Epidemiology of gastroschisis: A population-based study in California from 1995 to 2012.

BACKGROUND: Although the incidence of gastroschisis is increasing, risk factors are not clearly identified. METHODS: Using the Linked Birth Database from the California Office of Statewide Health Planning and Development from 1995 to 2012, patients with gastroschisis were identified by ICD-9 diagnosis/procedure code or birth certificate designation. Logistic regressions examined demographics, birth factors, and maternal exposures on risk of gastroschisis. RESULTS: The prevalence of gastroschisis was 2.7 cases per 10,000 live births. Patients with gastroschisis had no difference in fetal exposure to alcohol (p = 0.609), narcotics (p = 0.072), hallucinogenics (p = 0.239), or cocaine (p = 0.777), but had higher exposure to unspecified/other noxious substances (OR 3.27, p = 0.040; OR 2.02, p = 0.002). Gastroschisis was associated with low/very low birthweight (OR 5.08-16.21, p < 0.001) and preterm birth (OR 3.26-10.0, p < 0.001). Multivariable analysis showed lower risk in black (OR 0.44, p < 0.001), Asian/Pacific Islander (OR 0.76, p = 0.003), and Hispanic patients (OR 0.72, p < 0.001) compared to white patients. Risk was higher in rural areas (OR 1.24-1.76, p = 0.001). Compared to women age < 20, risk decreased with advancing maternal age (OR 0.49-OR 0.03, p < 0.001). Patients with gastroschisis had increased total charges ($336,270 vs. $9012, p < 0.001) and length of stay (38.1 vs. 2.9 days, p < 0.001). Mortality was 4.6%. CONCLUSIONS: This is the largest population-based study summarizing current epidemiology of gastroschisis in California. TYPE OF STUDY: Retrospective comparative cohort study. LEVEL OF EVIDENCE: III.

Are there differences in access to care, treatment, and outcomes for children with appendicitis treated at county versus private hospitals?

INTRODUCTION: We conducted a study to determine whether hospital type (county [ie, safety-net] vs private) affects health care access (appendiceal perforation [AP] rates), treatment (laparoscopic appendectomy [LA] rates), and outcomes in children with appendicitis. METHODS: A review of cases involving children who had appendicitis between 1998 and 2007 was performed. Data from county and private hospitals were compared. Outcomes were AP rates, LA rates, need for postoperative abscess drainage, length of hospitalization (LOH), and cost. RESULTS: Multivariate analysis confirmed that among 7902 patients, (county = 682; private = 7220), county-hospital patients had lower incomes, higher AP rates, higher LA rates, lower postoperative abscess drainage rates, and longer LOH than did private-hospital patients. The longer LOH at the county institution led to higher costs. Within the county hospital, outcomes were similar across all ethnic groups and income levels. CONCLUSIONS: Children with appendicitis treated at a county hospital were of lower socioeconomic background and had higher AP rates, longer LOH, and higher costs than their counterparts at private hospitals, but were more likely to undergo LA and require less abscess drainage. Within the county hospital, ethnic and socioeconomic disparities were not apparent; thus, these differences between institutions might have been caused by underlying disparities in ethnicity, income, and health care access.

A framework for sustainable invasive species management: Environmental, social, and economic objectives.

Applying the concept of sustainability to invasive species management (ISM) is challenging but necessary, given the increasing rates of invasion and the high costs of invasion impacts and control. To be sustainable, ISM must address environmental, social, and economic factors (or "pillars") that influence the causes, impacts, and control of invasive species across multiple spatial and temporal scales. Although these pillars are generally acknowledged, their implementation is often limited by insufficient control options and significant economic and political constraints. In this paper, we outline specific objectives in each of these three "pillars" that, if incorporated into a management plan, will improve the plan's likelihood of sustainability. We then examine three case studies that illustrate how these objectives can be effectively implemented. Each pillar reinforces the others, such that the inclusion of even a few of the outlined objectives will lead to more effective management that achieves ecological goals, while generating social support and long-term funding to maintain projects to completion. We encourage agency directors and policy-makers to consider sustainability principles when developing funding schemes, management agendas, and policy.