Median Annual Income Research Articles

Hypertension Management Using Mobile Technology and Home Blood Pressure Monitoring: Results of a Randomized Trial in Two Low/Middle-Income Countries

Hypertension and other noncommunicable diseases represent a growing threat to low/middle-income countries (LMICs). Mobile health technologies may improve noncommunicable disease outcomes, but LMICs lack resources to provide these services. We evaluated the efficacy of a cloud computing model using automated self-management calls plus home blood pressure (BP) monitoring as a strategy for improving systolic BPs (SBPs) and other outcomes of hypertensive patients in two LMICs. This was a randomized trial with a 6-week follow-up. Participants with high SBPs (≥140 mm Hg if nondiabetic and ≥130 mm Hg if diabetic) were enrolled from clinics in Honduras and Mexico. Intervention patients received weekly automated monitoring and behavior change telephone calls sent from a server in the United States, plus a home BP monitor. At baseline, control patients received BP results, hypertension information, and usual healthcare. The primary outcome, SBP, was examined for all patients in addition to a preplanned subgroup with low literacy or high hypertension information needs. Secondary outcomes included perceived health status and medication-related problems. Of the 200 patients recruited, 181 (90%) completed follow-up, and 117 of 181 had low literacy or high hypertension information needs. The median annual income was $2,900 USD, and average educational attainment was 6.5 years. At follow-up intervention patients' SBPs decreased 4.2 mm Hg relative to controls (95% confidence interval -9.1, 0.7; p=0.09). In the subgroup with high information needs, intervention patients' average SBPs decreased 8.8 mm Hg (-14.2, -3.4, p=0.002). Compared with controls, intervention patients at follow-up reported fewer depressive symptoms (p=0.004), fewer medication problems (p<0.0001), better general health (p<0.0001), and greater satisfaction with care (p≤0.004). Automated telephone care management plus home BP monitors can improve outcomes for hypertensive patients in LMICs. A cloud computing model within regional telecommunication centers could make these services available in areas with limited infrastructure for patient-focused informatics support.

82nd Annual Meeting of the American Thyroid AssociationMEETING ABSTRACTS &amp; PROGRAM

82nd Annual Meeting of the American Thyroid AssociationMEETING ABSTRACTS &amp; PROGRAM

Hand Washing as a Preventive Factor for a Chickenpox Outbreak in a Rural School, Yunnan Province, China

In China, usage of varicella vaccine is limited due to cost even though varicella outbreaks are common among children. On 8 Dec 2006, a varicella outbreak occurred among school children in a remote area of Yunnan Province. In this area, median annual income was less than 200 USD. We conducted an investigation to define risk factors and determine affordable control measures. A retrospective cohort study was conducted. Cases were identified through school health records and active case finding. Data on demographics, symptoms, behavior, vaccination status and previous varicella infection were obtained by questionnaire. Chickenpox cases were defined as students with generalized, vesicular pruritic rash lasting 3 or more days from 1 Sep to 14 Dec 2006. Of 604 students, 564 (93%) participated in this study. None had received chickenpox vaccination. 145 (26%) had history of past infection. Attack rates were 56% (236/419) among students without prior infection. Attack rates were higher in younger age groups (80% in 5-7 years, 75% in 8-10 years) than in the older age groups (32% in 11-13 years, 19% in 14-17 years). In multivariate analysis, close contacts with cases (Adjusted OR 2.5, 95% CI 1.6-4.0) and touching chickenpox lesions (Adjusted OR 17.8, 95% CI 4.0-78.3) were risk factors. Hand washing (Adjusted OR 0.4, 95% CI 0.2-0.7) was protective. Hand washing was promoted as an affordable control measure in this setting. Health education was implemented, emphasizing avoidance of contact with cases, especially touching lesions.

Laparoscopic Colectomy for the Treatment of Cancer Has Been Widely Adopted in the United States

Fewer than 10% of patients with colon cancer in the United States are reportedly treated with a laparoscopic colectomy despite the benefits it has over the open approach. This estimate, however, may be artificially low because of inaccurate case identification. The aim of this study was to estimate the proportion of colon resections performed laparoscopically for the treatment of colon cancer and to identify factors associated with its use. This study is a retrospective review of the 2008 to 2009 Nationwide Inpatient Sample. SETTINGS, PATIENTS, INTERVENTIONS: Adult patients with a diagnosis of colon cancer who underwent an elective colectomy were included. The overall proportion of colon resections performed laparoscopically was calculated. Multivariable regression modeling was used to identify patient and hospital characteristics associated with undergoing a laparoscopic procedure. During the study period, 9075 (weighted = 45,549) patients were identified with 50% treated via the laparoscopic approach. Patients were more likely to undergo a laparoscopic procedure if their median annual income was $63,000+ based on home zip code (adjusted relative risk = 1.08 (1.02-1.16)) and less likely if they were 70+ years of age (adjusted relative risk = 0.93 (0.87-1.00)), female (adjusted relative risk = 0.96 (0.92-0.99)), and had Medicaid (adjusted relative risk =0.84 (0.73-0.97)), or 3+ chronic conditions (adjusted relative risk = 0.84 (0.79-0.89)). Treatment at teaching hospitals (adjusted relative risk =1.10 (1.00-1.20)) and high-volume centers (adjusted relative risk =1.41 (1.22-1.63)) was associated with undergoing a laparoscopic colectomy, whereas treatment at rural hospitals was associated with less frequent use of laparoscopic colectomy (adjusted relative risk = 0.76 (0.64-0.90)). This study is subject to the limitations of using administrative data. There has been widespread adoption of the laparoscopic approach to colon resection for cancer in the United States. Disparities in access remain, with application of this technique favoring patients with a higher socioeconomic status and those able to be treated at higher-volume, academic, and nonrural centers.

Increased financial burden among patients with chronic myelogenous leukaemia receiving imatinib in Japan: a retrospective survey

BackgroundThe financial burden of medical expenses has been increasing for cancer patients. We investigated the relationship between household income and financial burden among patients with chronic myelogenous leukaemia (CML) who have been treated with imatinib.MethodsA questionnaire was distributed to 1200 patients between May and August 2009. We retrospectively surveyed their household incomes, out-of-pocket medical expenses, final co-payments after refunds, and the perceived financial burden of their medical expenses in 2000, 2005 and 2008.ResultsA total of 577 patients completed the questionnaire. Their median age was 61 years (range, 15–94). A financial burden was felt by 41.2 % (28 of 68) of the patients treated with imatinib in 2000, 70.8 % (201 of 284) in 2005, and 75.8 % (400 of 528) in 2008. Overall, 182 patients (31.7 %) considered its discontinuation because of the financial burden and 15 (2.6 %) temporarily stopped their imatinib prescription. In 2000, 2005 and 2008, the patients’ median annual household incomes were 49,615 US Dollars (USD), 38,510 USD and 36,731 USD, respectively, with an average currency exchange rate of 104 Yen/USD in 2008. Their median annual out-of-pocket expenses were 11,548, 12,067 and 11,538 USD and their median final annual co-payments were 4,375, 4,327 and 3,558 USD, respectively. Older patients (OR = 0.96, 95 % CI: 0.95–0.98, p ≪ 0.0001 for 1-year increments), and patients with higher household incomes (OR = 0.92, 95 % CI: 0.85–0.99, p = 0.03 for 10,000 USD-increments) were less likely to have considered discontinuing their imatinib treatment. Conversely, patients with higher annual final co-payments (OR = 2.21, 95 % CI: 1.28–4.28, p = 0.004 for 10,000 USD-increments) were more likely to have considered discontinuing their imatinib treatment.ConclusionsThe proportion of CML patients who sensed a financial burden increased between 2000 and 2008. During this period, their annual incomes fell by 13,000 USD, although their medical expenses did not change. Financial support for patients being treated with expensive drugs remains a major problem in Japan.

Remember the Women: Inequality is a Women’s Issue

At last, with the Occupy Wall Street Movement that began in September 2011, the media and politicians have begun to discover what most of the country has long known: economic inequality in the United States. The powerful slogan ‘‘We are the 99%’’ has breathed life into the dismal fact that 1% of the nation is thriving while the rest of us are, at best, treading water. In fact, in the past 4 years, the gap between the rich and the poor has more than doubled. The top 1% of earners have increased their portion of total income from 8% to 18%, while the portion of the bottom 20% is down from 8% to 5% (Organization for Economic Cooperation and Development, 2011). Although poverty (and that, in itself, is misleading, since the official poverty level is absurdly low) and near poverty have increased for all since the housing bust and the Great Recession, women are, once again, suffering the most. Women are 29% more likely to be poor than are men, with an annual median income (for those working full-time, full year) of only 77% of that for men. The gender wage gap is even more pronounced when you examine how women of color are faring. For African American women, it is 61.9% and for Latina/Hispanic women, it is 52.9% (Institute for Women’s Policy Research [IWPR], 2010a, Legal Momentum, 2011). While white women are earning $36,278 to white men’s $47,127 (only a little over twice the poverty level for a family of four), comparable figures are $31,824 for African American women and $27,181 for Latina/Hispanic women (IWPR, 2010a). When we dig further into how women are actually faring, the results are dismaying, shocking— abominable. IWPR (2010b) released a study, broken down by state, of how poor women are doing in three areas. In the United States, fully 31% of poor women have no health insurance. Massachusetts, with its statewide health insurance, ranks first, with only 7.6% without insurance, and Texas ranks last, with 56% without any health insurance. The figures for SNAP (the new acronym for the Food Stamp Program) are 61% of poor women without the benefit nationwide. Maine ranks first, where ‘‘only’’ 45.6% of poor women receive no food stamps, while California is at the bottom, with more than 77% receiving none. Finally, the figures for cash assistance (Temporary Assistance for Needy Families or TANF) are most startling. In the United States, almost 88% of poor women with children receive no cash assistance! The District of Columbia does ‘‘best,’’ with more than 60% receiving no cash assistance, and Louisiana is the worst, with 95.9% receiving none (IWPR, 2010b). More than 15 years ago, before the TANF legislation was passed, a number of academicians in social work,

Measuring the impacts of community-based grasslands management in Mongolia's Gobi.

We assessed a donor-funded grassland management project designed to create both conservation and livelihood benefits in the rangelands of Mongolia's Gobi desert. The project ran from 1995 to 2006, and we used remote sensing Normalized Differential Vegetation Index data from 1982 to 2009 to compare project grazing sites to matched control sites before and after the project's implementation. We found that the productivity of project grazing sites was on average within 1% of control sites for the 20 years before the project but generated 11% more biomass on average than the control areas from 2000 to 2009. To better understand the benefits of the improved grasslands to local people, we conducted 280 household interviews, 8 focus group discussions, and 31 key informant interviews across 6 districts. We found a 12% greater median annual income as well as a range of other socioeconomic benefits for project households compared to control households in the same areas. Overall, the project generated measurable benefits to both nature and people. The key factors underlying project achievements that may be replicable by other conservation projects include the community-driven approach of the project, knowledge exchanges within and between communities inside and outside the country, a project-supported local community organizer in each district, and strong community leadership.

Osteoarthritis pain in the workforce: evaluating its impact on health status, productivity, and health care costs

We evaluated the impact of osteoarthritis (OA) pain on outcomes and costs in an employed population using data from the 2009 US National Health and Wellness Survey. Our study included measures of health status (SF-12v2 physical and mental component summary scores, and the SF-6D), productivity (Work Productivity and Impairment questionnaire), and questions on healthcare utilization. Indirect costs were estimated from median annual income (Bureau of Labor Statistics), and direct costs were estimated by multiplying units of resource categories by average cost of the resource.

Socioeconomics of Retinopathy of Prematurity In-Hospital Care

To determine if there was any uniform experience across the United States relative to retinopathy of prematurity (ROP) services provided, reimbursement, and malpractice insurance coverage. An online pediatric ophthalmology listserv poll queried pediatric ophthalmologists regarding ROP screening, reimbursement, malpractice insurance, and call and consult coverage. Compensation for providing ROP services is quite variable around the United States. The Southern respondents reported the highest contract income while the Northeast reported the lowest. The mean annual contract income was $63 753 and the median annual contract income was $39 000. There was an even distribution between physicians vs hospitals providing malpractice coverage. There was also a fairly even distribution between physicians who do and do not provide consult and call coverage. Nationwide, there is no standard rate of compensation for ROP in-hospital care, coverage of liability insurance, or providing additional consult or on-call services. Income generation performing ROP screening examinations is roughly half what a pediatric ophthalmologist can generate by seeing patients in the clinic or performing surgery.

Determining Prevalence and Correlates of Psychiatric Treatment With Andersen's Behavioral Model of Health Services Use

Determining Prevalence and Correlates of Psychiatric Treatment With Andersen's Behavioral Model of Health Services Use

491 TIME TRENDS IN THE UTILIZATION OF HIGHER-COST TREATMENTS FOR PROSTATE CANCER, 2002-2007

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Practice Patterns, Cost Effectiveness II1 Apr 2010491 TIME TRENDS IN THE UTILIZATION OF HIGHER-COST TREATMENTS FOR PROSTATE CANCER, 2002-2007 Wesley Choi, Paul Nguyen, Xiangmei Gu, Stuart Lipsitz, Toni Choueiri, Yin Lei, Anthony D'Amico, and Jim Hu Wesley ChoiWesley Choi More articles by this author , Paul NguyenPaul Nguyen More articles by this author , Xiangmei GuXiangmei Gu More articles by this author , Stuart LipsitzStuart Lipsitz More articles by this author , Toni ChoueiriToni Choueiri More articles by this author , Yin LeiYin Lei More articles by this author , Anthony D'AmicoAnthony D'Amico More articles by this author , and Jim HuJim Hu More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.566AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To assess temporal trends in the use of higher-cost therapies for non-metastatic prostate cancer (PCa) in the US from 2002-2007 METHODS We determined treatment patterns for 58,581 men aged ≥65 years diagnosed with non-metastatic PCa from 2002-2005 and treated through 2007 using Surveillance, Epidemiology, and End-Results (SEER) –Medicare linked data. Current Procedural Terminology 4th edition (CPT-4) codes were used to distinguish intensity-modulated radiation therapy (IMRT) vs. standard conformal beam radiation, and between minimally-invasive radical prostatectomy (MIRP) vs. open prostatectomy. Annual trends were compared with the Mantel-Haenszel trend test. RESULTS Treatment rates for cancer diagnosed in 2002 vs. 2005 were as follows: external radiation (29.8% vs 29.4%, p=0.33), surgery (18.9% vs. 21.5%, p<0.001), brachytherapy (15.5 vs. 16.0%, p=0.28), primary androgen deprivation therapy (20.5% vs 16.5%, p<0.001), and cryotherapy (1.3% vs. 3.0%, p<0.001). For surgery, the utilization of MIRP increased substantially over time (9.5% vs 28.7%, p<0.001), and for external radiation, IMRT utilization increased substantially (28.7% vs. 81.7%, p<0.001). Men receiving IMRT vs. standard radiation were more likely to live in areas with >90% high-school graduates (40.1% vs. 29.0%, p<0.001), with median annual income '$60,000 (20.9% vs. 12.3%, p<0.001), reside in the Northeast or West (72.1% vs. 69.2%, p=0.017), and were more likely to be non-white (23.5% vs. 22.1%, p=0.03). Men receiving MIRP vs. open prostatectomy were more likely to reside in areas with >90% high-school graduates (50.1% vs. 40.1%, p<0.001), with median annual income ≥$60,000 (35.4% vs. 21.1%, p<0.001), and live in the Northeast or West (72.1% vs. 69.2%, p=0.017). CONCLUSIONS Shifts in the relative use of surgery, radiation, and brachytherapy for prostate cancer were generally minor, but within surgery and radiation, use of higher-cost therapies increased dramatically despite limited comparative effectiveness outcomes assessment. Utilization of these higher cost therapies was more likely to occur in areas with >90% high school education, median annual income of ≥$60,000, and in the Northeast or West. Boston, MA© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e194 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Wesley Choi More articles by this author Paul Nguyen More articles by this author Xiangmei Gu More articles by this author Stuart Lipsitz More articles by this author Toni Choueiri More articles by this author Yin Lei More articles by this author Anthony D'Amico More articles by this author Jim Hu More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Pre-Employment Inquiries: Drug Testing, Alcohol Screening, Physical Exams, Honesty Testing, Genetics Screening - Do They Discriminate?

How do employers decide who to hire for their workplace? Are there tests that are administered to screen out those job applicants that do not fit the employer's for good, honest, hard-working, never-complaining workers? Do employers use screening devices to discriminate against persons with disabilities? What kinds of screening tests do employers use to assist in hiring workers for their company? Fifty-four of the Fortune 500 companies from across the country were surveyed to elicit their opinions on these and other questions relating to pre-employment inquiries. The responses of these companies are tabulated and discussed and serve as a backdrop in this Article which analyzes pre-employment screening practices. Also, a look into the not too distant future where honesty and integrity testing are on the rise and genetics testing of job applicants is heading into the employment arena. Court cases in the area of pre-employment inquiries are analyzed and federal statutes are reviewed and discussed to demonstrate the prevalence of certain forms of employment tests being administered.The U.S. Census Bureau reported in 1988 that 13,415,000 people had a work disability, comprising 8.6% of the 16 to 64 year old population. The number of disabled persons participating in the labor force was 31.6%, however, only 18.2% of the 13.4 million people with a work disability were employed full time. The unemployment rate for those persons with a work disability was much greater than for those with no work disability, 14.2% as compared to 5.8%. Persons with a work disability earned less than half the income of those persons with no disability, $6,319 median annual income as compared to $14,354 of those persons with no work disability.These statistics serve as a reminder that many disabled people continue to face obstacles in gaining access into the employment arena. This Article will reveal how disabled persons are at greater risk when employers increase their screening and testing arsenal in the job selection area.

Regional variation in the utilization of carotid endarterectomy

In different regions of the United States, highly variable rates have been documented for a wide range of procedures, such as prostatectomy and caesarean section. It is generally held that this variation is due to inconsistent physician practice patterns or other nonmedical considerations. Only limited research has been conducted regarding vascular surgical operations. We examined national data on the utilization of carotid endarterectomy (CEA) to determine the extent and diversity of regional variations. Medicare discharge data quantified the per capita rate of CEA in 50 states and the District of Columbia in 2003. Multiple metrics pertaining to risk factors, socioeconomic status, access to care, provider density, and local health care capacity were quantified. We performed bivariate analysis, Pearson (PC) or Spearman (SC) correlations, and multiple regression modeling. In 2003, 83,164 CEAs were performed on 28,767,985 enrollees. CEA rates were 28.9 +/- 7.8 per 10,000 (range, 5.6-44.7 per 10,000). The rate of CEA was highly correlated with the number of heart disease deaths (PC = 0.575, P < .0001), deaths by stroke (PC = 0.504, P = .0002), and percentage of adult smokers in a state (PC = 0.643, P < .0001). These three factors held the strongest association with variation in CEA rates. Statistically, they explained 51% of the variation in total number of CEAs (R(2) = 0.5074, P < .0001). Median annual income (PC = -0.608, P < .0001) and percentage of college degrees (PC = -0.606, P < .0001) displayed inverse relationships to CEA rates. Per capita hospital beds (SC = 0.540, P < .0001) and rural health care clinics (SC = 0.518, P < .0001) exhibited positive correlations. The number of physicians or vascular surgeons did not predict higher utilization of CEA. The strongest correlations for CEA were three markers associated with atherosclerotic disease: percentage of adult smokers and deaths from heart disease or stroke. Geographic variation in this vascular procedure is chiefly associated with variance in markers of disease prevalence, not physician preference or other nonmedical factors. The increased utilization of carotid stenting, accompanied by the participation of a much wider range of medical specialists, may affect this relationship in the future.

Abstract B17: Measures to assess narrative influences on cancer prevention behaviors

Abstract B17 Background Narrative approaches to health promotion in cancer prevention have recently gained much attention. Cultural grounding to produce narrative-based messages is a well-suited method of health promotion to address health disparities, but cognitive and emotional mechanisms that purportedly work through narratives to change behavior are rarely specified nor directly measured. A model for assessing narrative characteristics and effects on intention to change behaviors (derived from narrative theory and entertainment-education) was proposed and tested in pilot studies of a community-based, storytelling intervention for Latinos. Method Seven sessions with health information embedded in narratives taught by experienced Promotoras de Salud (who assisted in developing story content) were pilot-tested prior to full study implementation. Novella-style stories featured a group of neighbors with various interpersonal challenges, and incorporating colorectal cancer prevention (dietary, physical activity, and screening) messages. Participants evaluated each story presented and answered questions pre- and post-intervention regarding intention to modify health behaviors. Scale items to assess factors theoretically predicted to change behavior were created; data reduction and regression modeling were used to examine model elements. Results Fifty-five Latinos completed the pilot study and assessed stories in each session; mean age 39.6, mean education level, 9th grade; 92% prefer Spanish; median annual income $15-25K. Factor analysis on story characteristics produced two scales, Cultural (α = .755) and Emotional Content (α =.817). Factor analysis on mediators expected to predict behavior yielded Identification (α = .925), Engagement (α = .976) and Attention (α = .966). Model testing indicated significant relationships between some of the story characteristic measures and mediators: Cultural and Emotional Content of stories was related to Identification with stories and characters, and Cultural Content was related to Attention (p &amp;lt; .01 for all). Mediators showed moderate relationships to health behavior change intentions, with significant findings for Identification predicting intentions to increase physical activity (p &amp;lt; .05) and Engagement predicting intentions for dietary change (p &amp;lt; .01). Conclusions Development and preliminary tests of measures to assess narrative characteristics and factors expected to mediate behavior change show promise for theory building. Story characteristics measured as cultural and emotional content provided predictive value for mediators shown in previous research to be important for persuasion and behavior change, Identification and Engagement (otherwise known as “transportation” into the story). Further, Identification and Engagement preliminarily appear to provide predictive power for cancer prevention behavioral intention. Implications The model and corresponding measures tested in this pilot study provide a starting point for evaluating narrative interventions prior to intervention. As our larger community study progresses and additional data are collected on attitudinal and behavioral responses to narratives, a more detailed model will be specified and tested (including social proliferation effects) for theory-building to understand more about narrative effects on behavior change. Funding: NCI Citation Information: Cancer Prev Res 2008;1(7 Suppl):B17.

Is religion a health resource for the poor?

This paper uses data from the 2004 General Social Survey to examine the relationship between religious belief and practice (religiosity), spirituality, social support, and health status. Health status is conceptualized first in terms of a subjective assessment and, second, as two objective indicators of physical problems. These relationships were examined first within the total GSS sample, and then separately for respondents who reported below or above the median annual income. Results indicate that spirituality is a positive predictor of respondents’ subjective assessment of their health in the overall sample, but not in either separate income group. Social support does not predict positive subjective or objective health outcomes in the entire sample or for any income group. However, religiosity is a positive predictor of physical health, but only for the most severe of the physical health problems measured, and only for respondents whose annual income is below the national median. Thus, it appears that religiosity is a health resource for those below average income.

Epidemiology of ventriculostomy in the United States from 1997 to 2001

Ventriculostomy is a common practice in neurosurgery, but the annual trend of this procedure in the United States has not been reported in the literature. This study evaluates the annual trend during a recent 5-year period. Between 1997 and 2001, a retrospective review was undertaken concerning all patients in the Nationwide Inpatient Sample (NIS) who had undergone ventriculostomy. The population sample represented approximately a 20% stratified sample of nonfederal hospitals in the United States. The annual number of patients who underwent ventriculostomy during the study period ranged from 20,586 to 25,634. Most patients were male (53.4%), with a mean age of 44.8 years, were commercially insured (46.0%) and had a median annual income above $25,000 (84.4%). Most frequent ICD-9-CM diagnoses were subarachnoid haemorrhage, intracerebral haemorrhage and obstructive hydrocephalus, respectively. The majority of ventriculostomies were performed in large, private, not-for-profit, metropolitan, teaching institutions. Mean length of hospital stay was 19.2 days. Regarding discharge status for patients who had undergone ventriculostomy, approximately one-quarter died in the hospital, one-third were discharged home and one-third were transferred to another institution. No demographic variables changed during the study with the exception of location of ventriculostomy in a teaching hospital, which increased from 64.4% in 1997 to 77.4% in 2001. Patient and hospital demographic characteristics were consistent during the study period. By extrapolation of the data, the prevalence of ventriculostomy in the United States averaged 24,380 per year. This study is the first to comprehensively document data concerning the epidemiology of this common procedure.

Differences in Utilization of Drug-Eluting Stents by Race and Payer

Numerous disparities in access to health care by race and gender have been identified in the literature. This study examines differences in the use of drug-eluting stents (DES) versus bare-metal stents (BMS) by race, payer, and income level. Data from New York State's Percutaneous Coronary Intervention Reporting System from July 2003 to December 2004 were used to examine use of DES (20,165 patients) relative to BMS (4,547 patients) by race, payer, and annual income level, controlling for a variety of patient and hospital characteristics. African-Americans were found to be less likely to receive DES than other races between July 2003 and March 2004 (adjusted odds ratio [OR] 0.56, 95% confidence interval [CI] 0.50 to 0.65) and between April 2004 and December 2004 (adjusted OR 0.74, 95% CI 0.61 to 0.90). These disparities were reduced (respective adjusted ORs 0.67, 95% CI 0.58 to 0.77 and 0.81, 95% CI 0.66 to 0.91) when controlling for admitting hospital and hospital volume, but were still significant. Medicaid/self-pay patients, and patients living in zip codes with median annual incomes between $20,000 and $30,000 were also less likely to receive DES in the first time period (adjusted respective ORs 0.80, 95% CI 0.68 to 0.93) and 0.85, 95% CI 0.75 to 0.96). In conclusion, African-Americans and low income groups receive DES less frequently than their counterparts compared with BMS. This is related to the hospitals where they are admitted, but not entirely.

What children do on the Internet: domains visited and their relationship to socio-demographic characteristics and academic performance.

HomeNetToo is a longitudinal field study designed to examine the antecedents and consequences of home Internet use in low-income families. Participants included 140 children, mostly 13-year-old African American (83%) boys (58%), living in single-parent households (75%) where the median annual income was $15,000 (USD). This report focuses on children's Internet activities, socio-demographic characteristics related to their Internet activities, and the relationship between academic performance and Internet activities. Overall, findings indicate that low-income children initially use the Internet primarily for entertainment. As home Internet use loses its novelty children become more focused in their Internet activities, reducing the number of websites they visit and visiting more websites targeted to their specific interests. Pornography websites are popular initially, especially among boys, but their popularity decreases dramatically after 3 months. Age, race, and sex have little influence on which websites are most popular. Academic performance predicts subsequent Internet activities, and Internet activities predict subsequent academic performance. Directions for future research to identify mechanisms that mediate the relationship between Internet activities and academic performance and implications for the digital divide are discussed.

Prognostic Factors and Outcomes of Patients with Acute Myeloid Leukemia (AML) Receiving Non Intensive Chemotherapy (NIC) or Best Supportive Care (BSC).

Background: AML in older adults poses therapeutic challenges, as many patients are not candidates for intensive chemotherapy (IC), and it is not clear that IC provides a survival benefit compared to NIC/BSC. While risk factors and outcomes of patients treated with IC are well-defined, few data support similar prognostication in patients treated with NIC or BSC.Methods: We conducted a retrospective review of all patients with AML receiving NIC or BSC at the Cleveland Clinic between January 1997 and December 2005. NIC consisted of treatment with hydroxyurea, low-dose cytarabine, or azacitidine. The choice and decision of therapy was dictated by patient and physician preferences. Data on known prognostic factors (age, white blood cell count (WBC) at diagnosis, cytogenetic risk groups (as defined by CALGB 8461) and AML etiology (de novo vs. secondary AML)) were collected and controlled for in multivariable analyses, and survival determined using the log-rank test, measured from the time of diagnosis. Race and residential zipcodes were obtained from information disclosed by patients in their electronic medical records. Average annual household income in a zipcode was obtained using a web-based database, www.melissadata.com.Results: Fifty-three patients were identified. The median age was 74 years (range 33–92), and 26 patients (49%) were female. Eight patients (15%) were African American (AA), while 44 patients were Caucasian (C) and 1 patient was neither AA nor C. The median WBC at presentation was 6.0 ×103/μL. Cytogenetics were favorable in 1 patient (2%), intermediate in 10 (19%), unfavorable in 19 (36%), and unknown in 23 (43%). Most patients (60%) had secondary AML. The median average annual income was $39,332 (range 23,375–82,806). The median survival was 54 days (95% CI 33–80 days) for all patients, and the 1 year survival was 7%. Known prognostic factors for AML (WBC at presentation, de novo vs. secondary AML, cytogenetics, and age at diagnosis) were not predictors of overall survival in multivariable analyses in patients not receiving intensive chemotherapy, though higher WBC count was predictive in univariable analyses. Race was a predictor for outcomes, with AA patients experiencing a worse median survival than their C counterparts (22 days versus 64 days, log rank p=0.03, figure 1) despite similar baseline characteristics. SES, however, had no impact on outcome.Conclusions: AML patients receiving NIC or BSC have a median survival of almost 8 weeks, with AA patients experiencing worse outcomes. A small but significant percentage of patients remain alive at one year. Prognostic variables useful in treatment decision-making in patients receiving IC are less valuable for NIC/BSC patients. This information can be used for patient counseling and to help guide treatment decisions. [Display omitted]

How Medicaid and the State Children's Health Insurance Program Can Do a Better Job of Insuring Uninsured Children: The Perspectives of Parents of Uninsured Latino Children

Eight and a half million US children are uninsured, despite the 1997 enactment of the State Children's Health Insurance Program (SCHIP) with $39 billion in funding, and Latinos continue to be the most uninsured racial/ ethnic group, with 24% (3 million) uninsured. Why SCHIP and Medicaid have not been more successful insuring uninsured children is unclear. To identify reasons why parents are unable to insure uninsured Latino children in a state where all low-income children are eligible for insurance. Bilingual focus groups of parents of uninsured Latino children from Boston communities with the highest proportion of uninsured Latino children. The 30 parents interviewed in 6 focus groups had a mean age of 39 years; 63% never graduated high school and 33% were US citizens. The mean age of their children was 12 years, and the median annual family income was $9120. Parents reported 52 barriers to insuring children. Major obstacles included lack of knowledge about the application process and eligibility (especially misconceptions about work, welfare, and immigration), language barriers, immigration issues, income, hassles, pending decisions, family mobility, misinformation from insurance representatives (being told insurance is too expensive and parents must work), and system problems (including lost applications, discrimination, and excessive waits). Parents universally agreed case managers would be helpful in insuring uninsured children. Even in a state where all low-income children are eligible for health insurance, current SCHIP and Medicaid outreach and enrollment are not effectively reaching uninsured Latino children. Parents need better information about programs, eligibility, and the application process, and a more efficient, user-friendly system.