Seminar: Multilevel Modeling Basics

2017 FEB 06

Location

Division of General Pediatrics, Boston University School of Medicine

Upcoming Events

Zhang J, Shang T, Ahn D, et al. How to Best Protect People With Diabetes From the Impact of SARS-CoV-2: Report of the International COVID-19 and Diabetes Summit. J Diabetes Sci Technol. Published online 2021.

See also: Chronic Disease Epidemiology

Publisher's Version

Abstract

The coronavirus disease 2019 (COVID-19) pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus has rapidly involved the entire world and exposed the pressing need for collaboration between public health and other stakeholders from the clinical, scientific, regulatory, pharmaceutical, and medical device and technology communities. To discuss how to best protect people with diabetes from serious outcomes from COVID-19, Diabetes Technology Society, in collaboration with Sansum Diabetes Research Institute, hosted the "International COVID-19 and Diabetes Virtual Summit" on August 26-27, 2020. This unique, unprecedented real-time conference brought together physicians, scientists, government officials, regulatory experts, industry representatives, and people with diabetes from six continents to review and analyze relationships between COVID-19 and diabetes. Over 800 attendees logged in. The summit consisted of five sessions: (I) Keynotes, (II) Preparedness, (III) Response, (IV) Recovery, and (V) Surveillance; eight parts: (A) Background, (B) Resilience, (C) Outpatient Care, (D) Inpatient Care, (E) Resources, (F) High-Risk Groups, (G) Regulation, and (H) The Future; and 24 sections: (1) Historic Pandemics and Impact on Society, (2) Pathophysiology/Risk Factors for COVID-19, (3) Social Determinants of COVID-19, (4) Preparing for the Future, (5) Medications and Vaccines, (6) Psychology of Patients and Caregivers, (7) Outpatient Treatment of Diabetes Mellitus and Non-Pharmacologic Intervention, (8) Technology and Telehealth for Diabetes Outpatients, (9) Technology for Inpatients, (10) Management of Diabetes Inpatients with COVID-19, (11) Ethics, (12) Accuracy of Diagnostic Tests, (13) Children, (14) Pregnancy, (15) Economics of Care for COVID-19, (16) Role of Industry, (17) Protection of Healthcare Workers, (18) People with Diabetes, (19) International Responses to COVID-19, (20) Government Policy, (21) Regulation of Tests and Treatments, (22) Digital Health Technology, (23) Big Data Statistics, and 24) Patient Surveillance and Privacy. The two keynote speeches were entitled (1) COVID-19 and Diabetes-Meeting the Challenge and (2) Knowledge Gaps and Research Opportunities for Diabetes and COVID-19. While there was an emphasis on diabetes and its interactions with COVID-19, the panelists also discussed the COVID-19 pandemic in general. The meeting generated many novel ideas for collaboration between experts in medicine, science, government, and industry to develop new technologies and disease treatment paradigms to fight this global pandemic.

PMID :
33476193

DOI :
10.1177/1932296820978399

Last updated on 02/25/2023
Chen K, Wisk L, Nuckols T, Elmore J, Steers N, Zimmerman F. Unmet Medical Needs Among Adults Who Move due to Unaffordable Housing: California Health Interview Survey, 2011-2017. J Gen Intern Med. Published online 2020.

See also: Financial Burden, Health Services Research, Mentee Work

Publisher's Version

Abstract

Background: Stable, affordable housing is an established determinant of health. As affordable housing shortages across the USA threaten to displace people from their homes, it is important to understand the implications of cost-related residential moves for healthcare access.

Objective: To examine the relationship between cost-related moves and unmet medical needs.

Design: We performed a cross-sectional analysis of 7 waves (2011-2017) of the California Health Interview Survey.

Participants: We included all respondents ages 18 and older.

Main measures: The primary predictor variable was residential move history in the past 5 years (cost-related move, non-cost-related move, or no move). The primary outcome was unmet medical needs in the past year (necessary medications and/or medical care that were delayed or not received).

Key results: Our sample included 146,417 adults (42-47% response rate), representing a weighted population of 28,518,590. Overall, 20.3% of the sample reported unmet medical needs in the past year, and 4.9% reported a cost-related move in the past 5 years. In multivariable logistic regression models, adjusted risk of unmet medical needs increased for adults with both cost-related moves (aOR 1.38; 95% CI 1.19-1.59) and non-cost-related moves (aOR 1.17; 95% CI 1.09-1.26) compared to those with no moves. Among people who had moved, those with cost-related moves were more likely to report unmet medical needs compared to people with non-cost-related moves (p = 0.03).

Conclusions: People who have moved due to unaffordable housing represent a population at increased risk for unmet medical needs. Policy makers seeking to improve population health should consider strategies to limit cost-related moves and to mitigate their adverse effects on healthcare access.

PMID :
33372238

DOI :
10.1007/s11606-020-06347-3

Last updated on 02/25/2023
Affordable Care Act eases health care costs for families with children, study finds

October 02, 2020

On November 10, the U.S. Supreme Court will hear arguments on a case challenging the Affordable Care Act. With the ACA’s future in question, a study from Boston Children’s Hospital provides a reminder that the law has substantially reduced health care expenses for many families with children — particularly low- and middle-income families.

Elimination of the ACA, popularly known as Obamacare, could raise barriers to care for many of the roughly 40 percent of U.S. households with children, the researchers say.

Read more at https://discoveries.childrenshospital.org/aca-and-children/
Obamacare Cut Out-of-Pocket Costs, But Many Families Still Struggle: Study

September 28, 2020

High out-of-pocket health care costs for low- and middle-income Americans with kids have fallen due to "Obamacare," but more needs to be done to reduce their medical-related financial struggles, a new study claims.

Read more at https://www.usnews.com/news/health-news/articles/2020-09-28/obamacare-cu...
Obamacare Cut Out-of-Pocket Costs, But Many Families Still Struggle: Study

September 28, 2020

High out-of-pocket health care costs for low- and middle-income Americans with kids have fallen due to "Obamacare," but more needs to be done to reduce their medical-related financial struggles, a new study claims.

The researchers examined data from 2000 to 2017 on more than 92,000 U.S. families with one or more children under 18 and one or more adult parents or guardians.

Families with out-of-pocket health care costs above a set percentage of their annual income (for example, 3.5% of incomes below $20,000, or 8.4% of those at $75,000) were said to have high financial burdens. Those whose out-of-pocket costs exceeded 10% of their annual income were classified as having extreme financial burdens.
Levy S, Weitzman E, Marin A, Magane K, Wisk L, Shrier L. Sensitivity and specificity of S2BI for identifying alcohol and cannabis use disorders among adolescents presenting for primary care. Subst Abus. Published online 2020:1-8.

See also: Adolescent and Young Adult Health

Abstract

BACKGROUND: The Screening to Brief Intervention (S2BI) tool was designed to identify substance use disorders in adolescents. We report the S2BI's sensitivity and specificity for identifying alcohol and cannabis use disorders (AUD and CUD) in adolescents presenting for primary care. Participants aged 14-18 ( = 517) completed an electronic survey, consisting of the S2BI, the Composite International Diagnostic Interview (CIDI), and anxiety and depression screens. We calculated sensitivity, specificity, and positive and negative predictive value (PPV, NPV) of the S2BI compared to the CIDI criterion standard, using past year "monthly" and "weekly or more" consumption of alcohol or marijuana as a threshold for AUD or CUD. Current AUD and CUD were present in 2.9% and 8.3% of the sample, respectively and severe AUD and CUD were present in 0.8% and 3.9%. The S2BI had 53.3% sensitivity and 94.2% specificity for identifying any AUD (PPV = 21.6%; NPV = 98.5%), and 81.4% sensitivity and 92.0% specificity for identifying any CUD (PPV = 47.9%; NPV = 98.2%). The same threshold had 100% sensitivity and 93.6% specificity for identifying moderate/severe AUD, and 90.0% sensitivity and 89.0% specificity for identifying moderate/severe CUD. S2BI had excellent sensitivity and specificity for identifying moderate and severe AUD and CUD. Sensitivity decreased when mild AUD and CUD were included.

PMID :
32814009

doi :
10.1080/08897077.2020.1803180

Last updated on 02/25/2023

Lauren E. Wisk, PhD

Seminar: Multilevel Modeling Basics