Analyzing the Potential Moderating Effect of School SES on the Relationship Between Student Sexuality and Mental Health

Background: It is estimated 1 in 5 children in the United States of America have a diagnosable mental health disorder, with only 21% of these children receiving treatment (American Academy of Pediatrics, 2017). Lesbian, gay, bisexual, and transgender (LBGT) youth mental health issues have been a consistent area of concern (Gonsiorek, 1988). The presence or absence of health-related resources and programs in schools has been shown to alter the health outcomes of students in their care (Leger, 1999). However, the extent to which a school can implement programs depends largely on a school’s socioeconomic status (SES). This study uses publicly accessible data from several sources to evaluate the moderating effect of school SES on the relationship between sexual orientation and mental health among primary and secondary students. Methods: Surveys were collected from 15,624 students in grades 9-12 through the National Youth Risk Behavior Survey (YRBS) (CDC, 2015). Data related to student sexuality and their mental health was extracted from this dataset. Students surveyed were also divided into 18 distinct large urban school districts and this was used to find the funding per student for each student surveyed in each district. A three variable cross tabulation analysis was conducted to assess the role of SES on the relationship between sexual orientation and mental health among the students surveyed. Discussion and Conclusion: The results of this analysis indicate that school socioeconomic status does not have a large moderating effect in the relationship between student sexuality and mental health. This finding is of particular interest because it suggests that school SES does not impact LGBT students’ mental health any more than their relatively mentally healthier peers. It may be worthwhile for schools with more funding available per student to direct efforts to specifically benefit groups who are disproportionately affected by mental health disorders, such as LGBT students

Use of International Classification of Diseases, Ninth Revision Codes for Obesity: Trends in the United States from an Electronic Health Record-Derived Database.

Obesity is a potentially modifiable risk factor for many diseases, and a better understanding of its impact on health care utilization, costs, and medical outcomes is needed. The ability to accurately evaluate obesity outcomes depends on a correct identification of the population with obesity. The primary objective of this study was to determine the prevalence and accuracy of International Classification of Diseases, Ninth Revision (ICD-9) coding for overweight and obesity within a US primary care electronic health record (EHR) database compared against actual body mass index (BMI) values from recorded clinical patient data; characteristics of patients with obesity who did or did not receive ICD-9 codes for overweight/obesity also were evaluated. The study sample included 5,512,285 patients in the database with any BMI value recorded between January 1, 2014, and June 30, 2014. Based on BMI, 74.6% of patients were categorized as being overweight or obese, but only 15.1% of patients had relevant ICD-9 codes. ICD-9 coding prevalence increased with increasing BMI category. Among patients with obesity (BMI ≥30 kg/m2), those coded for obesity were younger, more often female, and had a greater comorbidity burden than those not coded; hypertension, dyslipidemia, type 2 diabetes mellitus, and gastroesophageal reflux disease were the most common comorbidities. KEY FINDINGS: US outpatients with overweight or obesity are not being reliably coded, making ICD-9 codes undependable sources for determining obesity prevalence and outcomes. BMI data available within EHR databases offer a more accurate and objective means of classifying overweight/obese status

Effects of Evidence-Based Fall Reduction Programing on the Functional Wellness of Older Adults in a Senior Living Community: A Clinical Case Study.

BACKGROUND: Older adults at a high risk of falls may be referred to a physical therapist. A physical therapy episode of care is designed for the transition of an older adult from a high fall risk to a moderate to low fall risk. However, these episodes of care are limited in time and duration. There is compelling evidence for the efficacy of group-based exercise classes to address risk, and transitioning an older adult from physical therapy to a group-based program may be an effective way to manage risk through the continuum of care. OBJECTIVES: The purpose of this study was to translate research findings into a real world setting, and demonstrate the efficacy of integrating evidence-based fall prevention exercises into pre-existing exercise classes at a senior living facility as a proof of concept model for future programing. METHODS: Twenty-four participants aged 65 years and older living in a senior living community and the community were stratified into group-based exercise classes. Cutoff scores from functional outcome measures were used to stratify participants. Exercises from The Otago Exercise Program were implemented into the classes. Functional outcome measures collected included the 10-Meter Walk Test, 30-Second Sit to Stand, and Timed Up and Go (TUG). Number of falls, hospitalizations, and physical therapy episodes of care were also tracked. Data were compared to a control group in a different senior living community that offered classes with similar exercises aimed at improving strength and mobility. The classes were taught by an exercise physiologist and were of equal duration and frequency. RESULTS: Participants demonstrated significant improvements in all functional outcome measures. TUG mean improved from 13.5 to 10.4 s (p = 0.034). The 30-Second Sit to Stand mean improved from 10.5 to 13.4 (p = 0.002). The 10-Meter Walk Test improved from 0.81 to 0.98 m/s (p \u3c 0.0001). Participants did not experience any falls or hospitalizations, and two participants required physical therapy episodes of care. CONCLUSION: Implementing an evidence-based fall reduction program into a senior living program has a positive effect on strength, balance, fall risk, gait speed, fall rate, hospitalizations, and amount of physical therapy intervention

Fall-Related Emergency Department Traumas at Thomas Jefferson University Hospital: A Retrospective Analysis of Elderly Adult Trends

Falls are the most common reason for non-fatal injuries treated at Emergency Departments (EDs) in the United States (US), excluding those ages 15-24. Pennsylvania (PA) spends $2.7 billion treating fall-related injuries yearly, with an average per-hospitalization cost of$58,529. PA also has the 5th highest state senior population, and Philadelphia has the 5th oldest senior population among the major American cities. Examining the 2016 Thomas Jefferson University (TJU) ED trauma database, we analysed fall-related traumas in adults ages 65 and over. The sample was stratified into 3 age groups (65-74, 75-84, and ³85) and SAS 9.4 was used to investigate age group trends for fall type, average length of stay (LOS), post-ED destination, loss of consciousness (LOC), incidents by month, and if LOC impacted patient LOS. We found a significant association between LOC and LOS, with those experiencing an LOC staying in hospital an average of 1.7 days. We did not observe significant differences across age groups for fall type, length of stay, post-ED destination, LOC, or number of incidents by month. While results are not significant they are suggestive and may reveal patients being more likely to experience a simple fall (defined as a fall without a slip or trip) as age increases, and less likely to experience a fall with a trip as age increases. All patients, regardless of age group, have average LOS of approximately 7 days. Analysis of our study sample (n=400) describes trends in elderly adult fall-related trauma patients at the TJU ED. We observed that LOC due to a fall is associated with an increased LOS, and for several utilization comparisons there are no significant differences between age groups. This study helps to better understand the patients we serve and identify trends in utilization that may contribute to ongoing fall-prevention efforts at TJU

Primary Care Patient Experience in Pneumonia Patient and the Effects of Readmissions

Patient primary care experience is an essential component of patient care. Research has consistently demonstrated that patient experience correlates with clinical processes of care for prevention and disease management and with better health outcomes. Patients who are admitted to the hospital face numerous challenges upon discharge, including high readmission rates. In fact, one-fifth of Medicare patients admitted to the hospital will be readmitted within 30 days of discharge. With the Affordable Care Act’s creation of the Hospital Readmission Reduction Program (HRRP), hospitals are now penalized for excess readmission rates for common admitting diagnoses such as pneumonia. The purpose of this study was to examine how patients’ baseline primary care experiences relate to the likelihood of readmission. Patients diagnosed with pneumonia were identified during their initial hospitalization and administered the CG-CAHPS 3.0 and Supplementary CAHPS PCMH. The results of these surveys were compared between readmitted and non-readmitted patients. Also, the differences between the primary care experiences of the pneumonia patient cohort and patients at the hospital system’s primary care sites were examined. Results showed that 5 patients out of the 33 patients surveyed were readmitted with non-pneumonia related causes. Patients across 18 primary care sites report higher levels of satisfaction with their PCP (88.7%) compared to patients hospitalized for Pneumonia (66.7%; X2 =14.9,

Text Messaging in the Patient-Centered Medical Home to Improve Glucose Control and Retinopathy Screening.

Purpose: To evaluate the effectiveness of a text messaging program (TMP) to improve glucose control, retinopathy screening (RS) rates, and self-care behaviors in patients with uncontrolled type 2 diabetes. Methods: A single-group design with a quasi-systematic random sample (n=20) received educational/exhortational text messages on their cellular phones for 3 months. Subjects, 12 of whom identified as a minority ethnicity, were mostly male, aged 27-73 years. Results: Glucose control and RS rates improved significantly. Subjects (\u3e70%) reported changes in self-care behaviors. Conclusion: Leveraging ubiquitous technology, a TMP for patients with limited access to healthcare education, holds promis

Social Implications of Teenage Parenthood

Contrary to popular impression, the absolute level of teenage childbearing in the United States has not risen during the past decade, but has actually declined. Moreover, the newly discovered epidemic of adolescent pregnancy is not recent; elevated levels of teenage childbearing can be traced to the beginning of the baby boom after the Second World War. Nevertheless, the issue does seem more pressing now than ever before. In this chapter we shall touch on some of the reasons for this issue\u27s prominence. We shall look at the evidence in the literature on the social consequences of teenage childbearing for adolescent parents, their offspring, and members of their family of origin. After assessing this evidence, we shall briefly mention some of the policy initiatives open for us for preventing premature childbearing and for ameliorating its deleterious effects when it does occur