Pediatrics
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Although the frequency of pediatric office medical emergencies has been investigated in a retrospective manner, there have been no prospective studies. We examined how often pediatricians in a small rural state encountered medical emergencies in the office setting. This study included an in-office educational program and the donation of resuscitation equipment to study participants. ⋯ Serious medical emergencies are rare events in the primary care pediatric office, occurring less than once per office per year. The most common emergency situations encountered are respiratory. All of the emergencies in this study were managed effectively using a simple and relatively inexpensive resuscitation kit. We provided an emergency preparedness program for pediatric practices in a small rural state.
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The Temporary Assistance to Needy Families, enacted under the Personal Responsibility and Work Opportunity Reconciliation Act of 1996, is a reality for many working families. As public policies are enacted, unintended consequences for infants/children must be minimized. Child advocates in Wisconsin, leading this nation in reforming Aid to Families with Dependent Children (AFDC), are concerned about supporting eligible infants/children as safety-net programs are unlinked. ⋯ Wisconsin infants/children were rapidly removed from welfare rolls in unprecedented numbers during the periods January 1995 and August 1998. Comparisons of periods before W-2 implementation and 1 year after implementation support the fact that certification-linked programs, such as Medicaid and Food Stamps, were sufficiently aligned to AFDC/W-2 to significantly impact infants/children enrollment. Historically, WIC certification in Wisconsin has not been linked to AFDC, and infants/children traditionally eligible for Medicaid and Food Stamps are also eligible for WIC. Yet, contrary to the AFDC-linked safety-net programs, declines in WIC enrollment were not statistically significant during all study periods. Statewide and local interventions within Wisconsin, such as outreach activities, targeted to Medicaid/Healthy Start and more recently Title XXI (State Children Health Insurance Program), slowed the reductions of Medicaid enrollment for Wisconsin infants/children. These findings support that altering safety-net programs can result in unintended consequences if not carefully transitioned as demonstrated in Wisconsin welfare reform.