Changes in hospitals' credentialing requirements for board certification from 2005 to 2010

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/98213/1/jhm2033.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/98213/2/jhm23033-sup-0001-suppinfo.pd

Racial differences in prediabetes prevalence by test type for the US pediatric and adult population: NHANES 1999‐2016

BackgroundPrevious studies have shown that US estimates of prediabetes or diabetes differ depending on test type, fasting plasma glucose (FPG) vs hemoglobin A1c (HbA1c). Given age, race, and test differences reported in the literature, we sought to further examine these differences in prediabetes detection using a nationally representative sample.MethodsUsing the National Health and Nutrition Examination Survey (NHANES) 1999‐2016, individuals were identified as having prediabetes with an HbA1c of 5.7% to 6.4% or a FPG of 100 to 125 mg/dL. We excluded individuals with measurements in the diabetic range. We ran generalized estimating equation logistic regressions to examine the relationship between age, race, and test type with interactions, controlling for sex and body mass index. We compared the difference in predicted prediabetes prevalence detected by impaired fasting glycemia (IFG) vs HbA1c by race/ethnicity among children and adults separately using adjusted Wald tests.ResultsThe absolute difference in predicted prediabetes detected by IFG vs HbA1c was 19.9% for white adolescents, 0% for black adolescents, and 20.1% for Hispanic adolescents; 21.4% for white adults, −1.2% for black adults, and 19.2% for Hispanic adults. Using adjusted Wald tests, we found the absolute differences between black vs white and black vs Hispanic individuals to be significant, but, not between Hispanic and white individuals among children and adults separately.ConclusionsThese observations highlight differences in test performance among racial/ethnic groups. Our findings corroborate the need for further studies to determine appropriate HbA1c cutoff levels for diagnosis of prediabetes by age group and race.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/163459/2/pedi13083_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/163459/1/pedi13083.pd

Validation of EpiTRAQ, a transition readiness assessment tool for adolescents and young adults with epilepsy

ObjectiveTo design and validate a transition readiness assessment tool for adolescents and young adults with epilepsy and without intellectual disability.MethodsWe adapted a general transition readiness assessment tool (TRAQ) to add epilepsy‐relevant items based on concepts in current epilepsy quality measures. The adapted tool, EpiTRAQ, maintained the original structure and scoring system. Concurrent with clinical implementation in pediatric and adult epilepsy clinics at an academic medical center, we assessed the validity and reliability of this adapted tool for patients 16‐26 years of age. This process included initial validation with 302 patients who completed EpiTRAQ between October 2017 and May 2018; repeat validation with 381 patients who completed EpiTRAQ between June 2018 and September 2019; and retest reliability among 153 patients with more than one completed EpiTRAQ.ResultsMean scores were comparable between initial and repeat validation populations (absolute value differences between 0.05 and 0.1); internal consistency ranged from good to high. For both the initial and repeat validation, mean scores and internal consistency demonstrated high comparability to the original TRAQ validation results. Upon retest, few patients rated themselves with a lower score, while the majority rated themselves with higher scores.SignificanceEpiTRAQ is a valid and reliable tool for assessing transition readiness in adolescents and young adults with epilepsy and without intellectual disability.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/162789/2/epi412427_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/162789/1/epi412427.pd

Change in settings for early-season influenza vaccination among US adults, 2012 to 2013

AbstractVaccination in non-medical settings is recommended as a strategy to increase access to seasonal influenza vaccine. To evaluate change in early-season influenza vaccination setting, we analyzed data from the National Internet Flu Survey. Bivariate comparison of respondent characteristics by location of vaccination was assessed using chi-square tests. Multinomial logistic regression was performed to compare the predicted probability of being vaccinated in medical, retail, and mobile settings in 2012 vs 2013. In both 2012 and 2013, vaccination in medical settings was more likely among elderly adults, those with chronic conditions, and adults with a high school education or less. Adults 18–64 without a chronic condition had a lower probability of vaccination in the medical setting, and higher probability of vaccination in a retail or mobile setting, in 2013 compared to 2012. Adults 18–64 with a chronic condition had no change in their location of flu vaccination. Elderly adults had a lower probability of vaccination in the medical setting, and higher probability of vaccination in a retail setting, in 2013 compared to 2012. Non-medical settings continue to play an increasing role in influenza vaccination of adults, particularly for adults without a chronic condition and elderly adults. Retail and mobile settings should continue to be viewed as important mechanisms to ensure broad access to influenza vaccination

Change in settings for early-season influenza vaccination among US adults, 2012 to 2013

Vaccination in non-medical settings is recommended as a strategy to increase access to seasonal influenza vaccine. To evaluate change in early-season influenza vaccination setting, we analyzed data from the National Internet Flu Survey. Bivariate comparison of respondent characteristics by location of vaccination was assessed using chi-square tests. Multinomial logistic regression was performed to compare the predicted probability of being vaccinated in medical, retail, and mobile settings in 2012 vs 2013. In both 2012 and 2013, vaccination in medical settings was more likely among elderly adults, those with chronic conditions, and adults with a high school education or less. Adults 18–64 without a chronic condition had a lower probability of vaccination in the medical setting, and higher probability of vaccination in a retail or mobile setting, in 2013 compared to 2012. Adults 18–64 with a chronic condition had no change in their location of flu vaccination. Elderly adults had a lower probability of vaccination in the medical setting, and higher probability of vaccination in a retail setting, in 2013 compared to 2012. Non-medical settings continue to play an increasing role in influenza vaccination of adults, particularly for adults without a chronic condition and elderly adults. Retail and mobile settings should continue to be viewed as important mechanisms to ensure broad access to influenza vaccination. Keywords: Influenza vaccines, Place of vaccination, Adults, Age

Age and Sex Differences in Hospitalizations Associated with Diabetes

Abstract Aim: To evaluate national trends in hospitalizations and hospital charges associated with diabetes over a recent 14-year period. Methods: We evaluated hospital discharges with a primary or secondary diagnosis of diabetes (250.xx)in the Nationwide Inpatient Sample (1993?2006). Outcomes included population-adjusted estimates of hospital discharges and hospital charges (2006 $U.S.). Results: Overall, discharges associated with diabetes increased 65.3% (1,384/100,000 in 1993, 2,288/100,000 in 2006) over the 14-year period (p?<?0.001 test for trend). The largest increase in hospitalizations occurred among adults 30?39 years of age, representing a 102% increase. Among young adults, increases among women were ?1.3 times greater compared with men, for the 20?29 year (63% vs. 46%) and 30?39 year (118% vs. 85%) age groups, even after excluding pregnancy-related hospitalizations. Overall, women had higher rates of hospitalizations associated with diabetes compared with men, but there was evidence of an age by sex interaction, with higher rates of hospitalizations among women in the younger age groups and among men in the older age groups. Annual inflation-adjusted total charges for hospitalizations with diabetes increased 220% over the period. Conclusions: Large increases in diabetes hospitalizations occurring among adults aged 30?39 years and young women signal a shift in the hospital burden of diabetes.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/85088/1/jwh_2010_2029.pd

Child Passenger Safety Needs and Resources in Michigan

This study was performed to characterize child passenger safety resources in Michigan and to analyze the impact of Michigan’s child passenger safety technicians (CPSTs), who are certified to instruct caregivers on how to correctly use child restraints. The objective was to provide OHSP with the information to guide equitable distribution of child passenger safety resources throughout Michigan. Analyses used existing data from the 2010 U.S. Census, the American Community Survey 2009-2013, Michigan State Police crash reports from 2010 through 2014, Michigan Office of Highway Safety Planning (OHSP) lists of certified CPSTs and their locations from 2012 to 2015, OHSP records of child restraint system distribution, and child passenger safety checklist form data from Safe Kids Michigan. Counties were considered areas at risk (with greatest need for child passenger safety resources) based on a composite risk score that included population characteristics including minority race, Hispanic/non-English speaking, poverty, and low educational attainment and crash-related injuries or suboptimal child passenger restraint behaviors associated with a crash adjusted for the child population ≤9 years. Needs and resources were assessed for the 83 counties and 15 OHSP Traffic Safety Regions in Michigan. A survey of CPSTs in Michigan was conducted to gather data on the workforce characteristics. Results show that counties with the highest risk scores are concentrated in the southern Lower Peninsula of Michigan and the counties with the largest number of CPSTs are in the Lower Peninsula. The total number of CPSTs in Michigan has been stable around 950, with 140 to 260 new CPSTs in a given year. Only Keweenaw, Alcona, and Montmorency counties had no CPSTs who reported living or working there. The majority of CPSTs self-identified as white race. Spanish was the most common non-English language spoken by CPSTs. The largest proportions of CPSTs worked in law enforcement, social work/health education, and healthcare. Of the CPSTs considered “high-activity”, most were both paid and volunteered for seat checks and many reported an affiliation with a Safe Kids Coalition. Car seat inspection (or fitting) stations and events were offered primarily in counties throughout the southern Lower Peninsula, with the largest number in metro Detroit and Kent counties. The number of children ≤9 years per CPST per county was lowest in Gogebic (166) and highest in Jackson (4618). Forty counties had 1,000 or more children per CPST and were distributed throughout the state. Data from 32,411 Safe Kids Michigan seat checks revealed that nearly half resulted in a change in restraint type, installation method, or location in the vehicle. Half of seat checks included the distribution of a child restraint system. The most services per child ≤9 years were provided in the following OHSP regions: Thumb Area, West Michigan, South Central, Traverse Bay Area, Huron Valley, and Upper Peninsula Regions. The fewest services per child ≤9 years were provided in the Northern Lower, Southwest, Oakland, and Macomb/St. Clair Regions. In conclusion, the child passenger safety needs are not evenly distributed throughout the state. There is wide variation in the current distribution of child passenger safety resources. Many counties with the most resources have a greater unmet need than lower-resourced counties due to the large total number of children and children considered at risk living within them.https://deepblue.lib.umich.edu/bitstream/2027.42/136921/1/klinich 2016-19 report.docxDescription of klinich 2016-19 report.docx : Main articl

Validation of EpiTRAQ, a transition readiness assessment tool for adolescents and young adults with epilepsy

ObjectiveTo design and validate a transition readiness assessment tool for adolescents and young adults with epilepsy and without intellectual disability.MethodsWe adapted a general transition readiness assessment tool (TRAQ) to add epilepsy‐relevant items based on concepts in current epilepsy quality measures. The adapted tool, EpiTRAQ, maintained the original structure and scoring system. Concurrent with clinical implementation in pediatric and adult epilepsy clinics at an academic medical center, we assessed the validity and reliability of this adapted tool for patients 16‐26 years of age. This process included initial validation with 302 patients who completed EpiTRAQ between October 2017 and May 2018; repeat validation with 381 patients who completed EpiTRAQ between June 2018 and September 2019; and retest reliability among 153 patients with more than one completed EpiTRAQ.ResultsMean scores were comparable between initial and repeat validation populations (absolute value differences between 0.05 and 0.1); internal consistency ranged from good to high. For both the initial and repeat validation, mean scores and internal consistency demonstrated high comparability to the original TRAQ validation results. Upon retest, few patients rated themselves with a lower score, while the majority rated themselves with higher scores.SignificanceEpiTRAQ is a valid and reliable tool for assessing transition readiness in adolescents and young adults with epilepsy and without intellectual disability.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/162789/2/epi412427_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/162789/1/epi412427.pd