Role of primary care providers in a pandemic – conflicting views and future opportunities

Abstract In pandemic situations, primary care providers may be involved in a variety of roles related to disease surveillance, diagnosis and treatment, prevention, and patient education. This commentary describes the contextual factors that may influence primary care providers’ perspectives on their pandemic roles and responsibilities. These factors include the natural evolution of the pandemic situation, with early uncertainty affecting decision-making and communication; the variation in typical practice patterns and clinical expertise across and within primary care providers; and the lack of representation of practicing primary care providers in pandemic planning and decision-making bodies.http://deepblue.lib.umich.edu/bitstream/2027.42/116031/1/13584_2015_Article_54.pd

Two outcomes from one assessment process: Analysing language assessment recordings for interactional data

Dementia is rapidly becoming a prominent public health issue, with its prevalence in the Australian population predicted to rise by 251% in 2050 (Jorm, Dear & Burgess, 2005). “Dementia” is a generic psychological term used to describe the gradual decline in cognitive functioning which, in turn, causes a decline in many everyday functions (Rabins, Lyketsos & Steele, 2006). This decline in everyday functions includes a decline in language skills and consequently, communication (Thompson, 1987; 2008). There is a growing recognition that many of the everyday difficulties associated with caring for individuals with dementia are linked to these communication difficulties

Male Scarcity is Associated with Higher Prevalence of Premature Gestation and Low Birth Weight Births Across the United States

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/96668/1/ajhb22369.pd

Trends in Observation‐prone Emergency Department Visits Among Michigan Children, 2007–2011

ObjectivesTo the best of the authors’ knowledge, admission of children under observation status in community hospitals has not been examined. The hypothesis of this study was that there has been an increase in observation charge code use over time and variations in the application of observation charge codes across hospital types.MethodsThis was a cross‐sectional analysis of 5 years (2007 through 2011) of administrative claims data from Michigan residents enrolled in Medicaid, Blue Cross/Blue Shield of Michigan preferred provider organization, and Blue Cross Network health maintenance organization compiled into a single data set. Emergency department (ED) visits to facilities in Michigan made by children (younger than 18 years) were selected. Observation‐prone ED visits were identified based on the presence of International Classification of Diseases, Ninth Revision, Clinical Modification (ICD‐9‐CM) codes. Counts of observation‐prone ED visits were determined and descriptive statistics were calculated. Changes over time in the proportion of visits with observation charge codes by hospital type were assessed with chi‐square analysis.ResultsThe observation‐prone ICD‐9‐CM codes were identified in 881,622 ED visits made by children to 142 Michigan facilities during the 5‐year study period. Overall, the vast majority of visits (n = 646,499; 91.0%) with the selected ICD‐9‐CM codes resulted in discharge from the ED without associated observation or inpatient charge codes. Among the 64,288 visits that resulted in admission for observation or inpatient care, observation charge codes without inpatient charge codes were applied to 22,933 (35.7%) admissions, observation and inpatient charge codes were applied to 4,756 (7.4%) admissions, and inpatient charge codes without observation charge codes were applied to 36,599 (56.9%) admissions. Hospitals with pediatric ED and inpatient services (Type 1 and Type 2 hospitals) had higher proportions of ED visits that went on to admission for observation or inpatient care (15.9 and 10.7%) than hospitals without pediatric ED services (Type 3 and Type 4 hospitals; 7.2 and 3.7%). The proportion of admissions that had observation charge codes for all hospital types increased over time, most prominently among Type 1 and Type 2 hospitals.ConclusionsThe application of observation charge codes to Michigan children with observation‐prone conditions has increased over time across all hospital types. There is a need to evaluate pediatric observation care in diverse settings to compare the effectiveness of different models.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/111217/1/acem12624-sup-0001-DataSupplementS1.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/111217/2/acem12624-sup-0002-DataSupplementS2.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/111217/3/acem12624.pd

Overcoming the Legacy of Mistrust: African Americans’ Mistrust of Medical Profession

Recent studies show that racism still exists in the American medical profession, the fact of which legitimizes the historically long-legacy of mistrust towards medical profession and health authorities among African Americans. Thus, it was suspected that the participation of black patients in end-of-life care has always been significantly low stemmed primarily from their mistrust of the medical profession. On the other hand, much research finds that there are other reasons than the mistrust which makes African Americans feel reluctant to the end-of-life care, such as cultural-religious difference and genuine misunderstanding of the services. If so, two crucial questions are raised. One is how pervasive or significant the mistrust is, compared to the other factors, when they opt out of the end-of-life care. The other is if there is a remedy or solution to the seemingly broken relationship. While no studies available answer these questions, we have conducted an experiment to explore them. The research was performed at two Philadelphia hospitals of Mercy Health System, and the result shows that Black patients’ mistrust is not too great to overcome and that education can remove the epistemic obstacles as well as overcome the mistrust

Incremental Hospital Charges Associated With Obesity as a Secondary Diagnosis in Children

Objective: The objective was to evaluate the association of obesity as a comorbidity with hospital charges, by comparing charges for pediatric hospitalizations with vs. without obesity as a secondary diagnosis. Methods: Using the 2000 Healthcare Cost and Utilization Project (HCUP) Kids’ Inpatient Database (KID), a nationally representative sample of pediatric hospital discharges, we identified the most common non‐pregnancy‐related principal diagnoses for children 2 to 18 years of age: asthma, pneumonia, affective disorders, and appendicitis. For each we compared mean charges and mean length of stay for hospitalizations with vs. without obesity as a secondary diagnosis, adjusting for relevant socio‐demographics and hospital type. Results: Among children's discharges in 2000, 1.1% listed obesity as a secondary diagnosis. These had a disproportionate likelihood of being older, black, Medicaid beneficiaries, and hospitalized at a general hospital. Adjusted mean hospital charges were significantly higher for discharges with obesity as a secondary diagnosis vs. those without: appendicitis ($14,134 vs.$11,049; p < 0.01), asthma ($7766 vs.$6043; p < 0.05), pneumonia ($12,228 vs.$9688; p < 0.05), and affective disorders ($8292 vs.$7769; p < 0.01). Whereas obesity as a secondary diagnosis was associated with a pattern of increased adjusted mean length of stay, only asthma and affective disorders had statistically significant differences (0.6 days) ( p < 0.01). Conclusion: This national analysis suggests obesity as a secondary diagnosis is associated with significantly higher charges for the most common reasons for pediatric hospitalizations. This presents a financial imperative for further research to evaluate factors that contribute to higher inpatient charges related to obesity as a comorbidity and underscores the need for obesity prevention initiatives.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/93704/1/oby.2007.224.pd

Prescribing for Children With Rheumatic Disease: Perceived Treatment Approaches Between Pediatric and Adult Rheumatologists

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/141687/1/acr23273.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/141687/2/acr23273_am.pd

How Black Twitter and Other Social Media Communities Interact With Mainstream News

People have been forming communities using digital communication technologies since long before the web as we know it today. Social media are only the latest in a long series of digital forums that have enabled global conversations and connections around nearly any topic imaginable. With its emphasis on public accessibility and real-time content production, Twitter has become a major hub for communities of all types and sizes. The issues and voices of people of color and women have attracted much attention from professional journalists over the past few years.1 Yet many such individuals have criticized journalists’ portrayals and coverage of issues that are important to them. In response, some participants have assumed the role of news creators and distributors, focusing on their communities’ particular concerns.2 Understanding these emerging social subcultures will allow more accurate portrayals of diverse communities and yield insights for better journalistic engagement in the digital age