Clinical characteristics and risk factors for death among hospitalised children and adolescents with COVID-19 in Brazil: an analysis of a nationwide database.

BACKGROUND: COVID-19 is usually less severe and has lower case fatality in children than in adults. We aimed to characterise the clinical features of children and adolescents hospitalised with laboratory-confirmed SARS-CoV-2 infection and to evaluate the risk factors for COVID-19-related death in this population. METHODS: We did an analysis of all patients younger than 20 years who had quantitative RT-PCR-confirmed COVID-19 and were registered in the Influenza Epidemiological Surveillance Information System (SIVEP-Gripe, a nationwide surveillance database of patients admitted to hospital with severe acute respiratory disease in Brazil), between Feb 16, 2020, and Jan 9, 2021. The primary outcome was time to recovery (discharge) or in-hospital death, evaluated by competing risks analysis using the cumulative incidence function. FINDINGS: Of the 82 055 patients younger than 20 years reported to SIVEP-Gripe during the study period, 11 613 (14·2%) had available data showing laboratory-confirmed SARS-CoV-2 infection and were included in the sample. Among these patients, 886 (7·6%) died in hospital (at a median 6 days [IQR 3-15] after hospital admission), 10 041 (86·5%) patients were discharged from the hospital, 369 (3·2%) were in hospital at the time of analysis, and 317 (2·7%) were missing information on outcome. The estimated probability of death was 4·8% during the first 10 days after hospital admission, 6·7% during the first 20 days, and 8·1% at the end of follow-up. Probability of discharge was 54·1% during the first 10 days, 78·4% during the first 20 days, and 92·0% at the end of follow-up. Our competing risks multivariate survival analysis showed that risk of death was increased in infants younger than 2 years (hazard ratio 2·36 [95% CI 1·94-2·88]) or adolescents aged 12-19 years (2·23 [1·84-2·71]) relative to children aged 2-11 years; those of Indigenous ethnicity (3·36 [2·15-5·24]) relative to those of White ethnicity; those living in the Northeast region (2·06 [1·68-2·52]) or North region (1·55 [1·22-1·98]) relative to those in the Southeast region; and those with one (2·96 [2·52-3·47]), two (4·96 [3·80-6·48]), or three or more (7·28 [4·56-11·6]) pre-existing medical conditions relative to those with none. INTERPRETATION: Death from COVID-19 was associated with age, Indigenous ethnicity, poor geopolitical region, and pre-existing medical conditions. Disparities in health care, poverty, and comorbidities can contribute to magnifying the burden of COVID-19 in more vulnerable and socioeconomically disadvantaged children and adolescents in Brazil. FUNDING: National Council for Scientific and Technological Development, Research Support Foundation of Minas Gerais.

Hospitalization in adolescence affects the likelihood of giving birth: a Swedish population-based register study.

AIM: To examine the effect of hospitalization during adolescence on the likelihood of giving birth. METHODS: 142 998 women born in 1973-75 were followed with the help of the Swedish Medical Birth Register (MBR) and the Swedish Total Population Register (TPR) up until the end of 2000 with respect to their likelihood of giving birth. All analyses were adjusted for parental socio-economic characteristics and factors related to the studied women's own birth. RESULTS: The likelihood of giving birth between 20 and 27 years of age was positively affected by hospitalization at least once during adolescence according to the Swedish Hospital Discharge Register (HDR); adjusted hazard ratio (HR) = 1.32, 95% confidence interval: 1.29-1.35. Women hospitalized due to genitourinary diseases, respiratory diseases, abdominal problems and abuse of alcohol and drugs were more likely to have given birth during the study period, while hospitalizations according to cerebral palsy and congenital malformations tended to decrease childbearing. Women hospitalized due to psychiatric diseases had an increase likelihood of given birth at 20-24 years but a reduced thereafter. CONCLUSION: A majority of the causes of hospitalization during adolescence increased the likelihood of giving birth between ages 20 to 27.

Trends in illness severity and length of stay in inner-city adolescents hospitalized for pelvic inflammatory disease.

BACKGROUND: In 1998, the Centers for Disease Control and Prevention (CDC) changed their guidelines for treatment of adolescents with pelvic inflammatory disease (PID), no longer recommending hospitalization of all teenagers. STUDY OBJECTIVES: (1) To determine the proportion of adolescents with PID who were admitted for failed outpatient treatment after the CDC guideline change. (2) To determine if adolescents admitted for PID after the guideline change needed longer hospital stays and/or were more likely to be "very ill" [as measured by inflammation markers, e.g. fever] or to have tubo-ovarian abscess (TOA) than those admitted before the change. DESIGN: Retrospective chart review SETTING/PARTICIPANTS: All 12-21-year-old females with the diagnosis of PID admitted to an adolescent inpatient unit in an inner-city teaching hospital during a two-year period before [T1=1995-1997 (54 cases)] and after [T2=1998-2000 (91 cases)] the CDC guideline change. INTERVENTIONS: None MAIN OUTCOME MEASURES: Reason for admission (failed outpatient treatment; TOA; or admission at the time of diagnosis of PID); clinical toxicity at admission, and length of hospital stay (LOS). RESULTS: During T2, 22% of PID admissions were for failure of outpatient therapy. However, those admitted after failure of outpatient therapy (n=20) in T2 were less likely to be "very ill" than those who were admitted at the time of PID diagnosis in either T1 or T2 (n=123) [RR:0.30; 95% CI:0.09-0.94]. Mean LOS for females admitted to the adolescent unit with all diagnoses other than PID did not change between T1 and T2 but mean LOS for those diagnosed with PID decreased significantly from 6.3 +/- 3.7 days to 4.7 +/- 2.7 days, respectively (P = 0.002). LOS for PID was longer for younger (<16 years; 8.20 +/- 4.5 days) than older (> or =16 years; 5.0 +/- 2.8 days) girls (P = 0.02) and for adolescents with TOA (7.9 +/- 5.0 days) than for those without (5.3 +/- 2.9 days) (P = 0.05). CONCLUSION: At our medical center, after the CDC guideline change many adolescents with PID were admitted because of failure of outpatient therapy but they were not sicker than those admitted at the time of diagnosis and overall LOS for PID was shorter. These findings are reassuring because they suggest that an initial trial of outpatient therapy for PID is unlikely to harm adolescents and may lead to significant cost savings.

Trends in avoidable hospitalizations for children in Florida from 1992 to 2003.

This article examines trends in avoidable hospitalizations to determine whether improved access following post-1997 Balanced Budget Act expansions in public health insurance programs resulted in a decreased rate among affected populations, particularly children of ages 0-19 years. Florida inpatient discharge data sets from 1992 to 2003 were compiled in order to analyze trends using descriptive and linear regression methods. The rate of avoidable hospitalizations for children was subsequently compared to that of adults (ages 20-64 years) to assess relative changes. The rate declined significantly for black and other nonwhite children. Based on age, the declines were concentrated in the subgroups for ages 0-1 year, 5-9 years, and 10-14 years. In contrast, the rate for adults, with the exception of nonwhite and black populations, increased. The decline in the overall rate of avoidable hospitalizations for children indicates that increased expenditures related to the expansions were at least partially offset. However, the trend could not be directly attributed to the Balanced Budget Act.

Patient characteristics and setting variables related to use of restraint on four inpatient psychiatric units for youths.

OBJECTIVES: This study examined the characteristics of children and adolescents who were restrained during brief inpatient psychiatric treatment and identified whether restraint use was related to the characteristics of the youths or to the setting-time of day, day of the week, place, or programming. Incidents related to restraint use were also examined. METHODS: Charts were reviewed for 100 youths who were admitted to four inpatient units between December 1998 and January 2000. RESULTS: Thirty-one youths were not restrained, 57 were restrained once or twice, and 12 were restrained three or more times. Youths were significantly more likely to be restrained if they were male, had multiple admissions to the facility during the study period, remained in the hospital longer, had been given a diagnosis of a psychotic disorder, or had a previous psychiatric hospitalization. Youths who were restrained were also more likely to be enrolled in special education or to be in foster care or in custody of the Department of Children and Family Services. Also, these youths were more likely to have a history of voicing suicidal ideation and attempting suicide. No single setting variable was significantly related to restraint use. Incidents that prompted restraint generally involved agitation, threats, or assaults. CONCLUSIONS: Youths who were at greatest risk of being restrained during brief inpatient treatment shared particular characteristics related to greater use of inpatient services, guardianship arrangements, special education placement, and history of suicide attempts. Inpatient staff members should remain particularly alert to the processing and regulation problems of these groups of patients.

Parasuicide among youth in a general hospital in South Africa.

Parasuicide cases among youth (15-24 years) referred to the clinical psychology section of a regional hospital from 1995 to 1998 were reviewed. In all 100 cases (37 males and 63 females) were identified being about 10% of the caseload. As part of the clinical psychological assessment sociodemographic, clinical characteristics, trigger factors, employed methods and suicide intentions were analysed. Most patients were students (79%) or unemployed (16%). The major method employed to attempt suicide was ingestion of harmful substances (like paraffin, pesticides or battery acid)(73%). Acute social conflicts (38%), socio-economic deprivation (17%), AIDS phobia (17%), academic failure (14%), teenage pregnancy (10%) and mental illness (5%) triggered suicide attempts. Fifty-eight percent of the attempts were categorised as demonstrative and 27% as genuine. The psychodynamics of parasuicides are discussed in case studies and with reference to other studies.

Predictors of aggression in hospitalized adolescents.

Client records spanning a 14-month period were examined for an adolescent unit of a large state psychiatric hospital to identify client variables predictive of acts of physical aggression in hospitalized adolescents. Forty-two percent of the 43 girls and 55% of the 57 boys were classified as aggressive because they had committed at least one act of physical aggression during the data collection period. In logistic regression analyses, client characteristics were used to predict aggression classification and 79%, 81%, and 92% of the total sample, girls, and boys, respectively, were correctly classified. Aggression in the girls was associated with having a history of family violence, being of a minority race, and being on medication; for the boys, aggression was associated with a diagnosis of a conduct disorder, being on medication, and being previously hospitalized.

Hospitalización pediátrica. Estudio de la población asistida: Clínica Pediátrica "A" 1991-1995 / Pediatric hospitalization. Study of assisted population: Pediatric Clinic \"A\" 1991-1995

Con el propósito de contribuir a reformular el rol del hospital como parte integrante de la red de servicios de atención pediátrica en Uruguay se realizó un estudio, en la Clínica Pediátrica "A" del Centro Hospitalario Pereira-Rossell, que abarcó el quinquenio 1991-1995. Se analizaron algunas características de la población asistida, se identificaron las enfermedades más frecuentes que motivaron la internación y se evaluó la producción y el rendimiento del servicio. Como fuente de datos se utilizaron los formularios de epicrisis. De los 8.478 egresos, 47 por ciento eran menores de 1 año. Se detectaron fallas en el primer nivel de atención: fracaso de la lactancia natural, alterciones nutricionales, mala cobertura de vacunación, más evidentes en los menores de 2 años. Como causa de hospitalización las enfermedades respiratorias ocuparon el primer lugar en todas las edades, destacándose la problemática psico-social como segunda causa en los adolescentes. La duración de la estadía, el porcentaje ocupacional y el giro cama, no se apartaron de los estándares de referencia. Se concluye que es prioritario fortalecer el programa Materno-Infantil en el primer nivel. Se proponen modificaciones del modelo de asistencia hospitalaria que permitan satisfacer en forma más adecuada la demanda y lograr una mayor eficiencia del proceso de atención. Se destaca la importancia de continuar y profundizar este tipo de investigaciones

Diagnosis and assessment of depression and suicidality using the NIMH Diagnostic Interview Schedule for Children (DISC-2.3).

The diagnostic Interview Schedule for Children (DISC-2.3) was studied in a sample of 265 adolescent inpatients to determine type and concurrent validity of depressive symptoms and depressive disorder diagnoses for different DISC-2.3 informants (parent, adolescent, both). The Children's Depression Rating Scale--Revised, Reynolds Adolescent Depression Scale (RADS), Suicide Ideation Questionnaire--Junior, Spectrum of Suicide Behavior Scale, and clinical consensus diagnoses were used to assess concurrent validity. Results indicated that (1) parents, compared to adolescents, reported a higher prevalence of all depressive symptoms with the exception of weight change; (2) DISC-2.3 depressive and suicidality symptoms were related positively to independent validating criteria for all informant conditions, suggesting good concurrent validity; (3) the DISC-2.3 both informant condition correctly identified the most depressive disorders; and (4) the parent, but not the adolescent, DISC-2.3 Informant condition contributed to the prediction of clinical consensus diagnoses of depression after taking into account RADS scores.