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Paul H. Wise, MD, MPH

Richard E. Behrman Professor in Child Health and Professor, by courtesy, of Health Research and Policy

Academic Appointments: 
Administrative Appointments: 
Richard E. Behrman Professor of Child Health and Society, Stanford University (2005 - Present)
Director, Center for Policy, Outcomes and Prevention (2004 - Present)
Vice-Chief, Division of Social Medicine and Health Inequalities Department of Medicine, Brigham and Women’s Hospital (2003 - 2004)
Director, Social and Health Policy Research, Boston Medical Center (1996 - 2003)
Director, Harvard Institute for Reproductive and Child Health, Harvard Medical School (1992 - 1996)
Director, Emergency and Primary Care Services, Children's Hospital, Boston (1981 - 1985)
Honors and Awards: 
George A. Silver Memorial Lecture, George Washington University School of Medicine (2007)
2006 Hugh and Alison Westgate Award in Justice and International Pediatrics, Minnesota Children’s Hospital (2006)
Susan Packard Orr Lecturer, Lucile Packard Children’s Hospital (2006)
A.B. awarded summa cum laude,, Cornell University (1974)
Charles L. Horn Prize for Leadership in Medicine, Cornell University Medical College (1978)
Young Professional Award,, American Public Health Association (1988)
Franklin Delano Roosevelt Award, The March of Dimes (1995)
Richard and Millie Brock Award for Contributions to Pediatrics, New York Academy of Medicine (2001)
Anne E. Dyson Memorial Award Visiting Professor, University Rochester School of Medicine (2002)
William Root Lecturer and AOA Visiting Professor, Kansas University School of Medicine (2003)
A.B., Cornell University, Latin American Studies (1974)
M.D., Cornell Univ Medical College, Medicine (1978)
M.P.H., Harvard School of Public Health, General Studies (1978)
Community and International Work: 
International Work
Research & Scholarship
Courses Taught: 
Academic Year: 
Global Public Health
HUMBIO 129S (Win)
Health and Security
HUMBIO 92Q (Win)
Independent Study Courses: 
Directed Reading in Pediatrics
PEDS 299 (Aut, Win, Spr, Sum)
Directed Reading/Special Projects
HUMBIO 199 (Aut, Win, Spr)
Early Clinical Experience
PEDS 280 (Aut, Win, Spr, Sum)
Graduate Research
PEDS 399 (Aut, Win, Spr, Sum)
HUMBIO 194 (Win, Spr)
Medical Scholars Research
PEDS 370 (Aut, Win, Spr, Sum)
Research in Human Biology
HUMBIO 193 (Aut, Win, Spr)
Undergraduate Directed Reading/Research
PEDS 199 (Aut, Win, Spr, Sum)
Academic Year: 
Global Public Health
HUMBIO 129S (Win)
Independent Study Courses: 
Directed Reading in Pediatrics
PEDS 299 (Aut, Win, Spr, Sum)
Directed Reading/Special Projects
HUMBIO 199 (Aut, Win, Spr)
Early Clinical Experience
PEDS 280 (Aut, Win, Spr, Sum)
Graduate Research
PEDS 399 (Aut, Win, Spr, Sum)
HUMBIO 194 (Aut, Win, Spr)
Medical Scholars Research
PEDS 370 (Aut, Win, Spr, Sum)
Research in Human Biology
HUMBIO 193 (Aut, Win, Spr)
Undergraduate Directed Reading/Research
PEDS 199 (Aut, Win, Spr, Sum)
Academic Year: 
Global Public Health
HUMBIO 129S (Win)
Independent Study Courses: 
Directed Reading in Pediatrics
PEDS 299 (Aut, Win, Spr, Sum)
Directed Reading/Special Projects
HUMBIO 199 (Aut, Win, Spr)
Early Clinical Experience
PEDS 280 (Aut, Win, Spr, Sum)
Graduate Research
PEDS 399 (Aut, Win, Spr, Sum)
HUMBIO 194 (Aut, Win, Spr)
Medical Scholars Research
PEDS 370 (Aut, Win, Spr, Sum)
Research in Human Biology
HUMBIO 193 (Aut, Win, Spr)
Undergraduate Directed Reading/Research
PEDS 199 (Aut, Win, Spr, Sum)
Transdisciplinary translational science and the case of preterm birth JOURNAL OF PERINATOLOGY Stevenson, D. K., Shaw, G. M., Wise, P. H., Norton, M. E., Druzin, M. L., Valantine, H. A., McFarland, D. A. 2013; 33 (4): 251-258


Medical researchers have called for new forms of translational science that can solve complex medical problems. Mainstream science has made complementary calls for heterogeneous teams of collaborators who conduct transdisciplinary research so as to solve complex social problems. Is transdisciplinary translational science what the medical community needs? What challenges must the medical community overcome to successfully implement this new form of translational science? This article makes several contributions. First, it clarifies the concept of transdisciplinary research and distinguishes it from other forms of collaboration. Second, it presents an example of a complex medical problem and a concrete effort to solve it through transdisciplinary collaboration: for example, the problem of preterm birth and the March of Dimes effort to form a transdisciplinary research center that synthesizes knowledge on it. The presentation of this example grounds discussion on new medical research models and reveals potential means by which they can be judged and evaluated. Third, this article identifies the challenges to forming transdisciplines and the practices that overcome them. Departments, universities and disciplines tend to form intellectual silos and adopt reductionist approaches. Forming a more integrated (or 'constructionist'), problem-based science reflective of transdisciplinary research requires the adoption of novel practices to overcome these obstacles.

View details for DOI 10.1038/jp.2012.133

View details for Web of Science ID 000316833300001

Predictors of Hospitalization After an Emergency Department Visit for California Youths With Psychiatric Disorders PSYCHIATRIC SERVICES Huffman, L. C., Wang, N. E., Saynina, O., Wren, F. J., Wise, P. H., Horwitz, S. M. 2012; 63 (9): 896-905


This study examined patient, hospital, and county characteristics associated with hospitalization after emergency department visits for pediatric mental health problems.Retrospective analysis of emergency department encounters (N=324,997) of youths age five years to 17 years with psychiatric diagnoses was conducted with 2005-2009 California Office of Statewide Health Planning and Development emergency department statewide data.For youths with any psychiatric diagnosis, 23.4% of emergency department encounters resulted in hospitalization. In these cases, hospitalization largely was predicted by clinical need. Nonclinical factors that decreased the likelihood of hospitalization included demographic characteristics (such as younger age, lack of insurance, and rural residence) and resource characteristics (private hospital ownership, lack of psychiatric consultation in the emergency department, and lack of pediatric psychiatric beds). For youths with a significant psychiatric diagnosis plus a suicide attempt, 53.8% of emergency department encounters resulted in hospitalization. In these presumably more life-threatening cases, nonclinical factors that decreased the likelihood of hospitalization persisted: demographic characteristics (lack of insurance and rural residence) and resource characteristics (public hospital ownership, lack of psychiatric consultation, and lack of pediatric psychiatric beds).Mental health service delivery can improve only by addressing nonclinical demographic and resource obstacles that independently decrease the likelihood of hospitalization after an emergency department visit for a mental health issue; this is true even for the most severely ill youths-those with a suicide attempt as well as a serious psychiatric diagnosis.

View details for DOI 10.1176/

View details for Web of Science ID 000308841700010

View details for PubMedID 22710574

The Association Between Insurance Status and Emergency Department Disposition of Injured California Children ACADEMIC EMERGENCY MEDICINE Arroyo, A. C., Wang, N. E., Saynina, O., Bhattacharya, J., Wise, P. H. 2012; 19 (5): 541-551


This study examined the relationship between insurance status and emergency department (ED) disposition of injured California children.Multivariate regression models were built using data obtained from the 2005 through 2009 California Office of Statewide Health Planning and Development (OSHPD) data sets for all ED visits by injured children younger than 19 years of age.Of 3,519,530 injury-related ED visits, 52% were insured by private, and 36% were insured by public insurance, while 11% of visits were not insured. After adjustment for injury characteristics and demographic variables, publicly insured children had a higher likelihood of admission for mild, moderate, and severe injuries compared to privately insured children (mild injury adjusted odds ratio [AOR] = 1.36, 95% confidence interval [CI] = 1.34 to 1.39; moderate and severe injury AOR = 1.34, 95% CI = 1.28 to 1.41). However, uninsured children were less likely to be admitted for mild, moderate, and severe injuries compared to privately insured children (mild injury AOR = 0.63, 95% CI = 0.61 to 0.66; moderate and severe injury AOR = 0.50, 95% CI = 0.46 to 0.55). While publicly insured children with moderate and severe injuries were as likely as privately insured children to experience an ED death (AOR = 0.91, 95% CI = 0.70 to 1.18), uninsured children with moderate and severe injuries were more likely to die in the ED compared to privately insured children (AOR = 3.11, 95% CI = 2.38 to 4.06).Privately insured, publicly insured, and uninsured injured children have disparate patterns of ED disposition. Policy and clinical efforts are needed to ensure that all injured children receive equitable emergency care.

View details for DOI 10.1111/j.1553-2712.2012.01356.x

View details for Web of Science ID 000304133300009

Emerging Technologies and Their Impact on Disability FUTURE OF CHILDREN Wise, P. H. 2012; 22 (1): 169-191


Technological innovation is transforming the prevalence and functional impact of child disability, the scale of social disparities in child disability, and perhaps the essential meaning of disability in an increasingly technology-dominated world. In this article, Paul Wise investigates several specific facets of this transformation. He begins by showing how technological change influences the definition of disability, noting that all technology attempts to address some deficiency in human capacity or in the human condition. Wise then looks at the impact of technology on childhood disabilities. Technical improvements in the physical environment, such as better housing, safer roads, and poison-prevention packaging, have significantly reduced childhood injury and disability. Other technological breakthroughs, such as those that identify genetic disorders that may lead to pregnancy termination, raise difficult moral and ethical issues. Technologies that identify potential health risks are also problematic in the absence of any efficient treatment. Wise stresses the imbalance in the existing health care delivery system, which is geared toward treating childhood physical illnesses that are declining in prevalence at a time when mental and emotional conditions, many of which are not yet well understood, are on the rise. This mismatch, Wise says, poses complex challenges to caring for disabled children, particularly in providing them with highly coordinated and integrated systems of care. Technology can also widen social disparities in health care for people, including children with disabilities. As Wise observes, efficacy--the ability of a technology to change health outcomes--is key to understanding the relationship of technology to social disparities. As technological innovation enhances efficacy, access to that technology becomes more important. Health outcomes may improve for those who can afford the technology, for example, but not for others. Hence, as efficacy grows, so too does the burden on society to provide access to technology equitably to all those in need. Without such access, technological innovation will likely expand disparities in child outcomes rather than reduce them.

View details for Web of Science ID 000303139700008

View details for PubMedID 22550690

The Morality of Saved Lives AMERICAN JOURNAL OF BIOETHICS Batniji, R., Wise, P. H. 2012; 12 (12): 1-2

View details for DOI 10.1080/15265161.2012.739388

View details for Web of Science ID 000312338300004

View details for PubMedID 23215917

Access to Pediatric Subspecialty Care: A Population Study of Pediatric Rheumatology Inpatients in California ARTHRITIS CARE & RESEARCH Pineda, N., Chamberlain, L. J., Chan, J., Cidon, M. J., Wise, P. H. 2011; 63 (7): 998-1005


To examine trends in the specialty care hospitalization of pediatric rheumatology patients and determine how nonclinical factors influence access.This study used California's Office of Statewide Health Planning and Development discharge database to perform a retrospective population analysis of pediatric rheumatology hospitalizations in California between 1999 and 2007. We used logistic regression to examine the relationship between hospitalization in specialty care centers with a pediatric rheumatologist and nonclinical patient characteristics.A total of 18,641 pediatric discharges revealed that 57% were discharged from a specialty care center with a pediatric rheumatologist. Multivariate analysis showed that the factors associated with increased utilization of specialty care centers with a pediatric rheumatologist were public insurance (odds ratio [OR] 1.62, 95% confidence interval [95% CI] 1.51-1.74; P < 0.0001), being Hispanic (OR 1.29, 95% CI 1.19-1.40; P < 0.0001) or Asian non-Hispanic (OR 1.39, 95% CI 1.26-1.54; P < 0.0001), and high pediatric rheumatology specialty care bed supply (OR 2.79, 95% CI 2.49-3.14; P < 0.0001). A decreased utilization of specialty care centers with a pediatric rheumatologist was seen for patients ages <1 year (OR 0.45, 95% CI 0.40-0.52; P < 0.0001), ages 1-4 years (OR 0.50, 95% CI 0.46-0.55; P < 0.0001), ages 5-9 years (OR 0.68, 95% CI 0.62-0.75; P < 0.0001), ages 15-18 years (OR 0.51, 95% CI 0.47-0.56; P < 0.0001), males (OR 0.75, 95% CI 0.70-0.80; P < 0.0001), and patients residing farther away from a specialty care center with a pediatric rheumatologist (OR 0.57, 95% CI 0.51-0.63; P < 0.0001).Nonclinical factors play an increasingly important role in the hospitalization patterns of pediatric rheumatology patients in California. Understanding these factors is crucial if we are to ensure that the variation in access to care reflects clinical need.

View details for DOI 10.1002/acr.20458

View details for Web of Science ID 000292809200011

View details for PubMedID 21360697

Integrity Matters: Recapturing the Relevance of General Academic Pediatrics ACADEMIC PEDIATRICS Wise, P. H. 2011; 11 (2): 123-127

View details for Web of Science ID 000288525900010

View details for PubMedID 21282084

Child Health Policy: Where Are You When We Need You? ACADEMIC PEDIATRICS Wise, P. H. 2010; 10 (5): 285-286

View details for Web of Science ID 000282109700002

View details for PubMedID 20816651

Can State Early Intervention Programs Meet the Increased Demand of Children Suspected of Having Autism Spectrum Disorders? JOURNAL OF DEVELOPMENTAL AND BEHAVIORAL PEDIATRICS Wise, M. D., Little, A. A., Holliman, J. B., Wise, P. H., Wang, C. J. 2010; 31 (6): 469-476


To determine whether Early Intervention programs have the capacity to accommodate the expected increase in referrals following the American Academy of Pediatrics' 2007 recommendation for universal screening of 18- and 24-month-old children for Autism Spectrum Disorders (ASD).We conducted a telephone survey of all state and territory early. Intervention coordinators about the demand for ASD evaluations, services, and program capacity. We used multivariate models to examine state-level factors associated with the capacity to serve children with ASD.Fifty-two of the 57 coordinators (91%) responded to the survey. Most states reported an increase in demand for ASD-related evaluations (65%) and services (58%) since 2007. In addition, 46% reported that their current capacity poses a challenge to meeting the 45-day time limit for creating the Individualized Family Service Plan. Many states reported that they have shortages of ASD-related personnel, including behavioral therapists (89%), speech-language pathologists (82%), and occupational therapists (79%). Among states that reported the number of service hours (n = 34) 44% indicated that children with ASD receive 5 or fewer weekly service hours. Multivariate models showed that states with a higher percentage of African-American and Latino children were more likely to have provider shortages whereas states with higher population densities were more likely to offer a greater number of service hours.Many Early Intervention programs may not have the capability to address the expected increase in demand for ASD services. Early Intervention programs will likely need enhanced resources to provide all children with suspected ASD with appropriate evaluations and services.

View details for DOI 10.1097/DBP.0b013e3181e56db2

View details for Web of Science ID 000279648300002

View details for PubMedID 20585267

Variation in Specialty Care Hospitalization for Children With Chronic Conditions in California PEDIATRICS Chamberlain, L. J., Chan, J., Mahlow, P., Huffman, L. C., Chan, K., Wise, P. H. 2010; 125 (6): 1190-1199


Despite the documented utility of regionalized systems of pediatric specialty care, little is known about the actual use of such systems in total populations of chronically ill children. The objective of this study was to evaluate variations and trends in regional patterns of specialty care hospitalization for children with chronic illness in California.Using California's Office of Statewide Health Planning and Development unmasked discharge data set between 1999 and 2007, we performed a retrospective, total-population analysis of variations in specialty care hospitalization for children with chronic illness in California. The main outcome measure was the use of pediatric specialty care centers for hospitalization of children with a chronic condition in California.Analysis of 2 170 102 pediatric discharges revealed that 41% had a chronic condition, and 44% of these were discharged from specialty care centers. Specialty care hospitalization varied by county and type of condition. Multivariate analyses associated increased specialty care center use with public insurance and high pediatric specialty care bed supply. Decreased use of regionalized care was seen for adolescent patients, black, non-Hispanic children, and children who resided in zip codes of low income or were located farther from a regional center of care.Significant variation exists in specialty care hospitalization among chronically ill children in California. These findings suggest a need for greater scrutiny of clinical practices and child health policies that shape patterns of hospitalization of children with serious chronic disease.

View details for DOI 10.1542/peds.2009-1109

View details for Web of Science ID 000278268600013

View details for PubMedID 20439593

Impact of Managed Care on Publicly Insured Children with Special Health Care Needs ACADEMIC PEDIATRICS Huffman, L. C., Brat, G. A., Chamberlain, L. J., Wise, P. H. 2010; 10 (1): 48-55


The aim of this review was to evaluate the impact of managed care on publicly insured children with special health care needs (CSHCN).We conducted a review of the extant literature. Using a formal computerized search, with search terms reflecting 7 specific outcome categories, we summarized study findings and study quality.We identified 13 peer-reviewed articles that evaluated the impact of Medicaid and State Children's Health Insurance program (SCHIP) Managed Care (MSMC) on health services delivery to populations of CSHCN, with all studies observational in design. Considered in total, the available scientific evidence is varied. Findings concerning care access demonstrate a positive effect of MSMC; findings concerning care utilization were mixed. Little information was identified concerning health care quality, satisfaction, costs, or health status, whereas no study yielded evidence on family impact.The available studies suggest that the evaluated record of MSMC for CSHCN has been mixed, with considerable heterogeneity in the definition of CSHCN, program design, and measured outcomes. These findings suggest caution should be exercised in implementing MSMC for CSHCN and that greater emphasis on health outcomes and cost evaluations is warranted.

View details for Web of Science ID 000279188000010

View details for PubMedID 20129481

Confronting social disparities in child health: a critical appraisal of life-course science and research. Pediatrics Wise, P. H. 2009; 124: S203-11


The utility of the life-course framework to address disparities in child health is based on its ability to integrate the science of child development with the requirements of effective and just public policy. I argue that the life-course framework is best assessed in a historical context and through 4 essential observations. First, early genetic and environmental interactions are complex and influence outcomes in different settings in very different ways. Second, these early-life interactions are themselves subject to considerable later influences and, therefore, may not be highly predictive of later outcomes. Third, the etiologic nature or timing of early-life interactions does not, per se, determine if their life-course effects are amenable to later interventions. Fourth, a highly deterministic view of early-life interactions is not supported by the science and can generate counterproductive approaches to research and policy development. Finally, an alternative approach is proposed on the basis of a "human-capacity" model of the life course that connects the search for underlying basic mechanisms with a policy-based examination of the comparative effectiveness of influences at different developmental stages. This approach suggests an expanded research and policy agenda that might be more capable of generating urgently needed strategies for reducing disparities in child health. Such an approach could ultimately define more comprehensively the power and limits of life-course effects in shaping the social distribution of health outcomes in the real world.

View details for DOI 10.1542/peds.2009-1100H

View details for PubMedID 19861471

Children of the Recession ARCHIVES OF PEDIATRICS & ADOLESCENT MEDICINE Wise, P. H. 2009; 163 (11): 1063-1064

View details for Web of Science ID 000271427700014

View details for PubMedID 19884599

Quality Improvement Strategies for Children With Asthma A Systematic Review ARCHIVES OF PEDIATRICS & ADOLESCENT MEDICINE Bravata, D. M., Gienger, A. L., Holty, J. C., Sundaram, V., Khazeni, N., Wise, P. H., McDonald, K. M., Owens, D. K. 2009; 163 (6): 572-581


To evaluate the evidence that quality improvement (QI) strategies can improve the processes and outcomes of outpatient pediatric asthma care.Cochrane Effective Practice and Organisation of Care Group database (January 1966 to April 2006), MEDLINE (January 1966 to April 2006), Cochrane Consumers and Communication Group database (January 1966 to May 2006), and bibliographies of retrieved articles.Randomized controlled trials, controlled before-after trials, or interrupted time series trials of English-language QI evaluations.Must have included 1 or more QI strategies for the outpatient management of children with asthma.Clinical status (eg, spirometric measures); functional status (eg, days lost from school); and health services use (eg, hospital admissions).Seventy-nine studies met inclusion criteria: 69 included at least some component of patient education, self-monitoring, or self-management; 13 included some component of organizational change; and 7 included provider education. Self-management interventions increased symptom-free days by approximately 10 days/y (P = .02) and reduced school absenteeism by about 0.1 day/mo (P = .03). Interventions of provider education and those that incorporated organizational changes were likely to report improvements in medication use. Quality improvement interventions that provided multiple educational sessions, had longer durations, and used combinations of instructional modalities were more likely to result in improvements for patients than interventions lacking these characteristics.A variety of QI interventions improve the outcomes and processes of care for children with asthma. Use of similar outcome measures and thorough descriptions of interventions would advance the study of QI for pediatric asthma care.

View details for Web of Science ID 000266566700011

View details for PubMedID 19487615

The "etiome": identification and clustering of human disease etiological factors BMC BIOINFORMATICS Liu, Y. I., Wise, P. H., Butte, A. J. 2009; 10


Both genetic and environmental factors contribute to human diseases. Most common diseases are influenced by a large number of genetic and environmental factors, most of which individually have only a modest effect on the disease. Though genetic contributions are relatively well characterized for some monogenetic diseases, there has been no effort at curating the extensive list of environmental etiological factors.From a comprehensive search of the MeSH annotation of MEDLINE articles, we identified 3,342 environmental etiological factors associated with 3,159 diseases. We also identified 1,100 genes associated with 1,034 complex diseases from the NIH Genetic Association Database (GAD), a database of genetic association studies. 863 diseases have both genetic and environmental etiological factors available. Integrating genetic and environmental factors results in the "etiome", which we define as the comprehensive compendium of disease etiology. Clustering of environmental factors may alert clinicians of the risks of added exposures, or synergy in interventions to alter these factors. Clustering of both genetic and environmental etiological factors puts genes in the context of environment in a quantitative manner.In this paper, we obtained a comprehensive list of associations between disease and environmental factors using MeSH annotation of MEDLINE articles. It serves as a summary of current knowledge between etiological factors and diseases. By combining the environmental etiological factors and genetic factors from GAD, we computed the "etiome" profile for 863 diseases. Comparing diseases across these profiles may have utility for clinical medicine, basic science research, and population-based science.

View details for DOI 10.1186/1471-2105-10-S2-S14

View details for Web of Science ID 000265602500015

View details for PubMedID 19208189

The Rebirth of Pediatrics PEDIATRICS Wise, P. H. 2009; 123 (1): 413-416

View details for DOI 10.1542/peds.2008-3254

View details for Web of Science ID 000262046400060

View details for PubMedID 19117909

Variability in Pediatric Utilization of Trauma Facilities in California: 1999 to 2005 ANNALS OF EMERGENCY MEDICINE Wang, N. E., Saynina, O., Kuntz-Duriseti, K., Mahlow, P., Wise, P. H. 2008; 52 (6): 607-615


We identify geographic, system, and socioeconomic differences between injured children cared for within and outside of state-designated trauma centers.This was a nonconcurrent observational study of a population-based sample from the California Office of Statewide Health Planning and Development Public Patient Discharge Database 1999 to 2005. Patients were 1 to 14 years of age, with International Classification of Diseases, Ninth Revision (ICD-9) diagnostic codes indicative of trauma. Injury Severity Scores were calculated from ICD-9 codes and categorized into severity categories. Outcomes were hospitalization in a trauma or nontrauma center.Children with severe injury who resided 0 to 10, 11 to 25, 26 to 50, and more than 50 miles from a trauma center were hospitalized in these centers at rates of 80.0%, 71.2%, 51.4%, and 28.5%, respectively. Children with severe injury who were living in a county with a trauma center were hospitalized in these centers at rates of 78.8%, whereas children living in a county without a trauma center were hospitalized in trauma centers at rates of 39.0%. Children with severe injury and public, private non-health maintenance organization (HMO), and HMO insurance were hospitalized in trauma centers at rates of 77.7%, 68.0%, and 55.4%, respectively. Age, injury severity, insurance type, residence in a county with a trauma center, and proximity to a trauma center were identified as predictors of trauma center utilization by logistic regression.We demonstrate considerable variation in the utilization pattern of trauma specialty care for children with moderate and severe injuries. Children with HMO and private insurance are cared for less often in trauma centers than those with public insurance, even after adjustment for other variables. Increased distance to a trauma center, as well as lack of trauma center within a county, also decreases trauma center utilization. These results suggest that assessing trauma center utilization patterns in total populations of children may identify opportunities for improved referral policies and practices as part of a larger effort to ensure high-quality trauma care for all children in need.

View details for DOI 10.1016/j.annemergmed.2008.05.011

View details for Web of Science ID 000261540200002

View details for PubMedID 18562043



Preconception and interconception care respond to the growing body of evidence that many of the most important determinants of birth outcomes may exist before pregnancy occurs. In this sense, the strategy of extending prenatal care into the preconception and interconception periods marks a useful step in reforming the public health approach to improving birth outcomes. However, although helpful in underscoring the continuity of risk that can ultimately find expression in adverse birth outcomes, the concern is that without greater critical attention these relatively new care constructs have the potential to undermine rather than strengthen a comprehensive system of women's health care.

View details for DOI 10.1016/j.whi.2008.07.014

View details for Web of Science ID 000262091300004

View details for PubMedID 18951817

The future pediatrician: The challenge of chronic illness JOURNAL OF PEDIATRICS Wise, P. H. 2007; 151 (5): S6-S10


To relate the changing epidemiology of childhood to current patterns of pediatric practice in the United States, a critical literature review and selected analyses of national datasets, including the National Health Interview Survey, the National Hospital Discharge Survey, and National Vital Statistics System, were conducted. Trends over the past several decades suggest that the incidence of serious acute illness in children has fallen while the prevalence of chronic disease has risen. These trends have resulted in a growing concentration of serious childhood morbidity and mortality into chronic disorders. Current pediatric practice structures appear to be poorly suited to meet the growing demands of chronic disease in children and likely will require major reform in organization, financing, and training.

View details for DOI 10.1016/Jpeds.2007.08.013

View details for Web of Science ID 000250915000003

View details for PubMedID 17950322

The relationship of immigrant status with access, utilization, and health status for children with asthma AMBULATORY PEDIATRICS Javier, J. R., Wise, P. H., Mendoza, F. S. 2007; 7 (6): 421-430


Despite their high levels of poverty and less access to health care, children in immigrant families have better than expected health outcomes compared with children in nonimmigrant families. However, this observation has not been confirmed in children with chronic illness. The objective of this study was to determine whether children with asthma in immigrant families have better than expected health status than children with asthma in nonimmigrant families.Data from the 2001 and 2003 California Health Interview Survey (CHIS) were used to identify 2600 children, aged 1 to 11, with physician-diagnosed asthma. Bivariate analyses and logistic regression were performed to examine health care access, utilization, and health status measures by our primary independent variable, immigrant family status.Compared with children with asthma in nonimmigrant families, children with asthma in immigrant families are more likely to lack a usual source of care (2.6% vs 1.0%; P < .05), report a delay in medical care (8.9% vs 5.2%; P < .01), and report no visit to the doctor in the past year (7.0% vs 3.8%; P < .05). They are less likely to report asthma symptoms (60.8% vs 74.4%; P < .01) and an emergency room visit in the past year (14.1% vs 21.1%; P < .01), yet more likely to report fair or poor perceived health status (25.0% vs 10.5%; P < .01). Multivariate models revealed that the relationship of immigrant status with health measures was complex. These models suggested that lack of insurance and poverty was associated with reduced access and utilization. Children in immigrant families were less likely to visit the emergency room for asthma in the past year (odds ratio 0.58, confidence interval, 0.36-0.93). Poverty was associated with having a limitation in function and fair or poor perceived health, whereas non-English interview language was associated with less limitation in function but greater levels of fair or poor perceived health.Clinicians should be aware of important barriers to care that may exist for immigrant families who are poor, uninsured, and non-English speakers. Reduced health care access and utilization by children with asthma in immigrant families requires policy attention. Further research should examine barriers to care as well as parental perceptions of health for children with asthma in immigrant families.

View details for Web of Science ID 000251638400005

View details for PubMedID 17996835

Inhalational, gastrointestinal, and cutaneous anthrax in children ARCHIVES OF PEDIATRICS & ADOLESCENT MEDICINE Bravata, D. M., Holty, J. C., Wang, E., Lewis, R., Wise, P. H., McDonald, K. M., Owens, D. K. 2007; 161 (9): 896-905


To systematically review all published case reports of children with anthrax to evaluate the predictors of disease progression and mortality.Fourteen selected journal indexes (1900-1966), MEDLINE (1966-2005), and the bibliographies of all retrieved articles.Case reports (any language) of anthrax in persons younger than 18 years published between January 1, 1900, and December 31, 2005. Main Exposures Cases with symptoms and culture or Gram stain or autopsy evidence of anthrax infection.Disease progression, treatment responses, and mortality.Of 2499 potentially relevant articles, 73 case reports of pediatric anthrax (5 inhalational cases, 22 gastrointestinal cases, 37 cutaneous cases, 6 cases of primary meningoencephalitis, and 3 atypical cases) met the inclusion criteria. Only 10% of the patients were younger than 2 years, and 24% were girls. Of the few children with inhalational anthrax, none had nonheadache neurologic symptoms, a key finding that distinguishes adult inhalational anthrax from more common illnesses, such as influenza. Overall, observed mortality was 60% (3 of 5) for inhalational anthrax, 65% (13 of 20) for gastrointestinal anthrax, 14% (5 of 37) for cutaneous anthrax, and 100% (6 of 6) for primary meningoencephalitis. Nineteen of the 30 children (63%) who received penicillin-based antibiotics survived, and 9 of the 11 children (82%) who received anthrax antiserum survived.The clinical presentation of children with anthrax is varied. The mortality rate is high in children with inhalational anthrax, gastrointestinal anthrax, and anthrax meningoencephalitis. Rapid diagnosis and effective treatment of anthrax in children requires recognition of the broad spectrum of clinical presentations of pediatric anthrax.

View details for Web of Science ID 000249156800013

View details for PubMedID 17768291

The UNICEF report on child well-being AMBULATORY PEDIATRICS Wise, P. H., Blair, M. E. 2007; 7 (4): 265-266

View details for Web of Science ID 000248501100001

View details for PubMedID 17660094

Trauma center utilization for children in California 1998-2004: Trends and areas for further analysis ACADEMIC EMERGENCY MEDICINE Wang, N. E., Chan, J., Mahlow, P., Wise, P. H. 2007; 14 (4): 309-315


While it is known that trauma systems improve the outcome of injury in children, there is a paucity of information regarding trauma system function amid changes in policies and health care financing that affect emergency medical systems for children.To describe the trends in the proportion of pediatric trauma patients acutely hospitalized in trauma-designated versus non-trauma-designated hospitals.This was a retrospective observational study of a population-based cohort obtained by secondary analysis of a publicly available data set: the California Office of Statewide Health Planning and Development Patient Discharge Database from 1998 to 2004. Patients were included in the analysis if they were 0-19 years old, had International Classification of Disease, Ninth Revision (ICD-9) diagnostic codes and E-codes indicative of trauma, had an unscheduled admission, and were discharged from a general acute care hospital (N = 111,566). Proportions of patients hospitalized in trauma-designated hospitals versus non-trauma-designated hospitals were calculated for Injury Severity Score and death. Injury Severity Scores were calculated from ICD-9 codes. Primary outcomes were hospitalization in a trauma center and death two or more days after hospitalization.Over the study period, the proportion of children aged 0-14 years with acute trauma requiring hospitalization and who were cared for in trauma-designated hospitals increased from 55% (95% confidence interval [CI] = 54% to 56%) in 1998 to 66% (95% CI = 65% to 67%) in 2004 (p < 0.01). For children aged 15-19 years, the proportion increased from 55% (95% CI = 54% to 57%) in 1998 to 74% (95% CI = 72% to 75%) in 2004 (p < 0.0001). When trauma discharges were stratified by injury severity, the proportion of children with severe injury who were hospitalized in trauma-designated hospitals increased from 69% (95% CI = 66% to 72%) in 1998 to 84% (95% CI = 82% to 87%) in 2004, a rate higher than in children with moderate injury (59% [95% CI = 58% to 61%] in 1998 and 75% [95% CI = 74% to 76%] in 2004) and mild injury (51% [95% CI = 50% to 52%] in 1998 and 63% [95% CI = 62% to 64%] in 2004) (p < 0.0001 for each injury severity category and both age groups). Of the hospitalized children who died two or more days after injury (n = 502), 18.1% died in non-trauma-designated hospitals (p < 0.002 for children aged 0-14 years; p = 0.346 for children aged 15-19 years).An increasing majority of children with trauma were cared for in trauma-designated hospitals over the study period. However, 23% of children with severe injuries, and 18.1% of pediatric deaths more than two days after injury, were cared for in non-trauma-designated hospitals. These findings demonstrate an important opportunity for improvement. If we can characterize those children who do not access the trauma system despite severe injury or death, we will be able to design clinical protocols and implement policies that ensure access to appropriate regional trauma care for all children in need.

View details for DOI 10.1197/j.aem.2006.11.012

View details for Web of Science ID 000245579300003

View details for PubMedID 17296799

Creating an analytic voice in the policy storm AMBULATORY PEDIATRICS Wise, P. H., Chamberlain, L. 2005; 5 (1): 45-46

View details for Web of Science ID 000226460500004

View details for PubMedID 15656704

The transformation of child health in the United States HEALTH AFFAIRS Wise, P. H. 2004; 23 (5): 9-25


Social trends and medical progress have fueled major changes in the epidemiology of child health in the United States. Injuries remain a major contributor to childhood illness and death. However, among noninjury causes, chronic illness now accounts for the majority of children's hospital days and deaths. Although mortality rates for all children have fallen dramatically, social disparities persist. Approximately half of all excess deaths among African American children occur during infancy, primarily from extremely premature births, and the remaining portion, primarily from homicide and serious chronic conditions. These challenges may require changes in today's child health practices and policies.

View details for DOI 10.1377/hlthaff.23.5.9

View details for Web of Science ID 000224027800002

View details for PubMedID 15495347

Framework as metaphor: the promise and peril of MCH life-course perspectives. Maternal and child health journal Wise, P. H. 2003; 7 (3): 151-156


Life-course analytic frameworks expressly link the determinants of health and illness across the lifespan. Such frameworks could serve as a foundation for integrating child and adult health policies by emphasizing the potential that social and biologic processes early in life can find clinical expression as adult-onset disease. However, there are elements of these frameworks that can be misinterpreted in ways that obscure scientific processes and fragment rather than integrate health policies. First, casting early life influences as determining rather than merely influencing adult health obscures the complexity of social and biologic etiologies over a lifetime and diminishes the impact of events in adolescence and adult life. Second, oversimplifying the impact of early influences on adult disease tends to imply that such processes are particularly unamenable to clinical and public health interventions, a suggestion without an empirical basis and likely to undermine pleas for enhanced access to such interventions. Third, exaggerating early life events as being highly deterministic of adult illness in order to shift societal resources from the elderly towards children can generate unnecessary antagonisms between potentially allied constituencies. Together, these considerations suggest that the utility of life-course frameworks will depend upon cautious interpretation and an ongoing process of active refinement.

View details for PubMedID 14509410

The anatomy of a disparity in infant mortality ANNUAL REVIEW OF PUBLIC HEALTH Wise, P. H. 2003; 24: 341-362


This article suggests that while disparities in infant mortality have been longstanding, the mechanisms of disparity creation are undergoing intense change. This dynamic character is explored by first developing an analytic model that examines the interaction between social factors and the public health and clinical capacity to intervene. Disparities in infant mortality are then broken down into their component parts and linked to specific arenas of intervention. Disparities in postneonatal mortality are being shaped by differential access to interventions designed to prevent infant death from congenital anomalies and the Sudden Infant Death Syndrome. Disparities in neonatal mortality are primarily determined by factors that influence the birthrate of extremely premature infants and access to specialized obstetrical and pediatric care. This analysis suggests that the epidemiology and social meaning of disparities in infant mortality are intensely dynamic and increasingly reflect the interaction between social forces and technical innovation.

View details for DOI 10.1146/annurev.publhealth.24.100901.140816

View details for Web of Science ID 000185094600018

View details for PubMedID 12471271

The State Children's Health Insurance Program - Effective but vulnerable ARCHIVES OF PEDIATRICS & ADOLESCENT MEDICINE Wise, P. H. 2002; 156 (12): 1175-1176

View details for Web of Science ID 000179661400002

View details for PubMedID 12444823

The data are in: Health matters in welfare policy AMERICAN JOURNAL OF PUBLIC HEALTH Chavkin, W. 2002; 92 (9): 1392-1395

View details for Web of Science ID 000177661900009

View details for PubMedID 12197962

Welfare to work? Impact of maternal health on employment AMERICAN JOURNAL OF PUBLIC HEALTH Romero, D., Chavkin, W., Wise, P. H., Smith, L. A., Wood, P. R. 2002; 92 (9): 1462-1468


This study investigated whether health problems among poor mothers of chronically ill children affect their ability to obtain and maintain employment.Mothers of children with chronic illnesses were surveyed at clinical and welfare agency sites in San Antonio, Tex.There were distinct health differences according to mothers' TANF and employment status. Mothers without TANF experience reported better physical and mental health and less domestic violence and substance use than did those who had TANF experience. Those not currently working had higher rates of physical and mental health problems.Poor maternal health is associated with need for cash assistance and health insurance. Policymakers must recognize that social policies promoting employment will fail if they do not address the health needs of poor women and children.

View details for Web of Science ID 000177661900021

View details for PubMedID 12197974

Relationships between welfare status, health insurance status, and health and medical care among children with asthma AMERICAN JOURNAL OF PUBLIC HEALTH Wood, P. R., Smith, L. A., Romero, D., Bradshaw, P., Wise, P. H., Chavkin, W. 2002; 92 (9): 1446-1452


This study evaluated the relationships between health insurance and welfare status and the health and medical care of children with asthma.Parents of children with asthma aged 2 to 12 years were interviewed at 6 urban clinical sites and 2 welfare offices.Children whose families had applied for but were denied welfare had more asthma symptoms than did children whose families had had no contact with the welfare system. Poorer mental health in parents was associated with more asthma symptoms and higher rates of health care use in their children. Parents of uninsured and transiently insured children identified more barriers to health care than did parents whose children were insured.Children whose families have applied for welfare and children who are uninsured are at high risk medically and may require additional services to improve health outcomes.

View details for Web of Science ID 000177661900018

View details for PubMedID 12197971

Employment barriers among welfare recipients and applicants with chronically ill children AMERICAN JOURNAL OF PUBLIC HEALTH Smith, L. A., Romero, D., Wood, P. R., Wampler, N. S., Chavkin, W., Wise, P. H. 2002; 92 (9): 1453-1457


This study evaluated the association of chronic child illness with parental employment among individuals who have had contact with the welfare system.Parents of children with chronic illnesses were interviewed.Current and former welfare recipients and welfare applicants were more likely than those with no contact with the welfare system to report that their children's illnesses adversely affected their employment. Logistic regression analyses showed that current and former receipt of welfare, pending welfare application, and high rates of child health care use were predictors of unemployment.Welfare recipients and applicants with chronically ill children face substantial barriers to employment, including high child health care use rates and missed work. The welfare reform reauthorization scheduled to occur later in 2002 should address the implications of chronic child illness for parental employment.

View details for Web of Science ID 000177661900019

View details for PubMedID 12197972

Chronic illness among poor children enrolled in the temporary assistance for needy families program AMERICAN JOURNAL OF PUBLIC HEALTH Wise, P. H., Wampler, N. S., Chavkin, W., Romero, D. 2002; 92 (9): 1458-1461


This study assessed chronic child illness among recipients of Temporary Assistance for Needy Families (TANF) benefits and poor families not receiving benefits.Data from the 1998 National Health Interview Survey were used to examine chronic child illness, enrollment in TANF, health insurance status, and selected access indicators.One quarter of TANF-enrolled children had chronic illnesses. Unenrolled children were 3 times as likely as TANF-enrolled children to be uninsured. Among the chronically ill, 31.7% of unenrolled and 14.3% of enrolled children experienced gaps in insurance coverage that were associated with access barriers.Welfare policies should consider the effects of chronic illness and gaps in insurance coverage on the health of poor children.

View details for Web of Science ID 000177661900020

View details for PubMedID 12197973

Women's health after pregnancy and child outcomes at age 3 years: A prospective cohort study AMERICAN JOURNAL OF PUBLIC HEALTH Kahn, R. S., Zuckerman, B., Bauchner, H., Homer, C. J., Wise, P. H. 2002; 92 (8): 1312-1318


This study examined the persistence and comorbidity of women's physical and mental health conditions after pregnancy and the association of these conditions with child outcomes.A national cohort of women who recently gave birth were surveyed in 1988 and again in 1991. We examined longitudinal data on maternal poor physical health, depressive symptoms, and smoking, and maternal report of child outcomes (at age approximately 3 years).Women's poor physical health and smoking had strong, graded associations with children's physical health and behavior problems, whereas women's depressive symptoms were associated with children's delayed language and behavior problems.Substantial persistence and comorbidity of women's health conditions exist after pregnancy with adverse effects on early child outcomes. Child health professionals should support services and policies that promote women's health outside the context of pregnancy.

View details for Web of Science ID 000177109800028

View details for PubMedID 12144990

Knowledge of welfare reform program provisions among families of children with chronic conditions AMERICAN JOURNAL OF PUBLIC HEALTH Smith, L. A., Wise, P. H., Wampler, N. S. 2002; 92 (2): 228-230


This study examined the knowledge of and application for health-related welfare program provisions among beneficiaries with children who have chronic conditions.We administered a survey to 143 parents of children aged 3 to 16 years with asthma or sickle cell anemia in 2 clinical settings.Respondents indicated incomplete knowledge of work requirements (69.9%) and work exemptions (50.3%). Applications for work exemptions were rare, even among Supplemental Security Income recipients (30%).Welfare beneficiaries with children who have chronic conditions show limited knowledge and use of program provisions, placing them at risk for penalties or benefit termination.

View details for Web of Science ID 000173558000021

View details for PubMedID 11818296

Maternal cigarette smoking, metabolic gene polymorphism, and infant birth weight JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION Wang, X. B., Zuckerman, B., Pearson, C., Kaufman, G., Chen, C. Z., Wang, G. Y., Niu, T. H., Wise, P. H., Bauchner, H., Xu, X. P. 2002; 287 (2): 195-202


Little is known about genetic susceptibility to cigarette smoke in relation to adverse pregnancy outcomes.To investigate whether the association between maternal cigarette smoking and infant birth weight differs by polymorphisms of 2 maternal metabolic genes: CYP1A1 and GSTT1.Case-control study conducted in 1998-2000 among 741 mothers (174 ever smokers and 567 never smokers) who delivered singleton live births at Boston Medical Center. A total of 207 cases were preterm or low-birth-weight infants and 534 were non-low-birth-weight, full-term infants (control).Birth weight, gestation, fetal growth by smoking status and CYP1A1 MspI (AA vs Aa and aa, where Aa and aa were combined because of small numbers of aa and similar results), and GSTT1 (present vs absent) genotypes.Without consideration of genotype, continuous maternal smoking during pregnancy was associated with a mean reduction of 377 g (SE, 89 g) in birth weight (odds ratio [OR], 2.1; 95% confidence interval [CI], 1.2-3.7). When CYP1A1 genotype was considered, the estimated reduction in birth weight was 252 g (SE, 111 g) for the AA genotype group (n = 75; OR, 1.3; 95% CI, 0.6-2.6), but was 520 g (SE, 124 g) for the Aa/aa genotype group (n = 43 for Aa, n = 6 for aa; OR, 3.2; 95% CI, 1.6-6.4). When GSTT1 genotype was considered, the estimated reduction in birth weight was 285 g (SE, 99 g) (OR, 1.7; 95% CI, 0.9-3.2) and 642 g (SE, 154 g) (OR, 3.5; 95% CI, 1.5-8.3) for the present and absent genotype groups, respectively. When both CYP1A1 and GSTT1 genotypes were considered, the greatest reduction in birth weight was found among smoking mothers with the CYP1A1 Aa/aa and GSTT1 absent genotypes (-1285 g; SE, 234 g; P<.001). Among never smokers, genotype did not independently confer an adverse effect. A similar pattern emerged in analyses stratified by maternal ethnicity and in analyses for gestation.In our study, maternal CYP1A1 and GSTT1 genotypes modified the association between maternal cigarette smoking and infant birth weight, suggesting an interaction between metabolic genes and cigarette smoking.

View details for Web of Science ID 000173114900021

View details for PubMedID 11779261

Welfare, women, and children: it's time for doctors to speak out. Journal of the American Medical Women's Association (1972) Chavkin, W., Wise, P. H., Romero, D. 2002; 57 (1): 3-?

View details for PubMedID 11905487

State welfare reform policies and maternal and child health services: a national study. Maternal and child health journal Romero, D., Chavkin, W., Wise, P. H., Hess, C. A., Vanlandeghem, K. 2001; 5 (3): 199-206


Welfare reform (Personal Responsibility and Work Opportunity Reconciliation Act of 1996) resulted in dramatic policy changes, including health-related requirements and the administrative separation of cash assistance from Medicaid. We were interested in determining if changes in welfare and health policies had had an impact on state MCH services and programs.We conducted a survey in fall 1999 of state MCH Title V directors. Trained interviewers administered the telephone survey over a 3-month period. MCH directors from all 50 states, Washington, DC, and Puerto Rico participated (n = 52; response rate = 100%).Among the most noteworthy findings is that similar proportions of respondents reported that welfare policy changes had either helped (46%) or hindered (42%) the agency's work, with most of the positive impact attributed to increased funding. MCH data linkages with welfare and other social programs were low. Despite welfare reform's emphasis on work, limited services and exemptions were available for mothers with CSHCN. Almost no efforts have been undertaken to specifically address the needs of substance abusers in the context of new welfare policies.Few MCH agencies have developed programs to address the special needs of women receiving TANF who either have health problems themselves or have children with health problems. Recommendations including increased MCH and family planning funding and improved coordination between TANF and MCH to facilitate linkages and services are put forth in light of reauthorization of PRWORA.

View details for PubMedID 11605725

State income inequality, household income, and maternal mental and physical health: cross sectional national survey BRITISH MEDICAL JOURNAL Kahn, R. S., Wise, P. H., Kennedy, B. P., Kawachi, I. 2000; 321 (7272): 1311-1315


To examine the association of state income inequality and individual household income with the mental and physical health of women with young children.Cross sectional study. Individual level data (outcomes, income, and other sociodemographic covariates) from a 1991 follow up survey of a birth cohort established in 1988. State level income inequality calculated from the income distribution of each state from 1990 US census.United States, 1991. Participants: Nationally representative stratified random sample of 8060 women who gave birth in 1988 and were successfully contacted (89%) in 1991.Depressive symptoms (Center for Epidemiologic Studies depression score >15) and self rated health19% of women reported depressive symptoms, and 7.5% reported fair or poor health. Compared with women in the highest fifth of distribution of household income, women in the lowest fifth were more likely to report depressive symptoms (33% v 9%, P<0.001) and fair or poor health (15% v 2%, P<0. 001). Compared with low income women in states with low income inequality, low income women in states with high income inequality had a higher risk of depressive symptoms (odds ratio 1.6, 95% confidence interval 1.0 to 2.6) and fair or poor health (1.8, 0.9 to 3.5).High income inequality confers an increased risk of poor mental and physical health, particularly among the poorest women. Both income inequality and household income are important for health in this population.

View details for Web of Science ID 000165561600023

View details for PubMedID 11090512

Implications of welfare reform for child health: Emerging challenges for clinical practice and policy PEDIATRICS Smith, L. A., Wise, P. H., Chavkin, W., Romero, D., Zuckerman, B. 2000; 106 (5): 1117-1125

View details for Web of Science ID 000165052300026

View details for PubMedID 11061785

State welfare reform policies and declines in health insurance AMERICAN JOURNAL OF PUBLIC HEALTH Chavkin, W., Romero, D., Wise, P. H. 2000; 90 (6): 900-908


This study sought to determine whether there is a relationship between state policies on Temporary Assistance to Needy Families (TANF), declines in both TANF and Medicaid caseloads, and the rise in the number of uninsured.Extant data sources of state TANF policies, TANF and Medicaid participation, and uninsurance rates were analyzed, with the state as the unit of analysis. The independent variables included state TANF policies that directly address receipt of benefits or relate to health; dependent variables included changes in state TANF enrollment, Medicaid enrollment, and health insurance status since the enactment of the law.In the bivariate analysis, declines in Medicaid were associated with sanction for work noncompliance, lack of a child care guarantee, and strategies to deter TANF enrollment; this last factor was also associated with increased uninsurance. In the multivariate analysis, lack of a child care guarantee and deterrent strategies predicted TANF declines; deterrent strategies predicted Medicaid decline and uninsurance increases.This analysis suggests that policies deterring TANF enrollment may contribute to declines in Medicaid and increased uninsurance. To maintain health insurance for the poor, policymakers should consider revising policies that deter TANF enrollment.

View details for Web of Science ID 000087335800015

View details for PubMedID 10846507

The impact of managed care insurance on use of lower-mortality hospitals by children undergoing cardiac surgery in California PEDIATRICS Erickson, L. C., Wise, P. H., Cook, E. F., Beiser, A., Newburger, J. W. 2000; 105 (6): 1271-1278


Managed care plans aggressively seek to contain costs, but few data are available regarding their impact on access to high quality care for their members.To assess the impact of managed care health insurance on use of lower-mortality hospitals for children undergoing heart surgery in California.Retrospective cohort study using state-mandated hospital discharge datasets.Pediatric cardiovascular surgical centers in California.Five thousand seventy-one children admitted for open cardiac surgical procedures during 1992-1994.Hospitals were divided into lower- and higher-mortality groups according to adjusted surgical mortality. Using multivariate logistic regression analysis to control for medical, socioeconomic, demographic, and distance factors, children with managed care insurance were less likely to be admitted to a lower-mortality hospital for surgery relative to children with indemnity insurance (odds ratio:.53; 95% confidence interval:.45,.63). Similar findings resulted when the analysis was stratified by race/ethnicity. In addition, length of stay, a correlate of health care costs, was no longer for children admitted to lower-mortality centers than for those at higher-mortality centers (adjusted difference:.54 days shorter at lower-mortality centers; 95% confidence interval: -1.50,. 41).During this study, children with managed care insurance had significantly reduced use of lower-mortality hospitals for pediatric heart surgery in California compared with children with indemnity insurance. Further study is necessary to determine the mechanisms of this apparent insurance-specific inequity.

View details for Web of Science ID 000087441400029

View details for PubMedID 10835068

Antibiotics without prescription: "bacterial or medical resistance"? LANCET Bauchner, H., Wise, P. H. 2000; 355 (9214): 1480-1480

View details for Web of Science ID 000086830100007

View details for PubMedID 10801167

Efficacy and justice: the importance of medical research and tertiary care to social disparities in infant mortality. Journal of perinatology Wise, P. H. 1999; 19 (6): S24-7

View details for PubMedID 10685292

Implementation of Fetal and Infant Mortality Review (FIMR): experience from the national Healthy Start program. Maternal and child health journal Baltay, M., McCormick, M. C., Wise, P. H. 1999; 3 (3): 141-150


The implementation of the Fetal and Infant Mortality Review (FIMR) process was examined as part of the evaluation of the national Healthy Start program, a federal program designed to reduce infant mortality in several communities. The implementation of the FIMR process over the 5-year funding period is described in terms of productivity, barriers and facilitators to implementation, and project expenditures.Data were derived from grant continuation applications and personal interviews with program staff to produce a qualitative description.As of the summer of 1996, 14 of the 15 Healthy Start sites in the national evaluation had successfully implemented the FIMR process. Most sites had developed a two-tiered review process for examination of case data in which a review by health and social services professionals was followed by community review. In the period 1993 to 1995, the percentage of fetal and infant deaths reviewed had a median of 34% with a range of 4-79% across the sites at a cost of $600 to $3400 per death reviewed. Recommendations were variably implemented.The FIMR process provides an important opportunity to contribute to the knowledge base regarding infant mortality in these communities. The process, however, has important logistical requirements and may require substantial financial resources that may affect implementation of confidential inquiries into infant mortality and other health problems.

View details for PubMedID 10746753

The scope of unmet maternal health needs in pediatric settings PEDIATRICS Kahn, R. S., Wise, P. H., Finkelstein, J. A., Bernstein, H. H., Lowe, J. A., Homer, C. J. 1999; 103 (3): 576-581


Previous work has focused attention on the prevalence of specific maternal health problems known to affect children, such as smoking or depression. However, the cumulative health burden experienced by mothers and the potential for a practical pediatric health services response have not been examined. The aims of this study were to characterize: 1) the prevalence and cumulative burden of maternal health behaviors and conditions, 2) maternal access to a source of comprehensive adult primary care, and 3) maternal perceptions of a pediatric role in screening and referral.We surveyed 559 consecutive women bringing a child 18 months of age or less to one of four pediatric primary care sites between July 1996 and May 1997. The pediatric sites included one outpatient program in an academic hospital, one in a community health center, and two in-staff model practices of a managed care organization (these last two were combined for analysis). The self-administered questionnaire contained previously validated questions to assess health behaviors and conditions (smoking, alcohol abuse, depression, violence, risk for unintended pregnancy, serious illness, self-reported health) and access to care (regular source, regular provider, health insurance, care delayed or not received). Maternal attitudes toward a pediatric role in screening and referral were also elicited.In the three settings, response rates ranged from 75% to 84%. The average age of the women ranged from 25.1 to 32. 1 years and the average age of the children ranged from 6.5 to 8.0 months. Across the settings, the percentage of women reporting at least one health condition (66%-74%) was similarly high, despite significant demographic differences among sites. Many women reported more than one condition (31%-37%); among all women who smoked, 33% also screened positive for alcohol abuse, 31% for emotional or physical abuse, and 48% for depression. Access to comprehensive adult primary care was variable with 23% to 58% of women reporting one or more barriers depending on the site. Across all sites, >85% of mothers reported they would "not mind" or "would welcome" a pediatric role in screening and referral.Two-thirds of women bringing their children for pediatric care had health problems regardless of the site of care. Many women also reported substantial barriers to comprehensive health care. Most women reported acceptance of a pediatric role in screening and referral. Given the range and depth of maternal health needs, strategies to connect or reconnect mothers to comprehensive adult primary care from a variety of pediatric settings should be explored.

View details for Web of Science ID 000078960100007

View details for PubMedID 10049959

Topics for our times: Welfare reform and women's health AMERICAN JOURNAL OF PUBLIC HEALTH Chavkin, W., Wise, P. H., Elman, D. 1998; 88 (7): 1017-1018

View details for Web of Science ID 000074610600005

View details for PubMedID 9663145

National survey of the states: Policies and practices regarding drug-using pregnant women AMERICAN JOURNAL OF PUBLIC HEALTH Chavkin, W., Breitbart, V., Elman, D., Wise, P. H. 1998; 88 (1): 117-119


This study assessed the impact of national policy shifts on state policies and practices regarding substance-using mothers.A 1995 telephone survey of substance abuse and child protective services directors in all 50 states and the District of Columbia was compared with a similar 1992 survey.There have been significant increases in state interventions for drug-using pregnant women (e.g., criminal prosecution, toxicology testing of women and neonates). Federal resources for treatment and oversight are being replaced by state control of reduced funds for treatment.The earlier policy of expanding treatment for addicted women is being replaced by reduction of services and increased state intervention.

View details for Web of Science ID 000073804800023

View details for PubMedID 9584016

Policies towards pregnancy and addiction - Sticks without carrots COCAINE: EFFECTS ON THE DEVELOPING BRAIN Chavkin, W., Wise, P. H., Elman, D. 1998; 846: 335-340


Throughout this century in the United States, tension has existed between those who believe drug abuse is best combatted through the criminal justice system and those who emphasize a medical/public health model of prevention and treatment. In the last decade this debate has centered around the person of the pregnant addict. The former have construed her addiction as willful harm to the fetus punishable on criminal and child abuse grounds. The latter have countered that pregnancy is a moment of increased motivation for treatment and focused on expansion and improvement of treatment options. Both managed care and welfare reform have exacerbated conditions between these opposing policy approaches. The addicted woman is increasingly caught between policies that punish her drug use without options for overcoming addiction.

View details for Web of Science ID 000074931100028

View details for PubMedID 9668420

War experiences and distress symptoms of Bosnian children PEDIATRICS Goldstein, R. D., Wampler, N. S., Wise, P. H. 1997; 100 (5): 873-878


The war in Bosnia has had a tremendous impact on civilians. Little is known about the impact of modern warfare on children. This survey documents the nature and frequency of war-related experiences among Bosnian children and describes their manifestations of selected psychological sequelae.A cross-sectional survey of 364 internally displaced 6- to 12-year-old children and their parents living in central Bosnian collectives was conducted during the war. Parents were surveyed for their children's war experiences; the children were surveyed for war-related distress symptoms.The children were exposed to virtually all of the surveyed war-related experiences. The majority had faced separations from family, bereavement, close contact with war and combat, and extreme deprivation. The prevalence and severity of experiences were not significantly related to a child's gender, wealth, or age, but were related to their region of residence, with children from the region of Sarajevo having the highest prevalence of experiences. Almost 94% of the children met Diagnostic and Statistical Manual of Mental Disorders, 4th ed, criteria for posttraumatic stress disorder. Significant life activity affecting sadness and anxiety were reported by 90.6% and 95.5% of the children, respectively. High levels of other symptoms surveyed were also found. Children with greater symptoms had witnessed the death, injury, or torture of a member of their nuclear family, were older, and came from a large city.The war-related experiences of the children studied were both varied and severe, and were associated with a variety of psychological sequelae. This experience underscores the vulnerability of civilians in areas of conflict and the need to address the effects of war on the mental health of children.

View details for Web of Science ID A1997YD73900016

View details for PubMedID 9346989

Fertility therapy and the risk of very low birth weight OBSTETRICS AND GYNECOLOGY McElrath, T. F., Wise, P. H. 1997; 90 (4): 600-605


To test the hypothesis of an association between maternal infertility therapy and the risk of very low birth weight (VLBW), defined as birth weight less than 1500 g, independent of the risk of multiple births, and to estimate the contribution of infertility therapy to the national incidence of VLBW.The National Maternal and Infant Health Survey conducted in 1988 was used to develop statistics describing outcomes among this birth cohort and to construct logistic regression models evaluating fertility therapy as an independent risk factor for VLBW.An estimated 10.1% of live births and 18.2% of VLBW births nationally were associated with either maternal subfertility or infertility therapy (6.8% and 11.4%, respectively). The risk of VLBW among women concerned with subfertility (i.e., receiving diagnostic testing or advice on timing intercourse) was 1.4 (95% confidence interval [CI] 1.1, 1.9), whereas that for women undergoing therapeutic interventions (ie, ovarian stimulation, surgery, in vitro fertilization, or artificial insemination) was 2.6 (95% CI 2.1, 3.2). Accounting for effects of multiple gestation, maternal age, and a history of miscarriage, the odds ratios for the concerned and therapy groups were 1.5 (95% CI 1.1, 1.9) and 2.0 (95% CI 1.5, 2.5), respectively. Black women were less likely to use fertility therapy but more likely to experience a therapy-related VLBW.Fertility therapy is associated with an important portion of all VLBW and with an elevated risk of VLBW, related only in part to an increased risk of multiple gestations. Women expressing concern about subfertility but not receiving therapy are also at increased risk of VLBW, suggesting that a history of infertility may mediate part of the risk associated with fertility therapy.

View details for Web of Science ID A1997XX74500023

View details for PubMedID 9380323

Home uterine activity monitoring in the prevention of very low birth weight PUBLIC HEALTH REPORTS Kempe, A., Sachs, B. P., Ricciotti, H., Sobol, A. M., Wise, P. H. 1997; 112 (5): 433-439


Despite controversy regarding the efficacy of home uterine activity monitoring (HUAM), it is currently licensed for detection of preterm labor in women with previous preterm deliveries. In practice, however, it is being more widely utilized in an effort to prevent preterm delivery. This study seeks to determine which group of mothers delivering very low birth weight (VLBW) infants would have qualified for HUAM given three different sets of criteria and in which women it could have been used to help prolong gestation.The authors reviewed the medical records of mothers of VLBW infants born in five U.S. locations (N = 1440), retrospectively applying three sets of eligibility criteria for HUAM use: (a) the current FDA licensing criterion for use of HUAM, a previous preterm birth; (b) indication for HUAM commonly cited in published reports; (c) a broad set of criteria based on the presence of any reproductive or medical conditions that might predispose to premature delivery. The authors then analyzed the conditions precipitating delivery for each group to determine whether delivery might have been prevented with HUAM and tocolytic therapy.Only 4.4% of the total group of women delivering VLBW infants would have been eligible for HUAM under the FDA criterion and might potentially have benefited from this technology. If extremely broad criteria had been applied to identify those eligible for monitoring, under which almost 80% of all women who delivered VLBW infants would have been monitored, only 20.3% of the total group would have been found eligible and would potentially have benefited. If such broad criteria were applied to all pregnant women, a sizable proportion of pregnancies would be monitored at great expense with small potential clinical benefit.Because VLBW births are usually precipitated by conditions that are unlikely to benefit from HUAM, this technology will have little impact on reducing VLBW and neonatal mortality rates. More comprehensive preventive strategies should be sought.

View details for Web of Science ID A1997XW23600028

View details for PubMedID 9323396

Maternal and infant health - Effects of moderate reductions in postpartum length of stay Mandl, K. D., Brennan, T. A., Wise, P. H., Tronick, E. Z., Homer, C. J. AMER MEDICAL ASSOC. 1997: 915-921


The Newborns' and Mothers' Health Protection Act of 1996 prohibits payers from restricting "benefits for any hospital length of stay in connection with childbirth for the mother or newborn child, following a normal vaginal delivery, to less than 48 hours." The law recognizes the basic right of women and physicians to make decisions about aptness of discharge timing.To provide data as a basis for decisions about aptness of discharge timing by studying the effect of voluntary, moderate reductions in length of postpartum hospital stay on an array of maternal and infant health outcomes.A prospective cohort study. Patients were surveyed by telephone at 3 and 8 weeks postpartum.A teaching hospital where 38% of the patients are in a managed care health plan with a noncompulsory reduced stay program offering enhanced prepartum and postpartum services, including home visits.Consecutive mothers discharged after vaginal delivery during a 3-month period.The outcomes were health services use within 21 days, breast-feeding, depression, sense of competence, and satisfaction with care. Multivariate analyses adjusted for sociodemographic factors, payer status, services, and social support.Of 1364 eligible patients, 1200 (88%) were surveyed at 3 weeks; of these 1200, 1015 (85%) were resurveyed at 8 weeks. The mean length of stay was 41.9 hours (SD, 12.2 hours). Of patients going home in 30 hours or less, 60.8% belonged to a managed care health plan. The length of stay was not related to the outcomes, except that women hospitalized shorter than 48 hours had more emergency department visits than those staying 40 to 48 hours (adjusted odds ratio, 5.78; 95% confidence interval, 1.19-28.05).When adequate postpartum outpatient care is accessible, a moderately shorter length of postpartum stay after an uncomplicated vaginal delivery had no adverse effect on an array of outcomes. Researchers and policy makers should seek to better define the content of postpartum services necessary for achieving optimal outcomes for women and newborns; funding should be available to provide such services, regardless of the setting in which they are provided.

View details for Web of Science ID A1997XW19800009

View details for PubMedID 9308869

Mandatory testing of pregnant women and newborns: HIV, drug use, and welfare policy. The Fordham urban law journal Chavkin, W., Elman, D., Wise, P. H. 1997; 24 (4): 749-755

View details for PubMedID 12455509

Ethics in context AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY Chavkin, W., Wise, P. H. 1997; 176 (3): 732-732

View details for Web of Science ID A1997WR88600055

View details for PubMedID 9077647

Risk status at discharge and cause of death for postneonatal infant deaths: A total population study PEDIATRICS Kempe, A., Wise, P. H., Wampler, N. S., Cole, F. S., Wallace, H., Dickinson, C., RINEHART, H., Lezotte, D. C., Beaty, B. 1997; 99 (3): 338-344


To obtain population-based, clinical information regarding potentially modifiable factors contributing to death during the postneonatal period (28 to 364 days), we examined all postneonatal infant deaths in four areas of the United States to determine: (1) the cause of death from clinical and autopsy data rather than vital statistics, (2) whether death occurred during initial hospitalization or after discharge, and (3) the portion of postneonatal mortality attributable to infants who left the hospital with identified high-risk medical conditions.Retrospective medical record review of all postneonatal infant deaths with birth weights greater than 500 g (total N = 386) born to mothers residing in: (1) the city of Boston (1984 and 1985, N = 55), (2) the city of St Louis and contiguous areas (1985 and 1986, N = 123), (3) San Diego County (1985, N = 112), and (4) the state of Maine (1984 and 1985, N = 96). Deaths were identified using linked birth and death vital statistics, and medical record audits of infants' and mothers' charts were performed. Causes of death were obtained from medical record review in conjunction with autopsy if performed (72%, N = 278), medical record alone (17%, N = 67), or vital statistics if no other source was available (11%, N = 41). The medical conditions at the time of discharge for each infant were reviewed and, if judged to confer an increased risk of morbidity or mortality, were classified as high risk.The causes of death were sudden infant death syndrome (47%, N = 181), congenital conditions (20%, N = 77), prematurity-related conditions (11%, N = 43), infections (9%, N = 34), external causes (including injuries, drownings, ingestions, and burns) (7%, N = 25), and other (6%, N = 23). In 24% of congenital and 25% to 44% of prematurity-related deaths, infection was the acute or associated cause of death. Infants born to black mothers were more likely than those born to white mothers to die during the postneonatal period of all major causes of death (7.3 per 1000 vs 3.0 per 1000). Overall, 18% (N = 68) of deaths occurred to infants who never left the hospital; 79% (N = 305) of the infants were discharged before death; and discharge status was unknown in 3% (N = 13). Eighty-one percent of all infants with prematurity-related postneonatal deaths were never discharged, and of the total infants who were initially discharged, only 1% (N = 4) subsequently died of prematurity-related causes. Of all postneonatal deaths, only 16% (N = 62) left the hospital with identified high-risk medical conditions.These findings suggest that the etiology of postneonatal mortality is heterogeneous, with significant complexity in attributing specific causes of death and making designations of "preventability." The vast majority of infants who died of prematurity-related postneonatal causes never left the hospital, and only a small percentage of all infants that left the hospital before death were identified as being at high medical risk. Therefore, strategies for further decreasing postneonatal mortality must link high-risk follow-up programs to more comprehensive strategies that address risk throughout pregnancy and early childhood.

View details for Web of Science ID A1997WR14700004

View details for PubMedID 9041284

Inadequate hepatitis B vaccination of adolescents and adults at an urban community health center JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION Sharfstein, J., Wise, P. H. 1997; 89 (2): 86-92


Hepatitis B remains a major public health problem in the United States, but public vaccination policy has targeted infants rather than the high-risk adults who constitute the vast majority of patients at imminent risk of infection. The effects of this policy were studied at a community health center in Boston. Adolescents and adults who attended a community health center between January 1, 1992 and May 31, 1993 and had human immunodeficiency virus (HIV) or another sexually transmitted disease (STD)--indications for vaccination according to the Centers for Disease Control and Prevention--were identified through chart review. The vaccination rate and missed opportunities were determined. In addition, directors of Boston health centers were surveyed on hepatitis B vaccine at their clinics. Of 178 individuals with HIV or another STD and without serologic evidence of prior exposure to hepatitis B, two (1.1%) received the vaccine. There were 342 missed opportunities. Only two of 14 medical directors said their clinics routinely offered vaccine to individuals with STDs. The medical directors rated financial barriers as more important obstacles to hepatitis B vaccination than nonfinancial barriers. These results indicate that many high-risk adolescents and adults do not receive a preventive intervention that is federally recommended, potentially life saving, and cost effective. Inadequate public funding for vaccine may be a key barrier for this population.

View details for Web of Science ID A1997WH30700002

View details for PubMedID 9046761

The first injustice: Socioeconomic disparities, health services technology, and infant mortality ANNUAL REVIEW OF SOCIOLOGY Gortmaker, S. L., Wise, P. H. 1997; 23: 147-170


"Infant mortality has long been viewed as a synoptic indicator of the health and social condition of a population. In this article we examine critically the structure of this reflective capacity with a particular emphasis on how new health care technologies may have altered traditional pathways of social influence.... Current patterns of infant mortality in the United States provide a useful illustration of the dynamic interaction of underlying social forces and technological innovation in determining trends in health outcomes. We review the implications of this perspective for [future] sociological research into disparate infant mortality...."

View details for Web of Science ID A1997XR65000007

View details for PubMedID 12348279

Racial disparities in outcomes of military and civilian births in California ARCHIVES OF PEDIATRICS & ADOLESCENT MEDICINE Barfield, W. D., Wise, P. H., Rust, F. P., RUST, K. J., Gould, J. B., Gortmaker, S. L. 1996; 150 (10): 1062-1067


To examine racial disparities in prenatal care utilization, birth weight, and fetal and neonatal mortality in a population for whom financial barriers to health care services are minimal.Using linked birth, fetal death, and infant death certificate files, we examined prenatal care utilization, birth weight distribution, and fetal and neonatal mortality rates for all white and black births occurring in military hospitals in California from January 1, 1981, to December 31, 1985. These patterns were compared with the experience of their civilian counterparts during the same time period.Black mothers had higher percentages of births occurring in teenaged and unmarried mothers than did white mothers in military and civilian populations. First-trimester prenatal care initiation was lower for blacks in the military (relative risk, 0.79; 95% confidence interval, 0.75-0.82) and civilian (relative risk, 0.51; 95% confidence interval, 0.50-0.52) populations. However, the scale of the disparity in prenatal care utilization was significantly smaller (P < .001) in the military group. Rates of low birth weight and fetal and neonatal mortality among blacks were elevated in the military and civilian groups. However, the racial disparity in low birth weight was significantly smaller in the military group (P < .01 and P < .001, respectively).In populations with decreased financial barriers to health care, racial disparities in prenatal care use and low birth weight were reduced. However, the persistence of significant disparities suggests that more comprehensive strategies will be required to ensure equity in birth and neonatal outcome.

View details for Web of Science ID A1996VM05900010

View details for PubMedID 8859139

The influence of the wider use of surfactant therapy on neonatal mortality among blacks and whites NEW ENGLAND JOURNAL OF MEDICINE Hamvas, A., Wise, P. H., Yang, R. K., Wampler, N. S., Noguchi, A., MAURER, M. M., Walentik, C. A., Schramm, W. F., Cole, F. S. 1996; 334 (25): 1635-1640


Surfactant therapy reduces morbidity and mortality among premature infants with the respiratory distress syndrome (RDS). Fetal pulmonary surfactant matures more slowly in white than in black fetuses, and therefore RDS is more prevalent among whites than among blacks. We reasoned that the increased use of surfactant after its approval by the Food and Drug Administration (FDA) in 1990 might have reduced neonatal mortality more among whites than among blacks.We merged vital-statistics information for all 1563 infants with very low birth weights (500 to 1500 g) born from 1987 through 1989 or in 1991 and 1992 to residents of St. Louis with clinical data from the four neonatal intensive care units in the St. Louis area; we then compared neonatal mortality during two periods, one before and one after the FDA's approval of surfactant for clinical use (1987 through 1989 and 1991 through 1992).The use of surfactant increased by a factor of 10 between 1987 through 1989 and 1991 through 1992. The neonatal mortality rate among all very-low-birth-weight infants decreased 17 percent, from 220.3 deaths per 1000 very-low-birth-weight babies born alive (in 1987 through 1989) to 183.9 per 1000 (in 1991 through 1992; P = 0.07). This decrease was due to a 41 percent reduction in the mortality rate among white newborns with very low birth weights (from 261.5 per 1000 to 155.5 per 1000; P = 0.003). In contrast, among black infants, the mortality rate for very-low-birth-weight infants did not change significantly (195.6 per 1000 and 196.8 per 1000). The relative risk of death among black newborns with very low birth weights as compared with white newborns with similar weights was 0.7 from 1987 through 1989 and 1.3 from 1991 through 1992 (P = 0.02). The differences in mortality were not explained by differences in access to surfactant therapy, by differences in mortality between black and white infants who received surfactant, or by differences in the use of antenatal corticosteroid therapy.After surfactant therapy for RDS became generally available, neonatal mortality improved more for white than for black infants with very low birth weights.

View details for Web of Science ID A1996UQ70600004

View details for PubMedID 8628359

The importance of extreme prematurity and low birthweight to US neonatal mortality patterns: implications for prenatal care and women's health. Journal of the American Medical Women's Association (1972) Wise, P. H., Wampler, N., Barfield, W. 1995; 50 (5): 152-155


In order to frame the appropriateness of neonatal mortality reduction efforts that begin only after pregnancy is recognized, this study examined the relative contributions of different gestational age and birthweight groups to total neonatal mortality and to racial disparities in neonatal mortality in the United States.Using the national linked birth/infant death data set for the 1988 cohort, the relative contributions of different birthweight and gestational age groups to national neonatal mortality rates were calculated. The relative contributions of these groups to the racial disparity in neonatal mortality were also assessed.Very low birthweight infants (< 1,500 g) accounted for 1.2% of all births, but 64.2% of all neonatal deaths. The very low birthweight rate for whites was 0.93%, while that for blacks was 2.79% with the contribution of this group to neonatal mortality higher for blacks than whites. Infants less than 1,000 g contributed more than 80% of the racial disparity in neonatal mortality.Neonatal mortality patterns in the United States have become highly dependent on infants with gestational ages that approach the second trimester. Preventing neonatal mortality by enhancing care only after pregnancy has been recognized, therefore, may be limited. Strategies that link prenatal care to broader initiatives to improve the health of women regardless of pregnancy status may be more effective.

View details for PubMedID 7499702



Mortality rates were examined for Boston women, aged 15 to 44, from 1980 to 1989. There were 1234 deaths, with a rate of 787.8/100,000 for the decade. Leading causes were cancer, accidents, heart disease, homicide, suicide, and chronic liver disease. After age adjustment, African-American women in this age group were 2.3 times more likely to die than White women. Deaths at least partly attributable to smoking and alcohol amounted to 29.8% and 31.9%, respectively. Mortality was found to be related more directly to the general well-being of young women than to their reproductive status, and many deaths were preventable. African-American/White disparities were most likely linked to social factors. These findings suggest that health needs of reproductive-age women transcend reproductive health and require comprehensive interventions.

View details for Web of Science ID A1995RN32000025

View details for PubMedID 7625513



To identify the potential impact that different definitions of live births and practice patterns have on infant mortality rates in England and Wales, France, Japan, and the United States.United States data were obtained from the 1986 linked national birth-infant death cohort, and those for the other countries came from either published sources or directly from the Ministries of Health.In 1986 in the United States, infants weighing less than 1 kg accounted for 36% of deaths (32% white and 46% black); 32% resulted from fatal congenital anomalies. These rates were much higher in both categories than in England and Wales in 1990 (24 and 22%, respectively), France in 1990 (15 and 25%, respectively), and Japan in 1991 (9% for infants weighing less than 1 kg, percentage of fatal congenital anomalies unknown). These cases are more likely to be excluded from infant mortality statistics in their countries than in the United States.In 1990, the United States infant mortality rate was 9.2 per 1000 live births, ranking the United States 19th internationally. However, infant mortality provides a poor comparative measure of reproductive outcome because there are enormous regional and international differences in clinical practices and in the way live births are classified. Future international and state comparisons of reproductive health should standardize the definition of a live birth and fatal congenital anomaly, and use weight-specific fetal-infant mortality ratios and perinatal statistics.

View details for Web of Science ID A1995QZ91800007

View details for PubMedID 7770264

Child Beauty, Child Rights and the Devaluation of Women. Health and human rights Wise, P. H. 1995; 1 (4): 472-476

View details for PubMedID 10393800



Through simulated calls to 294 drug treatment programs in five cities, this study investigated access for pregnant women and compared New York City's provision of services in 1989 to that in 1993. In all sites, the majority of programs accepted pregnant women. There was also a marked improvement in the availability of services in New York City. Yet options were more limited for Medicaid recipients and women needing child care, and an appointment or referral for prenatal care was usually not offered. Although the door for treatment may be opening for pregnant women, institutional barriers still remain.

View details for Web of Science ID A1994PM43500023

View details for PubMedID 7943491


View details for Web of Science ID A1994QA21100011

View details for PubMedID 7749483


View details for Web of Science ID A1994PJ24700003

View details for PubMedID 8092356

HEALTH-CARE REFORM AND THE SPECIAL NEEDS OF CHILDREN PEDIATRICS Perrin, J. M., Kahn, R. S., Bloom, S. R., Davidson, S., Guyer, B., Hollinshead, W., Richmond, J. B., Walker, D. K., Wise, P. H. 1994; 93 (3): 504-506

View details for Web of Science ID A1994MY68700027

View details for PubMedID 8115214



The public debate surrounding disparities in infant mortality has resulted from a profound failure to seek a common wisdom. Because of its essential social roots, infant mortality will always remain the province of fundamental ideological and political conflict. However, without a more integrated analytic approach, progress in reducing disparate infant mortality will remain limited by internecine struggles for disciplinary purview and false claims of societal relevance. For in the end, the struggle to address disparate infant mortality will be advanced best by integrated technical and political strategies that recognize that the pursuits of efficacy and justice are inextricably linked.

View details for Web of Science ID A1993MR85100003

View details for PubMedID 8123287

Infant mortality. Current opinion in pediatrics McCormick, M. C., Wise, P. H. 1993; 5 (5): 552-557


Infant mortality continues to be a major public health issue in the United States. Although some preventive strategies for neonatal mortality are emerging for congenital malformations, notably neural tube defects, the prevention of preterm deliveries among disadvantaged populations remains elusive, suggesting the need for different approaches to women's health needs. Despite the lack of success in preventing preterm birth, neonatal mortality rates continued to decline substantially, a decline attributed to improvements in neonatal intensive care associated with surfactant use. The increasing survival of very preterm infants continues to raise questions about their longer term outcomes especially with several recent studies on difficulties in school, and about the need for postdischarge developmental interventions. Attempts to decrease postneonatal mortality received marked attention with the recommendations for specific positioning to prevent sudden infant death syndrome and heightened attention to increased immunization completion rates. The dismal ranking of the United States in infant mortality rates among industrialized countries, however, continues to present a social policy challenge.

View details for PubMedID 8287078



Despite improvements in many child health indicators, several important ones, including the racial disparity in infant mortality, have not improved in recent years. A focus on dramatic but rare risk factors has distracted attention away from the primary determinants of these indicators. An analytic model to assess these indicators identifies three interacting determinates: (a) social well-being, (b) our technical capacity to reduce the risk that low social status conveys, and (c) our performance in providing access to this technical capacity. These three determinants can move independently and can, therefore, mask important trends in social status and the impact of programs and policies.

View details for Web of Science ID A1992KD84300005

View details for PubMedID 1474908

CLINICAL DETERMINANTS OF THE RACIAL DISPARITY IN VERY-LOW-BIRTH-WEIGHT NEW ENGLAND JOURNAL OF MEDICINE Kempe, A., Wise, P. H., Barkan, S. E., Sappenfield, W. M., Sachs, B., Gortmaker, S. L., Sobol, A. M., First, L. R., Pursley, D., RINEHART, H., Kotelchuck, M., Cole, F. S., Gunter, N., Stockbauer, J. W. 1992; 327 (14): 969-973


Although the risk of very low birth weight (less than 1500 g) is more than twice as high among blacks as among whites in the United States, the clinical conditions associated with this disparity remain poorly explored.We reviewed the medical records of over 98 percent of all infants weighing 500 to 1499 g who were born in Boston during the period 1980 through 1985 (687 infants), in St. Louis in 1985 and 1986 (397 infants), and in two health districts in Mississippi in 1984 and 1985 (215 infants). The medical records of the infants' mothers were also reviewed. These data were linked to birth-certificate files. During the study periods, there were 49,196 live births in Boston, 16,232 in St. Louis, and 16,332 in the Mississippi districts. The relative risk of very low birth weight among black infants as compared with white infants ranged from 2.3 to 3.2 in the three areas. The higher proportion of black infants with very low birth weights was related to an elevated risk in their mothers of major conditions associated with very low birth weight, primarily chorioamnionitis or premature rupture of the amniotic membrane (associated with 38.0 percent of the excess proportion of black infants with very low birth weights [95 percent confidence interval, 31.3 to 45.4 percent]); idiopathic preterm labor (20.9 percent of the excess [95 percent confidence interval, 16.0 to 26.4 percent]); hypertensive disorders (12.3 percent [95 percent confidence interval, 8.6 to 16.6]); and hemorrhage (9.8 percent [95 percent confidence interval, 5.5 to 13.5]).The higher proportion of black infants with very low birth weights is associated with a greater frequency of all major maternal conditions precipitating delivery among black women. Reductions in the disparity in birth weight between blacks and whites are not likely to result from any single clinical intervention but, rather, from comprehensive preventive strategies.

View details for Web of Science ID A1992JQ22500001

View details for PubMedID 1518548


View details for Web of Science ID A1992HW97200009

View details for PubMedID 1579140

From the Surgeon General, US Public Health Service. JAMA : the journal of the American Medical Association Novello, A. C., Clinton, J. J., Wise, P. H., Mitchell, W. I. 1991; 266 (6): 770-?

View details for PubMedID 1865514

From the Surgeon General, US Public Health Service. JAMA : the journal of the American Medical Association Novello, A. C., Wise, P. H., Kleinman, D. V., Orenstein, W. A., SEPE, S. I. 1991; 265 (11): 1364-?

View details for PubMedID 1999874


View details for Web of Science ID A1991EQ60200035

View details for PubMedID 1984157



We undertook a study of 414 bacteremic patients (167 with Haemophilus influenzae and 247 with Streptococcus pneumoniae bacteremia) to evaluate their clinical presentation, laboratory and clinical results, and subsequent outcomes. Patients with H influenzae bacteremia were more likely to have soft-tissue foci, poorer clinical appearance at presentation, and be at higher risk for subsequent serious focal infections, persistent bacteremia, and subsequent hospital admissions than patients with S pneumoniae. Patients with H influenzae bacteremia had a 21.1-fold increase in risk of meningitis (95% confidence interval [CI] of 3.8 to 78.0) compared with those with S pneumoniae. The odds ratio for initial lumbar puncture was 5.25 (95% CI [1.1-23.6]). Ambulatory patients treated with antibiotics at presentation were less likely to develop new serious soft-tissue infections, persistent bacteremia, or to require subsequent hospital admissions than untreated patients. The effect of treatment was greater for patients with S pneumoniae than those with H influenzae. Careful follow-up and reevaluation of patients with presumptive bacteremia is essential because treated and untreated patients can still develop serious soft-tissue infections.

View details for Web of Science ID A1990EG62700014

View details for PubMedID 2239857

Poverty, technology and recent trends in the United States infant mortality rate. Paediatric and perinatal epidemiology Wise, P. H. 1990; 4 (4): 390-401

View details for PubMedID 2267180



Human immunodeficiency virus (HIV) disease is increasing rapidly in the ranks of the leading causes of death among children. It is already the ninth leading cause of death among children 1 to 4 years of age and the seventh in young people between the ages of 15 and 24 years. If current trends continue, AIDS can be expected to move into the top five leading causes of death in the pediatric and adolescent age group in the next 3 or 4 years. To address this problem and also to provide focus for the US Department of Health and Human Services activities dealing with pediatric AIDS, an intradepartmental work group was established as a central health and human services component. This was done to ensure the best possible use of federal resources on behalf of children and adolescents with AIDS. Its recommendations are the basis of this report.

View details for Web of Science ID A1989AN65500024

View details for PubMedID 2671915


View details for Web of Science ID A1989U395700010

View details for PubMedID 2710193



Poverty is now more heavily concentrated in children than at any other time in U.S. history. Poverty's influence on child health is pervasive and creates a variety of clinical challenges. This discussion reviews the clinical expression of poverty in childhood and assesses our clinical and political capacity to reduce its tragic impact.

View details for Web of Science ID A1988R232700002

View details for PubMedID 3059293

Interpretation of indices of fetal pulmonary maturity by gestational age. Paediatric and perinatal epidemiology VANMARTER, L. J., Berwick, D. M., Torday, J., Frigoletto, F. D., Wise, P. H., EPSTEIN, M. F. 1988; 2 (4): 360-364

View details for PubMedID 3244554



In this study, the determinants of an apparent increase in the infant mortality rate of an urban population with high access to tertiary neonatal care are reviewed. For a 4-year period (1980 to 1983), all infant deaths (n = 422) of the 32,329 births to residents of the City of Boston were analyzed through linked vital statistics data and a review of medical records. A significant increase in the infant mortality rate occurred in 1982 due to increases in three components of the infant mortality rate: the birth rate of very low birth weight infants (less than 1,500 g), the neonatal mortality rate of normal birth weight infants (greater than or equal to 2,500 g), and the mortality rate of infants dying during the postneonatal period (28 to 365 days). These increases were associated with inadequate levels of prenatal care. Although transient, the impact of the observed alterations in these infant mortality rate components was enhanced by a more long-standing phenomenon: the stabilization of mortality rates for low birth weight infants. This stabilization allowed the increases in other component rates to be expressed more fully than in previous years. In this report a mechanism is shown whereby fully regionalized neonatal care ultimately may confer to the infant mortality rate a heightened sensitivity to socioeconomic conditions and levels of adequate prenatal care.

View details for Web of Science ID A1988M915500009

View details for PubMedID 3353187



We studied the effect of legislation requiring deposits for beverage containers on the incidence of lacerations in urban children. Records of emergency room visits for lacerations and fractures were reviewed for three years pre-legislation (1980-82) and the immediate post-legislation period (1983). The incidence of total sutured lacerations did not change substantially after the legislation, but glass-related lacerations fell by 60 per cent, due to a reduced incidence in lacerations occurring outside of the home.

View details for Web of Science ID A1986E074100015

View details for PubMedID 3752330


View details for Web of Science ID A1986E097800006

View details for PubMedID 3639144



We examined racial and income-related patterns of mortality from birth through adolescence in Boston, where residents have high access to tertiary medical care. Childhood mortality was significantly higher among black children (odds ratio, 1.24; P less than 0.05) and low-income children (odds ratio, 1.47; P less than 0.001). Socioeconomic effects varied for different age groups and causes of death. The largest relative disparity occurred in the neonatal and postneonatal periods, and the smallest in adolescence. Of the total racial differential in neonatal mortality (6.88 deaths per 1000 live births), 51.2 per cent occurred in premature infants, 13.4 per cent in term infants who were small for their gestational age, and 25.9 per cent in neonates who were both premature and small for their age. Black neonatal mortality was elevated at all income levels. Beyond the neonatal period, mortality from respiratory disease, fire, and homicide had strong inverse relationships with income, and mortality from injuries to the occupants of motor vehicles was directly related to income. These data suggest that despite access to tertiary medical services, substantial social differentiation in mortality may exist throughout childhood. Equity in childhood survival will probably require policies that emphasize preventive goals.

View details for Web of Science ID A1985ANG6700005

View details for PubMedID 4010752

Evaluation of the febrile child under 2 years of age. journal of emergency medicine McGravey, A., Wise, P. H. 1984; 1 (4): 299-305


Unlike older children and adults, fever in young children may reflect serious underlying disease despite the lack of associated findings on physical examination. Laboratory examinations may provide important information in the management of these children. The recent literature suggests a systematic approach to the evaluation and management of the young febrile child.

View details for PubMedID 6501842

Ethics and the ED nurse: triage in emergency services. Journal of emergency nursing Hanson, M., Wise, P. H., Robbins, D. 1981; 7 (3): 118-119

View details for PubMedID 7029060

FLOW-VOLUME LOOPS IN NEWBORN-INFANTS CRITICAL CARE MEDICINE Wise, P. H., Krauss, A. N., Waldman, S., Auld, P. A. 1980; 8 (2): 61-63


Flow-volume loops were obtained during the performance of crying vital capacity (CVC) maneuvers in 31 infants, 18 of whom had hyaline membrane disease (HMD). Both healthy and distressed infants had flow-volume loops resembling those found in adults with variable intrathoracic obstruction of the central airways. Flow rates during inspiration and expiration increased as the CVC increased. Infants with HMD had narrower inspiratory loops and attained peak expiratory flow later than nondistressed infants, but these differences were not statistically significant. Vocalizations, loss of lung recoil associated with loss of lung volume, and partial collapse of intrathoracic airways may all contribute to the shape of the flow-volume loop in infants.

View details for Web of Science ID A1980JE34000002

View details for PubMedID 7353388