scholarly journals High-level psychotropic polypharmacy: a retrospective comparison of children in foster care to their peers on Medicaid

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Deborah Winders Davis ◽  
W. David Lohr ◽  
Yana Feygin ◽  
Liza Creel ◽  
Kahir Jawad ◽  
...  
Keyword(s):  
Foster Care ◽  
Low Income ◽  
Secondary Analysis ◽  
The United States ◽  
Prescribing Patterns ◽  
Cross Sectional ◽  
Children In Foster Care ◽  
Metabolic Monitoring ◽  
Concurrent Use ◽  
High Level

Abstract Background The use of antipsychotic medication and psychotropic polypharmacy has increased in the United States over the last two decades especially for children from low-income families and those in foster care. Although attention has been paid to providing greater insight, prescribing patterns remain concerning since there is a lack of evidence related to safety and efficacy. High-level psychotropic polypharmacy has not been described. We aim to compare the use of HLPP for children receiving Medicaid services and those in foster care and identify factors associated with the duration of use of high-level psychotropic polypharmacy. Additionally, we will examine the frequency of laboratory metabolic screening and emergency department, inpatient, and outpatient visits. Methods A cross-sectional, secondary analysis of statewide data describes trends in high-level psychotropic polypharmacy from 2012 to 2017 and the prevalence and predictors of high-level psychotropic polypharmacy duration and resource use in 2017 for all children on Medicaid and those in foster care. High-level psychotropic polypharmacy included concurrent use, at least four classes of medications including an antipsychotic, and at least 30 days duration. Results High-level psychotropic polypharmacy increased from 2012 to 2014 for both groups but stabilized in 2015–2016. Children in foster care showed a slight increase compared to their peers in 2017. There was no association between duration and demographic characteristics or foster care status. Diagnoses predicted duration. Neither group received metabolic monitoring at an acceptable rate. Conclusions Concerning patterns of high-level psychotropic polypharmacy and metabolic monitoring were identified. Cautious use of high-level psychotropic polypharmacy and greater oversight to ensure that these children are receiving comprehensive services like behavioral health, primary care, and primary prevention.

Sense of clubhouse community belonging and empowerment

2018 ◽  
Vol 64 (3) ◽  
pp. 276-285 ◽  
Author(s):  
Kimiko Tanaka ◽  
Larry Davidson ◽  
Thomas J Craig
Keyword(s):  
Mental Health ◽  
Sense Of Community ◽  
Secondary Analysis ◽  
The United States ◽  
Structured Interview ◽  
Self Report ◽  
Hierarchical Regression ◽  
Future Research ◽  
Cross Sectional ◽  
Community Belonging

Background: While the neighborhood community literature well documents a link between participation in supportive and effective community groups or activities and empowerment, there is as yet little empirical evidence of this relationship in the context of community mental health programs. Aim: The primary purpose of the study was to examine the relationship between sense of community belonging and empowerment among members of mental health clubhouses. Methods: A secondary analysis using a hierarchical regression model was conducted on cross-sectional structured interview data collected through a self-report questionnaire from 102 clubhouse members from six clubhouses in the United States and Finland. Results: The results indicated that members’ sense of clubhouse community belonging positively contributes to their empowerment. Conclusion: Fostering sense of community belonging appears to be a valid approach to catalyze empowerment. Study limitations and future research agendas were discussed.

Assessing the Health Status of Children Entering Foster Care

PEDIATRICS ◽  
1994 ◽  
Vol 93 (4) ◽  
pp. 594-601 ◽  
Author(s):  
Robin Chernoff ◽  
Terri Combs-Orme ◽  
Christina Risley-Curtiss ◽  
Alice Heisler
Keyword(s):  
Mental Health ◽  
Foster Care ◽  
Care Delivery ◽  
Cross Sectional ◽  
Children In Foster Care ◽  
High Prevalence ◽  
Complete Health ◽  
History Of ◽  
Short Time

Objective. Most research on health problems of children in foster care has been cross-sectional, resulting in overselection of children who have been in care long-term and underrepresentation of children who are in care for a short time. Methodology. This paper reports on the health of a large cohort of children who had complete health examinations at the time of entry into foster care in a middle-size city during a 2-year period. Results. Results indicate that >90% of the children had an abnormality in atleast one body system, 25% failed the vision screen, and 15% failed the hearing screen. The children were also lighter and shorter than the norm. Mental health screening revealed that 75% had a family history of mental illness or drug or alcohol abuse. Of children older than 3 years of age, 15% admitted to or were suspect for suicidal ideation and 7% for homicidal ideation. Of the children younger than 5 years of age, 23% had abnormal or suspect results on developmental screening examinations. At the time of entry into foster care, 12% of the children required an antibiotic. More than half needed urgent or nonurgent referrals for medical services and, for children >3 years of age, more than half needed urgent or nonurgent referrals for dental and mental health services. Just 12% of the children required only routine follow-up care. Conclusions. The high prevalence and broad range of health needs of children at the time they enter foster care necessitate the design and implementation of better models of health care delivery for children in foster care.

Physician Prescribing Patterns of Innovative Antidepressants in the United States: The Case of MDD Patients 1993–2007

2011 ◽  
Vol 42 (4) ◽  
pp. 353-368 ◽  
Author(s):  
Hsien-Chang Lin ◽  
Steven R. Erickson ◽  
Rajesh Balkrishnan
Keyword(s):  
Logistic Regression ◽  
Multinomial Logistic Regression ◽  
Private Insurance ◽  
Selection Procedure ◽  
The United States ◽  
Prescribing Patterns ◽  
Insurance Status ◽  
Cross Sectional ◽  
Physician Practices ◽  
Sociological Factors

Objective: Innovative antidepressants such as SSRIs and SNRIs have been widely adopted. However, the differences in their adoption across patients' and physicians' characteristics, geographic regions, and insurance status need to be further explored. This study was trying to disentangle the patterns of physician antidepressant prescribing and medication choice for major depressive disorder treatment. Method: A retrospective cross-sectional study was conducted using the 1993–2007 National Ambulatory Medical Care Survey database. A multinomial logistic regression with the Heckman two-step selection procedure was applied to capture the two-step nature of physician prescription decision making. Results: The weighted logistic regression indicated that patients' race/ethnicity and primary source of payment for services, physician ownership status, and physicians' practice regions were associated with differential likelihood of physician' antidepressant prescribing. Non-Hispanic white patients were more likely to be prescribed antidepressants compared to Hispanic patients (OR=1.52, 95% CI 1.24–1.87). Physicians' choice on antidepressant varied across with patient age and health insurance status. Compared to private insurance, patients who were primarily covered by Medicare were less likely to be prescribed only SSRIs/SNRIs or other newer antidepressants (RRRs=0.42 and 0.39; 95% CIs 0.21–0.83 and 0.18–0.84, respectively). Conclusions: We observed strong associations between sociological factors and physicians' antidepressant prescribing patterns. Possible health disparities and gaps between optimal and suboptimal healthcare for patient mental health caused by systematic differences in sociological factors need to be mitigated. We need policy makers to design effective policy interventions to improve physician practice guidelines adherence to eliminate possible variations among physician practices.

scholarly journals Birth weight and childhood obesity: effect modification by residence and household wealth

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Helen Andriani
Keyword(s):  
Birth Weight ◽  
Childhood Obesity ◽  
Rural Area ◽  
Low Income ◽  
Secondary Analysis ◽  
Household Wealth ◽  
Z Score ◽  
Cross Sectional ◽  
Effective Prevention ◽  
Nationally Representative

Abstract Background There are both genetic and environmental factors which contribute to a child’s chances of being obese. When low birth weight (LBW) has been specifically evaluated relative to its association with childhood obesity, the results have produced conflicting findings. This study aims to describe the relationship between birth weight and childhood obesity and investigate the influence that residence and household wealth has on this relationship. Methods I performed a secondary analysis on the 2013 Riskesdas (or Basic Health Research), a cross-sectional, nationally representative survey of the Indonesian population. Height, weight, information regarding child’s birth weight, and basic characteristics of the study population were collected from parents with children aged 0 to 5 years (n = 63,237) in 2013. The exposure was child’s birth weight and the outcomes were child’s current weight, BMI z-score, and obesity. Data were analyzed by using multiple linear regression and multiple logistic regression. Results I found a significant increase in the weight, BMI z-score, and risk of childhood obesity to be associated with LBW. LBW children in rural area were associated with higher BMI z-score (mean ± standard error: 1.44 ± 0.02) and higher odds (odds ratio (95% confidence interval): 7.46 (6.77–8.23)) of obesity than those in urban area. LBW children from low class families were associated with higher BMI z-score (1.79 ± 0.04) and had higher odds (14.79 (12.47–17.54)) of obesity than those from middle class and wealthy families. Conclusions Effective prevention and intervention to childhood obesity as early as possible are imperative. As far as this study was concerned, efforts, policies, and targets are required to reduce the prevalence of LBW. Children born of LBW, who live in a rural area and from low income families, should be emphatically intervened as early as possible.

scholarly journals Differences in Health Behavior Profiles of Adolescents in Urban and Rural Areas in a Korean City

Healthcare ◽  
2021 ◽  
Vol 9 (3) ◽  
pp. 282
Author(s):  
Myungah Chae ◽  
Kihye Han
Keyword(s):  
Health Behavior ◽  
Rural Areas ◽  
Fast Food ◽  
Latent Class ◽  
Secondary Analysis ◽  
Risk Groups ◽  
Rural Students ◽  
Cross Sectional ◽  
Urban And Rural Areas ◽  
High Level

Through a latent class analysis approach, we can classify individuals and identify subgroups according to health behavior patterns, and find evidence for the development of customized intervention programs to target high-risk groups. Our study aimed to explore differences in latent classes of health behaviors in adolescents by region (urban vs. rural areas) in a Korean city. This cross-sectional secondary analysis utilized data collected from all first graders’ student health checkups in middle school and high school in a city of the largest island in Korea in 2016 (n = 1807). Health behavior indicators included both healthy (consuming breakfast regularly, consuming vegetables daily, consuming milk daily, consuming fast food on a limited basis, engaging in vigorous physical activities, brushing teeth, and practicing hand hygiene) and unhealthy (drinking, smoking, and overusing the internet) behaviors. Nutritional and diet behaviors were important factors for classifying healthy and unhealthy adolescents in both regions. Approximately 11% of rural students belonged to the risky group, which was characterized by a high level of drinking alcohol and smoking. These results suggest that when developing health policies for adolescents, customized policy-making and education based on the targeted groups’ behavioral patterns could be more effective than a uniform approach.

School Hopscotch: A Comprehensive Review of K–12 Student Mobility in the United States

2016 ◽  
Vol 87 (3) ◽  
pp. 475-511 ◽  
Author(s):  
Richard O. Welsh
Keyword(s):  
United States ◽  
Low Income ◽  
Negative Impact ◽  
Student Mobility ◽  
The United States ◽  
Policy Implications ◽  
Cross Sectional ◽  
Transition Costs ◽  
K 12 ◽  
Changing Schools

This article provides an integrative review of the extant literature on K–12 student mobility in the United States. Student mobility is a widespread phenomenon with significant policy implications. Changing schools is most prevalent among minority and low-income students in urban school districts. There is an ongoing debate about whether student mobility is helpful or harmful. Earlier research compared movers with nonmovers using cross-sectional data and did not always include controls for the students’ prior achievement and demographic characteristics. Studies in the past decade compared movers with themselves over time using longitudinal data and provided more convincing estimates. Overall, switching schools is associated with a negative impact on students’ educational outcomes; however, transferring to higher quality schools may offset and outweigh the transition costs of moving. Strong causal claims are elusive due to considerable data and methodological challenges and the inability to account for the motivating reasons for changing schools.

scholarly journals Insufficient Vitamin C Levels among Adults in the United States: Results from the NHANES Surveys, 2003–2006

Nutrients ◽  
2021 ◽  
Vol 13 (11) ◽  
pp. 3910
Author(s):  
Jennifer Crook ◽  
Ann Horgas ◽  
Saun-Joo Yoon ◽  
Oliver Grundmann ◽  
Versie Johnson-Mallard
Keyword(s):  
United States ◽  
At Risk ◽  
Vitamin C ◽  
Mexican Americans ◽  
Secondary Analysis ◽  
Health Impact ◽  
The United States ◽  
Plasma Vitamin ◽  
Cross Sectional ◽  
Key Factor

Vitamin C, well-established in immune function and a key factor in epigenetic inflammatory modifications, is only obtained through consistent dietary intake. Identifying individuals at risk for Vitamin C insufficiency may guide prevention and treatment, however, national surveillance has not been evaluated in the United States since 2006. A descriptive, cross-sectional secondary analysis was performed utilizing data from the 2003–2006 National Health and Nutrition Examination Surveys (NHANES) assessing non-institutionalized adults. Five categories of plasma Vitamin C were delineated: deficiency (<11 μmol/L), hypovitaminosis (11–23 μmol/L), inadequate (23–49 μmol/L), adequate (50–69 μmol/L), and saturating (≥70 μmol/L). Results indicated 41.8% of the population possessed insufficient levels (deficiency, hypovitaminosis, and inadequate) of Vitamin C. Males, adults aged 20–59, Black and Mexican Americans, smokers, individuals with increased BMI, middle and high poverty to income ratio and food insecurity were significantly associated with insufficient Vitamin C plasma levels. Plasma Vitamin C levels reveal a large proportion of the population still at risk for inflammatory driven disease with little to no symptoms of Vitamin C hypovitaminosis. Recognition and regulation of the health impact of Vitamin C support the goal of Nutrition and Healthy Eating as part of the Healthy People 2030.

scholarly journals Income-based inequalities in self-reported moderate-to-vigorous physical activity among adolescents in England and the United States: a cross-sectional study

2020 ◽  
Author(s):  
Shaun Scholes ◽  
Jennifer S Mindell
Keyword(s):  
Physical Activity ◽  
Low Income ◽  
Vigorous Physical Activity ◽  
The United States ◽  
Cross Sectional Study ◽  
High Income ◽  
Sectional Study ◽  
Cross Sectional ◽  
The Us ◽  
Low Income Households

Objective: Quantify inequalities in self-reported moderate-to-vigorous physical activity (MVPA) in England and the United States (US). Design: Population-based cross-sectional study. Participants: 4019 adolescents aged 11-15 years in England (Health Survey for England 2008, 2012, 2015) and 4312 aged 12-17 years in the US (National Health and Nutrition Examination Survey 2007-16). Main outcome measures: Three aspects of MVPA: (1) doing any, (2) average min/day (MVPA: including those who did none), and (3) average min/day conditional on participation (MVPA-active). Using hurdle models, we quantified inequalities (average marginal effects: AMEs) using the absolute difference in marginal means. Results: In England, adolescents in high-income households were more likely than those in low-income households to have done any formal sports/exercise in the last seven days (boys: 11%; 95% CI: 4% to 17%; girls: 13%; 95% CI: 6% to 20%); girls in high-income households did more than their low-income counterparts (MVPA: 6 min/day, 95% CI: 2 to 9). Girls in low-income households spent more time in informal activities than girls in high-income households (MVPA: 21 min/day; 95% CI: 10 to 33), whilst boys in low-income versus high-income households spent longer in active travel (MVPA: 21 min/week; 95% CI: 8 to 34). In the US, in a typical week, recreational activity was greater among high-income versus low-income households (boys: 15 min/day; 95% CI: 6 to 24 min/day; girls: 19 min/day; 95% CI: 12 to 27). In contrast, adolescents in low-income versus high-income households were more likely to travel actively (boys: 11%; 95% CI: 3% to 19%; girls: 10%; 95% CI: 3% to 17%) and do more. Conclusions: Policy actions and interventions are required to increase MVPA across all income groups in England and the US. Differences in formal sports/exercise (England) and recreational (US) activities suggest that additional efforts are required to reduce inequalities.

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