Karen L. Olson

Stability of babyfaceness and attractiveness across the life span.

Differential, structural, and absolute stability of babyfaceness and attractiveness at 5 ages were investigated. Attractiveness had differential stability across the life span. Babyfaceness had differential stability from childhood through the 30s for males and through adolescence for females. Consistent with sexual dimorphisms in facial maturation, males had less differential stability in babyfaceness from childhood to puberty than females. Structural stability of facial appearance, as reflected in the relationship between babyfaceness and attractiveness across the life span, was low, with these qualities positively related for females in childhood and for both sexes in their 30s and 50s but unrelated in puberty and adolescence. Absolute stability of babyfaceness and attractiveness was also low, with mean levels decreasing across the life span. Contrary to cultural stereotypes, age-related decreases in attractiveness were equal for male and female Ss.

Patients Treated at Multiple Acute Health Care Facilities: Quantifying Information Fragmentation

BACKGROUND Fragmentation of medical information places patients at risk for medical errors, adverse events, duplication of tests, and increased costs. We sought to quantify, at the population level, the burden of fragmentation in the acute care setting across the state of Massachusetts by measuring the rates at which individuals seek care across multiple sites. METHODS A retrospective observational study of all adult patients with at least 2 visits or hospitalizations to the emergency departments, inpatient units, and observation units in Massachusetts from October 1, 2002, to September 30, 2007. RESULTS The 3,692,178 adult patients who visited an acute care site during our study period accounted for 12,758,498 acute care visits. A total of 1,130,124 adult patients (31%) visited 2 or more hospitals during the study period, accounting for 56.5% of all acute care visits, while a subgroup of 43,794 patients (1%) visited 5 or more hospitals, contributing to almost one-tenth of all acute visits. Patients who visited multiple sites were younger (P < .001), more likely to be male (P < .001), more likely to have a primary psychiatric diagnosis (P < .001), and more frequently hospitalized (P < .001) and incurred higher charges than patients who used only a single site of care (P < .001). CONCLUSIONS A large number of patients seek care at multiple acute care sites. These findings provide one basis for assessing the value of an integrated electronic health information system for clinicians caring for patients across sites of care and therefore the return on investment in health information technology.

Use of emergency department chief complaint and diagnostic codes for identifying respiratory illness in a pediatric population.

Objectives: (1) To determine the value of emergency department chief complaint (CC) and International Classification of Disease diagnostic codes for identifying respiratory illness in a pediatric population and (2) to modify standard respiratory CC and diagnostic code sets to better identify respiratory illness in children. Results: We determined the sensitivity and specificity of CC and diagnostic codes by comparing code groups with a criterion standard. CC and diagnostic codes for 500 pediatric emergency department patients were retrospectively classified as respiratory or nonrespiratory. Respiratory diagnostic codes were further classified as upper or lower respiratory. The criterion standard was a blinded, reviewer-assigned illness category based on history, physical examination, test results, and treatment. We also modified our respiratory code sets to better identify respiratory illness in this population. Methods: Four hundred ninety-six charts met inclusion criteria. By the criterion standard, 87 (18%) patients had upper and 47 (10%) had lower respiratory illness. The specificity of CC and diagnostic codes groups was >0.97 [95% confidence interval (CI) 0.95-0.98]. The code group sensitivities were as follows: CC was 0.47 (95% CI 0.38-0.55), upper respiratory diagnostic was 0.56 (95% CI 0.45-0.67), lower respiratory diagnostic was 0.87 (95% CI 0.74-0.95), and combined CC and/or diagnostic was 0.72 (95% CI 0.63-0.79). Modifying the respiratory code sets to better identify respiratory illness increased sensitivity but decreased specificity. Conclusions: Diagnostic and CC codes have substantial value for emergency department syndromic surveillance. Adapting our respiratory code sets to a pediatric population forced a tradeoff between sensitivity and specificity.

Pediatric Versus Adult Drug Trials for Conditions With High Pediatric Disease Burden

BACKGROUND AND OBJECTIVE: Optimal treatment decisions in children require sufficient evidence on the safety and efficacy of pharmaceuticals in pediatric patients. However, there is concern that not enough trials are conducted in children and that pediatric trials differ from those performed in adults. Our objective was to measure the prevalence of pediatric studies among clinical drug trials and compare trial characteristics and quality indicators between pediatric and adult drug trials. METHODS: For conditions representing a high burden of pediatric disease, we identified all drug trials registered in ClinicalTrials.gov with start dates between 2006 and 2011 and tracked the resulting publications. We measured the proportion of pediatric trials and subjects for each condition and compared pediatric and adult trial characteristics and quality indicators. RESULTS: For the conditions selected, 59.9% of the disease burden was attributable to children, but only 12.0% (292/2440) of trials were pediatric (P < .001). Among pediatric trials, 58.6% were conducted without industry funding compared with 35.0% of adult trials (P < .001). Fewer pediatric compared with adult randomized trials examined safety outcomes (10.1% vs 16.9%, P = .008). Pediatric randomized trials were slightly more likely to be appropriately registered before study start (46.9% vs 39.3%, P = .04) and had a modestly higher probability of publication in the examined time frame (32.8% vs 23.2%, P = .04). CONCLUSIONS: There is substantial discrepancy between pediatric burden of disease and the amount of clinical trial research devoted to pediatric populations. This may be related in part to trial funding, with pediatric trials relying primarily on government and nonprofit organizations.

Validation of Syndromic Surveillance for Respiratory Infections

Study objective A key public health question is whether syndromic surveillance data provide early warning of infectious outbreaks. One cause for skepticism is that biological correlates of the administrative and clinical data used in these systems have not been rigorously assessed. This study measures the value of respiratory data currently used in syndromic surveillance systems to detect respiratory infections by comparing it against criterion standard viral testing within a pediatric population. Methods We conducted a longitudinal study with prospective validation in the emergency department (ED) of a tertiary care children’s hospital. Children aged 7 years or younger who presented with a respiratory syndrome or who were tested for respiratory syncytial virus (RSV), influenza virus, parainfluenza virus, adenovirus, or enterovirus between January 1993 and June 2004 were included. We assessed the predictive ability of the viral tests by fitting generalized linear models to respiratory syndrome counts. Results Of 582,635 patient visits, 89,432 (15.4%) were for respiratory syndromes, and of these, 7,206 (8.1%) patients were tested for the viruses of interest. RSV was significantly related to respiratory syndrome counts (adjusted rate ratio [RR] 1.33; 95% confidence interval [CI] 1.04 to 1.71). In multivariate models including all viruses tested, influenza virus was also a significant predictor of respiratory syndrome counts (RR 1.47; 95% CI 1.03 to 2.10). This model accounted for 81.6% of the observed variability in respiratory syndrome counts. Conclusion Respiratory syndromic surveillance data strongly correlate with virologic test results in a pediatric population, providing evidence of the biologic validity of such surveillance systems. Real-time outbreak detection systems relying on syndromic data may be an important adjunct to the current set of public health systems for the detection and surveillance of respiratory infections.

AEGIS: a robust and scalable real-time public health surveillance system

In this report, we describe the Automated Epidemiological Geotemporal Integrated Surveillance system (AEGIS), developed for real-time population health monitoring in the state of Massachusetts. AEGIS provides public health personnel with automated near-real-time situational awareness of utilization patterns at participating healthcare institutions, supporting surveillance of bioterrorism and naturally occurring outbreaks. As real-time public health surveillance systems become integrated into regional and national surveillance initiatives, the challenges of scalability, robustness, and data security become increasingly prominent. A modular and fault tolerant design helps AEGIS achieve scalability and robustness, while a distributed storage model with local autonomy helps to minimize risk of unauthorized disclosure. The report includes a description of the evolution of the design over time in response to the challenges of a regional and national integration environment.

Evaluation of Influenza Prevention in the Workplace Using a Personally Controlled Health Record: Randomized Controlled Trial

Background Personally controlled health records (PCHRs) are accessible over the Internet and allow individuals to maintain and manage a secure copy of their medical data. These records provide a new opportunity to provide customized health recommendations to individuals based on their record content. Health promotion programs using PCHRs can potentially be used in a variety of settings and target a large range of health issues. Objectives The aim was to assess the value of a PCHR in an employee health promotion program for improving knowledge, beliefs, and behavior around influenza prevention. Methods We evaluated a PCHR-based employee health promotion program using a randomized controlled trial design. Employees at Hewlett Packard work sites who reported reliable Internet access and email use at least once every 2 days were recruited for participation. PCHRs were provided to all participants for survey administration, and tailored, targeted health messages on influenza illness and prevention were delivered to participants in the intervention group. Participants in the control group received messages addressing cardiovascular health and sun protection. The main outcome measure was improvement in knowledge, beliefs, and behavior around influenza prevention. Secondary outcomes were influenza vaccine rates among household members, the impact of cardiovascular health and sun protection messages on the control group, and the usability and utility of the PCHR-based program for employees. Results The intervention did not have a statistically significant effect on the influenza knowledge elements we assessed but did impact certain beliefs surrounding influenza. Participants in the intervention group were more likely to believe that the influenza vaccine was effective (OR = 5.6; 95% CI = 1.7-18.5), that there were actions they could take to prevent the flu (OR = 3.2; 95% CI = 1.1-9.2), and that the influenza vaccine was unlikely to cause a severe reaction (OR = 4.4; 95% CI = 1.3-15.3). Immunization rates did not differ between the intervention and control groups. However, participants in the intervention group were more likely to stay home during an infectious respiratory illness compared with participants in the control group (39% [16/41] vs 14% [5/35], respectively; P = .02). The program also succeeded in improving recognition of the signs of heart attack and stroke among participants in the control group. Overall, 78% of participants rated the PCHR as “extremely/very” easy to use, and 73% responded that they would be “extremely/very” likely to participate again in a PCHR-based health promotion system such as this one. Conclusions With a small sample size, this study identified a modest impact of a PCHR-based employee health program on influenza prevention and control. Employees found the PCHR acceptable and easy to use, suggesting that it should be explored as a common medium for health promotion in the workplace. Trial Registration ClinicalTrials.gov NCT00142077

Baby talk to the babyfaced

The power of an infantile appearance to elicit baby talk was investigated by assessing the use of baby talk in task instructions to four-year-old children, who were portrayed as either relatively babyfaced or maturefaced. Men and women taught two tasks to a randomly selected boy or girl via a telephone conversation after being shown a photograph, which presumably depicted the child whom they were instructing. Paralleling facial differences between babies and adults, babyfaced children had rounder faces, larger eyes, thinner eyebrows, and smaller noses than the maturefaced. As predicted, adults used more baby talk when instructing babyfaced than maturefaced children. This effect was manifested in linguistic indicators of baby talk (slow timing and high clarification, simplification, and attention maintenance), as well as in paralinguistic indicators of baby talk (high pitch and changing intonation). The receipt of linguistic baby talk, in turn, facilitated the childs ability to choose a card which matched the one being described. The fact that facial babyishness influenced baby talk even when baby- and maturefaced children were equated in age, attractiveness, and perceived competence suggests that a small approximation to the craniofacial qualities that distinguish infants from adults may in and of itself be sufficient to elicit this speech register.

Healthy Newborns' Neurobehavior: Norms and Relations to Medical and Demographic Factors

OBJECTIVE To generate neurobehavioral norms for an unselected random sample of clinically healthy newborns by examining the newborns with use of the Neonatal Intensive Care Unit Network Neurobehavioral Scale (NNNS). STUDY DESIGN We recruited 344 healthy mothers and newborns from a well-child nursery. The NNNS, a 128-item assessment of infant neurobehavior, was used to examine newborn performance. Associations between 11 NNNS summary scales and the stress/abstinence scale, as well as medical and demographic variables, were evaluated. Mean, SD, and 5th and 95th percentile values for the summary scores of the NNNS are presented. RESULTS NNNS scores from the 10th to the 90th percentile represent a range of normative performance. Performance on different neurobehavioral domains was related to marital status, ethnicity, prenatal, intrapartum and neonatal risk factors, complications during labor/delivery, cesarean delivery, gestational age, the age of the newborn at testing, and infant sex. CONCLUSION These data provide clinicians and researchers with normative data for evaluation of newborn neurobehavior. Even in a low-risk sample, medical and demographic factors below clinical cut-offs were related to newborn performance. Infants with scores outside the ranges for the 11 NNNS summary scores and the stress/abstinence scale may need further observation and, if necessary, early intervention.

Effects of Naloxone on Ethanol Dependence in Rats

Adult male Long-Evans rats were maintained on an ethanol-containing liquid diet. During development of ethanol dependence, the rats were given daily i.p. injections of either naloxone (2 mg/kg) or saline daily. At the beginning of ethanol withdrawal, the rats were injected with either naloxone (10 mg/kg) or saline i.p. Rats injected with naloxone during the development of ethanol dependence consumed significantly more of the ethanol diet and therefore more ethanol than rats injected with saline. Rats treated with naloxone throughout both the development of ethanol dependence and during ethanol-withdrawal showed delayed or reduced withdrawal symptomatology compared to rats injected with only saline, naloxone only during the development of dependence and naloxone only during ethanol withdrawal. These results indicate that naloxone can alter the effects of chronic ethanol exposure and further suggest that ethanol may exert some of its actions via the brain opioid system.