Patterns of Treatment for Psychiatric Disorders Among Children and Adolesecents in Mississippi Medicaid

The nature of services for psychiatric disorders in public health systems has been understudied, particularly with regard to frequency, duration, and costs. The current study examines patterns of service reception and costs among Medicaid-covered youth newly diagnosed with anxiety, depression, or behavioral disturbance in a large data set of provider billing claims submitted between 2015–2016. Eligibility criteria included: 1) identification of an initial diagnosis of a single anxiety, unipolar mood, or specific behavioral disorder; 2) continuous Medicaid eligibility over the duration of the time period studied; and 3) under 18 years of age on the date of initial psychiatric diagnosis. The final cohort included 7,627 cases with a mean age of 10.65 (±4.36), of which 58.04% were male, 57.09% were Black, 38.97% were White, and 3.95% were of other ethnicities. Data indicated that 65.94% of the cohort received at least some follow-up services within a median 18 days of diagnosis. Of those, 54.27% received a combination of medical and psychosocial services, 32.01% received medical services only, and 13.72% received psychosocial services only. Overall median costs for direct treatment were $576.69, with wide discrepancies between the lowest (anxiety =$308.41) and highest (behavioral disturbance = $653.59) diagnostic categories. Across all categories the frequency and duration of psychosocial services were much lower than would be expected in comparison to data from a well-known effectiveness trial. Overall, follow-up to psychiatric diagnosis could be characterized as highly variable, underutilized, and emphasizing biomedical treatment. Understanding more about these patterns may facilitate systematic improvements and greater cost efficiency in the future

Prevalence of and factors associated with violations of a campus smoke-free policy: A cross-sectional survey of undergraduate students on a university campus in the USA

© 2020 Author(s). Objective: The aim of this study is to estimate the prevalence of smoking behaviour on campus and to identify the key factors that influence adherence to a campus smoke-free policy. Design & participants: This study employed a cross-sectional, self-administered survey of undergraduate students at University of Mississippi. A random sample of all available undergraduate classes was recruited for data collection. Students were provided a survey that included questions on demographics, alcohol use, smoking status, policy awareness, policy attitudes, smoking attitudes, policy support, barriers to policy success and policy violations. Results: The prevalence of past 30-day smoking was 23%. More than 63% of current smokers report ever smoking on campus, but less than 10% ever received a warning or a ticket for their violation. Nearly all respondents (92.5%) reported witnessing someone smoking on campus, and 22% reported witnessing someone receiving a ticket. Barriers to policy success include lack of reminders about the policy, lack of support from students and University administrators, and insufficient fines. Smoking behaviour (OR: 7.96; 95% CI: 5.13 to 12.36), beliefs about policy adherence (OR: 0.52; 95% CI: 0.40 to 0.69), support for the policy (OR: 0.71; 95% CI: 0.55 to 0.91) and attitudes against smoking behaviour (OR: 0.35; 95% CI: 0.25 to 0.49) were all significantly associated with self-reported policy violations. Conclusions: This study found that violations of the campus smoke-free policy were fairly frequent and the policy has been largely ineffective, indicating a need for other interventions. Approaches to improve adherence to the policy should address barriers such as reminders about the policy, better policy enforcement and support from the administration

Do Formulation and Dose of Long-Term Opioid Therapy Contribute to Risk of Adverse Events among Older Adults?

Background: Chronic non-cancer pain (CNCP) is highly prevalent in older adults and long-term opioid therapy (LTOT) has been used to manage chronic pain. However, the safety of LTOT among older adults with CNCP is not well-established and there is a need to identify therapy-related risk factors of opioid-related adverse events among older adults. Objective: To evaluate the relationship between opioid dose and formulation and the risk of opioid-related adverse events among Medicare-eligible older adults on LTOT. Design: Nested case-control study. Participants: Older Medicare beneficiaries (N=35,189) who received \u3e 3 opioid prescriptions with a total days-supply of \u3e45 days within a 90-day period for CNCP between 2012 and 2016. Main Measures: This study utilized Medicare 5% medical and prescription claims data. Outcome measures included opioid-induced respiratory depression (OIRD), opioid overdose, all-cause mortality, and a composite outcome, defined as the first occurrence of any of the previous three events. Key independent variables were opioid formulation and opioid dose (measured in morphine milligram equivalents (MME)) prescribed during LTOT. Key Results: Seventy-four OIRD, 133 overdose, 982 all-cause mortality, and 1122 composite outcome events were observed during follow-up. In unadjusted analyses, the use of combination opioids (OR: 4.52 [95%CI: 1.51–13.47]) was significantly associated with OIRD compared to short-acting (SA) opioids. In adjusted analyses, opioid-related adverse events were significantly associated with the use of LA (overdose OR: 13.00 [95%CI: 1.30–130.16] and combination opioids (overdose OR: 6.27 [95%CI: 1.91–20.55]; mortality OR: 2.75 [95%CI: 1.87–4.04]; composite OR: 2.82 [95%CI: 2.01–3.96]) when compared to SA opioids. When compared to an average dose of less than 20 MME, outcomes were significantly associated with doses of 20–50 MME (mortality OR: 1.61 [95%CI: 1.24–2.10]; composite OR: 1.59 [95%CI: 1.26–2.01]) and \u3e50 MME (mortality OR: 1.99 [95%CI: 1.28–3.10]; composite OR: 2.09 [95%CI: 1.43–3.04]). Conclusions: Older adults receiving medically prescribed opioids at higher doses and those using LA and combination of LA and SA opioids are at increased risks for opioid-related adverse events, highlighting the need for close patient supervision

Exploration of Health Technology Nonuse: The Case of Online Medical Records

Online Medical Records (OMR) platforms remain a key enabler to health management. Yet, how beliefs toward OMR and its subsequent nonuse are related is not understood. Applying the status quo bias (SQB) theory and the privacy paradox paradigm the study examines OMR nonusers and contributes to the health technology use literature. Using the Health Information National Trends Survey (HINTS) iteration 5, Cycle 1 and 3 data, mediation analysis reveals that inertia expressed as preference for speaking directly with healthcare providers predicts perceived need for OMR and partially mediates the relationship between perceived privacy concerns and need; having a chronic disease partially moderates such relationships. Thus, not all nonusers are created equal. Attaining benefits that come with capabilities and functionalities of OMR necessitates meaningful use of OMR by individuals. Healthcare providers or policymakers should intervene to dispel inertia or patient concerns to expand OMR use to facilitate healthcare decision making

Gravitational Effects upon Locomotion Posture

Researchers use actual microgravity (AM) during parabolic flight and simulated microgravity (SM) obtained with horizontal suspension analogs to better understand the effect of gravity upon gait. In both environments, the gravitational force is replaced by an external load (EL) that returns the subject to the treadmill. However, when compared to normal gravity (N), researchers consistently find reduced ground reaction forces (GRF) and subtle kinematic differences (Schaffner et al., 2005). On the International Space Station, the EL is applied by elastic bungees attached to a waist and shoulder harness. While bungees can provide EL approaching body weight (BW), their force-length characteristics coupled with vertical oscillations of the body during gait result in a variable load. However, during locomotion in N, the EL is consistently equal to 100% body weight. Comparisons between AM and N have shown that during running, GRF are decreased in AM (Schaffner et al, 2005). Kinematic evaluations in the past have focussed on joint range of motion rather than joint posture at specific instances of the gait cycle. The reduced GRF in microgravity may be a result of differing hip, knee, and ankle positions during contact. The purpose of this investigation was to compare joint angles of the lower extremities during walking and running in AM, SM, and N. We hypothesized that in AM and SM, joints would be more flexed at heel strike (HS), mid-stance (MS) and toe-off (TO) than in N

Factors Influencing Sun Protection Behaviors among Patients with Skin Cancer: An Application of the Information-Motivation-Behavioral Skills Model

© 2019 by the Dermatology Nurses\u27 Association. This study aimed to assess predictors of sun protection behaviors based on the information-motivation-behavioral skills (IMB) model among people diagnosed with nonmelanoma skin cancer (NMSC). For this descriptive, cross-sectional study, a convenience sample of 311 patients with NMSC was recruited at a medical center in Mississippi. Patients were invited to complete a face- A nd content-valid, IMB-model-based questionnaire. The average age of the participants was 64.12 (±12.02) years, and most (58.8%) were male. Most participants indicated not using sun protection behaviors while outdoors. Findings showed that sun protection behaviors were directly predicted by self-efficacy (standardized path coefficient = 0.504, p \u3c.001) and social support (standardized path coefficient = 0.199, p =.010). In addition, sun protection behavior was indirectly predicted (through self-efficacy) by social support (standardized indirect effect = 0.160, p \u3c.001) and attitudes (standardized indirect effect = 0.192, p =.001). The explained variances for self-efficacy and sun protection behaviors were 43% and 35.4%, respectively. In conclusion, the IMB model appears to be a useful theoretical framework for predicting sun protection behaviors among patients with NMSC. Sun safety intervention programs should be developed based on this theoretical model for patients with NMSC