The distribution of child physicians and early academic achievement.

OBJECTIVE: To describe the distribution of pediatricians and family physicians (child physicians) across school districts and examine the association between physician supply and third-grade test scores. DATA SOURCES AND STUDY SETTING: Data come from the January 2020 American Medical Association Physician Masterfile, the 2009-2013 and 2014-2018 waves of American Community Survey 5-Year Data, and the Stanford Education Data Archive (SEDA), which uses test scores from all U.S. public schools. We use covariate data provided by SEDA to describe student populations. STUDY DESIGN: This descriptive analysis constructs a physician-to-child-population ratio for every school district in the country and describes the child population served by the current distribution of physicians. We fit a set of multivariable regression models to estimate the associations between district test score outcomes and district physician supply. Our model includes state fixed effects to control for unobservable state-level factors, as well as a covariate vector of sociodemographic characteristics. DATA COLLECTION: Public data from three sources were matched by district ID. PRINCIPAL FINDINGS: Physicians are highly unequally distributed across districts: nearly 3640 (29.6%) of 12,297 districts have no child physician, which includes 49% of rural districts. Rural children of color in particular have very little access to pediatric care, and this inequality is more extreme when looking exclusively at pediatricians. Districts that have higher child physician supplies tend to have higher academic test scores in early education, independent of community socioeconomic status and racial/ethnic composition. While the national data show this positive relationship (0.012 SD, 95% CI, 0.0103-0.0127), it is most pronounced for districts in the bottom tertile of physician supply (0.163 SD, 95% CI, 0.108-0.219). CONCLUSIONS: Our study demonstrates a highly unequal distribution of child physicians in the U.S., and that children with less access to physicians have lower academic performance in early education.

Pediatric regional anesthesia: what is the current safety record?

The use of regional anesthetics, whether as adjuncts, primary anesthetics or postoperative analgesia, is increasingly common in pediatric practice. Data on safety remain limited because of the paucity of very large-scale prospective studies that are necessary to detect low incidence events, although several studies either have been published or have reported preliminary results. This paper will review the data on complications and risk in pediatric regional anesthesia. Information currently available suggests that regional blockade, when performed properly, carries a very low risk of morbidity and mortality in appropriately selected infants and children.

Higher hemoglobin is associated with less cerebral infarction, poor outcome, and death after subarachnoid hemorrhage.

OBJECTIVE: Higher-goal hemoglobin (hgb) and more packed red blood cell transfusions lead to worse outcomes in general critical care patients. There are few data on hgb, transfusion, and outcomes after aneurysmal subarachnoid hemorrhage (SAH). METHODS: We reviewed the daily hgb levels of 103 patients with aneurysmal SAH. Cerebral infarction was diagnosed by computed tomographic scan. We corrected for Hunt and Hess grade, age, and angiographic vasospasm in multivariate models. RESULTS: Of 103 patients, the mean age was 55.3 +/- 14.5 years, 63% were women, and 29% were Hunt and Hess Grades 4 and 5; hgb values steadily declined from 12.6 +/- 1.7 g/dl the day of SAH to 10.4 +/- 1.2 g/dl by Day 14. Patients who died had lower hgb than survivors on Days 0, 1, 2, 4, 6, 10, 11, and 12 (P < or = 0.05). Higher mean hgb was associated with reduced odds of poor outcome (odds ratio, 0.57 per g/dl; 95% confidence interval [CI], 0.38-0.87; P = 0.008) after correcting for Hunt and Hess grade, age, and vasospasm; results for hgb on Days 0 and 1 were similar. Higher Day 0 (odds ratio, 0.7 per g/dl; 95% CI, 0.5-0.99; P = 0.05) and mean hgb (odds ratio, 0.57 per g/dl; 95% CI, 0.38-0.87; P = 0.009) predicted a lower risk of cerebral infarction independent of vasospasm. There were no associations between hgb and other prognostic variables. CONCLUSION: We found that SAH patients with higher initial and mean hgb values had improved outcomes. Higher hgb in SAH patients may be beneficial. The efficacy and safety of blood transfusions to increase hgb in patients with SAH may warrant further study.