Public Health Reports®

The purpose of this study was to assess the effect of low birthweight on chronic renal failure among young Medicaid patients with diabetes and/or hypertension.

The study included Caucasian and African American young adults, aged 18–50, who enrolled in the Medicaid program from 1993 to 1996 in South Carolina and were diagnosed with diabetes and/or hypertension. The odds of chronic renal failure by low birthweight (<2,500 grams) was estimated using logistic regression.

Of the 7,505 Medicaid patients with diabetes and/or hypertension, 179 (2.4%) were diagnosed with chronic renal failure. These patients were younger (mean age of 33.9 vs. 37.6, p=0.0024) and had a higher proportion of low birthweight (15.1% vs. 11.4%, p=0.07) compared with the 7,326 patients without renal failure. The odds ratio of chronic renal failure for low birthweight was significantly higher compared with normal birthweight (2,500-3,999 grams) (adjusted odds ratio [OR] 1.56, 95% confidence interval [95% CI] 1.0, 2.4). The association between low birthweight and chronic renal failure was stronger among the 888 patients with both diabetes and hypertension (OR 2.6, 95% CI 1.3, 5.7) than the 1,812 diabetes or the 4,805 hypertension patients.

The odds of chronic renal failure by low birthweight was highest in patients with both diabetes and hypertension, suggesting that the mechanism(s) involved in the disease progression to chronic renal failure may have a fetal early life origin.

We sought to determine whether literacy mediates the relationship between education and glycemic control among diabetes patients.

We measured educational attainment, literacy using the Short Test of Functional Health Literacy in Adults (s-TOFHLA), and glycemic control (HbA1c) in 395 diabetes patients at a U.S. public hospital. We performed path analysis to compare two competing models to explain glycemic control. The direct effects model estimated how education was related to HbA1c; the mediational model estimated the strength of the direct relationship when the additional pathway from education to literacy to HbA1c was added.

Both the model with a direct effect of education on HbA1c and the model with literacy as a mediator were supported by good fit to observed data. The mediational model, however, was a significant improvement, with the additional path from literacy to HbA1c reducing the discrepancy from observed data (p<0.01). After including this path, the direct relationship between education and HbA1c fell to a non-significant threshold.

In a low-income population with diabetes, literacy mediated the relationship between education and glycemic control. This finding has important implications for both education and health policy.

Workers' compensation insurance in some states may not provide coverage for medical evaluation costs of workplace exposures related to potential bioterrorism acts if there is no diagnosed illness or disease. Personal insurance also may not provide coverage for these exposures occurring at the workplace. Governmental entities, insurers, and employers need to consider how to address such situations and the associated costs. The objective of this study was to examine characteristics of workers and total costs associated with workers' compensation claims alleging potential exposure to the bioterrorism organism B. anthracis.

We examined 192 claims referred for review to the Ohio Bureau of Workers' Compensation (OBWC) from October 10, 2001, through December 20, 2004.

Although some cases came from out-of-state areas where B. anthracis exposure was known to exist, no Ohio claim was associated with true B. anthracis exposure or B. anthracis-related illness. Of the 155 eligible claims, 126 included medical costs averaging $219 and ranging from $24 to $3,126. There was no difference in mean cost for government and non-government employees (p=0.202 Wilcoxon).

The number of claims and associated medical costs for evaluation and treatment of potential workplace exposure to B. anthracis were relatively small. These results can be attributed to several factors, including no documented B. anthracis exposures and disease in Ohio and prompt transmission of recommended diagnostic and prophylactic treatment protocols to physicians. How employers, insurers, and jurisdictions address payment for evaluation and treatment of potential or documented exposures resulting from a potential terrorism-related event should be addressed proactively.

We compared the prevalence of measles immunization determined by serology with the prevalence of measles immunization determined by immunization records, and identified factors predictive of measles immunization among a sample of children from two Chicago communities.

We collected demographic information and blood specimens from a sample of children aged 12–71 months in two Chicago communities at risk for low measles immunization coverage levels. We collected immunization information from provider records, parent-held records, and the statewide immunization registry. We compared evidence of immunization determined by serology with evidence of immunization from these three sources of immunization records.

The sample of children from the two communities had serologic measles immunity levels of 85% and 90%. Significantly fewer children had evidence of immunization by record in both communities (45% and 63%, respectively).

Immunization coverage levels determined using immunization records were significantly lower than immunization coverage determined using serology. A fully populated immunization registry used by all immunization providers could prevent the problems of record loss and scatter.

This study was designed to determine the role of flushing dental water lines for the removal of heterotrophic plate count bacteria, Legionella spp., and free-living protozoa.

Forty dental offices were surveyed in the study. An initial sample and a sample taken after three minutes of flushing were obtained from the air/water syringe at each location. All samples were quantitatively analyzed for heterotrophic bacteria using three bacteriological procedures. The samples were analyzed for the presence of Legionella spp. using cultural, immunological, and molecular procedures and for the occurrence of free-living protozoa using a killed bacteria plate procedure.

The flushing process reduced the level of heterotrophic plate count bacteria by 1.1 to 1.5 log₁₀ CFU/ml. Compliance with recommendations for bacterial levels varied depending on the methodology employed in the analysis. The flushing process did not reduce the occurrence of Legionella spp. or free-living protozoa.

The results support recent U.S. Centers for Disease Control and Prevention recommendations that the process of flushing dental water lines cannot be relied upon as a sole means of reliably improving the quality of water used in dental treatment.

The Hispanic population in the United States represents more than 40 million individuals, with Mexican Americans (MA) as the largest subgroup. To assess the utility of death certificates and medical records as the source of race/ethnicity data for epidemiologic studies, we compared self-reported race/ethnicity to race/ethnicity recorded on death certificates and medical records in a bi-ethnic, non-immigrant U.S. community with a significant MA population.

This study utilized data collected from a subset of 1,856 participants of the Brain Attack Surveillance in Corpus Christi (BASIC) project. In-person interviews were conducted to determine self-reported race/ethnicity. Of those interviewed, 480 subsequently expired. Using self-reported race/ethnicity as the gold standard, we determined percent agreement, sensitivity, and specificity of the death certificate and medical record.

Of the 480 subjects, 259 self-reported their race/ethnicity as non-Hispanic white (NHW), 195 self-reported as MA, and 26 self-reported as non-Hispanic black. Median age was 78.5 years and 55.8% were female. Percent agreement between self-reported race/ethnicity and race/ethnicity recorded on the death certificate and medical record was 97.1% and 96.3% respectively. Five percent of MAs were misclassified as NHW on their death certificates and 3% on their medical records.

Results indicated that Hispanic designation recorded on death certificates and medical records in this community was largely consistent with that of self-report. This study suggests that vital statistics data in non-immigrant U.S. Hispanic communities can be used with confidence to investigate ethnic-specific aspects of disease and mortality. Similar studies in other multi-racial communities should be conducted to confirm and generalize these results.

Death certificate data are used to estimate state and national incidence of traumatic brain injury (TBI)-related deaths. This study evaluated the accuracy of this estimate in Oklahoma and examined the case characteristics of those persons who experienced a TBI-related death but whose death certificate did not reflect a TBI.

Data from Oklahoma's vital statistics multiple-cause-of-death database and from the Oklahoma Injury Surveillance System database were analyzed for TBI deaths that occurred during 2002. Cases were defined using the Centers for Disease Control and Prevention (CDC) ICD-10 code case definition. In multivariate analysis using a logistic regression model, we examined the association of case characteristics and the absence of a death certificate for persons who experienced a TBI-related death.

Overall, sensitivity of death certificate-based surveillance was 78%. The majority (62%) of missed cases were due to listing “multiple trauma” as the cause of death. Death certificate surveillance was more likely to miss TBI-related deaths among traffic crashes, falls, and persons aged ≥65 years. After adding missed cases to cases captured by death certificate surveillance, traffic crashes surpassed firearm fatalities as the leading external cause of TBI-related death.

Death certificate surveillance underestimated TBI-related death in Oklahoma and might lead to national underreporting. More accurate and detailed completion of death certificates would result in better estimates of the burden of TBI-related death. Educational efforts to improve death certificate completion could substantially increase the accuracy of mortality statistics.

This study was designed to investigate demonstrable impacts of the Mental Health Services Program for Youth (MHSPY), a highly coordinated, intentionally integrated “system of care,” on patterns of health service utilization for youth with multiple needs.

The MHSPY intervention is available to a target population of urban youth who face barriers to health care and are at risk for out-of-home placement. These youth are enrolled in a non-profit managed care organization (MCO). Patterns of medical, pharmacy, and mental health and substance abuse service use were compared for children aged 3 to 19 across insurance categories.

Despite risks for access and engagement barriers to care, and for greater medical expense due to greater morbidity, MHSPY enrollees received significantly more ambulatory care per person-year than either the privately insured population or the Medicaid Standard population, and medical expense for MHSPY members was significantly lower than expected. During the four years studied, individuals in the privately insured and Medicaid Standard populations were less likely than MHSPY enrollees to have had an ambulatory pediatric visit (odds ratio [OR] 0.833, 95% confidence interval [CI] 0.765, 0.908 and OR 0.823, 95% CI 0.775, 0.897, respectively). Medical expenses per member per month for MHSPY enrollees were significantly less than that for the similarly impaired Medicaid Disabled population with any medical claim (p<0.001) or with any outpatient mental health claim (p<0.01).

Patterns of health care for subpopulations with known risk are important to identify to evaluate system-of-care effectiveness. The service utilization patterns for youth enrolled in the MHSYP system of care vs. those for similar MCO youth suggest health care access for individuals can be affected by delivery system design variables.

The American Academy of Pediatrics (AAP) recommends that parents not use harsh disciplinary practices. Previous studies have characterized the disciplinary practices of African American parents as harsh, with reliance on more aggressive techniques not currently recommended by the AAP. However, recent research has indicated more disciplinary practice diversity among African Americans. This study describes factors associated with the use of AAP-recommended disciplinary practices among lower-income African American caregivers of children in Head Start.

Subjects were caregivers of children at three Head Start sites. Participants were eligible for inclusion if the biological mother, biological father, or target child was identified as African American. Using consensus methods, responses to the Parental Discipline Methods Interview (PDMI) were described as consistent or inconsistent with AAP guidelines regarding use of negative disciplinary practices (e.g., spanking, yelling). Caregivers avoiding any of these inconsistent methods were referred to as “adherent.”

“Adherent” caregivers were older (32.5 years vs. 30.4 years) and had more education (86.0% vs. 75.4% high school graduates). They were also less likely to report that their child had behavioral problems (12.9% vs. 25.2%) or deficient social skills (1.7% vs. 8.0%).

Lower-income African American caregivers were more likely to use disciplinary practices consistent with AAP guidelines if they had higher levels of education and were living in an urban setting. Caregivers describing their child as having fewer behavior problems, better social skills, or themselves as less stressed were also more likely to be “adherent.”