Overweight among Children with Attention Deficit Hyperactivity Disorder

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  • agencies in the USA, the YAI/National Institute for People with

    described incidence of Hispanic children with physical and mental

    ealthDisabilities that provides a wide range of services, including health care,

    to individuals with ID. The development of a more comprehensive

    assessment of an individuals risk factors for obesity and an improved

    method for tracking changes to and the recombination of psychotropic

    and/or antipsychotic medication to limit weight gain by medical staff will

    be outlined.

    Re-assessing physical disability among US medical schools

    Demetrius Moutsiakis, MD, MPH, School of Public Health and Health

    Professions, University at Buffalo, Buffalo, NY

    Thomas Polisoto, MD, Department of Rehabilitation Medicine, Erie

    County Medical Center, Buffalo, NY

    In 1996, one survey aimed to assess the prevalence of physical

    disabilities among medical school graduates in the 1987 through 1990

    graduating classes. The study reported 64 graduating medical students

    with documented physical disability. This comprised 0.19% of the 33,138

    students who graduated from the 67 medical schools.

    This study seeks to determine what effects, if any, the passage of the

    Americans with Disabilities Act (ADA) of 1991 has had on the admission

    rate of individuals with disabilities. A questionnaire is sent to the deans of

    student affairs at all accredited medical schools in the United States and

    Puerto Rico (n5 125) in attempts to determine: (1) the prevalence of

    medical students with physical disabilities (MSPD) who graduated during

    the years 2000-2007, (2) the types of physical disabilities present, (3) the

    onset of disabilities, either before or during medical school, and (4) the

    academic standing of MSPD.

    To date, 10medical schools have returned their completed surveys.On the

    one hand, results appear to be favorable: 0.23% of the graduating medical

    students reported having documented disability. On the other hand, only

    two schools accounted for 85% of all graduating medical students with

    documented physical disability. Half of the medical schools reported

    having no graduating medical students with documented physical disability.

    These results represent disturbing trends among US medical schools.

    Texas disabled Hispanic children: A quest for healthcare access

    Katandria L. Johnson, MA, MS, CCC-SLP, Social and Behavioral Sciences

    Department, University of North Texas Health Science Center at Fort

    Worth, Fort Worth, TX

    Julius Larry, MPHc, Health Management and Policy, School of Public

    Health, University of North Texas Health Science Center, Fort Worth, TX

    Alberto Coustasse, MD,MBA, DrPH, Health Management and Policy,

    School of Public Health, University of North Texas Health Science Center,

    Fort Worth, TX

    This study was designed to identify and describe barriers to andThere is increasing recognition that medication use, specifically

    psychotropic medication, can cause significant weight gain. Given that

    30-50% of adults with ID are dually diagnosed and receive psychotropic

    medication and/or antipsychotic mediation, medication use amongst this

    group has become an important factor in the treatment of individualswith ID.

    Given the consequences of obesity and being overweight, and the

    potential to significantly reverse these consequences by returning to

    a normal body weight, the goal of this presentation is two-fold. The first

    goal is discuss the results from a study examining the relations between

    challenging behaviors, psychiatric care, medical conditions, and obesity

    in adults with ID living in a group home setting.

    The second goal of this presentation will be to describe the development and

    implementation of an obesity center in one of the largest not-for-profit

    Abstracts / Disability and Hfacilitators of healthcare access for the Hispanic pediatric population with

    physical and mental disabilities.disabilities in the U.S. less than 18 years, which parents or guardians

    reported the quality of health care services provided and their barriers to

    access to healthcare was also performed.

    Results revealed healthcare access disparities related to race/ethnicity, and

    socioeconomic status still persist in the U.S. healthcare system. For patients,

    the primary barrier to healthcare access was linked to lack of insurance and

    secondary and tertiary barriers were lack of linguistic and cultural

    competency of the front end and provider, respectively. Specific statistical

    findings from the NHDR illustrated that families reported their childs

    healthcare providers sometimes or never listened carefully; did not explain

    facts clearly; respected what they had to say, nor spent enough timewith them.

    Areas that can facilitate better healthcare access are to increase the cultural

    and linguistic competencies of healthcare providers through policy

    development. Cultural and linguistic assistance can be initiated at the

    university level by recruiting multi-ethnic and linguistic students and by

    increasing sociocultural and sociolinguistic content in the coursework,

    practicum, or residencies. Such changes are central to effectively addressing

    healthcare disparities and promoting positive, long-term healthcare

    outcomes among culturally and linguistically diverse populations.

    Unmet healthcare needs of persons with tetraplegia and their

    primary caregivers: Policy implications

    Colette Duggan, BSN, MSN, PhD, Research Department, Rehabilitation

    Institute of Michigan, Detroit, MI

    Virginia Miller, DrPH MS MPH, Department of Family Medicine and

    Public Health Sciences, Wayne State University School of Medicine,

    Detroit, MI

    Persons with tetraplegic (cervical) spinal cord injuries (SCI) have

    complex health care needs. They require access to a wide range of goods

    and services to maintain their health and prevent/minimize further

    functional losses. The severity of SCI impairment puts these individuals at

    great risk for incurring serious, costly medical complications over their

    lifetime. This 2-year, qualitative/quantitative study, funded by Blue Cross

    Blue Shield of Michigan, focuses on the healthcare experiences of the

    most needy and vulnerable segment of this population: public insurance

    recipients with tetraplegia and their primary caregivers. Qualitative data

    comes from in-depth, audiotaped interviews with 20 Medicaid/Medicare

    recipients with tetraplegic injuries and their primary caregivers.

    Participants also completed survey instruments measuring stress, health/

    functioning, and quality of life. Content analysis of coded interviews

    transcripts revealed many unmet needs. SCI consumers cited (a)

    inadequate supplies, such as catheters and dressings; (b) difficulty

    acquiring/repairing durable medical equipment, such as wheelchairs and

    lifts; (c) denial of requests for ramps and other environmental

    modifications, and (d) untrained, unreliable agency caregivers. SCI

    caregivers cited (a) unsatisfactory service by home care agencies; (b) no or

    insufficient financial compensation for SCI care provided by the family;

    (c) lack of respite care for caregiver; and (d) lack of affordable health

    insurance for family caregivers. Participants recommendations for

    improving access to goods and services were based on an insider logic

    that stressed long-term savings in hospital/nursing home costs through

    prevention of SCI secondary complications and inclusion of health

    insurance coverage and respite services for the family caregiver.

    Overweight among Children with Attention Deficit Hyperactivity

    DisorderPeer-reviewed journals, books, national reports including: Unequal

    treatment and the National Healthcare Disparities Report (NHDR) 2005

    were utilized to conduct this research study. An evaluation of the

    e7Journal 2 (2009) e1ee15Juhee Kim, ScD, Kinesiology and Community Health, University of Illinois

    at Urbana-Champaign, Champaign, IL

  • Medicare program National Health Insurance Experience

    ealthJae Kennedy, Department of Health Policy and Administration,

    Washington State University, Spokane, WA

    Katie Mackay, MHPA (cand), Department of Health Policy and

    Administration, Washington State University, Spokane, WA

    Josh Engle, MHPA (cand), Department of Health Policy and

    Administration, Washington State University, Spokane, WA

    Research Objective: To identify critical differences in prescription drug

    access among working age (18-64) and older (65+) Medicare beneficiaries.

    Study Design: Secondary analysis of the 2005 Medicare Current

    Beneficiary Survey (MCBS) on Access to Care.

    Population Studied: Medicare beneficiaries in the period immediately

    preceding implementation of the new Medicare prescription drug

    benefit.

    Principal Findings: Younger beneficiaries had significantly higher rates of

    prescription nonadherance (28.9%) than older beneficiaries (11.6%).

    Younger and older beneficiaries had similar rates of prescription drug

    coverage (60.2% vs. 61.6%); but younger beneficiaries were more likely

    to have coverage through Medicaid (28.3% vs. 6.8%) and less likely to

    have private coverage (22.8% vs. 34.6%) or Medicare HMO coverage

    (6.4% vs. 12.3%). Younger beneficiaries were more likely to be in poor

    health (60.8% vs. 20.2%) and to have ADL limitations (29.8% vs. 15.3%)

    than older beneficiaries.

    Conclusions: Younger Medicare beneficiaries are at greater risk of

    prescription nonadherance. This population is also more likely to

    report poor health, low incomes, and multiple impairments or chronic

    conditions.

    Implications for Policy, Delivery or Practice: Adults under age 65 who

    receive Social Security Disability Income (SSDI) become eligible for

    Medicare 25 months after they begin to receive SSDI benefits. YoungerBo Fernhall, PhD, Kinesiology and Community Health, University of

    Illinois at Urbana-Champaign, Champaign, IL

    Objectives: To examine the prevalence of overweight among children with

    Attention Deficit Hyperactivity Disorder (ADHD) and their difference by

    medication.

    Method:We conducted a secondary data analysis using the National Survey

    of Childrens Health 2003(aged 6-17 years, n5 62,476). The definition of

    ADHD is used from the question of Has a doctor or health professional

    ever told that [study child] has ADD or ADHD? The odds of overweight

    (BMI> 95% percentile) were estimated among children with ADHD who

    were or were not taking medication compared with children without

    ADHD. Covariates were age, race, education, poverty, family structure,

    number of family meals, computer and reading hours, TV viewing hours,

    physical activity, sleep, participation of organized activities, and

    supportive neighborhood. Further, we adjusted weights and multistage

    sampling design effects in multivariate logistic regression models.

    Results: Overall 9% of U.S. children had either ADD or ADHD in 2003.

    Only girls with ADHD had a higher rate of overweight than that of girls

    without ADHD (20% vs. 16%). However, both boys and girls with

    ADHD and currently NOT taking medication were more likely to be

    overweight than those without ADHD (OR (95% CI) for Boys, 1.44

    (1.13-1.84) and Girls, 1.79 (1.20-2.67).

    Conclusions: The prevalence of overweight among children with ADHD

    is dependent on sex and medication. Children with ADHD who not take

    ADHD medication have a higher risk of overweight than those taking

    medication and compared to children without ADHD. These data

    suggest that medication use should be carefully considered in children

    with ADHD.

    Age disparities in prescription drug access and utilization within the

    e8 Abstracts / Disability and Hbeneficiaries are particularly vulnerable to rising drug costs, coverage

    gaps, and discontinuities in prescription regimens. The new MedicareGuey-Ing Day, PhD, Bureau of Planning, Department of Health, The

    Executive Yuan, Taiwan, Taipei, Taiwan

    Shwu-Chong Wu, PhD, Institute of Health Policy and Management,

    College of Public Health, National Taiwan Unerversity, Taipei, Taiwan

    Shin-Chung Huang, Bureau of National Health Insurance, Taiwan., Taipei,

    Taiwan

    The study examines factors associated with the utilization of post-

    hospital care of disabled stroke patients within 6 months after hospital

    discharge and the varied costs to the national health insurance (NHI)

    system. A sample of 1,534 disabled stroke individuals 50 and order who

    were hospitalized in the past year was extracted from a nation-wide

    random sample. The first hospitalization in that year was designated as

    their index hospitalization. Six months of NHI claim data together with

    matched survey results were analyzed. Multiple regression and ANOVA

    identified factors associated with the use of post-hospital care.

    Results: The hospital readmission rate within 6 months after index

    hospitalization was 46.5%. Utilization of outpatient service was 98.1%,

    emergency service 38.0%, home nursing service 12.2%, and rehabilitation

    rate 32.3%. Results revealed that co-payment, long-term care arrangement,

    living in cities, co-morbidities, functional dependency were significant

    variables. Patients who are waived of NHI co-payments, cared in

    institutions, living in municipalities, completely dependent, or have

    suffered from three and more chronic diseases consume more health care

    and higher cost to the NHI.

    Implication & Conclusion: In allocating NHI resources and policy design,

    these factors should be taken into consideration for better resource

    management and efficiency. While an diagnosis related groups system in

    the NHI being started, issues concerning post-hospital care in terms of

    insurance benefits and co-payment need to be re-examined. Theprescription drug benefit should help reduce, but not eliminate, access

    barriers to prescribed medicines.

    Meeting the occupational safety and health training needs of

    workers with developmental disabilities

    Robin Dewey, MPH, Labor Occupational Health Program, UC Berkeley,

    Berkeley, CA

    Approximately 4.5 million individuals in the US have developmental

    disabilities. An estimated 30% of working-age adults with developmental

    disabilities are employed either in segregated workshops or

    mainstream settings. The results from recent needs assessments indicate

    there are very few examples of health and safety training being provided

    to workers with developmental disabilities. When safety training does

    occur, it is usually limited to task-specific instructions provided on an as

    needed basis. This lack of real health and safety training leaves these

    workers unprepared to be able to identify hazards in a variety of settings,

    know what to do when something unexpected happens, and advocate for

    themselves when a problem arises. This presentation will describe

    a unique effort to bridge this gap by creating an occupational safety and

    health education training program that meets the cognitive needs of

    workers with developmental disabilities. The training program has been

    pilot-tested with several adults with developmental disabilities, including

    employees participating in Walgreens Companys initiative to hire a third

    of its warehouse employees from this population. Attendees will be

    introduced to the learning activities that are p...

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