An examination of the effects of mountaintop removal coal mining on respiratory symptoms and COPD using propensity scores

Previous research on public health consequences of mountaintop removal (MTR) coal mining has been limited by the observational nature of the data. The current study used propensity scores, a method designed to overcome this limitation, to draw more confident causal inferences about mining effects on respiratory health using non-experimental data. These data come from a health survey of 682 adults residing in two rural areas of Virginia, USA characterized by the presence or absence of MTR mining. Persons with a history of occupational exposure as coal miners were excluded. Nine covariates including age, sex, current and former smoking, overweight, obesity, high school education, college education, and exposure to coal as a home-heating source were selected to estimate propensity scores. Propensity scores were tested for balance and then used as weights to create quasi-experimental exposed and unexposed groups. Results indicated that persons in the mountaintop mining group had significantly (p?相似文献   

Diabetes support groups improve health care of older diabetic patients.

OBJECTIVE: To assess whether knowledge or psychosocial and glycemic benefits of a diabetes education program are enhanced by a support group for older patients. DESIGN: A partially randomized controlled trial involving two groups of patients: Group A, subjects who received an education program followed by 18 months of support group sessions; Group B, only the diabetes education program. A third convenience sample, Group C, received neither intervention. Groups A and B were assessed before and immediately after the education program, and all groups were assessed 2 years after the education program. SETTING: Diabetes clinic at a Veterans Affairs Medical Center. PATIENTS: All subjects were male (mean age = 68 +/- 1.3 years, range = 57-82 years; duration of diabetes = 10 +/- 2 years, range 3-16). Sample sizes were 11 in Group A, 13 in Group B, and 8 in Group C. INTERVENTION: The education program consisted of six weekly sessions covering aspects of diabetes self-care. The support group consisted of 18 monthly sessions for continuing education, discussion, and structured social activities. OUTCOME MEASURES: Diabetes knowledge, psychosocial factors (self-care-related quality of life, stress, family involvement in care, and social involvement), depression, and glycemic control. RESULTS: Group A scored better (at least P less than 0.05) on knowledge, quality of life, and depression than the other groups. Groups A and B showed less stress, greater family involvement, better glycemic control, but less involvement in social activities than Group C. CONCLUSION: Diabetes education programs can have long term benefits on knowledge, psychosocial functioning, and glycemic control for older diabetic patients. The addition of support groups enhances diabetes knowledge and psychosocial functioning.     

Anesthesia staffing and anesthetic complications during cesarean delivery: a retrospective analysis

BACKGROUND: Obstetrical anesthesia services may be provided by Certified Registered Nurse Anesthetists (CRNAs), anesthesiologists, or a combination of the two providers. Research is needed to assist hospitals and anesthesia groups in making cost-effective staffing choices. OBJECTIVES: To identify differences in the rates of anesthetic complications in hospitals whose obstetrical anesthesia is provided solely by CRNAs compared to hospitals with only anesthesiologists. METHODS: Washington State hospital discharge data were obtained from 1993 to 2004 for all cesarean sections, and were merged with a survey of hospital obstetrical anesthesia staffing. Anesthetic complications were identified via International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis codes. Resulting rates were risk-adjusted using regression analysis. RESULTS: Hospitals with CRNA-only staffing had a lower rate of anesthetic complications than those with anesthesiologist staffing (0.58% vs. 0.76%, p=.0006). However, after regression analysis, this difference was not significant (odds ratio for CRNA vs. anesthesiologist complications: 1.046 to 1, 95% confidence interval 0.649-1.658, p=.85). DISCUSSION: There is no difference in rates of complications between the two types of staffing models. As a result, hospitals and anesthesiology groups may safely examine other variables, such as provider availability and costs, when staffing for obstetrical anesthesia. Further study is needed to validate the use of ICD-9-CM codes for anesthesia complications as an indicator of quality.     

Relationship between blood cadmium,lead, and serum thyroid measures in US adults – the National Health and Nutrition Examination Survey (NHANES) 2007–2010

Experimental studies have shown that both cadmium (Cd) and lead have potent endocrine disrupting activity. However, studies on whether these heavy metals disrupt thyroid system in humans, especially in general populations with low levels of exposure, are sparse. The study analyzed 6,231 participants aged 20 and older with measurements from 2007–2010 of the National Health and Nutrition Examination Survey (NHANES) to investigate whether whole blood Cd and lead level are associated with serum thyroid hormones measures. Our study suggests that thyroid function may be disrupted by both Cd and lead exposures in the general population and the specific roles of Cd and lead exposure on thyroid axis may differ by sex. However, the mechanisms by which these heavy metals may disrupt thyroid system function in general population needs to be further investigated.     

Birth weight,weight over the adult life course and risk of breast cancer

Breast cancer has been suggested to potentially have prenatal origins. We examined associations between birth weight, body mass index (BMI) at four-time points over 25 years of adulthood, and risk of postmenopausal breast cancer, with emphasis on whether the association between birth weight and risk of breast cancer was mediated by weight and height changes over the adult life course. Postmenopausal women (n = 70,397) aged 50–79 years without breast cancer at enrollment (1993–1998) were followed up to 25 years. Weight and height were measured at baseline. Birth weight, and weights at ages 18, 35 and 50 were self-reported. Breast cancer cases were centrally adjudicated. Compared to women with birth weight of 6–8 pounds, women with birth weight of <6 pounds had lower risk of breast cancer (HR = 0.88 95% CI: 0.79–0.99). 44% and 21% of the relationship between birth weight and breast cancer risk was mediated by adult height and weight at baseline, respectively. Birth weight of 8 pounds or more was not associated with risk of postmenopausal breast cancer. Weight gain in adulthood was associated with increased risk of breast cancer regardless of time periods. In conclusion, lower birthweight was associated with lower risk of postmenopausal breast cancer, and this reduction in risk was significantly mediated by childhood or adolescent growth, especially by adult height. Our data suggest that reaching and maintaining a healthy weight during adulthood is key in the prevention of breast cancer.     

Predicting rehospitalization and outpatient services from administration and clinical databases

The study tests whether psychiatric services utilization may be predicted from administrative databases without clinical variables equally as well as from databases with clinical variables. Persons with a psychiatric hospitalization at an urban medical center were followed for 1 year postdischarge (N=1384.) Dependent variables included statewide rehospitalization and the number of hours of outpatient services received. Three linear and logistic regression models were developed and cross-validated: a basic model with limited administrative independent variables, an intermediate model with diagnostic and limited clinical indicators, and a full model containing additional clinical predictors. For rehospitalization, the clinical cross-validated model accounted for twice the variance accounted by the basic model (adjusted R²=.13 and .06, respectively). For outpatient hours, the basic cross-validated model performed as well as the clinical model (adjusted R²=.36 and .34, respectively.) Clinical indicators such as assessment of functioning and co-occurring substance use disorder should be considered for inclusion in predicting rehospitalization.     

Comparing alternative risk-adjustment models

The use of mental health indicators to compare provider performance requires that comparisons be fair. Fair provider comparisons mean that scores are risk adjusted for client characteristics that influence scores and that are beyond provider control. Data for the study are collected from 336 outpatients receiving publicly funded mental health services in Washington State. The study compares alternative specifications of multiple regression-based risk-adjustment models to argue that the particular form of the model will lead to different conclusions about comparative treatment agency performance. In order to evaluate performance fairly it is necessary to not only incorporate risk adjustment, but also identify the most correct form that the risk-adjustment model should take. Future research is needed to specify, test, and validate the mental health risk-adjustment models best suited to particular treatment populations and performance indicators.     

An Examination of Methods for Risk-Adjustment of Rehospitalization Rates

This study examines three methods of conducting risk-adjustment to determine if the choice of method results in different conclusions about comparative mental health center performance. The three methods of risk-adjustment are stratification-weighting, logistic regression without interaction effects, and logistic regression with interaction effects. The dependent variable of interest is psychiatric rehospitalization within 14–60 days of discharge to a community mental health center. Subjects are adults discharged in fiscal year 1998 from inpatient psychiatric care to a designated community mental health center in Oklahoma. Using each method, we examine the mental health centers to determine whether their rehospitalization rates are significantly greater than, less than, or not different from, expected. Results show that, for some agencies, method of risk adjustment leads to different conclusions about center performance. Results are discussed with respect to identifying the preferred method of risk-adjustment, study limitations, and next steps in developing risk-adjustment technology and applications.     

A continuum of care from hospital to community

This study evaluates the impact of deinstitutionalization on a multiorganizational inpatient and outpatient treatment system. Data are presented on the system's use by 613 patients over an 8 1/2 year period. Goals of a deinstitutionalization program, increasing outpatient service utilization and decreasing rehospitalization, were not clearly achieved. The needs of an inpatient and outpatient care system include effective communication between systems of care, provisions for patient drift from one community to another, and outpatient services of sufficient breadth and quantity to meet the needs of various service users, particularly the severely disabled.This research was partially supported by a NRSA training grant, No. 2 T32 MH17053-06.