1
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Feng Q, Che Y, Yi S, Wang Y, Chen W, Xia X. Analysis of medical impoverishment and its influencing factors among China's rural near-poor, 2016-2020. Front Public Health 2024; 12:1412536. [PMID: 38818447 PMCID: PMC11137257 DOI: 10.3389/fpubh.2024.1412536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 04/30/2024] [Indexed: 06/01/2024] Open
Abstract
Objective This study investigates the determinants of medical impoverishment among China's rural near-poor, aiming to enhance public health services and establish preventative and monitoring systems. Methods Using China Family Panel Studies and World Bank methods, we categorized rural populations and calculated their 2020 Poverty Incidence (PI) and Poverty Gap (PG), with impoverishing health expenditures (IHE) as the primary indicator. We analyzed the data from 2016 to 2020 using a conditional fixed-effects multinomial logit model and 2020 logistic regression to identify factors influencing medical impoverishment risk. Results (1) In 2020, the near-poor in China faced a PI of 16.65% post-health expenditures, 8.63 times greater than the non-poor's PI of 1.93%. The near-poor's Average Poverty Gap (APG) was CNY 1,920.67, notably surpassing the non-poor's figure of CNY 485.58. Health expenses disproportionately affected low-income groups, with the near-poor more prone to medical impoverishment. (2) Disparities in medical impoverishment between different economic household statuses were significant (P < 0.001), with the near-poor being particularly vulnerable. (3) For rural near-poor households in China, those with over six members faced a lower risk of medical impoverishment compared to those with three or fewer. Unmarried individuals had a 7.1% reduced risk of medical impoverishment relative to married/cohabiting counterparts. Unemployment was associated with a 9% increased risk. A better self-rated health status was linked to a lower probability of IHE, with the "very healthy" reporting a 25.8% lower risk than those "unhealthy." Chronic disease sufferers in the near-poor and non-poor categories were at an increased risk of 12 and 1.4%, respectively. Other surveyed factors, including migrant status, age, insurance type, gender, educational level, and recent smoking or drinking, were not statistically significant (P > 0.05). Conclusion Rural near-poor in China are much more susceptible to medical impoverishment, influenced by specific socio-economic factors. The findings advocate for policy enhancements and health system reforms to mitigate health poverty. Further research should extend to urban areas for comprehensive health poverty strategy development.
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Affiliation(s)
- Qiwei Feng
- School of Humanities and Management, Hunan University of Chinese Medicine, Changsha, Hunan, China
| | - Yi Che
- School of Humanities and Management, Hunan University of Chinese Medicine, Changsha, Hunan, China
| | - Shuying Yi
- School of Humanities and Management, Hunan University of Chinese Medicine, Changsha, Hunan, China
| | - Ying Wang
- School of Humanities and Management, Hunan University of Chinese Medicine, Changsha, Hunan, China
| | - Wen Chen
- Key Laboratory of Vascular Biology and Translational Medicine, Medical School, Hunan University of Chinese Medicine, Changsha, China
| | - Xinbin Xia
- School of Humanities and Management, Hunan University of Chinese Medicine, Changsha, Hunan, China
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2
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Fuji KT, White ND, Packard KA, Kalkowski JC, Walters RW. Effect of a Financial Education and Coaching Program for Low-Income, Single Mother Households on Child Health Outcomes. Healthcare (Basel) 2024; 12:127. [PMID: 38255016 PMCID: PMC10815544 DOI: 10.3390/healthcare12020127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 12/23/2023] [Accepted: 01/03/2024] [Indexed: 01/24/2024] Open
Abstract
The financial difficulties of parents have a negative impact on the health of their children. This problem is more pronounced in single mother families. There is limited research on low-income, single mothers and how interventions to help them address financial difficulties may also benefit their children. The purpose of this study was to evaluate the effect of a year-long financial education and coaching program on school absenteeism and health care utilization of children in employed, low-income, single mother households. This was a post hoc analysis of the Finances First study, a randomized controlled trial conducted in 2017-2020 examining the impact of a financial coaching and education program on economic stability and health outcomes in 345 low-income, single mothers. Either generalized estimating equations (GEEs) or generalized linear mixed models (GLMMs) were used to account for relationships between participants. For the continuous outcomes of child absenteeism, physician visits, emergency room visits, and hospitalization days, a linear mixed-effects model was used. The Finances First study demonstrated improvements in various financial strain measures. Compared to the control group, children of intervention group participants experienced 1 fewer day of school absence (p = 0.049) and 1 fewer physician visit (p = 0.032) per year, but no impact was seen on emergency room visits (p = 0.55) or hospitalizations (p = 0.92). Addressing social determinants of health in parents is necessary for improving child health outcomes.
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Affiliation(s)
- Kevin T. Fuji
- Department of Pharmacy Sciences, School of Pharmacy and Health Professions, Creighton University, Omaha, NE 68178, USA
| | - Nicole D. White
- Department of Pharmacy Practice, School of Pharmacy and Health Professions, Creighton University, Omaha, NE 68178, USA
| | - Kathleen A. Packard
- Department of Pharmacy Practice, School of Pharmacy and Health Professions, Creighton University, Omaha, NE 68178, USA
| | - Julie C. Kalkowski
- Financial Hope Collaborative, Heider College of Business, Creighton University, Omaha, NE 68178, USA
| | - Ryan W. Walters
- Department of Clinical Research and Public Health, School of Medicine, Creighton University, Omaha, NE 68178, USA
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3
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Birkenmaier J, Jung E, McMillin S, Qian Z. Are credit scores and financial well-being associated with physical health? SOCIAL WORK IN HEALTH CARE 2023; 62:162-178. [PMID: 37120849 DOI: 10.1080/00981389.2023.2207614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 11/03/2022] [Accepted: 04/21/2023] [Indexed: 05/30/2023]
Abstract
Consumer credit score has been used as an indicator of financial strain that could potentially impact health. Subjective financial well-being, or one's feelings about one's expectations, preferences, and satisfaction with their financial situation, is related to financial strain. This study examined whether subjective financial well-being mediates the association between credit score and self-reported physical health in a national representative sample. Using structural equation modeling (SEM), we test whether a mediating association exists between self-rated credit score and self-rated physical health. Results suggest that, after controlling for sociodemographic variables, those who reported higher credit scores have better health (β = 0.175, p < .001) and higher financial well-being (β = 0.469, p < .001), and those who reported higher financial well-being have better health (β = 0.265, p < .001). The mediation effect of financial well-being on the association between credit and physical health is also positive and statistically significant (β = 0.299, p < .001). Thus, subjective feelings about one's financial situation would enhance the observed positive association between credit and health. Practice and policy implications are included.
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Affiliation(s)
- Julie Birkenmaier
- School of Social Work, Saint Louis University, St Louis, Missouri, USA
| | - Euijin Jung
- Refugee Behavioral Health Postdoctoral Fellow, Research Program on Children and Adversity, Boston College School of Social Work, Chestnut Hill, Massachusetts, USA
| | - Stephen McMillin
- School of Social Work, Saint Louis University, St Louis, Missouri, USA
| | - Zhengmin Qian
- College for Public Health and Social Justice, Saint Louis University, Saint Louis, Missouri, USA
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4
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Schickedanz A, Perales L, Holguin M, Rhone-Collins M, Robinson H, Tehrani N, Smith L, Chung PJ, Szilagyi PG. Clinic-Based Financial Coaching and Missed Pediatric Preventive Care: A Randomized Trial. Pediatrics 2023; 151:190619. [PMID: 36727274 DOI: 10.1542/peds.2021-054970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/10/2022] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVES Poverty is a common root cause of poor health and disrupts medical care. Clinically embedded antipoverty programs that address financial stressors may prevent missed visits and improve show rates. This pilot study evaluated the impact of clinic-based financial coaching on adherence to recommended preventive care pediatric visits and vaccinations in the first 6 months of life. METHODS In this community-partnered randomized controlled trial comparing clinic-based financial coaching to usual care among low-income parent-infant dyads attending pediatric preventive care visits, we examined the impact of the longitudinal financial intervention delivered by trained coaches addressing parent-identified, strengths-based financial goals (employment, savings, public benefits enrollment, etc.). We also examined social needs screening and resource referral on rates of missed preventive care pediatric visits and vaccinations through the 6-month well-child visit. RESULTS Eighty-one parent-infant dyads were randomized (35 intervention, 46 control); nearly all parents were mothers and more than one-half were Latina. The rate of missed visits among those randomized to clinic-based financial coaching was half that of controls (0.46 vs 1.07 missed of 4 recommended visits; mean difference, 0.61 visits missed; P = .01). Intervention participants were more likely to have up-to-date immunizations each visit (relative risk, 1.26; P = .01) with fewer missed vaccinations by the end of the 6-month preventive care visit period (2.52 vs 3.8 missed vaccinations; P = .002). CONCLUSIONS In this pilot randomized trial, a medical-financial partnership embedding financial coaching within pediatric primary care improved low-income families' adherence to recommended visits and vaccinations. Clinic-based financial coaching may improve care continuity and quality in the medical home.
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Affiliation(s)
- Adam Schickedanz
- Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Lorraine Perales
- Department of Social Welfare, UCLA Luskin School of Public Affairs, Los Angeles, California
| | - Monique Holguin
- Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, California.,USC Suzanne Dworak-Peck School of Social Work, Los Angeles, California
| | | | | | - Niloufar Tehrani
- Department of Pediatrics, Harbor-UCLA Medical Center, Torrance, California
| | - Lynne Smith
- Department of Pediatrics, Harbor-UCLA Medical Center, Torrance, California
| | - Paul J Chung
- Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, California.,Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
| | - Peter G Szilagyi
- Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, California
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5
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Earnest M, Wong SL, Federico S, Cervantes L. A Model of Advocacy to Inform Action. J Gen Intern Med 2023; 38:208-212. [PMID: 36323827 PMCID: PMC9629756 DOI: 10.1007/s11606-022-07866-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 10/21/2022] [Indexed: 11/06/2022]
Abstract
The need for effective advocacy on the part of health professionals has never been greater. The recent COVID-19 pandemic has made the connection between human health and social conditions clear, while highlighting the limitations of biomedical interventions to address those conditions. Efforts to increase the frequency and effectiveness of advocacy activities by health professionals have been hampered by the lack of a practical framework to define and develop advocacy competencies among trainees as well as to plan and execute advocacy activities. The authors of this article propose a framework which defines advocacy as occurring across three domains of influence (practice, community, and government) using three categories of advocacy skills (policy, communication, and relationships). When these skills are successfully applied in the appropriate domains of influence, the resulting change falls into three levels: individual, adjacent, and structural. The authors assert that this framework is immediately applicable to a broad variety of health professionals, educators, researchers, organizations, and professional societies as they individually and collectively seek to improve the health and well-being of those they care for.
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Affiliation(s)
- Mark Earnest
- Division of General Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
| | - Shale L Wong
- Department of Pediatrics, Eugene S. Farley, Jr. Health Policy Center, University of Colorado Anschutz Medical Campus, Aurora, USA
| | - Steve Federico
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, USA.,Denver Health and Hospital Authority, Denver, USA
| | - Lilia Cervantes
- Division of Hospital Medicine, University of Colorado Anschutz Medical, Aurora, USA
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6
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Bazzano AN, Sun Y, Chavez-Gray V, Akintimehin T, Gustat J, Barrera D, Roi C. Effect of Yoga and Mindfulness Intervention on Symptoms of Anxiety and Depression in Young Adolescents Attending Middle School: A Pragmatic Community-Based Cluster Randomized Controlled Trial in a Racially Diverse Urban Setting. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12076. [PMID: 36231378 PMCID: PMC9564597 DOI: 10.3390/ijerph191912076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 09/19/2022] [Accepted: 09/21/2022] [Indexed: 06/16/2023]
Abstract
Mental health conditions in childhood and adolescence are increasing in the U.S. population and require early intervention, as highlighted by a recent Surgeon General's Advisory on Protecting Youth Mental Health. These health issues, which have been exacerbated by the COVID-19 pandemic, impair functioning, and may lead to longer term reductions in quality of life. Young adolescents are likely to experience stressors including academic pressure, feelings of loneliness and isolation, and excessive exposure to social media, all of which have been made worse by the pandemic and associated disruptions. Universal preventive programs at school serve as an important strategy for equipping youth with coping skills to address current and future social and emotional challenges. Yoga and mindfulness programs have emerged as a promising preventive approach for schools and have proven feasible and acceptable. The current study evaluated a universal, school-based mindfulness and yoga program among youth aged 11-14 in a racially diverse, urban setting in the United States. Outcomes of interest included symptoms of anxiety and depression. Anxiety and depression symptoms decreased in the intervention group, although these differences were not statistically significant. In the control group, anxiety symptoms decreased but depression symptoms increased. The resulting time effect indicated a significant decrease in anxiety symptoms, while the time by group effect revealed a strong trend in depression symptoms. Future research should investigate the utility of yoga and mindfulness interventions for early adolescents in a larger population, and the differences in intervention effect among subgroups, with attention to longer term outcomes.
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Affiliation(s)
- Alessandra N. Bazzano
- Center of Excellence in Maternal Child Health, Department of Social, Behavioral and Population Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA 70112, USA
| | - Yaoyao Sun
- Institute of Mental Health, Peking University Sixth Hospital, Beijing 100191, China
| | - Vaughne Chavez-Gray
- Center of Excellence in Maternal Child Health, Department of Social, Behavioral and Population Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA 70112, USA
| | - Temitope Akintimehin
- Center of Excellence in Maternal Child Health, Department of Social, Behavioral and Population Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA 70112, USA
| | - Jeanette Gustat
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA 70112, USA
| | - Denise Barrera
- Center of Excellence in Maternal Child Health, Department of Social, Behavioral and Population Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA 70112, USA
| | - Cody Roi
- Department of Child and Adolescent Psychiatry, Louisiana State University Health Sciences Center, New Orleans, LA 70112, USA
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7
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Houtrow A, Martin AJ, Harris D, Cejas D, Hutson R, Mazloomdoost Y, Agrawal RK. Health Equity for Children and Youth With Special Health Care Needs: A Vision for the Future. Pediatrics 2022; 149:188222. [PMID: 35642875 DOI: 10.1542/peds.2021-056150f] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/04/2022] [Indexed: 11/24/2022] Open
Abstract
Health equity is a key pillar in supporting a future in which CYSHCN enjoy a full life and thrive, as envisioned by experts and community partners who gathered in 2019 and 2020 to develop the Blueprint for Change: Guiding Principles for a System of Services for Children and Youth With Special Health Care Needs and Their Families. However, a variety of contextual factors impact health outcomes across the life course and intergenerationally and must be addressed to achieve this goal. For example, poverty and discrimination, including by some health care professionals and systems, are important, modifiable root causes of poor health outcomes. There are numerous barriers to achieving health equity, including political will, lack of resources, insufficient training, and limited cross-sector collaborations. Political, cultural, societal, and environmental interventions are necessary to eliminate health disparities and achieve health equity. The entities that serve CYSHCN should be equitably designed and implemented to improve health outcomes and address health disparities. Many entities that serve CYSHCN are taking positive steps through workforce development, policy changes, community engagement, and other means. The purpose of this article is to frame health equity for CYSHCN, detail their health disparities, review barriers to health equity, provide examples of strategies to advance health equity for them, and describe a path toward the future in which all CYSHCN have a fair and just opportunity to be as healthy as possible.
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Affiliation(s)
- Amy Houtrow
- Departments of Physical Medicine Rehabilitation.,Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Alison J Martin
- Oregon Center for Children and Youth with Special Health Needs, School of Public Health, Oregon Health and Science University-Portland State University, Portland, Oregon.,Institute on Development and Disability, Oregon Health and Science University, Portland, Oregon
| | - Debbi Harris
- The Arc of the United States, Washington, District of Columbia.,Family Voices of Minnesota, St. Paul, Minnesota
| | - Diana Cejas
- Carolina Institute for Developmental Disabilities, University of North Carolina at Chapel Hill, Carrboro, North Carolina
| | - Rachel Hutson
- Title V Maternal and Child Health, Colorado Department of Public Health and Environment
| | | | - Rishi K Agrawal
- Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.,Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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8
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Schickedanz A, Szilagyi PG, Dreyer B. Child Poverty and Health in the United States: Introduction and Executive Summary. Acad Pediatr 2021; 21:S81-S85. [PMID: 34740430 DOI: 10.1016/j.acap.2021.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 09/11/2021] [Indexed: 12/28/2022]
Affiliation(s)
- Adam Schickedanz
- Department of Pediatrics, David Geffen School of Medicine at UCLA (A Schickedanz and PG Szilagyi), Los Angeles, Calif.
| | - Peter G Szilagyi
- Department of Pediatrics, David Geffen School of Medicine at UCLA (A Schickedanz and PG Szilagyi), Los Angeles, Calif
| | - Benard Dreyer
- Department of Pediatrics, NYU Grossman School of Medicine, Hassenfeld Children's Hospital, Bellevue Hospital Center (B Dreyer), New York, NY
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9
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Metzger GA, Cooper J, Lutz C, Jatana KR, Nishimura L, Deans KJ, Minneci PC, Halaweish I. The value of telemedicine for the pediatric surgery patient in the time of COVID-19 and beyond. J Pediatr Surg 2021; 56:1305-1311. [PMID: 33648729 PMCID: PMC7894074 DOI: 10.1016/j.jpedsurg.2021.02.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 01/19/2021] [Accepted: 02/08/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Prior to COVID-19, the use of telemedicine within pediatric surgery was uncommon. To curb the spread of the virus many institutions restricted non-emergent clinic appointments, resulting in an increase in telemedicine use. We examined the value of telemedicine for patients presenting to a pediatric surgery clinic before and after COVID-19 METHODS: Perspectives and the potential value of telemedicine were assessed by surveying patients or caregivers of patients being evaluated by a general pediatric surgeon in-person prior to COVID-19 and by patients or caregivers of patients who completed a telemedicine appointment with a pediatric surgical provider during the COVID-19 period. RESULTS The pre-COVID survey was completed by 57 respondents and the post-COVID survey by 123. Most respondents were white and were caregivers 31-40 years of age. Prior to COVID-19, only 26% were familiar with telemedicine, 25% reported traveling more than 100 miles and >50% traveled more than 40 miles for their appointment. More than 25% estimated additional travel costs of at least $30 and in 43% of households, at least one adult had to miss time from work. Following a telemedicine appointment during the COVID-19 period, 76% reported the care received as excellent, 86% were very satisfied with their care, 87% reported the appointment was less stressful for their child than an in-person appointment, and 57% would choose a telemedicine appointment in the future. CONCLUSION For families seeking an alternative to the in-person encounter, telemedicine can provide added value over the traditional in-person encounter by reducing the burden of travel without compromising the quality of care. Telemedicine should be viewed as a viable option for pediatric surgery patients and future research directed toward optimizing the experience for patients and providers. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Gregory A. Metzger
- The Center for Surgical Outcomes Research, Nationwide Children's Hospital, Columbus, OH, USA
| | - Jennifer Cooper
- The Center for Surgical Outcomes Research, Nationwide Children's Hospital, Columbus, OH, USA
| | - Carley Lutz
- The Center for Surgical Outcomes Research, Nationwide Children's Hospital, Columbus, OH, USA
| | - Kris R. Jatana
- Department of Pediatric Otolaryngology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Leah Nishimura
- The Center for Surgical Outcomes Research, Nationwide Children's Hospital, Columbus, OH, USA
| | - Katherine J. Deans
- Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH, USA,The Center for Surgical Outcomes Research, Nationwide Children's Hospital, Columbus, OH, USA
| | - Peter C. Minneci
- Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH, USA,The Center for Surgical Outcomes Research, Nationwide Children's Hospital, Columbus, OH, USA
| | - Ihab Halaweish
- Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH, USA.
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10
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Bentley R, Simons K, Kvelsvig A, Milne B, Blakely T. Short-run effects of poverty on asthma, ear infections and health service use: analysis of the Longitudinal Study of Australian Children. Int J Epidemiol 2021; 50:1526-1539. [PMID: 33880535 DOI: 10.1093/ije/dyab059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Many studies have reported an inferred causal association of income poverty with physical health among children; but making causal inference is challenging due to multiple potential sources of systematic error. We quantified the short-run effect of changes in household poverty status on children's health (asthma and ear infections) and service use (visits to the doctor and parent-reported hospital admissions), using a national longitudinal study of Australian children, with particular attention to potential residual confounding and selection bias due to study attrition. METHODS We use four modelling approaches differing in their capacity to reduce residual confounding (generalized linear, random effects (RE), hybrid and fixed effects (FE) regression modelling) to model the effect of income poverty (<60% of median income) on health for 10 090 children surveyed every 2nd year since 2004. For each method, we simulate the potential impact of selection bias arising due to attrition related to children's health status. RESULTS Of the 10 090 children included, 20% were in families in poverty at survey baseline (2004). Across subsequent years, ∼25% experienced intermittent and <2% persistent poverty. No substantial associations between poverty and child physical health and service use were observed in the FE models least prone to residual confounding [odds ratio (OR) 0.94, 95% confidence interval (CI) 0.81-1.10 for wheeze], in contrast to RE models that were positive (consistent with previous studies). Selection bias causing null findings was unlikely. CONCLUSIONS While poverty has deleterious causal effects on children's socio-behavioural and educational outcomes, we find little evidence of a short-run causal effect of poverty on asthma, ear infections and health service use in Australia.
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Affiliation(s)
- Rebecca Bentley
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Koen Simons
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Amanda Kvelsvig
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Barry Milne
- Department of Statistics, University of Auckland, Auckland, New Zealand
| | - Tony Blakely
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
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11
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Pinto AD, Da Ponte M, Bondy M, Craig-Neil A, Murphy K, Ahmed S, Nair P, Swartz A, Green S. Addressing financial strain through a peer-to-peer intervention in primary care. Fam Pract 2020; 37:815-820. [PMID: 32537646 DOI: 10.1093/fampra/cmaa046] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Financial strain is a key social determinant of health. As primary care organizations begin to explore ways to address social determinants, peer-to-peer interventions hold promise. OBJECTIVE Our objective was to evaluate a peer-to-peer intervention focussed on financial empowerment delivered in primary care, in partnership with a social enterprise. METHODS This intervention was hosted by a large primary care organization in Toronto, Canada. Participants were recruited within the organization and from local services. We organized three separate groups who met over 10 weekly in-person, facilitated sessions: millennials (age 19-29) no longer in school, precariously employed adults (age 30-55) and older adults near retirement (age 55-64). We applied principles of adult education and peer-to-peer learning. We administered surveys at intake, at exit and at 3 months after the intervention, and conducted three focus groups. RESULTS Fifty-nine people took part. At 3 months, participants had sustained higher rates of optimism about their financial situation (54% improved from baseline), their degree of control (55% improved) and stress around finances (50% improved). In focus groups, participants reported greater understanding of their finances, that they were not alone in struggling with finances, and that it was useful to meet with others. One group continued to meet for several months after the intervention. CONCLUSIONS In this study, a peer-to-peer intervention helped address a key social determinant of health, likely through reducing stigma, providing group support and creating a space to discuss solutions. Primary care can host these interventions and help engage potential participants.
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Affiliation(s)
- Andrew D Pinto
- The Upstream Lab, MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.,Department of Family and Community Medicine, St. Michael's Hospital, Toronto, ON, Canada.,Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,University of Toronto Practice-Based Research Network (UTOPIAN), Toronto, ON, Canada
| | - Monica Da Ponte
- Strive, Toronto, ON, Canada.,Shift & Build, Toronto, ON, Canada
| | - Madeleine Bondy
- The Upstream Lab, MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.,Undergraduate Medical Education, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Amy Craig-Neil
- The Upstream Lab, MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | | | - Suhal Ahmed
- Shelter, Support, and Housing Administration, City of Toronto, ON, Canada
| | | | - Alyssa Swartz
- Department of Family and Community Medicine, St. Michael's Hospital, Toronto, ON, Canada
| | - Samantha Green
- Department of Family and Community Medicine, St. Michael's Hospital, Toronto, ON, Canada.,Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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12
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Houtrow AJ, Carle A, Perrin JM, Stein REK. Children With Special Health Care Needs on Supplemental Security Income for Disability Have More Health Impacts and Needs Than Other Children With Special Health Care Needs on Medicaid. Acad Pediatr 2020; 20:258-266. [PMID: 31698084 DOI: 10.1016/j.acap.2019.10.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 10/06/2019] [Accepted: 10/26/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The Supplemental Security Income (SSI) program for children with disabilities has come under recent public and political scrutiny. We sought to determine if children with special health care needs (CSHCN) on Medicaid/SCHIP who receive SSI for disability were more severely impacted by their health conditions compared to other CSHCN on Medicaid/SCHIP by comparing their health service utilization, markers of quality health care, and family impacts. METHODS Using the 2009/2010 National Survey of CSHCN, we divided the population of CSHCN on Medicaid/SCHIP into 2 groups: CSHCN on SSI for disability and other CSHCN. We compared these 2 groups on measures of health condition severity, health service need and unmet need, health system quality measures, and family impact. RESULTS CSHCN on SSI had significantly higher adjusted odds of being affected by their health conditions, aOR = 4.33 (3.33-5.9) and having 2 or more functional difficulties, AOR = 3.38 (2.83-4.03). CSHCN on SSI had significantly higher health care needs but not higher unmet needs. The families of CSHCN on SSI experienced more work loss, aOR = 3.01 (2.52-3.59) and more financial problems, aOR = 1.68 (1.38-2.04). CONCLUSION This study indicates higher severity and extensive health service needs among CSHCN receiving SSI, compared to other low income children. CSHCN receiving SSI experience substantially more difficulty related to their health conditions and their conditions have considerably more impact on the daily lives of their parents.
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Affiliation(s)
- Amy J Houtrow
- Departments of Physical Medicine and Rehabilitation and Pediatrics, University of Pittsburgh (AJ Houtrow), Pittsburgh, Pa.
| | - Adam Carle
- Departments of Pediatrics and Psychology, University of Cincinnati (A Carle), Cincinnati, Ohio
| | - James M Perrin
- Department of Pediatrics, Harvard Medical School and MassGeneral Hospital for Children (JM Perrin), Boston, Mass
| | - Ruth E K Stein
- Department of Pediatrics, Albert Einstein College of Medicine/Children's Hospital at Montefiore (REK Stein), New York, NY
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13
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Bell ON, Hole MK, Johnson K, Marcil LE, Solomon BS, Schickedanz A. Medical-Financial Partnerships: Cross-Sector Collaborations Between Medical and Financial Services to Improve Health. Acad Pediatr 2020; 20:166-174. [PMID: 31618676 PMCID: PMC7331932 DOI: 10.1016/j.acap.2019.10.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 09/04/2019] [Accepted: 10/01/2019] [Indexed: 12/29/2022]
Abstract
Financial stress is the root cause of many adverse health outcomes among poor and low-income children and their families, yet few clinical interventions have been developed to improve health by directly addressing patient and family finances. Medical-Financial Partnerships (MFPs) are novel cross-sector collaborations in which health care systems and financial service organizations work collaboratively to improve health by reducing patient financial stress, primarily in low-income communities. Financial services provided by MFPs include individually tailored financial coaching, free tax preparation, budgeting, debt reduction, savings support, and job assistance, among others. MFPs have been shown to improve finances and, in the few existing studies available, health outcomes. We describe the rationale for MFPs and examine 8 established MFPs providing financial services under 1 of 3 models: full-scope on-site service partnerships; targeted on-site service partnerships; and partnerships facilitating referral to off-site financial services. The services MFPs provide complement clinical social risk screening and navigation programs by preventing or repairing common financial problems that would otherwise lead to poverty-related social needs, such as food and housing insecurity. We identify common themes, as well as unique strengths and solutions to a variety of implementation challenges MFPs commonly encounter. Given that the financial circumstances and health outcomes of socially marginalized patients and families are closely linked, MFPs represent a promising and feasible cross-sector service delivery approach and a new model for upstream health care to promote synergistic financial well-being and health improvement.
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Affiliation(s)
- Orly N Bell
- David Geffen School of Medicine at UCLA (ON Bell), Los Angeles, Calif.
| | - Michael K Hole
- Department of Pediatrics, Dell Medical School, The University of Texas at Austin (MK Hole), Austin, Tex
| | - Karl Johnson
- Krieger School of Arts and Sciences, Johns Hopkins University (K Johnson), Baltimore, Md
| | - Lucy E Marcil
- Department of Pediatrics, Boston University School of Medicine (LE Marcil), Boston, Mass
| | - Barry S Solomon
- Department of Pediatrics, Johns Hopkins University School of Medicine (BS Solomon), Baltimore, Md
| | - Adam Schickedanz
- Department of Pediatrics, David Geffen School of Medicine at UCLA (A Schickedanz), Los Angeles, Calif
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14
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Schickedanz A, Halfon N. Evolving Roles for Health Care in Supporting Healthy Child Development. THE FUTURE OF CHILDREN 2020; 30:143-164. [PMID: 33875912 PMCID: PMC8053141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Health care reaches more children under age three in the United States than any other family-facing system and represents the most common entry point for developmental assessment of and services for children. In this article, Adam Schickedanz and Neal Halfon examine how well the child health care system promotes healthy child development early in life. They also review children's access to health care through insurance coverage, the health care system's evolution in response to scientific and technical advances, and the shifting epidemiology of health and developmental risk. The authors find that the health care system is significantly underperforming because it is constrained by antiquated conventions, insufficient resources, and outmoded incentive structures inherent in the traditional medical model that still dominates pediatric care. These structural barriers, organization challenges, and financial constraints limit the system's ability to adequately recognize, respond to, and, most importantly, prevent adverse developmental outcomes at the population level. To achieve population-level progress in healthy child development, Schickedanz and Halfon argue that pediatric care will need to transform itself and go beyond simply instituting incremental clinical process improvement. This will require taking advantage of opportunities to deliver coordinated services that bridge sectors and focusing not only on reducing developmental risk and responding to established developmental disability but also on optimizing healthy child development before developmental vulnerabilities arise. New imperatives for improved population health, along with the growing recognition among policy makers and practitioners of the social and developmental determinants of health, have driven recent innovations in care models, service coordination, and coverage designs. Yet the available resources and infrastructure are static or shrinking, crowded out by rising overall health care costs and other policy priorities. The authors conclude that child health systems are at a crossroads of conflicting priorities and incentives, and they explore how the health system might successfully respond to this impasse.
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Affiliation(s)
- Adam Schickedanz
- Adam Schickedanz is an assistant professor in residence in the Department of Pediatrics at the David Geffen School of Medicine at the University of California, Los Angeles. Neal Halfon is the founding director of the Center for Healthier Children, Families and Communities; a professor of pediatrics in the David Geffen School of Medicine; a professor of health policy and management in the Fielding School of Public Health; and a professor of public policy in the Luskin School of Public Affairs, all at the University of California, Los Angeles
| | - Neal Halfon
- Adam Schickedanz is an assistant professor in residence in the Department of Pediatrics at the David Geffen School of Medicine at the University of California, Los Angeles. Neal Halfon is the founding director of the Center for Healthier Children, Families and Communities; a professor of pediatrics in the David Geffen School of Medicine; a professor of health policy and management in the Fielding School of Public Health; and a professor of public policy in the Luskin School of Public Affairs, all at the University of California, Los Angeles
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15
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Allison MA, Attisha E, Lerner M, De Pinto CD, Beers NS, Gibson EJ, Gorski P, Kjolhede C, O’Leary SC, Schumacher H, Weiss-Harrison A. The Link Between School Attendance and Good Health. Pediatrics 2019; 143:peds.2018-3648. [PMID: 30835245 DOI: 10.1542/peds.2018-3648] [Citation(s) in RCA: 85] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
More than 6.5 million children in the United States, approximately 13% of all students, miss 15 or more days of school each year. The rates of chronic absenteeism vary between states, communities, and schools, with significant disparities based on income, race, and ethnicity. Chronic school absenteeism, starting as early as preschool and kindergarten, puts students at risk for poor school performance and school dropout, which in turn, put them at risk for unhealthy behaviors as adolescents and young adults as well as poor long-term health outcomes. Pediatricians and their colleagues caring for children in the medical setting have opportunities at the individual patient and/or family, practice, and population levels to promote school attendance and reduce chronic absenteeism and resulting health disparities. Although this policy statement is primarily focused on absenteeism related to students' physical and mental health, pediatricians may play a role in addressing absenteeism attributable to a wide range of factors through individual interactions with patients and their parents and through community-, state-, and federal-level advocacy.
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Affiliation(s)
- Mandy A. Allison
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Adult and Child Consortium for Health Outcomes Research and Delivery Science, School of Medicine, University of Colorado, and Children’s Hospital Colorado, Aurora, Colorado; and
| | - Elliott Attisha
- Detroit Public Schools Community District, Detroit, Michigan
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16
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Quinn C, Johnson K, Raney C, Baker J, Topel K, Tschudy MM, Jaganath D, Solomon BS. "In the Clinic They Know Us": Preferences for Clinic-Based Financial and Employment Services in Urban Pediatric Primary Care. Acad Pediatr 2018; 18:912-919. [PMID: 29959085 DOI: 10.1016/j.acap.2018.06.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 06/15/2018] [Accepted: 06/16/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To understand views of adolescent and adult caregivers on integrating employment and financial services into a pediatric primary care clinic serving low-income families. METHODS Eighteen in-depth qualitative interviews were conducted among caregivers of pediatric patients. Participants were recruited from those who completed a survey assessing financial and employment needs. Audio-recorded transcripts were analyzed using line-by-line coding of emerging themes. RESULTS Adolescent and adult caregivers expressed difficulty managing financial stress. They cited having a criminal history, limited financial literacy, and lack of available quality jobs as barriers to achieving financial stability. A clinic-based employment and financial program was highly acceptable among potential users for the convenience it offers and the established trust and understanding between patients and clinical providers. Participants preferred one-on-one counseling for sensitive employment and financial issues, although they did believe that some topics, such as building a resume, could be accomplished in group workshops. CONCLUSIONS Caregivers attending a pediatric clinic expressed interest in and anticipated value from clinic-based employment and financial services if implemented services are relevant, accessible, and provide options for group and individualized approaches.
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Affiliation(s)
- Caitlin Quinn
- Department of International Health, Social and Behavioral Interventions , Johns Hopkins Bloomberg School of Public Health.
| | - Karl Johnson
- Krieger School of Arts and Sciences , Johns Hopkins University
| | | | | | | | - Megan M Tschudy
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics , Johns Hopkins School of Medicine, Baltimore, Md
| | - Devan Jaganath
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics , Johns Hopkins School of Medicine, Baltimore, Md; Division of Pediatric Infectious Diseases, Department of Pediatrics, University of California , San Francisco School of Medicine
| | - Barry S Solomon
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics , Johns Hopkins School of Medicine, Baltimore, Md
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17
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Jaganath D, Johnson K, Tschudy MM, Topel K, Stackhouse B, Solomon BS. Desirability of Clinic-Based Financial Services in Urban Pediatric Primary Care. J Pediatr 2018; 202:285-290. [PMID: 30029865 DOI: 10.1016/j.jpeds.2018.05.055] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Revised: 05/01/2018] [Accepted: 05/31/2018] [Indexed: 01/21/2023]
Abstract
OBJECTIVES To determine the desirability of integrating financial services in pediatric primary care among caregivers and older adolescents. STUDY DESIGN We conducted a cross-sectional study among caregivers and late adolescents 18 years and older attending an urban, pediatric primary care clinic. RESULTS The 221 participants had a mean age of 32.1 years, with 28% of the sample aged 18-25 years. The majority were African American (90.1%), female (83.3%), and single parents (55.1%). More than one-third of the participants (35.8%) reported no household earned income, and 26.7% had a yearly household total income of <$12,000. More than one-half (61.5%) reported financial stress in general, and 67.9% believed that the clinic should provide financial services, including financial education and job workshops. A greater proportion of those who desired clinic-based services were African American (94.7% vs 75%; P < .001) and had a low or middle subjective social status (95.7% vs 83.7%; P = .01). CONCLUSIONS Clinic-based financial services are desired by caregivers and late adolescents in an urban pediatric primary care practice. Prospective studies are needed to assess the long-term impact of integrated services on childhood poverty and family well-being.
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Affiliation(s)
- Devan Jaganath
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD; Division of Pediatric Infectious Diseases, Department of Pediatrics, University of California San Francisco School of Medicine, San Francisco, CA.
| | - Karl Johnson
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD
| | - Megan M Tschudy
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD
| | | | - Brian Stackhouse
- Biostatistics, Epidemiology and Data Management (BEAD) Core, Center for Child and Community Health Research, Johns Hopkins Bayview Medical Center, Baltimore, MD
| | - Barry S Solomon
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD
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18
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Christensen DS, Flensborg-Madsen T, Garde E, Hansen ÅM, Pedersen JM, Mortensen EL. Parental socioeconomic position and midlife allostatic load: a study of potential mediators. BMC Public Health 2018; 18:1029. [PMID: 30126406 PMCID: PMC6102839 DOI: 10.1186/s12889-018-5956-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 08/13/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The mechanisms underlying the association of parental socioeconomic position with later life allostatic load remain unclear. The present study aims to examine potential pathways underlying this association: personality, social relations, intelligence and education. METHODS The study comprised 361 members of the Copenhagen Perinatal Cohort who participated in two subsequent follow-ups: the Prenatal Development Project (mean age 27 years) and the Copenhagen Aging and Midlife Biobank study (mean age 50 years). Allostatic load was based on 14 biomarkers representing the inflammatory, metabolic and cardiovascular system measured at midlife. Information on potential mediators was collected in young adulthood, and their role in the association of parental socioeconomic position with midlife allostatic load were examined in linear regression path analyses. RESULTS Parental socioeconomic position at one year was inversely associated with midlife allostatic load (β = - 0.238, p < .001). No mediation effects were found for personality or social relations. In a model including intelligence and education, a significant indirect effect was found for education (β = - 0.151, p < .001). A significant direct effect remained (β = - 0.111, p = .040). CONCLUSIONS Parental socioeconomic position was inversely associated with allostatic load in midlife. Results suggest that part of this association was mediated by education. A better understanding of the non-cognitive pathways related to education is an important prerequisite for the development of effective intervention strategies.
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Affiliation(s)
- Dinne S Christensen
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Øster Farimagsgade 5A, 1353, Copenhagen K, Denmark. .,Center for Healthy Aging, University of Copenhagen, 3B, Blegdamsvej, Copenhagen N,, Denmark.
| | - Trine Flensborg-Madsen
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Øster Farimagsgade 5A, 1353, Copenhagen K, Denmark.,Center for Healthy Aging, University of Copenhagen, 3B, Blegdamsvej, Copenhagen N,, Denmark
| | - Ellen Garde
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Øster Farimagsgade 5A, 1353, Copenhagen K, Denmark.,Center for Healthy Aging, University of Copenhagen, 3B, Blegdamsvej, Copenhagen N,, Denmark.,Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Kettegard Allé 30, 2650, Hvidovre, Denmark
| | - Åse M Hansen
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen K, Denmark.,National Research Centre for the Working Environment, Lersø Parkallé 105, 2100, Copenhagen, Denmark
| | - Jolene M Pedersen
- Center for Healthy Aging, University of Copenhagen, 3B, Blegdamsvej, Copenhagen N,, Denmark.,Section of Social Medicine, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen K, Denmark
| | - Erik L Mortensen
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Øster Farimagsgade 5A, 1353, Copenhagen K, Denmark.,Center for Healthy Aging, University of Copenhagen, 3B, Blegdamsvej, Copenhagen N,, Denmark
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19
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Buck KD, Summers JK, Smith LM, Harwell LC. Application of the Human Well-Being Index to Sensitive Population Divisions: A Children's Well-Being Index Development. CHILD INDICATORS RESEARCH 2018; 11:1249-1280. [PMID: 30220939 PMCID: PMC6133323 DOI: 10.1007/s12187-017-9469-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
The assessment of community well-being is critical as an end-point measure that will facilitate decision support and assist in the identification of sustainable solutions to address persistent problems. While the overall measure is important, it is equally vital to distinguish variations among groups within the population who may be impacted in a different manner. The U.S. Environmental Protection Agency (US EPA) developed the Human Well-Being Index (HWBI), as a way of measuring these outcomes and assessing community characteristics. The HWBI approach produces a suite of indicators, domains and a final composite index appropriate for characterizing well-being of a population. While generalized approaches are needed, it is important to also recognize variations in well-being across community enclaves. This paper presents an adaption of the HWBI for child populations to test the applicability of the index framework to specific community enclaves. First, an extensive literature review was completed to ensure the theoretical integrity of metric and indicator substitutions from the original HWBI framework. Metric data were then collected, refined, imputed where necessary and evaluated to confirm temporal and spatial availability. A Children's Well-Being Index (CWBI) value, representing the same indicators and domains of well-being as the original HWBI, was calculated for the population under age 18 across all US counties for 2011. Implications of this research point to an effective, holistic end-point measure that can be tracked over time. Similarly, there is great potential for the application of the original HWBI method to other statistical population segments within the greater US population. These adaptations could help identify and close gaps in equity of resource distribution among these groups.
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Affiliation(s)
- Kyle D Buck
- United States Environmental Protection Agency - Office of Research and Development - National Health and Environmental Effects Research Laboratory - Gulf Ecology Division
| | - J Kevin Summers
- United States Environmental Protection Agency - Office of Research and Development - National Health and Environmental Effects Research Laboratory - Gulf Ecology Division
| | - Lisa M Smith
- United States Environmental Protection Agency - Office of Research and Development - National Health and Environmental Effects Research Laboratory - Gulf Ecology Division
| | - Linda C Harwell
- United States Environmental Protection Agency - Office of Research and Development - National Health and Environmental Effects Research Laboratory - Gulf Ecology Division
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20
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Prevalence of malnutrition in Spanish schoolchildren. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2018. [DOI: 10.1016/j.anpede.2017.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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21
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Moschovis PP, Wiens MO, Arlington L, Antsygina O, Hayden D, Dzik W, Kiwanuka JP, Christiani DC, Hibberd PL. Individual, maternal and household risk factors for anaemia among young children in sub-Saharan Africa: a cross-sectional study. BMJ Open 2018; 8:e019654. [PMID: 29764873 PMCID: PMC5961577 DOI: 10.1136/bmjopen-2017-019654] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE Anaemia affects the majority of children in sub-Saharan Africa (SSA). Previous studies of risk factors for anaemia have been limited by sample size, geography and the association of many risk factors with poverty. In order to measure the relative impact of individual, maternal and household risk factors for anaemia in young children, we analysed data from all SSA countries that performed haemoglobin (Hb) testing in the Demographic and Health Surveys. DESIGN AND SETTING This cross-sectional study pooled household-level data from the most recent Demographic and Health Surveys conducted in 27 SSA between 2008 and 2014. PARTICIPANTS 96 804 children age 6-59 months. RESULTS The prevalence of childhood anaemia (defined as Hb <11 g/dL) across the region was 59.9%, ranging from 23.7% in Rwanda to 87.9% in Burkina Faso. In multivariable regression models, older age, female sex, greater wealth, fewer household members, greater height-for-age, older maternal age, higher maternal body mass index, current maternal pregnancy and higher maternal Hb, and absence of recent fever were associated with higher Hb in tested children. Demographic, socioeconomic factors, family structure, water/sanitation, growth, maternal health and recent illnesses were significantly associated with the presence of childhood anaemia. These risk factor groups explain a significant fraction of anaemia (ranging from 1.0% to 16.7%) at the population level. CONCLUSIONS The findings from our analysis of risk factors for anaemia in SSA underscore the importance of family and socioeconomic context in childhood anaemia. These data highlight the need for integrated programmes that address the multifactorial nature of childhood anaemia.
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Affiliation(s)
| | - Matthew O Wiens
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Olga Antsygina
- Scientific Research Institute of Healthcare Organization and Medical Management, Moscow, Russia
| | - Douglas Hayden
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Walter Dzik
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - David C Christiani
- Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
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22
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Wong P, Denburg A, Dave M, Levin L, Morinis JO, Suleman S, Wong J, Ford-Jones E, Moore AM. Early life environment and social determinants of cardiac health in children with congenital heart disease. Paediatr Child Health 2018; 23:92-95. [PMID: 29686491 PMCID: PMC5905484 DOI: 10.1093/pch/pxx146] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Congenital heart disease is a significant cause of infant mortality. Epidemiology and social context play a crucial role in conditioning disease burden and modulating outcomes, while diagnosis and treatment remain resource intensive. This review will address the role of social demographics, environmental exposure, epigenetics and nutrition in the aetiology of congenital heart disease. We then discuss the determinant effect of social factors on the provision and outcomes of care for congenital heart disease and implications for practice. It is our hope that enhanced knowledge of the intersection of social determinants of health and congenital heart disease will facilitate effective preventative strategies at the individual and population levels to optimize heart health outcomes across the life course.
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Affiliation(s)
- Peter Wong
- Department of Paediatrics, The Hospital for Sick Children and University of Toronto, Toronto, Ontario
| | | | - Malini Dave
- Department of Paediatrics, The Hospital for Sick Children and University of Toronto, Toronto, Ontario
| | - Leo Levin
- Department of Paediatrics, The Hospital for Sick Children and University of Toronto, Toronto, Ontario
| | - Julia Orkin Morinis
- Department of Paediatrics, The Hospital for Sick Children and University of Toronto, Toronto, Ontario
| | - Shazeen Suleman
- Department of Paediatrics, The Hospital for Sick Children and University of Toronto, Toronto, Ontario
| | - Jonathan Wong
- Department of Paediatrics, The Hospital for Sick Children and University of Toronto, Toronto, Ontario
| | - Elizabeth Ford-Jones
- Department of Paediatrics, The Hospital for Sick Children and University of Toronto, Toronto, Ontario
| | - Aideen M Moore
- Department of Paediatrics, The Hospital for Sick Children and University of Toronto, Toronto, Ontario
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Preventive Parenting Interventions: Advancing Conceptualizations of Participation and Enhancing Reach. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2018; 19:603-608. [PMID: 29574674 DOI: 10.1007/s11121-018-0876-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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24
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Pakulak E, Stevens C, Neville H. Neuro-, Cardio-, and Immunoplasticity: Effects of Early Adversity. Annu Rev Psychol 2018; 69:131-156. [DOI: 10.1146/annurev-psych-010416-044115] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Eric Pakulak
- Brain Development Lab, Department of Psychology, University of Oregon, Eugene, Oregon, 97403;,
| | - Courtney Stevens
- Department of Psychology, Willamette University, Salem, Oregon 97301
| | - Helen Neville
- Brain Development Lab, Department of Psychology, University of Oregon, Eugene, Oregon, 97403;,
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25
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Tornero Patricio S, Charris-Castro L, Granero Asencio M, Daponte Codina A. Influence of postcode on paediatric admissions in Seville. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2017. [DOI: 10.1016/j.anpede.2016.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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26
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Pérez-Ríos M, Santiago-Pérez MI, Leis R, Malvar A, Suanzes J, Hervada X. [Prevalence of malnutrition in Spanish schoolchildren]. An Pediatr (Barc) 2017; 89:44-49. [PMID: 29102499 DOI: 10.1016/j.anpedi.2017.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 08/14/2017] [Accepted: 09/01/2017] [Indexed: 10/18/2022] Open
Abstract
INTRODUCTION AND AIMS The term malnutrition includes malnutrition due to excess or obesity, underweight as well as stunted growth. Its prevalence in a population can be estimated using anthropometric variables. The aim of this study is to estimate the prevalence of malnutrition in Galician schoolchildren aged 6 to 15years in the school year 2013-2014. METHODS A cross-sectional study was conducted on a representative sample by gender and age of the Galician population of 6 to 15years old. The prevalence of obesity, underweight, and short stature was estimated by age and gender using the reference standards proposed by the World Health Organisation. RESULTS Of the total of 7,438 schoolchildren weighed and measured, 16.4% had malnutrition. The prevalence of obesity was 14.8%, underweight was 0.7%, and short stature for age was estimated at 1%. Obesity was more prevalent among boys. As regards underweight and short stature, when there were differences, prevalence was higher among girls. CONCLUSIONS In Galicia, 16 out of every 100 schoolchildren aged 6 to 15years had malnutrition, with that due to excess or obesity being the most frequent. Prevalence of underweight and short stature did not exceed 1%. This data shows that primary prevention measures should be promoted at an early age to reduce malnutrition due to excess or adiposity, in particular.
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Affiliation(s)
- Mónica Pérez-Ríos
- Subdirección de Información sobre Saúde e Epidemioloxía, Dirección Xeral de Saúde Pública, Consellería de Sanidade, Xunta de Galicia, Santiago de Compostela, La Coruña, España; Área de Medicina Preventiva y Salud Pública, Universidad de Santiago de Compostela, Santiago de Compostela, La Coruña, España.
| | - María I Santiago-Pérez
- Subdirección de Información sobre Saúde e Epidemioloxía, Dirección Xeral de Saúde Pública, Consellería de Sanidade, Xunta de Galicia, Santiago de Compostela, La Coruña, España
| | - Rosaura Leis
- Servicio de Pediatría, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, La Coruña, España
| | - Alberto Malvar
- Subdirección de Información sobre Saúde e Epidemioloxía, Dirección Xeral de Saúde Pública, Consellería de Sanidade, Xunta de Galicia, Santiago de Compostela, La Coruña, España
| | - Jorge Suanzes
- Subdirección de Programas de Fomento de Estilos de Vida Saudables, Dirección Xeral de Saúde Pública, Consellería de Sanidade, Xunta de Galicia, Santiago de Compostela, La Coruña, España
| | - Xurxo Hervada
- Subdirección de Información sobre Saúde e Epidemioloxía, Dirección Xeral de Saúde Pública, Consellería de Sanidade, Xunta de Galicia, Santiago de Compostela, La Coruña, España
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27
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Basu A, McLaughlin KA, Misra S, Koenen KC. Childhood Maltreatment and Health Impact: The Examples of Cardiovascular Disease and Type 2 Diabetes Mellitus in Adults. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2017; 24:125-139. [PMID: 28867878 DOI: 10.1111/cpsp.12191] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Child maltreatment is associated with increased risk for an array of mental and physical health problems. We reviewed studies examining associations of child maltreatment, assessed either alone or in combination with other adversities, with cardiovascular disease (CVD) and Type 2 Diabetes. PubMed was searched for relevant studies until December, 2015. Forty publications met inclusion criteria. Consistent positive associations were noted across a range of childhood adversities. Child maltreatment was associated with CVD (myocardial infarction, stroke, ischemic heart disease, coronary heart disease) in 91.7% of studies, with diabetes in 88.2% of studies, and with blood pressure/hypertension in 61.5% of studies. Inclusion of mental disorders tended to attenuate associations. Sex-related differences were under-examined. Implications for future research and intervention efforts are discussed.
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Affiliation(s)
- Archana Basu
- Harvard T. H. Chan School of Public Health, Massachusetts General Hospital
| | | | | | - Karestan C Koenen
- Harvard T. H. Chan School of Public Health, Massachusetts General Hospital
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28
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Zimmerman MS. Information Poverty and Reproductive Healthcare: Assessing the Reasons for Inequity between Income Groups. SOCIAL WORK IN PUBLIC HEALTH 2017; 32:210-221. [PMID: 28129076 DOI: 10.1080/19371918.2016.1268990] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
It is commonly known that in the United States women who are low income do not access reproductive healthcare services and information with the same reliability and regularity of women who are higher income. A qualitative research approach was undertaken to assess the root cause of this disparity. In-depth semistructured interviews were conducted with 15 women divided among socioeconomic lines. The primary barriers to care for women who are low income are clinical staff attitudes, knowledge of care available and needed, and cost or lack of insurance. This study adds to the current understanding of the barriers to reproductive healthcare for women of different socioeconomic statuses.
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Affiliation(s)
- Margaret S Zimmerman
- a School of Library and Information Science , University of South Carolina , Columbia , South Carolina , USA
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29
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Calem M, Bromis K, McGuire P, Morgan C, Kempton MJ. Meta-analysis of associations between childhood adversity and hippocampus and amygdala volume in non-clinical and general population samples. NEUROIMAGE-CLINICAL 2017; 14:471-479. [PMID: 28275547 PMCID: PMC5331153 DOI: 10.1016/j.nicl.2017.02.016] [Citation(s) in RCA: 99] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 02/20/2017] [Accepted: 02/21/2017] [Indexed: 11/25/2022]
Abstract
Background Studies of psychiatric populations have reported associations between childhood adversity and volumes of stress-related brain structures. This meta-analysis investigated these associations in non-clinical samples and therefore independent of the effects of severe mental health difficulties and their treatment. Methods The MEDLINE database was searched for magnetic resonance imaging studies measuring brain structure in adults with and without childhood adversity. Fifteen eligible papers (1781 participants) reporting hippocampal volumes and/or amygdala volumes were pooled using a random effects meta-analysis. Results Those with childhood adversity had lower hippocampus volumes (hedges g = − 0.15, p = 0.010). Controlling for gender, this difference became less evident (hedges g = − 0.12, p = 0.124). This association differed depending on whether studies included participants with some psychopathology, though this may be due to differences in the type of adversity these studies examined. There was no strong evidence of any differences in amygdala volume. Discussion Childhood adversity may have only a modest impact on stress-related brain structures in those without significant mental health difficulties. Reduced hippocampal volume found in non-clinical people with childhood adversity This effect was less marked than those found in psychiatric populations. There was some evidence for confounding by gender. Further studies needed on impact of different forms of adversity on neuroanatomy.
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Affiliation(s)
- Maria Calem
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK
| | - Konstantinos Bromis
- School of Electrical and Computer Engineering, National Technical University of Athens, Greece
| | - Philip McGuire
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK
| | - Craig Morgan
- Health Services and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK
| | - Matthew J Kempton
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK
- Corresponding author at: Department of Psychosis Studies, PO67, Institute of Psychiatry, 16 de Crespigny Park, London SE5 8AF, UK.Department of Psychosis StudiesPO67Institute of Psychiatry16 de Crespigny ParkLondonSE5 8AFUK
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30
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Tornero Patricio S, Charris-Castro L, Granero Asencio M, Daponte Codina A. [Influence of postcode on paediatric admissions in Seville]. An Pediatr (Barc) 2017; 87:320-329. [PMID: 28063821 DOI: 10.1016/j.anpedi.2016.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 11/23/2016] [Accepted: 12/01/2016] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The postcode (where the home is situated) is an indicator of socioeconomic status and is associated with morbidity, mortality, and the use of health services. The aim of this study was to analyse its effects on paediatric admissions and to determine the rates of the most common causes of paediatric admissions in Seville. MATHERIAL AND METHODS An observational cross-sectional study with two analysis units: under 15 year-old "admissions" in public hospitals in Seville (n=2,660) and "city districts" of Seville (n=11). The independent variable analysed was whether the postcode of the admitted patients was within a Regional Government designated "area with social transformation needs". The analysis of the admissions was performed using X2-test, Fisher test and Student-t test, with the description of rates using the calculation of crude and specific rates, and by rate ratio. RESULTS Children living in districts with a lower socioeconomic status were on average 7 months younger (P<.001), and they were significantly more likely to be admitted via the emergency department (P<.001). There was no statistical difference detected in either the length of hospital stay or mortality. The crude admission rate ratio was higher in districts with a lower socioeconomic status (1.8), with a higher specific rate ratio detected in admissions due to asthma, respiratory infections, inguinal hernia, and epilepsy/convulsions. CONCLUSIONS Paediatric hospital admission rates of the main diagnoses were higher in districts with a lower socioeconomic status. Children living in these districts were more likely to be admitted younger and via the emergency department.
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Affiliation(s)
- Sebastián Tornero Patricio
- Pediatría Atención Primaria, Distrito Sevilla de Atención Primaria, Servicio Andaluz de Salud, Sevilla, España.
| | - Liliana Charris-Castro
- Unidad de Cuidados Intensivos, Hospital Universitario Virgen del Rocío, Servicio Andaluz de Salud, Sevilla, España
| | - Mercedes Granero Asencio
- Unidad de Neonatología, Hospital Universitario Virgen Macarena, Servicio Andaluz de Salud, Sevilla, España
| | - Antonio Daponte Codina
- Ciber de Epidemiología y Salud Pública (CIBERESP), Observatorio de Salud y Medio Ambiente de Andalucía (OSMAN), Escuela Andaluza de Salud Pública, Campus Universitario de la Cartuja, Granada, España
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31
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Fierman AH, Beck AF, Chung EK, Tschudy MM, Coker TR, Mistry KB, Siegel B, Chamberlain LJ, Conroy K, Federico SG, Flanagan PJ, Garg A, Gitterman BA, Grace AM, Gross RS, Hole MK, Klass P, Kraft C, Kuo A, Lewis G, Lobach KS, Long D, Ma CT, Messito M, Navsaria D, Northrip KR, Osman C, Sadof MD, Schickedanz AB, Cox J. Redesigning Health Care Practices to Address Childhood Poverty. Acad Pediatr 2016; 16:S136-46. [PMID: 27044692 DOI: 10.1016/j.acap.2016.01.004] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 12/30/2015] [Accepted: 01/05/2016] [Indexed: 01/16/2023]
Abstract
Child poverty in the United States is widespread and has serious negative effects on the health and well-being of children throughout their life course. Child health providers are considering ways to redesign their practices in order to mitigate the negative effects of poverty on children and support the efforts of families to lift themselves out of poverty. To do so, practices need to adopt effective methods to identify poverty-related social determinants of health and provide effective interventions to address them. Identification of needs can be accomplished with a variety of established screening tools. Interventions may include resource directories, best maintained in collaboration with local/regional public health, community, and/or professional organizations; programs embedded in the practice (eg, Reach Out and Read, Healthy Steps for Young Children, Medical-Legal Partnership, Health Leads); and collaboration with home visiting programs. Changes to health care financing are needed to support the delivery of these enhanced services, and active advocacy by child health providers continues to be important in effecting change. We highlight the ongoing work of the Health Care Delivery Subcommittee of the Academic Pediatric Association Task Force on Child Poverty in defining the ways in which child health care practice can be adapted to improve the approach to addressing child poverty.
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Affiliation(s)
| | - Andrew F Beck
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Esther K Chung
- Department of Pediatrics, The Sidney Kimmel Medical College of Thomas Jefferson University and Nemours, Philadelphia, PA
| | - Megan M Tschudy
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD
| | - Tumaini R Coker
- Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Kamila B Mistry
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD; Office of Extramural Research, Education, and Priority Populations, Agency for Healthcare Research and Quality, US Department of Health and Human Services, Rockville, MD
| | - Benjamin Siegel
- Department of Pediatrics, Boston Medical Center, Boston University School of Medicine, Boston, MA
| | | | - Kathleen Conroy
- Division of General Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Steven G Federico
- General Pediatrics, Department of Pediatrics, Denver Health, Denver, CO
| | - Patricia J Flanagan
- Department of Pediatrics, Warren Alpert Medical School of Brown University/Hasbro Children's Hospital, Providence, RI
| | - Arvin Garg
- Department of Pediatrics, Boston Medical Center, Boston University School of Medicine, Boston, MA
| | | | - Aimee M Grace
- Department of Pediatrics, George Washington University, Washington, DC
| | - Rachel S Gross
- Department of Pediatrics, Albert Einstein College of Medicine, The Children's Hospital at Montefiore, Bronx, New York
| | - Michael K Hole
- Division of General Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Perri Klass
- Department of Pediatrics, NYU School of Medicine, New York, NY
| | - Colleen Kraft
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Alice Kuo
- Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA; Department of Medicine, David Geffen School of Medicine at UCLA
| | - Gena Lewis
- Department of Pediatrics, UCSF Benioff Children's Hospital Oakland, San Francisco, CA
| | - Katherine S Lobach
- Department of Pediatrics, Albert Einstein College of Medicine, The Children's Hospital at Montefiore, Bronx, New York
| | - Dayna Long
- Department of Pediatrics, UCSF Benioff Children's Hospital Oakland, San Francisco, CA; Center of Community Health and Engagement, UCSF Benioff Children's Hospital Oakland, San Francisco, CA
| | - Christine T Ma
- Department of Pediatrics, UCSF Benioff Children's Hospital Oakland, San Francisco, CA
| | - Mary Messito
- Department of Pediatrics, NYU School of Medicine, New York, NY
| | - Dipesh Navsaria
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | | | - Cynthia Osman
- Department of Pediatrics, NYU School of Medicine, New York, NY
| | - Matthew D Sadof
- Department of Pediatrics, Tufts University School of Medicine, Boston, MA; Baystate Children's Hospital, Springfield, MA
| | - Adam B Schickedanz
- Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Joanne Cox
- Division of General Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA
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Minkovitz CS, O'Neill KMG, Duggan AK. Home Visiting: A Service Strategy to Reduce Poverty and Mitigate Its Consequences. Acad Pediatr 2016; 16:S105-11. [PMID: 27044687 DOI: 10.1016/j.acap.2016.01.005] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 01/13/2016] [Accepted: 01/15/2016] [Indexed: 11/16/2022]
Abstract
Home visiting programs are increasingly recognized as an important part of the early childhood system of care in the United States. The objectives of this report are to review the rationale for home visiting; characterize the Federal Home Visiting Program; highlight the evidence of home visiting effectiveness, particularly for low income families; identify opportunities to promote coordination between medical homes and home visiting programs; and explain the critical role of research, evaluation, and quality improvement to strengthen home visiting effectiveness. Home visiting programs offer voluntary home-based services and other supports to meet the needs of vulnerable pregnant women and young families. Home visiting intends to address poverty in 2 ways. First, it promotes economic self-sufficiency directly by building parents' knowledge, skills, and motivation related to employment opportunities and by linking families with community services such as adult education and job training. Second, it mitigates the effects of poverty through direct service and community linkages to enhance parents' capacity for positive parenting and for their own health and family functioning. Home visiting has shown effectiveness in multiple domains, including family economic self-sufficiency, birth outcomes, maternal health, child health and development, and positive parenting practices. Authorized as part of the Affordable Care Act in 2010 and reauthorized in 2015, the Federal Home Visiting Program invests an unprecedented $1.9 billion in the form of grants to states to expand home visiting programs and support rigorous research. As part of the early childhood system of services, home visiting programs must coordinate with other community services and supports. Programs will be most effective when resources are used efficiently, duplication of services is avoided, and alignment and reinforcement of other providers' messages are achieved. The Federal Home Visiting Program has established 4 mechanisms of research, evaluation, and quality improvement to enhance home visiting implementation and effectiveness.
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Affiliation(s)
- Cynthia S Minkovitz
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Baltimore, MD.
| | - Kay M G O'Neill
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Baltimore, MD
| | - Anne K Duggan
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Baltimore, MD
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33
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O'Malley DM, Randell KA, Dowd MD. Family Adversity and Resilience Measures in Pediatric Acute Care Settings. Public Health Nurs 2016; 33:3-10. [DOI: 10.1111/phn.12246] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Donna M. O'Malley
- Children's Mercy Kansas City; Kansas City Missouri
- School of Nursing and Health Studies; University of Missouri Kansas City; Kansas City Missouri
| | - Kimberly A. Randell
- Children's Mercy Kansas City; Kansas City Missouri
- School of Medicine; University of Missouri Kansas City; Kansas City Missouri
| | - M. Denise Dowd
- Children's Mercy Kansas City; Kansas City Missouri
- School of Medicine; University of Missouri Kansas City; Kansas City Missouri
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