Visit Counts Research Articles

Physician Work Hours and the Gender Pay Gap — Evidence from Primary Care

BackgroundThe gender gap in physician pay is often attributed in part to women working fewer hours than men, but evidence to date is limited by self-report and a lack of detail regarding clinical revenue and gender differences in practice style.MethodsUsing national all-payer claims and data from electronic health records, we conducted a cross-sectional analysis of 24.4 million primary care office visits in 2017 and performed comparisons between female and male physicians in the same practices. Our primary independent variable was physician gender; outcomes included visit revenue, visit counts, days worked, and observed visit time (interval between the initiation and the termination of a visit). We created multivariable regression models at the year, day, and visit level after adjustment for characteristics of the primary care physicians (PCPs), patients, and types of visit and for practice fixed effects.ResultsIn 2017, female PCPs generated 10.9% less revenue from office visits than their male counterparts (−$39,143.2; 95% confidence interval [CI], −53,523.0 to −24,763.4) and conducted 10.8% fewer visits (−330.5 visits; 95% CI, −406.6 to −254.3) over 2.6% fewer clinical days (−5.3 days; 95% CI, −7.7 to −3.0), after adjustment for age, academic degree, specialty, and number of sessions worked per week, yet spent 2.6% more observed time in visits that year than their male counterparts (1201.3 minutes; 95% CI, 184.7 to 2218.0). Per visit, after adjustment for PCP, patient, and visit characteristics, female PCPs generated equal revenue but spent 15.7% more time with a patient (2.4 minutes; 95% CI, 2.1 to 2.6). These results were consistent in subgroup analyses according to the gender and health status of the patients and the type and complexity of the visits.ConclusionsFemale PCPs generated less visit revenue than male colleagues in the same practices owing to a lower volume of visits, yet spent more time in direct patient care per visit, per day, and per year. (Funded in part by the Robert Wood Johnson Foundation.)

Implications of COVID-19 for HIV Research: data sources, indicators and longitudinal analyses.

Implications of COVID-19 for HIV Research: data sources, indicators and longitudinal analyses.

Short-Term Infectious Diarrhea Prediction Using Weather and Search Data in Xiamen, China

Infectious diarrhea has high morbidity and mortality around the world. For this reason, diarrhea prediction has emerged as an important problem to prevent and control outbreaks. Numerous studies have built disease prediction models using large-scale data. However, these methods perform poorly on diarrhea data. To address this issue, this paper proposes a parsimonious model (PM), which takes historical outpatient visit counts, meteorological factors (MFs) and Baidu search indices (BSIs) as inputs to perform prediction. An experimental evaluation was done to compare the short-term prediction performance of ten algorithms for four groups of inputs, using data collected in Xiamen, China. Results show that the proposed method is effective in improving the prediction accuracy.

The Impact of the “Muslim Ban” Executive Order on Healthcare Utilization in Minneapolis-St. Paul, Minnesota

Background: On January 27, 2017, President Trump issued Executive Order (EO) 13769, “Protecting the Nation from Foreign Terrorist Entry into the United States,” which suspended the U.S. Refugee Resettlement program and prevented citizens from seven Muslim-majority countries (Iraq, Syria, Iran, Libya, Somalia, Sudan, and Yemen) from traveling or immigrating to the U.S. The impact of EO 13769 on healthcare utilization among people from EO-targeted nations is unknown. Methods: We conducted a retrospective review of primary care and emergency department (ED) visits to HealthPartners clinics and hospitals in Minneapolis-St. Paul, Minnesota, home to the largest Somali Muslim community in the U.S. We compared visit counts, missed appointments, and visits for stress-responsive diagnoses before and after EO issuance among three groups: 1) adults born in EO-targeted nations, 2) adults born in Muslim-majority nations not listed in the EO, and 3) U.S.-born non-Latinx adults. We evaluated visit trends using linear regression and differences between groups using difference-in-difference analyses. Findings: From 2016 to 2017, 252,594 patients were included in the analysis: 5,667 (2.2%) in Group 1, 1,254 (0.5%) in Group 2, and 245,673 (97.3%) in Group 3. In early 2016, primary care visits and stress-responsive diagnoses dramatically increased for individuals from Muslim majority nations (Groups 1 and 2). Following EO 13769 issuance, there was no change in missed clinic appointments and an increase in ED visits among individuals from EO-targeted nations, particularly in the first 30- to 60-days after issuance. Interpretation: Increases in clinic utilization among people born in Muslim majority countries before EO 13769 issuance and subsequent increased ED utilization by people from EO-targeted nations likely reflect elevated cumulative stress due to an increasingly hostile climate toward Muslims in the U.S., rather than one specific policy change. Funding Statement: This study was not supported by any funding source. Declaration of Interests: The authors have no conflicts of interest to disclose. Dr. Gonsalves is supported by the National Institutes of Health National Institute on Drug Abuse (1DP2DA049282-01 and 2 R37 DA15612-16) and the National Institute of Allergy and Infectious Diseases (5R01AI042006-23). Dr. Padela receives grant support from the US Department of Health and Human Services Health Resources and Services Administration, the Greenwall Making a Difference Program, and Patient Centered Outcomes Research Institute. Dr. Samuels is supported by an Advance Clinical and Translational Research (Advance-CTR U54GM115677) Mentored Research Award. Ethics Approval Statement: This study was approved by the HealthPartners and Yale Institutional Review Boards.

Particulate matter and emergency visits for asthma: a time-series study of their association in the presence and absence of wildfire smoke in Reno, Nevada, 2013\u20132018

BackgroundHealth risks due to particulate matter (PM) from wildfires may differ from risk due to PM from other sources. In places frequently subjected to wildfire smoke, such as Reno, Nevada, it is critical to determine whether wildfire PM poses unique risks. Our goal was to quantify the difference in the association of adverse asthma events with PM on days when wildfire smoke was present versus days when wildfire smoke was not present.MethodsWe obtained counts of visits for asthma at emergency departments and urgent care centers from a large regional healthcare system in Reno for the years 2013–2018. We also obtained dates when wildfire smoke was present from the Washoe County Health District Air Quality Management Division. We then examined whether the presence of wildfire smoke modified the association of PM2.5, PM10–2.5, and PM10 with asthma visits using generalized additive models. We improved on previous studies by excluding wildfire-smoke days where the PM concentration exceeded the maximum PM concentration on other days, thus accounting for possible nonlinearity in the association between PM concentration and asthma visits.ResultsAir quality was affected by wildfire smoke on 188 days between 2013 and 2018. We found that the presence of wildfire smoke increased the association of a 5 μg/m3 increase in daily and three-day averages of PM2.5 with asthma visits by 6.1% (95% confidence interval (CI): 2.1–10.3%) and 6.8% (CI: 1.2–12.7%), respectively. Similarly, the presence of wildfire smoke increased the association of a 5 μg/m3 increase in daily and three-day averages of PM10 with asthma visits by 5.5% (CI: 2.5–8.6%) and 7.2% (CI: 2.6–12.0%), respectively. We did not observe any significant increases in association for PM10–2.5 or for seven-day averages of PM2.5 and PM10.ConclusionsSince we found significantly stronger associations of PM2.5 and PM10 with asthma visits when wildfire smoke was present, our results suggest that wildfire PM is more hazardous than non-wildfire PM for patients with asthma.

A Method for Grouping Emergency Department Visits by Severity and Complexity.

IntroductionTriage functions to quickly prioritize care and sort patients by anticipated resource needs. Despite widespread use of the Emergency Severity Index (ESI), there is still no universal standard for emergency department (ED) triage. Thus, it can be difficult to objectively assess national trends in ED acuity and resource requirements. We sought to derive an ESI from National Hospital Ambulatory Medical Care Survey (NHAMCS) survey items (NHAMCS-ESI) and to assess the performance of this index with respect to stratifying outcomes, including hospital admission, waiting times, and ED length of stay (LOS).MethodsWe used data from the 2010–2015 NHAMCS, to create a measure of ED visit complexity based on variables within NHAMCS. We used NHAMCS data on chief complaint, vitals, resources used, interventions, and pain level to group ED visits into five levels of acuity using a stepwise algorithm that mirrored ESI. In addition, we examined associations of NHAMCS-ESI with typical indicators of acuity such as waiting time, LOS, and disposition. The NHAMCS-ESI categorization was also compared against the “immediacy” variable across all of these outcomes. Visit counts used weighted scores to estimate national levels of ED visits.ResultsThe NHAMCS ED visits represent an estimated 805,726,000 ED visits over this time period. NHAMCS-ESI categorized visits somewhat evenly, with most visits (42.5%) categorized as a level 3. The categorization pattern is distinct from that of the “immediacy” variable within NHAMCS. Of admitted patients, 89% were categorized as NHAMCS-ESI level 2–3. Median ED waiting times increased as NHAMCS-ESI levels decreased in acuity (from approximately 14 minutes to 25 minutes). Median LOS decreased as NHAMCS-ESI decreased from almost 200 minutes for level 1 patients to nearly 80 minutes for level 5 patients.ConclusionWe derived an objective tool to measure an ED visit’s complexity and resource use. This tool can be validated and used to compare complexity of ED visits across hospitals and regions, and over time.

Trends in Emergency Department Visits and Hospital Admissions in Health Care Systems in 5 States in the First Months of the COVID-19 Pandemic in the US

As coronavirus disease 2019 (COVID-19) spread throughout the US in the early months of 2020, acute care delivery changed to accommodate an influx of patients with a highly contagious infection about which little was known. To examine trends in emergency department (ED) visits and visits that led to hospitalizations covering a 4-month period leading up to and during the COVID-19 outbreak in the US. This retrospective, observational, cross-sectional study of 24 EDs in 5 large health care systems in Colorado (n = 4), Connecticut (n = 5), Massachusetts (n = 5), New York (n = 5), and North Carolina (n = 5) examined daily ED visit and hospital admission rates from January 1 to April 30, 2020, in relation to national and the 5 states' COVID-19 case counts. Time (day) as a continuous variable. Daily counts of ED visits, hospital admissions, and COVID-19 cases. A total of 24 EDs were studied. The annual ED volume before the COVID-19 pandemic ranged from 13 000 to 115 000 visits per year; the decrease in ED visits ranged from 41.5% in Colorado to 63.5% in New York. The weeks with the most rapid rates of decrease in visits were in March 2020, which corresponded with national public health messaging about COVID-19. Hospital admission rates from the ED were stable until new COVID-19 case rates began to increase locally; the largest relative increase in admission rates was 149.0% in New York, followed by 51.7% in Massachusetts, 36.2% in Connecticut, 29.4% in Colorado, and 22.0% in North Carolina. From January through April 2020, as the COVID-19 pandemic intensified in the US, temporal associations were observed with a decrease in ED visits and an increase in hospital admission rates in 5 health care systems in 5 states. These findings suggest that practitioners and public health officials should emphasize the importance of visiting the ED during the COVID-19 pandemic for serious symptoms, illnesses, and injuries that cannot be managed in other settings.

Differential time-lag effects of ambient PM2.5 and PM2.5-bound PAHs on asthma emergency department visits.

Epidemiological studies have suggested the effects of ambient fine particles (PM2.5) on asthma, but the effects of specific components of PM2.5 on asthma remain to be explored. Here, we studied the effect of PM2.5-bound polycyclic aromatic hydrocarbons (PAHs) on asthma acute exacerbation. The data on daily counts of emergency room visits (ERVs) were obtained from Wan Fang Medical Center, Taipei, Taiwan, from 2012 to 2015. The daily concentrations of PM2.5 and pollutant gases were obtained from a local air quality monitoring station. The levels of PM2.5-bound PAH were estimated by an established grid-scale model. Relative risks for ERVs as the increase in the level of ambient pollutants were calculated by using a generalized additive model of Poisson regression. In the present study, we observed statistically significant positive associations between PM2.5 and asthma ERVs for all age groups. PM2.5-bound PAH was also associated with asthma ERVs for all age groups. In the adult subgroup analysis, there was a significant association between PM2.5-bound PAH and asthma ERVs at lags 1 and 2 (RR 1.289, 95% CI 1.050-1.582 and RR 1.242, 95% CI 1.039-1.485). The impacts of air pollution on the risk of pediatric asthma ERV were found to be significant for PM2.5 at lag day 0 (RR 1.310, 95% CI 1.069-1.606). Moreover, pediatric asthma ERVs were significantly associated with the levels of PM2.5-bound PAH at lag 1 and 2 days (RR 1.576, 95% CI 1.371-1.810 and RR 1.426, 95% CI 1.265-1.607). The study provides evidence that PM2.5-bound PAHs were associated with an increased risk of asthma attacks. Our data further suggested that traffic exhaust is a primary source of PM2.5-bound PAHs.

Resource Utilization in the First 2 Years Following Operative Correction for Tetralogy of Fallot: Study Using Data From the Optum's De-Identified Clinformatics Data Mart Insurance Claims Database.

BackgroundDespite excellent operative survival, correction of tetralogy of Fallot frequently is accompanied by residual lesions that may affect health beyond the incident hospitalization. Measuring resource utilization, specifically cost and length of stay, provides an integrated measure of morbidity not appreciable in traditional outcomes.Methods and ResultsWe conducted a retrospective cohort study, using de‐identified commercial insurance claims data, of 269 children who underwent operative correction of tetralogy of Fallot from January 2004 to September 2015 with ≥2 years of continuous follow‐up (1) to describe resource utilization for the incident hospitalization and subsequent 2 years, (2) to determine whether prolonged length of stay (>7 days) in the incident hospitalization was associated with increased subsequent resource utilization, and (3) to explore whether there was regional variation in resource utilization with both direct comparisons and multivariable models adjusting for known covariates. Subjects with prolonged incident hospitalization length of stay demonstrated greater resource utilization (total cost as well as counts of outpatient visits, hospitalizations, and catheterizations) after hospital discharge (P<0.0001 for each), though the number of subsequent operative and transcatheter interventions were not significantly different. Regional differences were observed in the cost of incident hospitalization as well as subsequent hospitalizations, outpatient visits, and the costs associated with each.ConclusionsThis study is the first to report short‐ and medium‐term resource utilization following tetralogy of Fallot operative correction. It also demonstrates that prolonged length of stay in the initial hospitalization is associated with increased subsequent resource utilization. This should motivate research to determine whether these differences are because of modifiable factors.

Examining the relationship between ambient carbon monoxide, nitrogen dioxide, and mental health-related emergency department visits in California, USA

Growing evidence suggests air pollutants may harm the central nervous system, potentially impacting mental health. However, such impacts of air pollutants on mental health and the sub-populations most affected remain poorly understood, especially in California. We examined the relationship between short-term ambient carbon monoxide (CO), nitrogen dioxide (NO2), and mental health-related emergency department (ED) visits in California from 2005 to 2013. Daily mean concentrations of the pollutants were acquired from the U.S. Environmental Protection Agency Air Quality System Data Mart ground monitoring data. Moving averages of pollutant concentrations were linked to counts of ED visits obtained from the California Office of Statewide Health Planning and Development. Seven mental health outcomes, defined by International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes, were studied: all mental disorders, bipolar disorder, depression, schizophrenia, substance abuse, homicide/inflicted injury, and suicide/self-harm. Monitor-level associations were estimated with quasi-Poisson regression models and combined using random-effects meta-analysis. CO and NO2 were found to be positively associated with ED visits due to homicide/inflicted injury, with the warm season (May–October) driving the CO association. An interquartile range (IQR) (0.28 ppm) increase in two-day average CO during the warm season was associated with a 3.13% (95% confidence interval (CI): 1.43, 4.84) elevation in risk of an ED visit due to homicide/inflicted injury (n = 122,749 ED visits). An IQR (10.79 ppb) increase in two-day average NO2 was associated with a 2.60% (95% CI: 1.17, 4.05) elevation in risk of an ED visit due to homicide/inflicted injury (n = 206,919 ED visits). Subgroup analyses indicated children, Hispanics, and males were particularly vulnerable. Except for an inverse relationship between NO2 and substance abuse, neither pollutant was robustly associated with visits due to other mental health morbidities. Our results suggest short-term elevations in CO and NO2 may promote violent behavior. Further investigation in other populations and ranges of air pollution exposure is warranted.

Esthetic perception of clear aligner therapy attachments using eye-tracking technology

The purpose of this research was to assess and compare esthetic perceptions of clear aligner therapy with attachments and esthetic brackets by measuring differences in eye fixations using eye-tracking technology. The sample involved 250 adult subjects. The subjects gave verbal consent, then viewed photographs showing 4 variations of orthodontic appliances: clear aligner control with minimal attachments, clear aligner with anterior and posterior attachments, esthetic brackets, and clear aligner with posterior attachments. Images were displayed for 6seconds each on a computer monitor. Location and time to first fixation, total fixation duration, and total visit count and duration for each type of appliance were measured. Subjects were then asked to complete an online survey. Participants spent the least amount of time looking at the photograph of the control, followed by those of the ceramic brackets, posterior attachments, and anterior and/or posterior attachments. The anterior and/or posterior image had the least number of visits but garnered the longest visit duration (1.32 visits averaging 0.74seconds per visit). This was followed by the images of the posterior attachments (1.40 visits, 0.70seconds per visit), ceramic brackets (1.43 visits, 0.65seconds per visit), and minimal attachments control (1.45 visits, 0.61seconds per visit). The hierarchy of most preferred appliances across all 250 respondents was as follows: minimal attachments control, ceramic brackets, posterior attachments, and anterior and/or posterior attachments. Overall, 88.4% of subjects would compromise appliance esthetics during treatment for a better outcome (n=221). Eye-tracking data show that time to the first fixation was negatively correlated with its survey ranking and that an increase in attachments led to an increase in total fixation duration. There is a general desire for clear aligners without attachments and ceramic brackets over clear aligners with multiple attachments. Survey data suggest that although respondents viewed appliance esthetics as highly important, nearly all would compromise appliance esthetics during treatment if it resulted in a better outcome.

Exploring spatio-temporal patterns in mental health related emergency department use from children and adolescents

To understand the spatio-temporal patterns and associated risk factors with the frequency, we analyze records of mental health related emergency department (MHED) visits from youth. The data are extracted for the period 2002--2011 from the population-based, provincial health administrative data systems of Alberta, Canada. Guided by a descriptive analysis, we conduct generalized linear regression analyses of the counts of MHED visits from various health areas. Seasonal effects are examined via three different types of functions, including trigonometric functions. We specify the temporal correlation using an autoregressive model of order 1 and formulate the spatial correlation by a random effects model. Our analysis reveals a strong seasonal pattern and indicates that the MHED visit counts are significantly associated with age, gender, and a proxy for socio-economic status. The final statistical model may be used to forecast future MHED use and identify regions and groups at a higher risk to the MHEDs.

Social determinants and emergency department utilization: Findings from the Veterans Health Administration

BackgroundSocial determinants of health (SDH) are strong predictors of morbidity and mortality but health care systems struggle to integrate documentation of SDH into health records in ways that can be used for health services research. Given the impact of social factors on health, it is important to examine the relationship with emergency department (ED) utilization. ObjectiveTo examine the association between seven indicators of SDH and ED utilization using electronic health record (EHR) data from the Veterans Health Administration (VHA). MethodsThis cross-sectional analysis included data from all patients who had at least one health care visit in the Veterans Integrated Service Network region 4 from October 1, 2015 through September 30, 2016 (n=293,872). Seven categories of adverse SDH included violence, housing instability, employment or financial problems, legal problems, social or family problems, lack of access to care or transportation, and non-specific psychosocial needs identified through structured coding in EHR. Negative binomial regression was used to examine the association of the count of adverse SDH (0–7) with the count of ED visits, adjusting for socio-demographic and health-related factors. ResultsApproximately 18% of patients visited the ED during the observation period. After adjusting for covariates, adverse SDH were positively associated with VHA ED utilization. Each of the SDH indicators, other than legal issues, was positively associated with increased ED utilization. ConclusionEven after accounting for several demographic and health-related factors, adverse SDH demonstrated strong positive associations with VHA ED utilization.

Vehicle to Grid Frequency Regulation Capacity Optimal Scheduling for Battery Swapping Station Using Deep Q-Network

Battery swapping stations (BSSs) are ideal candidates for fast frequency regulation services (FFRS) due to their large battery stock capacity. In addition, BSSs can precharge batteries for customers and the batteries that are not in charging can provide a stable regulation capacity to the market. However, uncertainties, such as ACE signals and the EV per-hour visit counts, introduce stochastic nonlinear dynamics into the operation of a BSS-based FFRS. Currently, there is no quantification method to ensure its optimal economical operation. To close this gap, in this article, we propose a novel deep Q-learning-based FFRS capacity dynamic scheduling strategy. This method can autonomously schedule the hourly regulation capacity in real time to maximize the BSS's revenue for providing FFRS. Case studies using real-world data verify the efficacy of the proposed work.

Unmet Social Needs in the Prenatal Period: Effects on Birth Outcomes and Child Health [39O

INTRODUCTION: The impact of prenatal social needs, including food insecurity, on both perinatal and child health is not fully understood. It is clear that childhood social needs negatively impact child developmental and health outcomes. This study examines the extent to which prenatal social needs are associated with adverse pregnancy and child health outcomes. METHODS: We conducted a retrospective chart review of 268 mother-child dyads receiving prenatal and pediatric care at a large public, academically affiliated safety net medical center. All mother-child dyads who completed any pediatric clinic social need screening between October 2018 and July 2019 were included in the study. IRB approval obtained from LA-Biomed. RESULTS: Mothers who experienced prenatal food insecurity had higher odds of experiencing various social needs in the pediatric setting (odds ratio [OR] 3.57; 95% confidence interval [CI] 1.52–8.35, P=.003). Mothers experiencing prenatal food insecurity had 4.45 higher odds of having a child that was born premature at fewer than 36 weeks gestation (95% CI 1.33–14.91, P=.016). Mothers who had prenatal food insecurity also had children with higher counts of inpatient visits (incidence rate ratio [IRR] 2.49, 95% CI 1.07–5.82, P=.035) and missed immunizations (IRR 1.25, 95% CI 0.15–2.35, P=.026) in the first 6 months of life. CONCLUSION: Prenatal social needs, especially food insecurity, were found to be associated with adverse perinatal and pediatric outcomes, including prematurity, inpatient hospitalizations, and missed vaccinations. Social needs in the prenatal period may offer opportunities to intervene and reduce their impact on both perinatal and child health as well as family well-being.

A geographic identifier assignment algorithm with Bayesian variable selection to identify neighborhood factors associated with emergency department visit disparities for asthma

BackgroundEcologic health studies often rely on outcomes from health service utilization data that are limited by relatively coarse spatial resolutions and missing geographic information, particularly neighborhood level identifiers. When fine-scale geographic data are missing, the ramifications and strategies for addressing them are not well researched or developed. This study illustrates a novel spatio-temporal framework that combines a geographic identifier assignment (i.e., geographic imputation) algorithm with predictive Bayesian variable selection to identify neighborhood factors associated with disparities in emergency department (ED) visits for asthma.MethodsED visit records with missing fine-scale spatial identifiers (~ 20%) were geocoded using information from known, coarser, misaligned spatial units using an innovative geographic identifier assignment algorithm. We then employed systematic variable selection in a spatio-temporal Bayesian hierarchical model (BHM) predictive framework within the NIMBLE package in R. Our novel methodology is illustrated in an ecologic case study aimed at identifying neighborhood-level predictors of asthma ED visits in South Carolina, United States, from 1999 to 2015. The health outcome was annual ED visit counts in small areas (i.e., census tracts) with primary diagnoses of asthma (ICD9 codes 493.XX) among children ages 5 to 19 years.ResultsWe maintained 96% of ED visit records for this analysis. When the algorithm used areal proportions as probabilities for assignment, which addressed differential missingness of census tract identifiers in rural areas, variable selection consistently identified significant neighborhood-level predictors of asthma ED visit risk including pharmacy proximity, average household size, and carbon monoxide interactions. Contrasted with common solutions of removing geographically incomplete records or scaling up analyses, our methodology identified critical differences in parameters estimated, predictors selected, and inferences. We posit that the differences were attributable to improved data resolution, resulting in greater power and less bias. Importantly, without this methodology, we would have inaccurately identified predictors of risk for asthma ED visits, particularly in rural areas.ConclusionsOur approach innovatively addressed several issues in ecologic health studies, including missing small-area geographic information, multiple correlated neighborhood covariates, and multiscale unmeasured confounding factors. Our methodology could be widely applied to other small-area studies, useful to a range of researchers throughout the world.

Ambient air pollution and sickle cell disease-related emergency department visits in Atlanta, GA

BackgroundSickle cell disease (SCD) is an inherited, autosomal recessive blood disorder, among the most prevalent genetic diseases, globally. While the genetic and hemolytic dynamics of SCD have been well-characterized, the etiology of SCD-related pathophysiological processes is unclear. Although limited, observational evidence suggests that environmental factors, including urban air pollution, may play a role. Objectives: We assessed whether daily ambient air pollution concentrations are associated with corresponding emergency department (ED) visit counts for acute SCD exacerbations in Atlanta, Georgia, during a 9-year (2005–2013) period. We also examined heterogeneity in response by age and sex. MethodsED visit data were from 41 hospitals in the 20-county Atlanta, GA area. Associations between daily air pollution levels for 8 urban air pollutants and counts of SCD related ED visits were estimated using Poisson generalized linear models. Results: We observed positive associations between pollutants generally indicative of traffic emissions and corresponding SCD ED visits [e.g., rate ratio of 1.022 (95% CI: 1.002, 1.043) per interquartile range increase in carbon monoxide]. Age stratified analyses indicated stronger associations with traffic pollutants among children (0–18 years), as compared to older age strata. Associations involving other pollutants, including ozone and particulate matter and for models of individuals >18 years old, were consistent a null hypothesis of no association. DiscussionThis analysis represents the first North American study to examine acute risk among individuals with SCD to urban air pollution and provide evidence of urban air pollution, especially from traffic sources, as a trigger for acute exacerbations. These findings are consistent with a hypothesis that biological pathways, including several centrally associated with oxidative stress, may contribute towards enhanced susceptibility in individuals with SCD.

The Impact of Heat Waves on Emergency Department Visits in Roanoke, Virginia

The Impact of Heat Waves on Emergency Department Visits in Roanoke, Virginia

Different levels of associations between medical co-morbidities and preterm birth outcomes among racial/ethnic women enrolled in Medicaid 2014\u20132015: retrospective analysis

BackgroundThe causes of preterm birth are multi-dimensional, including delayed and inadequate prenatal services as well as other medical and socioeconomic factors. This study aimed to examine the different levels of association between preterm birth and major medical co-morbidities among various racial/ethnic women enrolled in Medicaid.MethodsThis is a retrospective analysis of 457,200 women aged between 15 and 44 with a single live birth from the IBM® MarketScan® Multi-State Medicaid Database from 2014 to 2015. Preterm birth, defined by delivery before 37 completed weeks of gestation, was the primary dependent variable. All births were dichotomously categorized as either preterm or full-term birth using the International Classification of Diseases, Ninth Revision, Clinical Modification codes. Independent variables included race/ethnicity, categorized as non-Hispanic white, non-Hispanic black, Hispanic, or other. Medical co-morbidities included smoking, drug dependence, alcohol dependence, diabetes, and hypertension. Total healthy prenatal visit count and high-risk prenatal visit encounters identified during 30 weeks prior to the delivery date were included in the analysis.ResultsA significantly higher preterm birth rate was found in black women after controlled for medical co-morbidities, age, prenatal visit count, and high-risk pregnancy. Different levels of association between preterm birth outcome and major medical co-morbidities were examined among various racial/ethnic women enrolled in Medicaid. Drug dependence was associated with higher odds of preterm birth in black (OR = 2.56, 95% CI [1.92–3.41]) and white women (OR = 2.12, 95% CI [1.91–2.34]), when controlled for other variables. In Hispanic women, diabetes (OR=1.44, 95% CI [1.27, 1.64]) and hypertension (OR=1.98, 95% CI [1.74, 2.26]) were associated with higher odds of preterm birth. White women diagnosed with drug dependence had a 14.0% predicted probability of preterm birth, whereas black women diagnosed with drug dependence had a predicted probability of preterm birth of 21.5%.ConclusionsThe associations of medical co-morbidities and preterm births varied across racial and ethnic groups of women enrolled in Medicaid. This report calls for future research on racial/ethnic disparity in preterm birth to apply integrative and qualitative approaches to understand the disparity from a contextual perspective, especially for vulnerable pregnant women like Medicaid enrollees.

Analítica web en revistes acadèmiques d''accés obert : justificació, planificació i aplicacions

espanolPanoramica de recursos y estrategias de analitica web utiles en la configuracion de soluciones de captacion de estadisticas de uso y de evaluacion de audiencias en revistas academicas de acceso abierto. Se contempla un conjunto de metricas complementarias a las citas para ayudar a los editores y gestores de revistas a proveer evidencias del desempeno de la revista en conjunto y de cada articulo en particular en el entorno web. Mediante las mediciones y los indicadores seleccionados se busca generar valor anadido a la gestion editorial para asegurar su sostenibilidad. La propuesta se configura en torno a tres ambitos: recuento de consultas y descargas, optimizacion del sitio web o de las campanas de atraccion de visitas, y elaboracion de un cuadro de mando para la evaluacion estrategica. Se concluye que, a partir de la elaboracion de planes de medicion del desempeno web, basados en los recursos y propuestas analizadas, las revistas pueden estar en mejores condiciones de abordar con evidencias la mejora de la capacidad de atraccion de autores y lectores, asi como facilitar la rendicion de cuentas a los actores implicados en el proceso editorial de la publicacion en acceso abierto. EnglishAn overview is presented of resources and web analytics strategies useful in setting solutions for capturing usage statistics and assessing audiences for open access academic journals. A set of complementary metrics to citations is contemplated to help journal editors and managers to provide evidence of the performance of the journal as a whole, and of each article in particular, in the web environment. The measurements and indicators selected seek to generate added value for editorial management in order to ensure its sustainability. The proposal is based on three areas: counts of visits and downloads, optimization of the website alongside with campaigns to attract visitors, and preparation of a dashboard for strategic evaluation. It is concluded that, from the creation of web performance measurement plans based on the resources and proposals analysed, journals may be in a better position to plan the data-driven web optimization in order to attract authors and readers and to offer the accountability that the actors involved in the editorial process need to assess their open access business model. catalaPanoramica de recursos i estrategies d'analitica web utils en la configuracio de solucions de captacio d'estadistiques d'us i d'avaluacio d'audiencies en revistes academiques d'acces obert. S'analitzen un conjunt de metriques complementaries a les citacions per ajudar els editors i gestors de revistes a proveir mostres de l'acompliment de la revista en conjunt i de cada article en particular en l'entorn web. Mitjancant els mesuraments i els indicadors seleccionats es busca generar valor afegit a la gestio editorial per assegurar-ne la sostenibilitat. La proposta es configura al voltant de tres ambits: recompte de consultes i descarregues, optimitzacio del lloc web o de les campanyes d'atraccio de visites, i elaboracio d'un quadre de comandament per a l'avaluacio estrategica. Es conclou que, a partir de l'elaboracio de plans de mesurament de l'acompliment web, basats en els recursos i propostes analitzades, les revistes poden estar en millors condicions d'abordar amb mostres la millora de la capacitat d'atraccio d'autors i lectors, aixi com facilitar la rendicio de comptes als actors implicats en el proces editorial de la publicacio en acces obert.