Search results

ABSTRACT: The Affordable Care Act (ACA) provides financial incentives to prevent substance use disorders (SUDs). Local health departments (LHDs) can receive funds to establish care teams that partner with primary care providers and health systems. This study estimates the potential effect of LHDs on emergency visits for SUDs, using linked data sets from the Healthcare Cost and Utilization Project Emergency Department (ED) sample for the State of Maryland-2012, the National Association of County and City Health Officials Profiles Survey 2013, and Area Health Resource File 2013 to estimate potential effect of LHDs' provision of SUD preventive care and SUD-related policy implementation. Local health department involvement in SUD-related policy during the past 2 years and provision of preventive care for behavioral health in the past year significantly reduced the probability of having a SUD-related ED visit by 11% and 6%, respectively, after controlling for individual characteristics (odds ratio [OR] = 0.89, p < .001; OR = 0.93, p < .001). After adjusting for the individual and contextual factors, LHD involvement in policy was still associated with 14% reduction in SUD-related ED visits (OR = 0.86, p < .001). Results offer insights on the extent to which the LHD activities can possibly affect SUD-related ED visits and provide a foundation for future work to identify effective LHD interventions. 

ABSTRACT: The Affordable Care Act (ACA) provides financial incentives to prevent substance use disorders (SUDs). Local health departments (LHDs) can receive funds to establish care teams that partner with primary care providers and health systems. This study estimates the potential effect of LHDs on emergency visits for SUDs, using linked data sets from the Healthcare Cost and Utilization Project Emergency Department (ED) sample for the State of Maryland-2012, the National Association of County and City Health Officials Profiles Survey 2013, and Area Health Resource File 2013 to estimate potential effect of LHDs' provision of SUD preventive care and SUD-related policy implementation. Local health department involvement in SUD-related policy during the past 2 years and provision of preventive care for behavioral health in the past year significantly reduced the probability of having a SUD-related ED visit by 11% and 6%, respectively, after controlling for individual characteristics (odds ratio [OR] = 0.89, p < .001; OR = 0.93, p < .001). After adjusting for the individual and contextual factors, LHD involvement in policy was still associated with 14% reduction in SUD-related ED visits (OR = 0.86, p < .001). Results offer insights on the extent to which the LHD activities can possibly affect SUD-related ED visits and provide a foundation for future work to identify effective LHD interventions. 

Background Atmospheric particulate matter (PM) has been associated with endothelial dysfunction, an early marker of cardiovascular risk. Our aim was to extend this research to a genetically homogenous, geographically stable rural population using location-specific moving-average air pollution exposure estimates indexed to the date of endothelial function measurement. Methods We measured endothelial function using brachial artery flow-mediated dilation (FMD) in 615 community-dwelling healthy Amish participants. Exposures to PM < 2.5 μm (PM 2.5 ) and PM < 10 μm (PM 10 ) were estimated at participants’ residential addresses using previously developed geographic information system-based spatio-temporal models and normalized. Associations between PM exposures and FMD were evaluated using linear mixed-effects regression models, and polynomial distributed lag (PDL) models followed by Bayesian model averaging (BMA) were used to assess response to delayed effects occurring across multiple months. Results Exposure to PM 10  was consistently inversely associated with FMD, with the strongest (most negative) association for a 12-month moving average (− 0.09; 95% CI: − 0.15, − 0.03). Associations with PM 2.5  were also strongest for a 12-month moving average but were weaker than for PM 10  (− 0.07; 95% CI: − 0.13, − 0.09). Associations of PM 2.5  and PM 10  with FMD were somewhat stronger in men than in women, particularly for PM 10 . Conclusions Using location-specific moving-average air pollution exposure estimates, we have shown that 12-month moving-average estimates of PM 2.5  and PM 10  exposure are associated with impaired endothelial function in a rural population.

The Impact of Expanding Public Health Insurance on Safety Net Program Participation: Evidence from the ACA Medicaid Expansion

Midwifery linked to better birth outcomes in state-by-state "report card"

Hazards of childbirth persist in rich and poor nations

Dr. MadDorman's research included in a group 40 articles seen as significant advances for the year

Maternal mortality rose nationally, doubled in Texas

Detailed examination of death certificates reframes maternal death data

Five-year R01 project will examine kin relationships in Nairobi, Kenya