Does ethnic concentration buffer effects of neighborhood deprivation on early childhood growth?

Background: Neighborhood socioeconomic marginalization and racial residential segregation are associated with differential health outcomes in adulthood and pregnancy, but the intergenerational effects of these exposures on early childhood growth are underexplored. Our objective was to investigate racial and ethnic differences in the association between neighborhood deprivation and early childhood growth trajectories, with modification by neighborhood racial concentration.

Methods: Using longitudinal clinical data among 58,860 children receiving care in community-based clinics in the ADVANCE Clinical Data Research Network, we identified four early childhood (0-24 months) body mass index (BMI) trajectories using group-based trajectory modeling: Low, Catch-Up, Moderate, and High.

Pediatric Endocrinology Milestones 2.0-guide to their implementation.

The Milestones were initiated by the Accreditation Council for Graduate Medical Education (ACGME) to provide a framework for monitoring a trainee's progression throughout residency/fellowship. The Milestones describe stepwise skill progression through six core domains of clinical competency: Patient Care, Medical Knowledge, Interpersonal and Communication Skills, Practice-based Learning and Improvement, Professionalism, and Systems-based Practice. Since their introduction in 2013, several barriers to implementation have emerged.

Virilization of a 46,XX Fetus Following Aromatase Inhibitor Treatment of Breast Cancer.

Virilization of the 46,XX infant may be attributed to maternal or fetoplacental origin. Maternal sources may be endogenous, as with an androgen-producing tumor, or drug-related. Iatrogenic virilization by maternal drug exposure is rarely reported, with individual case reports and case series demonstrating the effects of progesterone and other medications affecting the pituitary-ovarian axis.

Patient-level factors associated with receipt of preventive care in the safety net.

Prevention is critical to optimizing health, yet most people do not receive all recommended preventive services. As the complexity of preventive recommendations increases, there is a need for new measurements to capture the degree to which a person is up to date, and identify individual-level barriers and facilitators to receiving needed preventive care. We used electronic health record data from a national network of community health centers (CHCs) in the United States (US) during 2014-2017 to measure patient-level up-to-date status with preventive ratios (measuring up-to-date person-time denoted as a percent) for 12 preventive services and an aggregate preventive index.

Uptake of Preventive Services Among Patients With and Without Multimorbidity.

Introduction: Patients with multiple chronic conditions (multimorbidity) are seen commonly in primary care practices and often have suboptimal uptake of preventive care owing to competing treatment demands. The complexity of multimorbidity patterns and their impact on receiving preventive services is not fully understood. This study identifies multimorbidity combinations associated with low receipt of preventive services.

Implementation and adoption of a health insurance support tool in the electronic health record: a mixed methods analysis within a randomized trial.

Background: In addition to delivering vital health care to millions of patients in the United States, community health centers (CHCs) provide needed health insurance outreach and enrollment support to their communities. We developed a health insurance enrollment tracking tool integrated within the electronic health record (EHR) and conducted a hybrid implementation-effectiveness trial in a CHC-based research network to assess tool adoption using two implementation strategies.

Methods: CHCs were recruited from the OCHIN practice-based research network.

Use of a Preventive Index to Examine Clinic-Level Factors Associated With Delivery of Preventive Care.

Introduction: There is an increasing need for the development of new methods to understand factors affecting delivery of preventive care. This study applies a new measurement approach and assesses clinic-level factors associated with preventive care delivery.

Methods: This retrospective longitudinal cohort study of 94 community health centers used electronic health record data from the OCHIN community health information network, 2014-2015.

Not so implausible: impact of longitudinal assessment of implausible anthropometric measures on obesity prevalence and weight change in children and adolescents.

Purpose: Implausible anthropometric measures are typically identified using population outlier definitions, conflating implausible and extreme measures. We determined the impact of a longitudinal outlier approach on prevalence of body mass index (BMI) categories and mean change in anthropometric measures in pediatric electronic health record data.

Methods: We examined 996,131 observations from 147,375 children (10-18 years) in the ADVANCE Clinical Data Research Network, a national network of community health centers.

Implementation of Health Insurance Support Tools in Community Health Centers.

Background: Health information technology (HIT) provides new opportunities for primary care clinics to support patients with health insurance enrollment and maintenance. We present strategies, early findings, and clinic reflections on the development and implementation of HIT tools designed to streamline and improve health insurance tracking at community health centers.

Methods: We are conducting a hybrid implementation-effectiveness trial to assess novel health insurance enrollment and support tools in primary care clinics.

Characterizing a "Big Data" Cohort of Over 200,000 Low-Income U.S. Infants and Children for Obesity Research: The ADVANCE Early Life Cohort.

Introduction Low-income populations have elevated exposure to early life risk factors for obesity, but are understudied in longitudinal research. Our objective was to assess the utility of a cohort derived from electronic health record data from safety net clinics for investigation of obesity emerging in early life. Methods We examined data from the PCORNet ADVANCE Clinical Data Research Network, a national network of Federally-Qualified Health Centers serving >1.

Using the electronic health record for assessment of health insurance in community health centers.

Objective: To demonstrate use of the electronic health record (EHR) for health insurance surveillance and identify factors associated with lack of coverage.

Materials And Methods: Using EHR data, we conducted a retrospective, longitudinal cohort study of adult patients (n = 279 654) within a national network of community health centers during a 2-year period (2012-2013).

Results: Factors associated with higher odds of being uninsured (vs Medicaid-insured) included: male gender, age >25 years, Hispanic ethnicity, income above the federal poverty level, and rural residence (P < .

Trends in Type of Health Insurance Coverage for US Children and Their Parents, 1998-2011.

Objective: To examine trends in health insurance type among US children and their parents.

Methods: Using the Medical Expenditure Panel Survey (1998-2011), we linked each child (n = 120,521; weighted n ≈ 70 million) with his or her parent or parents and assessed patterns of full-year health insurance type, stratified by income. We examined longitudinal insurance trends using joinpoint regression and further explored these trends with adjusted regression models.

Effect of expanding medicaid for parents on children's health insurance coverage: lessons from the Oregon experiment.

Importance: In the United States, health insurance is not universal. Observational studies show an association between uninsured parents and children. This association persisted even after expansions in child-only public health insurance.

Predictors of children's health insurance coverage discontinuity in 1998 versus 2009: parental coverage continuity plays a major role.

To identify predictors of coverage continuity for United States children and assess how they have changed in the first 12 years since implementation of the Children's Health Insurance Program in 1997. Using data from the nationally-representative Medical Expenditure Panel Survey, we used logistic regression to identify predictors of discontinuity in 1998 and 2009 and compared differences between the 2 years. Having parents without continuous coverage was the greatest predictor of a child's coverage gap in both 1998 and 2009.

Variation in outcomes of quality measurement by data source.

Objective: To evaluate selected Children's Health Insurance Program Reauthorization Act claims-based quality measures using claims data alone, electronic health record (EHR) data alone, and both data sources combined.

Methods: Our population included pediatric patients from 46 clinics in the OCHIN network of community health centers, who were continuously enrolled in Oregon's public health insurance program during 2010. Within this population, we calculated selected pediatric care quality measures according to the Children's Health Insurance Program Reauthorization Act technical specifications within administrative claims.

Recent health insurance trends for US families: children gain while parents lose.

In the past decade, political and economic changes in the United States (US) have affected health insurance coverage for children and their parents. Most likely these policies have differentially affected coverage patterns for children (versus parents) and for low-income (versus high-income) families. We aimed to examine--qualitatively and quantitatively--the impact of changing health insurance coverage on US families.

Prescription opioids for back pain and use of medications for erectile dysfunction.

Study Design: Cross-sectional analysis of electronic medical and pharmacy records.

Objective: To examine associations between use of medication for erectile dysfunction or testosterone replacement and use of opioid therapy, patient age, depression, and smoking status.

Summary Of Background Data: Males with chronic pain may experience erectile dysfunction related to depression, smoking, age, or opioid-related hypogonadism.

Changes in health insurance for US children and their parents: comparing 2003 to 2008.

Background And Objectives: Recent policy changes have affected access to health insurance for families in the United States. Private health insurance premiums have increased, and state Medicaid programs have cut back coverage for adults. Concurrently, the Children's Health Insurance Program has made public insurance available to more children.

Advances in Nutritional Metabolomics.

Metabolomics is maturing as an experimental approach in nutrition science, and it is a useful analysis for revealing systems biology outcomes associated with changes in diet. A major goal of this review is to present the rapidly evolving body of scientific literature that seeks to reveal connections between an individual's metabolic profile and experimentally manipulated or naturally varied dietary intakes. Metabolite profiles in tissue, serum, urine, or stool reflect changes in metabolic pathways that respond to dietary intervention which makes them accessible samples for revealing metabolic effects of diet.

Trends in health insurance status of US children and their parents, 1998-2008.

In the United States (US), a parent's health insurance status affects their children's access to health care making it critically important to examine trends in coverage for both children and parents. To gain a better understanding of these health insurance trends, we assessed the coverage status for both children and their parents over an 11-year time period (1998-2008). We conducted secondary analysis of data from the nationally-representative Medical Expenditure Panel Survey.

The effects of health insurance and a usual source of care on a child's receipt of health care.

Introduction: Although recent health care reforms will expand insurance coverage for U.S. children, disparities regarding access to pediatric care persist, even among the insured.

Feasibility of evaluating the CHIPRA care quality measures in electronic health record data.

The Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA) includes provisions for identifying standardized pediatric care quality measures. These 24 "CHIPRA measures" were designed to be evaluated by using claims data from health insurance plan populations. Such data have limited ability to evaluate population health, especially among uninsured people.

A multilevel approach to predicting community addiction treatment attitudes about contingency management.

Adoption of contingency management (CM) by the addiction treatment community is limited to date despite much evidence for its efficacy. This study examined systemic and idiographic staff predictors of CM adoption attitudes via archival data collected from treatment organizations affiliated with the National Drug Abuse Treatment Clinical Trials Network. Multilevel modeling analyses evaluated potential predictors from organizational, treatment unit, and workforce surveys.