Assessing the Feasibility of Partnering with a Home Visiting Program for Early Childhood Obesity Prevention

PURPOSE

Little empirical data exists evaluating the feasibility of partnering with established home visiting programs to implement early childhood obesity prevention programs, despite the recommendation to do so. To inform this gap, we evaluated the feasibility of collecting anthropometric measurements of children by home visitors across multiple sites, and the alignment of these measurements with children in need, including with adverse family experiences (AFEs) given emerging evidence suggests an association with childhood obesity.

DESCRIPTION

Our proof-of-concept study included primary data collection of child anthropometric measurements through an established home visiting program in four states. This sample included 248 children ages 6 months to 5 years.

ASSESSMENT

In the sample, 37.1% of the children had overweight or obesity, 50% were female, 64.2% Hispanic/Latinx, 15.8% non-Hispanic Black, and 42.3% from rural/small towns. Households included substantial needs: 87.1% were low income, 73.8% low education, and 59.3% underemployment. Regarding AFEs, 38.3% of the children had at least one, with the most common being mothers who were treated violently. A multivariable model revealed community type, not AFEs, was significantly associated with overweight/obesity status, suggesting children in suburban and especially rural/small town residences (odds ratio 5.11; 95% CI [1.59, 16.39]) could be priority populations for childhood obesity prevention programs.

CONCLUSION

Findings of this multi-site study inform the feasibility of partnering with home visiting programs to reach and measure a diverse sample of children and families in need of childhood obesity prevention.

Practice Perspectives on Care Coordination in Rural Settings

PURPOSE

Social needs and nonmedical health determinants are increasingly incorporated into care coordination models. However, little is known about the practice of operationalizing enhanced care coordination, particularly in rural settings. The objective of this study was to determine care coordination practices in rural settings that integrate social services with health care.

PRIMARY PRACTICE SETTINGS

Staff and administrators in rural Missouri health and health care settings were interviewed about their organization's implementation of enhanced care coordination practices.

METHODOLOGY AND SAMPLE

This is a mixed-methods study; 16 key informant structured interviews were conducted across 14 organizations.

RESULTS

Organizations reported a median care coordination population of 800 (range: 50-21,500) across a median of 11 case managers (range: 3-375). The percentage of organizations reporting social determinants of health services included the following: 100% transportation, 86% mental health, 79% food, 71% housing, and 50% dental. Implementation of the essential indicators of care coordination quality ranged from 41.7% to 100%. We report organizations' innovative solutions to care coordination barriers.

IMPLICATIONS FOR CASE MANAGEMENT PRACTICE

This study contributes to a very limited literature on the practice of rural care coordination by assessing the quality of care provided compared with a recommended standard. This study also contributes an in-depth reporting on the variety of service models being implemented. Finally, this study uniquely contributes innovative interprofessional examples of enhanced care coordination initiatives. These examples may provide inspiration for rural health care organizations. As the care coordination landscape evolves to include social determinants of health, there remain important fundamental barriers to ensuring quality of care.

Disparities in Text Messaging Interventions to Improve Diabetes Management in the United States

Substantial progress has been made in the development of evidence-based interventions to facilitate the management of type 2 diabetes. The increase in ownership of mobile phones has made short messaging services (SMS, or text messaging) a feasible way to enhance information delivery. The goals of this study were to 1) summarize characteristics of diabetes SMS interventions implemented in the United States and 2) identify the extent to which disadvantaged populations are represented in SMS-based diabetes management intervention studies. We conducted a literature search to identify published studies of type 2 diabetes self-management SMS interventions conducted with adults in the United States. Of the 792 articles retrieved, only 9 met inclusion criteria. We systematically extracted data on the theoretical basis, recruitment, incentives, inclusion/exclusion criteria, strategies toward ensuring a racially/ethnically or income-diverse sample, text message delivery, and study duration. Sixty-three percent of the participants across the nine studies were non-white. Only two studies reported participants' education level, and four captured non-English-speaking status. Interventions varied in offering one-way, two-way, or a combination of messaging strategies. Five studies did not describe cultural adaptations or report results separately for different cultural groups. None of the studies provided cell phones, and not having texting capability was an exclusion criterion for six studies. There is a dearth of published research on type 2 diabetes management interventions using text messaging among racially/ethnically or income-diverse populations. Future interventions should be better tailored to these target populations and include the collection of complete sociodemographic data and cell phone/smartphone availability, thereby ensuring cultural appropriateness.

Collecting Early Childhood Obesity Measurements Through a Home Visiting Program: A Proof-of-Concept Study

Community-based home visiting programs are recommended vehicles for early life-course interventions to prevent childhood obesity. We developed and implemented a proof-of-concept protocol for collecting child weight and length or height data for children aged 6 months to 5 years through Parents as Teachers (PAT) affiliates that were geographically dispersed throughout the United States. We implemented our protocol with 1 affiliate in each of 4 states. We assessed formative measures of the implementation from parent educators and site leaders and reviewed delivery process measures. Findings suggest that collecting data on child measurements through an existing home visiting program is 1) feasible (91% of estimated measurements achieved); 2) does not require much time (median, 0.5 hours spent per child); 3) is a positive experience for families (71% of parent educators indicated that families enjoyed the experience); and 4) is fairly accurate (82% of collected data met eligibility and quality standards).

The economic case for US hospitals to revise their approach to heart failure readmission reduction

To support hospital decision makers in their effort to reduce readmissions, the authors of this perspective present employer self-insurance as a potential incentive strategy, in particular for heart failure (HF). In 2010, US health reform identified hospital readmission as a key area for improving care coordination and achieving potential healthcare savings, and enacted the Hospital Readmissions Reduction Program (HRRP). In 2012, the Centers for Medicare and Medicaid Services (CMS) started the implementation of the HRRP by penalizing hospitals with excess 30-day readmission rates. The HRRP targets certain conditions, including HF, which is among the most expensive conditions treated in US hospitals. HF has the highest readmission rate for patients aged 65 and above, and its prevalence is expected to rise to over 8 million people by 2030 due to the aging population. Although the HRRP has been associated with reduced readmission rates, the rate of reduction has slowed. Furthermore, the HRRP may have alarming unintended consequences, such as possible increased mortality among HF patients. As a result, a critical analysis of financial incentives is needed to re-energize these efforts. One opportunity to incentivize readmission reduction is through employer self-insurance. More than half of colleges and universities self-insure the health care coverage they offer to their employees. With these self-insured plans, a hospital could be rewarded through shared savings with a university for readmission reduction. This perspective proposes that the economic case for a hospital to invest in readmission reduction is stronger when a hospital is a part of a self-insured university.

The Evidence Base for the Maternal, Infant, and Early Childhood Home Visiting Program Constructs

OBJECTIVES

The federal Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program requires grantees to demonstrate program improvement as a condition of funding. The MIECHV program monitors grantee progress in federally mandated conceptual areas (ie, benchmarks) that are further subcategorized into related sub-areas or constructs (eg, breastfeeding). Each construct has an associated performance measure that helps MIECHV collect data on program implementation and performance. In 2016, MIECHV modified the constructs and associated performance measures required of grantees. Our objective was to identify whether the constructs were supported by the home visiting literature.

METHODS

We conducted an evaluation of one of the MIECHV program's benchmarks (Benchmark 1: Maternal and Newborn Health) for alignment of the Benchmark 1 constructs (preterm birth, breastfeeding, depression screening, well-child visit, postpartum care, and tobacco cessation referrals) with home visiting evidence. In March 2016, we searched the Home Visiting Evidence of Effectiveness database for all publicly available articles on studies conducted in the United States to determine how well the study findings aligned with the MIECHV program constructs.

RESULTS

Of 59 articles reviewed, only 3 of the 6 MIECHV constructs-preterm birth, breastfeeding, and well-child visits-were supported by home visiting evidence.

CONCLUSIONS

This evaluation highlights a limited evidence base for the MIECHV Benchmark 1 constructs and a need to clarify other criteria, beyond evidence, used to choose constructs and associated performance measures. One implication of not having evidence-based performance measures is a lack of confidence that the program will drive positive outcomes. If performance measures are not evidence based, it is difficult to attribute positive outcomes to the home visiting services.

Is Twitter a forum for disseminating research to health policy makers?

Findings from scientific research largely remain inside the scientific community. Research scientists are being encouraged to use social media, and especially Twitter, for dissemination of evidence. The potential for Twitter to narrow the gap on evidence translated into policy presents new opportunities. We explored the innovative question of the feasibility of Twitter as a tool for the scientific community to disseminate to and engage with health policy makers for research impact. We created a list of federal "health policy makers." In December 2014, we identified members using several data sources, then collected and summarized their Twitter usage data. Nearly all health policy makers had Twitter accounts. Their communication volume varied broadly. Policy makers are more likely to push information via Twitter than engage with constituents, although usage varied broadly. Twitter has the potential to aid the scientific community in dissemination of health-related research to health policy makers, after understanding how to effectively (and selectively) use Twitter.

Evaluation of the national prevention strategy in reference to historical population health

Scientists have estimated that approximately half of all deaths in the United States are attributed to largely preventable behaviors and exposures, such as tobacco use, diet and physical activity, and alcohol consumption. These findings are similar to reflections reported more than 100 years ago by public health authorities. Is it inevitable that half of the population will die prematurely, even as the average life span increases?

Research recruitment using Facebook advertising: big potential, big challenges

To our knowledge, ours is the first study to report on Facebook advertising as an exclusive mechanism for recruiting women ages 35-49 years residing in the USA into a health-related research study. We directed our survey to women ages 35-49 years who resided in the USA exclusively using three Facebook advertisements. Women were then redirected to our survey site. There were 20,568,960 women on Facebook that met the eligibility criteria. The three ads resulted in 899,998 impressions with a reach of 374,225 women. Of the women reached, 280 women (0.075 %) clicked the ad. Of the women who clicked the ad, nine women (3.2 %) proceeded past the introductory page. Social networking, and in particular Facebook, is an innovative venue for recruiting participants for research studies. Challenges include developing an ad to foster interest without biasing the sample, and motivating women who click the ad to complete the survey. There is still much to learn about this potential method of recruitment.

A prospective assessment of racial/ethnic differences in future mammography behavior among women who had early mammography

BACKGROUND

Twenty-nine percent of women, aged 30 to 39, report having had a mammogram, though sensitivity and specificity are low. We investigate racial/ethnic differences in future mammography behavior among women who had a baseline screening mammogram prior to age 40.

METHODS

Using 1994-2008 data from the Breast Cancer Surveillance Consortium (BCSC), we identified 29,390 women aged 35 to 39 with a baseline screening mammogram. We followed this cohort for 2 outcomes: (i) future BCSC mammography between ages 40 and 45; and (2) among those, delay in screening mammography until ages 43 to 45 compared with ages 40 to 42. Using adjusted log-linear models, we estimated the relative risk (RR) of these outcomes by race/ethnicity, while also considering the impact of false-positive/true-negative (FP/TN) baseline mammography results on these outcomes.

RESULTS

Relative to non-Hispanic white women, Hispanic women had an increased risk of no future BCSC mammography (RR: 1.21, 95% CI: 1.13-1.30); Asian women had a decreased risk (RR: 0.67, 95% CI: 0.61-0.74). Women with a FP result, compared with a TN result, had a decreased risk of no future BCSC mammography (RR: 0.89, 95% CI: 0.85-0.95). Among those with future BCSC screening mammography, African American women were more likely to delay the timing (RR: 1.26, 95% CI: 1.09-1.45). The interaction between race/ethnicity and FP/TN baseline results was not significant.

CONCLUSIONS

Race/ethnicity is differentially associated with future BCSC mammography and the timing of screening mammography after age 40.

IMPACT

These findings introduce the need for research that examines disparities in lifetime mammography use patterns from the initiation of mammography screening.

Interdisciplinary Collaboration: The Voices of Hospice Medical Directors

The value of interdisciplinary collaboration is a significant aspect of the palliative care philosophy, as identified by the founder of the modern hospice movement Cecily Saunders. The purpose of this descriptive study was to explore the experiences of hospice medical directors within this collaborative context. Open-ended interviews with 17 hospice medical directors were done and their responses were thematically analyzed. These narratives present a very positive collaborative experience by these medical directors in their hospice settings. Assisting medical directors to find time and financial opportunities for professional development and support within their role was found to be an opportunity to further improve collaboration.

Performance of first mammography examination in women younger than 40 years

BACKGROUND

Few data have been published on mammography performance in women who are younger than 40 years.

METHODS

We pooled data from six mammography registries across the United States from the Breast Cancer Surveillance Consortium. We included 117 738 women who were aged 18-39 years when they had their first screening or diagnostic mammogram during 1995-2005 and followed them for 1 year to determine accuracy of mammography assessment. We measured the recall rate for screening examinations and the sensitivity, specificity, positive predictive value, and cancer detection rate for all mammograms.

RESULTS

For screening mammograms, no cancers were detected in 637 mammograms for women aged 18-24 years. For women aged 35-39 years who had the largest number of screening mammograms (n = 73 335) in this study, the recall rate was 12.7% (95% confidence interval [CI] = 12.4% to 12.9%), sensitivity was 76.1% (95% CI = 69.2% to 82.6%), specificity was 87.5% (95% CI = 87.2% to 87.7%), positive predictive value was 1.3% (95% CI = 1.1% to 1.5%), and cancer detection rate was 1.6 cancers per 1000 mammograms (95% CI = 1.3 to 1.9 cancers per 1000 mammograms). Most (67 468 [77.7%]) of the 86 871 women screened reported no family history of breast cancer. For diagnostic mammograms, the age-adjusted rates across all age groups were: sensitivity of 85.7% (95% CI = 82.7% to 88.7%), specificity of 88.8% (95% CI = 88.4% to 89.1%), positive predictive value of 14.6% (95% CI = 13.3% to 15.8%), and cancer detection rate of 14.3 cancers per 1000 mammograms (95% CI = 13.0 to 15.7 cancers per 1000 mammograms). Mammography performance, except for specificity, improved in the presence of a breast lump.

CONCLUSIONS

Younger women have very low breast cancer rates but after mammography experience high recall rates, high rates of additional imaging, and low cancer detection rates. We found no cancers in women younger than 25 years and poor performance for the large group of women aged 35-39 years. In a theoretical population of 10 000 women aged 35-39 years, 1266 women who are screened will receive further workup, with 16 cancers detected and 1250 women receiving a false-positive result.

Are there racial/ethnic disparities among women younger than 40 undergoing mammography?

While the probability of a woman developing invasive breast cancer at age <40 is low (<1%), mammography use reported among younger women (age <40) is substantial, and varies by race/ethnicity. Little detail is known about mammography use among women aged <40, particularly by race/ethnicity. We describe racial/ethnic differences in: (1) mammography indication after considering underlying risk factors (breast symptoms and family history); (2) follow-up recommendations, and (3) mammography outcomes for first mammograms in women aged <40. These 1996-2005 Breast Cancer Surveillance Consortium data are prospectively pooled from seven U.S. mammography registries. Our community-based sample included 99,615 women aged 18-39 who self-reported race/ethnicity and presented for a first mammogram (screening or diagnostic) with no history of breast cancer. Multivariable analyses controlled for registry site, age, family history of breast cancer, symptoms, and exam year. Overall, 73.6% of the women in our sample were seen for a screening mammogram. Following screening mammography, African American (AA) women were more likely than white women to be recommended for additional workup [relative risk (RR): 1.15 (95% CI: 1.07-1.23)]. Following diagnostic mammography, AA [RR: 1.30 (95% CI: 1.17-1.44)] and Asian [RR: 1.44 (95% CI: 1.26-1.64)] women were more likely to be recommended for biopsy, fine-needle aspiration, or surgical consultation. Depending on race/ethnicity, and considering the rate of true positive to total first screening mammograms of younger women, a women has a likelihood of a true positive of 1 in 363-1,122; she has a likelihood of a false positive of 1 in 7-10. This study of community-based practice found racial/ethnic variability in mammography indication, recommendations, and outcomes among women undergoing first mammography before 40. These findings highlight important areas for future research to understand the motivating factors for these practice patterns and the implications of early mammography use.

Do Early Screening Mammography Outcomes &lt;Age 40 Adversely Impact the Timing of Screening Mammography &gt;40 Differentially by Race?

Purpose: Previous studies suggest 29% of women ages 30-39 report having had a mammogram; this varies by race/ethnicity. Black women have a greater odds than White women of reporting multiple mammograms &lt;40; yet ≥40, Black and Asian women are less likely to receive adequate mammography screening. Could early mammography testing adversely impact future mammography use? Our objective is to determine whether racial/ethnic differences and the outcome of a first mammogram &lt;40 (false positive (FP) or true negative (TN)) may delay the age of the first mammogram ≥40.

Methods: Data were pooled from seven mammography registries of the National Cancer Institute's Breast Cancer Surveillance Consortium (BCSC), a network created to study performance and outcomes in community practice. Using 1996-2006 data, we identified 29,158 women with a screening mammogram between ages 40-45 who also underwent screening mammography for the first time ever at an age &lt;40 in the BCSC data. We used logistic regression to examine the association between race/ethnicity and first mammography outcomes on the odds of delayed mammography after 40 (ages 43-45 compared to 40-42).

Results: Overall, 96% of these women's first screens &lt;40 were at ages 35 or later, and 93% of their first screens &gt;40 were at ages 40-42. Regression models adjusted for age at first screen suggest: (1) Hispanic women have an increased odds of waiting to screen until 43-45 compared to White women, regardless of first screening outcome &lt;40; (2) White and Black women whose first screen &lt;40 was a FP have less odds of delaying future screening than those with a TN; and (3) among women with a TN, Black women have an increased odds of waiting to screen until 43-45 relative to White women, with no observed difference between Asian and White women.

Conclusions: Findings suggest a differential impact of early mammography outcomes on future mammography use by race/ethnicity, among the women in our sample with a known first screening mammogram before and after age 40. The concern for harmful effects of over-screening young women drives the need for additional work in this area.

Abstract A92: Racial and ethnic distribution of mammography outcomes before age 40

Purpose: The probability of a woman developing invasive breast cancer &lt; age 40 is low (&lt;1%). For in situ or invasive cancer, the incidence rate per 100,000 woman-years for African American (AA) and white women, respectively, is 16.8 and 15.1 (Brinton et al, 2008). Yet, 34% of non-Hispanic AA women, 30% of non-Hispanic white women, and 22% of Hispanic women ages 30–39 reported ever having a mammogram from a national population-based sample (Kapp et al, 2009). We describe first mammograms in younger women to investigate racial/ethnic differences (AA, Asian, Hispanic, white) in mammography outcomes.

Methods: Data are pooled from the National Cancer Institute's Breast Cancer Surveillance Consortium, a collaborative network of mammography registries created for the purpose of studying performance and outcomes in community practice. We included women ages 18–39, with no prior history of breast cancer, with a first mammogram (screening or diagnostic) between 1996 and 2005. We determined whether a cancer diagnosis (DCIS or invasive) was made within the 12 months following each mammogram and, using standard definitions, classified each mammogram as a true positive (TP), false positive (FP), true negative (TN) or false negative (FN).

Results: Our sample included 73,353 screening mammograms and 26,262 diagnostic mammograms. Our FP results for screening mammograms reflected modest variability across race/ethnicity (10.4–14.1%). AA woman had a TP to total screening mammogram ratio of 1 in 363, compared to 1 in 623 for white women, while the ratio of a FP to total screening mammograms was similar across all racial/ethnic groups (1 in 7–10). Among diagnostic mammograms, the FP variability was greater, ranging from 8.7% for white women to 18.2% for Asian women with an absolute risk difference of a TP of &lt;1% among all racial/ethnic groups.

Conclusions: While the FP rates may vary moderately by race/ethnicity, their impact may vary substantially. Average risk AA women have greater odds than white women of reporting multiple mammograms &lt; age 40 (Kapp et al, 2009); yet ≥40 are less likely to receive adequate mammography screening (Smith-Bindman et al, 2006). Could early mammography testing adversely impact future mammography use? This deserves further study.

Citation Information: Cancer Prev Res 2010;3(1 Suppl):A92.

Are mammography recommendations in women younger than 40 related to increased risk?

Our objective was to examine the association between self-reported breast cancer risk factors and reported physician recommendations for mammography among women younger than 40. This study uses the 2005 National Health Interview Survey (NHIS) and includes 2,703 women ages 30-39 who reported having seen a doctor in the past 12 months. The NHIS is a population-based, cross-sectional survey of adult respondents in the United States. Overall, 19.0% of these women reported a recent mammography recommendation. Among women reporting no prior mammogram, women ages 30-34 with risk factors for breast cancer were more likely to report a recent mammogram recommendation than women without risk factors. There was no such association for women ages 35-39. Among women who reported a prior mammogram, risk factors were not associated with a recommendation for mammography; there was an association with age and recent clinical breast examination. Despite a lack of evidence-based guidelines for women under 40 years of age, these data suggest some younger women are being recommended for early mammography without indication. The relative benefits and harms of recommending mammography in this age group need further examination.

Physician recommendations for mammography in women aged 70 and older

OBJECTIVES

To estimate the percentage of U.S. women aged 70 and older who reported a recent mammography recommendation and to identify whether factors suggesting limited life expectancy, such as comorbidities, are associated with a lower probability of a reported recommendation.

DESIGN

A national, population-based, cross-sectional survey.

SETTING

United States.

PARTICIPANTS

There were 1,782 screen-eligible women 70 and older who responded to the National Health Interview Survey in 2005 and met eligibility criteria, including reporting at least one doctor visit in the previous 12 months. Weighted, these women represented almost 9.3 million women nationally.

MEASUREMENTS

Multiple logistic regression was used to examine the relationship between demographic, comorbidity, and health services utilization variables on self-reported physician recommendation for a mammogram.

RESULTS

More than half (58.9%) of the sample reported a recent mammography recommendation (63.0% of those aged 70 to 79 and 51.5% of those aged 80 and older). The strongest multivariable association suggested that women who reported a recent clinical breast examination (CBE) had 5.9 times greater odds of reporting a mammography recommendation than women who reported never having a CBE.

CONCLUSION

This study failed to find negative associations between factors suggesting limited life expectancy and a recent mammography recommendation. Instead, findings revealed a strong positive association between a recent CBE and mammography recommendation. Findings may suggest that recent clinical interactions weigh more heavily on a decision to recommend mammography to older, screen-eligible women than considerations for the woman's overall long-term health or may reflect a greater perceived or actual recall of physician recommendations from women with a recent CBE.

Reliability of health-related quality-of-life indicators in cancer survivors from a population-based sample, 2005, BRFSS

OBJECTIVE

The current emphasis in cancer survivorship research, which includes health-related quality of life (HRQoL), drives the need to monitor the nation's cancer burden. Routine, ongoing public health surveillance tools, such as the Behavioral Risk Factor Surveillance System (BRFSS), may be relevant for this purpose.

STUDY DESIGN

A subsample of the 2005 Missouri BRFSS was used to estimate test-retest reliability of HRQoL questions among persons who did and did not report a personal cancer history.

METHODS

Retest interviews were conducted by telephone 14-21 days after the initial data collection (n=540, 67% response rate). Reliability was estimated overall and by cancer history using intraclass correlation coefficients (ICCs) and kappa statistics.

RESULTS

The majority of retest respondents were White, female and married, with 13% reporting a history of cancer. Overall, point estimates of the reliability coefficients ranged from moderate to excellent (kappa=0.57-0.75). There were no statistically significant differences in test-retest reliability between persons with and without a history of cancer, except for self-reported pain (ICC=0.59 and ICC=0.78, respectively).

CONCLUSIONS

In general, BRFSS questions appear to have adequate reliability for monitoring HRQoL in this community-dwelling population, regardless of cancer history.

Racial and ethnic differences in mammography use among U.S. women younger than age 40

OBJECTIVE

Evidence-based recommendations for routine breast cancer screening suggest that women begin mammography at age 40, although some women receive a mammogram before that age. Little is known about mammography use among younger women, especially with respect to race and ethnicity.

METHODS

We used data from the 2005 National Health Interview Survey to examine racial/ethnic differences in mammography use among U.S. women ages 30-39. We examined descriptive characteristics of women who reported ever having a mammogram, and used logistic regression to estimate associations between race/ethnicity and mammography use among women at average risk for breast cancer.

RESULTS

Our sample comprised 3,098 women (18% Hispanic, 13% non-Hispanic [NH] black, 69% NH white), of whom 29% reported having ever had a mammogram. NH black women were more likely than NH white women to report ever having a mammogram and receiving multiple mammograms before age 40 among women of average risk. Patterns of mammography use for Hispanic women compared to NH white women varied.

CONCLUSION

Findings suggest differential utilization of mammograms by race/ethnicity among women outside current recommendations and of average risk. Future studies should examine the role of practice patterns and patient-provider communication.

Diabetes and tooth loss in a national sample of dentate adults reporting annual dental visits

INTRODUCTION

Periodontal disease has been associated with tooth loss and reported as more prevalent among people with diabetes than among those without diabetes. Having an annual dental examination is a national goal of Healthy People 2010. Our objective was to examine whether an association exists between diabetes and tooth loss among a population reporting an annual dental visit.

METHODS

We used data from the 2004 Behavioral Risk Factor Surveillance System to examine the association between self-reported diabetes and tooth removal due to decay or periodontal disease among 155,280 respondents reporting a dental visit within the past year. We calculated prevalence estimates, odds ratios, and 95% confidence intervals. Multiple logistic regression allowed for adjustment.

RESULTS

The overall prevalence of tooth removal among the people in the study was 38.3%. People with diabetes had a significantly higher prevalence of tooth removal. In a multivariable model adjusting for selected covariates, respondents with diabetes were 1.46 times as likely (95% CI, 1.30-1.64) to have at least one tooth removed than respondents without diabetes. A stronger association between diabetes and tooth loss was observed among people in the younger age groups than among those in the older age groups.

CONCLUSION

Even among people reporting a recent dental visit, diabetes was independently associated with tooth loss. Multidisciplinary efforts are needed to raise awareness of the risk of tooth loss among younger people with diabetes. Good oral hygiene as well as annual dental examinations are important for preventing tooth loss.

US and Canadian physicians' attitudes and experiences regarding disclosing errors to patients

BACKGROUND

Patients are often not told about harmful medical errors. The malpractice environment is considered a major determinant of physicians' willingness to disclose errors to patients. Yet, little is known about the malpractice environment's actual effect on physicians' error disclosure attitudes and experiences.

METHODS

Mailed survey of 2637 physicians (62.9% response rate) in the United States (Missouri and Washington) and Canada, countries with different malpractice environments.

RESULTS

Physicians' error disclosure attitudes and experiences were similar across country and specialty. Of the physicians, 64% agreed that errors are a serious problem. However, 50% disagreed that errors are usually caused by system failures. Ninety-eight percent endorsed disclosing serious errors to patients and 78% supported disclosing minor errors; 74% thought disclosing a serious error would be very difficult. Fifty-eight percent had disclosed a serious error to a patient, and 85% were satisfied with the disclosure, and 66% agreed that disclosing a serious error reduces malpractice risk. Respondents' estimates of the probability of lawsuits were not associated with their support for disclosure. The belief that disclosure makes patients less likely to sue (odds ratio, 1.58), not being in private practice (odds ratio, 1.47), being Canadian (odds ratio, 1.43), and being a surgeon (odds ratio, 1.26) were independently associated with higher support for disclosing serious errors.

CONCLUSIONS

US and Canadian physicians' error disclosure attitudes and experiences are similar despite different malpractice environments, and reveal mixed feelings about disclosing errors to patients. The medical profession should address the barriers to transparency within the culture of medical and surgical specialties.

Racial disparities in diabetes-related preventive care: results from the Missouri Behavioral Risk Factor Surveillance System

INTRODUCTION

Racial disparities exist in the rates of diabetes complications in the United States and in the state of Missouri. It is unclear to what degree such disparities involve diabetes-related preventive care. We sought evidence for racial disparities in diabetes-related preventive care between non-Hispanic blacks and whites in Missouri.

METHODS

We analyzed data from the Missouri Behavioral Risk Factor Surveillance System from 1994 through 2002. This state-specific survey is conducted annually among a representative sample of Missourians. We examined data from 842 Missourians who reported a diagnosis of type 1 or type 2 diabetes and who had consulted a health professional in the 12 months before they were interviewed. We analyzed reported receipt of glycosylated hemoglobin testing, foot examinations, and dilated eye examinations in the year before interview.

RESULTS

Non-Hispanic blacks were significantly less likely than whites to report having had glycosylated hemoglobin testing (odds ratio [OR], 0.47; 95% confidence interval [CI], 0.22-0.99) but more likely to report having received foot examinations (OR, 1.99; 95% CI, 1.21-2.39). There was no difference between blacks and whites in the probability of dilated eye examinations (OR, 1.49; 95% CI, 0.94-2.36).

CONCLUSION

Compared with whites, non-Hispanic blacks in Missouri receive adequate screening for diabetic complications but not for glycemic control. Further studies are needed to investigate whether these disparities are linked to differences in the rate of diabetes complications in Missouri.