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Pediatric hospitalizations for mood disorders

By on August 17, 2014 in Children's mental health, Epidemiology, Geographic variation, Health Services Research, News, Public Health

Children get hospitalized for depression and bipolar disorders.

I wasn’t aware of how frequently this happens until I got my hands on some BIG DATA – the HCUP KID database of children’s hospitalizations. My colleagues and I analyzed hospitalizations in 2000, 2003 and 2006 and published our results in the journal, Child and Adolescent Psychiatry and Mental Health in 2011. For each of these years, we were able to look at records for over 2 million hospitalizations, and able to project these to the entire number of pediatric hospitalizations in the US in those years.

Some take home points

Percentages of hospitalizations where the principal diagnosis was a mental health diagnosis

  • In children age 15-17, 13.7 to 15.2% of hospitalizations had a mental health principal diagnosis
  • In children age 10-14, 15.0 to 15.6% of hospitalizations had a mental health principal diagnosis
  • In children age 5-9, 4.4 to 4.8% of hospitalizations had a mental health principal diagnosis accounted

The incidence of hospitalizations with mood disorders as the principal diagnosis compared to the entire population of children

12.1-13.0 out of every 10,000 children were hospitalized with mood disorders as the principal diagnosis in 2000-2006.

Age

The incidence of hospitalizations for children with mood disorders increased with age – this figure uses data from 2006 to show the trend.

Children mood disorders by age

Region of the country

A surprising finding was the big differences between regions of the country. As an example, in 2006, the Western region experienced the lowest rates (10.2/10,000) while the Midwest had the highest rates (25.4/10,000). This figure shows the rates for 2000, 2003 and 2006.

children mood disorders by region of the US

Did you know?

Mood disorders including depression and bipolar disorders are a major cause of morbidity in childhood and adolescence, and hospitalizations for mood disorders are the leading diagnosis for all hospitalizations in general hospitals for children age 13 to 17.

Between 2000 and 2006, inflation-adjusted hospital charges increased from $10,600 to $16,300.

Ch 3 Health disparities associated with race and ethnicity

By on August 11, 2014 in Cultural Competence, Epidemiology, News, Pharmacy Practice, Racial and ethnic health disparities

Health disparities statistics

Chapter 3 of “What Pharmacists Need to Know About Race and Ethnicity” presents the data documenting disparities in mortality, morbidity, provision of health care, and other health indicators by race and ethnicity. The attached infographic highlights differences in life expectancy. Students are always startled to see the data and it always provokes questions and interest.

Health disparities statistics

Health disparities occur along the causal pathway from exposures and risk factors to all health outcomes.

The chapter explores disparities in life expectancy, mortality, incidence of disease, risk factors, and access to care, allowing students to explore the disparities along the pathways from causal factors to health outcomes. Students apply their skills in epidemiology, data analysis and statistics and gain a deeper understanding of how health disparities are manifested.

The figures and data are drawn from a range of government sources including the Centers for Disease Control and Prevention, Agency for Healthcare Research and Quality, and Health Resources and Services Administration. All provide extensive documentation and resources for further study, such as the CDC Health Disparities and Inequalities Report.

Ch 2 Classification of race and ethnicity in the United States

By on August 10, 2014 in Cultural Competence, News, Pharmacy Practice, Racial and ethnic health disparities

How are race and ethnicity defined in the US?

In Chapter 1 of “What Pharmacists Need to Know About Racial and Ethnic Health Disparities,  we spoke about race and ethnicity as social constructs. In Chapter 2 we pivot to describe the process used by the United States government uses to develop operational definitions of race and ethnicity to be used in carrying out government activities. It starts with the US census, where data are collected every 10 years to provide information about the US population. The definitions developed for the Census must be used by all federal agencies, as well as any other organization receiving federal funds. This covers pretty much everyone doing research on health disparities.

Classification of race and ethnicity is an unsatisfying process for a reason – it is a social construct and not based in science or biology.

Here’s the infographic.

Classification of race and ethnicity

Chapter 2 infographic

Farmer’s markets, cultural competence, pharmacy practice – do these dots connect?

By on November 20, 2013 in Cultural Competence, News, Pharmacy Practice, Racial and ethnic health disparities

A walk through the farmer’s market can be a step on the way to cultural competence.

I visited Gainesville, Florida at the end of October, and my hosts from the College of Pharmacy took me through the local farmer’s market. My attention was piqued by the sub-tropical produce such as persimmons and pecans, items I don’t see at my farmer’s market in New England. Passing up the opportunity to purchase wild boar liver and other wild boar products, I stopped in my tracks when I saw a red, fruit-like thing, exotic and new to me, the calyx of the hibiscus flower. The calyx is a capsule surrounding the seeds, and it is about an inch in diameter.

Cultural competence

Photo: Jeff McMillian, used with permission

 

The hand written sign said, “sorrelle”. Walking further we found more “sorrelle”, also labeled “roselle”, and the stand owners explained that these were used to make a tea similar to the red zinger teas we could buy in the supermarket. From this I inferred that we were looking at hibiscus, and I bought a dried sample to take home with me. Once back home, I learned that the plant has many names. The scientific name is Hibiscus sabdariffa L, but it is also called Roselle, its original Arabic name is Karkade. and other common names are Sorrel, Red sorrel, Jamaica Sorrel, Lozey, Cabitutu, Vinuela, Oseille de Guinee, Pink Lemonade Flower, Vinagrillo, Afrika Bamya, sour-sour and Florida cranberry. The names hint at the many places around the world where it is used to make teas or iced beverages, and it is easy to access recipes for the beverage, including a recipe by Martha Stewart for Hibiscus Iced Tea.

As shown on this US Department of Agriculture map, Florida is the only place in the mainland United States where this plant grows. http://plants.usda.gov/core/profile?symbol=hisa2

USDA map showing where H. sabdariffa L grows in the United States.

USDA map showing where H. sabdariffa L grows in the United States.

A number of sources refer to widely held beliefs about the herb’s efficacy in lowering blood pressure, and it is not clear where and when these beliefs arose. Even less clear is the scientific evidence supporting such beliefs. A study funded by the USDA Agricultural Research Service and Celestial Seasonings and published in 2008 reported that hibiscus tea lowered blood pressure by 7.2 in a group of pre-hypertensive and mildly hypertensive adults compared to 1.3 points in a similar group of people drinking placebo beverage. Another USDA funded study confirmed antimicrobial activity of sorrel (Hibiscus sabdariffa) on Esherichia coli 0157:H7 isolates from food, veterinary and clinical samples.  It is possible to find other studies about H. sabdariffa L, and its potential effects on blood pressure, and even cholesterol, and this might make an interesting topic for a systematic literature review.

Whether or not there is a biologic effect on health, we are left wondering about the number of people in the area drinking the beverage, as well as their beliefs about the tea. Do people believe that the herb will lower their blood pressure? If so, does this affect their adherence to pharmacologic therapies? We can begin to envision some interesting lines of inquiry. At minimum it might be an interesting way to engage the local community and learn about local customs and beliefs.

Walking around a farmer’s market (or other local sites) is a pleasant way to begin learning about a community, and a nice metaphor for one aspect of cultural competence: Go out into the community you serve, look around, ask questions, taste, learn – repeat!

References
United States Department of Agriculture Natural Resources Conservation Service Plants Profile for Hibiscus sabdariffa (roselle). Available at http://plants.usda.gov/core/profile?symbol=hisa2
Fullerton M, Khatiwada J, Johnson JU, et al., “Determination of Antimicrobial Activity of Sorrel (Hibiscus sabdariffa) on Esherichia coli 0157:H7 Isolated from Food, Veterinary, and Clinical Samples” J Med Food 2011 September 14(9):950-956. Available at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3157304/
Bliss M, “Study Shows Consuming Hibiscus Tea Lowers Blood Pressure” USDA Agricultural Research Service News 2008. Available at http://www.ars.usda.gov/is/pr/2008/081110.htm

Learning module – Patient Reported Outcomes (PROs)

By on May 10, 2013 in News, Patient Reported Outcomes (PROs)

Just released by ISPOR’s Distance Learning Program, the module, “Patient Reported Outcomes – Analysis and Interpretation”, Tamar Lasky, PhD, faculty.

Course Description

The module will review definitions of patient reported outcomes and the contexts in which they are used, including applications to health quality improvement, clinical trials and drug safety. The module will provide an overview of methodologic issues to consider when using patient reported outcomes or research with patient reported outcomes, and the concepts that are assessed by government agencies such as FDA and NIH. Measurement concepts such as content validity will be introduced, and limitations of discussed.

After the overview, the module will walk through all issues related to statistical analysis of patient reported outcomes after the instrument has been validated, calibrated, approved and finalized. Concepts related to development will be introduced only as they relate to ultimate analysis of the data (development will be covered more thoroughly in a separate module). The use of multiple endpoints and composite endpoints will be covered, as well as approaches to continuous, categorical and time to event analysis. Approaches to analysis of missing data will be introduced.

Three case studies will be used to illustrate analysis of PRO data in different contexts. The first case study will describe the work being done by PROMIS, and the status of the outcome measures available for measuring health care quality. The second case study will describe work being done in the United Kingdome National Health Service (NHS) in PROMs, and analysis of data within a health system. The final case study will illustrate the use of PROs in clinical trials, in support of FDA labeling claims. All modules will discuss statistical analysis, and interpretation of statistical results.

Learning Objectives

By the end of the Patient Reported Outcomes – Analysis and Interpretation module, you will be able to describe what patient-reported outcomes are, general statistical issues to consider when analyzing data collected from PRO instruments, and three case studies demonstrating use of PRO instruments.