1
|
Rogers EM, Melde C, Williams J, Heinze J, McGarrell E. Adolescent Mental Health and Resilience Before and During the COVID-19 Pandemic. J Adolesc Health 2024:S1054-139X(24)00113-7. [PMID: 38493399 DOI: 10.1016/j.jadohealth.2024.02.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 02/15/2024] [Accepted: 02/15/2024] [Indexed: 03/18/2024]
Abstract
PURPOSE We aimed to assess levels of depression, anxiety, and resilience factors before and during the COVID-19 pandemic in a school sample of adolescents. We also aimed to examine the compensatory and protective effects of individual, family, and school resilience factors on adolescent mental health. METHODS We used fall 2019 and fall 2020 survey responses from a cluster randomized controlled trial implemented in 20 schools in a Midwestern county. The sample consisted of 3,085 responses from students in grades 5 and 6. Multilevel mixed-effects models with cluster robust standard errors were used to investigate the associations between exposure to the COVID-19 pandemic, mental health (anxiety, depression), and resilience factors (future orientation, family engagement, and having a caring school adult). RESULTS Anxiety, but not depression, was higher in fall 2020 compared to fall 2019. Family engagement increased during the pandemic, while future orientation of the student body was lower during that time and the prevalence of having a caring adult at school was unchanged. A positive future orientation was associated with lower levels of anxiety and depression, while having a caring school adult was associated with lower depression. Adolescents with less positive future orientations, low family engagement, and no caring school adults experienced the greatest increases in anxiety. DISCUSSION Positive future orientations, family engagement, and supportive nonparental adult relationships had compensatory and protective effects on adolescent mental health during the COVID-19 pandemic. Adding these measures to the inventory of modifiable resilience factors during natural disasters may promote healthy adaptation among adolescents.
Collapse
Affiliation(s)
- Ethan M Rogers
- Public Policy Center, University of Iowa, Iowa City, Iowa.
| | - Chris Melde
- School of Criminal Justice, Michigan State University, East Lansing, Michigan
| | - Jalena Williams
- School of Criminal Justice, Michigan State University, East Lansing, Michigan
| | - Justin Heinze
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Edmund McGarrell
- School of Criminal Justice, Michigan State University, East Lansing, Michigan
| |
Collapse
|
2
|
Yang KH, Tam RM, Satybaldiyeva N, Kepner W, Han BH, Moore AA, Palamar JJ. Trends in past-month cannabis use among US adults across a range of disabilities and health conditions, 2015-2019. Prev Med 2023; 177:107768. [PMID: 37951542 PMCID: PMC10842214 DOI: 10.1016/j.ypmed.2023.107768] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 11/05/2023] [Accepted: 11/07/2023] [Indexed: 11/14/2023]
Abstract
INTRODUCTION While there is increasing interest in the use of cannabis to manage a range of health-related symptoms, little is known about trends in recent cannabis use with respect to various health conditions. METHODS We examined data from a US representative sample of noninstitutionalized adults age ≥ 18 from the 2015-2019 National Survey on Drug Use and Health (N = 214,505). We estimated the pooled prevalences followed by linear time trends, overall, and by disability (i.e., difficulty hearing, seeing, thinking, walking, dressing, doing errands) and lifetime (i.e., bronchitis, cancer, diabetes, hepatitis, kidney disease) and current (i.e., asthma, depression, heart disease, hypertension) health condition status using logistic regression. Models with year-by-condition status interaction terms were used to assess differential time trends, adjusting for demographic characteristics. RESULTS From 2015 to 2019, cannabis use increased significantly among adults with and without each disability and health condition examined. However, the increase was more rapid among those with (versus without) difficulty hearing (89.8% increase [4.9% to 9.3%] vs. 37.9% increase [8.7% to 12.0%], p = 0.015), difficulty walking (84.1% increase [6.3% to 11.6%] vs. 36.8% increase [8.7% to 11.9%], p < 0.001), 2-3 impairments (75.3% increase [9.3% to 16.3%] vs. 36.6% increase [8.2% to 11.2%], p = 0.041), and kidney disease (135.3% increase [3.4% to 8.0%] vs. 38.4% increase [8.6% to 11.9%], p = 0.045). CONCLUSION Given the potential adverse effects of cannabis, prevention and harm reduction efforts should focus on groups at increasingly higher risk for use, including those with disabilities and kidney disease.
Collapse
Affiliation(s)
- Kevin H Yang
- University of California San Diego School of Medicine, Department of Psychiatry, 9500 Gilman Drive, San Diego, CA 92093, USA.
| | - Rowena M Tam
- University of California San Diego Herbert Wertheim School of Public Health and Human Longevity Science, 9500 Gilman Drive, San Diego, CA 92093, USA
| | - Nora Satybaldiyeva
- University of California San Diego Herbert Wertheim School of Public Health and Human Longevity Science, 9500 Gilman Drive, San Diego, CA 92093, USA
| | - Wayne Kepner
- University of California San Diego Herbert Wertheim School of Public Health and Human Longevity Science, 9500 Gilman Drive, San Diego, CA 92093, USA
| | - Benjamin H Han
- University of California San Diego School of Medicine, Department of Medicine, 9500 Gilman Drive, San Diego, CA 92093, USA
| | - Alison A Moore
- University of California San Diego School of Medicine, Department of Medicine, 9500 Gilman Drive, San Diego, CA 92093, USA
| | - Joseph J Palamar
- NYU Grossman School of Medicine, Department of Population Health, 180 Madison Avenue, New York, NY 10016, USA
| |
Collapse
|
3
|
Aron MB, Ndambo MK, Munyaneza F, Mulwafu M, Makungwa H, Nhlema B, Connolly E. A time-motion study of community health workers delivering community-based primary health care in Neno District, Malawi. Hum Resour Health 2023; 21:51. [PMID: 37365561 DOI: 10.1186/s12960-023-00839-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 06/22/2023] [Indexed: 06/28/2023]
Abstract
INTRODUCTION Community health workers (CHWs) are vital resources in delivering community-based primary health care, especially in low-and-middle-income countries (LMIC). However, few studies have investigated detailed time and task assessments of CHW's work. We conducted a time-motion study to evaluate CHWs' time on health conditions and specific tasks in Neno District, Malawi. METHODS We conducted a descriptive quantitative study utilizing a time observation tracker to capture time spent by CHWs on focused health conditions and tasks performed during household visits. We observed 64 CHWs between 29 June and 20 August 2020. We computed counts and median to describe CHW distribution, visit type, and time spent per health condition and task. We utilized Mood's median test to compare the median time spent at a household during monthly visits with the program design standard time. We used pairwise median test to test differences in median time duration for health conditions and assigned tasks. RESULTS We observed 660 CHW visits from 64 CHWs, with 95.2% (n = 628) of the visits as monthly household visits. The median time for a monthly household visit was 34 min, statistically less than the program design time of 60 min (p < 0.001). While the CHW program focused on eight disease areas, pretesting with the observation tool showed that CHWs were engaged in additional health areas like COVID-19. Of the 3043 health area touches by CHWs observed, COVID-19, tuberculosis, and non-communicable diseases (NCDs) had the highest touches (19.3%, 17.6%, and 16.6%, respectively). The median time spent on sexually transmitted infections (STIs) and NCDs was statistically higher than in other health areas (p < 0.05). Of 3813 tasks completed by CHWs, 1640 (43%) were on health education and promotion. A significant difference was observed in the median time spent on health education, promotion, and screening compared to other tasks (p < 0.05). CONCLUSION This study demonstrates that CHWs spend the most time on health education, promotion, and screening per programmatic objectives but, overall, less time than program design. CHWs deliver care for a broader range of health conditions than the programmatic design indicates. Future studies should examine associations between time spent and quality of care delivery.
Collapse
Affiliation(s)
- Moses Banda Aron
- Partners In Health/Abwenzi Pa Za Umoyo, PO Box 56, Neno, Malawi.
| | | | | | - Manuel Mulwafu
- Partners In Health/Abwenzi Pa Za Umoyo, PO Box 56, Neno, Malawi
| | - Henry Makungwa
- Partners In Health/Abwenzi Pa Za Umoyo, PO Box 56, Neno, Malawi
| | | | - Emilia Connolly
- Partners In Health/Abwenzi Pa Za Umoyo, PO Box 56, Neno, Malawi
- Division of Pediatrics, University of Cincinnati College of Medicine, 3230 Eden Ave, Cincinnati, OH, 45267, United States of America
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45529, United States of America
| |
Collapse
|
4
|
Tam CC, Kerr WC, Cook WK, Li L. At-Risk Drinking in US Adults with Health Conditions: Differences by Gender, Race, and Ethnicity in the National Survey of Drug Use and Health, 2015-2019. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01621-6. [PMID: 37219733 PMCID: PMC10729902 DOI: 10.1007/s40615-023-01621-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 04/26/2023] [Accepted: 04/30/2023] [Indexed: 05/24/2023]
Abstract
Few studies in the US address alcohol consumption patterns in adults with chronic health conditions, and little is known about race and ethnicity differences. This study examined at-risk drinking prevalence rates among US adults with hypertension, diabetes, heart condition or cancer and assessed differences by gender and, among adults aged 50 and older, by race and ethnicity. We used data from the 2015-2019 National Survey on Drug Use and Health (N = 209,183) to estimate (1) prevalence rates and (2) multivariable logistic regression models predicting odds of at-risk drinking among adults with hypertension, diabetes, heart condition, or cancer, compared to adults with none of these conditions. To examine subgroup differences, analyses were stratified by gender (ages 18-49 and ages 50 +) and by gender and race and ethnicity for adults ages 50 + . Results showed that all adults with diabetes and women ages 50 + with heart conditions in the full sample had lower odds of at-risk drinking relative to their counterparts without any of the four conditions. Men ages 50 + with hypertension had greater odds. In race and ethnicity assessments among adults ages 50 + , only non-Hispanic White (NHW) men and women with diabetes and heart conditions had lower odds, and NHW men and women and Hispanic men with hypertension had greater odds of at-risk drinking. There were differential associations of at-risk drinking with demographic and lifestyle indicators across race and ethnicity groups. These findings underscore tailored efforts in community and clinical settings to reduce at-risk drinking in subgroups with health condition diagnoses.
Collapse
Affiliation(s)
- Christina C Tam
- Alcohol Research Group, Public Health Institute, 6001 Shellmound Street, Suite 450, Emeryville, CA, 94608-1010, USA.
| | - William C Kerr
- Alcohol Research Group, Public Health Institute, 6001 Shellmound Street, Suite 450, Emeryville, CA, 94608-1010, USA
| | - Won Kim Cook
- Alcohol Research Group, Public Health Institute, 6001 Shellmound Street, Suite 450, Emeryville, CA, 94608-1010, USA
| | - Libo Li
- Alcohol Research Group, Public Health Institute, 6001 Shellmound Street, Suite 450, Emeryville, CA, 94608-1010, USA
| |
Collapse
|
5
|
Ramos DK, Anastácio BS, da Silva GA, Rosso LU, Mattar J. Burnout syndrome in different teaching levels during the covid-19 pandemic in Brazil. BMC Public Health 2023; 23:235. [PMID: 36737710 PMCID: PMC9896436 DOI: 10.1186/s12889-023-15134-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 01/24/2023] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND This article's purpose is to compare burnout syndrome indicators at different levels of teaching in Brazil during the covid-19 pandemic. The comparison also considers the teachers' quality of life and health, working conditions, and digital competence. METHODS The hypotheses of this study are that there are statistically significant differences in teachers' burnout rates, quality of life, working conditions, and digital competences depending on the teaching level. A mixed-methods ex-post-facto survey involved 438 Brazilian teachers, with a mean age of 42.93 years (SD = 9.66), 330 females (75%) and 108 males (25%). Data were collected through an online questionnaire. Statistical analysis of variance (ANOVA) tests was performed to compare groups, the Tukey test for paired comparison of the analyzed groups, and the chi-square to verify the association between variables. RESULTS Higher levels of digital competence were associated with lower burnout syndrome scores. Elementary and middle school teachers presented worse quality of life and health indexes. Adapting pedagogical work involved learning but also overwork, exhaustion, and frustration. CONCLUSIONS The study concludes that basic education teachers had higher burnout rate scores than higher education teachers during the covid-19 pandemic and that early childhood education should be treated as a separate category. TRIAL REGISTRATION Ethics approval was obtained from the University of Santa Catarina (UFSC) Research Ethics Committee (4.432.063, December 7, 2020). Informed consent was obtained from all subjects.
Collapse
Affiliation(s)
- Daniela Karine Ramos
- grid.411237.20000 0001 2188 7235Universidade Federal de Santa Catarina, Florianópolis, Brazil
| | - Bruna Santana Anastácio
- grid.411237.20000 0001 2188 7235Universidade Federal de Santa Catarina, Florianópolis, Brazil
| | | | | | - João Mattar
- Pontifícia Universidade Católica de São Paulo, São Paulo, Brazil.
| |
Collapse
|
6
|
Gumà-Lao J, Arpino B. A machine learning approach to determine the influence of specific health conditions on self-rated health across education groups. BMC Public Health 2023; 23:131. [PMID: 36653815 PMCID: PMC9848707 DOI: 10.1186/s12889-023-15053-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 01/13/2023] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Self-rated health, a subjective health outcome that summarizes an individual's health conditions in one indicator, is widely used in population health studies. However, despite its demonstrated ability as a predictor of mortality, we still do not full understand the relative importance of the specific health conditions that lead respondents to answer the way they do when asked to rate their overall health. Here, education, because of its ability to identify different social strata, can be an important factor in this self-rating process. The aim of this article is to explore possible differences in association pattern between self-rated health and functional health conditions (IADLs, ADLs), chronic diseases, and mental health (depression) among European women and men between the ages of 65 and 79 according to educational attainment (low, medium, and high). METHODS Classification trees (J48 algorithm), an established machine learning technique that has only recently started to be used in social sciences, are used to predict self-rated health outcomes. The data about the aforementioned health conditions among European women and men aged between 65 and 79 comes from the sixth wave of the Survey of Health, Ageing and Retirement in Europe (SHARE) (n = 27,230). RESULTS It is confirmed the high ability to predict respondents' self-rated health by their reports related to their chronic diseases, IADLs, ADLs, and depression. However, in the case of women, these patterns are much more heterogeneous when the level of educational attainment is considered, whereas among men the pattern remains largely the same. CONCLUSIONS The same response to the self-rated health question may, in the case of women, represent different health profiles in terms of the health conditions that define it. As such, gendered health inequalities defined by education appear to be evident even in the process of evaluating one's own health status.
Collapse
Affiliation(s)
- Jordi Gumà-Lao
- Department of Sociology, Umeå University, Vindarnas torg 1 Beteendevetarhuset, Umeå, 901 87, Sweden.
| | - Bruno Arpino
- grid.8404.80000 0004 1757 2304Department of Statistics, Computer Science, Applications, University of Florence, Viale Morgagni, 59, Firenze, 50134 Italy
| |
Collapse
|
7
|
Le Bonniec A, Sun S, Andrin A, Dima AL, Letrilliart L. Barriers and Facilitators to Participation in Health Screening: an Umbrella Review Across Conditions. Prev Sci 2022; 23:1115-1142. [PMID: 35705780 DOI: 10.1007/s11121-022-01388-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2022] [Indexed: 11/28/2022]
Abstract
Screening is an essential prevention practice for a number of health conditions. However, screening coverage remains generally low. Studies that investigate determinants of screening participation are becoming more common, but oftentimes investigate screening for health conditions in an individualized rather than integrated fashion. In routine clinical practice, however, healthcare professionals are often confronted with situations in which several screening procedures are recommended for the same patient. The consideration of their common determinants may support a more integrated screening approach. The objectives of this umbrella review were therefore to examine: 1) the determinants (barriers and facilitators) that have been identified in relation to recommended health screening procedures; and 2) the modifiable determinants (in primary care) common across health conditions or specific to individual procedures. Results were presented through a narrative synthesis. PubMed, PsycInfo and Cochrane were searched up to January 2022. Systematic reviews reporting determinants of participation in health screening procedures with grade A or B recommendation according to the US Preventive Services Task Force were included. A total of 85 systematic reviews were included, most which contained both qualitative and quantitative studies on determinants that describe individual factors (961 occurrences), social factors (113 occurrences, healthcare professional factors (149 occurrences), health system factors (105 occurrences) and screening procedure factors (99 occurrences). The most studied screening procedures concerned cervical cancer/human papillomavirus (n = 33), breast cancer (n = 28), colorectal cancer (n = 25) and the human immunodeficiency virus (n = 12). Other conditions have been under-studied (e.g. cardiovascular problems, lung cancer, syphilis). The individual domain, including determinants such as knowledge, beliefs and emotions, was the most covered across health conditions. Healthcare professional's recommendations and the quality of patient-provider communication were identified to have a strong influence on screening participation in most conditions. The other three domains included determinants which were more specific to a condition or a population. Various determinants modifiable in primary care were found in the individual domain and in the health system, healthcare professional and screening procedure domains. Quality was assessed as low for most systematic reviews included. The identification of various modifiable determinants common across conditions highlights the potential of an integrated screening participation approach. Interventions may address common determinants in a broader person-centred framework within which tailoring to specific procedures or populations can be considered. This approach needs to be explored in intervention studies. The systematic review registration is PROSPERO CRD42019126709.
Collapse
Affiliation(s)
- Alice Le Bonniec
- Research On Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France.
- Groupe de Recherche en Psychologie Sociale (GRePS) EA4163, Université Lumière Lyon 2, Lyon, France.
| | - Sophie Sun
- Research On Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
- Collège Universitaire de Médecine Générale, Université Claude Bernard Lyon 1, Lyon, France
| | - Amandine Andrin
- Research On Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
- Groupe de Recherche en Psychologie Sociale (GRePS) EA4163, Université Lumière Lyon 2, Lyon, France
| | - Alexandra L Dima
- Research On Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
| | - Laurent Letrilliart
- Research On Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
- Collège Universitaire de Médecine Générale, Université Claude Bernard Lyon 1, Lyon, France
| |
Collapse
|
8
|
|
9
|
Abstract
The optimal, or even minimum, duration of medication treatment for opioid use disorder (OUD) needed to improve long-term outcomes has not been established empirically. As a result, health plans set potentially restrictive treatment standards to guide benefits and payment. To address this gap, we used a National Quality Forum measure for OUD medication treatment duration (180 days) to examine the impact of longer treatment on health care outcomes within a key population of Medicaid enrollees. Compared to buprenorphine discontinuation around the National Quality Forum benchmark (six to nine months), longer treatment (at least fifteen months) was associated with relative reductions in the risk of having all-cause inpatient (-52 percent) and emergency department (-26 percent) use, opioid-related hospital use (-128 percent), overdose events (-173 percent), and opioid prescriptions (-120 percent) and in the rate of prescription opioid use (-124 percent). We argue that these clinical benefits provide a rationale for policies that increase access to longer-term buprenorphine treatment, including lengthening the standards for minimum treatment duration.
Collapse
Affiliation(s)
- Hillary Samples
- Hillary Samples ( h. samples@columbia. edu ) is a postdoctoral research fellow in the Department of Epidemiology, Columbia University Mailman School of Public Health, in New York City
| | - Arthur Robin Williams
- Arthur Robin Williams is an assistant professor in the Department of Psychiatry, New York State Psychiatric Institute and Columbia University Irving Medical Center, in New York City
| | - Stephen Crystal
- Stephen Crystal is the Board of Governors Professor in the Institute for Health, Health Care Policy, and Aging Research, Rutgers University, in New Brunswick, New Jersey
| | - Mark Olfson
- Mark Olfson is the Elizabeth K. Dollard Professor of Psychiatry, Medicine, and Law in the Department of Psychiatry, Vagelos College of Physicians and Surgeons, and a professor of epidemiology in the Mailman School of Public Health, both at Columbia University; and a research psychiatrist at the New York State Psychiatric Institute, in New York City
| |
Collapse
|
10
|
Saloner B, Maclean JC. Specialty Substance Use Disorder Treatment Admissions Steadily Increased In The Four Years After Medicaid Expansion. Health Aff (Millwood) 2021; 39:453-461. [PMID: 32119615 DOI: 10.1377/hlthaff.2019.01428] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The Affordable Care Act's Medicaid expansion provided insurance coverage to many low-income adults with substance use disorders, but it is unclear whether this led to more people receiving treatment. We used the Treatment Episode Data Set and a difference-in-differences approach to compare annual rates of specialty treatment admissions in expansion versus nonexpansion states in the period 2010-17. We found that admissions to treatment steadily increased in the four years after Medicaid expansion, with 36 percent more people entering treatment by the fourth expansion year in expansion states compared to nonexpansion states. Changes were largest for people entering intensive outpatient programs and those seeking medication treatment for opioid use disorder. The share of admissions paid for by Medicaid increased 23 percentage points in expansion states compared to nonexpansion states, largely displacing treatment paid for by state and local governments. The gradual increase in specialty substance use disorder treatment admissions after Medicaid expansion may reflect improving capacity and access to care.
Collapse
Affiliation(s)
- Brendan Saloner
- Brendan Saloner ( bsaloner@jhu. edu ) is an associate professor in the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, in Baltimore, Maryland
| | - Johanna Catherine Maclean
- Johanna Catherine Maclean is an associate professor of economics at Temple University, in Philadelphia, Pennsylvania, and a research associate at the National Bureau of Economic Research in Cambridge, Massachusetts
| |
Collapse
|
11
|
Jarlenski MP, Krans EE, Kim JY, Donohue JM, James AE, Kelley D, Stein BD, Bogen DL. Five-Year Outcomes Among Medicaid-Enrolled Children With In Utero Opioid Exposure. Health Aff (Millwood) 2021; 39:247-255. [PMID: 32011940 DOI: 10.1377/hlthaff.2019.00740] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The health of women and children affected by opioid use disorder is a priority for state Medicaid programs. Little is known about longer-term outcomes among Medicaid-enrolled children exposed to opioids in utero. We examined well-child visit use and diagnoses of pediatric complex chronic conditions in the first five years of life among children with opioid exposure, tobacco exposure, or neither exposure in utero. The sample consisted of 82,329 maternal-child dyads in the Pennsylvania Medicaid program in which the children were born in the period 2008-11 and followed up for five years. Children with in utero opioid exposure had a lower predicted probability of recommended well-child visit use at age fifteen months (42.1 percent) compared to those with tobacco exposure (54.1 percent) and those with neither exposure (55.7 percent). Children with in utero opioid exposure had a predicted probability of being diagnosed with a pediatric complex chronic condition similar to that among children with tobacco exposure and those with neither exposure (20.4 percent, 18.7 percent, and 20.2 percent, respectively). Our findings were consistent when we examined a subgroup of opioid-exposed children identified as having neonatal opioid withdrawal symptoms.
Collapse
Affiliation(s)
- Marian P Jarlenski
- Marian P. Jarlenski ( marian. jarlenski@pitt. edu ) is an assistant professor in the Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, in Pennsylvania
| | - Elizabeth E Krans
- Elizabeth E. Krans is an assistant professor in the Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine, and at the Magee-Womens Research Institute, in Pittsburgh
| | - Joo Yeon Kim
- Joo Yeon Kim is a senior data analyst in the Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health
| | - Julie M Donohue
- Julie M. Donohue is a professor in the Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health
| | - A Everette James
- A. Everette James III is a professor in the Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health
| | - David Kelley
- David Kelley is senior medical director in the Pennsylvania Department of Human Services, in Harrisburg
| | - Bradley D Stein
- Bradley D. Stein is a senior physician policy researcher at the RAND Corporation in Pittsburgh
| | - Debra L Bogen
- Debra L. Bogen is a professor in the Department of Pediatrics, University of Pittsburgh School of Medicine
| |
Collapse
|
12
|
Koh KA, Racine M, Gaeta JM, Goldie J, Martin DP, Bock B, Takach M, O'Connell JJ, Song Z. Health Care Spending And Use Among People Experiencing Unstable Housing In The Era Of Accountable Care Organizations. Health Aff (Millwood) 2021; 39:214-223. [PMID: 32011951 DOI: 10.1377/hlthaff.2019.00687] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Provider organizations are increasingly held accountable for health care spending in vulnerable populations. Longitudinal data on health care spending and use among people experiencing episodes of homelessness could inform the design of alternative payment models. We used Medicaid claims data to analyze spending and use among 402 people who were continuously enrolled in the Boston Health Care for the Homeless Program (BHCHP) from 2013 through 2015, compared to spending and use among 18,638 people who were continuously enrolled in Massachusetts Medicaid with no evidence of experiencing homelessness. The BHCHP population averaged $18,764 per person per year in spending-2.5 times more than spending among the comparison Medicaid population ($7,561). In unadjusted analyses this difference was explained by greater spending in the BHCHP population on outpatient care, including emergency department care, as well as on inpatient care and prescription drugs. After adjustment for covariates and multiple hypothesis testing, the difference was largely driven by outpatient spending. Differences were sensitive to adjustments for risk score, which suggests that housing instability and health risk are meaningfully correlated. This longitudinal analysis improves understanding of health care use and resource needs among people who are homeless or have unstable housing, and it could inform the design of alternative payment models for vulnerable populations.
Collapse
Affiliation(s)
- Katherine A Koh
- Katherine A. Koh ( kkoh@partners. org ) is a physician at the Boston Health Care for the Homeless Program and Massachusetts General Hospital, both in Boston, Massachusetts
| | - Melanie Racine
- Melanie Racine is the director of special projects at the Boston Health Care for the Homeless Program and a member of its Institute for Research, Quality, and Policy in Homeless Health Care
| | - Jessie M Gaeta
- Jessie M. Gaeta is chief medical officer at the Boston Health Care for the Homeless Program and a member of its Institute for Research, Quality, and Policy in Homeless Health Care. She is also an assistant professor of medicine at Boston University School of Medicine
| | - John Goldie
- John Goldie is executive director of system analytics, Boston Medical Center Health System
| | - Daniel P Martin
- Daniel P. Martin is a data scientist in the Population Health Analytics and Strategy team, Boston Medical Center Health System
| | - Barry Bock
- Barry Bock is chief executive officer of the Boston Health Care for the Homeless Program
| | - Mary Takach
- Mary Takach is a senior health policy adviser at the Boston Health Care for the Homeless Program
| | - James J O'Connell
- James J. O'Connell is president of the Boston Health Care for the Homeless Program and an assistant professor of medicine at Harvard Medical School, in Boston
| | - Zirui Song
- Zirui Song is an assistant professor of health care policy and medicine at Harvard Medical School and Massachusetts General Hospital, and a faculty member in the Center for Primary Care at Harvard Medical School
| |
Collapse
|
13
|
Abstract
After increasing for nearly two decades, rates of neonatal abstinence syndrome have recently leveled off, reaching a plateau as early as 2014. These findings may represent successful efforts to prevent and treat opioid use before and during pregnancy.
Collapse
Affiliation(s)
- Ashley A Leech
- Ashley A. Leech ( ashley. leech@vanderbilt. edu ) is an assistant professor of health policy at Vanderbilt University School of Medicine and faculty member of the Vanderbilt Center for Child Health Policy, Vanderbilt University Medical Center, in Nashville, Tennessee
| | - William O Cooper
- William O. Cooper is the Cornelius Vanderbilt Professor of Health Policy and Pediatrics at Vanderbilt University School of Medicine and faculty member of the Vanderbilt Center for Child Health Policy, Vanderbilt University Medical Center
| | - Elizabeth McNeer
- Elizabeth McNeer is a biostatistician in the Department of Biostatistics at Vanderbilt University School of Medicine and at the Vanderbilt Center for Child Health Policy, Vanderbilt University Medical Center
| | - Theresa A Scott
- Theresa A. Scott is a senior application developer at the Vanderbilt Center for Child Health Policy, Pediatrics, and Mildred Stahlman Division of Neonatology, Vanderbilt University Medical Center
| | - Stephen W Patrick
- Stephen W. Patrick is an associate professor of pediatrics and health policy at Vanderbilt University School of Medicine, practicing neonatologist in the Division of Neonatology at Vanderbilt University Medical Center, and director of the Vanderbilt Center for Child Health Policy, Vanderbilt University Medical Center
| |
Collapse
|
14
|
Arain MA, Ahmad A, Chiu V, Kembel L. Medication adherence support of an in-home electronic medication dispensing system for individuals living with chronic conditions: a pilot randomized controlled trial. BMC Geriatr 2021; 21:56. [PMID: 33446126 PMCID: PMC7807760 DOI: 10.1186/s12877-020-01979-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 12/21/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Medication adherence is challenging for older adults due to factors such as the number of medications, dosing schedule, and the duration of drug therapy. The objective of this study was to examine the effectiveness of an in-home electronic medication dispensing system (MDS) on improving medication adherence and health perception in older adults with chronic conditions. METHODS A pilot Randomized Controlled Trial (RCT) was conducted using a two-arm parallel assignment model. The intervention group used an MDS as their medication management method. The control group continued to use their current methods of medication management. Block randomization was used to assign participants into the intervention or control group. The inclusion criteria included 1) English speaking 2) age 50 and over 3) diagnosed with one or more chronic condition(s) 4) currently taking five or more oral medications 5) City of Calgary resident. Participants were recruited from a primary care clinic in Alberta, Canada. The study was open-label where knowledge about group assigned to participants after randomization was not withheld. Medication adherence was captured over a continuous, six-month period and analyzed using Intention-to-Treat (ITT) analysis. RESULTS A total of 91 participants were assessed for eligibility and 50 were randomized into the two groups. The number of participants analyzed for ITT was 23 and 25 in the intervention and control group, respectively. Most of the demographic characteristics were comparable in the two groups except the mean age of the intervention group, which was higher compared to the control group (63.96 ± 7.86 versus 59.52 ± 5.93, p-value = 0.03). The average recorded adherence over 26 weeks was significantly higher in the intervention group than the control group (98.35% ± 2.15% versus 91.17% ± 9.76%, p < 0.01). The self-rated medication adherence in the intervention group also showed a significant increase from baseline to 6-month (Z=-2.65, p < 0.01). The control group showed a non-significant increase (Z=-1.79, p = 0.07). CONCLUSION The MDS can be an effective, long-term solution to medication non-adherence in older adults experiencing chronic conditions and taking multiple medications. The technology induces better consistency and improvement in medication taking behaviour than simple, non-technological intervention. TRIAL REGISTRATION Registered with ClinicalTrials.gov on April 09, 2020 with identifier NCT04339296 .
Collapse
Affiliation(s)
- Mubashir Aslam Arain
- Health Systems Evaluation and Evidence, Alberta Health Services, 10301 Southport Lane SW, Calgary, Alberta, Canada.
- Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada.
| | - Armghan Ahmad
- Health Systems Evaluation and Evidence, Alberta Health Services, 10301 Southport Lane SW, Calgary, Alberta, Canada
| | - Venus Chiu
- Health Systems Evaluation and Evidence, Alberta Health Services, 10301 Southport Lane SW, Calgary, Alberta, Canada
| | - Lorena Kembel
- Health Systems Evaluation and Evidence, Alberta Health Services, 10301 Southport Lane SW, Calgary, Alberta, Canada
| |
Collapse
|
15
|
Abstract
The domestic medical examination of newly arrived refugees is a comprehensive medical visit. It includes a review of the overseas medical examination and a thorough medical and immigration history. It should include laboratory testing for infectious diseases, pregnancy, and other conditions as recommended by the Centers for Disease Control and Prevention and resettlement state, as well as a comprehensive physical examination with attention paid to conditions known to specific refugee groups. It should also include vaccinations for age-appropriate vaccine-preventable diseases. The concept of preventive care should be introduced, and future visits should be scheduled for preventive care.
Collapse
Affiliation(s)
- Kelly Reese
- Family & Community Medicine Residency Program, Penn Medicine Lancaster General Health, 540 North Duke Street, Lancaster, PA 17602, USA.
| | - Brianna Moyer
- Family & Community Medicine Residency Program, Penn Medicine Lancaster General Health, 540 North Duke Street, Lancaster, PA 17602, USA
| |
Collapse
|
16
|
Ishida M, Montagni I, Matsuzaki K, Shimamoto T, Cariou T, Kawamura T, Tzourio C, Iwami T. The association between depressive symptoms and self-rated health among university students: a cross-sectional study in France and Japan. BMC Psychiatry 2020; 20:549. [PMID: 33228615 PMCID: PMC7685657 DOI: 10.1186/s12888-020-02948-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 11/07/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Depressive disorders in University students have risen dramatically in the past few decades to the extent that students' mental health has become a current global public health priority. Obtaining information from University students about their mental health is challenging because of potential embarrassment of disclosing one's concerns and fear of stigmatization. Self-rated health might be a good solution to evaluate mental health state by a simple and neutral indicator. The aim of the study is to investigate the association between depressive symptoms and self-rated health by sex among University students in France and Japan. METHODS A cross-sectional study was conducted by using two large cohorts of students aged ≥18 years (n = 5655 in Bordeaux, France and n = 17,148 in Kyoto, Japan). Depressive symptoms (PHQ-2 scale), Likert scale of self-rated health, socio-demographic characteristics and health habits were collected through self-administered questionnaires. Multivariate logistic regression models were performed to describe the association between depressive symptoms and other variables including self-rated health, stratified by sex. RESULTS A high score of PHQ-2 (high depressive symptoms) was associated with poor self-rated health in both cohorts independently of all other variables (OR 2.82, 95%CI 1.99-4.01 in France, OR 7.10, 95%CI 5.76-8.74 in Japan). Although the prevalence of depressive symptoms between sexes was different in French students (males 15.4%, females 25.0%, p < 0.001), it was similar in Japanese students (males 3.5%, females 3.3%, p = 0.466), who reported less depressive symptoms than French students. The association between depressive symptoms and poor self-rated health was greater in Japanese females (OR 12.40, 95%CI 7.74-20.00) than in males (OR 6.30, 95%CI 4.99-7.95), whereas the strength of the association was almost similar in French students (OR 2.17, 95%CI 0.86-5.47 in males, OR 2.98, 95%CI 2.03-4.38 in females). CONCLUSIONS Depressive symptoms were associated with self-rated health among University students in both countries with slightly differences in sex. Self-rated health would be a simple, reliable and universal indicator for healthcare professionals and University staff to identify students at risk of depression.
Collapse
Affiliation(s)
- Mami Ishida
- grid.258799.80000 0004 0372 2033Department of Preventive Services, Kyoto University School of Public Health, Yoshida-honmachi, Sakyo-ku, Kyoto, 606-8501 Japan
| | - Ilaria Montagni
- grid.412041.20000 0001 2106 639XTeam HEALTHY, UMR 1219, University of Bordeaux, Inserm, Bordeaux Population Health Research Center, F-33000 Bordeaux, France
| | - Keiichi Matsuzaki
- Kyoto University Health Service, Yoshida-honmachi, Sakyo-ku, Kyoto, 606-8501, Japan.
| | - Tomonari Shimamoto
- grid.258799.80000 0004 0372 2033Kyoto University Health Service, Yoshida-honmachi, Sakyo-ku, Kyoto, 606-8501 Japan
| | - Tanguy Cariou
- grid.412041.20000 0001 2106 639XTeam HEALTHY, UMR 1219, University of Bordeaux, Inserm, Bordeaux Population Health Research Center, F-33000 Bordeaux, France
| | - Takashi Kawamura
- grid.258799.80000 0004 0372 2033Kyoto University Health Service, Yoshida-honmachi, Sakyo-ku, Kyoto, 606-8501 Japan
| | - Christophe Tzourio
- grid.412041.20000 0001 2106 639XTeam HEALTHY, UMR 1219, University of Bordeaux, Inserm, Bordeaux Population Health Research Center, F-33000 Bordeaux, France
| | - Taku Iwami
- grid.258799.80000 0004 0372 2033Kyoto University Health Service, Yoshida-honmachi, Sakyo-ku, Kyoto, 606-8501 Japan
| |
Collapse
|
17
|
Liang T, Munro HM, Hargreaves MK, Steinwandel MD, Blot WJ, Buchowski MS. Patterns and correlates of sleep duration in the Southern cohort community study. Sleep Med 2020; 75:459-467. [PMID: 32998092 DOI: 10.1016/j.sleep.2020.09.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 09/03/2020] [Accepted: 09/08/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To investigate whether race (African American (AA) and white) is associated with sleep duration among adults from low socioeconomic (SES) strata and whether SES status, lifestyle behaviors, or health conditions are associated with sleep duration within race-sex groups. METHODS This cross-sectional study includes 78,549 participants from the Southern Community Cohort Study (SCCS). Averaged daily sleep duration was assessed by weighted averages of self-reported sleep duration on weekdays and weekends. Adjusted odds ratios (ORs) of very short (<5 h/day), short (5-6 h/day), and long sleep (≥9 h/day) associated with pre-selected risk factors in each race-sex group were determined by multinomial logistic models. RESULTS The prevalence of very short and short sleep was similar among AAs (6.2% and 29.1%) and whites (6.5% and 29.1%). Long sleep was considerably more prevalent among AAs (19.3%) than whites (13.0%). Very short sleep was associated with lower education and family income, with stronger associations among whites. Higher physical activity levels significantly decreased odds for both very short (OR = 0.80) and long sleep (OR = 0.78). Smoking, alcohol use, and dietary intake were not associated with sleep duration. Regardless of race or sex, very short, short, and long sleep were significantly associated with self-reported health conditions, especially depression (ORs were 2.06, 1.33, and 1.38, respectively). CONCLUSIONS Sleep duration patterns differed between AAs and whites from the underrepresented SCCS population with low SES. Sleep duration was associated with several socioeconomic, health behaviors, and health conditions depending on race and sex.
Collapse
Affiliation(s)
- Tao Liang
- Division of Gastroenterology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Heather M Munro
- International Epidemiology Field Station, Rockville, MD, USA; Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Mark D Steinwandel
- International Epidemiology Field Station, Rockville, MD, USA; Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - William J Blot
- International Epidemiology Field Station, Rockville, MD, USA; Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN, USA; Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Maciej S Buchowski
- Division of Gastroenterology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
| |
Collapse
|
18
|
Abstract
We used data from the Medical Expenditure Panel Survey to explore potential explanations for racial/ethnic disparities in coronavirus disease 2019 (COVID-19) hospitalizations and mortality. Black adults in every age group were more likely than White adults to have health risks associated with severe COVID-19 illness. However, Whites were older, on average, than Blacks. Thus, when all factors were considered, Whites tended to be at higher overall risk compared with Blacks, with Asians and Hispanics having much lower overall levels of risk compared with either Whites or Blacks. We explored additional explanations for COVID-19 disparities-namely, differences in job characteristics and how they interact with household composition. Blacks at high risk for severe illness were 1.6 times as likely as Whites to live in households containing health-sector workers. Among Hispanic adults at high risk for severe illness, 64.5 percent lived in households with at least one worker who was unable to work from home, versus 56.5 percent among Black adults and only 46.6 percent among White adults.
Collapse
Affiliation(s)
- Thomas M Selden
- Thomas M. Selden is director of the Division of Research and Modeling, Center for Financing, Access, and Cost Trends, Agency for Healthcare Research and Quality, in Rockville, Maryland
| | - Terceira A Berdahl
- Terceira A. Berdahl is a social science analyst in the Division of Research and Modeling, Center for Financing, Access, and Cost Trends, Agency for Healthcare Research and Quality
| |
Collapse
|
19
|
Azar R, Doucet S, Horsman AR, Charlton P, Luke A, Nagel DA, Hyndman N, Montelpare WJ. A concept analysis of children with complex health conditions: implications for research and practice. BMC Pediatr 2020; 20:251. [PMID: 32456672 PMCID: PMC7248453 DOI: 10.1186/s12887-020-02161-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 05/20/2020] [Indexed: 11/10/2022] Open
Abstract
Background This concept analysis aimed to clarify the meaning of “children with complex health conditions” and endorse a definition to inform future research, policy, and practice. Methods Using Walker and Avant’s (2011)‘s approach, we refined the search strategy with input from our team, including family representatives. We reviewed the published and grey literature. We also interviewed 84 health, social, and educational stakeholders involved in the care of children with complex health conditions about their use/understanding of the concept. Results We provided model, borderline, related, and contrary cases for clarification purposes. We identified defining attributes that nuance the concept: (1) conditions and needs’ breadth; (2) uniqueness of each child/condition; (3) varying extent of severity over time; 4) developmental age; and (5) uniqueness of each family/context. Antecedents were chronic physical, mental, developmental, and/or behavioural condition(s). There were individual, family, and system consequences, including fragmented services. Conclusions Building on previous definitions, we proposed an iteration that acknowledges the conditions’ changing trajectories as involving one or more chronic condition(s), regardless of type(s), whose trajectories can change over time, requiring services across sectors/settings, oftentimes resulting in a lower quality of life. A strength of this paper is the integration of the stakeholders’/family’s voices into the development of the definition.
Collapse
Affiliation(s)
- Rima Azar
- Psychobiology of Stress and Health Lab, Psychology Department, Mount Allison University, 49A York Street, Sackville, NB, E4L 1C7, Canada. .,NaviCare/SoinsNavi, Sackville, Canada.
| | - Shelley Doucet
- Department of Nursing and Health Sciences, University of New Brunswick, PO Box 5050, Saint John, NB, E2L 4L5, Canada
| | - Amanda Rose Horsman
- Interdisciplinary Studies, School of Graduate Studies, University of New Brunswick, 100 Tucker Park Rd, Box 5050, Saint John, NB, E2L 4L5, Canada
| | - Patricia Charlton
- Faculty of Nursing, University of Prince Edward Island, 550 University Avenue, Charlottetown, Prince Edward Island, C1A 4P3, Canada
| | - Alison Luke
- Department of Nursing and Health Sciences, University of New Brunswick, PO Box 5050, Saint John, NB, E2L 4L5, Canada
| | - Daniel A Nagel
- Department of Nursing and Health Sciences, University of New Brunswick, PO Box 5050, Saint John, NB, E2L 4L5, Canada
| | - Nicky Hyndman
- Veterans Affairs Canada, PO Box 7700, Charlottetown, PE, C1A 8M9, Canada
| | - William J Montelpare
- Faculty of Science, University of Prince Edward Island, 550 University Avenue, Charlottetown, Prince Edward Island, C1A 4P3, Canada
| |
Collapse
|
20
|
Husky MM, Alvarez Fernandez V, Tapia G, Oprescu F, Navarro-Mateu F, Kovess-Masfety V. Mental disorders and medical conditions associated with causing injury or death: A population-based study. Psychiatry Res 2020; 287:112899. [PMID: 32169724 DOI: 10.1016/j.psychres.2020.112899] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 02/24/2020] [Accepted: 02/25/2020] [Indexed: 11/23/2022]
Abstract
The aim of the present study is to examine mental disorders and medical conditions associated with causing harm to another person in the general adult population. The sample (n=22,138) was drawn from a cross-sectional survey designed to characterize mental health needs in France. Twelve-month DSM-IV axis I mental disorders and medical conditions, and lifetime occurrence of potentially traumatic events were assessed with the Composite International Diagnostic Interview-SF Overall, 2% (n=430) of the sample reported having injured or killed someone. Causing harm was associated with male gender, lower education level, and being unemployed. The great majority (85%) of those who caused harm had experienced two or more additional potentially traumatic events. When adjusting for gender, employment status, education and number of events experienced, causing harm was associated with certain anxiety disorders, drug dependence and lifetime suicide attempt but not with major depression or post-traumatic stress disorder. Furthermore, causing harm was not associated with medical conditions in multivariate analyses. These results highlight the need for clinicians to be particularly attentive to the psychological burden that may be experienced by those who have harmed or killed someone.
Collapse
|
21
|
Janevic T, Zeitlin J, Egorova N, Hebert PL, Balbierz A, Howell EA. Neighborhood Racial And Economic Polarization, Hospital Of Delivery, And Severe Maternal Morbidity. Health Aff (Millwood) 2020; 39:768-776. [PMID: 32364858 PMCID: PMC9808814 DOI: 10.1377/hlthaff.2019.00735] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Recent national and state legislation has called attention to stark racial/ethnic disparities in maternal mortality and severe maternal morbidity (SMM), the latter of which is defined as having a life-threatening condition or life-saving procedure during childbirth. Using linked New York City birth and hospitalization data for 2012-14, we examined whether racial and economic spatial polarization is associated with SMM rates, and whether the delivery hospital partially explains the association. Women in ZIP codes with the highest concentration of poor blacks relative to wealthy whites experienced 4.0 cases of SMM per 100 deliveries, compared with 1.7 cases per 100 deliveries among women in the neighborhoods with the lowest concentration (risk difference = 2.4 cases per 100). Thirty-five percent of this difference was attributable to the delivery hospital. Women in highly polarized neighborhoods were most likely to deliver in hospitals located in similarly polarized neighborhoods. Housing policy that targets racial and economic spatial polarization may address a root cause of SMM, while hospital quality improvement may mitigate the impact of such polarization.
Collapse
Affiliation(s)
- Teresa Janevic
- Blavatnik Family Women’s Health Research Institute, Departments of Population Health Science and Policy and Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, in New York City
| | - Jennifer Zeitlin
- Center for Epidemiology and Biostatistics, Inserm UMR 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Research Team (Epopé), Paris Descartes University, in France
| | - Natalia Egorova
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai
| | - Paul L. Hebert
- Veterans Affairs (VA) Health Services Research and Development Center for Veteran-Centered, Value-Driven Health, VA Puget Sound Health Care System, and a research associate professor in the Department of Health Services, School of Public Health, University of Washington, both in Seattle
| | - Amy Balbierz
- Blavatnik Family Women’s Health Research Institute, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai
| | - Elizabeth A. Howell
- Blavatnik Family Women’s Health Research Institute, Departments of Population Health Science and Policy and Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai
| |
Collapse
|
22
|
Cook BL, Flores M, Zuvekas SH, Newhouse JP, Hsu J, Sonik R, Lee E, Fung V. The Impact Of Medicare's Mental Health Cost-Sharing Parity On Use Of Mental Health Care Services. Health Aff (Millwood) 2020; 39:819-827. [PMID: 32364860 PMCID: PMC7745666 DOI: 10.1377/hlthaff.2019.01008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Before the implementation of cost-sharing parity in Medicare, beneficiaries faced higher cost sharing for mental health services than for other medical services. The Medicare Improvements for Patients and Providers Act of 2008 phased in cost-sharing reductions in Medicare for outpatient mental health services in the period 2010-14. Using data for 2006-15 from the Medical Expenditure Panel Survey and difference-in-differences analyses, we assessed whether this reduction in mental health cost sharing was associated with changes in specialty and primary care outpatient mental health visits and psychotropic medication fills. We compared people with Medicare and with private insurance before and after parity implementation. Medicare beneficiaries' use of psychotropic medication increased after the implementation of cost-sharing parity, but we did not detect a change in visits. Changes in the use of psychotropic medications were greater among people with probable serious mental illness and among Medicare beneficiaries who did not report having supplemental coverage. The increased medication use could signal improvements in mental health care access among Medicare beneficiaries, especially among the subgroups most likely to benefit from the policy change.
Collapse
Affiliation(s)
- Benjamin Lê Cook
- Benjamin Lê Cook ( bcook@cha. harvard. edu ) is director of the Health Equity Research Lab, Cambridge Health Alliance, in Cambridge, Massachusetts, and an associate professor in the Department of Psychiatry at Harvard Medical School, in Boston, Massachusetts
| | - Michael Flores
- Michael Flores is an instructor in the Department of Psychiatry at Harvard Medical School and a research scientist at the Health Equity Research Lab, Cambridge Health Alliance
| | - Samuel H Zuvekas
- Samuel H. Zuvekas is a senior economist in the Center for Financing, Access, and Cost Trends, Agency for Healthcare Research and Quality, in Rockville, Maryland
| | - Joseph P Newhouse
- Joseph P. Newhouse is the John D. MacArthur Professor of Health Policy and Management in the Department of Health Care Policy, Harvard Medical School; the Department of Health Policy and Management at the Harvard T. H. Chan School of Public Health, in Boston; and the Harvard Kennedy School, in Cambridge. He is also a faculty research fellow at the National Bureau of Economic Research in Cambridge
| | - John Hsu
- John Hsu is director of the Clinical Economics and Policy Analysis Program at the Mongan Institute Health Policy Center, Massachusetts General Hospital, in Boston, and an associate professor in the Departments of Medicine and of Health Care Policy, Harvard Medical School
| | - Rajan Sonik
- Rajan Sonik is director of research at AltaMed Institute for Health Equity, in Los Angeles, California
| | - Esther Lee
- Esther Lee is a project manager at the Health Equity Research Lab, Cambridge Health Alliance
| | - Vicki Fung
- Vicki Fung is a senior scientist at the Mongan Institute Health Policy Center, Massachusetts General Hospital, and an assistant professor in the Department of Medicine at Harvard Medical School
| |
Collapse
|
23
|
Dorji N, Dunne M, Deb S. Adverse childhood experiences: association with physical and mental health conditions among older adults in Bhutan. Public Health 2020; 182:173-178. [PMID: 32334184 DOI: 10.1016/j.puhe.2020.02.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 02/10/2020] [Accepted: 02/14/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Adverse childhood experiences (ACEs) are events stressful, traumatic, and related to the development of a wide range of health conditions throughout the person's lifespan. This study explored the relationship between ACEs and health conditions among older adults in Bhutan. STUDY DESIGN Cross-sectional survey. METHODS Older adults aged 60-101 years (n = 337) completed a face-to-face interview in a convenient community setting in the four major towns of Bhutan. Measurements included the modified World Health Organization Adverse Childhood Experiences International Questionnaire and the checklist of chronic health conditions. RESULTS Commonest ACEs reported by the sample were related to the contribution of physical labour in childhood (n = 284 [84.3%]) and witnessing of community violence (n = 185 [54.9%]). Assuming an adult role while still a child highly co-occur with other forms of ACEs. Compared to 0-2 ACEs, participants with ≥7 ACEs had the higher odds of reporting lung disease (odds ratio [OR] = 2.15, 95% confidence interval [CI]: 1.03-4.49), visual impairment (OR = 2.38, 95%CI: 1.16-4.85), insomnia (OR = 2.35, 95%CI: 1.11-4.98), and memory decline (OR = 2.30, 95%CI: 1.10-4.78) by twofold and high blood pressure by threefold (OR = 3.21, 95%CI: 1.39-7.38). Overall, the odds of self-rated poor health conditions among those ≥7 ACEs compared to 0-2 ACEs was high by almost twofold (OR = 1.97; 95%CI: 1.04-3.73). CONCLUSIONS The influence of ACEs on health conditions persisted into late adulthood, and older people in Bhutan have had a complex variety of chronic health conditions implicating greater demand on the free healthcare system in Bhutan. ACEs prevention is critical to promote better health for a country like Bhutan, where the healthcare services are provided free of cost to its citizens.
Collapse
Affiliation(s)
- N Dorji
- Faculty of Nursing and Public Health, Khesar Gyalpo University of Medical Sciences of Bhutan, Bhutan.
| | - M Dunne
- School of Public Health and Social Work, Queensland University of Technology, Australia
| | - S Deb
- Department of Applied Psychology, Pondicherry University, India
| |
Collapse
|
24
|
Abstract
In 2016 only 13.8 percent of substance use disorder treatment programs offered medication treatment for opioid use disorder for older adults who used Medicare to pay for treatment. With increasing demand for treatment among older adults and a rapidly aging population, improved access to medication treatment for this population is needed.
Collapse
Affiliation(s)
- Samantha J Harris
- Samantha J. Harris ( sjh75852@uga. edu ) is a doctoral candidate in the Department of Public Administration and Policy, University of Georgia School of Public and International Affairs, in Athens
| | - Amanda J Abraham
- Amanda J. Abraham is an associate professor in the Department of Public Administration and Policy, University of Georgia School of Public and International Affairs, in Athens
| | - Christina M Andrews
- Christina M. Andrews is an associate professor in the College of Social Work, University of South Carolina, in Columbia
| | - Courtney R Yarbrough
- Courtney R. Yarbrough is an assistant professor in the Department of Health Policy and Management, Rollins School of Public Health, Emory University, in Atlanta, Georgia
| |
Collapse
|
25
|
Hohl BC, Kondo MC, Kajeepeta S, MacDonald JM, Theall KP, Zimmerman MA, Branas CC. Creating Safe And Healthy Neighborhoods With Place-Based Violence Interventions. Health Aff (Millwood) 2019; 38:1687-1694. [PMID: 31589538 PMCID: PMC7336498 DOI: 10.1377/hlthaff.2019.00707] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Violence is a leading cause of death and disability in the United States and abroad, with far-reaching consequences for individuals and communities. Interventions that address environmental and social contexts have the potential for greater populationwide effects, yet research has been slow to identify and rigorously evaluate these types of interventions to reduce violence. Several urban communities across the US are conducting experimental and quasi-experimental community-based research to examine the effect of place-based interventions on violence. Using examples from Philadelphia, Pennsylvania; Flint, Michigan; Youngstown, Ohio; and New Orleans, Louisiana, we describe how place-based interventions that remediate vacant land and abandoned buildings work to reduce violence. These examples support the potential for place-based interventions to create far-reaching and sustainable improvements in the health and safety of communities that experience significant disadvantage. These interventions warrant the attention of community stakeholders, funders, and policy makers.
Collapse
Affiliation(s)
- Bernadette C Hohl
- Bernadette C. Hohl ( bernadette. hohl@rutgers. edu ) is an assistant professor in the Department of Biostatistics and Epidemiology, Rutgers School of Public Health, in Piscataway, New Jersey
| | - Michelle C Kondo
- Michelle C. Kondo is a research social scientist at the Northern Research Station, Forest Service, Department of Agriculture, in Philadelphia, Pennsylvania
| | - Sandhya Kajeepeta
- Sandhya Kajeepeta is a doctoral student in epidemiology at the Mailman School of Public Health, Columbia University, in New York City
| | - John M MacDonald
- John M. MacDonald is a professor in the Department of Criminology and Sociology, University of Pennsylvania, in Philadelphia
| | - Katherine P Theall
- Katherine P. Theall is a professor of epidemiology in the Department of Global Community Health and Behavioral Sciences, School of Public Health and Tropical Medicine, Tulane University, in New Orleans, Louisiana
| | - Marc A Zimmerman
- Marc A. Zimmerman is the Marshall H. Becker Collegiate Professor of Public Health and a professor of health behavior and health education and of psychology in the School of Public Health, University of Michigan, in Ann Arbor
| | - Charles C Branas
- Charles C. Branas is the Gelman Professor in and chair of the Department of Epidemiology, Mailman School of Public Health, Columbia University
| |
Collapse
|
26
|
Oh H, Waldman K, Stubbs B, Koyanagi A. Psychotic experiences in the context of mood and anxiety disorders and their associations with health outcomes among people of color in the United States. J Psychosom Res 2019; 118:27-33. [PMID: 30782351 DOI: 10.1016/j.jpsychores.2019.01.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 01/09/2019] [Accepted: 01/10/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Psychotic experiences appear to increase risk for health outcomes above and beyond mood/anxiety disorders. However, existing studies that have found this association were conducted mostly in low- and middle-income countries, calling for more studies to explore the association in other contexts, such as the U.S., where people of color face considerable health disparities. MATERIALS/METHODS Data from the National Latino and Asian American Survey, and the National Survey of American Life were analyzed. After restricting the analytic sample to individuals with at least one mood or anxiety disorder (N = 2929), multivariable logistic regression was used to examine the associations between psychotic experiences and health outcomes, disabilities, and help-seeking behaviors, adjusting for socio-demographic characteristics and psychiatric disorders. RESULTS Among people of color with mood/anxiety disorders, 16.58% (n = 519) of the weighted analytic sample reported psychotic experiences. Psychotic experiences were associated with 1.75 times greater odds (95% CI: 1.24-2.47) for reporting a lifetime health condition, with varying odds depending on the specific conditions (e.g. arthritis, heart disease, ulcers, and asthma), and specific disabilities (e.g. cognition, mobility, social interaction, and time out of role). Psychotic experiences were associated with 1.66 times the odds of seeking any treatment (95% CI: 1.20-2.29), and the perceived need for help among people who did not seek treatment (e.g. feeling the need for treatment, being encouraged to seek treatment by others). CONCLUSIONS Mental health practitioners serving people of color who have mood/anxiety disorders should routinely screen for psychotic experiences, which may suggest health problems and disabilities that warrant integrated healthcare.
Collapse
Affiliation(s)
- Hans Oh
- University of Southern California, Suzanne Dworak-Peck School of Social Work, CA, USA.
| | - Kyle Waldman
- University of Southern California, Suzanne Dworak-Peck School of Social Work, CA, USA.
| | - Brendon Stubbs
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, Denmark Hill, London, United Kingdom; Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; Faculty of Health, Social Care and Education, Anglia Ruskin University, Chelmsford, United Kingdom.
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Barcelona, Spain; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain.
| |
Collapse
|
27
|
Kavalidouª K, Smith DJ, Der G, O’Connor RC. The role of physical and mental multimorbidity in suicidal thoughts and behaviours in a Scottish population cohort study. BMC Psychiatry 2019; 19:38. [PMID: 30674288 PMCID: PMC6344985 DOI: 10.1186/s12888-019-2032-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 01/16/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Physical illness and mental disorders play a significant role in fatal and non-fatal suicidal behaviour. However, there is no clear evidence for the effect of physical and mental illness co-occurrence (multimorbidity) in suicidal ideation and attempts. The aim of the current study was to investigate, whether physical/mental health multimorbidity predicted suicidal thoughts and behaviours as outcomes. METHODS Data from the West of Scotland Twenty-07 cohort were analysed. Twenty-07 is a multiple cohort study following people for 20 years, through five waves of data collection. Participants who responded to past-year suicidal thoughts and suicide attempt items were grouped into four distinct health-groups based on having: (1) neither physical nor mental health condition (controls); (2) one or more physical health condition; (3) one or more mental health condition and; (4) multimorbidity. The role of multimorbidity in predicting suicidal ideation and suicide attempts was tested with a generalised estimating equation (GEE) model and odds ratios (ORs) and 95% CIs are presented. Whether the effect of multimorbidity was stronger than either health condition alone was also assessed. RESULTS Multimorbidity had a significant effect on suicidal thoughts and suicide attempts, compared to the control group, but was not found to increase the risk of either suicide-related outcomes, more than mental illness alone. CONCLUSIONS We identified an effect of physical/mental multimorbidity on risk of suicidal thoughts and suicide attempts. Considering that suicide and related behaviour are rare events, future studies should employ a prospective design on the role of multimorbidity in suicidality, employing larger datasets.
Collapse
Affiliation(s)
- Katerina Kavalidouª
- Suicidal Behaviour Research Laboratory, Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK. .,Hull York Medical School, University of Hull, Hull, HU6 7RX, UK.
| | - Daniel J. Smith
- 0000 0001 2193 314Xgrid.8756.cInstitute of Health & Wellbeing, University of Glasgow, Glasgow, UK
| | - Geoff Der
- 0000 0001 2193 314Xgrid.8756.cMRC/CSO Social & Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Rory C. O’Connor
- 0000 0001 2193 314Xgrid.8756.cSuicidal Behaviour Research Laboratory, Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK
| |
Collapse
|
28
|
Zhang Z, Ahmed W. A comparison of information sharing behaviours across 379 health conditions on Twitter. Int J Public Health 2018; 64:431-440. [PMID: 30585297 PMCID: PMC6451705 DOI: 10.1007/s00038-018-1192-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 11/24/2018] [Accepted: 12/14/2018] [Indexed: 11/30/2022] Open
Abstract
Objectives To compare information sharing of over 379 health conditions on Twitter to uncover trends and patterns of online user activities.
Methods We collected 1.5 million tweets generated by over 450,000 Twitter users for 379 health conditions, each of which was quantified using a multivariate model describing engagement, user and content aspects of the data and compared using correlation and network analysis to discover patterns of user activities in these online communities.
Results We found a significant imbalance in terms of the size of communities interested in different health conditions, regardless of the seriousness of these conditions. Improving the informativeness of tweets by using, for example, URLs, multimedia and mentions can be important factors in promoting health conditions on Twitter. Using hashtags on the contrary is less effective. Social network analysis revealed similar structures of the discussion found across different health conditions. Conclusions Our study found variance in activity between different health communities on Twitter, and our results are likely to be of interest to public health authorities and officials interested in the potential of Twitter to raise awareness of public health. Electronic supplementary material The online version of this article (10.1007/s00038-018-1192-5) contains supplementary material, which is available to authorized users.
Collapse
|
29
|
Abstract
Higher income neighborhoods are associated with better health, a relation observed in many cross-sectional studies. However, prior research focused on the prevalence of health conditions, and examining the incidence of new health conditions may provide stronger support for a potential causal role of neighborhoods on health. We used the 2004 and 2014 waves of the Midlife in the United States Study (n = 1726; ages 34-83) to examine health condition incidence as a function of neighborhood income. Among participants who had lived in the same neighborhood across the time period, we hypothesized that higher neighborhood income would be associated with a lower incidence of health conditions ten years later. Health included 18 chronic conditions related to mental (anxiety, depression) and physical (cardiovascular, immune) health. Multinomial logistic regression analyses adjusting for individual income and sociodemographics indicated that the odds of developing two or more new health conditions (no new health conditions as referent), was significantly lower (OR = 0.92, CI: 0.86, 0.99) for every $10,000 increment in neighborhood income. Associations did not vary by age or neighborhood tenure. Results add to a literature documenting that higher neighborhood income is associated with better health.
Collapse
|
30
|
McKee MM, Stransky ML, Reichard A. Hearing loss and associated medical conditions among individuals 65 years and older. Disabil Health J 2017; 11:122-125. [PMID: 28596096 DOI: 10.1016/j.dhjo.2017.05.007] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 05/25/2017] [Accepted: 05/29/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Hearing loss is prevalent, but few studies have investigated its associations with common medical conditions. OBJECTIVE The objective was to assess the prevalence of medical conditions among individuals with hearing loss, compared to those without hearing loss, in people aged 65 years and older. METHODS The National Health Interview Survey (NHIS) collects data on a variety of health-related topics, including disability. Three years of NHIS data (2011-2013; unweighted n = 53,111) were pooled to examine subpopulations of individuals with hearing loss. Comparisons were made between adults aged 65 and older with, and without, self-reported hearing loss. Statistical analysis included descriptive frequencies, Chi-square tests, and multiple logistic regressions. The outcomes of interest included self-reported diagnosis of arthritis, cardiovascular disease, diabetes, high blood pressure, emphysema, stroke, cancer, asthma, multiple chronic conditions, health status, and obesity. RESULTS Hearing loss prevalence was nearly 37%. After adjusting for sociodemographics, smoking status, and disability, hearing loss was independently associated with the following conditions: arthritis (OR 1.41; 1.27-1.57), cancer (OR 1.35; 1.21-1.5), cardiovascular disease (OR 1.48; 1.33-1.66), diabetes (OR 1.16; 1.03-1.31), emphysema (OR 1.41; 1.14-1.74), high blood pressure (OR 1.29; 1.17-1.43), and stroke (OR 1.39; 1.12-1.66). There was an association with worse health status over the past year (OR 1.5 (1.3-1.73). CONCLUSIONS Hearing loss among older individuals is independently associated with increased disease burden and poorer self-reported health. Future studies are needed to investigate the mechanistic nature of these associations, and whether improved access to hearing healthcare surveillance can reduce the overall health burden among these individuals.
Collapse
Affiliation(s)
- Michael M McKee
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States.
| | - Michelle L Stransky
- Institute on Disability, University of New Hampshire, Durham, NH, 03824, United States
| | - Amanda Reichard
- Institute on Disability, University of New Hampshire, Durham, NH, 03824, United States
| |
Collapse
|
31
|
Abstract
This paper estimates the causal long-term consequences of an exposure to war in utero and during childhood on the risk of obesity and the probability of having a chronic health condition in adulthood. Using the plausibly exogenous city-by-cohort variation in the intensity of WWII destruction as a unique quasi-experiment, I find that individuals who were exposed to WWII destruction during the prenatal and early postnatal periods have higher BMIs and are more likely to be obese as adults. I also find an elevated incidence of chronic health conditions such as stroke, hypertension, diabetes, and cardiovascular disorder in adulthood among these wartime children.
Collapse
|
32
|
Scott D, Ferguson GD, Jelsma J. The use of the EQ-5D-Y health related quality of life outcome measure in children in the Western Cape, South Africa: psychometric properties, feasibility and usefulness - a longitudinal, analytical study. Health Qual Life Outcomes 2017; 15:12. [PMID: 28103872 PMCID: PMC5248508 DOI: 10.1186/s12955-017-0590-3] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 01/13/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The EQ-5D-Y, an outcome measure of Health Related Quality of Life (HRQoL) in children, was developed by an international task team in 2010. The multinational feasibility, reliability and validity study which followed was undertaken with mainly healthy children. The aim of this study was to investigate the psychometric properties of the EQ-5D-Y when used to assess the HRQoL of children with different health states. METHOD A sample of 224 children between eight and twelve years were grouped according to their health state. The groups included 52 acutely ill children, 67 children with either a chronic health condition or disability and 105 mostly healthy, mainstream school children as a comparator. They were assessed at baseline, at three months and at six months. An analysis of the psychometric properties was performed to assess the reliability, validity and responsiveness of the EQ-5D-Y in the different groups of children. Cohen's kappa, the intraclass correlation coefficient, Pearson Chi-square, Kruskal-Wallis ANOVA and effect size of Wilcoxon Signed-rank test were used to determine the reliability, validity and responsiveness of the instrument. RESULTS The EQ-5D-Y dimensions were found to be reliable on test-retest (kappa varying from 0.365 to 0.653), except for the Usual Activities dimension (kappa 0.199). The Visual Analogue Scale (VAS) was also reliable (ICC = 0.77). Post-hoc analysis indicated that dimensions were able to discriminate between acutely ill and healthy children (all differences p < 0.001). The acutely ill children had the lowest ranked VAS (median 50, range 0-100), indicating worst HRQoL and was the only group significantly different from the other three groups (p < 0.001 in all cases). Convergent validity between all similar EQ-5D-Y and PedsQL, WeeFIM and Faces Pain Scale dimensions was only evident in the acutely ill children. As expected the largest treatment effect was also observed in these children (Wilcoxon Signed-rank test for VAS was 0.43). Six of the nine therapists who took part in the study, found the measure quick and easy to apply, used the information in the management of the child and would continue to use it in future. CONCLUSIONS The EQ-5D-Y could be used with confidence as an outcome measure for acutely-ill children, but demonstrated poorer psychometric properties in children with no health condition or chronic conditions. It appears to be feasible and useful to include the EQ-5D-Y in routine assessments of children.
Collapse
Affiliation(s)
- Des Scott
- Department of Health and Rehabilitation Sciences, Faculty of Health Sciences, University of Cape Town, Observatory 7925, Cape Town, South Africa.
| | - Gillian D Ferguson
- Department of Health and Rehabilitation Sciences, Faculty of Health Sciences, University of Cape Town, Observatory 7925, Cape Town, South Africa
| | - Jennifer Jelsma
- Department of Health and Rehabilitation Sciences, Faculty of Health Sciences, University of Cape Town, Observatory 7925, Cape Town, South Africa
| |
Collapse
|
33
|
Castaneda MA, Saygili M. The health conditions and the health care consumption of the uninsured. Health Econ Rev 2016; 6:55. [PMID: 27924584 PMCID: PMC5142170 DOI: 10.1186/s13561-016-0137-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Accepted: 11/30/2016] [Indexed: 06/06/2023]
Abstract
This paper investigates the difference in the health conditions and the health care consumption of uninsured individuals as compared to individuals with private insurance, using a nationally representative data set of inpatient hospital admissions from the US. In line with the previous literature, our results indicate that uninsured individuals are, on average, in worse health conditions. However, if we compare individuals within the same diagnosis category, the uninsured are actually healthier, with a lower number of chronic conditions and a lower risk of mortality. This indicates that the uninsured are admitted to the hospital only for more serious conditions. In addition, our results show that uninsured individuals consume less health care. In particular, conditional on being admitted to a hospital and controlling for health conditions, the uninsured have lower total charges, fewer procedures, and a higher mortality rate.
Collapse
Affiliation(s)
- Marco A. Castaneda
- Department of Social Sciences, The University of Texas at Tyler, 3900 University Blvd, Tyler, TX 75799 USA
| | - Meryem Saygili
- Department of Social Sciences, The University of Texas at Tyler, 3900 University Blvd, Tyler, TX 75799 USA
| |
Collapse
|
34
|
Li J, Green M, Kearns B, Holding E, Smith C, Haywood A, Cooper C, Strong M, Relton C. Patterns of multimorbidity and their association with health outcomes within Yorkshire, England: baseline results from the Yorkshire Health Study. BMC Public Health 2016; 16:649. [PMID: 27464646 PMCID: PMC4964308 DOI: 10.1186/s12889-016-3335-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Accepted: 07/21/2016] [Indexed: 11/25/2022] Open
Abstract
Background Multimorbidity is increasingly being recognized as a serious public health concern. Research into its determinants, prevalence, and management is needed and as the risk of experiencing multiple chronic conditions increases over time, attention should be given to investigating the development of multimorbidity through prospective cohort design studies. Here we examine the baseline patterns of multimorbidity and their association with health outcomes for residents in Yorkshire, England using data from the Yorkshire Health Study. Methods Baseline data from the Yorkshire Health Study (YHS) was collected from 27,806 patients recruited between 2010 and 2012. A two-stage sampling strategy was implemented which first involved recruiting 43 general practice surgeries and then having them consent to mailing invitations to their patients to complete postal or online questionnaires. The questionnaire collected information on chronic health conditions, demographics, health-related behaviours, healthcare and medication usage, and a range of other health related variables. Descriptive statistics (chi-square and t tests) were used to examine associations between these variables and multimorbidity. Results In the YHS cohort, 10,332 participants (37.2 %) reported having at least two or more long-term health conditions (multimorbidity). Older age, BMI and deprivation were all positively associated with multimorbidity. Nearly half (45.7 %) of participants from the most deprived areas experienced multimorbidity. Based on the weighted sample, average health-related quality of life decreased with the number of health conditions reported; the mean EQ-5D score for participants with no conditions was 0.945 compared to 0.355 for participants with five or more. The mean number of medications used for those without multimorbidity was 1.81 (range 1-13, SD = 1.25) compared to 3.81 (range 1-14, SD = 2.44) for those with at least two long-term conditions and 7.47 (range 1-37, SD = 7.47) for those with 5+ conditions. Conclusion Patterns of multimorbidity within the Yorkshire Health Study support research on multimorbidity within previous observational cross-sectional studies. The YHS provides both a facility for participant recruitment to intervention trials, and a large population-based longitudinal cohort for observational research. It is planned to continue to record chronic conditions and other health related behaviours in future waves which will be useful for examining determinants and trends in chronic disease and multimorbidity.
Collapse
Affiliation(s)
- Jessica Li
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK. .,Public Health Section, ScHARR, Regent Court, University of Sheffield, 30 Regent Street, Sheffield, S1 4DA, UK.
| | - Mark Green
- Department of Geography & Planning, University of Liverpool, Liverpool, UK
| | - Ben Kearns
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Eleanor Holding
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | | | - Annette Haywood
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Cindy Cooper
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Mark Strong
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Clare Relton
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| |
Collapse
|
35
|
Principi A, Galenkamp H, Papa R, Socci M, Suanet B, Schmidt A, Schulmann K, Golinowska S, Sowa A, Moreira A, Deeg DJH. Do predictors of volunteering in older age differ by health status? Eur J Ageing 2016; 13:91-102. [PMID: 28804374 DOI: 10.1007/s10433-016-0377-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
It has been widely recognised that poor health is one of the main barriers to participation in volunteer activities in older age. Therefore, it is crucial to examine the participation of older people in volunteering, especially those in poor health. Based on the resource theory of volunteering, the aim of this study is to better understand the correlates of volunteering among older people with different health statuses, namely those without health problems (neither multimorbidity nor disability), those with mild health problems (multimorbidity or disability), and those with severe health problems (multimorbidity and disability). Data were drawn from the fourth wave (2011-2012, release 1.1.1) of the Survey of Health, Ageing and Retirement in Europe, which includes European people aged 50 years or older. The results showed that variables linked to volunteering were generally similar regardless of health status, but some differences were nevertheless identified. For older people with mild or severe health problems, for instance, depressive symptoms were negatively associated with their involvement in volunteer activities. We found a positive association of being widowed (rather than married) with volunteering in older people with particularly poor health, whereas high income was associated with volunteering in the case of mild health problems only. These results demonstrate that variables associated with volunteer participation partially differ between older people depending on their health status. These differences should be considered by policy makers in their attempts to promote volunteering in older people, as a means of preventing their social exclusion.
Collapse
|
36
|
Ubalde-Lopez M, Delclos GL, Benavides FG, Calvo-Bonacho E, Gimeno D. Measuring multimorbidity in a working population: the effect on incident sickness absence. Int Arch Occup Environ Health 2016; 89:667-78. [PMID: 26615549 DOI: 10.1007/s00420-015-1104-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 11/03/2015] [Indexed: 11/03/2022]
Abstract
PURPOSE Multimorbidity research typically focuses on chronic and common diseases in patient and/or older populations. We propose a multidimensional multimorbidity score (MDMS) which incorporates chronic conditions, symptoms, and health behaviors for use in younger, presumably healthier, working populations. METHODS Cross-sectional study of 372,370 Spanish workers who underwent a standardized medical evaluation in 2006. We computed a MDMS (range 0-100) based on the sex-specific results of a multicorrespondence analysis (MCA). We then used Cox regression models to assess the predictive validity of this MDMS on incident sickness absence (SA) episodes. RESULTS Two dimensions in the MCA explained about 80% of the variability in both sexes: (1) chronic cardiovascular conditions and health behaviors, and (2) pain symptoms, in addition to sleep disturbances in women. More men than women had at least one condition (40 vs 15%) and two or more (i.e., multimorbidity) (12 vs 2%). The MDMS among those with multimorbidity ranged from 16.8 (SD 2.4) to 51.7 (SD 9.9) in men and 18.5 (SD 5.8) to 43.8 (SD 7.8) in women. We found that the greater the number of health conditions, the higher the risk of SA. A higher MDMS was also a risk factor for incident SA, even after adjusting for prior SA and other covariates. In women, this trend was less evident. CONCLUSIONS A score incorporating chronic health conditions, behaviors, and symptoms provides a more holistic approach to multimorbidity and may be useful for defining health status in working populations and for predicting key occupational outcomes.
Collapse
|
37
|
Rosales-Rueda MF. Family investment responses to childhood health conditions: intrafamily allocation of resources. J Health Econ 2014; 37:41-57. [PMID: 25063956 DOI: 10.1016/j.jhealeco.2014.05.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Revised: 04/22/2014] [Accepted: 05/09/2014] [Indexed: 06/03/2023]
Abstract
The onset of a health condition during childhood impairs skill formation. A number of studies have investigated the long-lasting effects of poor health during childhood on later-in-life outcomes. However, this evidence ignores how parents respond to the onset of health conditions. Do their investments reinforce the health condition? Or compensate, or behave neutrally? If parents change their investments, the relationship between early health and later outcomes combines the biological effect and the investment responses. To address this question, I use within-sibling variation in the incidence of health conditions to control for selection from unobserved household heterogeneity. Parents invest, on average, 0.16 standard deviations less in children with mental conditions relative to their healthy siblings, using a measure of investment that includes time and resources. On the contrary, when children have a physical condition, parental investments do not differ across siblings. Results are robust to alternative measures of health conditions and the inclusion of child fixed effects.
Collapse
|
38
|
Abstract
This study expands upon previous research by utilizing nationally representative data and multivariate analyses to examine the relationship between an adolescent's disability status and their likelihood of engaging in a spectrum of delinquent behaviors through age 16. Logistic regression models of 7,232 adolescents from the National Longitudinal Survey of Youth 1997 are used to investigate the association between the presence of a learning disability or emotional condition, chronic health condition, sensory condition, physical disability, or multiple conditions and ten delinquent acts, including violence-related delinquency, property crimes, drug offenses, and arrest. Additional analyses explore differences in delinquency prevalence by more specific types of limiting conditions. Results indicate that adolescents with learning disabilities or emotional conditions are particularly at risk of committing delinquent acts. Findings suggest that disability status is important to consider when examining adolescent delinquency; however, not all youth with disabilities have equal experiences.
Collapse
Affiliation(s)
- Carrie L. Shandra
- Department of Sociology, Hofstra University, Hempstead, NY 11549, USA
| | - Dennis P. Hogan
- Department of Sociology/Population Studies and Training Center, Brown University, Providence, RI 02912, USA
| |
Collapse
|