National Healthcare Quality and Disparities Report
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Topics
- Antibiotics (2)
- Asthma (2)
- Children/Adolescents (6)
- Chronic Conditions (2)
- Comparative Effectiveness (1)
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- Neonatal Intensive Care Unit (NICU) (1)
- (-) Newborns/Infants (22)
- Nutrition (1)
- Outcomes (2)
- Patient-Centered Outcomes Research (3)
- Pneumonia (1)
- Practice Patterns (1)
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- Prevention (1)
- (-) Respiratory Conditions (22)
- Risk (2)
- Screening (1)
- Skin Conditions (1)
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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 22 of 22 Research Studies DisplayedFerro DF, Bonafide CP, Fregene N
Parental insights into improving home pulse oximetry monitoring in infants.
Home pulse oximeters prescribed for infants with cardiorespiratory conditions can result in many false alarms, contributing to caregiver stress, sleep disturbance, and potentially unsafe practices. The impact of oximeters, alarms, and daily living demands on caregivers remains unclear. The purpose of this study was to explore parental perspectives on home pulse oximetry monitoring during the problem analysis phase of a quality improvement (QI) initiative. The researchers conducted interviews with a purposive sample of parents whose infants were prescribed home pulse oximeters and were receiving services from a local home care company. The interview questions were based on systems engineering frameworks previously applied in healthcare. Data were coded iteratively and analyzed using both deductive (theoretical frameworks) and inductive (emerging themes) approaches. The study found that the identified themes generally aligned with the theoretical frameworks. Parents expressed dissatisfaction with the frequent false alarms generated by home pulse oximeters, which they primarily attributed to inadequate probe adhesiveness and the devices' inability to account for infant movement. The interviews underscored the burden posed by poor device tones and limited portability. Device-related issues negatively affected the entire family in terms of sleep quality, mobility, and social interactions. All parents developed workarounds, including discontinuing monitoring. The researchers concluded that parents of infants using home pulse oximetry monitoring face numerous challenges, potentially compromising safety.
AHRQ-funded; HS026620.
Citation: Ferro DF, Bonafide CP, Fregene N .
Parental insights into improving home pulse oximetry monitoring in infants.
Pediatr Qual Saf 2022 Mar-Apr; 7(2):e538. doi: 10.1097/pq9.0000000000000538..
Keywords: Newborns/Infants, Respiratory Conditions
Ong T, Onchiri FM, Britto MT
Impact of guideline-recommended dietitian assessments on weight gain in infants with cystic fibrosis.
This study’s purpose was to characterize nutrition management for infants with cystic fibrosis (CF) with inadequate weight gain and to assess association of dietitian assessments and center-level weight-for-age Z-scores (WAZ). Encounter data from 226 infants was used from across 28 US CF Centers from the Baby Observational Nutritional study between January 2012 through December 2017. The authors identified dietitian assessments and consensus guideline-recommended responses to inadequate weight gain: calorie increases, pancreatic enzyme replacement therapy (PERT) increases, or shortened time to next visit. They compared center assessments by funnel plot and summarized median WAZ by center. Of 2,527 visits, 808 visits had identified inadequate weight gain, distributed in 216 infants. Assessments occurred in 77% of visits but varied widely between centers (range 17% - 98%). They used funnel plot analysis to identify high-performers for frequent dietitian assessments (range 92% - 98%) and 4 under-performers (range 17% - 56%). High-performers treated inadequate weight gain more often with adequate calories (80% vs 52%) and closer follow-up (63% vs 49%) compared to underperformers. Three of 4 high-performing sites met center nutrition goals for positive median WAZ at 2 years old unlike 3 under-performers, despite similar patient characteristics.
AHRQ-funded; HS026393.
Citation: Ong T, Onchiri FM, Britto MT .
Impact of guideline-recommended dietitian assessments on weight gain in infants with cystic fibrosis.
J Cyst Fibros 2022 Jan; 21(1):115-22. doi: 10.1016/j.jcf.2021.08.005..
Keywords: Newborns/Infants, Respiratory Conditions, Chronic Conditions, Nutrition, Evidence-Based Practice, Guidelines
Rasooly IR, Makeneni S, Khan AN
The alarm burden of excess continuous pulse oximetry monitoring among patients with bronchiolitis.
This study’s objective was to quantify alarm burden of excess continuous pulse oximetry monitoring among hospitalized infants with bronchiolitis who are not receiving supplemental oxygen. The authors evaluated admissions of 201 children (aged 0-24 months) with bronchiolitis. They categorized time ≥60 minutes following discontinuation of supplemental oxygen as "continuously monitored (guideline-discordant)," "intermittently measured (guideline-concordant)," or "unable to classify." Among 4402 classifiable hours, 77% of alarms occurred during periods of guideline-discordant monitoring. Patients experienced a median of 35 alarms during guideline-discordant, continuously monitored time, representing a rate of 6.7 alarms per hour. When the monitoring was guideline-concordant, median hourly alarm rate was 0.5 alarms per hour.
AHRQ-funded; HS026620.
Citation: Rasooly IR, Makeneni S, Khan AN .
The alarm burden of excess continuous pulse oximetry monitoring among patients with bronchiolitis.
J Hosp Med 2021 Dec;16(12):727-29. doi: 10.12788/jhm.3731..
Keywords: Newborns/Infants, Respiratory Conditions, Inpatient Care
Kern-Goldberger AS, Rasooly IR, Luo B
EHR-integrated monitor data to measure pulse oximetry use in bronchiolitis.
This study’s objective was to determine if electronic health record (EHR) data can accurately estimate the extent of actual oxygen saturation monitoring use in bronchiolitis. The study included infants aged 8 weeks through 23 months who were hospitalized with bronchiolitis. Findings showed that EHR-integrated monitor data were a valid measure of actual oxygen saturation monitoring use that may help hospitals more efficiently identify opportunities to de-implement guideline-inconsistent use.
AHRQ-funded; HS026620.
Citation: Kern-Goldberger AS, Rasooly IR, Luo B .
EHR-integrated monitor data to measure pulse oximetry use in bronchiolitis.
Hosp Pediatr 2021 Oct;11(10):1073-82. doi: 10.1542/hpeds.2021-005894..
Keywords: Newborns/Infants, Respiratory Conditions, Electronic Health Records (EHRs), Health Information Technology (HIT)
Schondelmeyer AC, Bettencourt AP, Xiao R
Evaluation of an educational outreach and audit and feedback program to reduce continuous pulse oximetry use in hospitalized infants with stable bronchiolitis: a nonrandomized clinical trial.
National guidelines recommend against continuous pulse oximetry use for hospitalized children with bronchiolitis who are not receiving supplemental oxygen, yet guideline-discordant use remains high. The objective of this study was to evaluate deimplementation outcomes of educational outreach and audit and feedback strategies aiming to reduce guideline-discordant continuous pulse oximetry use in children hospitalized with bronchiolitis who are not receiving supplemental oxygen.
AHRQ-funded; HS026763.
Citation: Schondelmeyer AC, Bettencourt AP, Xiao R .
Evaluation of an educational outreach and audit and feedback program to reduce continuous pulse oximetry use in hospitalized infants with stable bronchiolitis: a nonrandomized clinical trial.
JAMA Netw Open 2021 Sep;4(9):e2122826. doi: 10.1001/jamanetworkopen.2021.22826..
Keywords: Newborns/Infants, Hospitalization, Guidelines, Practice Patterns, Training, Respiratory Conditions
Beam KS, Lee M, Hirst K
Specificity of International Classification of Diseases codes for bronchopulmonary dysplasia: an investigation using electronic health record data and a large insurance database.
This study analyzed the accuracy of International Classification of Diseases (ICD) codes to identify bronchopulmonary dysplasia (BPD) in newborns. A retrospective cohort study in a single-center NICU (n=166) was conducted to evaluate sensitivity and specificity of ICD-10 codes for BPD diagnosis. The sensitivity of any BPD-related codes ranged from 0.82 to 0.95, while specificity range was 0.25 to 0.36. The most common date of BPD diagnosis was the day of birth, which is inconsistent with the clinical definition. The authors conclude that the ICD codes for BPD are unlikely to accurately reflect the current clinical definition and should be interpreted with caution.
AHRQ-funded; HS000063.
Citation: Beam KS, Lee M, Hirst K .
Specificity of International Classification of Diseases codes for bronchopulmonary dysplasia: an investigation using electronic health record data and a large insurance database.
J Perinatol 2021 Apr;41(4):764-71. doi: 10.1038/s41372-021-00965-3..
Keywords: Newborns/Infants, Respiratory Conditions, Electronic Health Records (EHRs), Health Information Technology (HIT)
Rossol SL, Yang JK, Toney-Noland C
Non-contact video-based neonatal respiratory monitoring.
Respiratory rate (RR) has been shown to be a reliable predictor of cardio-pulmonary deterioration, but standard RR monitoring methods in the neonatal intensive care units (NICU) with contact leads have been related to iatrogenic complications. This iterative design study developed a novel algorithm that produced RR from footage analyzed from stable NICU patients in open cribs with corrected gestational ages ranging from 33 to 40 weeks. The final algorithm used a proprietary technique of micromotion and stationarity detection to model background noise to be able to amplify and record respiratory motions.
AHRQ-funded; HS023506.
Citation: Rossol SL, Yang JK, Toney-Noland C .
Non-contact video-based neonatal respiratory monitoring.
Children 2020 Oct 6;7(10). doi: 10.3390/children7100171..
Keywords: Newborns/Infants, Health Information Technology (HIT), Respiratory Conditions, Neonatal Intensive Care Unit (NICU), Intensive Care Unit (ICU)
Abreo A, Wu P, Donovan BM
Infant respiratory syncytial virus bronchiolitis and subsequent risk of pneumonia, otitis media, and antibiotic utilization.
This study looked at infant respiratory syncytial virus (RSV) bronchiolitis and its association with increased odds of pneumonia, otitis media, and antibiotic utilization in infants 7-12 months. The data suggested the potential value of future RSV vaccination programs on subsequent respiratory health.
AHRQ-funded; HS026395.
Citation: Abreo A, Wu P, Donovan BM .
Infant respiratory syncytial virus bronchiolitis and subsequent risk of pneumonia, otitis media, and antibiotic utilization.
Clin Infect Dis 2020 Jun 24;71(1):211-14. doi: 10.1093/cid/ciz1033..
Keywords: Newborns/Infants, Antibiotics, Medication, Respiratory Conditions, Pneumonia
Rosenbloom J, Lewkowitz A, Sondgeroth K
Antenatal corticosteroid administration in late-preterm gestations: a cost-effectiveness analysis.
The purpose of this study was to evaluate whether administration of antenatal late-preterm betamethasone was cost-effective in the immediate neonatal period. Cost-effectiveness analysis of late-preterm betamethasone administration with a time horizon of 7.5 days was conducted using a health-system perspective The investigators concluded that administration of betamethasone in the late-preterm period was likely not cost-effective in the short-term.
AHRQ-funded; HS022330.
Citation: Rosenbloom J, Lewkowitz A, Sondgeroth K .
Antenatal corticosteroid administration in late-preterm gestations: a cost-effectiveness analysis.
J Matern Fetal Neonatal Med 2020 Jun;33(12):2109-15. doi: 10.1080/14767058.2018.1540582..
Keywords: Healthcare Cost and Utilization Project (HCUP), Newborns/Infants, Pregnancy, Respiratory Conditions, Medication, Healthcare Costs, Healthcare Utilization
Coon ER, Stoddard G, Brady PW
Intensive care unit utilization after adoption of a ward-based high-flow nasal cannula protocol.
This study examined whether the adoption of ward-based high-flow nasal cannula (HFNC) protocol in pediatric intensive care units (ICUs) reduced ICU utilization. This retrospective cohort study included infants aged 3 to 24 months hospitalized with bronchiolitis at hospitals in the Pediatric Health Information System database. There was a 93% response rate with the 44 hospitals contacted for the survey, of which 18 were categorized as non-adopting hospitals and 12 were categorized as adopting hospitals. Ward-based HFNC protocol data were included from the 2010-2011 and 2015-2016 respiratory seasons. Early protocols were paradoxically associated with increased ICU utilization.
AHRQ-funded; HS023827.
Citation: Coon ER, Stoddard G, Brady PW .
Intensive care unit utilization after adoption of a ward-based high-flow nasal cannula protocol.
J Hosp Med 2020 Jun;15(6):325-30. doi: 10.12788/jhm.3417..
Keywords: Children/Adolescents, Intensive Care Unit (ICU), Respiratory Conditions, Healthcare Utilization, Newborns/Infants, Inpatient Care
Donovan BM, Abreo A, Ding T
Dose, timing, and type of infant antibiotic use and the risk of childhood asthma.
This study examined the association between dose, timing and type of infant antibiotic use and the risk of childhood asthma. The study examined a cohort of 152,622 children enrolled in the Tennessee Medicaid Program. At least 79% had at least one antibiotic prescription fill during infancy. There was a 20% increase in odds of childhood asthma for each additional antibiotic filled. There was no significant association between timing, formulation, anaerobic coverage and class of antibiotics and childhood asthma. However, broad spectrum antibiotic fills increased the odds of development of childhood asthma compared to narrow spectrum only fills.
AHRQ-funded; HS018454.
Citation: Donovan BM, Abreo A, Ding T .
Dose, timing, and type of infant antibiotic use and the risk of childhood asthma.
Clin Infect Dis 2020 Apr 10;70(8):1658-65. doi: 10.1093/cid/ciz448..
Keywords: Newborns/Infants, Children/Adolescents, Antibiotics, Medication, Asthma, Respiratory Conditions, Risk, Chronic Conditions
Greenhawt M, Shaker M
Determining levers of cost-effectiveness for screening infants at high risk for peanut sensitization before early peanut introduction.
The authors sought to identify scenarios in which current early peanut introduction guidelines would be cost-effective. They found that the current screening approach to early peanut introduction could be cost-effective at a particular health utility for an in-clinic reaction, skin prick test sensitivity and specificity, and high baseline peanut allergy prevalence among high-risk infants. However, such conditions are unlikely to be plausible to achieve realistically. They recommend further research to define the health state utility associated with reaction location.
AHRQ-funded; HS024599.
Citation: Greenhawt M, Shaker M .
Determining levers of cost-effectiveness for screening infants at high risk for peanut sensitization before early peanut introduction.
JAMA Netw Open 2019 Dec 2;2(12):e1918041. doi: 10.1001/jamanetworkopen.2019.18041..
Keywords: Patient-Centered Outcomes Research, Newborns/Infants, Children/Adolescents, Respiratory Conditions, Skin Conditions, Screening, Healthcare Costs, Evidence-Based Practice, Guidelines
Patel SM, Spees L, Smieja M
Patel SM, Spees L, Smieja M, Luinstra K, Steenhoff AP, Feemster KA, Arscott-Mills T, et al. Predictors of poor outcomes among infants with respiratory syncytial virus-associated acute lower respiratory infection in Botswana.
This article examined predictors of poor outcomes among infants with respiratory syncytial virus-associated acute lower respiratory infection in Botswana. Among children 1-23 months of age with respiratory syncytial virus-associated acute lower respiratory infection in Botswana, young age (<6 months), household use of wood as a cooking fuel, moderate or severe malnutrition and oxygen saturation <90% on room air were independent predictors of clinical nonresponse at 48 hours.
AHRQ-funded; HS000032.
Citation: Patel SM, Spees L, Smieja M .
Patel SM, Spees L, Smieja M, Luinstra K, Steenhoff AP, Feemster KA, Arscott-Mills T, et al. Predictors of poor outcomes among infants with respiratory syncytial virus-associated acute lower respiratory infection in Botswana.
Pediatr Infect Dis J 2019 May;38(5):525-27. doi: 10.1097/inf.0000000000002168..
Keywords: Newborns/Infants, Respiratory Conditions, Outcomes
Travers CP, Carlo WA, Nakhmani A
Environmental or nasal cannula supplemental oxygen for preterm infants: a randomized cross-over trial.
The purpose of this study was to test the hypothesis that environmental compared with nasal cannula oxygen decreases episodes of intermittent hypoxemia in preterm infants on supplemental oxygen by providing a more stable hypopharyngeal oxygen concentration. The investigators found that in preterm infants receiving supplemental oxygen, servo-controlled oxygen environment decreased hypoxemia compared with nasal cannula.
AHRQ-funded; HS013852.
Citation: Travers CP, Carlo WA, Nakhmani A .
Environmental or nasal cannula supplemental oxygen for preterm infants: a randomized cross-over trial.
J Pediatr 2018 Sep;200:98-103. doi: 10.1016/j.jpeds.2018.03.010..
Keywords: Newborns/Infants, Newborns/Infants, Respiratory Conditions, Respiratory Conditions
Wu P, Escobar GJ, Gebretsadik T
Effectiveness of respiratory syncytial virus immunoprophylaxis in reducing bronchiolitis hospitalizations among high-risk infants.
This retrospective cohort study examined the effectiveness of respiratory syncytial virus (RSV) prophylaxis for infants born between 1996 and 2008. The infants were enrolled in the Kaiser Permanente Northern California integrated health system. Infants who ever received RSV immunoprophylaxis had a 32% decreased risk of bronchiolitis hospitalization and finants with chronic lung disease (CLD) had a 52% decreased risk. The 2014 American Academy of Pediatrics (AAP) guidelines changed recommendations for RSV immunoprophylaxis which made 48% of infants no longer eligible but nearly all infants with CLD would remain eligible.
AHRQ-funded; HS018454.
Citation: Wu P, Escobar GJ, Gebretsadik T .
Effectiveness of respiratory syncytial virus immunoprophylaxis in reducing bronchiolitis hospitalizations among high-risk infants.
Am J Epidemiol 2018 Jul;187(7):1490-500. doi: 10.1093/aje/kwy008..
Keywords: Comparative Effectiveness, Evidence-Based Practice, Hospitalization, Newborns/Infants, Outcomes, Patient-Centered Outcomes Research, Prevention, Respiratory Conditions, Risk
Travers CP, Carlo WA, McDonald SA
Mortality and pulmonary outcomes of extremely preterm infants exposed to antenatal corticosteroids.
This study sought to determine if exposure to antenatal corticosteroids is associated with a lower rate of death and pulmonary morbidities by 36 weeks' postmenstrual age. It concluded that among infants 22-28 weeks' gestational age, any or partial antenatal exposure to corticosteroids compared to no exposure is associated with a lower rate of death while the rate of bronchopulmonary dysplasia in survivors did not differ.
AHRQ-funded; HS013852.
Citation: Travers CP, Carlo WA, McDonald SA .
Mortality and pulmonary outcomes of extremely preterm infants exposed to antenatal corticosteroids.
Am J Obstet Gynecol 2018 Jan;218(1):130.e1-30.e13. doi: 10.1016/j.ajog.2017.11.554.
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Keywords: Medication, Mortality, Newborns/Infants, Patient-Centered Outcomes Research, Respiratory Conditions
Niles DE, Cines C, Insley E
Incidence and characteristics of positive pressure ventilation delivered to newborns in a US tertiary academic hospital.
The Neonatal Resuscitation Program (NRP) guidelines recommend positive pressure ventilation (PPV) in the first 60s of life to support perinatal transition in non-breathing newborns. The aim of this study was to describe the incidence and characteristics of newborn PPV using real-time observation in the delivery unit. The authors suggest that compliance with current NRP guidelines is difficult, and assert that it's not clear whether it is the recommendations or the training to achieve PPV recommendations that should be modified.
AHRQ-funded; HS022469.
Citation: Niles DE, Cines C, Insley E .
Incidence and characteristics of positive pressure ventilation delivered to newborns in a US tertiary academic hospital.
Resuscitation 2017 Jun;115:102-09. doi: 10.1016/j.resuscitation.2017.03.035..
Keywords: Guidelines, Newborns/Infants, Respiratory Conditions
Carroll KN, Gebretsadik T, Escobar GJ
Respiratory syncytial virus immunoprophylaxis in high-risk infants and development of childhood asthma.
This study sought to determine whether greater adherence to immunoprophylaxis in infants at high risk for severe respiratory syncytial virus (RSV) would be associated with decreased childhood asthma in a Medicaid population. The investigation of RSV immunoprophylaxis in high-risk children primarily found nonsignificant associations on prevention of asthma in specific preterm groups .
AHRQ-funded; HS018454.
Citation: Carroll KN, Gebretsadik T, Escobar GJ .
Respiratory syncytial virus immunoprophylaxis in high-risk infants and development of childhood asthma.
J Allergy Clin Immunol 2017 Jan;139(1):66-71.e3. doi: 10.1016/j.jaci.2016.01.055.
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Keywords: Asthma, Newborns/Infants, Children/Adolescents, Respiratory Conditions, Vaccination
Sloan CD, Gebretsadik T, Rosas-Salazar C
Seasonal timing of infant bronchiolitis, apnea and sudden unexplained infant death.
The researchers analyzed ecological associations between timing of Sudden Unexplained Infant Death (SUID) cases, bronchiolitis, and apnea healthcare visits. They found a temporal relationship between infant bronchiolitis and apnea, but no peak in SUID cases during peaks of bronchiolitis. They concluded that consistent trends between bronchiolitis, apnea, and SUID were not established due to small numbers of SUID cases.
AHRQ-funded; HS018454.
Citation: Sloan CD, Gebretsadik T, Rosas-Salazar C .
Seasonal timing of infant bronchiolitis, apnea and sudden unexplained infant death.
PLoS One 2016 Jul 12;11(7):e0158521. doi: 10.1371/journal.pone.0158521.
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Keywords: Newborns/Infants, Respiratory Conditions, Mortality
Cristea AI, Ackerman VL, Swigonski NL
Physiologic findings in children previously ventilator dependent at home due to bronchopulmonary dysplasia.
Bronchopulmonary dysplasia (BPD) is the primary respiratory complication of premature birth. Little is known about spirometric indices in patients with severe BPD who were previously ventilator dependent at home. The study concluded that extreme prematurity associated with severe BPD requiring home ventilator support carries significant risks of morbidity. These patients had substantially diminished respiratory function reflecting airflow abnormalities that remained static over time.
AHRQ-funded; HS017588.
Citation: Cristea AI, Ackerman VL, Swigonski NL .
Physiologic findings in children previously ventilator dependent at home due to bronchopulmonary dysplasia.
Pediatr Pulmonol 2015 Nov;50(11):1113-8. doi: 10.1002/ppul.23129.
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Keywords: Children/Adolescents, Newborns/Infants, Newborns/Infants, Respiratory Conditions
Weinberger DM, Klugman KP, Steiner CA
AHRQ Author: Steiner CA
Association between respiratory syncytial virus activity and pneumococcal disease in infants: a time series analysis of US hospitalization data.
The researchers evaluated whether variations in respiratory syncytial virus (RSV) epidemic timing and magnitude are associated with variations in pneumococcal disease epidemics and whether changes in pneumococcal disease following the introduction of a pneumococcal conjugate vaccine (PCV7) were associated with changes in the rate of RSV hospitalizations. Their findings indicate that RSV is associated with increases in the incidence of pneumococcal pneumonia.
AHRQ-authored.
Citation: Weinberger DM, Klugman KP, Steiner CA .
Association between respiratory syncytial virus activity and pneumococcal disease in infants: a time series analysis of US hospitalization data.
PLoS Med 2015 Jan 6;12(1):e1001776. doi: 10.1371/journal.pmed.1001776..
Keywords: Healthcare Cost and Utilization Project (HCUP), Newborns/Infants, Respiratory Conditions, Hospitalization
Pitzer VE, Viboud C, Alonso WJ
AHRQ Author: Steiner CA
Environmental drivers of the spatiotemporal dynamics of respiratory syncytial virus in the United States.
The authors examined the association between environmental variables and state-specific measures of respiratory syncytial virus (RSV) seasonality. They found that states with low mean vapor pressure and the largest seasonal variation in potential evapotranspiration tended to experience biennial patterns of RSV activity, with alternating years of "early-big" and "late-small" epidemics. Their results successfully connected environmental drivers to the epidemic dynamics of RSV; however, the results do not fully explain why RSV activity begins in Florida, one of the warmest states, when RSV is a winter-seasonal pathogen.
AHRQ-authored.
Citation: Pitzer VE, Viboud C, Alonso WJ .
Environmental drivers of the spatiotemporal dynamics of respiratory syncytial virus in the United States.
PLoS Pathog 2015 Jan;11(1):e1004591. doi: 10.1371/journal.ppat.1004591.
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Keywords: Children/Adolescents, Healthcare Cost and Utilization Project (HCUP), Newborns/Infants, Infectious Diseases, Respiratory Conditions