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Objective: To test whether rapid expansion of mental health services in Federally Qualified Health Centers (FQHCs) reduces African American/white disparities in youth psychiatric emergency department (ED) visits.Data Sources: Secondary ED data for psychiatric care for 3.3 million African American and white youth in nine states, 2006-2011. We used the HCUP SEDD and SID. We obtained FQHC service data from the Uniform Data System.Study Design: The psychiatric ED visit is the dependent variable. Logistic regression methods control for individual risk factors for ED use, as well as county-level health system factors and county and year fixed effects. Key independent variables include indicators of mental health service capacity in FQHCs in a county-year.Data Extraction Methods: We extracted ED psychiatric visits for 3.3 million African American and white youth in nine states, 2006-2011, from the HCUP SEDD and SID, and FQHC data from the Uniform Data System.Principal Findings: Overall mental health visits at FQHCs correlate positively with psychiatric ED visits among African American youth. However, increases in the number of mental health visits per FQHC patient corresponds with fewer outpatient psychiatric ED visits among African American youth, relative to white youth (odds ratio = 0.96; 95% CI = 0.94, 0.98).Conclusions: Increases in the intensity of services offered per mental health patient at FQHCs-rather than increases in overall capacity-may reduce African American youth's overreliance on the ED for psychiatric care. [ABSTRACT FROM AUTHOR]

Objectives: Repeat visits (revisits) to emergency departments (EDs) for psychiatric care reflect poor continuity of care and impose a high financial cost. We test whether rapid expansion of community health centers (CHCs)—which provide regional, low‐cost primary care—correspond with fewer repeat psychiatric‐related ED visits (PREDVs). Methods: We obtained repeated cross‐sectional time‐series data for 7.8 million PREDVs from the State Emergency Department Database for four populous U.S. states (California, Florida, North Carolina, and New York) from 2006 to 2011. We specified as the outcome variable the count of repeat visits per ED visitor with a psychiatric diagnosis. We retrieved aggregate‐level mental health visits at CHCs from the Uniform Data System. Negative binomial regression methods controlled for individual‐level confounders, county health system and sociodemographic attributes, year fixed effects, and county fixed effects. Results: The risk of a repeat PREDV decreased with a county‐level increase in mental health patients seen at CHCs (incidence rate ratio = 0.986, 95% confidence interval = 0.98 to 0.99). Conversion of this rate ratio to the number of revisits averted indicated 34,000 fewer repeat PREDVs in these four states statistically associated with a 1% expansion in CHC mental health visits. Exploratory analyses found that revisits decline for relatively mild/moderate illnesses (e.g., mood, anxiety disorders) but not for severe illnesses (e.g., schizophrenia/psychoses). Conclusion: An increase in mental health services at CHCs corresponds with a modest decline in repeat PREDVs. This decline concentrates among those with less severe mental illnesses. [ABSTRACT FROM AUTHOR]

Background: Down syndrome (DS) ranks as one of the most common birth defects in the United States. The relaxed filter hypothesis (RFH) asserts that mothers with no previous children but nearing reproductive senescence reduce fetal selectivity against DS pregnancies in the first trimester given the high probability of having no offspring at all if the DS pregnancy is not carried to term. We test the parity prediction of RFH—specifically, that pregnancies to older mothers with no previous live births show an elevated prevalence of DS above values expected from the separate contributions of older maternal age and primiparity. Methods: We retrieved maternal age and parity information on 2,748 DS cases (live, stillborn, or terminated due to anomaly) from the Paris Birth Defects Registry, 1983–2015. We used two waves of the Enquête Fertility Survey (n = 5,460) and counts of stillbirths to calculate total prevalence of DS by maternal age and parity. Results: Primiparous mothers 35+ years show the greatest prevalence of any parity group (9.78 cases per 1,000 deliveries). Tests for additive interaction of primiparity and older maternal age reject the null (relative excess risk due to interaction = 1.01; 95% confidence interval: 0.33, 1.69; null value on additive scale is 0). Conclusions: Relaxed selection may account for 10% of the increase in the prevalence, among older primiparous mothers, of DS detected during or after the 11th week. Future work may hold implications for understanding, among older mothers, the strength of this maternal screen against other defects. [ABSTRACT FROM AUTHOR]

Background The terrorist attacks of 11 September 2001 (hereafter referred to as 9/11) preceded an increase in male fetal deaths and reduced male live births among exposed gestational cohorts across several geographic locations in the United States, including California. We analyze whether the extreme stressor of 9/11 may have selected against frail males in utero by testing if the prevalence of male births with selected defects in California fell among cohorts exposed to the stressor during gestation. Methods We used data from the California Birth Defects Monitoring Program from July 1985 to January 2004 (223 conception cohorts). We included six birth defects that as a group of phenotypes disproportionately affect males. We applied time-series methods and defined as 'exposed to 9/11' the cohorts conceived in February, March, April, May, June, July, and August 2001. Results Three of the seven monthly conception cohorts exposed to 9/11 in utero show lower than expected odds of live born males with the studied defects: February 2001 (odds ratio [OR] = 0.39; 95% confidence interval [CI], 0.21-0.71), May 2001 (OR = 0.36; 95% CI, 0.16-0.81), and August 2001 (OR = 0.51; 95% CI, 0.28-0.93). Conclusion The population-wide stressor of 9/11 precedes a reduction in the risk of live born males with selected birth defects. Our analysis contributes to the understanding of adaptation to stress among pregnant women exposed to large and unexpected ambient stressors. Results further support the notion that the prevalence of live born defects may reflect temporal variation in cohort selection in utero against frail males. Birth Defects Research 109:1277-1283, 2017. © 2017 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Objectives: We know little about whether an elevated stillbirth sex ratio (ratio of male to female stillbirths) gauges stronger selection in utero against frail male gestations and therefore predicts greater male infant survival. An alternative scenario could involve a "low endowment" case in which pregnancy cohorts show both excess male stillbirths and elevated mortality risk among male live births. We exploit the longest sex‐specific stillbirth series (Denmark, 1835‐1923) to explore whether annual deviations in age‐specific male mortality vary with the annual cohort's stillbirth sex ratio. Methods: We applied autoregressive, integrated, moving average time series methods to annual counts of age‐specific male mortality in Denmark. We derived the independent variable, the stillbirth sex ratio, from only late stillbirths (ie, 28th week and thereafter) owing to data availability. Methods control for secular patterns as well as shared antecedents of male and female mortality. Results: Cohort male infant mortality varies positively with the stillbirth sex ratio (coef = 0.0081, standard error [SE] = 0.0019, P < 0.001). This positive relation persists into childhood (ie, ages 1‐4.99 years) but attenuates with age. Discussion: We infer support for the "low endowment" argument in that high stillbirth sex ratios predict a relatively greater risk of mortality among males which ultimately survive to birth. These findings provide evidence that the stillbirth sex ratio may serve as a marker of population health among male cohorts. [ABSTRACT FROM AUTHOR]