Patterns and predictors of asthma-related emergency department use in Harlem.

STUDY OBJECTIVES: To assess the roles of poor access to care, psychological risk factors, and asthma severity in frequent emergency department (ED) use. DESIGN: A cross-sectional survey. SETTING: Harlem Hospital Center ED and outpatient chest clinic. PARTICIPANTS: Three hundred seventy-five adult residents of Harlem, a predominantly African-American community in New York City. MEASUREMENTS: Asthma severity was assessed by self-reported symptoms using National Asthma Education and Prevention Program guidelines, health-care utilization, and psychometric scales. RESULTS: Respondents with more severe asthma were more likely to have a primary asthma care provider, and to have had more scheduled office visits for asthma in the year prior to the interview (mean number of visits for patients with severe asthma, 3.6 visits; moderate asthma, 2.4 visits; and mild asthma, 1.7 visits). Despite having a regular source of care, 69% of respondents identified the ED as their preferred source of care; 82% visited the ED more than once in the year prior to interview (median, four visits). Persons with moderate or severe asthma were 3.8 times more likely to be frequent ED users compared to those with mild asthma (odds ratio [OR], 3.8; 95% confidence interval [CI], 2.2 to 6.6). This was the strongest predictor of frequent ED use. Other predictors of ED use were number of comorbid disorders (OR, 1.5; 95% CI, 1.1 to 2.1) and self-reported global health in the year prior to the ED visit (OR, 1.8; 95% CI, 1.2 to 2.7). Psychological characteristics were not predictive of frequent ED use when controlling for disease severity. CONCLUSIONS: Frequent ED users present with serious medical conditions. They do not substitute physician care with ED care; they augment it to address serious health needs.

Does drought increase migration? A study of migration from rural Mali during the 1983-1985 drought.

"Using data from a longitudinal panel study conducted in 1982 and 1989 in...Mali, this article demonstrates that the level of migration did not rise during the drought of 1983-1985. However, there was a dramatic increase in the migration of women and children during the severe 1983-1985 drought. Along with this increase in migration by women and children, there was a shift to short-cycle circulation, with 64 percent of the migrants adopting circular patterns. The study describes the characteristics of these migrants and recommends changes to development and migration policies that will facilitate such migrations in subsequent droughts."

The directionality and age selectivity of the health-migration relation: evidence from sequences of disability and mobility in the United States.

PIP: Evidence regarding the effects of health status on migration are mixed, with some concluding that there is a positive relation while others conclude a negative relation. This study examines the analytical bases for conflicting findings and proposes a model of the health-migration relation which allows for age selectivity, nonlinearities, interactions, and dynamic effects. Often in migration research we focus on migrant-nonmigrant differentials, which helps us to understand the cross-sectional differences between the 2 groups of persons, but it does little to elucidate the complex process by which nonmigrants become migrants. The sequence of migration and health events, from the US National Health Interview Survey from 1979-1980, show that for the population under age 45, there is little temporal connection between migration and health status changes. 2/3 of the younger population with at least 1 health or migration event migrated only, with health status changes neither preceding nor following the migration. Since the migration and health events for these persons are not associated in time, there is little basis for positing strong relations of either direction for the nonelderly. The age groups for which migration and health events are connected in time are those over age 45, and the temporal proximity becomes even more marked for the elderly. Among the elderly, the migrant-only group constituted only 10% of those with at least 1 event. As expected, for the elderly the dominant relation is health deterioration after migration, the pattern displayed by 65% of the elderly with events in the last 5 years. The elderly are also more likely to be in the Destabilized Migrant category, experiencing health status declines both before and after migration. This is also consistent with the theory that the elderly in poor health at the time of migration will be more likely to be stressed by their migration and experience further deteriorations in health. The conditional probabilities indicate that health status declines are unlikely to precipitate immediate migrations, except for those with pre-existing serious conditions or more severe activity limitations.^ieng

Changing WIC changes what children eat.

OBJECTIVE: This study assessed the impact of revisions to the USDA Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) food packages on nutritional behavior and obesity in children 0- to 4-years-old participating in the New York State (NYS) WIC program. In January 2009, NYS was the first to implement these revisions, which added fruits, vegetables, and whole grains and replaced whole milk with low(1%)-/nonfat milk for children 2- to 4-year-old. DESIGN AND METHODS: In this cross-sectional study, >3.5 million administrative records in the NYS WIC Statewide Information System (WICSIS) were analyzed at 6-month intervals from July to December 2008 (pre-implementation) through July to December 2011. Behavioral data in WICSIS were obtained from parent interview by WIC staff at mandatory certification and recertification visits. RESULTS: Comparing July to December in 2008 and 2011, increases were observed in breastfeeding initiation (72.2-77.5%); delaying introduction of solid foods until after 4 months of age (90.1-93.8%); daily fruit (87.0-91.6%), vegetable (78.1-80.8%), and whole grain consumption (59.0-64.4%) by children aged 1-4 years; and switches from whole milk to low-/nonfat milk by children aged 2-4 years (66.4-69.4%). In 1-year-old children, the proportion ≥95th percentile weight-for-recumbent length decreased from 15.1 to 14.2%; the proportion of children 2- to 4-year-old with body mass index (BMI) ≥95th percentile decreased from 14.6 to 14.2%. CONCLUSIONS: These findings demonstrate that positive changes in dietary intake and reductions in obesity followed implementation of the USDA-mandated cost-neutral revisions to the WIC food package for the hundreds of thousands of young children participating in the NYS WIC program.

Seasonality of childhood infectious diseases in Niono, Mali.

Common childhood diseases vary seasonally in Mali, much of the Sahel, and other parts of the world, yet patterns for multiple diseases have rarely been simultaneously described for extended periods at single locations. In this retrospective longitudinal (1996-2004) investigation, we studied the seasonality of malaria, acute respiratory infection and diarrhoea time-series in the district of Niono, Sahelian Mali. We extracted and analysed seasonal patterns from each time-series with the Multiplicative Holt-Winters and Wavelet Transform methods. Subsequently, we considered hypothetical scenarios where successful prevention and intervention measures reduced disease seasonality by 25 or 50% to assess the impact of health programmes on annual childhood morbidity. The results showed that all three disease time-series displayed remarkable seasonal stability. Malaria, acute respiratory infection and diarrhoea peaked in December, March (and September) and August, respectively. Finally, the annual childhood morbidity stemming from each disease diminished 7-26% in the considered hypothetical scenarios. We concluded that seasonality may assist with guiding the development of integrated seasonal disease calendars for programmatic child health promotion activities.

An interactive contextual model of migration in Ilocos Norte, the Philippines.

This paper develops and estimates an interactive contextual model of migration in Ilocos Norte, the Philippines. It focuses on how contextual features alter the effects of family class status and community development level on the family's migration decisions. The model estimates show a curvilinear relation between class status and migration, but the pattern differs in accordance with the prevalence of migration from the community in the past. In addition, the effects of socioeconomic development and agricultural commercialization patterns vary with context. These results demonstrate the importance of using interactive models for analyzing the contextual influences on migration.

Rehabilitation needs in the 1990s. Effects of an aging population.

The number of physically disabled persons has risen in the past few decades. Acute rehabilitation will continue to increase in importance as a result of the disease and age structure of the population, as well as current hospital reimbursement practices. This project quantifies the continued rise to be expected into the 1990s on the basis of increasing age of the population, using census and hospital discharge data for the state of Rhode Island, which has a population of almost 1 million and is well suited to demographic studies. Although Rhode Island's population is expected to increase by only 3% between 1980 and 1990, a 20% increase is expected for persons over age 65. Age-specific national disability rates applied to these projections show an increase of 7% in persons with activity limitations, with those over age 65 constituting 58% of those with limitations. The most severely disabled, those requiring inpatient rehabilitation, are increasing even more. Estimates of inpatient rehabilitation for the recently disabled person show an increase of 15% by methods developed here based on acute hospitalization data.

Children on the move and vaccination coverage in a low-income, urban Latino population.

OBJECTIVES: The purpose of this study was to determine the impact of childhood moves and foreign birth on vaccination coverage among Latino children in New York City. METHODS: Vaccination coverage was assessed in a survey of 314 children younger than 5 years at 2 immunization clinics. RESULTS: Forty-seven percent of the study children had moved abroad. After adjustment for health insurance, regular source of care, and country of birth, child moves had no independent effect on vaccination coverage. Foreign-born children had diphtheria-pertussis-tetanus, oral polio vaccine, and measles-mumps-rubella vaccination coverage rates similar to those of US-born children, but they were underimmunized in regard to Haemophilus influenzae type b and hepatitis B. CONCLUSIONS: Foreign birth, but not childhood moves, is a barrier to vaccinations among low-income, urban Latino children.