by You Tube | Aug 9, 2019 | ADHD, Advocacy and Policy, Assessment and Diagnosis, Bipolar, Children and Teens, Emergency, Emergency Room, General, Hospital, kids, Mental Health and Wellness, psychiatric hold, Psychiatry, Psychology, Psychology and Therapy News, Psychosis, Research, Schizophrenia, Teens
Children without health insurance who present to the emergency department (ED) for mental health issues are more likely to be transferred to another hospital compared to kids with private insurance, according to a new study by researchers at the University of California (UC) Davis Children’s Hospital and the UC Davis Department of Psychiatry.
Previous research has shown a significant increase in the number of children and teens presenting to the ED for mental health issues. Between 2012 and 2016, hospital EDs saw a 55 percent jump in kids with mental health problems, according to findings presented at a meeting of the American Academy of Pediatrics in 2018. The increase is highest among minorities.
Transferring a child from one hospital to another creates additional burdens for the patient, family and health care system as a whole. It can add to overcrowding in busy emergency departments, higher costs of care and higher out-of-pocket costs for the family.
For the study, the researchers analyzed a national sample of 9,081 acute mental health events among children in EDs. They looked at the patient’s insurance coverage and a hospital’s decision to admit or transfer patients with a mental health disorder.
“We found that children without insurance are 3.3 times more likely to be transferred than those with private insurance,” said Jamie Kissee Mouzoon, research manager for the Pediatric Telemedicine Program at UC Davis Children’s Hospital and first author on the study.
“The rate was even higher for patients presenting with bipolar disorder, attention-deficit and conduct disorders and schizophrenia.”
The findings, published in the journal Pediatric Emergency Care, reveal gaps in providing equitable and quality care to pediatric patients with mental health emergencies based on their insurance coverage.
According to James Marcin, senior author on the study, there are regulations in place to prevent EDs from making treatment decisions based on the patients’ insurance. Transferring a patient for any other reason than clinical necessity should be avoided.
“Unfortunately, the financial incentives are sometimes hard to ignore and can be even unconscious,” said Marcin, who also is director for the UC Davis Center for Health and Technology and leads the telemedicine program at UC Davis Health.
“What we have found in this study is consistent with other research that demonstrates that patients without health insurance are more likely to get transferred from clinic to clinic or hospital to hospital.”
Marcin is currently looking into how telemedicine — video visits delivered to the children who seek care in remote EDs — might be a solution to the tendency to transfer the patient to another hospital.
Source: University of California – Davis Health
by YouTube | Sep 7, 2018 | Advocacy and Policy, Alzheimer's, Assessment and Diagnosis, Brain and Behavior, Children and Teens, Cognition, Dementia, Environment, General, Genetics, Health-related, kids, Learning, LifeHelper, Memory and Perception, Mental Health and Wellness, Neuropsychology and Neurology, Pollution, Psychology, Psychology and Therapy News, Research, Students
Previous research has shown that exposure to air pollution is linked to diminished cognitive development, increased behavioral problems, and even structural differences in the brains of children. And yet the mechanisms behind these associations have remained a mystery.
In a new study, researchers at the Barcelona Institute for Global Health (ISGlobal) in Spain have discovered that a certain gene variant often implicated in Alzheimer’s disease may play a significant role in this process.
The scientists analyzed data from over 1,600 children attending 39 schools in Barcelona and observed that the association between exposure to traffic-related pollution and adverse effects on neurodevelopment was more significant in the children who carried the ε4 allele of the APOE gene.
Carriers of this genetic variant had higher behavior problem scores and their attention capacity developed more slowly. Moreover, the volume of the caudate nucleus — an anatomical brain structure — tended to be smaller in that group.
“These findings suggest that children who carry this allele could be more vulnerable to the detrimental effects that air pollution has on important aspects of their neurodevelopment,” explained Silvia Alemany, ISGlobal researcher and lead author of the study.
“Systemic inflammation and oxidative stress are two of the most well-established mechanisms underlying the adverse health effects of air pollution. Interestingly, both these mechanisms are also involved in the pathogenesis of dementia. In fact, research has demonstrated an association between exposure to air pollution and cognitive impairment in older people.”
“All these considerations, and the fact that APOE ε4 is the most important known genetic risk factor for Alzheimer’s disease, led us to wonder whether the allele might also have a relationship with the adverse effects air pollution has on brain function in children.”
Genetic data were available for all of the children. Tests were also conducted to assess cognitive function, behavioral problems and possible symptoms of attention-deficit/hyperactivity disorder (ADHD). Traffic-related air pollution levels were calculated on the basis of actual measurements. Magnetic resonance imaging (MRI) data were available for 163 of the study participants.
“More research will be needed in other populations to replicate these results and we need to establish whether this possible genetic vulnerability also applies to exposure to air pollution during earlier stages of development, for example, in the prenatal period,” warns ISGlobal researcher Jordi Sunyer, who is also director of the BREATHE project, an agency that collects and distributes scientific information on air quality in Pittsburgh, southwestern Pennsylvania and beyond.
“In any case, once again the findings are clear: it is essential to implement measures to reduce traffic in the urban environment and, particularly, in places where children are present, such as the areas around schools.”
The findings are published in the journal Environmental Health Perspectives.
Source: Barcelona Institute for Global Health (ISGlobal)
