What are the costs of suspected but not reported tuberculosis?

PURPOSE: Little is known regarding patients suspected, but not proven, to have tuberculosis before meeting reporting requirements. These patients generate unmeasured tuberculosis costs to the health care system. Elimination efforts are undervalued without fully quantifying the burden of tuberculosis. This may lead to decreased support and resurgence of this disease. This report provides a preliminary quantification of these costs. METHODS: We used acid-fast bacillus (AFB) cultures completed as a proxy to estimate the number of patients with suspected tuberculosis who are never reported. We collected data on the number of AFB tests conducted in Tarrant County, TX, for calendar year 2002. We excluded all tests positive for Mycobacterium tuberculosis or secondary to growth of mycobacteria not M tuberculosis. We considered all AFBs conducted on an individual within 90 days to be single diagnostic episodes. We measured the number of diagnostic episodes, number of AFBs, number of AFBs meeting inclusion criteria, estimated cost incurred by testing, and individuals affected. RESULTS: The Tarrant County hospitals sampled completed 6935 AFB cultures on an inpatient volume of 142,356 patients. One hundred ninety-three cultures confirmed tuberculosis or other mycobacteria, and 6742 AFBs were collected on persons suspected, but not proved, to have tuberculosis at an estimated $114.06 per culture. The total cost of eliminating tuberculosis as a cause of illness was $768,993. Laboratory costs for each patient with suspected, but not confirmed, tuberculosis averaged $364.11. One hundred forty-eight AFB cultures costing $16,830 were needed to confirm one case of tuberculosis. CONCLUSIONS: The suspicion of tuberculosis incurs significant burdens and cost in the US health care system. More fully valuing tuberculosis elimination is important for tuberculosis management and will help maintain support for tuberculosis elimination.     

Incentives for Survey Participation: When Are They “Coercive”?

Monetary incentives are increasingly used to help motivate survey participation. This article summarizes several theories underlying the use of incentives and briefly reviews research demonstrating their intended and unintended effects on response rates, sample composition, response bias, and response quality. It also considers the evidence for the effectiveness of incentives in reducing nonresponse bias. Institutional review boards have begun to ask whether, and under what conditions, the use of monetary incentives to induce participation might be coercive and to question the use of such incentives in surveys of "vulnerable" populations, including surveys of injury and violence. The article reviews the ethical principles underlying the requirement for voluntary informed consent as well as current regulations and a broad theoretical and empirical literature bearing on this question, concluding that incentives are never coercive. The question of whether they exert "undue influence" in a specific situation is more difficult, but it may be the wrong question to ask. The article concludes with several recommendations designed to ensure the ethical use of incentives in surveys on violence and injury.     

Developing a Danish version of the “Impact on Participation and Autonomy Questionnaire”

Abstract

Objective: To translate the “Impact on Participation and Autonomy Questionnaire” into Danish (IPAQ-DK), and estimate its internal consistency and test–retest reliability in order to promote participation-based interventions and research. Design: Translation and two successive reliability assessments through test–retest. Subjects: 137 adults with varying degrees of impairment; of these, 67 participated in the final reliability assessment. Methods: The translation followed guidelines set forth by the “European Group for Quality of Life Assessment and Health Measurement”. Internal consistency for subscales was estimated by Chronbach's alpha. Weighted kappa coefficients and intraclass correlation coefficients were calculated to assess the test–retest reliability at item and subscale level, respectively. Results: A preliminary reliability assessment revealed residual issues regarding the translation and cultural adaptation of the instrument. The revised version (IPAQ-DK) was subsequently subjected to a similar assessment demonstrating Chronbach's alpha values from 0.698 to 0.817. Weighted kappa ranged from 0.370 to 0.880; 78% of these values were higher than 0.600. The intraclass correlation coefficient covered values from 0.701 to 0.818. Conclusion: IPAQ-DK is a useful instrument for identifying person-perceived participation restrictions and satisfaction with participation. Further studies of IPAQ-DK's floor/ceiling effects and responsiveness to change are recommended, and whether there is a need for further linguistic improvement of certain items.     

Deprofessionalization or Postprofessionalization? Reflections on the State of Social Work as a Profession

ABSTRACT

Recent literature considering the state of the social work profession has primarily focused on concerns about deprofessionalization. This article provides an overview of the literature on professionalization and professional decline in order to situate the social work profession within a broader context. The article then describes the emergence of a new role for social workers in Canada that crosses the boundaries between clinical, managerial, and legal aspects of client care in the area of mental health forensics. It is argued that the future of social work's professionalization project around the world may not be as bleak as has been portrayed in the literature.     

“Balancing on Skates on the Icy Surface of Work”: A Metasynthesis of Work Participation for Persons with Psychiatric Disabilities

Purpose To explore how persons with psychiatric disabilities experience facilitators of and barriers to participation in paid work in transitional, supported, and open employment settings, in order to provide guidance for efforts to attract and retain these persons in gainful employment as a key dimension of recovery and community life. Methods A metasynthesis was conducted using 16 qualitative studies published between 1990 and 2011. Results Ten themes, two phases, and an overarching metaphor were identified. The first five themes describe facilitators of and impediments to getting a job (getting off the bench): (1) fighting inertia; (2) taking control; (3) encouraging peers; (4) disruptions related to the illness; (5) lack of opportunities and supports. The next five themes represent facilitators of and impediments to working (skating on the ice); (6) going mainstream; (7) social cohesion; (8) clarity in role and responsibilities; (9) environmental factors; (10) managing self-disclosure. We chose as our overarching metaphor “Balancing on Skates on the Icy Surface of Work,” as we view both iceskaters and workers with psychiatric disabilities as needing to achieve and maintain their balance while being “on the edge” between various extremities. Conclusion We have shown that, for persons with psychiatric disabilities to “get off the bench” and “onto the ice” of employment, they may need to be supported in finding and maintaining their balance in new situations through a combination of learning new skills and competencies (learning how to skate) while receiving in vivo assistance from empathic and knowledgeable supporters (being coached while on the ice).     

Effect of Omega-3 Fatty Acids on Telomeres—Are They the Elixir of Youth?

Telomeres are complexes consisting of tandem repeat DNA combined with associated proteins that play a key role in protecting the ends of chromosomes and maintaining genome stability. They are considered a biological clock, as they shorten in parallel with aging. Furthermore, short telomeres are associated with several age-related diseases. However, the variability in telomere shortening independent of chronological age suggests that it is a modifiable factor. In fact, it is regulated inter alia by genetic damage, cell division, aging, oxidative stress, and inflammation. A key question remains: how can we prevent accelerated telomere attrition and subsequent premature replicative senescence? A number of studies have explored the possible impact of omega-3 fatty acids on telomere shortening. This review summarizes published cross-sectional studies, randomized controlled trials, and rodent studies investigating the role of omega-3 fatty acids in telomere biology. It also covers a broad overview of the mechanism, currently favored in the field, that explains the impact of omega-3 fatty acids on telomeres—the food compound’s ability to modulate oxidative stress and inflammation. Although the results of the studies performed to date are not consistent, the vast majority indicate a beneficial effect of omega-3 fatty acids on telomere length.     

Do health behaviors moderate the effect of socioeconomic status on metabolic syndrome?

PURPOSE: The purpose of this study is to determine whether the effect of socioeconomic factors on metabolic syndrome is influenced by such covariates as health behavior and psychosocial factors. METHODS: This study used data collected from 4400 households during the 2001 Korea National Health and Nutrition Examination Survey. A stratified multistage probability sampling method was applied and the final sample included 6601 subjects older than 20 years who had completed necessary health examinations. RESULTS: The prevalence of metabolic syndrome in Koreans was 25.5% (95% confidence interval [CI], 23.8-27.2) for men and 28.7% (95% CI, 27.2-30.2) for women. Analysis of moderator effects showed that interactions between education and smoking or exercise status and between income and alcohol or smoking status were significant. The significance of the interaction terms indicates that health behavior and psychosocial factors modified the relationship between socioeconomic factors and metabolic syndrome. CONCLUSIONS: Results of this study provide evidence that such behaviors as smoking, drinking alcohol, and insufficient exercise contribute to the incidence of metabolic syndrome. Changes to higher socioeconomic status may not reduce the odds of metabolic syndrome unless behavior also is adapted.     

Lost in translation? Reflections on the role of research in improving health care for children

While the budget of the National Institutes of Health (NIH) has grown to double its 1993 level, growing understanding of the chasm between the "health care we have and the health care we could have" has led to a stronger focus on the need to translate research into practice. Children's health care has much to gain from this new emphasis; however, the unique features of children's health, health services, and the history of funding for child health research are limiting our ability to make rapid progress.