Utility In Children Research Articles

Healthcare Utilization After a Children's Health Insurance Program Expansion in Oregon.

The future of the Children's Health Insurance Program (CHIP) is uncertain after 2017. Survey-based research shows positive associations between CHIP expansions and children's healthcare utilization. To build on this prior work, we used electronic health record (EHR) data to assess temporal patterns of healthcare utilization after Oregon's 2009-2010 CHIP expansion. We hypothesized increased post-expansion utilization among children who gained public insurance. Using EHR data from 154 Oregon community health centers, we conducted a retrospective cohort study of pediatric patients (2-18 years old) who gained public insurance coverage during the Oregon expansion (n = 3054), compared to those who were continuously publicly insured (n = 10,946) or continuously uninsured (n = 10,307) during the 2-year study period. We compared pre-post rates of primary care visits, well-child visits, and dental visits within- and between-groups. We also conducted longitudinal analysis of monthly visit rates, comparing the three insurance groups. After Oregon's 2009-2010 CHIP expansions, newly insured patients' utilization rates were more than double their pre-expansion rates [adjusted rate ratios (95 % confidence intervals); increases ranged from 2.10 (1.94-2.26) for primary care visits to 2.77 (2.56-2.99) for dental visits]. Utilization among the newly insured spiked shortly after coverage began, then leveled off, but remained higher than the uninsured group. This study used EHR data to confirm that CHIP expansions are associated with increased utilization of essential pediatric primary and preventive care. These findings are timely to pending policy decisions that could impact children's access to public health insurance in the United States.

Barriers and facilitators of dental service utilization by children aged 8 to 11years in Enugu State, Nigeria.

BackgroundMultiple factors influence a child’s ability to access oral health care. The aim of this study was to identify factors that facilitated and served as barriers to children’s utilization of oral health care services in Enugu, Nigeria.MethodsThe study recruited 1406 primary school pupils aged 8 to 11 years. All the children received oral health education, with the aid of an oral health education curriculum appropriate for their age. After this, referral letters were given to the children. Twelve months later, the study participants were revisited in their schools to obtain information on their reasons for utilizing, or not utilizing an oral health care service in the last 12 months. The association between socio-economic status; form of parenthood; number of siblings, birth rank and reasons for utilization and non-utilization of dental services were assessed. Influence on the child’s predisposition to oral health service utilization on dental visit was also assessed.ResultsOnly 116 (14.7 %) of the 791 children accessible during the 12 months follow-up visit had visited the dental clinic and the main reason for utilization was the desire to fulfill the dentist’s request for dental visit (41.9 %) while parents’ inability to make out time for a dental visit (43.3 %) was the main reason for non-utilization. The odds of utilizing oral health care services for study participants from the middle (AOR: 0.50; CI: 0.31–0.79; P = 0.003) and low (AOR: 0.24; CI: 0.13–0.45; p = <0.001) socioeconomic strata, and those living with guardians/relatives (AOR: 0.08; CI: 0.01–0.60; p = 0.01) were decreased when compared to those living with both parents, respectively. Respondents with positive perception about dental service utilization had increased odds of utilizing oral health care (AOR: 2.96; CI: 1.48–5.90; p = 0.002).ConclusionDentists can be strong motivators for children to utilize oral health care. Time is a significant barrier for the utilization of dental services. The programs designed to address barriers to oral health care utilization for children should be geared towards overcoming the possible threats that socio-economic status and type of parents they have may pose, to reduce inequity in dental service utilization.

Importance and Utility of Children in the light of Quran and Hadith

Islam outlines the basic principles regarding the treatment of the children. According to the teachings of Quran, the material things of this world and children are the test of this life. The Prophet (PUBH) enjoined upon the parents to take care of the religious instruction of their children from the very beginning, otherwise they will be called to account for negligence on the day of judgement. They must be properly brought and taught good manners. In the contemporary world, how to raise children is a major issue. The Muslims are instructed to keep in mind that it is Allah who gives them Rizq and to the children as well. So it is a major sin to kill the children for want and poverty. Allah says: "Kill not your children on a plea of want, We provide sustenance for you and for them" Those who make their children good human being and good Muslim are getting the reward of descendents, provides the parents an equal share of rewards in their graves.

Health literacy and disease-specific knowledge of caregivers for children with sickle cell disease

ABSTRACTThis study was conducted to measure the health literacy (HL) and disease-specific knowledge (DSK) of caregivers for children with sickle cell disease (SCD) and relate them to their child's health care utilization. The authors conducted a cross-sectional study of caregiver-child dyads attending an urban pediatric sickle cell clinic. Caregivers were administered the Shortened Test of Functional Health Literacy (S-TOFHLA) and a locally developed DSK questionnaire. Retrospective review of the child's electronic medical record (EMR) was performed to determine annual emergency department (ED) visits and hospitalizations. A total of 142 caregiver-child dyads were recruited for the study. Less than 5% of caregivers had limited HL, with less education (P =.03) and primary language other than English (P =.04) being the only risk factors. Although caregiver HL was not associated with ED visits or hospitalizations, surprisingly DSK was. Caregivers with higher DSK scores had children with higher annual rates of ED utilization (P =.002) and hospitalizations (P =.001), and these children were also more likely to be classified as high ED utilizers (≥4 visits per year; P =.01). Further, caregiver adherence to medication and clinic visits was associated with their child's age (P =.01). Although HL and DSK are both constructs that measure basic health understanding, they differently affect caregivers' ability to navigate and understand the health care system of children with chronic illnesses. This study suggests that the DSK/health care utilization relationship may be a more important measure than HL for programs following children with sickle cell disease and could also have applications in other pediatric chronic diseases.

Determining Health Care Utilization of Children Placed into Foster Care from the Hospital Electronic Medical Record

Determining Health Care Utilization of Children Placed into Foster Care from the Hospital Electronic Medical Record

Behavioral Problems and Service Utilization in Children with Chronic Illnesses Referred for Trauma-Related Mental Health Services.

Given its prevalence and impact on health and well-being, children's exposure to traumatic experiences is of growing importance to pediatricians and other medical providers. Little is known, however, about the traumatic experiences profiles, trauma-related sequelae, and service use patterns of youth with chronic or recurrent medical problems/disabilities. This study aimed to fill this research gap. Participants were children less than 18 years of age who were referred for assessment and/or treatment services at one of the 56 National Child Traumatic Stress Network centers from 2004 to 2010 across the United States and had experienced at least one of 13 types of traumatic experience(s) (n = 9885; mean = 11 years, SD = 4.3; 52.3% girls). Generalized linear mixed models were used to examine associations among types of trauma, emotional and behavioral problems, and rates of service utilization adjusting for treatment center-level random effects, demographic characteristics, and the total number of types of trauma exposures. Among children seeking treatment for traumatic stress, those with comorbid medical problems/disabilities had different demographic characteristics, different types of trauma exposure, and more service utilization in multiple sectors before trauma treatment entry than those without comorbid medical problems/disabilities. Those without comorbid medical problems/disabilities had higher levels of some types of traumatic exposures, associated symptoms, and higher levels of behavioral problems at home, school, or day care. Those with medical disorders/disabilities were at 30% to 40% higher odds of meeting clinical criteria for hyperarousal and re-experiencing posttraumatic stress disorder symptoms, used more medical and mental health services for trauma, and had more emotional and behavioral concerns. Given that pediatricians are more likely to see children with medical disabilities and concerns than those without, there is an opportunity to ask directly about traumatic exposures and associated symptoms and provide support and interventions to promote resilience. Integrating trauma screening and mental health services into medical care could be especially beneficial for children with chronic medical conditions.

A Study of Predictors of Clinical Outcomes and Healthcare Utilization in Children with Sickle Cell Disease Undergoing Allogeneic Hematopoietic Cell Transplantation

▪Introduction: Current advances in allogeneic hematopoietic cell transplant (alloHCT) may warrant a paradigm shift in managing children with sickle cell disease (SCD). This study characterizes the clinical outcomes and health care utilization (HCU) of alloHCT for pediatric SCD. We hypothesize that early alloHCT will have improved clinical outcomes, and decreased HCU.Methods: The Center for International Blood and Marrow Transplant Research database was used to identify children 21 years or less with alloHCT for SCD in the United States. Patient data included comprehensive research forms (CRF) from 2000-13 and transplant essential data (TED) forms from 2000-11.CRFs provided clinical risk factors associated with overall survival, graft failure, grade III-IV acute GVHD, and GVHD related event free survival (GREFS) - the survival free of graft failure, chronic GVHD, or death. Risk factors included age, gender, performance status, year of alloHCT, prior SCD complications and therapy, CMV status, donor type, conditioning regimen, and GVHD prophylaxis. Due to low event rates and sample size, only univariate analysis of risk factors was performed.TED data was merged with Pediatric Health Information System (PHIS) inpatient data using a probabilistic merging algorithm to determine risk factors and clinical outcomes associated with HCU. Available PHIS adjusted cost data was used to determine the total adjusted cost for all inpatient admissions per patient per hospital day. To standardize these costs, the total adjusted cost per 30 hospital days was calculated for each patient and used as the primary HCU outcome. HCU outcomes were analyzed for the alloHCT year, day 0 to day +365.Results: CRF data for 161 patients showed an overall survival at 2 years of 90% (95% confidence intervals [CI] 85-95%): 96% (95% CI 89-100%) for related and unrelated cord blood transplant (CBT), 94% (95% CI 86-98%) matched siblings (MSD), and 74% (95% CI 54-90%) matched unrelated donors (MUD, p=0.002). All deaths occurred among children with pre-alloHCT complications of SCD, and deaths were due to organ failure (37.5%), infections (25%), GVHD (6.25%).Risk of death was significantly higher for children ≥10 years old (HR 21, p=0.003) and MUD compared to MSD (HR 5.88, p=0.005) but lower with cyclosporine A (CSA) GVHD prophylaxis versus FK506 (HR 0.33, p=0.031). 75% of deaths occurred before day +42.Cumulative acute GVHD incidence at day 100 was 14% (95% CI 9-20%)and was associated with age ≥10yrs (HR 2.63, p=0.035). Chronic GVHD incidence was 31% (95% CI 23-38%) at 2yrs, and factors associated were age ≥10yrs (HR 1.92, p=0.034), MUD vs MSD (HR 2.53, p=0.017), and CSA vs FK506 prophylaxis (HR 0.48, p=0.018). Chronic GVHD risk increased significantly after 2006 (HR 2.81, p=0.018). The 2yr GREFS was 64% (95% CI 56-71%). Age ≥10yrs (HR 2.2, p=0.005), MUD (vs MSD, HR 3.00, p=0.002) and CSA prophylaxis (vs FK506, HR 0.49, p=0.011) were significantly associated with this outcome.Among the 175 patients with combined TED and PHIS data, the median total adjusted cost was $117,393 per 30 hospital days per patient (range: $36,244-$515,640) during the alloHCT year with a median of 53 hospital days per patient (range: 16-304). Age ≥10yrs and HCU were not significantly associated (p=0.775). MSD had the lowest HCU compared to CBT and unrelated transplants (p<0.001). CBT and peripheral blood stem cells were associated with higher HCU compared to bone marrow (p=0.004). Increased HCU was associated with prior stroke (p=0.0004) and pain crises (p=0.0094) but not acute chest syndrome (p=0.2913). Overall SCD complication and severity indices correlated with increased HCU (p=0.052, p=0.0219, respectively).Conclusions: AlloHCT outcomes in children with SCD were linked to age and donor type suggesting that early alloHCT before age 10 years is preferred. Specifically, SCD severity and MUD alloHCT are associated with poorer outcomes and increased HCU. This supports the recommendation of early alloHCT, prior to onset of SCD complications, for children with SCD and an available MSD.Donor source and type had a significant impact on both outcomes and HCU. CBT outcomes were similar to MSD bone marrow; yet CBT had higher HCU suggesting additional analysis is needed to determine if the clinical benefit outweighs the cost. Further analysis is also needed to better understand and mitigate risk factors associated with poor outcomes and increased HCU following MUD alloHCT. DisclosuresArnold:Robert Wood Johnson Foundation Harold Amos Medical Faculty Development Program: Other: award. Hahn:NIH/NHLBI: Research Funding; Novartis: Equity Ownership.

Factors Determining Children's Private Health Insurance Enrolment and Healthcare Utilization Patterns: Evidence From the 2008 to 2011 Health Panel Data.

Objectives:Parental socioeconomic status (SES) exerts a substantial influence on children’s health. The purpose of this study was to examine factors determining children’s private health insurance (PHI) enrolment and children’s healthcare utilization according to PHI coverage.Methods:Korea Health Panel data from 2011 (n=3085) was used to explore the factors determining PHI enrolment in children younger than 15 years of age. A logit model contained health status and SES variables for both children and parents. A fixed effects model identified factors influencing healthcare utilization in children aged 10 years or younger, using 2008 to 2011 panel data (n=9084).Results:The factors determining children’s PHI enrolment included children’s age and sex and parents’ educational status, employment status, and household income quintile. PHI exerted a significant effect on outpatient cost, inpatient cost, and number of admissions. Number of outpatient visits and total length of stay were not affected by PHI status. The interaction between PHI and age group increased outpatient cost significantly.Conclusions:Children’s PHI enrolment was influenced by parents’ SES, while healthcare utilization was affected by health and disability status. Therefore, the results of this study suggest disparities in healthcare utilization according to PHI enrollment.

Usefulness of Arrhythmias as Predictors of Death and Resource Utilization in Children with Myocarditis: Anderson BR, Silver ES, Richmond ME, et al. Am J Cardiol 2014;114:1400–5.

Usefulness of Arrhythmias as Predictors of Death and Resource Utilization in Children with Myocarditis: Anderson BR, Silver ES, Richmond ME, et al. Am J Cardiol 2014;114:1400–5.

The Rotten Kid Theorem and Almost Transferable Utility

We assume like Bergstrom (1989) and Dijkstra (2007) that each child's utility is treated as a normal good in the altruistic head's utility function, and show that if utility functions lead to Almost Transferable Utility children can manipulate the tradeoff between their own utility and the parent's utility through their own actions, but they have an incentive to maximize the altruistic head's utility if the altruistic head also considers children's utilities as Hicksian substitutes and hence the rotten kid theorem holds. A special class of such altruistic utility functions that treat utilities of children as normal and Hicksian substitutes are the Generalized Utilitarian Welfare functions.

Welfare Reform and Children's Health.

This study investigates the effect of the Temporary Aid to Needy Families (TANF) program on children's health outcomes using data from the Survey of Income and Program Participation over the period 1994 to 2005. The TANF policies have been credited with increased employment for single mothers and a dramatic drop in welfare caseload. Our results show that these policies also had a significant effect on various measures of children's medical utilization among low-income families. These health measures include a rating of the child's health status reported by the parents, the number of times that parents consulted a doctor, and the number of nights that the child stayed in a hospital. We compare the overall changes of health status and medical utilization for children with working and nonworking mothers. We find that the child's health status as reported by the parents is affected by the maternal employment status.

Comparison of Resource Utilization in Children Discharged Versus Children That Remain Hospitalized Following Chemotherapy for Acute Myeloid Leukemia

Treatment for pediatric acute myeloid leukemia (AML) involves multiple courses of intensive chemotherapy leading to prolonged neutropenia with substantive infection risks. Patients are typically hospitalized at each course for the duration of chemotherapy and associated marrow aplasia. Evaluations of early discharge and outpatient supportive care in adult AML patients demonstrate comparable mortality and shorter lengths of stay compared to standard discharge. Similar data in the pediatric setting are limited. We used data from the Pediatric Health Information System (PHIS) to evaluate course-specific mortality and resource utilization in AML patients who were discharged prior to count recovery relative to comparable patients who remained hospitalized.We used a cohort of children treated for new onset AML at children’s hospitals in the US contributing to PHIS. Analyses were restricted to patients considered eligible for discharge prior to count recovery. Patients were categorized at each course as early or standard discharge. Discharges within 3 days after chemotherapy completion were considered “early”. Course-specific follow-up started on the last day of chemotherapy and continued until the earliest of: start of the subsequent course, death, or 50 days after commencement of chemotherapy. Resource utilization was determined based on daily billing data and reported as days of use per 100 hospital days. Case fatality rates and duration of hospitalization were compared using chi-square and Wilcoxon rank sum tests. Poisson regression with inpatient days as offset was used to compare resource use by discharge status.The study population included 996 patients representing 2358 courses. Fewer patients were discharged early following Induction I (7%) compared to subsequent courses (22-24%). Rates of early discharge varied greatly by hospital ranging from 0% to 100%. Across courses, patients discharged early experienced 8-12 fewer inpatient days (all p<0.001) despite readmission rates >90%. Case fatality rates were low across courses (0-1.3%) and did not differ significantly by discharge status. However, more early discharge patients required ICU level care at each course (7.2-18.1%) compared to standard discharge patients (2.0%-8.7%; all p <0.02). Table 1 presents resource utilization by discharge status with corresponding rate ratios (RR). Rates of antibiotic, vasopressor, and oxygen therapy use were each consistently elevated for early discharge patients. Following Intensification I and II, blood product use was also higher among those discharged early.The data suggest a similar overall survival and shorter hospitalization following early compared to standard discharge. However, based on increased rates of vasopressor and antibiotic use, early discharge patients may be at greater risk for life-threatening chemotherapy-related infectious complications.Table 1:Resource utilization (per 100 hospital days) by Discharge StatusEarly DischargeStandard DischargeAdjusted1 RR (95% CI)AntibioticsInduction I153.6131.51.17 (1.00, 1.36)*Induction II146.789.71.64 (1.48, 1.81)*Intensification I144.295.11.52 (1.38, 1.67)*Intensification II162.4117.01.39 (1.27, 1.52)*AntifungalsInduction I78.991.60.87 (0.72, 1.05)Induction II84.190.20.93 (0.86, 1.01)Intensification I79.387.90.90 (0.82, 1.00)Intensification II80.684.10.96 (0.86, 1.07)AntiviralsInduction I6.211.60.56 (0.20, 1.56)Induction II4.05.90.58 (0.41, 1.11)Intensification I8.713.10.66 (0.39, 1.12)Intensification II5.713.00.44 (0.19, 0.98)Blood ProductsInduction I34.629.91.16 (0.99, 1.35)Induction II26.924.21.12 (0.99, 1.26)Intensification I28.420.51.38 (1.11, 1.72)*Intensification II39.129.11.34 (1.17, 1.55)*VasopressorsInduction I2.40.46.47 (2.67, 15.7)*Induction II3.50.75.04 (2.13, 12.0)*Intensification I3.60.56.62 (2.91, 15.0)*Intensification II3.81.03.69 (1.74, 7.83)*Parenteral nutritionInduction I14.517.00.85 (0.43, 1.70)Induction II10.39.51.09 (0.64, 1.86)Intensification I7.56.11.24 (0.76, 2.02)Intensification II11.08.41.30 (0.87, 1.96)Supplemental OxygenInduction I4.60.94.95 (1.87, 13.1)*Induction II2.00.53.86 (1.89, 7.92)*Intensification I1.60.72.33 (1.15, 4.77)*Intensification II4.71.62.93 (1.44, 5.93)*1adjusted for age, race, sex, and insurance status;*statistically significant DisclosuresNo relevant conflicts of interest to declare.

Treatment Toxicity and Supportive Care Utilization in Children with Down Syndrome and Acute Lymphoid Leukemia at Free-Standing Pediatric Hospitals in the United States

Introduction: Children with Down syndrome (DS) and acute lymphoid leukemia (ALL) have inferior outcomes due to increased treatment-related toxicity. In 2005 and 2006, multiple clinical trial protocols were modified to increase supportive care measures for these children; however, national supportive care utilization patterns for these patients have not been subsequently evaluated.Methods: A validated retrospective cohort of pediatric patients with ALL admitted from 1999 to 2011 was assembled from the Pediatric Health Information System (PHIS) database to examine organ toxicity, sepsis, and resource utilization in children with and without DS. A sub-analysis of mortality in children with DS ALL before and after the 2006 supportive care recommendation was also conducted.Results: 10699 patients with ALL were identified; 298 of these children had DS ALL (2.8%). Children with DS ALL had a significantly higher percentage of patients who were female (52% vs. 44%, p = 0.003), white (83% vs. 75%, p = 0.005), publically insured (48% vs. 38%, p = 0.002), and who had a congenital cardiac abnormality (26% vs. 2%, p < 0.0001). DS was associated with an increased risk of cardiovascular failure (OR 2.0, 95% CI 1.6-2.7), respiratory failure (OR 2.1, 95% CI: 1.6-2.9) and sepsis (OR 1.8, 95% CI: 1.4-2.4) in adjusted analyses (Table 1). Children with DS ALL had significantly greater utilization of antibiotics indicated for gram-positive infections, quinolones, azoles, supplemental oxygen, and ventilation, as well as significantly less utilization of opiate and non-opiate analgesics, PCAs, and antiemetics compared to children with non-DS ALL. Cardiac failure and sepsis rates were decreased in all children diagnosed after 2006 (OR 0.8, CI: 0.8-0.9, and OR 0.7, CI: 0.6-0.7, respectively). Children with DS ALL demonstrated a non-significant decrease in mortality after the 2006 guideline implementation (6.6% to 2.8%, p=0.116).Conclusion: In conclusion, children with DS ALL have significantly increased cardiac, respiratory, and infectious toxicity. The elevated antibiotic and antifungal usage in children with DS ALL and trend towards mortality decrease may suggest successful implementation of supportive care measures; however, decreased analgesic and antiemetic use may suggest other unmet supportive care needs in these patients. TableTable 1. Adjusted analyses of organ failure by Down syndrome status, demographics, congenital cardiac defects, and year of admission.CardiovascularFailure OR (95% CI)RespiratoryFailure OR (95% CI)Sepsis OR (95% CI)NeurologicFailure OR (95% CI)LiverFailure OR (95% CI)Down syndrome2.0 (1.6-2.7)***2.1 (1.6-2.9)***1.8 (1.4-2.4)***3.4 (1.9-6.2)***1.4 (1.0-1.9)*Age< 1 yr.4.5 (3.5-5.8)***7.4 (5.7-9.7)***8.3 (4.9-8.2)***1.4 (0.6-3.3)1.9 (1.4-2.5)***³ 1 yr. and < 5 yrs.0.7 (0.6-0.7)***0.7 (0.6-0.8)***0.9 (0.7-1.0)*0.4 (0.3-0.7)**1.0 (0.8-1.1)³ 5 yrs. and < 10 yrs.-----³ 10 yrs. and < 15 yrs.2.2 (1.9-2.5)***1.8 (1.5-2.1)***1.7 (1.4-1.9)***2.1 (1.4-3.2)**1.4 (1.2-1.6)***³ 15 yrs.2.4 (2.0-2.8)***2.2 (1.8-2.7)***2.0 (1.6-2.3)***2.7 (1.7-1.2)***1.7 (1.4-2.0)***RaceNon-Whitea0.9 (0.8-1.0)1.1 (0.9-1.2)1.0 (0.9-1.2)1.4 (1.0-2.0)*0.8 (0.7-0.9)**White----InsurancePublicb1.3 (1.1-1.4)***1.2 (1.1-1.4)**1.5 (1.3-1.6)***1.3 (0.9-1.9)1.0 (0.9-1.1)Otherc1.2 (1.0-1.3)*0.8 (0.7-1.0)*1.0 (0.9-1.1)1.5 (1.0-2.3)*1.0 (0.8-1.1)Private----GenderFemale1.1 (1.0-1.2)*1.0 (0.9-1.1)1.2 (1.1-1.3)**1.0 (0.7-1.3)1.1 (1.0-1.2)Male----Congenital Cardiac Defectd1.6 (1.2-2.1)**1.5 (1.1-2.1)**1.3 (0.9-1.7)1.7 (0.8-3.4)1.1 (0.8-1.6)Diagnosis in 2006-20110.8 (0.8-0.9)**1.0 (0.9-1.2)0.7 (0.6-0.7)***0.8 (0.6-1.0)1.0 (0.9-1.1)a Non-white includes Black, Asian/Pacific Islander, American Indian, Other, and Unknown. bPublic includes Medicaid, Medicare, other government, and Title V. cOther includes Self-pay, Other, and Unknown. d Congenital cardiac defect was defined by ICD-9 codes as described in supplemental table 1. *** p < 0.001; ** p < 0.01; * p < 0.05. DisclosuresNo relevant conflicts of interest to declare.

Quality Of Life Of Diarrheal Children And Caregivers In Thailand.

Objectives: To estimate the utility scores for diarrheal children aged under 5 years and their caregivers and to identify the influencing factors which affected on these. Methods: Hospitalized diarrheal children aged between 2 months and 5 years and their caregivers at were recruited in this cross-sectional study at three hospitals in Phetchabun province. The EQ-5D instrument was used to collect the quality of life (QoL) data at the first date of admission. Quality of life of diarrheal children was measured as proxy report from caregiver while QoL of caregiver was measured as self-report. The raw data was converted to utility values using the Thai algorithm. The clinical severity of diarrheal children was rated using the Vesikari clinical severity scoring system. Stepwise multivariate linear regression was applied to explore the impact of the various factors on the utility value of children and caregivers. Results: 468 children and caregivers were included in this study. Mean children's age was 1.77 years. The caregivers rated the mean child's utility and themselves as 0.604 (95%CI: 0.592, 0.615) and 0.618 (95%CI: 0.606, 0.629), respectively. Mainly domains of diarrheal children were affected as pain/discomfort and anxiety/ depression similarly to their caregivers. On multivariate regression analysis, factors which affected the children's utility significantly were Vesikari score, child's age and child's gender. Next, reduced QoL of their caregivers related to caregiver's gender and Vesikari score. Conclusions: Diarrhea had an impact on quality of life of children and their caregivers. It appeared that QoL of children with diarrhea was impacted worse in girls, those with high severity score and was associated with age. In addition, the diarrheal severity and female gender reduced the impact of diarrhea on QoL of caregivers. These results can be useful to evaluate the cost-effectiveness of vaccines against diarrhea such as rotavirus vaccines.

Usefulness of Arrhythmias as Predictors of Death and Resource Utilization in Children With Myocarditis

Myocarditis in children can result in significant morbidity and mortality, yet limited prognostic data exist. The aim of this study was to test the hypothesis that pediatric patients with arrhythmias during hospitalization for acute myocarditis have worse outcomes and increased resource utilization. A retrospective study using the Pediatric Health Information System database was performed to examine the effects of clinically significant arrhythmias on in-hospital mortality, length of stay, and costs per day. Data were obtained for children ≤18years of age, discharged from January 1, 2004 to March 31, 2013, with a diagnosis of myocarditis. Clinically significant tachyarrhythmia was defined as supraventricular tachycardia, atrial fibrillation or flutter, or ventricular tachycardia or fibrillation in patients receiving antiarrhythmic medications or cardioversion. Clinically significant bradyarrhythmia was defined as second-degree, complete, or other heart block for which a pacemaker was placed. Multivariable analyses were performed. A total of 2,041 subjects with myocarditis were identified. Tachyarrhythmias were reported in 234 (11.5%) and bradyarrhythmias in 22 (1.1%). Overall mortality was 8.7%. In multivariable analyses, after considering the effects of gender, age at admission, geographic region, year and month of admission, presence of congenital heart disease or an identified virus, and use of steroids, nonsteroidal anti-inflammatories, or inotropes, and after controlling for clustering by institution, tachyarrhythmias were associated with a 2.3 times increase in the odds of mortality (95% confidence interval 1.6 to 3.3, p < 0.001), a 58% increase in length of stay (95% confidence interval 38% to 82%, p < 0.001), and a 28% increase in costs per day (95% confidence interval 15% to 43%, p < 0.001). Bradyarrhythmia was not associated with mortality, length of stay, or costs per day. In conclusion, tachyarrhythmias are associated with significant increases in mortality and resource utilization in children with myocarditis.

Mobile phone use and health symptoms in children.

To investigate the mobile phone (MP) use for talking in relation to health symptoms among 2042 children aged 11-15 years in Taiwan. A nationwide, cross-sectional study, using the computer assisted telephone interview (CATI) technique, was conducted in 2009 to collect information on children's utilization of MPs and the perceived health symptoms reported by their parents. The overall prevalence of MP use in the past month was estimated at 63.2% [95% confidence interval (CI)=61.1-65.3%]. MP use was associated with a significantly increased adjusted odds ratio (AOR) for headaches and migraine (1.42, 95% CI=1.12-1.81) and skin itches (1.84, 95% CI=1.47-2.29). Children who regularly used MPs were also considered to have a health status worse than it was 1 year ago (β=0.27, 95% CI=0.17-0.37). Although the cross-sectional design precludes the causal inference for the observed association, our study tended to suggest a need for more cautious use of MPs in children, because children are expected to experience a longer lifetime exposure to radiofrequency electromagnetic fields (RF-EMF) from MPs.

Children's utilization of emotion expectancies in moral decision-making

This study investigated the relevance of emotion expectancies for children's moral decision-making. The sample included 131 participants from three different grade levels (M = 8.39 years, SD = 2.45, range 4.58-12.42). Participants were presented a set of scenarios that described various emotional outcomes of (im)moral actions and asked to decide what they would do if they were in the protagonists' shoes. Overall, it was found that the anticipation of moral emotions predicted an increased likelihood of moral choices in antisocial and prosocial contexts. In younger children, anticipated moral emotions predicted moral choice for prosocial actions, but not for antisocial actions. Older children showed evidence for the utilization of anticipated emotions in both prosocial and antisocial behaviours. Moreover, for older children, the decision to act prosocially was less likely in the presence of non-moral emotions. Findings suggest that the impact of emotion expectancies on children's moral decision-making increases with age. Contrary to happy victimizer research, the study does not support the notion that young children use moral emotion expectancies for moral decision-making in the context of antisocial actions.

Mo1854 Clinical Characteristics, Treatment Outcomes, and Resource Utilization in Children and Adults With Eosinophilic Gastroenteritis

Mo1854 Clinical Characteristics, Treatment Outcomes, and Resource Utilization in Children and Adults With Eosinophilic Gastroenteritis

The Effect of Geographic Moves on Mental Healthcare Utilization in Children

Geographic moves have been reported to have a negative impact on the mental health of children, but it is often difficult to separate the effect of the move from the circumstances that impelled it. Military populations may offer a way to examine this issue. Moves are common in military families, but parental employment and healthcare coverage remain constant. Children of military parents with geographic moves in 2008 were compared with those without geographic moves with regard to the odds of mental health service use in2009. This study included 548,336 children aged 6-17years, and 179,486 (25%) children moved in 2008. Children aged 6-11 years with a geographic move had higher odds of mental health and outpatient visits (odds ratio [OR] 1.03; 95% confidence interval [CI] 1.01-1.06). Children aged 12-17 years with a geographic move had higher odds of mental outpatient visits (OR 1.04; 95% CI 1.01-1.07), psychiatric hospitalizations (OR 1.19; 95% CI 1.07-1.32), and emergency psychiatric visits (OR 1.20; 95% CI 1.07-1.32). Children with a geographic move in the previous year have increased odds of mental health encounters. Among adolescents, this increase extends to psychiatric hospitalizations and emergency visits.

A50: Mental Health and Healthcare Utilization in Children with SLE and MCTD

Background/Purpose:Depression and anxiety are prevalent in children with systemic lupus erythematosus (SLE), representing a health‐related burden. SLE healthcare utilization is high, and the impact of these disorders on utilization is unclear. We aimed to characterize the association of depression and anxiety with healthcare utilization in children with SLE and the SLE‐like syndrome of mixed connective tissue disease (MCTD).Methods:We conducted a cross‐sectional analysis of pediatric‐onset SLE and MCTD patients with disease duration &gt;=6 months, consecutively recruited from CHOP rheumatology and nephrology outpatient clinics. The Patient Health Questionnaire 9 (PHQ‐9) and the Screen for Child Anxiety Related Disorders (SCARED) were used to measure depression and anxiety, respectively. The primary outcome was average outpatient visits per person‐year, measured as a composite of rheumatology, nephrology, primary care and emergency department (ED) visits within the preceding year. Secondary outcomes were average hospital visits and telephone consultations to rheumatology/nephrology per person‐year, within the preceding year. Multivariable negative binomial regression analysis was performed including the following covariates: age, race/ethnicity, education level, disease duration and disease activity.Results:We recruited 42 patients, with a median SLEDAI (SLE Disease Activity Index) score of 2 (IQR 0,4) and median physician VAS (visual assessment score) of 0 (IQR 0,1). We identified symptoms of depression in 8 patients (19%), anxiety in 9 patients (21%), and comorbid depression and anxiety in 4 patients (10%). Only 14% of patients with positive screens for depression and/or anxiety had previous mental health care. The average number of outpatient visits per person‐year was 4.6 [95% confidence interval (CI) 3.4–6.2], hospitalizations 0.2 (95% CI 0.09–0.66) and phone consultations 0.8 (95% CI 0.53–1.35). In multivariable analysis, there was a statistically significant decrease in outpatient visits for those with depressive symptoms compared to those without (IRR = 0.6, 95%CI 0.4–0.9, p = 0.02). Secondary analysis showed a statistically significant decrease in primary care provider (PCP) visits in the depressed group (IRR = 0.33, 95%CI 0.16–0.7, p &lt; 0.01); however, there was no difference in rheumatology, nephrology or ED visits. Depressive symptoms were also not associated with differences in hospitalizations or phone consultations. There was no significant association of anxiety symptoms with the healthcare utilization outcomes.Conclusion:Depression and anxiety symptoms were prevalent in this cohort of children with minimally active SLE and MCTD. Those with depressive symptoms had significantly decreased outpatient visits, particularly to the PCP. Rheumatology and nephrology providers are therefore an important point of contact for identifying mental health disorders in these patients. Further investigation is needed to understand the patient and caregiver factors contributing to differences in healthcare provider contact for pediatric SLE patients with depressive symptoms.