environment interactions. The major environmental, nutritional and social factors as well as clinical variables known or suspected to be associated with PTD will be used to test for gene-environment interactions. This study integrates epidemiological and clinical data as well as genetic markers along major pathogenic pathways of PTD. The findings from this study should improve our understanding of genetic influences on PTD and gene-environment interactions.

  View details for Web of Science ID 000170483900008

  View details for PubMedID 11520401

• Generalized *-products, Wilson lines and the solution of the Seiberg-Witten equations JOURNAL OF HIGH ENERGY PHYSICS Mehen, T., Wise, M. B. 2000

  View details for Web of Science ID 000168161600008

• State income inequality, household income, and maternal mental and physical health: cross sectional national survey BRITISH MEDICAL JOURNAL Kahn, R. S., Wise, P. H., Kennedy, B. P., Kawachi, I. 2000; 321 (7272): 1311-1315

  Abstract

  To examine the association of state income inequality and individual household income with the mental and physical health of women with young children.Cross sectional study. Individual level data (outcomes, income, and other sociodemographic covariates) from a 1991 follow up survey of a birth cohort established in 1988. State level income inequality calculated from the income distribution of each state from 1990 US census.United States, 1991. Participants: Nationally representative stratified random sample of 8060 women who gave birth in 1988 and were successfully contacted (89%) in 1991.Depressive symptoms (Center for Epidemiologic Studies depression score >15) and self rated health19% of women reported depressive symptoms, and 7.5% reported fair or poor health. Compared with women in the highest fifth of distribution of household income, women in the lowest fifth were more likely to report depressive symptoms (33% v 9%, P<0.001) and fair or poor health (15% v 2%, P<0. 001). Compared with low income women in states with low income inequality, low income women in states with high income inequality had a higher risk of depressive symptoms (odds ratio 1.6, 95% confidence interval 1.0 to 2.6) and fair or poor health (1.8, 0.9 to 3.5).High income inequality confers an increased risk of poor mental and physical health, particularly among the poorest women. Both income inequality and household income are important for health in this population.

  View details for Web of Science ID 000165561600023

  View details for PubMedID 11090512

• Implications of welfare reform for child health: Emerging challenges for clinical practice and policy PEDIATRICS Smith, L. A., Wise, P. H., Chavkin, W., Romero, D., Zuckerman, B. 2000; 106 (5): 1117-1125

  View details for Web of Science ID 000165052300026

  View details for PubMedID 11061785

• State welfare reform policies and declines in health insurance AMERICAN JOURNAL OF PUBLIC HEALTH Chavkin, W., Romero, D., Wise, P. H. 2000; 90 (6): 900-908

  Abstract

  This study sought to determine whether there is a relationship between state policies on Temporary Assistance to Needy Families (TANF), declines in both TANF and Medicaid caseloads, and the rise in the number of uninsured.Extant data sources of state TANF policies, TANF and Medicaid participation, and uninsurance rates were analyzed, with the state as the unit of analysis. The independent variables included state TANF policies that directly address receipt of benefits or relate to health; dependent variables included changes in state TANF enrollment, Medicaid enrollment, and health insurance status since the enactment of the law.In the bivariate analysis, declines in Medicaid were associated with sanction for work noncompliance, lack of a child care guarantee, and strategies to deter TANF enrollment; this last factor was also associated with increased uninsurance. In the multivariate analysis, lack of a child care guarantee and deterrent strategies predicted TANF declines; deterrent strategies predicted Medicaid decline and uninsurance increases.This analysis suggests that policies deterring TANF enrollment may contribute to declines in Medicaid and increased uninsurance. To maintain health insurance for the poor, policymakers should consider revising policies that deter TANF enrollment.

  View details for Web of Science ID 000087335800015

  View details for PubMedID 10846507

• Latency and accuracy of discriminations of odor quality between binary mixtures and their components CHEMICAL SENSES Wise, P. M., Cain, W. S. 2000; 25 (3): 247-265

  Abstract

  Subjects made timed, same-different discriminations of odor quality, with the following principal findings: (i) latency reflected accuracy, with difficult discriminations, i.e. those between 50-50 mixtures and their components, requiring more time than less difficult discriminations, i.e. those between unmixed chemicals. This finding demonstrated the face validity of latency as a measure of qualitative similarity. (ii) Latency provided better resolution among pairs of odors than did errors of discrimination. This finding demonstrated the utility of collecting response times. (iii) Latency-based similarities among odors tested previously predicted similarities among pairs not yet tested. This finding demonstrated internal/predictive validity. (iv) A signal detection model assuming a differencing strategy best described the pattern of errors. Subjects appeared to make relative judgements regarding quality. (v) Finally, latency-based similarities between mixtures and their components demonstrated additivity. This finding suggested that binary mixtures fall on straight lines connecting their components in 'odor-space'.

  View details for Web of Science ID 000087819600002

  View details for PubMedID 10866984

• The impact of managed care insurance on use of lower-mortality hospitals by children undergoing cardiac surgery in California PEDIATRICS Erickson, L. C., Wise, P. H., Cook, E. F., Beiser, A., Newburger, J. W. 2000; 105 (6): 1271-1278

  Abstract

  Managed care plans aggressively seek to contain costs, but few data are available regarding their impact on access to high quality care for their members.To assess the impact of managed care health insurance on use of lower-mortality hospitals for children undergoing heart surgery in California.Retrospective cohort study using state-mandated hospital discharge datasets.Pediatric cardiovascular surgical centers in California.Five thousand seventy-one children admitted for open cardiac surgical procedures during 1992-1994.Hospitals were divided into lower- and higher-mortality groups according to adjusted surgical mortality. Using multivariate logistic regression analysis to control for medical, socioeconomic, demographic, and distance factors, children with managed care insurance were less likely to be admitted to a lower-mortality hospital for surgery relative to children with indemnity insurance (odds ratio:.53; 95% confidence interval:.45,.63). Similar findings resulted when the analysis was stratified by race/ethnicity. In addition, length of stay, a correlate of health care costs, was no longer for children admitted to lower-mortality centers than for those at higher-mortality centers (adjusted difference:.54 days shorter at lower-mortality centers; 95% confidence interval: -1.50,. 41).During this study, children with managed care insurance had significantly reduced use of lower-mortality hospitals for pediatric heart surgery in California compared with children with indemnity insurance. Further study is necessary to determine the mechanisms of this apparent insurance-specific inequity.

  View details for Web of Science ID 000087441400029

  View details for PubMedID 10835068

• Antibiotics without prescription: "bacterial or medical resistance"? LANCET Bauchner, H., Wise, P. H. 2000; 355 (9214): 1480-1480

  View details for Web of Science ID 000086830100007

  View details for PubMedID 10801167

• The impact of welfare reform policies on Child Protective Services: A national study JOURNAL OF SOCIAL ISSUES Romero, D., Chavkin, W., Wise, P. H. 2000; 56 (4): 799-809

  View details for Web of Science ID 000166328300012

• Assessing the effects of welfare reform policies on reproductive and infant health AMERICAN JOURNAL OF PUBLIC HEALTH Wise, P., Chavkin, W., Romero, D. 1999; 89 (10): 1514-1521

  Abstract

  The welfare reform law of 1996 marked a historical moment in US policy toward the poor by ending the entitlement to cash assistance, by requiring work, and by establishing time limits. This article examines the potential impact on the health of women and children, the primary recipients of welfare benefits.The authors outline the reproductive health outcomes most likely to be sensitive to welfare policies, identify indicators that might be used to assess these outcomes, review empirical evidence, and suggest specific methods and data sources.State welfare requirements could improve health outcomes or deter families from Medicaid and food stamps, as well as income support, thus worsening health outcomes. National and state data may prove useful in detecting these effects; however, new data sources may be required for specific health-related questions.Assessing the effects of welfare policies on reproductive and infant health is possible, although challenging. Reauthorization of the legislation is required in 2002; it is essential that the consequences for health be included in the next round of public debate.

  View details for Web of Science ID 000082752700011

  View details for PubMedID 10511833

• Efficacy and justice: the importance of medical research and tertiary care to social disparities in infant mortality. Journal of perinatology Wise, P. H. 1999; 19 (6): S24-7

  View details for PubMedID 10685292

• Implementation of Fetal and Infant Mortality Review (FIMR): experience from the national Healthy Start program. Maternal and child health journal Baltay, M., McCormick, M. C., Wise, P. H. 1999; 3 (3): 141-150

  Abstract

  The implementation of the Fetal and Infant Mortality Review (FIMR) process was examined as part of the evaluation of the national Healthy Start program, a federal program designed to reduce infant mortality in several communities. The implementation of the FIMR process over the 5-year funding period is described in terms of productivity, barriers and facilitators to implementation, and project expenditures.Data were derived from grant continuation applications and personal interviews with program staff to produce a qualitative description.As of the summer of 1996, 14 of the 15 Healthy Start sites in the national evaluation had successfully implemented the FIMR process. Most sites had developed a two-tiered review process for examination of case data in which a review by health and social services professionals was followed by community review. In the period 1993 to 1995, the percentage of fetal and infant deaths reviewed had a median of 34% with a range of 4-79% across the sites at a cost of $600 to $3400 per death reviewed. Recommendations were variably implemented.The FIMR process provides an important opportunity to contribute to the knowledge base regarding infant mortality in these communities. The process, however, has important logistical requirements and may require substantial financial resources that may affect implementation of confidential inquiries into infant mortality and other health problems.

  View details for PubMedID 10746753

• The scope of unmet maternal health needs in pediatric settings PEDIATRICS Kahn, R. S., Wise, P. H., Finkelstein, J. A., Bernstein, H. H., Lowe, J. A., Homer, C. J. 1999; 103 (3): 576-581

  Abstract

  Previous work has focused attention on the prevalence of specific maternal health problems known to affect children, such as smoking or depression. However, the cumulative health burden experienced by mothers and the potential for a practical pediatric health services response have not been examined. The aims of this study were to characterize: 1) the prevalence and cumulative burden of maternal health behaviors and conditions, 2) maternal access to a source of comprehensive adult primary care, and 3) maternal perceptions of a pediatric role in screening and referral.We surveyed 559 consecutive women bringing a child 18 months of age or less to one of four pediatric primary care sites between July 1996 and May 1997. The pediatric sites included one outpatient program in an academic hospital, one in a community health center, and two in-staff model practices of a managed care organization (these last two were combined for analysis). The self-administered questionnaire contained previously validated questions to assess health behaviors and conditions (smoking, alcohol abuse, depression, violence, risk for unintended pregnancy, serious illness, self-reported health) and access to care (regular source, regular provider, health insurance, care delayed or not received). Maternal attitudes toward a pediatric role in screening and referral were also elicited.In the three settings, response rates ranged from 75% to 84%. The average age of the women ranged from 25.1 to 32. 1 years and the average age of the children ranged from 6.5 to 8.0 months. Across the settings, the percentage of women reporting at least one health condition (66%-74%) was similarly high, despite significant demographic differences among sites. Many women reported more than one condition (31%-37%); among all women who smoked, 33% also screened positive for alcohol abuse, 31% for emotional or physical abuse, and 48% for depression. Access to comprehensive adult primary care was variable with 23% to 58% of women reporting one or more barriers depending on the site. Across all sites, >85% of mothers reported they would "not mind" or "would welcome" a pediatric role in screening and referral.Two-thirds of women bringing their children for pediatric care had health problems regardless of the site of care. Many women also reported substantial barriers to comprehensive health care. Most women reported acceptance of a pediatric role in screening and referral. Given the range and depth of maternal health needs, strategies to connect or reconnect mothers to comprehensive adult primary care from a variety of pediatric settings should be explored.

  View details for Web of Science ID 000078960100007

  View details for PubMedID 10049959

• Topics for our times: Welfare reform and women's health AMERICAN JOURNAL OF PUBLIC HEALTH Chavkin, W., Wise, P. H., Elman, D. 1998; 88 (7): 1017-1018

  View details for Web of Science ID 000074610600005

  View details for PubMedID 9663145

• The influence of tail autotomy on agonistic behaviour in a territorial salamander ANIMAL BEHAVIOUR Wise, S. E., Jaeger, R. G. 1998; 55: 1707-1716

  View details for Web of Science ID 000074936600028

• Policies towards pregnancy and addiction - Sticks without carrots Conference on Cocaine - Effects on the Developing Brain Chavkin, W., Wise, P. H., Elman, D. NEW YORK ACAD SCIENCES. 1998: 335–340

  Abstract

  Throughout this century in the United States, tension has existed between those who believe drug abuse is best combatted through the criminal justice system and those who emphasize a medical/public health model of prevention and treatment. In the last decade this debate has centered around the person of the pregnant addict. The former have construed her addiction as willful harm to the fetus punishable on criminal and child abuse grounds. The latter have countered that pregnancy is a moment of increased motivation for treatment and focused on expansion and improvement of treatment options. Both managed care and welfare reform have exacerbated conditions between these opposing policy approaches. The addicted woman is increasingly caught between policies that punish her drug use without options for overcoming addiction.

  View details for Web of Science ID 000074931100028

  View details for PubMedID 9668420

• National survey of the states: Policies and practices regarding drug-using pregnant women AMERICAN JOURNAL OF PUBLIC HEALTH Chavkin, W., Breitbart, V., Elman, D., Wise, P. H. 1998; 88 (1): 117-119

  Abstract

  This study assessed the impact of national policy shifts on state policies and practices regarding substance-using mothers.A 1995 telephone survey of substance abuse and child protective services directors in all 50 states and the District of Columbia was compared with a similar 1992 survey.There have been significant increases in state interventions for drug-using pregnant women (e.g., criminal prosecution, toxicology testing of women and neonates). Federal resources for treatment and oversight are being replaced by state control of reduced funds for treatment.The earlier policy of expanding treatment for addicted women is being replaced by reduction of services and increased state intervention.

  View details for Web of Science ID 000073804800023

  View details for PubMedID 9584016

• War experiences and distress symptoms of Bosnian children PEDIATRICS Goldstein, R. D., Wampler, N. S., Wise, P. H. 1997; 100 (5): 873-878

  Abstract

  The war in Bosnia has had a tremendous impact on civilians. Little is known about the impact of modern warfare on children. This survey documents the nature and frequency of war-related experiences among Bosnian children and describes their manifestations of selected psychological sequelae.A cross-sectional survey of 364 internally displaced 6- to 12-year-old children and their parents living in central Bosnian collectives was conducted during the war. Parents were surveyed for their children's war experiences; the children were surveyed for war-related distress symptoms.The children were exposed to virtually all of the surveyed war-related experiences. The majority had faced separations from family, bereavement, close contact with war and combat, and extreme deprivation. The prevalence and severity of experiences were not significantly related to a child's gender, wealth, or age, but were related to their region of residence, with children from the region of Sarajevo having the highest prevalence of experiences. Almost 94% of the children met Diagnostic and Statistical Manual of Mental Disorders, 4th ed, criteria for posttraumatic stress disorder. Significant life activity affecting sadness and anxiety were reported by 90.6% and 95.5% of the children, respectively. High levels of other symptoms surveyed were also found. Children with greater symptoms had witnessed the death, injury, or torture of a member of their nuclear family, were older, and came from a large city.The war-related experiences of the children studied were both varied and severe, and were associated with a variety of psychological sequelae. This experience underscores the vulnerability of civilians in areas of conflict and the need to address the effects of war on the mental health of children.

  View details for Web of Science ID A1997YD73900016

  View details for PubMedID 9346989

• Fertility therapy and the risk of very low birth weight OBSTETRICS AND GYNECOLOGY McElrath, T. F., Wise, P. H. 1997; 90 (4): 600-605

  Abstract

  To test the hypothesis of an association between maternal infertility therapy and the risk of very low birth weight (VLBW), defined as birth weight less than 1500 g, independent of the risk of multiple births, and to estimate the contribution of infertility therapy to the national incidence of VLBW.The National Maternal and Infant Health Survey conducted in 1988 was used to develop statistics describing outcomes among this birth cohort and to construct logistic regression models evaluating fertility therapy as an independent risk factor for VLBW.An estimated 10.1% of live births and 18.2% of VLBW births nationally were associated with either maternal subfertility or infertility therapy (6.8% and 11.4%, respectively). The risk of VLBW among women concerned with subfertility (i.e., receiving diagnostic testing or advice on timing intercourse) was 1.4 (95% confidence interval [CI] 1.1, 1.9), whereas that for women undergoing therapeutic interventions (ie, ovarian stimulation, surgery, in vitro fertilization, or artificial insemination) was 2.6 (95% CI 2.1, 3.2). Accounting for effects of multiple gestation, maternal age, and a history of miscarriage, the odds ratios for the concerned and therapy groups were 1.5 (95% CI 1.1, 1.9) and 2.0 (95% CI 1.5, 2.5), respectively. Black women were less likely to use fertility therapy but more likely to experience a therapy-related VLBW.Fertility therapy is associated with an important portion of all VLBW and with an elevated risk of VLBW, related only in part to an increased risk of multiple gestations. Women expressing concern about subfertility but not receiving therapy are also at increased risk of VLBW, suggesting that a history of infertility may mediate part of the risk associated with fertility therapy.

  View details for Web of Science ID A1997XX74500023

  View details for PubMedID 9380323

• Home uterine activity monitoring in the prevention of very low birth weight PUBLIC HEALTH REPORTS Kempe, A., Sachs, B. P., Ricciotti, H., Sobol, A. M., Wise, P. H. 1997; 112 (5): 433-439

  Abstract

  Despite controversy regarding the efficacy of home uterine activity monitoring (HUAM), it is currently licensed for detection of preterm labor in women with previous preterm deliveries. In practice, however, it is being more widely utilized in an effort to prevent preterm delivery. This study seeks to determine which group of mothers delivering very low birth weight (VLBW) infants would have qualified for HUAM given three different sets of criteria and in which women it could have been used to help prolong gestation.The authors reviewed the medical records of mothers of VLBW infants born in five U.S. locations (N = 1440), retrospectively applying three sets of eligibility criteria for HUAM use: (a) the current FDA licensing criterion for use of HUAM, a previous preterm birth; (b) indication for HUAM commonly cited in published reports; (c) a broad set of criteria based on the presence of any reproductive or medical conditions that might predispose to premature delivery. The authors then analyzed the conditions precipitating delivery for each group to determine whether delivery might have been prevented with HUAM and tocolytic therapy.Only 4.4% of the total group of women delivering VLBW infants would have been eligible for HUAM under the FDA criterion and might potentially have benefited from this technology. If extremely broad criteria had been applied to identify those eligible for monitoring, under which almost 80% of all women who delivered VLBW infants would have been monitored, only 20.3% of the total group would have been found eligible and would potentially have benefited. If such broad criteria were applied to all pregnant women, a sizable proportion of pregnancies would be monitored at great expense with small potential clinical benefit.Because VLBW births are usually precipitated by conditions that are unlikely to benefit from HUAM, this technology will have little impact on reducing VLBW and neonatal mortality rates. More comprehensive preventive strategies should be sought.

  View details for Web of Science ID A1997XW23600028

  View details for PubMedID 9323396

• Maternal and infant health - Effects of moderate reductions in postpartum length of stay Annual Meeting of the Association-for-Health-Services-Research Mandl, K. D., Brennan, T. A., Wise, P. H., Tronick, E. Z., Homer, C. J. AMER MEDICAL ASSOC. 1997: 915–21

  Abstract

  The Newborns' and Mothers' Health Protection Act of 1996 prohibits payers from restricting "benefits for any hospital length of stay in connection with childbirth for the mother or newborn child, following a normal vaginal delivery, to less than 48 hours." The law recognizes the basic right of women and physicians to make decisions about aptness of discharge timing.To provide data as a basis for decisions about aptness of discharge timing by studying the effect of voluntary, moderate reductions in length of postpartum hospital stay on an array of maternal and infant health outcomes.A prospective cohort study. Patients were surveyed by telephone at 3 and 8 weeks postpartum.A teaching hospital where 38% of the patients are in a managed care health plan with a noncompulsory reduced stay program offering enhanced prepartum and postpartum services, including home visits.Consecutive mothers discharged after vaginal delivery during a 3-month period.The outcomes were health services use within 21 days, breast-feeding, depression, sense of competence, and satisfaction with care. Multivariate analyses adjusted for sociodemographic factors, payer status, services, and social support.Of 1364 eligible patients, 1200 (88%) were surveyed at 3 weeks; of these 1200, 1015 (85%) were resurveyed at 8 weeks. The mean length of stay was 41.9 hours (SD, 12.2 hours). Of patients going home in 30 hours or less, 60.8% belonged to a managed care health plan. The length of stay was not related to the outcomes, except that women hospitalized shorter than 48 hours had more emergency department visits than those staying 40 to 48 hours (adjusted odds ratio, 5.78; 95% confidence interval, 1.19-28.05).When adequate postpartum outpatient care is accessible, a moderately shorter length of postpartum stay after an uncomplicated vaginal delivery had no adverse effect on an array of outcomes. Researchers and policy makers should seek to better define the content of postpartum services necessary for achieving optimal outcomes for women and newborns; funding should be available to provide such services, regardless of the setting in which they are provided.

  View details for Web of Science ID A1997XW19800009

  View details for PubMedID 9308869

• Mandatory testing of pregnant women and newborns: HIV, drug use, and welfare policy. The Fordham urban law journal Chavkin, W., Elman, D., Wise, P. H. 1997; 24 (4): 749-755

  View details for PubMedID 12455509

• Ethics in context AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY Chavkin, W., Wise, P. H. 1997; 176 (3): 732-732

  View details for Web of Science ID A1997WR88600055

  View details for PubMedID 9077647

• Risk status at discharge and cause of death for postneonatal infant deaths: A total population study PEDIATRICS Kempe, A., Wise, P. H., Wampler, N. S., Cole, F. S., Wallace, H., Dickinson, C., RINEHART, H., Lezotte, D. C., Beaty, B. 1997; 99 (3): 338-344

  Abstract

  To obtain population-based, clinical information regarding potentially modifiable factors contributing to death during the postneonatal period (28 to 364 days), we examined all postneonatal infant deaths in four areas of the United States to determine: (1) the cause of death from clinical and autopsy data rather than vital statistics, (2) whether death occurred during initial hospitalization or after discharge, and (3) the portion of postneonatal mortality attributable to infants who left the hospital with identified high-risk medical conditions.Retrospective medical record review of all postneonatal infant deaths with birth weights greater than 500 g (total N = 386) born to mothers residing in: (1) the city of Boston (1984 and 1985, N = 55), (2) the city of St Louis and contiguous areas (1985 and 1986, N = 123), (3) San Diego County (1985, N = 112), and (4) the state of Maine (1984 and 1985, N = 96). Deaths were identified using linked birth and death vital statistics, and medical record audits of infants' and mothers' charts were performed. Causes of death were obtained from medical record review in conjunction with autopsy if performed (72%, N = 278), medical record alone (17%, N = 67), or vital statistics if no other source was available (11%, N = 41). The medical conditions at the time of discharge for each infant were reviewed and, if judged to confer an increased risk of morbidity or mortality, were classified as high risk.The causes of death were sudden infant death syndrome (47%, N = 181), congenital conditions (20%, N = 77), prematurity-related conditions (11%, N = 43), infections (9%, N = 34), external causes (including injuries, drownings, ingestions, and burns) (7%, N = 25), and other (6%, N = 23). In 24% of congenital and 25% to 44% of prematurity-related deaths, infection was the acute or associated cause of death. Infants born to black mothers were more likely than those born to white mothers to die during the postneonatal period of all major causes of death (7.3 per 1000 vs 3.0 per 1000). Overall, 18% (N = 68) of deaths occurred to infants who never left the hospital; 79% (N = 305) of the infants were discharged before death; and discharge status was unknown in 3% (N = 13). Eighty-one percent of all infants with prematurity-related postneonatal deaths were never discharged, and of the total infants who were initially discharged, only 1% (N = 4) subsequently died of prematurity-related causes. Of all postneonatal deaths, only 16% (N = 62) left the hospital with identified high-risk medical conditions.These findings suggest that the etiology of postneonatal mortality is heterogeneous, with significant complexity in attributing specific causes of death and making designations of "preventability." The vast majority of infants who died of prematurity-related postneonatal causes never left the hospital, and only a small percentage of all infants that left the hospital before death were identified as being at high medical risk. Therefore, strategies for further decreasing postneonatal mortality must link high-risk follow-up programs to more comprehensive strategies that address risk throughout pregnancy and early childhood.

  View details for Web of Science ID A1997WR14700004

  View details for PubMedID 9041284

• Inadequate hepatitis B vaccination of adolescents and adults at an urban community health center JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION Sharfstein, J., Wise, P. H. 1997; 89 (2): 86-92

  Abstract

  Hepatitis B remains a major public health problem in the United States, but public vaccination policy has targeted infants rather than the high-risk adults who constitute the vast majority of patients at imminent risk of infection. The effects of this policy were studied at a community health center in Boston. Adolescents and adults who attended a community health center between January 1, 1992 and May 31, 1993 and had human immunodeficiency virus (HIV) or another sexually transmitted disease (STD)--indications for vaccination according to the Centers for Disease Control and Prevention--were identified through chart review. The vaccination rate and missed opportunities were determined. In addition, directors of Boston health centers were surveyed on hepatitis B vaccine at their clinics. Of 178 individuals with HIV or another STD and without serologic evidence of prior exposure to hepatitis B, two (1.1%) received the vaccine. There were 342 missed opportunities. Only two of 14 medical directors said their clinics routinely offered vaccine to individuals with STDs. The medical directors rated financial barriers as more important obstacles to hepatitis B vaccination than nonfinancial barriers. These results indicate that many high-risk adolescents and adults do not receive a preventive intervention that is federally recommended, potentially life saving, and cost effective. Inadequate public funding for vaccine may be a key barrier for this population.

  View details for Web of Science ID A1997WH30700002

  View details for PubMedID 9046761

• The first injustice: Socioeconomic disparities, health services technology, and infant mortality ANNUAL REVIEW OF SOCIOLOGY Gortmaker, S. L., Wise, P. H. 1997; 23: 147-170

  Abstract

  "Infant mortality has long been viewed as a synoptic indicator of the health and social condition of a population. In this article we examine critically the structure of this reflective capacity with a particular emphasis on how new health care technologies may have altered traditional pathways of social influence.... Current patterns of infant mortality in the United States provide a useful illustration of the dynamic interaction of underlying social forces and technological innovation in determining trends in health outcomes. We review the implications of this perspective for [future] sociological research into disparate infant mortality...."

  View details for Web of Science ID A1997XR65000007

  View details for PubMedID 12348279

• Racial disparities in outcomes of military and civilian births in California ARCHIVES OF PEDIATRICS & ADOLESCENT MEDICINE Barfield, W. D., Wise, P. H., Rust, F. P., RUST, K. J., Gould, J. B., Gortmaker, S. L. 1996; 150 (10): 1062-1067

  Abstract

  To examine racial disparities in prenatal care utilization, birth weight, and fetal and neonatal mortality in a population for whom financial barriers to health care services are minimal.Using linked birth, fetal death, and infant death certificate files, we examined prenatal care utilization, birth weight distribution, and fetal and neonatal mortality rates for all white and black births occurring in military hospitals in California from January 1, 1981, to December 31, 1985. These patterns were compared with the experience of their civilian counterparts during the same time period.Black mothers had higher percentages of births occurring in teenaged and unmarried mothers than did white mothers in military and civilian populations. First-trimester prenatal care initiation was lower for blacks in the military (relative risk, 0.79; 95% confidence interval, 0.75-0.82) and civilian (relative risk, 0.51; 95% confidence interval, 0.50-0.52) populations. However, the scale of the disparity in prenatal care utilization was significantly smaller (P < .001) in the military group. Rates of low birth weight and fetal and neonatal mortality among blacks were elevated in the military and civilian groups. However, the racial disparity in low birth weight was significantly smaller in the military group (P < .01 and P < .001, respectively).In populations with decreased financial barriers to health care, racial disparities in prenatal care use and low birth weight were reduced. However, the persistence of significant disparities suggests that more comprehensive strategies will be required to ensure equity in birth and neonatal outcome.

  View details for Web of Science ID A1996VM05900010

  View details for PubMedID 8859139

• The influence of the wider use of surfactant therapy on neonatal mortality among blacks and whites NEW ENGLAND JOURNAL OF MEDICINE Hamvas, A., Wise, P. H., Yang, R. K., Wampler, N. S., Noguchi, A., MAURER, M. M., Walentik, C. A., Schramm, W. F., Cole, F. S. 1996; 334 (25): 1635-1640

  Abstract

  Surfactant therapy reduces morbidity and mortality among premature infants with the respiratory distress syndrome (RDS). Fetal pulmonary surfactant matures more slowly in white than in black fetuses, and therefore RDS is more prevalent among whites than among blacks. We reasoned that the increased use of surfactant after its approval by the Food and Drug Administration (FDA) in 1990 might have reduced neonatal mortality more among whites than among blacks.We merged vital-statistics information for all 1563 infants with very low birth weights (500 to 1500 g) born from 1987 through 1989 or in 1991 and 1992 to residents of St. Louis with clinical data from the four neonatal intensive care units in the St. Louis area; we then compared neonatal mortality during two periods, one before and one after the FDA's approval of surfactant for clinical use (1987 through 1989 and 1991 through 1992).The use of surfactant increased by a factor of 10 between 1987 through 1989 and 1991 through 1992. The neonatal mortality rate among all very-low-birth-weight infants decreased 17 percent, from 220.3 deaths per 1000 very-low-birth-weight babies born alive (in 1987 through 1989) to 183.9 per 1000 (in 1991 through 1992; P = 0.07). This decrease was due to a 41 percent reduction in the mortality rate among white newborns with very low birth weights (from 261.5 per 1000 to 155.5 per 1000; P = 0.003). In contrast, among black infants, the mortality rate for very-low-birth-weight infants did not change significantly (195.6 per 1000 and 196.8 per 1000). The relative risk of death among black newborns with very low birth weights as compared with white newborns with similar weights was 0.7 from 1987 through 1989 and 1.3 from 1991 through 1992 (P = 0.02). The differences in mortality were not explained by differences in access to surfactant therapy, by differences in mortality between black and white infants who received surfactant, or by differences in the use of antenatal corticosteroid therapy.After surfactant therapy for RDS became generally available, neonatal mortality improved more for white than for black infants with very low birth weights.

  View details for Web of Science ID A1996UQ70600004

  View details for PubMedID 8628359

• Efforts to reduce perinatal mortality, HIV, and drug addiction: surveys of the states. Journal of the American Medical Women's Association (1972) Chavkin, W., Breitbart, V., Wise, P. 1995; 50 (5): 164-166

  View details for PubMedID 7499705

• The importance of extreme prematurity and low birthweight to US neonatal mortality patterns: implications for prenatal care and women's health. Journal of the American Medical Women's Association (1972) Wise, P. H., Wampler, N., Barfield, W. 1995; 50 (5): 152-155

  Abstract

  In order to frame the appropriateness of neonatal mortality reduction efforts that begin only after pregnancy is recognized, this study examined the relative contributions of different gestational age and birthweight groups to total neonatal mortality and to racial disparities in neonatal mortality in the United States.Using the national linked birth/infant death data set for the 1988 cohort, the relative contributions of different birthweight and gestational age groups to national neonatal mortality rates were calculated. The relative contributions of these groups to the racial disparity in neonatal mortality were also assessed.Very low birthweight infants (< 1,500 g) accounted for 1.2% of all births, but 64.2% of all neonatal deaths. The very low birthweight rate for whites was 0.93%, while that for blacks was 2.79% with the contribution of this group to neonatal mortality higher for blacks than whites. Infants less than 1,000 g contributed more than 80% of the racial disparity in neonatal mortality.Neonatal mortality patterns in the United States have become highly dependent on infants with gestational ages that approach the second trimester. Preventing neonatal mortality by enhancing care only after pregnancy has been recognized, therefore, may be limited. Strategies that link prenatal care to broader initiatives to improve the health of women regardless of pregnancy status may be more effective.

  View details for PubMedID 7499702

• MORTALITY-RATES AMONG 15- TO 44-YEAR-OLD WOMEN IN BOSTON - LOOKING BEYOND REPRODUCTIVE STATUS AMERICAN JOURNAL OF PUBLIC HEALTH Katz, M. E., Holmes, M. D., Power, K. L., Wise, P. H. 1995; 85 (8): 1135-1138

  Abstract

  Mortality rates were examined for Boston women, aged 15 to 44, from 1980 to 1989. There were 1234 deaths, with a rate of 787.8/100,000 for the decade. Leading causes were cancer, accidents, heart disease, homicide, suicide, and chronic liver disease. After age adjustment, African-American women in this age group were 2.3 times more likely to die than White women. Deaths at least partly attributable to smoking and alcohol amounted to 29.8% and 31.9%, respectively. Mortality was found to be related more directly to the general well-being of young women than to their reproductive status, and many deaths were preventable. African-American/White disparities were most likely linked to social factors. These findings suggest that health needs of reproductive-age women transcend reproductive health and require comprehensive interventions.

  View details for Web of Science ID A1995RN32000025

  View details for PubMedID 7625513

• THE IMPACT OF EXTREME PREMATURITY AND CONGENITAL-ANOMALIES ON THE INTERPRETATION OF INTERNATIONAL COMPARISONS OF INFANT-MORTALITY OBSTETRICS AND GYNECOLOGY Sachs, B. P., Fretts, R. C., Gardner, R., HELLERSEIN, S., Wampler, N. S., Wise, P. H. 1995; 85 (6): 941-946

  Abstract

  To identify the potential impact that different definitions of live births and practice patterns have on infant mortality rates in England and Wales, France, Japan, and the United States.United States data were obtained from the 1986 linked national birth-infant death cohort, and those for the other countries came from either published sources or directly from the Ministries of Health.In 1986 in the United States, infants weighing less than 1 kg accounted for 36% of deaths (32% white and 46% black); 32% resulted from fatal congenital anomalies. These rates were much higher in both categories than in England and Wales in 1990 (24 and 22%, respectively), France in 1990 (15 and 25%, respectively), and Japan in 1991 (9% for infants weighing less than 1 kg, percentage of fatal congenital anomalies unknown). These cases are more likely to be excluded from infant mortality statistics in their countries than in the United States.In 1990, the United States infant mortality rate was 9.2 per 1000 live births, ranking the United States 19th internationally. However, infant mortality provides a poor comparative measure of reproductive outcome because there are enormous regional and international differences in clinical practices and in the way live births are classified. Future international and state comparisons of reproductive health should standardize the definition of a live birth and fatal congenital anomaly, and use weight-specific fetal-infant mortality ratios and perinatal statistics.

  View details for Web of Science ID A1995QZ91800007

  View details for PubMedID 7770264

• Child Beauty, Child Rights and the Devaluation of Women. Health and human rights Wise, P. H. 1995; 1 (4): 472-476

  View details for PubMedID 10393800

• Science - Introduction Symposium on Meaning in the Visual Arts - Views from the Outside Wise, M. N. INSTITUTE ADVANCED STUDY. 1995: 221–224

  View details for Web of Science ID A1995BF91B00018

• English gardens in Berlin: Aesthetics, technology, power Symposium on Meaning in the Visual Arts - Views from the Outside Wise, M. N. INSTITUTE ADVANCED STUDY. 1995: 237–254

  View details for Web of Science ID A1995BF91B00020

• FINDING COMMON GROUND - THE NECESSITY OF AN INTEGRATED AGENDA FOR WOMENS AND CHILDRENS HEALTH JOURNAL OF LAW MEDICINE & ETHICS Chavkin, W., Breitbart, V., Wise, P. H. 1994; 22 (3): 262-269

  View details for Web of Science ID A1994QA21100011

  View details for PubMedID 7749483

• THE ACCESSIBILITY OF DRUG-TREATMENT FOR PREGNANT-WOMEN - A SURVEY OF PROGRAMS IN 5 CITIES AMERICAN JOURNAL OF PUBLIC HEALTH Breitbart, V., Chavkin, W., Wise, P. H. 1994; 84 (10): 1658-1661

  Abstract

  Through simulated calls to 294 drug treatment programs in five cities, this study investigated access for pregnant women and compared New York City's provision of services in 1989 to that in 1993. In all sites, the majority of programs accepted pregnant women. There was also a marked improvement in the availability of services in New York City. Yet options were more limited for Medicaid recipients and women needing child care, and an appointment or referral for prenatal care was usually not offered. Although the door for treatment may be opening for pregnant women, institutional barriers still remain.

  View details for Web of Science ID A1994PM43500023

  View details for PubMedID 7943491

• WHAT YOU MEASURE IS WHAT YOU GET - PRENATAL-CARE AND WOMENS HEALTH AMERICAN JOURNAL OF PUBLIC HEALTH Wise, P. H. 1994; 84 (9): 1374-1375

  View details for Web of Science ID A1994PJ24700003

  View details for PubMedID 8092356

• COMMUNITY STUDY OF INFANT-MORTALITY IN SAN-DIEGO COUNTY JOURNAL OF TROPICAL PEDIATRICS Wallace, H. M., Micik, S., Wise, P. 1994; 40 (3): 172-178

  Abstract

  Infant mortality in San Diego County (USA) in 1988 was 6.9 per 1000 live births. This rate had remained unchanged since 1980. It rose to 8.3 in 1989 and fell to 7.0 in 1990. This study describes the results of an investigation into the causes of infant mortality during 1985. A total of 333 infant deaths were recorded. Nearly half the neonatal deaths were related to perinatal causes and more than half the post-neonatal deaths were attributed to the Sudden Infant Death Syndrome. Two-thirds of all infant deaths occurred in the neonatal period. The contribution of factors in the maternal background and those related to care during labour, as well as postnatally, is described.

  View details for Web of Science ID A1994NY33300010

  View details for PubMedID 8078117

• HEALTH-CARE REFORM AND THE SPECIAL NEEDS OF CHILDREN PEDIATRICS Perrin, J. M., Kahn, R. S., Bloom, S. R., Davidson, S., Guyer, B., Hollinshead, W., Richmond, J. B., Walker, D. K., Wise, P. H. 1994; 93 (3): 504-506

  View details for Web of Science ID A1994MY68700027

  View details for PubMedID 8115214

• MODEL PROGRAMS ADDRESSING PERINATAL DRUG EXPOSURE AND HUMAN-IMMUNODEFICIENCY-VIRUS INFECTION - INTEGRATING WOMENS AND CHILDRENS NEEDS BULLETIN OF THE NEW YORK ACADEMY OF MEDICINE Breitbart, V., Chavkin, W., Layton, C., Wise, P. 1994; 71 (2): 236-251

  Abstract

  Many of the efforts to address perinatal drug exposure and human immunodeficiency virus infection have been influenced by a perspective of conflict between the interests of mother and infant. This article highlights several programs that integrate women's and children's services while dealing with these health issues. It discusses the challenges encountered by these programs, such as funding restrictions, institutional barriers, professional attitudes, regulatory constraints, and local political issues. It presents strategies for overcoming these barriers including the creative coordination of funding streams, innovative relationships with child protective agencies, effective collaboration with other agencies, and advocacy on behalf of clients and programs, and makes recommendations for certain policy changes, which could foster the development of programs that serve women and children together.

  View details for Web of Science ID A1994PY43600008

  View details for PubMedID 19313104

• CONFRONTING RACIAL DISPARITIES IN INFANT-MORTALITY - RECONCILING SCIENCE AND POLITICS AMERICAN JOURNAL OF PREVENTIVE MEDICINE Wise, P. H. 1993; 9 (6): 7-16

  Abstract

  The public debate surrounding disparities in infant mortality has resulted from a profound failure to seek a common wisdom. Because of its essential social roots, infant mortality will always remain the province of fundamental ideological and political conflict. However, without a more integrated analytic approach, progress in reducing disparate infant mortality will remain limited by internecine struggles for disciplinary purview and false claims of societal relevance. For in the end, the struggle to address disparate infant mortality will be advanced best by integrated technical and political strategies that recognize that the pursuits of efficacy and justice are inextricably linked.

  View details for Web of Science ID A1993MR85100003

  View details for PubMedID 8123287

• Infant mortality. Current opinion in pediatrics McCormick, M. C., Wise, P. H. 1993; 5 (5): 552-557

  Abstract

  Infant mortality continues to be a major public health issue in the United States. Although some preventive strategies for neonatal mortality are emerging for congenital malformations, notably neural tube defects, the prevention of preterm deliveries among disadvantaged populations remains elusive, suggesting the need for different approaches to women's health needs. Despite the lack of success in preventing preterm birth, neonatal mortality rates continued to decline substantially, a decline attributed to improvements in neonatal intensive care associated with surfactant use. The increasing survival of very preterm infants continues to raise questions about their longer term outcomes especially with several recent studies on difficulties in school, and about the need for postdischarge developmental interventions. Attempts to decrease postneonatal mortality received marked attention with the recommendations for specific positioning to prevent sudden infant death syndrome and heightened attention to increased immunization completion rates. The dismal ranking of the United States in infant mortality rates among industrialized countries, however, continues to present a social policy challenge.

  View details for PubMedID 8287078

• Medicare and Medicaid. The state of health care in America Wise 1993: 56-62

  Abstract

  The federal Medicare and Medicaid programs were established as safety nets for the elderly, disabled, and most disadvantaged members of our society. Today, both programs are plagued by increasing demand and diminishing resources, and both are attempting to find ways to care for current and future beneficiaries.

  View details for PubMedID 10168062

• NOISE OR FUGUE - SEEKING THE LOGIC OF CHILD HEALTH INDICATORS MENTAL RETARDATION Wise, P. H., Lowe, J. A. 1992; 30 (6): 323-329

  Abstract

  Despite improvements in many child health indicators, several important ones, including the racial disparity in infant mortality, have not improved in recent years. A focus on dramatic but rare risk factors has distracted attention away from the primary determinants of these indicators. An analytic model to assess these indicators identifies three interacting determinates: (a) social well-being, (b) our technical capacity to reduce the risk that low social status conveys, and (c) our performance in providing access to this technical capacity. These three determinants can move independently and can, therefore, mask important trends in social status and the impact of programs and policies.

  View details for Web of Science ID A1992KD84300005

  View details for PubMedID 1474908

• CLINICAL DETERMINANTS OF THE RACIAL DISPARITY IN VERY-LOW-BIRTH-WEIGHT NEW ENGLAND JOURNAL OF MEDICINE Kempe, A., Wise, P. H., Barkan, S. E., Sappenfield, W. M., Sachs, B., Gortmaker, S. L., Sobol, A. M., First, L. R., Pursley, D., RINEHART, H., Kotelchuck, M., Cole, F. S., Gunter, N., Stockbauer, J. W. 1992; 327 (14): 969-973

  Abstract

  Although the risk of very low birth weight (less than 1500 g) is more than twice as high among blacks as among whites in the United States, the clinical conditions associated with this disparity remain poorly explored.We reviewed the medical records of over 98 percent of all infants weighing 500 to 1499 g who were born in Boston during the period 1980 through 1985 (687 infants), in St. Louis in 1985 and 1986 (397 infants), and in two health districts in Mississippi in 1984 and 1985 (215 infants). The medical records of the infants' mothers were also reviewed. These data were linked to birth-certificate files. During the study periods, there were 49,196 live births in Boston, 16,232 in St. Louis, and 16,332 in the Mississippi districts. The relative risk of very low birth weight among black infants as compared with white infants ranged from 2.3 to 3.2 in the three areas. The higher proportion of black infants with very low birth weights was related to an elevated risk in their mothers of major conditions associated with very low birth weight, primarily chorioamnionitis or premature rupture of the amniotic membrane (associated with 38.0 percent of the excess proportion of black infants with very low birth weights [95 percent confidence interval, 31.3 to 45.4 percent]); idiopathic preterm labor (20.9 percent of the excess [95 percent confidence interval, 16.0 to 26.4 percent]); hypertensive disorders (12.3 percent [95 percent confidence interval, 8.6 to 16.6]); and hemorrhage (9.8 percent [95 percent confidence interval, 5.5 to 13.5]).The higher proportion of black infants with very low birth weights is associated with a greater frequency of all major maternal conditions precipitating delivery among black women. Reductions in the disparity in birth weight between blacks and whites are not likely to result from any single clinical intervention but, rather, from comprehensive preventive strategies.

  View details for Web of Science ID A1992JQ22500001

  View details for PubMedID 1518548

• INFANT-MORTALITY AS A SOCIAL MIRROR NEW ENGLAND JOURNAL OF MEDICINE Wise, P. H., Pursley, D. M. 1992; 326 (23): 1558-1560

  View details for Web of Science ID A1992HW97200009

  View details for PubMedID 1579140

• MATERNAL SMOKING AND CHILDHOOD MORTALITY AND MORBIDITY International Symposium on the Control of Tobacco-related Cancers and Other Diseases Gortmaker, S. L., Kempe, A., Homer, C. J., Barkan, S., Sobol, A., Wise, P. OXFORD UNIV PRESS. 1992: 159–166

  View details for Web of Science ID A1992BA88C00016

• FOCUS OF ATTENTION IN NARRATIVE TEXT AND WORD-ORDER TYPOLOGY 18th Annual LACUS Forum Wise, M. R. LINGUISTIC ASSOCIATION CANADA & UNITED STATES. 1992: 101–107

  View details for Web of Science ID A1992BZ66S00007

• From the Surgeon General, US Public Health Service. JAMA : the journal of the American Medical Association Novello, A. C., Clinton, J. J., Wise, P. H., Mitchell, W. I. 1991; 266 (6): 770-?

  View details for PubMedID 1865514

• From the Surgeon General, US Public Health Service. JAMA : the journal of the American Medical Association Novello, A. C., Wise, P. H., Kleinman, D. V., Orenstein, W. A., SEPE, S. I. 1991; 265 (11): 1364-?

  View details for PubMedID 1999874

• HISPANIC HEALTH - TIME FOR DATA, TIME FOR ACTION JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION Novello, A. C., Wise, P. H., Kleinman, D. V. 1991; 265 (2): 253-255

  View details for Web of Science ID A1991EQ60200035

  View details for PubMedID 1984157

• BRAIN ENERGY-METABOLISM - CELL BODY OR SYNAPSE - GENERAL DISCUSSION SYMP ON EXPLORING BRAIN FUNCTIONAL ANATOMY WITH POSITRON TOMOGRAPHY SOKOLOFF, Porter, Roland, Wise JOHN WILEY & SONS LTD. 1991: 43–51

  View details for Web of Science ID A1991BU85G00004

• BACTEREMIA IN AN AMBULATORY SETTING - IMPROVED OUTCOME IN CHILDREN TREATED WITH ANTIBIOTICS AMERICAN JOURNAL OF DISEASES OF CHILDREN Woods, E. R., MEROLA, J. L., Bithoney, W. G., Spivak, H., Wise, P. H. 1990; 144 (11): 1195-1199

  Abstract

  We undertook a study of 414 bacteremic patients (167 with Haemophilus influenzae and 247 with Streptococcus pneumoniae bacteremia) to evaluate their clinical presentation, laboratory and clinical results, and subsequent outcomes. Patients with H influenzae bacteremia were more likely to have soft-tissue foci, poorer clinical appearance at presentation, and be at higher risk for subsequent serious focal infections, persistent bacteremia, and subsequent hospital admissions than patients with S pneumoniae. Patients with H influenzae bacteremia had a 21.1-fold increase in risk of meningitis (95% confidence interval [CI] of 3.8 to 78.0) compared with those with S pneumoniae. The odds ratio for initial lumbar puncture was 5.25 (95% CI [1.1-23.6]). Ambulatory patients treated with antibiotics at presentation were less likely to develop new serious soft-tissue infections, persistent bacteremia, or to require subsequent hospital admissions than untreated patients. The effect of treatment was greater for patients with S pneumoniae than those with H influenzae. Careful follow-up and reevaluation of patients with presumptive bacteremia is essential because treated and untreated patients can still develop serious soft-tissue infections.

  View details for Web of Science ID A1990EG62700014

  View details for PubMedID 2239857

• Poverty, technology and recent trends in the United States infant mortality rate. Paediatric and perinatal epidemiology Wise, P. H. 1990; 4 (4): 390-401

  View details for PubMedID 2267180

• FINAL REPORT OF THE UNITED-STATES-DEPARTMENT-OF-HEALTH-AND-HUMAN-SERVICES SECRETARYS WORK GROUP ON PEDIATRIC HUMAN IMMUNODEFICIENCY VIRUS-INFECTION AND DISEASE - CONTENT AND IMPLICATIONS PEDIATRICS Novello, A. C., Wise, P. H., Willoughby, A., Pizzo, P. A. 1989; 84 (3): 547-555

  Abstract

  Human immunodeficiency virus (HIV) disease is increasing rapidly in the ranks of the leading causes of death among children. It is already the ninth leading cause of death among children 1 to 4 years of age and the seventh in young people between the ages of 15 and 24 years. If current trends continue, AIDS can be expected to move into the top five leading causes of death in the pediatric and adolescent age group in the next 3 or 4 years. To address this problem and also to provide focus for the US Department of Health and Human Services activities dealing with pediatric AIDS, an intradepartmental work group was established as a central health and human services component. This was done to ensure the best possible use of federal resources on behalf of children and adolescents with AIDS. Its recommendations are the basis of this report.

  View details for Web of Science ID A1989AN65500024

  View details for PubMedID 2671915

• WHAT DO REGIONAL VARIATIONS IN THE RATES OF HOSPITALIZATION OF CHILDREN REALLY MEAN NEW ENGLAND JOURNAL OF MEDICINE Wise, P. H., Eisenberg, L. 1989; 320 (18): 1209-1211

  View details for Web of Science ID A1989U395700010

  View details for PubMedID 2710193

• POVERTY AND CHILD HEALTH PEDIATRIC CLINICS OF NORTH AMERICA Wise, P. H., Meyers, A. 1988; 35 (6): 1169-1186

  Abstract

  Poverty is now more heavily concentrated in children than at any other time in U.S. history. Poverty's influence on child health is pervasive and creates a variety of clinical challenges. This discussion reviews the clinical expression of poverty in childhood and assesses our clinical and political capacity to reduce its tragic impact.

  View details for Web of Science ID A1988R232700002

  View details for PubMedID 3059293

• Interpretation of indices of fetal pulmonary maturity by gestational age. Paediatric and perinatal epidemiology VANMARTER, L. J., Berwick, D. M., Torday, J., Frigoletto, F. D., Wise, P. H., EPSTEIN, M. F. 1988; 2 (4): 360-364

  View details for PubMedID 3244554

• INFANT-MORTALITY INCREASE DESPITE HIGH ACCESS TO TERTIARY CARE - AN EVOLVING RELATIONSHIP AMONG INFANT-MORTALITY, HEALTH-CARE, AND SOCIOECONOMIC CHANGE PEDIATRICS Wise, P. H., First, L. R., Lamb, G. A., Kotelchuck, M., Chen, D. W., Ewing, A., HERSEE, H., Rideout, J. 1988; 81 (4): 542-548

  Abstract

  In this study, the determinants of an apparent increase in the infant mortality rate of an urban population with high access to tertiary neonatal care are reviewed. For a 4-year period (1980 to 1983), all infant deaths (n = 422) of the 32,329 births to residents of the City of Boston were analyzed through linked vital statistics data and a review of medical records. A significant increase in the infant mortality rate occurred in 1982 due to increases in three components of the infant mortality rate: the birth rate of very low birth weight infants (less than 1,500 g), the neonatal mortality rate of normal birth weight infants (greater than or equal to 2,500 g), and the mortality rate of infants dying during the postneonatal period (28 to 365 days). These increases were associated with inadequate levels of prenatal care. Although transient, the impact of the observed alterations in these infant mortality rate components was enhanced by a more long-standing phenomenon: the stabilization of mortality rates for low birth weight infants. This stabilization allowed the increases in other component rates to be expressed more fully than in previous years. In this report a mechanism is shown whereby fully regionalized neonatal care ultimately may confer to the infant mortality rate a heightened sensitivity to socioeconomic conditions and levels of adequate prenatal care.

  View details for Web of Science ID A1988M915500009

  View details for PubMedID 3353187

• THE IMPACT OF BOTTLE BILL LEGISLATION ON THE INCIDENCE OF LACERATIONS IN CHILDHOOD AMERICAN JOURNAL OF PUBLIC HEALTH Baker, M. D., Moore, S. E., Wise, P. H. 1986; 76 (10): 1243-1244

  Abstract

  We studied the effect of legislation requiring deposits for beverage containers on the incidence of lacerations in urban children. Records of emergency room visits for lacerations and fractures were reviewed for three years pre-legislation (1980-82) and the immediate post-legislation period (1983). The incidence of total sutured lacerations did not change substantially after the legislation, but glass-related lacerations fell by 60 per cent, due to a reduced incidence in lacerations occurring outside of the home.

  View details for Web of Science ID A1986E074100015

  View details for PubMedID 3752330

• MIDWIFERY AND MEDICINE IN AMERICA - THE STRUGGLE FOR JUSTICE IN INFANT HEALTH JOURNAL OF NURSE-MIDWIFERY Richmond, J. B., Wise, P. H. 1986; 31 (5): 219-223

  View details for Web of Science ID A1986E097800006

  View details for PubMedID 3639144

• RACIAL AND SOCIOECONOMIC DISPARITIES IN CHILDHOOD MORTALITY IN BOSTON NEW ENGLAND JOURNAL OF MEDICINE Wise, P. H., Kotelchuck, M., Wilson, M. L., Mills, M. 1985; 313 (6): 360-366

  Abstract

  We examined racial and income-related patterns of mortality from birth through adolescence in Boston, where residents have high access to tertiary medical care. Childhood mortality was significantly higher among black children (odds ratio, 1.24; P less than 0.05) and low-income children (odds ratio, 1.47; P less than 0.001). Socioeconomic effects varied for different age groups and causes of death. The largest relative disparity occurred in the neonatal and postneonatal periods, and the smallest in adolescence. Of the total racial differential in neonatal mortality (6.88 deaths per 1000 live births), 51.2 per cent occurred in premature infants, 13.4 per cent in term infants who were small for their gestational age, and 25.9 per cent in neonates who were both premature and small for their age. Black neonatal mortality was elevated at all income levels. Beyond the neonatal period, mortality from respiratory disease, fire, and homicide had strong inverse relationships with income, and mortality from injuries to the occupants of motor vehicles was directly related to income. These data suggest that despite access to tertiary medical services, substantial social differentiation in mortality may exist throughout childhood. Equity in childhood survival will probably require policies that emphasize preventive goals.

  View details for Web of Science ID A1985ANG6700005

  View details for PubMedID 4010752

• Evaluation of the febrile child under 2 years of age. journal of emergency medicine McGravey, A., Wise, P. H. 1984; 1 (4): 299-305

  Abstract

  Unlike older children and adults, fever in young children may reflect serious underlying disease despite the lack of associated findings on physical examination. Laboratory examinations may provide important information in the management of these children. The recent literature suggests a systematic approach to the evaluation and management of the young febrile child.

  View details for PubMedID 6501842

• Ethics and the ED nurse: triage in emergency services. Journal of emergency nursing Hanson, M., Wise, P. H., Robbins, D. 1981; 7 (3): 118-119

  View details for PubMedID 7029060

• DECISION-MAKING IN AMINOGLYCOSIDE THERAPY - DISCUSSION JOURNAL OF ANTIMICROBIAL CHEMOTHERAPY Acar, KLASTERSKY, VACHON, FRANZEN, VONGRAEVENITZ, FOLLATH, Young, Reeves, WALDVOGEL, BILLE, DEBROE, Wise, Soep, SCHAAD, Levin, RIOS 1981; 8: 151-153

  View details for Web of Science ID A1981LY64600019

• DECISION-MAKING IN AMINOGLYCOSIDE THERAPY - DISCUSSION JOURNAL OF ANTIMICROBIAL CHEMOTHERAPY Soep, SANTELLA, FOLLATH, Reeves, HALLYNCK, MANUEL, Wise, Acar, KLASTERSKY, WALDVOGEL, Levin, Young, KAYSER, FARCHIONE 1981; 8: 51-56

  View details for Web of Science ID A1981LY64600008

• FLOW-VOLUME LOOPS IN NEWBORN-INFANTS CRITICAL CARE MEDICINE Wise, P. H., Krauss, A. N., Waldman, S., Auld, P. A. 1980; 8 (2): 61-63

  Abstract

  Flow-volume loops were obtained during the performance of crying vital capacity (CVC) maneuvers in 31 infants, 18 of whom had hyaline membrane disease (HMD). Both healthy and distressed infants had flow-volume loops resembling those found in adults with variable intrathoracic obstruction of the central airways. Flow rates during inspiration and expiration increased as the CVC increased. Infants with HMD had narrower inspiratory loops and attained peak expiratory flow later than nondistressed infants, but these differences were not statistically significant. Vocalizations, loss of lung recoil associated with loss of lung volume, and partial collapse of intrathoracic airways may all contribute to the shape of the flow-volume loop in infants.

  View details for Web of Science ID A1980JE34000002

  View details for PubMedID 7353388

• PROCEEDINGS OF A SYMPOSIUM HELD AT THE ROYAL-COLLEGE-OF-PHYSICIANS, LONDON, SEPTEMBER 21 AND 22, 1978 - PANEL DISCUSSION - SESSION 1 POSTGRADUATE MEDICAL JOURNAL WELLING, KAMMER, R. B., Preston, D. A., Fleming, Hanasono, G. K., DISNEY, F., Meyers, Wise, Simon, GILLETT, GARROD 1979; 55: 32-34

  View details for Web of Science ID A1979JG75300008