Introduction 1. Woman's Place in Man's Life Cycle 2. Images of Relationship 3. Concepts of Self and Morality 4. Crisis and Transition 5. Women's Rights and Women's Judgment 6. Visions of Maturity References Index of Study Participants General Index

In a Different Voice. Psychological Theory and Women’s Development. Cambridge, MA (Harvard University Press) 1982.

25. Multiple Imputation for Nonresponse in Surveys. By D. B. Rubin. ISBN 0 471 08705 X. Wiley, Chichester, 1987. 258 pp. £30.25.

Multiple Imputation for Nonresponse in Surveys

Attention deficit/hyperactivity disorder (ADHD) is a highly heritable childhood behavioral disorder affecting 5% of children and 2.5% of adults. Common genetic variants contribute substantially to ADHD susceptibility, but no variants have been robustly associated with ADHD. We report a genome-wide association meta-analysis of 20,183 individuals diagnosed with ADHD and 35,191 controls that identifies variants surpassing genome-wide significance in 12 independent loci, finding important new information about the underlying biology of ADHD. Associations are enriched in evolutionarily constrained genomic regions and loss-of-function intolerant genes and around brain-expressed regulatory marks. Analyses of three replication studies: a cohort of individuals diagnosed with ADHD, a self-reported ADHD sample and a meta-analysis of quantitative measures of ADHD symptoms in the population, support these findings while highlighting study-specific differences on genetic overlap with educational attainment. Strong concordance with GWAS of quantitative population measures of ADHD symptoms supports that clinical diagnosis of ADHD is an extreme expression of continuous heritable traits.

/pdf/discovery-of-the-first-genome-wide-significant-risk-loci-for-2dm35jbtdo.pdf

Discovery of the first genome-wide significant risk loci for attention deficit/hyperactivity disorder

Caring; A Feminine Approach To Ethics and Moral Education

Background
Little is known about the effectiveness of strategies to enable people to achieve and maintain recommended levels of physical activity.

Objectives
To assess the effectiveness of interventions designed to promote physical activity in adults aged 16 years and older, not living in an institution.

Search methods
We searched The Cochrane Library (issue 1 2005), MEDLINE, EMBASE, CINAHL, PsycLIT, BIDS ISI, SPORTDISCUS, SIGLE, SCISEARCH (from earliest dates available to December 2004). Reference lists of relevant articles were checked. No language restrictions were applied.

Selection criteria
Randomised controlled trials that compared different interventions to encourage sedentary adults not living in an institution to become physically active. Studies required a minimum of six months follow up from the start of the intervention to the collection of final data and either used an intention-to-treat analysis or, failing that, had no more than 20% loss to follow up.

Data collection and analysis
At least two reviewers independently assessed each study quality and extracted data. Study authors were contacted for additional information where necessary. Standardised mean differences and 95% confidence intervals were calculated for continuous measures of self-reported physical activity and cardio-respiratory fitness. For studies with dichotomous outcomes, odds ratios and 95% confidence intervals were calculated.

Main results
The effect of interventions on self-reported physical activity (19 studies; 7598 participants) was positive and moderate (pooled SMD random effects model 0.28 95% CI 0.15 to 0.41) as was the effect of interventions (11 studies; 2195 participants) on cardio-respiratory fitness (pooled SMD random effects model 0.52 95% CI 0.14 to 0.90). There was significant heterogeneity in the reported effects as well as heterogeneity in characteristics of the interventions. The heterogeneity in reported effects was reduced in higher quality studies, when physical activity was self-directed with some professional guidance and when there was on-going professional support.

Authors' conclusions
Our review suggests that physical activity interventions have a moderate effect on self-reported physical activity, on achieving a predetermined level of physical activity and cardio-respiratory fitness. Due to the clinical and statistical heterogeneity of the studies, only limited conclusions can be drawn about the effectiveness of individual components of the interventions. Future studies should provide greater detail of the components of interventions.

/pdf/interventions-for-promoting-physical-activity-461chrroe1.pdf

Interventions for promoting physical activity

Objectives: To provide the first nationally representative data on total health care expenses, out-of-pocket health care expenses, and information on the extent to which out-of-pocket expenses are financially burdensomeforfamiliesofchildrenwithspecialhealthcareneeds (CSHCN). To also compare utilization and expenditure patternsforchildrenwithandwithoutspecialhealthcare needs. Design: We used data from the 2000 Medical Expenditure Panel Survey (MEPS). We present univariate, bivariate, and multivariate statistics on utilization and expenditures adjusted for the complex sample design. Participants: The 2000 MEPS data set contains 6965 children younger than 18 years. Using the CSHCN definition adopted by the federal Maternal and Child Health Bureau and operationalized using the CSHCN Screener, 949children(15.6%)wereidentifiedaschildrenwithspecial health care needs. Main Outcome Measures: Compared with other children, CSHCN had 3 times higher health care expenditures ($2099 vs $628;P.01). The 15.6% of CSHCN accounted for 42.1% of total medical care costs (excluding dental costs) and 33.6% of total health care costs (includingdentalcosts)attributedtochildrenin2000.FamiliesofCSHCNwerebestprotectedagainstinpatienthospital care expenses and most exposed to dental care expenses. Families of CSHCN experiencing high out-ofpocket expenses (exceeding 5% of family income) were approximately 11 times more likely to be from households with incomes below 200% of the federal poverty level (odds ratio, 10.9; 95% confidence interval, 3.5533.76) than to be from families with incomes at or above 400% of the federal poverty level. Conclusions: Families with CSHCN experience much higher expenditures, including out-of-pocket expenditures, than other children. Insurance plays an importantprotectiveroleforfamiliesofCSHCN,butitstillprovides incomplete protection. Health policy changes that would extend the breadth and depth of insurance coverage are needed to ensure that all families of CSHCN are protected against burdensome expenses. Arch Pediatr Adolesc Med. 2005;159:10-17

/pdf/a-national-profile-of-health-care-utilization-and-1nxmvtgzwa.pdf

A national profile of health care utilization and expenditures for children with special health care needs.

Objective. To examine health care utilization and expenditure patterns for children with disabilities. Methods. Secondary data analysis was conducted of the 1999 and 2000 editions of the Medical Expenditure Panel Survey (MEPS), a nationally representative survey conducted in 5 rounds by household interview. Two years of MEPS data were combined in this analysis to improve the precision of estimates. Disability was defined by the presence of a limitation in age-appropriate social role activities, such as school or play, or receipt of specialized services through the early intervention or special education programs. The survey sample included 13 792 children younger than 18 years. The overall response rate was 65.5%. Results. Our findings demonstrate that the 7.3% of US children with disabilities used many more services than their counterparts without disabilities in 1999–2000. The largest differences in utilization were for hospital days (464 vs 55 days per 1000), nonphysician professional visits (3.0 vs 0.6), and home health provider days (3.8 vs 0.04). As a result of their greater use, children with disabilities also had much higher health care expenditures ($2669 vs $676) and higher out-of-pocket expenditures ($297 vs $189). We also found that the distributions of total and out-of-pocket expenses were highly skewed, with a small fraction of the disabled population accounting for a large proportion of expenditures: the upper decile accounted for 65% of total health care expenses and 85% of all out-of-pocket expenses for the population with disabilities. Health insurance was found to convey significant protection against financially burdensome expenses. However, even after controlling for insurance status, low-income families experienced greater financial burdens than higher income families. Conclusions. The skewed distribution of out-of-pocket expenses found in this and earlier studies indicates that the financial burden of childhood disability continues to be shared unevenly by families. Low-income families are especially vulnerable to burdensome out-of-pocket expenses. Additional efforts are needed to protect these high-risk families.

Health Services Use and Health Care Expenditures for Children With Disabilities

BACKGROUND
Over 35% of returned Iraq and Afghanistan veterans in VA care have received mental health diagnoses; the most prevalent is post-traumatic stress disorder (PTSD). Little is known about these patients’ use of non-mental health medical services and the impact of mental disorders on utilization.

/pdf/mental-health-diagnoses-and-utilization-of-va-non-mental-3z9tdkjbi4.pdf

Mental Health Diagnoses and Utilization of VA Non-Mental Health Medical Services Among Returning Iraq and Afghanistan Veterans

New evidence suggests that children with chronic conditions may be predisposed to overweight and obesity. This study provides prevalence estimate of obesity for children and adolescents with select chronic conditions. We analyzed reported height and weight and the corresponding BMI from 46,707 subjects aged 10-17 years collected by the National Survey of Children's Health (NSCH-2003). Our main outcome measure was the prevalence of obesity (defined as >/=95th percentile of the sex-specific BMI for age growth charts), adjusted for underlying demographic and socioeconomic factors. We found that the prevalence of obesity among children 10-17 years of age without a chronic condition was 12.2% (95% confidence interval (CI) 11.5-13.0); the prevalence of obesity for children with asthma was 19.7% (19.5-19.9); with a hearing/vision condition was 18.4% (18.2-18.5); with learning disability was 19.3% (19.2-19.4); with autism was 23.4% (23.2-23.6); and with attention-deficit/hyperactivity disorder was 18.9% (18.7-19.0). Our findings suggest that children 10-17 years of age with select chronic conditions were at increased risk for obesity compared to their counterparts without a chronic condition.

https://onlinelibrary.wiley.com/doi/pdf/10.1038/oby.2009.185

Prevalence of Obesity Among Children With Chronic Conditions

BACKGROUND:
Few studies have examined whether patients with language barriers receive worse hospital care in terms of quality or efficiency.

OBJECTIVE:
To examine whether patients' primary language influences hospital outcomes.

DESIGN AND SETTING:
Observational cohort of urban university hospital general medical admissions between July 1, 2001 to June 30, 2003.

PATIENTS:
Eighteen years old or older whose hospital data included information on their primary language, specifically English, Russian, Spanish or Chinese.

MEASUREMENTS:
Hospital costs, length of stay (LOS), and odds for 30-day readmission or 30-day mortality.

RESULTS:
Of 7023 admitted patients, 84% spoke English, 8% spoke Chinese, 4% Russian and 4% Spanish. In multivariable models, non-English and English speakers had statistically similar total cost, LOS, and odds for mortality. However, non-English speakers had higher adjusted odds of readmission (odds ratio [OR], 1.3; 95% confidence interval [CI], 1.0-1.7). Higher odds for readmission persisted for Chinese and Spanish speakers when compared to all English speakers (OR, 1.7; 95% CI, 1.2-2.3 and OR, 1.5; 95% CI, 1.0-2.3 respectively).

CONCLUSIONS:
After accounting for socioeconomic variables and comorbidities, non-English speaking Latino and Chinese patients have higher risk for readmission. Whether language barriers produce differences in readmission or are a marker for less access to post-hospital care remains unclear. Journal of Hospital Medicine 2010;5:276–282. © 2010 Society of Hospital Medicine.

https://cdn.mdedge.com/files/s3fs-public/pdfs/journals/658_ftp.pdf

Sue Kim

Papers

A national profile of health care utilization and expenditures for children with special health care needs.

Health Services Use and Health Care Expenditures for Children With Disabilities

Mental Health Diagnoses and Utilization of VA Non-Mental Health Medical Services Among Returning Iraq and Afghanistan Veterans

Prevalence of Obesity Among Children With Chronic Conditions

Influence of language barriers on outcomes of hospital care for general medicine inpatients