A current literature review of the social and economic ramifications of pharmacogenomic research

Objective. To explore issues in current literature concerning possible social and economic ramifications of pharmacogenomic research. Design. Review of the literature. Data sources: Academic Search Premier, Blackwell Synergy, PUBMED and Social Sciences Citation Index. Review methods. Articles dealing with the social and economic ramifications of pharmacogenomic research were selected. The articles discussed at least one of 5 areas (race, privacy/confidentiality, ethics, insurance, and research and development). Some restrictions were placed on the articles chosen to narrow down the number of articles to a relevant, manageable amount. Results. Approximately 219 articles were selected for review; 159 were fully reviewed and found to be relevant to the issues; and 33 were cited. Conclusion. Insurance and research and development decisions are led by the free-market system with limited intervention from government. Race/ethnicity, privacy/confidentiality, and ethics continue to be debated with no clear answer. However, some compromise is regulated by government based upon current laws involving these issues. ^

The determinants of sexually transmitted infection screening uptake among African American young adults: A systematic review

Objective. To conduct a systematic review of literature to determine the factors associated with STI including HIV screening uptake among African American young adults in the United States. ^ Methods. The electronic databases OVID Medline and OVID PsycINFO were systematically searched to identify potentially relevant articles. Ninety-six articles were initially identified, five of which were included in the final review. ^ Results. The results of this review were inconclusive. There was no definitive evidence to suggest which determinants were predictive of screening uptake. ^ Conclusions. There is a limited body of literature examining the demographic and behavioral risk factors associated with uptake or non-uptake of STI including HIV screening among African American young adult populations. This finding points to the need for more quality research to be conducted in this area. ^

A systematic review of economic evaluations for interventions of cardiovascular diseases

Background. Cardiovascular disease (CVD) exhibits the most striking public health significance due to its high prevalence and mortality as well as huge economic burdens all over the world, especially in industrialized countries. Major risk factors of CVDs have been the targets of population-wide prevention in the United States. Economic evaluations provide structured information in regard to the efficiency of resource utilization which can inform decisions of resource allocation. The main purpose of this review is to investigate the pattern of study design of economic evaluations for interventions of CVDs. ^ Methods. Primary journal articles published during 2003-2008 were systematically retrieved via relevant keywords from Medline, NHS Economic Evaluation Database (NHS EED) and EBSCO Academic Search Complete. Only full economic evaluations for narrowly defined CVD interventions were included for this review. The methodological data of interest were extracted from the eligible articles and reorganized in Microsoft Access database. Chi-square tests in SPSS were used to analyze the associations between pairs of categorical data. ^ Results. One hundred and twenty eligible articles were reviewed after two steps of literature selection with explicit inclusion and exclusion criteria. Descriptive statistics were reported regarding the evaluated interventions, outcome measures, unit costing and cost reports. The chi-square test of the association between prevention level of intervention and category of time horizon showed no statistical significance. The chi-square test showed that sponsor type was significantly associated with whether new or standard intervention being concluded as more cost effective. ^ Conclusions. Tertiary prevention and medication interventions are the major interests for economic evaluators. The majority of the evaluations were claimed from either a provider’s or a payer’s perspective. Almost all evaluations adopted gross costing strategy for unit cost data rather than micro costing. EQ-5D is the most commonly used instrument for subjective outcome measurement. More than half of the evaluations used decision analytic modeling techniques. The lack of consistency in study design standards in published evaluations appears in several aspects. Prevention level of intervention is not likely to be a factor for evaluators to decide whether to design an evaluation in a lifetime horizon or not. Published evaluations sponsored by industry are more likely to conclude that new intervention is more cost effective than standard intervention.^

A systematic review of literature on socioeconomic disparities in the prevalence of dental caries

Dental caries, also known as tooth decay, are a disease of the oral cavity that affects the tooth structure and leads to the occurrence of cavities in teeth. Dental caries are one of the leading chronic diseases in the population and are very common in childhood. If not treated appropriately, dental caries have debilitating effect on the oral and general health of individuals. ^ Objectives. The aims of this review are to (1) analyze and elucidate the relationship between the social and economic determinants of health like income, education and race/ethnicity and the prevalence of dental caries and (2) identify and understand the pathways/underlying causes through which these factors affect the occurrence of dental caries. This review will provide a foundation for formulation of better oral health policies in future by identifying the key socio-economic factors and pathways affecting the prevalence of dental caries. Knowledge about these socioeconomic factors could be incorporated in the design of future policies and interventions to achieve greater benefits.^ Methods. This review includes information from all pertinent articles, reviews, surveys, reports, peer reviewed literature and web sources that were published after 2000. The selection criterion includes literature focusing on individuals between the ages of 1 to 65 years, and individuals from different subgroups of community based on income, education and race/ethnicity. The analyses of literature include identifying if a relationship between income/education/race and the prevalence of dental caries exists by comparing the prevalence of dental caries in different socio-economic groups. Also included in this review are articles that are relevant to the mechanisms/pathways through which income/education/race affect the prevalence of dental caries.^ Results. Analyses of available literature suggests that disparities in the prevalence of dental caries may be attributed to differences in income, education and race/ethnicity. Higher prevalence of dental caries was observed in African-American and Mexican-American individuals, and in people with low income and low education. The leading pathways through which the socioeconomic factors affect the prevalence of dental caries are the lack of access to dental care, lack of awareness about good oral hygiene beliefs and habits, oral health, inability to afford dental care, lack of social support to maintain oral health and lack of dental insurance.^ Conclusion. Disparities in the prevalence of dental caries exist in various socio-economic groups. The relationship between socio-economic factors and dental caries prevalence should be considered in the development of future policies and interventions that are aimed at reducing the prevalence of dental caries and enhancing oral health status.^

A review of economic analysis in the vaccination program; decision making and governance: Adivisory Committee on Immunization Practices (ACIP)

The Advisory Committee on Immunization Practices (ACIP) develops written recommendations for the routine administration of vaccines to children and adults in the U.S. civilian population. The ACIP is the only entity in the federal government that makes such recommendations. ACIP elaborates on selection of its members and rules out concerns regarding its integrity, but fails to provide information about the importance of economic analysis in vaccine selection. ACIP recommendations can have large health and economic consequences. Emphasis on economic evaluation in health is a likely response to severe pressures of the federal and state health budget. This study describes the economic aspects considered by the ACIP while sanctioning a vaccine, and reviews the economic evaluations (our economic data) provided for vaccine deliberations. A five year study period from 2004 to 2009 is adopted. Publicly available data from ACIP web database is used. Drummond et al. (2005) checklist serves as a guide to assess the quality of economic evaluations presented. Drummond et al.'s checklist is a comprehensive hence it is unrealistic to expect every ACIP deliberation to meet all of their criteria. For practical purposes we have selected seven criteria that we judge to be significant criteria provided by Drummond et al. Twenty-four data points were obtained in a five year period. Our results show that out of the total twenty-four data point‘s (economic evaluations) only five data points received a score of six; that is six items on the list of seven were met. None of the data points received a perfect score of seven. Seven of the twenty-four data points received a score of five. A minimum of a two score was received by only one of the economic analyses. The type of economic evaluation along with the model criteria and ICER/QALY criteria met at 0.875 (87.5%). These three criteria were met at the highest rate among the seven criteria studied. Our study findings demonstrate that the perspective criteria met at 0.583 (58.3%) followed by source and sensitivity analysis criteria both tied at 0.541 (54.1%). The discount factor was met at 0.250 (25.0%).^ Economic analysis is not a novel concept to the ACIP. It has been practiced and presented at these meetings on a regular basis for more than five years. ACIP‘s stated goal is to utilize good quality epidemiologic, clinical and economic analyses to help policy makers choose among alternatives presented and thus achieve a better informed decision. As seen in our study the economic analyses over the years are inconsistent. The large variability coupled with lack of a standardized format may compromise the utility of the economic information for decision-making. While making recommendations, the ACIP takes into account all available information about a vaccine. Thus it is vital that standardized high quality economic information is provided at the ACIP meetings. Our study may provide a call for the ACIP to further investigate deficiencies within the system and thereby to improve economic evaluation data presented. ^

Resource Review: Child Food Insecurity: The Economic Impact on Our Nation

A review of Child Food Insecurity: The Economic Impact on our Nation. A Report on Research on the Impact of Food Insecurity and Hunger on Child Health, Growth and Development Commissioned by Feeding America and the ConAgra Foods Foundation by John Cook and Karen Jeng.

Understanding Impediments and Enablers to Physical Activity among African American Adults: A Systematic Review of Qualitative Studies

Objective: To systematically assess and summarize impediments and facilitating factors impacting physical activity participation among African American Adults. ^ Method: A systematic search of the literature was conducted, which included electronic databases, as well as reference list of relevant papers. Only qualitative studies which measured race and ethnicity and had African American as adult participants were included. The main themes and categories from the qualitative studies pertaining to impediments and facilitators to physical activity were identified and summarized, through descriptive meta-synthesis. ^ Result: Twenty nine qualitative studies were included. Twenty-one of the studies only focused on adult African American women, and the barriers and facilitators to physical activity as perceived by them. The biggest individual enabler towards physical activity was the positive health benefits associated with regular physical activity. Social support and easy access to parks and facilities were also identified as enablers. Barriers toward physical activity were lack of time, lack of motivation, long work hours, and physical disabilities. ^ Conclusions: The findings of this review study should be useful to those planning an intervention in African American communities. There is also a need for qualitative studies conducted only among African American men, to better understand their perspective on the facilitators and barriers to physical activity.^

The prevalence of periodontal disease in Mexican American vs European American elderly in three distinct socio-economic communities in San Antonio, Texas

Purpose of the Study: This study evaluated the prevalence of periodontal disease between Mexican American elderly and European American elderly residing in three socio-economically distinct neighborhoods in San Antonio, Texas. ^ Study Group: Subjects for the original protocol were participants of the Oral Health: San Antonio Longitudinal Study of Aging (OH: SALSA), which began with National Institutes of Health (NIH) funding in 1993 (M.J. Saunders, PI). The cohort in the study was the individuals who had been enrolled in Phases I and III of the San Antonio Heart Study (SAHS). This SAHS/SALSA sample is a community-based probability sample of Mexican American and European American residents from three socio-economically distinct San Antonio neighborhoods: low-income barrio, middle-income transitional, and upper-income suburban. The OH: SALSA cohort was established between July 1993 and May 1998 by sampling two subsets of the San Antonio Heart Study (SAHS) cohort. These subsets included the San Antonio Longitudinal Study of Aging (SALSA) cohort, comprised of the oldest members of the SAHS (age 65+ yrs. old), and a younger set of controls (age 35-64 yrs. old) sampled from the remainder of the SAHS cohort. ^ Methods: The study used simple descriptive statistics to describe the sociodemographic characteristics and periodontal disease indicators of the OH: SALSA participants. Means and standard deviations were used to summarize continuous measures. Proportions were used to summarize categorical measures. Simple m x n chi square statistics was used to compare ethnic differences. A multivariable ordered logit regression was used to estimate the prevalence of periodontal disease and test ethnic group and neighborhood differences in the prevalence of periodontal disease. A multivariable model adjustment for socio-economic status (income and education), gender, and age (treated as confounders) was applied. ^ Summary: In the unadjusted and adjusted model, Mexican American elderly demonstrated the greatest prevalence for periodontitis, p < 0.05. Mexican American elderly in barrio neighborhoods demonstrated the greatest prevalence for severe periodontitis, with unadjusted prevalence rates of 31.7%, 22.3%, and 22.4% for Mexican American elderly barrio, transitional, and suburban neighborhoods, respectively. Also, Mexican American elderly had adjusted prevalence rates of 29.4%, 23.7%, and 20.4% for barrio, transitional, and suburban neighborhoods, respectively. ^ Conclusion: This study indicates that the prevalence of periodontal disease is an important oral health issue among the Mexican American elderly. The results suggest that the socioeconomic status of the residential neighborhood increased the risk for severe periodontal disease among the Mexican American elderly when compared to European American elderly. A viable approach to recognizing oral health disparities in our growing population of Mexican American elderly is imperative for the provision of special care programs that will help increase the quality of care in this minority population.^

Sudden Infant Death disparities: A systematic review on health education and policy recommendations for decreasing Sudden Infant Death in the African-American community

Objective: To perform a systematic review of the literature on SIDS and SUID deaths concentrated in the African-American community, describe health education and policy recommendations and recommend a new approach that may aid in decreasing the disparity of infant mortality in the African-American community. ^ Methods: The PubMed database was systematically searched to identify relevant articles for final review and analysis. Using the CASP 2006 system to critique literature, twelve articles were found that met inclusion and exclusion criteria. ^ Results: Evidence in the literature confirmed there was a current disparity among African Americans' infant mortality rates in comparison to other US ethnic groups. The underlying reasons for these disparities included the following maternal and infant characteristics: mothers younger than eighteen, having more than one live infant, having a high school education or less, never been married, and have infants born preterm or with low birth weight. Maternal smoking, substance abuse, and breastfeeding did not have a significant impact on infant sleep environments among African Americans. ^ Conclusion: Tailored health education programs at the community level, better access to pre-pregnancy and prenatal care, and increased maternal perception of risk that is relevant to the infants sleeping environment are all possible solutions that may decrease African American infant mortality rates.^

Attitudes and other barriers to the utilization of clinical research findings by American physicians: A systematic review

Background: The Institute of Medicine estimates that only a maximum of 25% of clinical research findings are incorporated into practice by physicians. To improve clinical practice, efforts have been made to promote evidence-based medicine and the use of clinical guidelines. Despite these efforts, the gap between research and clinical practice remains wide.^ Objective: To systematically review the literature describing the factors which influence the use of clinical research recommendations by American physicians.^ Hypothesis: Barriers exist in the application of clinical research into clinical practice, and are multifactorial. The establishment of the Clinical and Translational Awards (CTSA; special federal grants awarded to selected institutions to support clinical and translational research) has reduced the effect of these barriers and improved the process of clinical research translation into practice among American physicians.^ Aims: Identify barriers and facilitators of the use of research findings in clinical practice by American physicians. Contrast studies published six years before and after the creation of the CTSA.^ Methods: The sources of data include published literature from Medline, PubMed and PsycINFO. Selected studies must be qualitative, a survey of American clinicians, based on evidence-based medicine practice, clinical guidelines or treatment pathways. Systematic reviews and reports were excluded, as well as studies with less than 100 respondents.^ Results: In total, 1036 abstracts were reviewed; 115 full text potential articles were identified and reviewed, and a total of 31 studies met all criteria for inclusion in the final review.^ Conclusions: The barriers against the application of clinical research findings, in the forms of clinical guidelines, evidence-based medicine guides and clinical pathways, can be divided broadly into physician barriers, practice/system barriers and patient barriers. Physician barriers are the most common barriers, especially the lack of familiarity with guidelines and the lack of time. Of the factors which improve the use of research based guidelines, physician factors such as younger age, lower duration of clinical practice, specialty training, and practice in large group Health Maintenance Organization (HMO) settings with fewer patients seen were the most commonly cited.^