Study objective We determine the optimal correction factor for cerebrospinal fluid WBC counts in infants with traumatic lumbar punctures. Methods We performed a secondary analysis of a retrospective ...cohort of infants aged 60 days or younger and with a traumatic lumbar puncture (cerebrospinal fluid RBC count ≥10,000 cells/mm3 ) at 20 participating centers. Cerebrospinal fluid pleocytosis was defined as a cerebrospinal fluid WBC count greater than or equal to 20 cells/mm3 for infants aged 28 days or younger and greater than or equal to 10 cells/mm3 for infants aged 29 to 60 days; bacterial meningitis was defined as growth of pathogenic bacteria from cerebrospinal fluid culture. Using linear regression, we derived a cerebrospinal fluid WBC correction factor and compared the uncorrected with the corrected cerebrospinal fluid WBC count for the detection of bacterial meningitis. Results Of the eligible 20,319 lumbar punctures, 2,880 (14%) were traumatic, and 33 of these patients (1.1%) had bacterial meningitis. The derived cerebrospinal fluid RBCs:WBCs ratio was 877:1 (95% confidence interval CI 805 to 961:1). Compared with the uncorrected cerebrospinal fluid WBC count, the corrected one had lower sensitivity for bacterial meningitis (88% uncorrected versus 67% corrected; difference 21%; 95% CI 10% to 37%) but resulted in fewer infants with cerebrospinal fluid pleocytosis (78% uncorrected versus 33% corrected; difference 45%; 95% CI 43% to 47%). Cerebrospinal fluid WBC count correction resulted in the misclassification of 7 additional infants with bacterial meningitis, who were misclassified as not having cerebrospinal fluid pleocytosis; only 1 of these infants was older than 28 days. Conclusion Correction of the cerebrospinal fluid WBC count substantially reduced the number of infants with cerebrospinal fluid pleocytosis while misclassifying only 1 infant with bacterial meningitis of those aged 29 to 60 days.
Considerations for an Obesity Policy Research Agenda McKinnon, Robin A., PhD, MPA; Orleans, C. Tracy, PhD; Kumanyika, Shiriki K., PhD, MPH ...
American journal of preventive medicine,
04/2009, Letnik:
36, Številka:
4
Journal Article
Recenzirano
Odprti dostop
Abstract The rise in obesity levels in the U.S. in the past several decades has been dramatic, with serious implications for public health and the economy. Experiences in tobacco control and other ...public health initiatives have shown that public policy may be a powerful tool to effect structural change to alter population-level behavior. In 2007, the National Cancer Institute convened a meeting to discuss priorities for a research agenda to inform obesity policy. Issues considered were how to define obesity policy research, key challenges and key partners in formulating and implementing an obesity policy research agenda, criteria by which to set research priorities, and specific research needs and questions. Themes that emerged were: (1) the embryonic nature of obesity policy research, (2) the need to study “natural experiments” resulting from policy-based efforts to address the obesity epidemic, (3) the importance of research focused beyond individual-level behavior change, (4) the need for economic research across several relevant policy areas, and (5) the overall urgency of taking action in the policy arena. Moving forward, timely evaluation of natural experiments is of especially high priority. A variety of policies intended to promote healthy weight in children and adults are being implemented in communities and at the state and national levels. Although some of these policies are supported by the findings of intervention research, additional research is needed to evaluate the implementation and quantify the impact of new policies designed to address obesity.
This article reports qualitative results from a mixed-methods evaluation of the Arkansas Health Care Independence Program. Qualitative data was collected using telephone interviews with 24 low-income ...Arkansans newly enrolled in Medicaid or a Qualified Health Plan in 2014. We used methods developed for rapid qualitative assessment to explore a range of general barriers and facilitators to accessing health care services. Secondary analysis guided by the most significant change technique aided in the construction of case summaries that permitted insights into participants’ experiences of managing their health over time. Barriers to accessing health care services included treatment costs, beliefs and values related to health, limited health literacy, poor quality health care, provider stigma, and difficulties that made travel challenging. For 1 participant who was no longer eligible for Medicaid or a QHP, lacking health care coverage was also problematic. Facilitators included having health care coverage, life experiences that re-enforced the value of prevention, health literacy, and enhanced health care services. Low-income Arkansans experiences accessing health care elucidate access as multi-dimensional, involving not only the availability of affordable services, but treatment effectiveness and patient experiences interacting with providers and clinic staff. We use these findings to formulate recommendations for programs and policies aimed at further increasing access to high-quality health care as a strategy for reducing health disparities.
Background Although incidence of vaccine-preventable diseases has decreased, states’ school immunization requirements are increasingly challenged. Subsequent to a federal court ruling affecting ...religious immunization exemptions to school requirements, new legislation made philosophical immunization exemptions available in Arkansas in 2003–2004. This retrospective study conducted in 2006 describes the impact of philosophical exemption legislation in Arkansas. Methods Arkansas Division of Health data on immunization exemptions granted were linked to Department of Education data for all school attendees (grades K through 12) during 2 school years before the legislation (2001–2002 and 2002–2003 Years 1 and 2, respectively) and 2 years after philosophical exemptions were available (2003–2004 and 2004–2005 Years 3 and 4, respectively). Changes in numbers, types, and geographic distribution of exemptions granted are described. Results The total number of exemptions granted increased by 23% (529 to 651) from Year 1 to 2; by 17% (total 764) from Year 2 to 3 after philosophical exemptions were allowed; and by another 50% from Year 3 to 4 (total 1145). Nonmedical exemptions accounted for 79% of exemptions granted in Years 1 and 2, 92% in Year 3, and 95% in Year 4. Importantly, nonmedical exemptions clustered geographically, suggesting concentrated risks for vaccine-preventable diseases in Arkansas communities. Conclusions Legislation allowing philosophical exemptions from school immunization requirements was linked to increased numbers of parents claiming nonmedical exemptions, potentially causing an increase in risk for vaccine-preventable diseases. Continued education and dialogue are needed to explore the balance between individual rights and the public’s health.
Background Studies of private sector employee populations have shown an association between health-risk factors and healthcare costs. Few studies have been conducted on large, public sector employee ...populations. The objective of the current study was to quantify health plan costs associated with individual tobacco, obesity, and physical inactivity risks in Arkansas's state employee plan. Methods De-identified medical and pharmacy claim costs incurred October 1, 2004–February 28, 2006 were linked with results from self-reported health-risk assessments (HRA) completed August 1, 2006–October 31, 2006. High- and no-risk groups were defined on the basis of cigarette use, BMI, and days/week of moderate physical activity. Annualized costs were compared between groups and across ages. Data were analyzed in September 2007. Results Of the eligible adults ( n =77,774), 56% ( n =43,461) voluntarily accessed and completed an Internet-based HRA and had claims data-linked for analyses. Average annual costs across the eligible population totaled $3205. Respondents with high risks incurred greater annual costs ($4432) than those with no risks ($2382). Costs were greater among those with one or more risks, compared with no risks, and increased with age. The greatest average annual cost was for people aged 55–64 years in the high-risk group, who had a 2.2-fold higher cost than those aged 55–64 years in the no-risk group ($7233 versus $3266). Conclusions Healthcare costs increased with age and were differentially higher for those who used tobacco, were obese, or were physically inactive. The financial viability of the healthcare system is at risk, particularly in plans with a high proportion of adults with health-risk factors.
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