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Objective: Nutrient-enriched formulas were developed to provide extra nutrients and facilitate optimal growth for low birth weight infants. This study examined the association between use of nutrient-enriched formulas and weight gain among low birth weight infants (birth weight 1500-2500 g)., Methods: This retrospective cohort study used data from infants enrolled in the Illinois Special Supplemental Nutrition Program for Women, Infants, and Children. Analyses were limited to infants born in 2010 with low birth weight (1500-2500 g, n = 3130). We examined weight gain by use of nutrient-enriched versus standard term formula, which was assigned to the infant by the Women, Infants, and Children program during the first month of life. The analyses used a multilevel mixed-effects linear regression model with random intercepts to determine the association between use of enriched versus standard term formula and weight gain while simultaneously adjusting for confounders including gestational age, birth weight, and history of breast-feeding., Results: Among 670 infants in the 1500 to 1999 g birth weight group, those fed enriched formula gained 46.4 g (95% confidence interval 7.4-85.3, P < 0.05) more per month in the first 6 months, and 34.0 g (95% confidence interval -0.4 to 68.3, P = 0.05) more per month >6 to 12 months of age compared with infants using standard term infant formula after adjustment for covariates. Similar findings were noted among the 2460 infants in the 2000 to 2500 g birth weight group., Conclusions: Use of nutrient-enriched formulas is associated with higher weight gain in low birth weight infants.

Objective: To compare serum total, serum free and salivary cortisol in critically ill children., Design: Prospective observational cohort study., Setting: Tertiary pediatric critical care unit at Ronald McDonald Children's Hospital at Loyola University Medical Center., Patients: We enrolled 59 patients (4 weeks to 18 years of age) between January 2012 and May 2013. Thirty-four patients were included in the salivary to serum free cortisol correlational analysis., Interventions: Blood and saliva samples were obtained simultaneously within 24 hours of admission between the hours of 6 AM and 12 PM. Salivary cortisol was tested by liquid chromatography/tandem mass spectrometry, serum free cortisol by liquid chromatography/tandem mass spectrometry followed by equilibrium dialysis, and serum total cortisol by liquid chromatography/tandem mass spectrometry., Measurements and Main Results: Salivary and serum free cortisol values from 34 patients had a correlation coefficient (r) of 0.87 (95% CI, 0.75-0.93; p < 0.0001). The total serum and salivary cortisol values had a correlation coefficient (r) of 0.67 (95% CI, 0.42-0.81; p < 0.0001). The total serum and serum free cortisol values had a correlation coefficient (r) of 0.83 (95% CI, 0.69-0.91; p < 0.0001)., Conclusions: Serum free and salivary cortisol values correlate in critically ill children. Salivary cortisol can be used as a surrogate for serum free cortisol in critically ill pediatric patients. Salivary cortisol is a cost-effective and less invasive measure of bioavailable cortisol and offers an alternate and accurate method for assessing critical illness-related corticosteroid insufficiency in children.

Objectives: In February 2002, the Department of Veterans Affairs (VA) raised medication copayments from $2 to $7 per 30-day supply of medication for certain veteran groups. We examined the impact of the copayment increase on medication acquisition from VA., Methods: This was a retrospective cohort study using data from national VA databases from February 2001 through February 2003. We took a random sample of over 5% of male VA users in 2001. Of 149,107 veterans sampled, 19,504 (13%) had copayments for no drugs, 101,410 (68%) had copayments for some drugs, and 28,193 (19%) had copayments for all drugs. We used multivariable count models to examine changes in the number of 30-day medication supplies after the increase., Results: After the copayment increase, veterans subject to copayments for all drugs received 8% fewer 30-day supplies of medication annually relative to veterans with no copayments (P < 0.001). The effect of the copayment increased as the number of different medications veterans received increased. Among veterans subject to copayments for all drugs, acquisition of lower-cost drugs fell by 36%, higher-cost medications fell by 6%, over-the-counter medications fell by 40%, and prescription-only medications fell by 4% relative to veterans with no drug copayments., Conclusions: The number of medications veterans obtained from VA decreased after the copayment increase. There were relatively larger impacts on veterans with higher medication use and on lower-cost and over-the-counter medications.

Background: Although individuals' health insurance coverage changes frequently, previous analyses have not accounted for changes in insurance coverage over time., Objective: We sought to determine the independent association between lack of insurance and the risk of a decline in self-reported overall health and death from 1992 to 2002, accounting for changes in self-reported overall health and insurance coverage., Methods: We analyzed data from the Health and Retirement study, a prospective cohort study of a national sample of community-dwelling adults age 51-61 years old at baseline. Major decline in self-reported overall health and mortality was determined at 2-year intervals., Results: People who were uninsured at baseline had a 35% (95% confidence interval [CI] 12-62%) higher risk-adjusted mortality from 1992 to 2002 compared with those with private insurance. However, when we analyzed outcomes over 2-year intervals, individuals who were uninsured at the start of each interval were more likely to have a major decline in their overall health (pooled adjusted relative risk 1.43, 95% CI 1.28-1.63), but they were equally likely to die (pooled adjusted relative risk 0.96, 95% CI 0.73-1.27). Of the 1512 people who were uninsured at baseline, 220 (14.6%) died; of those who died, only 70 (31.8%) were still uninsured at the HRS interview prior to death., Conclusions: Death does not appear to be a short-term consequence of being uninsured. Instead, higher long-term mortality among the uninsured results from erosion in this population's health status over time and the attendant higher mortality associated with this. Most deaths among the uninsured occur after individuals have gained either public or private health insurance.