Isolated diastolic high blood pressure: a distinct clinical phenotype in US children.

BACKGROUND: Screening studies have shown that 0.7-4.5% of generally healthy children have isolated diastolic high BP. We therefore studied the characteristics of children with diastolic BP in the elevated and hypertensive ranges according to current guidelines in US children from the National Health and Nutrition Examination Survey (NHANES, 1999-2016). METHODS: We studied 17,362 children (8-18 years) with BP measured by sphygmomanometry. High BP was categorized as isolated systolic (iSH), isolated diastolic (iDH), or Mixed. RESULTS: Overall, 86.0% (95% CI = 85.0-87.0) of the population had normal BP, 8.7% (8.0-9.3) elevated BP, 4.9% (4.4-5.5) Stage 1, and 0.4% (0.4-0.6) Stage 2. Moreover, 11.1% (10.3-12.0) had iSH, 1.9% (1.5-2.2) iDH, and 1.0% (0.8-1.2) Mixed. Children with iDH were more likely to be female, younger, white, and leaner than those with iSH, with lower rates of overweight/obesity. iDH was generally between normals and iSH. Resting heart rate was significantly higher in iDH even after adjustment for known covariates. CONCLUSIONS: Children with iDH may have a distinct clinical picture. A leaner habitus and higher resting heart rate may reflect differences in underlying pathophysiology. Longitudinal follow-up studies are needed to better define the pathogenesis, progression, and long-term prognosis in iDH. IMPACT: Using gold-standard auscultation and 2017 guidelines, isolated diastolic high BP (iDH) is found in 1.9% (95% CI 1.5-2.2) of American children; these children are younger, leaner, more female, and have fewer cardiometabolic risks. Resting heart rate is significantly higher in iDH compared to both normals and iSH even after adjustments for known covariates. Autonomic hyperactivity in iDH may speak to both etiology and therapeutic approaches. iDH appears to be a distinct clinical phenotype characterized by differences in anthropometric measures, sex, age, and resting heart rate. Follow-up studies are clearly needed to clarify its pathogenesis, progression, and prognosis.

Rates of pediatric emergency department visits vary according to neighborhood marginalization in Ottawa, Canada.

OBJECTIVES: To determine the association between neighborhood marginalization and rates of pediatric ED visits in Ottawa, Ontario. Secondary objectives investigated if the association between neighborhood marginalization and rates varied by year, acuity, and distance to hospital. METHODS: We calculated rates of pediatric ED visits per 1000 person-years for census dissemination areas within 100 km of the Children's Hospital of Eastern Ontario for patients < 18 years old from January 2018 through December 2020. The 2016 Ontario Marginalization Index categorized neighborhoods along quintiles of residential instability, material deprivation, ethnic concentration, and dependency. Generalized mixed-effects models determined the incidence rate ratios of pediatric ED visits for each quintile of marginalization; multivariate models were used to control for year of presentation and distance to hospital. Analysis was repeated for low versus high acuity ED visits. RESULTS: There were 154,146 ED visits from patients in 2055 census dissemination areas within 100 km of CHEO from 2018 to 2020. After controlling for year and distance from hospital in multivariate analyses, there were higher rates of pediatric ED visits for dissemination areas with high residential instability, high material deprivation, and low ethnic concentration. These findings did not change according to visit acuity. CONCLUSIONS: Neighborhood residential instability and material deprivation should be considered when locating alternatives to emergency care.

RéSUMé: OBJECTIFS: Déterminer l'association entre la marginalisation du quartier et les taux de visites aux urgences pédiatriques à Ottawa, en Ontario. Les objectifs secondaires visaient à déterminer si l'association entre la marginalisation du quartier et les taux variait selon l'année, l'acuité et la distance à l'hôpital. MéTHODES: Nous avons calculé les taux de visites aux urgences pédiatriques par tranche de 1000 années-personnes dans les aires de diffusion du recensement à moins de 100 km du Centre hospitalier pour enfants de l'est de l'Ontario pour les patients de moins de 18 ans de janvier 2018 à décembre 2020. L'Indice de marginalisation de l'Ontario de 2016 classait les quartiers selon des quintiles d'instabilité résidentielle, de privation matérielle, de concentration ethnique et de dépendance. Les modèles à effets mixtes généralisés ont déterminé les ratios des taux d'incidence des visites aux urgences pédiatriques pour chaque quintile de marginalisation; des modèles multivariés ont été utilisés pour contrôler l'année de présentation et la distance à l'hôpital. L'analyse a été répétée pour les visites à l'urgence de faible acuité par rapport à haute acuité. RéSULTATS: Il y a eu 154 146 visites aux urgences de patients dans 2 055 aires de diffusion du recensement à moins de 100 km du CHEO de 2018 à 2020. Après avoir tenu compte de l'année et de la distance par rapport à l'hôpital dans les analyses multivariées, on a constaté des taux plus élevés de visites aux urgences pédiatriques dans les zones de diffusion présentant une instabilité résidentielle élevée, une privation matérielle élevée et une faible concentration ethnique. Ces résultats n'ont pas changé selon l'acuité de la visite. CONCLUSIONS: L'instabilité résidentielle du quartier et la privation matérielle doivent être prises en compte lors de la recherche de solutions de rechange aux soins d'urgence.

What determines the selection of undergraduate medical students to the specialty of their future careers?

BACKGROUND: It is important to understand the factors that influence the undergraduate medical students' specialties choice for the post-graduation. OBJECTIVES: To identify the number of undergraduate medical students who decided their post-graduate specialty career, factors that may influence their decision to select a particular specialty, and their career specialties preference. METHODS: A self-administered questionnaire was used to achieve the objectives. RESULTS: Less than half of the students (40.2%) showed a future specialty preference. Senior students and having background about specialties were the significant factors for career choices. General Surgery (27.4%), ENT-Ophthalmology (24.6%) and Internal Medicine (22%) were preferred specialties. Male students preferred General Surgery (15.7%), Internal Medicine (15%), ENT-Ophthalmology (12%) and Orthopedics (9.1%). Female students showed interest in ENT-Ophthalmology (12.1%), Surgery (11.7%), Pediatrics (10.8%) and Dermatology (8.2%). The least popular specialties were Community Medicine, (6.6%), Anesthesia, (6%) and Forensic Medicine (4.6%). Obstetrics and Gynecology (Ob/Gyne) was a less popular branch even in female students. CONCLUSIONS: General Surgery, ENT-Ophthalmology and Internal Medicine were the most preferred specialties, while Community Medicine, Forensic and Ob/Gyne, even for female students were least selected specialties. Proper information and counseling should be offered to students about the challenges and opportunities to select their future careers.