Diagnosis Prevalence and Comorbidity in a Population of Mobile Integrated Community Health Care Patients.

INTRODUCTION: Frequent calls to 911 and requests for emergency services by individuals place a costly burden on emergency response systems and emergency departments (EDs) in the United States. Many of the calls by these individuals are non-emergent exacerbations of chronic conditions and could be treated more effectively and cost efficiently through another health care service. Mobile integrated community health (MICH) programs present a possible partial solution to the over-utilization of emergency services by addressing factors which contribute to a patient's likelihood of frequent Emergency Medical Services (EMS) use. To provide effective care to eligible individuals, MICH providers must have a working understanding of the common conditions they will encounter. OBJECTIVE: The purpose of this descriptive study was to evaluate the diagnosis prevalence and comorbidity among participants in the Queen Anne's County (Maryland USA) MICH Program. This fundamental knowledge of the most common medical conditions within the MICH Program will inform future mobile integrated health programs and providers. METHODS: This study examined preliminary data from the MICH Program, as well as 2017 Maryland census data. It involved secondary analysis of de-identified patient records and descriptive statistical analysis of the disease prevalence, degree of comorbidity, insurance coverage, and demographic characteristics among 97 program participants. Diagnoses were grouped by their ICD-9 classification codes to determine the most common categories of medical conditions. Multiple linear regression models and chi-squared tests were used to assess the association between age, sex, race, ICD-9 diagnosis groups, and comorbidity among program enrollees. RESULTS: Results indicated the most prevalent diagnoses included hypertension, high cholesterol, esophageal reflux, and diabetes mellitus. Additionally, 94.85% of MICH patients were comorbid; the number of comorbidities per patient ranged from one to 13 conditions, with a mean of 5.88 diagnoses per patient (SD=2.74). CONCLUSION: Overall, patients in the MICH Program are decidedly medically complex and may be well-suited to additional community intervention to better manage their many conditions. The potential for MICH programs to simultaneously improve patient outcomes and reduce health care costs by expanding into larger public health and addressing the needs of the most vulnerable citizens warrants further study.ScharfBM, BissellRA, TrevittJL, JenkinsJL.Diagnosis prevalence and comorbidity in a population of mobile integrated community health care patients.Prehosp Disaster Med. 2019;34(1):46-55.

Patterns and trends in adolescents' contraceptive use and discontinuation in developing countries and comparisons with adult women.

CONTEXT: The reproductive choices made by young women and men have an enormous impact on their health, schooling, employment prospects and overall transition to adulthood. As the largest cohort of young people in history enter their childbearing years, their reproductive behavior will determine the growth and size of the world's population for decades to come. METHODS: Demographic and Health Survey data from more than 40 countries were used to examine the proportions of 15-19-year-old women who are currently married or are unmarried but sexually active; their rates of contraceptive adoption, current use, discontinuation, method switching and contraceptive failure; trends in these indicators; and comparisons with older women. RESULTS: In many countries, the proportion of adolescent women using contraceptives increased substantially over the last two decades; prevalence among adolescents increased faster than among older women. Greater proportions of adolescents than of older women discontinued using a contraceptive method within a year or experienced contraceptive failure. CONCLUSIONS: Adolescent contraceptive use is growing, and compared with adult use, is characterized by shorter periods of consistent use with more contraceptive failure and more stopping for other reasons. Use through the reproductive years is likely to grow, fueled further by growth in the numbers of young people. An expanded demand for contraceptive supplies, services and information can be expected to challenge the preparedness, capacity and resources of existing family planning programs and providers.

Risk factors for unintentional injuries in children: are grandparents protective?

OBJECTIVE: We sought to identify sociodemographic and familial correlates of injury in children aged 2 to 3 years. METHODS: The Healthy Steps data set describes 5565 infants who were enrolled at birth in 15 US cities in 1996-1997 and had follow-up until they were 30 to 33 months of age. Data were linked to medical claims reporting children's medically attended office visits by age 30 to 33 months. Each claim was accompanied by a reason for the visit. An analytical sample of 3449 was derived from the children who could be effectively followed up and linked to medical charts. Missing data were imputed by using multiple imputation with chained equations. The analytical sample showed no systematic evidence of sample selection bias. Multivariate logistic regression was used to determine the odds ratios of injury events. RESULTS: Odds of medically attended injuries were decreased for children who received care from grandparents. Odds were increased for children who lived where fathers did not co-reside or in households where the parents never married. Statistical results were robust to the addition of a variety of covariates such as income, education, age, gender, and race. CONCLUSIONS: Children are at higher risk for medically attended injury when their parents are unmarried. Having grandparents as caregivers seems to be protective. Household composition seems to play a key role in placing children at risk for medically attended injuries.