A study of the cost and effect of newborn screening for Congenital Adrenal Hyperplasia in Texas

Congenital Adrenal Hyperplasia (CAH), due to 21-Hydroxylase deficiency, has an estimated incidence of 1:15,000 births and can result in death, salt-wasting crisis or impaired growth. It has been proposed that early diagnosis and treatment of infants detected from newborn screening for CAH will decrease the incidence of mortality and morbidity in the affected population. The Texas Department of Health (TDH) began mandatory screening for CAH in June, 1989 and Texas is one of fourteen states to provide neonatal screening for the disorder.^ The purpose of this study was to describe the cost and effect of screening for CAH in Texas during 1994 and to compare cases first detected by screen and first detected clinically between January 1, 1990 and December 31, 1994. This study used a longitudinal descriptive research design. The data was secondary and previously collected by the Texas Department of Health. Along with the descriptive study, an economic analysis was done. The cost of the program was defined, measured and valued for four phases of screening: specimen collection, specimen testing, follow-up and diagnostic evaluation.^ There were 103 infants with Classical CAH diagnosed during the study and 71 of the cases had the more serious Salt-Wasting form of the disease. Of the infants diagnosed with Classical CAH, 60% of the cases were first detected by screen and 40% were first detected because of clinical findings before the screening results were returned. The base case cost of adding newborn screening to an existing program (excluding the cost of specimen collection) was $357,989 for 100,000 infants. The cost per case of Classical CAH diagnosed, based on the number of infants first detected by screen in 1994, was \$126,892. There were 42 infants diagnosed with the more benign Nonclassical form of the disease. When these cases were included in the total, the cost per infant to diagnose Congenital Adrenal/Hyperplasia was $87,848. ^

Investigator/IRB-led community communication in genetic research: A descriptive feasibility pilot study

This pilot study, conducted in the Houston, TX, area, established a structured dialogue among a university Institutional Review Board, its researchers, and its local community members (i.e. pool of potential research participants) for the purpose of further educating all three parties about genetic research and community concerns related to such research. An IRB-designed educational presentation aimed at assisting potential subjects in making an informed decision to participate in genetic research was provided to four community groups (n=54); this presentation also included a current example of genetic research being conducted in the community as explained by the researcher, and a question-and-answer session designed to assist the IRB and the researcher in understanding the community's concerns about genetic research. Comparisons of pre- and post- presentation community questionnaires indicate that the joint presentation was effective in increasing community knowledge about genetic research, most notably related to the risks and benefits of this research to the individual, as well as the understanding that protections are in place for research participants. While researchers are optimistic about the idea of a collaborative effort with the IRB and the community, the feasibility of such a program and the benefit to the participating researchers remain unclear; additional research is necessary to establish the most effective method of communication for all groups involved, as well as to obtain statistically significant results with regard to race/ethnicity, gender, and education levels of community participants. ^

Evaluating the relative status of health and safety programs for minority academic and research institutions

A variety of occupational hazards are indigenous to academic and research institutions, ranging from traditional life safety concerns, such as fire safety and fall protection, to specialized occupational hygiene issues such as exposure to carcinogenic chemicals, radiation sources, and infectious microorganisms. Institutional health and safety programs are constantly challenged to establish and maintain adequate protective measures for this wide array of hazards. A unique subset of academic and research institutions are classified as historically Black universities which provide educational opportunities primarily to minority populations. State funded minority schools receive less resources than their non-minority counterparts, resulting in a reduced ability to provide certain programs and services. Comprehensive health and safety services for these institutions may be one of the services compromised, resulting in uncontrolled exposures to various workplace hazards. Such a result would also be contrary to the national health status objectives to improve preventive health care measures for minority populations.^ To determine if differences exist, a cross-sectional survey was performed to evaluate the relative status of health and safety programs present within minority and non-minority state-funded academic and research institutions. Data were obtained from direct mail questionnaires, supplemented by data from publicly available sources. Parameters for comparison included reported numbers of full and part-time health and safety staff, reported OSHA 200 log (or equivalent) values, and reported workers compensation experience modifiers. The relative impact of institutional minority status, institution size, and OSHA regulatory environment, was also assessed. Additional health and safety program descriptors were solicited in an attempt to develop a preliminary profile of the hazards present in this unique work setting.^ Survey forms were distributed to 24 minority and 51 non-minority institutions. A total of 72% of the questionnaires were returned, with 58% of the minority and 78% of the non-minority institutions participating. The mean number of reported full-time health and safety staff for the responding minority institutions was determined to be 1.14, compared to 3.12 for the responding non-minority institutions. Data distribution variances were stabilized using log-normal transformations, and although subsequent analysis indicated statistically significant differences, the differences were found to be predicted by institution size only, and not by minority status or OSHA regulatory environment. Similar results were noted for estimated full-time equivalent health and safety staffing levels. Significant differences were not noted between reported OSHA 200 log (or equivalent) data, and a lack of information provided on workers compensation experience modifiers prevented comparisons on insurance premium expenditures. Other health and safety program descriptive information obtained served to validate the study's presupposition that the inclusion criteria would encompass those organizations with occupational risks from all four major hazard categories. Worker medical surveillance programs appeared to exist at most institutions, but the specific tests completed were not readily identifiable.^ The results of this study serve as a preliminary description of the health and safety programs for a unique set of workplaces have not been previously investigated. Numerous opportunities for further research are noted, including efforts to quantify the relative amount of each hazard present, the further definition of the programs reported to be in place, determination of other means to measure health outcomes on campuses, and comparisons among other culturally diverse workplaces. ^

For-profit business safety interventions: A systematic, descriptive review of the literature

The purpose of this research was to determine if principles from organizational theory could be used as a framework to compare and contrast safety interventions developed by for-profit industry for the time period 1986–1996. A literature search of electronic databases and manual search of journals and local university libraries' book stacks was conducted for safety interventions developed by for-profit businesses. To maintain a constant regulatory environment, the business sectors of nuclear power, aviation and non-profits were excluded. Safety intervention evaluations were screened for scientific merit. Leavitt's model from organization theory was updated to include safety climate and renamed the Updated Leavitt's Model. In all, 8000 safety citations were retrieved, 525 met the inclusion criteria, 255 met the organizational safety intervention criteria, and 50 met the scientific merit criteria. Most came from non-public health journals. These 50 were categorized by the Updated Leavitt's Model according to where within the organizational structure the intervention took place. Evidence tables were constructed for descriptive comparison. The interventions clustered in the areas of social structure, safety climate, the interaction between social structure and participants, and the interaction between technology and participants. No interventions were found in the interactions between social structure and technology, goals and technology, or participants and goals. Despite the scientific merit criteria, many still had significant study design weaknesses. Five interventions tested for statistical significance but none of the interventions commented on the power of their study. Empiric studies based on safety climate theorems had the most rigorous designs. There was an attempt in these studies to address randomization amongst subjects to avoid bias. This work highlights the utility of using the Updated Leavitt's Model, a model from organizational theory, as a framework when comparing safety interventions. This work also highlights the need for better study design of future trials of safety interventions. ^

Mexican American parent atttitudes towards research participation

The objective of this cross sectional pilot study was to understand the cultural and social influences associated with the participation and retention of Mexican American parents in research studies. Mexican American parent's participation is limited due to cultural barriers that researchers may not recognize. Successful recruitment and retention of participants is a critical element for prevention research, particularly for groups that are underrepresented and carry a high burden of disease (Dunika, Garza, Roosa, & Stoerzinger, 1997). ^ The goal of this pilot study was to increase the understanding of research participation, recruitment and retention strategies among Mexican American adults using an instrument based on the Health Belief Model. This instrument was used to assess the cultural beliefs of Mexican American adults toward research participation. The dependent variable (research scenarios indexed by invasiveness) for each participant was compared to the independent variable (HBM scores) using chi-square analysis to see how the Health Belief Model constructs of perceived threat, perceived barriers, cues to action and perceived benefits are associated with how willing the participants are to participate in different risk levels of research. Descriptive statistics were used to assess the items on the instrument regarding acculturation, demographics, and sample size. ^ This study expands on current knowledge of research participation and retention strategies and methods involving the Mexican American parents. Using data from this study, researchers can observe relevant patterns from the participant's responses.^

Trends in health information seeking among cancer and non-cancer adults between 2003 and 2005: A descriptive analysis of Health Information National Trends Survey (HINTS) data

Cancer is the second leading cause of death in the United States. With the advent of new technologies, changes in health care delivery, and multiplicity of provider types that patients must see, cancer care management has become increasingly complex. The availability of cancer health information has been shown to help cancer patients cope with the management and effects of their cancers. As a result, more cancer patients are using the internet to find resources that can aid in decision-making and recovery. ^ The Health Information National Trends Survey (HINTS) is a nationally representative survey designed to collect information about the experiences of cancer and non-cancer adults with health information sources. The HINTS survey focused on both conventional sources as well as newer technologies, particularly the internet. This study is a descriptive analysis of the HINTS 2003 and HINTS 2005 survey data. The purpose of the research is to explore the general trends in health information seeking and use by US adults, and especially by cancer patients. ^ From 2003 to 2005, internet use for various health-related activities appears to have increased among adults with and without cancer. Differences were found between the groups in the general trust in information media, particularly the internet. Non-cancer respondents tended to have greater trust in information media than cancer respondents. ^ The latter portion of this work examined characteristics of HINTS respondents that were thought to be relevant to how much trust individuals placed in the internet as a source of health information. Trust in health information from the internet was significantly greater among younger adults, higher-earning households, internet users, online seekers of health or cancer information, and those who found online cancer information useful. ^

Lab animal allergy surveillance at a private medical school in three dissimilar animal research facilities

Very few studies have described MUP-1 concentrations and measured prevalence of Laboratory Animal Allergy (LAA) at such a diverse institution as the private medical school (MS) that is the focus of this study. Air sampling was performed in three dissimilar animal research facilities at MS and quantitated using a commercially available ELISA. Descriptive data was obtained from an anonymous laboratory animal allergy survey given to both animal facility employees and the researchers who utilize these facilities alike. Logistic regression analysis was then implemented to investigate specific factors that may be predictive of developing LAA as well as factors influencing the reporting of LAA symptoms to the occupational health program. Concentrations of MUP-1 detected ranged from below detectable levels (BDL) to a peak of 22.64 ng/m3 . Overall, 68 employees with symptoms claimed they improved while away from work and only 25 employees reported their symptoms to occupational health. Being Vietnamese, a smoker, not wearing a mask, and working in any facility longer than one year were all significant predictors of having LAA symptoms. This study suggests a LAA monitoring system that relies on self-reporting can be inadequate in estimating LAA problems. In addition, efforts need to be made to target training and educational materials for non-native English speaking employees to overcome language and cultural barriers and address their specific needs. ^

Performance tiers: Implementing comparative effectiveness analysis in the health care setting through operations research and spatial methods

This dissertation develops and tests a comparative effectiveness methodology utilizing a novel approach to the application of Data Envelopment Analysis (DEA) in health studies. The concept of performance tiers (PerT) is introduced as terminology to express a relative risk class for individuals within a peer group and the PerT calculation is implemented with operations research (DEA) and spatial algorithms. The analysis results in the discrimination of the individual data observations into a relative risk classification by the DEA-PerT methodology. The performance of two distance measures, kNN (k-nearest neighbor) and Mahalanobis, was subsequently tested to classify new entrants into the appropriate tier. The methods were applied to subject data for the 14 year old cohort in the Project HeartBeat! study.^ The concepts presented herein represent a paradigm shift in the potential for public health applications to identify and respond to individual health status. The resultant classification scheme provides descriptive, and potentially prescriptive, guidance to assess and implement treatments and strategies to improve the delivery and performance of health systems. ^

A descriptive and exploratory analysis of occupational injuries at a chemical manufacturing facility

A retrospective study of 1353 occupational injuries occurring at a chemical manufacturing facility in Houston, Texas from January, 1982 through May, 1988 was performed to investigate the etiology of the occupational injury process. Injury incidence rates were calculated for various sub-populations of workers to determine differences in the risk of injury for various groups. Linear modeling techniques were used to determine the association between certain collected independent variables and severity of an injury event. Finally, two sub-groups of the worker population, shiftworkers and injury recidivists, were examined. An injury recidivist as defined is any worker experiencing one or more injury per year. Overall, female shiftworkers evidenced the highest average injury incidence rate compared to all other worker groups analyzed. Although the female shiftworkers were younger and less experienced, the etiology of their increased risk of injury remains unclear, although the rigors of performing shiftwork itself or ergonomic factors are suspect. In general, females were injured more frequently than males, but they did not incur more severe injuries. For all workers, many injuries were caused by erroneous or foregone training, and risk taking behaviors. Injuries of these types are avoidable. The distribution of injuries by severity level was bimodal; either injuries were of minor or major severity with only a small number of cases falling in between. Of the variables collected, only the type of injury incurred and the worker's titlecode were statistically significantly associated with injury severity. Shiftworkers did not sustain more severe injuries than other worker groups. Injury to shiftworkers varied as a 24-hour pattern; the greatest number occurred between 1200-1230 hours, (p = 0.002) by Cosinor analysis. Recidivists made up 3.3% of the population (23 males and 10 females), yet suffered 17.8% of the injuries. Although past research suggests that injury recidivism is a random statistical event, analysis of the data by logistic regression implicates gender, area worked, age and job titlecode as being statistically significantly related to injury recidivism at this facility. ^

OUT-OF-HOSPITAL CHILDBEARING CENTERS IN THE UNITED STATES: A DESCRIPTIVE STUDY OF THE DEMOGRAPHIC AND MEDICAL-OBSTETRIC CHARACTERISTICS OF WOMEN BEGINNING LABOR THEREIN 1972-1979

There is currently much interest in the appropriate use of obstetrical technology, cost containment and meeting consumers' needs for safe and satisfying maternity care. At the same time, there has been an increase in professionally unattended home births. In response, a new type of service, the out-of-hospital childbearing center (CBC) has been developed which is administratively and structurally separate from the hospital. In the CBC, maternity care is provided by certified nurse-midwives to carefully screened low risk childbearing families in conjunction with physician and hospital back-up.^ It was the purpose of this study to accomplish the following objectives: (1) To describe in a historical prospective study the demographic and medical-obstetric characteristics of patients laboring in eleven selected out-of-hospital childbearing centers in the United States from May 1, 1972, to December 15, 1979. Labor is defined as the onset of regular contractions as determined by the patient. (2) To describe any differences between those patients who require transfer to a back-up hospital and those who do not. (3) To describe administrative and service characteristics of eleven selected out-of-hospital childbearing centers in the United States. (4) To compare the demographic and medical-obstetric characteristics of women laboring in eleven selected out-of-hospital childbearing centers with a national sample of women of similar obstetric risk who according to birth certificates delivered legitimate infants in a hospital setting in the United States in 1972.^ Research concerning CBCs and supportive to the development of CBCs including studies which identified factors associated with fetal and perinatal morbidity and mortality, obstetrical risk screening, and the progress of technological development in obstetrics were reviewed. Information concerning the organization and delivery of care at each selected CBC was also collected and analyzed.^ A stratified, systematic sample of 1938 low risk women who began labor in a selected CBC were included in the study. These women were not unlike those described previously in small single center studies reported in the literature. The mean age was 25 years. Sixty-three per cent were white, 34 per cent Hispanic, 88 per cent married, 45 per cent had completed at least two years of college, nearly one-third were professionals and over a third were housewives. . . . (Author's abstract exceeds stipulated maximum length. Discontinued here with permission of school.) UMI ^