Effect of different types of Medicaid managed care on childhood immunization rates.

Medicaid managed care can improve access to prevention services, such as immunization, for low-income children. The authors studied immunization rates for 7,356 children on Medicaid in three managed care programs: primary care case management (PCCM; n = 4,605), a voluntary HMO program (n = 851), and a mandatory HMO program (n = 1,900). Immunization rates (3:3:1 series) in PCCM (78%) exceeded rates in the voluntary HMO program (71%), which in turn exceeded those in the mandatory HMO program (67%). Adjusting for race, urban residence, and gender, compared to children in PCCM, children in the voluntary HMO program were less likely to complete the 3:3:1 series (OR = 0.75, CI = 0.63, 0.90), and children in the mandatory HMO program were even less likely to complete the series (OR = 0.59, CI = 0.51, 0.68). Results differed by individual HMOs. Monitoring of outcomes for all types of managed care by Medicaid agencies is imperative to assure better disease prevention for low-income children.

An analysis of malocclusion in children with otitis media.

PURPOSE: The purpose of this study was to examine the occlusion of children younger than 6 years with a diagnosis of otitis media. METHODS: The study consisted of 112 children diagnosed with otitis media by their pediatrician. Parents were surveyed regarding their child's history of pacifier use, thumb/finger-sucking habit, mouthbreathing habit, method of feeding, day care attendance, snoring, allergies, asthma, upper respiratory infections, otitis media in the family, and the number of people who smoke in the home. The children's occlusions were examined. RESULTS: In this study, 52% of the population presented with some type of malocclusion, with anterior open bite (17%) and an overbite measuring greater than 70% (17%) being the most prominent. This study showed that the following factors were common in children with otitis media: bottle feeding, smoking in the home, day care attendance, upper respiratory infection, history of otitis media with a sibling, pacifier habit, snoring, and mouthbreathing habit. CONCLUSION: A logistic regression analysis showed no significant association between malocclusion and factors related to otitis media.

Topical TAC (tetracaine, adrenaline, cocaine) solution for local anesthesia in children: prescribing inconsistency and acute toxicity.

The topical anesthetic solution TAC (tetracaine, adrenaline, cocaine) has gained widespread acceptance as the preferred local anesthetic for repairing skin lacerations in children. Despite this popularity, there are no universally accepted guidelines for its application. We report the case of a 6-month-old infant who had respiratory distress and seizures after TAC administration. In addition, we surveyed emergency departments within the state of Virginia regarding their guidelines for TAC application in children. Of the 91 hospitals surveyed, 32 (35%) currently administer TAC, and 14 (44%) of these have no guidelines regarding its use. Among the 20 (63%) with restrictions, there is wide variability in the way it is prescribed. TAC solution is a highly potent anesthetic agent with significant toxicity potential. Research into appropriate dosages, absorption, and actions needs to be undertaken before its widespread acceptance as the drug of choice for providing local anesthesia in children.