Achamyeleh Gebremariam

Decline in Varicella-Related Hospitalizations and Expenditures for Children and Adults After Introduction of Varicella Vaccine in the United States

Objective. Universal childhood immunization against varicella in the United States, first recommended in 1995, was predicted to lead to significant decreases in varicella-related hospitalization rates and corresponding charges. Previous studies have not found such effects. We studied trends in varicella-related hospitalization rates and associated charges before and after introduction of varicella vaccine. Methods. We examined hospitalization and charge data from the Nationwide Inpatient Sample for the years 1993–2001, representative of national hospitalization patterns for children and adults. We derived weighted estimates of population-adjusted, varicella-related hospitalization rates and inflation-adjusted, varicella-related hospital charges. Results. The annual varicella-related hospitalization rate exceeded 0.5 hospitalizations per 10 000 US population from 1993 to 1995, declined to 0.26 per 10 000 by 1999, and again halved to 0.13 per 10 000 by 2001. Hospitalization rates declined most substantially among individuals primarily targeted for vaccination (0- to 4-year-old children) but decreased among youths aged 5 to 19 years and among adults as well. Concomitantly, varicella-related hospital charges declined from

Getting heavier, younger: Trajectories of obesity over the life course

161.1 million (95% confidence interval:

Public Awareness, Perception, and Use of Online Physician Rating Sites

130.5 million–

Incremental hospital charges associated with obesity as a secondary diagnosis in children

191.8 million) in 1993 to

Bisphenol A and Chronic Disease Risk Factors in US Children

66.3 million (95% confidence interval:

Herpes Zoster–Related Hospitalizations and Expenditures Before and After Introduction of the Varicella Vaccine in the United States

50.9 million–

Evaluation of Nonfasting Tests to Screen for Childhood and Adolescent Dysglycemia

81.7 million) in 2001 (all 2001

Longitudinal Associations Between Poverty and Obesity From Birth Through Adolescence

US). Among expected primary payers, inflation-adjusted declines in varicella-related hospital discharges–related charges accrued to Medicaid, private insurance, and “other” payers (including uninsured and self-pay) but not to Medicare. Conclusions. This national analysis indicates a clinically and statistically significant reduction in varicella-related hospitalizations for children and adults associated with childhood varicella immunization in the United States and a corresponding significant decrease in hospital charges.

Trends in High-Turnover Stays Among Children Hospitalized in the United States, 1993-2003

Context:Although recent trends in obesity have been well documented, generational patterns of obesity from early childhood through adulthood across birth cohorts, which account for the recent epidemic of childhood obesity, have not been well described. Such trends may have implications for the prevalence of obesity-associated conditions among population subgroups, including type 2 diabetes.Objective:Our objective was to evaluate trajectories of obesity over the life course for the US population, overall and by gender and race.Design, Setting and Participants:We conducted an age, period and birth cohort analysis of obesity for US individuals who participated in the National Health and Nutrition Examination Surveys (NHANES) (1971–2006).Main Outcome Measures:Obesity was defined as a body mass index ⩾95th percentile for individuals aged 2–16 years or ⩾30 kg  m–2 among individuals older than 16 years. Age was represented by the age of the individual at each NHANES, period was defined by the year midpoint of each survey, and cohort was calculated by subtracting age from period.Results:Recent birth cohorts are becoming obese in greater proportions for a given age, and are experiencing a greater duration of obesity over their lifetime. For example, although the 1966–1975 and 1976–1985 birth cohorts had reached an estimated obesity prevalence of at least 20% by 20–29 years of age, this level was only reached by 30–39 years for the 1946–1955 and 1956–1965 birth cohorts, by 40–49 years for the 1936–1945 birth cohort and by 50–59 years of age for the 1926–1935 birth cohort. Trends are particularly pronounced for female compared with male, and black compared with white cohorts.Conclusions:The increasing cumulative exposure to excess weight over the lifetime of recent birth cohorts will likely have profound implications for future rates of type 2 diabetes, and mortality within the US population.

Which Pediatricians Are Providing Care to America's Children? An Update on the Trends and Changes During the Past 26 Years

Patients are increasingly turning to online physician ratings, just as they have sought ratings for other products and services. Much of what is known about these sites comes from studies of the ratings left on them.1 Little is known about the public’s awareness and use of online physician ratings, and whether these sites influence decisions about selecting a physician.