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Schootman M, Perez M, Schootman JC, Fu Q, McVay A, Margenthaler J, Colditz GA, Kreuter MW, Jeffe DB. Influence of built environment on quality of life changes in African-American patients with non-metastatic breast cancer. Health Place 2020; 63:102333. [PMID: 32543424 PMCID: PMC7676919 DOI: 10.1016/j.healthplace.2020.102333] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 03/10/2020] [Accepted: 03/30/2020] [Indexed: 12/15/2022]
Abstract
Research links the built environment to health outcomes, but little is known about how this affects quality of life (QOL) of African American breast cancer patients, especially those residing in disadvantaged neighborhoods. Using latent trajectory models, we examined whether the built environment using Google Street View was associated with changes in QOL over a 2-year follow-up in 228 newly diagnosed African American breast cancer patients. We measured QOL using the RAND 36-Item Health Survey subscales. After adjusting for covariates, improvement in emotional well-being and pain over time was greater for women living on streets with low-quality (vs. high-quality) sidewalks.
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Affiliation(s)
- M Schootman
- SSM Health, Department of Clinical Analytics and Insights, Center for Clinical Excellence, 10101 Woodfield Lane, St. Louis, MO, 63132, USA.
| | - M Perez
- Washington University in St Louis, School of Medicine, Department of Medicine, St. Louis, MO, 63110, USA
| | - J C Schootman
- Saint Louis University, College for Public Health and Social Justice, Department of Epidemiology and Biostatistics, St. Louis, MO, 63103, USA
| | - Q Fu
- Saint Louis University, College for Public Health and Social Justice, Department of Epidemiology and Biostatistics, St. Louis, MO, 63103, USA
| | - A McVay
- Saint Louis University, College for Public Health and Social Justice, Department of Epidemiology and Biostatistics, St. Louis, MO, 63103, USA
| | - J Margenthaler
- Washington University in St. Louis, School of Medicine, Department of Surgery, St. Louis, MO, 63110, USA
| | - G A Colditz
- Washington University in St. Louis, School of Medicine, Department of Surgery, St. Louis, MO, 63110, USA
| | - M W Kreuter
- Washington University in St. Louis, The Brown School, Health Communication Research Laboratory, St. Louis, MO, 63130, USA
| | - D B Jeffe
- Washington University in St Louis, School of Medicine, Department of Medicine, St. Louis, MO, 63110, USA
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Schootman M, Hendren S, Loux T, Ratnapradipa K, Eberth J, Davidson N. Differences in Effectiveness and Use of Robotic Surgery in Patients Undergoing Minimally Invasive Colectomy. J Gastrointest Surg 2017; 21:1296-1303. [PMID: 28567574 PMCID: PMC5576564 DOI: 10.1007/s11605-017-3460-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Accepted: 05/17/2017] [Indexed: 01/31/2023]
Abstract
BACKGROUND We compared patient outcomes of robot-assisted surgery (RAS) and laparoscopic colectomy without robotic assistance for colon cancer or nonmalignant polyps, comparing all patients, obese versus nonobese patients, and male versus female patients. METHODS We used the 2013-2015 American College of Surgeons National Surgical Quality Improvement Program data to examine a composite outcome score comprised of mortality, readmission, reoperation, wound infection, bleeding transfusion, and prolonged postoperative ileus. We used propensity scores to assess potential heterogeneous treatment effects of RAS by patient obesity and sex. RESULTS In all, 17.1% of the 10,844 of patients received RAS. Males were slightly more likely to receive RAS. Obese patients were equally likely to receive RAS as nonobese patients. In comparison to nonRAS, RAS was associated with a 3.1% higher adverse composite outcome score. Mortality, reoperations, wound infections, sepsis, pulmonary embolisms, deep vein thrombosis, myocardial infarction, blood transfusions, and average length of hospitalization were similar in both groups. Conversion to open surgery was 10.1% lower in RAS versus nonRAS patients, but RAS patients were in the operating room an average of 52.4 min longer. We found no statistically significant differences (p > 0.05) by obesity status and gender. CONCLUSIONS Worse patient outcomes and no differential improvement by sex or obesity suggest more cautious adoption of RAS.
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Affiliation(s)
- M. Schootman
- Saint Louis University, College for Public Health and Social Justice, Department of Epidemiology, 3545 Lafayette Avenue, Saint Louis, MO 63104,Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University, School of Medicine, Saint Louis, MO
| | - S. Hendren
- University of Michigan, Department of Surgery, Ann Arbor, MI
| | - T. Loux
- Saint Louis University, College for Public Health and Social Justice, Department of Biostatistics, 3545 Lafayette Avenue, Saint Louis, MO 63104
| | - K. Ratnapradipa
- Saint Louis University, College for Public Health and Social Justice, Department of Epidemiology, 3545 Lafayette Avenue, Saint Louis, MO 63104
| | - J.M. Eberth
- University of South Carolina, Arnold School of Public Health, Department of Epidemiology and Biostatistics, Columbia, SC
| | - N.O. Davidson
- Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University, School of Medicine, Saint Louis, MO,Washington University School of Medicine, Department of Medicine, Division of Gastroenterology, Saint Louis, MO
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Schootman M, Chien L, Yun S, Pruitt SL. Explaining large mortality differences between adjacent counties: a cross-sectional study. BMC Public Health 2016; 16:681. [PMID: 27484009 PMCID: PMC4970203 DOI: 10.1186/s12889-016-3371-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2015] [Accepted: 07/26/2016] [Indexed: 11/10/2022] Open
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Schootman M, Nelson EJ, Werner K, Shacham E, Elliott M, Ratnapradipa K, Lian M, McVay A. Emerging technologies to measure neighborhood conditions in public health: implications for interventions and next steps. Int J Health Geogr 2016; 15:20. [PMID: 27339260 PMCID: PMC4918113 DOI: 10.1186/s12942-016-0050-z] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 06/15/2016] [Indexed: 01/10/2023] Open
Abstract
Adverse neighborhood conditions play an important role beyond individual characteristics. There is increasing interest in identifying specific characteristics of the social and built environments adversely affecting health outcomes. Most research has assessed aspects of such exposures via self-reported instruments or census data. Potential threats in the local environment may be subject to short-term changes that can only be measured with more nimble technology. The advent of new technologies may offer new opportunities to obtain geospatial data about neighborhoods that may circumvent the limitations of traditional data sources. This overview describes the utility, validity and reliability of selected emerging technologies to measure neighborhood conditions for public health applications. It also describes next steps for future research and opportunities for interventions. The paper presents an overview of the literature on measurement of the built and social environment in public health (Google Street View, webcams, crowdsourcing, remote sensing, social media, unmanned aerial vehicles, and lifespace) and location-based interventions. Emerging technologies such as Google Street View, social media, drones, webcams, and crowdsourcing may serve as effective and inexpensive tools to measure the ever-changing environment. Georeferenced social media responses may help identify where to target intervention activities, but also to passively evaluate their effectiveness. Future studies should measure exposure across key time points during the life-course as part of the exposome paradigm and integrate various types of data sources to measure environmental contexts. By harnessing these technologies, public health research can not only monitor populations and the environment, but intervene using novel strategies to improve the public health.
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Affiliation(s)
- M Schootman
- Department of Epidemiology, College for Public Health and Social Justice, Saint Louis University, 3545 Lafayette Avenue, Saint Louis, MO, 63104, USA.
| | - E J Nelson
- Department of Epidemiology, College for Public Health and Social Justice, Saint Louis University, 3545 Lafayette Avenue, Saint Louis, MO, 63104, USA
| | - K Werner
- George W. Brown School of Social Work, Washington University in St. Louis, Saint Louis, MO, USA
| | - E Shacham
- Department of Behavioral and Science and Health Education, College for Public Health and Social Justice, Saint Louis University, Saint Louis, MO, USA
| | - M Elliott
- Department of Biostatistics, College for Public Health and Social Justice, Saint Louis University, Saint Louis, MO, USA
| | - K Ratnapradipa
- Department of Epidemiology, College for Public Health and Social Justice, Saint Louis University, 3545 Lafayette Avenue, Saint Louis, MO, 63104, USA
| | - M Lian
- Division of General Medical Sciences, Department of Medicine, Washington University School of Medicine, Saint Louis, MO, USA
| | - A McVay
- Department of Epidemiology, College for Public Health and Social Justice, Saint Louis University, 3545 Lafayette Avenue, Saint Louis, MO, 63104, USA
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Lian M, Sefko J, Struthers J, Schootman M. Neighborhood Socioeconomic Deprivation and Geographic Heterogeneity of Tobacco Environment in Missouri. Cancer Epidemiol Biomarkers Prev 2016. [DOI: 10.1158/1055-9965.epi-16-0092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Purpose: To examine neighborhood characteristics associated with geographic distribution of tobacco sale outlets in Missouri. Methods: We obtained the addresses of tobacco outlets in Missouri from the Missouri Department of Mental Health. We geocoded these addresses and computed the outlet density by 5-digit ZIP codes. Using the data from the 2008–2012 American Community Survey, we developed a ZIP Code Tabulation Area (ZCTA)-level socioeconomic deprivation (SED) index. We analyzed the relationships of tobacco outlet density with neighborhood SED index and five separate socioeconomic indicators (%population with less than high school, %population unemployed, %households below the poverty, % population under the poverty, and %African Americans). Results: There were more than 5,000 tobacco retailers within Missouri in January, 2014. The number of tobacco retailers ranged from 0 to 56 (median = 2) per ZIP code, while tobacco outlet density ranged from 0 to 29 per 1,000 persons age 18+ (median: 1.18). Tobacco outlet density was significantly correlated with neighborhood SED (rho = 0.21, P < 0.001). The consistency of quartiles of both variables was also statistically significant (weighted Kappa = 0.11, P < 0.001). Logistic regression analysis indicated that neighborhood SED was associated with more than 3 times higher odds of denser tobacco outlets (>median density) (the most vs. least deprived quartile: odd ratio = 3.24, 95% confidence interval = 2.26–4.65). Similar results were also found for each of the five individual socioeconomic indicators. Conclusion: Geographic distribution of tobacco retailing outlets was strongly associated with neighborhood SED environment. Neighborhoods with greater SED condition were also more likely to have a higher density of tobacco retailing outlets in Missouri. Our finding implies that higher accessibility to tobacco retailing outlets might play an important role in geographic SED disparity in smoking. Future studies should examine the degree to which neighborhood SED effect on smoking behaviors is mediated by higher accessibility to tobacco retailing outlets. This insight can help policy-makers develop appropriate geographic priority to effectively allocate tobacco control programs to reduce cigarette smoking in Missouri.
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Barnidge EK, Baker EA, Schootman M, Motton F, Sawicki M, Rose F. The effect of education plus access on perceived fruit and vegetable consumption in a rural African American community intervention. Health Educ Res 2015; 30:773-85. [PMID: 26338985 PMCID: PMC4668755 DOI: 10.1093/her/cyv041] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 08/06/2015] [Indexed: 06/05/2023]
Abstract
African Americans have an increased risk of cardiovascular disease partly due to low fruit and vegetable consumption. This article reports the results of an intervention to provide nutrition education and access to fruits and vegetables through community gardens to change dietary behaviors among African Americans in rural Missouri. Cross-sectional surveys evaluated the intervention effect on blood pressure, body mass index (BMI), and perceived fruit and vegetable consumption in this quasi-experimental study with a comparison group. Hypertension (OR = 0.52, 95% CI: 0.38-0.71) and BMI (OR = 0.73, 95% CI: 0.52-1.02) were lower in the intervention county at mid-intervention. Participation in nutrition education (OR = 2.67, 95% CI: 1.63-4.40) and access to fruits and vegetables from a community garden (OR = 1.95, 95% CI: 1.20-3.15) were independently associated with perceived fruit and vegetable consumption. The strongest effect on perceived fruit and vegetable consumption occurred with high participation in nutrition education and access to community gardens (OR = 2.18, 95% CI: 1.24-3.81). Those with access but without education had a reduced likelihood of consuming recommended servings of fruits and vegetables (OR = 0.57, 95% CI: 0.34-0.95). Education plus access interventions may be best at increasing consumption of fruits and vegetables in a rural African American population.
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Affiliation(s)
- E K Barnidge
- Department of Behavioral Science and Health Education
| | - E A Baker
- Department of Behavioral Science and Health Education,
| | | | - F Motton
- Department of Behavioral Science and Health Education
| | - M Sawicki
- Department of Nutrition and Dietetics, Saint Louis University College for Public Health & Social Justice, 3545 Lafayette Avenue, St. Louis, MO 63104, USA
| | - F Rose
- Department of Behavioral Science and Health Education
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Abstract
OBJECTIVES We examined the utility of January 2004 to April 2014 Google Trends data from information searches for cancer screenings and preparations as a complement to population screening data, which are traditionally estimated through costly population-level surveys. SETTING State-level data across the USA. PARTICIPANTS Persons who searched for terms related to cancer screening using Google, and persons who participated in the Behavioral Risk Factor Surveillance System (BRFSS). PRIMARY AND SECONDARY OUTCOME MEASURES (1) State-level Google Trends data, providing relative search volume (RSV) data scaled to the highest search proportion per week (RSV100) for search terms over time since 2004 and across different geographical locations. (2) RSV of new screening tests, free/low-cost screening for breast and colorectal cancer, and new preparations for colonoscopy (Prepopik). (3) State-level breast, cervical, colorectal and prostate cancer screening rates. RESULTS Correlations between Google Trends and BRFSS data ranged from 0.55 for ever having had a colonoscopy to 0.14 for having a Pap smear within the past 3 years. Free/low-cost mammography and colonoscopy showed higher RSV during their respective cancer awareness months. RSV for Miralax remained stable, while interest in Prepopik increased over time. RSV for lung cancer screening, virtual colonoscopy and three-dimensional mammography was low. CONCLUSIONS Google Trends data provides enormous scientific possibilities, but are not a suitable substitute for, but may complement, traditional data collection and analysis about cancer screening and related interests.
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Affiliation(s)
- M Schootman
- Department of Epidemiology, Saint Louis University College for Public Health and Social Justice, St. Louis, Missouri, USA Alvin J Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, Missouri, USA
| | - A Toor
- Department of Epidemiology, Saint Louis University College for Public Health and Social Justice, St. Louis, Missouri, USA
| | - P Cavazos-Rehg
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - D B Jeffe
- Alvin J Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, Missouri, USA Division of General Medical Sciences, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - A McQueen
- Alvin J Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, Missouri, USA Division of General Medical Sciences, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - J Eberth
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - N O Davidson
- Alvin J Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, Missouri, USA Division of Gastroenterology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
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Schootman M, Lian M, Pruitt SL, Hendren S, Mutch M, Deshpande AD, Jeffe DB, Davidson NO. Hospital and geographic variability in two colorectal cancer surgery outcomes: complications and mortality after complications. Ann Surg Oncol 2014; 21:2659-66. [PMID: 24748161 DOI: 10.1245/s10434-013-3472-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Indexed: 12/20/2022]
Abstract
BACKGROUND The purpose of this study was to describe hospital and geographic variation in 30-day risk of surgical complications and death among colorectal cancer (CRC) patients and the extent to which patient-, hospital-, and census-tract-level characteristics increased risk of these outcomes. METHODS We included patients at least 66 years old with first primary stage I-III CRC from the 2000-2005 National Cancer Institute's Surveillance, Epidemiology, and End Results data linked with 1999-2005 Medicare claims. A multilevel, cross-classified logistic model was used to account for nesting of patients within hospitals and within residential census tracts. Outcomes were risk of complications and death after a complication within 30 days of surgery. RESULTS Data were analyzed for 35,946 patients undergoing surgery at 1,222 hospitals and residing in 12,187 census tracts; 27.2 % of patients developed complications, and of these 13.4 % died. Risk-adjusted variability in complications across hospitals and census tracts was similar. Variability in mortality was larger than variability in complications, across hospitals and across census tracts. Specific characteristics increased risk of complications (e.g., census-tract-poverty rate, emergency surgery, and being African-American). No hospital characteristics increased complication risk. Specific characteristics increased risk of death (e.g. census-tract-poverty rate, being diagnosed with colon (versus rectal) cancer, and emergency surgery), while hospitals with at least 500 beds showed reduced death risk. CONCLUSIONS Large, unexplained variations exist in mortality after surgical complications in CRC across hospitals and geographic areas. The potential exists for quality improvement efforts targeted at the hospital and/or census-tract levels to prevent complications and augment hospitals' ability to reduce mortality risk.
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Affiliation(s)
- M Schootman
- Department of Epidemiology, Saint Louis University, Saint Louis, MO, USA,
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Willis AW, Schootman M, Kung N, Racette BA. Epidemiology and neuropsychiatric manifestations of Young Onset Parkinson's Disease in the United States. Parkinsonism Relat Disord 2012; 19:202-6. [PMID: 23083512 DOI: 10.1016/j.parkreldis.2012.09.014] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Revised: 09/26/2012] [Accepted: 09/29/2012] [Indexed: 12/12/2022]
Abstract
BACKGROUND To determine the demographic distribution of Young Onset Parkinson's Disease (YOPD) in the United States and to quantify the burden of neuropsychiatric disease manifestations. METHODS Cross sectional study of 3,459,986 disabled Americans, aged 30-54, who were receiving Medicare benefits in the year 2005. We calculated race and sex distributions of YOPD and used logistic regression to compare the likelihood of common and uncommon psychiatric disorders between beneficiaries with YOPD and the general disability beneficiary population, adjusting for race, age, and sex. RESULTS We identified 14,354 Medicare beneficiaries with YOPD (prevalence = 414.9 per 100,000 disabled Americans). White men comprised the majority of cases (48.9%), followed by White women (34.7%), Black men (6.8%), Black women (5.0%), Hispanic men (2.4%), and Hispanic women (1.2%). Asian men (0.6%) and Asian women (0.4%) were the least common race-sex pairs with a YOPD diagnosis in this population (chi square, p < 0.001). Compared to the general population of medically disabled Americans, those with YOPD were more likely to receive medical care for depression (OR: 1.89, 1.83-1.95), dementia (OR: 7.73, 7.38-8.09), substance abuse/dependence (OR: 3.00, 2.99-3.01), and were more likely to be hospitalized for psychosis (OR: 3.36, 3.19-3.53), personality/impulse control disorders (OR: 4.56, 3.28-6.34), and psychosocial dysfunction (OR: 3.85, 2.89-5.14). CONCLUSIONS Young Onset Parkinson's Disease is most common among white males in our study population. Psychiatric illness, addiction, and cognitive impairment are more common in YOPD than in the general population of disabled Medicare beneficiaries. These may be key disabling factors in YOPD.
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Affiliation(s)
- A W Willis
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, USA.
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Jeffe DB, Pérez M, Liu Y, Collins KK, Aft RL, Schootman M. Quality of life over time in women diagnosed with ductal carcinoma in situ, early-stage invasive breast cancer, and age-matched controls. Breast Cancer Res Treat 2012; 134:379-91. [PMID: 22484800 PMCID: PMC3448489 DOI: 10.1007/s10549-012-2048-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Accepted: 03/21/2012] [Indexed: 12/21/2022]
Abstract
Little is known about quality-of-life (QOL) differences over time between incident ductal carcinoma in situ (DCIS) and early-stage invasive breast cancer (EIBC) cases as compared with same-aged women without breast cancer (controls). We prospectively recruited and interviewed 1,096 women [16.8% DCIS, 33.3% EIBC (25.7% Stage I; and 7.6% Stage IIA), 49.9% controls; mean age 58; 23.7% non-white] at mean 6.7 weeks (T1), and 6.2 (T2), 12.3 (T3), and 24.4 months (T4) after surgery (patients) or screening mammogram (controls). We tested two hypotheses: (1) DCIS patients would report lower levels of QOL compared with controls but would report similar QOL compared with EIBC patients at baseline; and (2) DCIS patients' QOL would improve during 2-year follow-up and approach levels similar to that of controls faster than EIBC patients. We tested hypothesis 1 using separate general linear regression models for each of the eight subscales on the RAND 36-item Health Survey, controlling for variables associated with at least one subscale at T1. Both DCIS and EIBC patients reported lower QOL at T1 than controls on all subscales (each P<0.05). We tested hypothesis 2 using generalized estimating equations to examine change in each QOL subscale over time across the three diagnostic groups adjusting for covariates. By T3, physical functioning, role limitations due to physical problems, energy/fatigue, and general health each differed significantly by diagnostic group at P<0.05, because of larger differences between EIBC patients and controls; but DCIS patients no longer differed significantly from controls on any of the QOL subscales. At T4, EIBC patients still reported worse physical functioning (P=0.0001) and general health (P=0.0017) than controls, possibly because of lingering treatment effects. DCIS patients' QOL was similar to that of controls two years after diagnosis, but some aspects of EIBC patients' QOL remained lower.
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Affiliation(s)
- D B Jeffe
- Division of Health Behavior Research, Department of Medicine, Washington University School of Medicine, and Alvin J. Siteman Cancer Center, Barnes-Jewish Hospital, 4444 Forest Park, Suite 6700, St. Louis, MO 63108, USA.
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Wright Willis A, Schootman M, Perlmutter J, Racette B. Neurologist Care in PD Is Associated with Fewer PD Related Hospitalizations (P02.242). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p02.242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Willis AW, Schootman M, Evanoff BA, Perlmutter JS, Racette BA. Neurologist care in Parkinson disease: a utilization, outcomes, and survival study. Neurology 2011; 77:851-7. [PMID: 21832214 DOI: 10.1212/wnl.0b013e31822c9123] [Citation(s) in RCA: 195] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To investigate the utilization of neurologist providers in the treatment of patients with Parkinson disease (PD) in the United States and determine whether neurologist treatment is associated with improved clinical outcomes. METHODS This was a retrospective observational cohort study of Medicare beneficiaries with PD in the year 2002. Multilevel logistic regression was used to determine which patient characteristics predicted neurologist care between 2002 and 2005 and compare the age, race, sex, and comorbidity-adjusted annual risk of skilled nursing facility placement and hip fracture between neurologist- and primary care physician-treated patients with PD. Cox proportional hazards models were used to determine the adjusted 6-year risk of death using incident PD cases, stratified by physician specialty. RESULTS More than 138,000 incident PD cases were identified. Only 58% of patients with PD received neurologist care between 2002 and 2005. Race and sex were significant demographic predictors of neurologist treatment: women (odds ratio [OR] 0.78, 95% confidence interval [CI] 0.76-0.80) and nonwhites (OR 0.83, 95% CI 0.79-0.87) were less likely to be treated by a neurologist. Neurologist-treated patients were less likely to be placed in a skilled nursing facility (OR 0.79, 95% CI 0.77-0.82) and had a lower risk of hip fracture (OR 0.86, 95% CI 0.80-0.92) in logistic regression models that included demographic, clinical, and socioeconomic covariates. Neurologist-treated patients also had a lower adjusted likelihood of death (hazard ratio 0.78, 95% CI 0.77-0.79). CONCLUSIONS Women and minorities with PD obtain specialist care less often than white men. Neurologist care of patients with PD may be associated with improved selected clinical outcomes and greater survival.
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Affiliation(s)
- A W Willis
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, USA
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Kapp JM, Jackson-Thompson J, Petroski GF, Schootman M. Reliability of health-related quality-of-life indicators in cancer survivors from a population-based sample, 2005, BRFSS. Public Health 2008; 123:321-5. [PMID: 19081117 DOI: 10.1016/j.puhe.2008.10.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2007] [Revised: 05/14/2008] [Accepted: 10/15/2008] [Indexed: 11/27/2022]
Abstract
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.
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Affiliation(s)
- J M Kapp
- Department of Family and Community Medicine, 1 Hospital Drive, MA306E Medical Sciences Building, University of Missouri-Columbia, Columbia, MO 65212, USA.
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Lian M, Schootman M, Dixon K, Warner R, Alexander J. Spatial Pattern Of West Nile Neuroinvasive Disease In Texas. Ann Epidemiol 2008. [DOI: 10.1016/j.annepidem.2008.08.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Lian M, Struthers J, Schootman M. Neighborhood Characteristics Associated With Advanced Breast Cancer Incidence In Missouri. Ann Epidemiol 2008. [DOI: 10.1016/j.annepidem.2008.08.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Schootman M, Andresen EM, Wolinsky FD, Malmstrom TK, Miller JP, Yan Y, Miller DK. Schootman et al. Respond to "Diabetes Causality in African Americans". Am J Epidemiol 2007. [DOI: 10.1093/aje/kwm196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Turabelidze G, Zhu BP, Schootman M, Malone JL, Horowitz S, Weidinger J, Williamson D, Simoes E. Prevalence and Spatial Clustering of Amyotrophic Lateral Sclerosis in Jefferson County, Missouri, 1998–2002. Am J Epidemiol 2006. [DOI: 10.1093/aje/163.suppl_11.s123-b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Schootman M, Sterling D, Struthers J, Yan Y, Laboube T, Emo B, Higgs G. Positional Accuracy and Geographic Bias of 3 Methods of Geocoding in Epidemiologic Research. Am J Epidemiol 2006. [DOI: 10.1093/aje/163.suppl_11.s26-d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Schootman M, Andresen EM, Miller DK. 114: Neighborhood Conditions and Risk of Incident Lower Body Functional Limitations Among Middle-Aged African Americans. Am J Epidemiol 2005. [DOI: 10.1093/aje/161.supplement_1.s29a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- M Schootman
- Washington University, Saint Louis, MO 63108
| | | | - D K Miller
- Washington University, Saint Louis, MO 63108
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Zafar N, Wallace CM, Kieffer P, Schroeder P, Schootman M, Hamvas A. Improving survival of vulnerable infants increases neonatal intensive care unit nosocomial infection rate. Arch Pediatr Adolesc Med 2001; 155:1098-104. [PMID: 11576003 DOI: 10.1001/archpedi.155.10.1098] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To determine the factors associated with an increasing rate of nosocomial infections in infants with very low birth weights. METHODS Retrospective review of clinical and nosocomial infection databases for all infants with birth weights of 1500 g or less admitted to an academic neonatal intensive care unit between January 1, 1991, and December 31, 1997 (N = 1184). Two study periods were compared: 1991-1995 and 1996-1997. RESULTS Among the 1085 infants who survived beyond 48 hours, the proportion who developed nosocomial infections increased from 22% to 31% (P =.001) and the infection rate increased from 0.5 to 0.8 per 100 patient-days (P<.001) during the period from 1996 to 1997. In that same period, the median duration of indwelling vascular access increased from 10 to 16 days (P<.001), and the median duration of mechanical ventilation increased from 7 to 12 days (P<.001). Although the device-specific rate of bloodstream or respiratory infections did not change, the increase in infections was directly attributable to the increasing proportion of infants who required these devices. In both study periods, the peak incidence of initial infection occurred between 10 and 20 days of age. For the entire sample, proportional hazard models identified birth weight, duration of vascular access, and postnatal corticosteroid exposure as significant contributors to the risk of infection. CONCLUSIONS The increasing number of technology-dependent infants was the primary determinant in the increase of nosocomial infections. Because these infections occur in a small proportion of infants, understanding the host factors that contribute to this vulnerability is necessary to decrease nosocomial infections in neonatal intensive care units.
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Affiliation(s)
- N Zafar
- Edward Mallinckrodt Department of Pediatrics, Washington University School of Medicine and St. Louis Children's Hospital, St Louis, MO 63110, USA
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Schootman M, Fuortes LJ. Early indicators of the effect of a breast cancer screening program for low-income women. Cancer Detect Prev 2001; 25:138-46. [PMID: 11341349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) was developed to increase screening among low-income women who are uninsured or underinsured. This study reports early indicators of the effectiveness of this breast screening program in Iowa. Using data from the Census Bureau and the Iowa Behavioral Risk Factor Surveillance System, we found that racial and ethnic minorities aged 50 to 64 more likely were screened by the NBCCEDP than were their counterparts. Data collected by the Iowa BCCEDP showed a breast cancer detection rate (7.1 per 1,000 women screened) that was at least three times higher than its historical comparison, an indication of the lead time of the screened over the nonscreened population. Predictive values positive (referral and biopsy) and stage distribution were typically higher than for the national program but lower than in other countries. In conclusion, a breast cancer screening program among low-income women can be implemented successfully, judged by early indicators of program effectiveness.
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Affiliation(s)
- M Schootman
- Department of Internal Medicine, Washington University School of Medicine, St Louis, MO 63108, USA
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Abstract
PURPOSE Rural women in the United States are at a documented disadvantage with regard to breast cancer detection, diagnosis, and treatment and generally do not receive state-of-the-art therapy. The objective of the study was to determine if, and to what extent, rural women were less likely to receive radiation therapy (XRT) following breast conserving surgery (BCS) for ductal carcinoma in-situ (DCIS). METHODS Our analyses were based on 1991-1996 data provided by the Surveillance, Epidemiology, and End Results (SEER) Program. Only women who were diagnosed with their first primary, microscopically confirmed DCIS breast cancer were included. BCS and XRT were defined according to SEER definitions. Multiple logistic regression was used in the analysis. RESULTS During this time period, 6,988 women were treated with BCS for DCIS, 50.1% of whom received XRT. In multivariate analysis, rural women in general (OR = 0.58) and younger women (<65) in particular (OR = 0.38) were less likely to receive XRT. Local availability of XRT was not associated with receipt among younger women, while older women without this availability were less likely to receive XRT (OR = 0.48). CONCLUSIONS Barriers to XRT following BCS for DCIS may be different between younger and older rural women relative to their urban counterparts.
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Affiliation(s)
- M Schootman
- Department of Pediatrics, Washington University School of Medicine, Saint Louis, MO, USA.
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De La Morena M, Sweet S, White F, Mendeloff E, McBride G, Huddleston C, Shapiro S, Schootman M. Pediatric lung transplantation and CMV pneumonitis: a ten year experience. J Heart Lung Transplant 2001; 20:221. [PMID: 11250411 DOI: 10.1016/s1053-2498(00)00484-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- M De La Morena
- 1Washington University, St. Louis, MO; 2St. Louis Children's Hospital, St. Louis, MO, USA
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Abstract
OBJECTIVE This study uses Missouri's inpatient and outpatient E code data system to describe the demographic characteristics of Missouri children who suffered burn injuries during 1994 and 1995. METHODS Retrospective review of Missouri E code data. RESULTS Altogether 8,404 children aged 0-14 years were treated for burn injuries in Missouri hospitals during 1994 and 1995. The rate of burn injury in Missouri children was 339 per 100,000/year. African-American boys 0-4 years living in urban counties were at increased risk. In addition, African-American girls ages 0-4 years living in counties with a high poverty rate had raised burn injury rates. Burns from hot objects and scalds from hot liquids caused more than half of the burns. CONCLUSIONS Hospital based E coding has proven an invaluable tool for the study of burns and will, no doubt, prove equally useful for other injuries.
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Affiliation(s)
- K S Quayle
- Department of Pediatrics, Washington University School of Medicine, USA.
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Abstract
The burden of mild traumatic brain injury (TBI) is not well understood at the national level, but hospitalization rates show a decline over time. This paper describes ambulatory care for TBI patients at physician offices, hospital outpatient departments, and emergency departments (EDs) in comparison with non-TBI visits for the US during 1995-1997. An estimated 1.4 million visits for TBI were made each year for an average annual rate of 5.4/1,000 population. A decline in annual visit rate was noted during 1995-1997. Visit rates were higher for those aged 0 -14 and 75 and older. Falls (44%) and motor vehicles (28%) were the primary injury causes. Rural-urban differences were found, also in comparison with non-TBI. In 23% of visits to EDs, a CT scan was ordered or performed and in 33%, a mental status exam was conducted. Further investigations are warranted to describe ambulatory care for TBI in more detail, particularly in light of a decline in hospitalization rates.
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Affiliation(s)
- M Schootman
- Iowa Department of Public Health, Des Moines, USA.
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Schootman M, Myers-Geadelmann J, Fuortes L. Factors associated with adequacy of diagnostic workup after abnormal breast cancer screening results. J Am Board Fam Pract 2000; 13:94-100. [PMID: 10764189 DOI: 10.3122/15572625-13-2-94] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Women with certain characteristics, such as those residing in rural areas, are less likely screened for breast cancer. To enhance detection of early breast cancer, it is imperative that all women who have abnormal screening results receive appropriate diagnostic procedures. This study reports differences in receipt of diagnostic services following abnormal screening results. METHODS Screening and diagnostic data were collected as part of a breast and cervical cancer early detection program aimed at reaching women of lower socioeconomic status. Women with completed diagnostic information after having abnormal screening results were included. We based adequacy of diagnostic services on guidelines from the Society for Surgical Oncology, The Commission on Cancer of the American College of Surgeons, and the Centers for Disease Control and Prevention. Several factors were assessed for their association with adequacy of diagnostic follow-up: income, age, race, education, health insurance status, rural-urban residence, reported breast lump, family history of breast cancer, and clinical beast examination or mammogram results. RESULTS Overall, 14.1% of the 351 abnormal findings were considered inadequately followed up based on the algorithm used. Eighty percent involved an abnormal finding on a clinical breast examination regardless of the mammogram results. Rural women, those with abnormal clinical breast examination findings but normal or equivocal findings on mammograms, and those who self-discovered a mass were less likely to receive adequate follow-up than were their counterparts in multivariate analysis. Rural women were less likely to receive a biopsy or fine-needle aspiration, although it was indicated. One facility accounted for most of the inadequate follow-up screenings among urban women. CONCLUSIONS Women who have specific demographic and clinical characteristics were less likely to have received adequate diagnostic services. Breast cancers could have been missed initially as a result of inappropriate follow-up. Further investigation of the clinical scenarios using chart reviews is warranted.
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Affiliation(s)
- M Schootman
- Department of Internal Medicine, Washington University School of Medicine, and The Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital, St Louis, MO, USA
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Abstract
OBJECTIVE This study assessed the applicability of using three different data sources (hospital discharge data, Traumatic Brain Injury Registry data, and death certificates) to identify high-risk groups for traumatic brain injuries (TBI). Reporting biases were also addressed. METHODS Linkage of the data sources and log-linear modelling in conjunction with the capture-recapture method was used to estimate the number of missing TBI. Biased reporting to each data source was assessed by using the total number of estimated TBI by age and sex. RESULTS An estimated 2% of TBI that occurred in Iowa were not reported to any of the data sources. Overall, women 85 years old and older were more likely to be missed by the combined data sources. Males and those of advanced age were less likely to be reported to the Registry. By using the capture-recapture method, falls among the elderly were found to be a significant public health problem in Iowa. CONCLUSION Despite biased reporting to the three data sources, the capture-recapture method can be used to identify high-risk groups for TBI in Iowa.
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Affiliation(s)
- M Schootman
- Bureau of Injury and Disability Prevention, Iowa Department of Public Health, Des Moines, USA
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Abstract
Many studies have described functional outcomes following traumatic brain injury (TBI), but few have attempted to contrast differences in functional status and receipt of services of persons residing in rural and urban counties. Persons hospitalized with TBI completed a self-administered survey 1-1.5 years after their injury. Survivors of TBI in rural areas were more likely to be functionally dependent and reported a lower health status than their urban counterparts. Additionally, those who did not receive any TBI-related services but perceived an additional service need were more likely to be functionally dependent than those who received services and did not perceive any additional need. Perceived service needs of those functionally dependent are described. Further investigations into this rural-urban difference are warranted to maximize functional status following TBI for all individuals.
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Affiliation(s)
- M Schootman
- Bureau of Injury and Disability Prevention, Des Moines, IA, USA.
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Schootman M, Fuortes LJ. Breast and cervical carcinoma: the correlation of activity limitations and rurality with screening, disease incidence, and mortality. Cancer 1999; 86:1087-94. [PMID: 10491538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
BACKGROUND Although screening for breast and cervical carcinoma has been widely accepted as beneficial, specific segments of the population are not receiving these services as frequently as recommended. The objective of this study was to describe differences in breast and cervical screening prevalence among those with activity limitations and those residing in rural areas. Disparities in the incidence rates of in situ breast carcinoma and cervical carcinoma, as well as mortality among rural and urban women, are also described. METHODS Data from the Iowa Behavioral Risk Factor Surveillance System (BRFSS) and Iowa's Surveillance, Epidemiology, and End Results (SEER) were used to determine the prevalence of screening and adverse outcomes among rural populations. To describe the rural nature of counties, the authors used the number of residents per square mile for each county and classified the results into five groups. Mulitple logistic regression was used to determine the prevalence of screening among those with activity limitations and rural residents. RESULTS Using the BRFSS, those with activity limitations and those residing in rural Iowa were less likely screened for breast or cervical carcinoma. This translated into a lower in situ breast carcinoma incidence rate and a higher invasive cervical carcinoma incidence rate among rural women relative to their urban counterparts. No differences were found for mortality from these cancers. CONCLUSIONS Lower screening prevalence among rural residents translated into adverse health outcomes. Interventions for increasing the frequency of screening are described.
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Affiliation(s)
- M Schootman
- Bureaus of Health Promotion and Disability Prevention, Iowa Department of Public Health, Des Moines, Iowa, USA
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Abstract
An increase in the proportion of advanced malignancies among rural residents has been noted and may be due to a combination of factors, including availability of screening services, demographic characteristics, and access to health care facilities. A cross-sectional study was conducted in 33 nonmetropolitan Iowa counties among randomly selected middle-aged farm and rural nonfarm adults to compare utilization of cancer early detection services. A total of 1,126 adults in 600 farm households and 1,092 adults in 589 rural nonfarm households provided information through a 155-item in-home interview. Differences in income, age, and health insurance coverage (including preventive services) between the farm and nonfarm study populations were found. Although farm men were less likely to have had a checkup during the past year than men in the nonfarm population, no difference was found for women. Overall, differences in screening behaviors were small. Larger differences between both populations were observed for use of mammograms, prostate examinations among men age 50 and older, use of sigmoidoscopy among women age 50 and older, and skin cancer examinations among both sexes. When controlling for demographic characteristics and insurance coverage, members of the farm and rural nonfarm population were equally likely to use multiple screenings according to ACS guidelines. Because of the increased risk of breast cancer, interventions aimed at increasing utilization of mammography among women age 50 and older should be implemented. Although the farm population was more likely to use skin examinations, prevalence should be increased substantially to counteract the continuing rise in skin cancer.
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Abstract
STUDY OBJECTIVE To describe the development and completeness of an electronic injury-surveillance system, the Rural Injury Surveillance System (RISS). METHODS The emergency departments of nine rural Iowa hospitals submitted information on all patients treated from May 1993 through June 1994. RESULTS The EDs submitted information on 23,594 patients with 32,445 different injury, disease, or follow-up visits. On the basis of comparison with the handwritten ED logbook, 90% of visits were also available in the RISS. Of the visits recorded in the RISS, 99% were also recorded in the logbook. The proportion of missing diagnostic codes decreased from a high of 22.6% in May 1993 to 8.1% in June 1994. The proportion of missing external cause codes was about 25% at the end of the study period. The proportion of missing industry and occupational codes was less than 5% at the end of the study period. CONCLUSION Our findings show that complete, computerized, ED-based injury surveillance in rural EDs is possible and should be developed further.
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Affiliation(s)
- M Schootman
- Division of Substance Abuse and Health Promotion, Iowa Department of Public Health, Des Moines
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Fuortes LJ, Shi Y, Zhang M, Zwerling C, Schootman M. Epidemiology of back injury in university hospital nurses from review of workers' compensation records and a case-control survey. J Occup Med 1994; 36:1022-1026. [PMID: 7823214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Reviewing Workers' Compensation records for back injury from a large university hospital for a 2-year period, we found a yearly incidence of lost work time back injury among nurses of 2.0% per year, exceeded only by physical plant staff, who had a rate of 3.5%. Nurses' aides had an injury rate 3.3-fold higher than registered nurses and licensed practical nurses and higher than any other occupational group. We compared 100 cases of nurses with back injury in the previous 2 years with 197 noninjured control subjects using a mailed 40-item questionnaire. Multivariate logistic modelling showed that prior nonback injury and performing combined lifting activities were statistically significant risk factors for back injury, and being overweight approached significance, after adjusting for the effects of age, gender, and each of the evaluated risk factors.
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Abstract
Several different epidemiological study designs can be used for aetiological investigations of potential risk factors for the occurrence of sports injuries. The case-control study is an example of a retrospective design in which the investigator starts with the classification of injury status (case or control) and obtains information regarding prior exposure to risk factors. Several decisions need to be made when designing case-control studies. Firstly, the source of the study participants needs to be considered. Cases and controls need to be identified from the same source, i.e. same sport or clinic. Secondly, the same eligibility criteria need to be applied to potential cases and controls. Thirdly, when an injury occurred must be established. The fourth issue concerns the status of cases (incident or prevalent cases). Finally, the number and size of the control groups needs to be determined. Strengths of the case-control study design are the high level of information obtained, the relatively low cost and its usefulness for studying rare sports injuries. The higher susceptibility to bias is one of the limitations of case-control studies. Bias in a case-control study can lead to over or underestimation of the true association between an alleged risk factor and the occurrence of sports injuries. Three types of bias have been distinguished: (i) selection bias; (ii) information bias; and (iii) confounding. Furthermore, the applicability of this type of design is limited to risk factors that remain relatively stable after the occurrence of an injury. The effect of changeable risk factors, such as quadriceps strength and range of motion, is difficult to assess since in many cases data at the time of injury are unavailable.
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Affiliation(s)
- M Schootman
- Iowa Department of Public Health, Division of Health Protection, Des Moines
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Abstract
The goal of this study was to determine demographic factors associated with reported safety behavior by studying 2250 Iowa junior high and high school students via a self-administered questionnaire. Students attending rural schools used front seat belts and helmets less frequently than urban students. Seat belt and helmet use and swim safety decreased dramatically with age. Occurrences of driving or riding while drunk or high increased with age. Boys were less likely than girls to wear back seat belts and moped helmets and to check water depth before diving. Possession of a driver's license was not independently associated with any of the safety behaviors.
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Affiliation(s)
- M Schootman
- Department of Preventive Medicine and Environmental Health, University of Iowa, Iowa City
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Zwerling C, Ryan J, Schootman M. A case-control study of risk factors for industrial low back injury. The utility of preplacement screening in defining high-risk groups. Spine (Phila Pa 1976) 1993; 18:1242-7. [PMID: 8362334 DOI: 10.1097/00007632-199307000-00020] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Using a cohort of 8183 postal workers, this study assesses the efficacy of preplacement medical examinations in defining the risk of occupational low back injuries. From this cohort, 154 subjects with occupational low back injuries between 1983 and 1988 and 942 control subjects who did not have low back injuries were identified. A multivariate logistic regression shows that a history of prior disability, odds ratio 2.90 (95% confidence interval 1.88-4.48), and a heavy lifting job, odds ratio 1.91 (1.32-276) are associated with occupational low back injuries. However, a history of previous back injury on screening examination is not associated with subsequent occupational injury. The association between a history of disability and occupational low back injury has not been previously noted and warrants further research.
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Affiliation(s)
- C Zwerling
- University of Iowa Injury Prevention Research Center, Department of Preventive Medicine and Environmental Health, College of Medicine
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Powell JW, Schootman M. A multivariate risk analysis of selected playing surfaces in the National Football League: 1980 to 1989. An epidemiologic study of knee injuries. Am J Sports Med 1992; 20:686-94. [PMID: 1456362 DOI: 10.1177/036354659202000609] [Citation(s) in RCA: 80] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
This study focuses on the injury rates for natural grass and AstroTurf surfaces and the risk factors of game position and type of play. We examined the game-related knee sprains, medial collateral ligament sprains, and anterior cruciate ligament sprains that occurred in the National Football League during the 1980 to 1989 seasons. The findings are controlled for categories of severity (number of games missed due to injury), position, and situation (rushing or passing) at the time of injury. The analysis of the data incorporates epidemiologic techniques associated with incidence density ratios. The data show that there is a statistically significant difference between the higher AstroTurf injury rates for knee sprains. When knee sprains are separated into medial collateral ligament sprains and anterior cruciate ligament sprains, only the anterior cruciate ligament sprains show a statistically significant higher injury rate for AstroTurf. When simultaneous control variables are considered, significantly more knee sprains occurred to backs on rushing plays and linemen on passing plays. When controlling the data for severity, only the Category II injuries (three or more games missed) sustained by linemen on passing plays had statistically significant higher injury rates for the AstroTurf. For medial collateral ligament sprains, only the Category II injuries for linemen on passing plays remain statistically significant. The data for the ACL sprains show statistically significant differences between the injury rate on natural grass and the injury rate on Astro Turf under conditions of special teams play.
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Affiliation(s)
- J W Powell
- Department of Orthopaedic Surgery, University of Iowa Hospitals and Clinics, Iowa City
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