This is the second year that an award for the best
student poster will be given in honor of Dr. Catherine “Kit” Allen.
Student posters that are eligible for the Kit Allen Memorial Scholarship
are denoted with an ►.
►Poster 2, Location 3: Infant Mortality: Black-White Disparities
in Wisconsin
►Poster 3, Location 5: Evening/Morning Preference
as a Predictor of Insomnia and Sleepiness
►Poster 4, Location 10: Characteristics of
School Sanctioned Sports: Participation and Attrition in Wisconsin Public
High Schools
►Poster 5, Location 11: Geographic Variation
in Traffic Injury Risk Factors and Outcome among Children aged 0-18
in Wisconsin, 1992-2001
Poster 6, Location 12: Sleep Problems and Usual Alcohol
Consumption: A Population-Based Study of Men and Women
►Poster 7, Location 18: Factors Affecting Patient
Response to Symptoms after Outpatient Surgery
Poster 8 Location 19: Sleep-Disordered Breathing
and Usual Alcohol Consumption: A Population-Based Study
►Poster 9, Location 20: Using Local Data to
Monitor Obesity Rates in Wisconsin Counties, 1994-2003
Poster 10, Location 24: Racial/ Ethnic, & Gender
Differences in Job Strain Over the Life Course and Changes in Behavioral
Determinants of Health & Mortality
►Poster 11, Location 25: The patient journey
in outpatient surgery: Information flow and the quality chasm
►Poster 12, Location 26: Psychological traits
and preference for control over health care decisions
Poster 13, Location 27: Using Community Action Research
to Improve Understanding of Neighborhood Social Capital for Population
Health
►Poster 14, Location 29: Caring for the Underserved:
Preceptor Knowledge Attitudes and Behaviors
►Poster 15, Location 30: Serving the Underserved:
Evaluation of a Web-Based Curriculum
►Poster 16, Location 31: Diastolic blood pressure levels in children
vary widely between population studies
Poster 17, Location 32: The Case for Limited Malignant
Potential Breast Cancer: Results from the Wisconsin Breast Cancer Epidemiology
Simulation model.
Poster 18, Location 34: First-degree family history
of cancer in relation to ovarian cancer risk.
Poster 19, Location 35: Isolated REM Apnea/Hypopnea
Index as a predictor for developing Sleep-Disordered Breathing in women
Poster 20, Location 36: Psychological well-being,
sleep, and interleukin-6 regulation in aging women
Poster 21, Location 37: Factors associated with
bone mineral density (BMD) in premenopausal women with type 1 diabetes:
a pilot study
Poster 22, Location 38: Public Participation and
Policy Making: Why are some states more actively engaging the public?
►Poster 23, Location 41: The Chronic Care
Model: Diabetes Quality Improvement for Health Plans in Wisconsin
Poster 24, Location 43: Between hospital variation
and NICU outcomes in a statewide cohort of very low birth weight infants
born in 2003
►Poster 25, Location 44: Models to predict
length of hospital stay and associated charges for Very Low Birth Weight
infants
Poster 26 Location 45: Logistic Regression Tree
Analysis in the Newborn Lung Project
Poster 27, Location 46: Evaluation of the Wisconsin
Tuberculosis Program’s Progress towards Documentation of Treatment Improvement
and Completion of Treatment in Active Cases of Reported Tuberculosis,
Wisconsin 2000-2002
Poster 28, Location 47: Program Evaluation: A Tool
for Tribal Communities
►Poster
1, Location 2
Health Disparities
in Wisconsin: The Wisconsin
County Health Rankings
Angela Kempf,
Patrick Remington, Paul Peppard, Elizabeth Dranger,
and David Kindig
Introduction: The UW Population
Health Institute–with assistance from state government, community,
and university groups–annually compiles county data and produces the
Wisconsin County Health Rankings.
The objective of this project is to rank the “population health”
of counties in Wisconsin to promote use of local population health information,
identify disparities within and between counties, encourage population
health improvement, and broaden the understanding of the determinants
of health.
Methods: This project is
modeled after the United Health Foundation’s annual State Health Rankings
and based on a model of population health in which a variety of determinants
impact health outcomes. Mortality
(YPLL) and self-reported health status are used to develop a summary
measure of county “health outcomes.”
A summary measure of “health determinants” was developed using
24 measures in four (weighted) categories–health care (10%), health
behaviors (40%), socioeconomic factors (40%), and physical environment
(10%). Data sources include
the CDC, U.S Census, state vital statistics, and Wisconsin Department
of Health and Family Services. Health disparities between counties were examined
using the measures described above.
In addition, disparities in mortality existing within each
county by level of education were highlighted.
Results: Significant disparities
exist in the health outcomes and determinants of Wisconsin counties. The county ranking lowest
for mortality had a YPLL value that was more
than three times that of the highest ranking county. Mortality disparities by level of education
were identified across the state; in every county, those with a high
school education or less had a mortality rate that was at least 1.5
times the mortality rate of those with more than a high school education.
Conclusion: Numerous health
disparities exist both within and among Wisconsin counties. The Wisconsin County
Health Rankings provides a valuable vehicle for the delivery and discussion
of county-level health information and to engage stakeholders in the
discussion of approaches to reduce these observed disparities.
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►Poster 2, Location 3
Infant Mortality: Black-White Disparities in Wisconsin
Deannah Byrd, Patrick Remington
Background: Infant
mortality and maternal health are two important indicators of overall
health in a society. National
objectives for maternal and infant health have been set for the year
2010 to reduce deaths among infants to less than 4.5 per 1000 live
births among all racial/ethnic groups.
Wisconsin’s black infant mortality rate is one of the highest in
the nation.
Objective: To
determine the extent to which the risk factors of maternal age, maternal
educational attainment, region of the state, and adequacy of prenatal
care explain the black-white disparity in infant mortality in
Wisconsin.
Method: We examined
infant mortality data for 1998-2002, using the Wisconsin Interactive
Statistics on Health (WISH) database.
The study population consisted of 271,146 white infants and
31, 944 black infants. Logistic
regression was used to examine the effect of race independent of other
risk factors.
Result: Before
statistical adjustment of the data, babies of black mothers had a
3-fold greater risk of infant death than those of white mothers. After adjustment for the model variables, the
estimated risk ratio was reduced to 2.2 (95% confidence interval,
1.98 to 2.54).
Conclusion: Black
race, apart from maternal age, maternal education, region of the state,
and adequacy of prenatal care, is a strong predictor of infant mortality. This study suggests that prenatal care, delayed
childbirth, and education could reduce the disparities in black infant
mortality, partially, but not completely.
Further research must identify the causes of the persistent
higher rates of infant mortality among blacks.
Learning Objectives: To recognize that implementing evidence-based practices such as providing
prenatal care and educational programs, only partially reduces the
black-white disparity in infant mortality.
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►Poster
3, Location 5
Evening/Morning Preference as a Predictor of Insomnia
and Sleepiness
Elizabeth Younger,
Terry Young, Laurel Finn
Introduction:
The Horne-Osberg morningness-eveningness
questionnaire (MEQ) is widely used as an indicator of circadian typology. However, there has been little research in how
morning or evening tendencies may predispose individuals to sleep
problems, particularly insomnia or daytime sleepiness.
Methods: The
sample for this study comprised 1141 middle-aged adults in the longitudinal
Wisconsin Sleep Cohort Study. Participants
completed the MEQ, and reported on frequency (never, rarely, sometimes,
often, always) of the occurrence of 4 insomnia symptoms
and 2 indicators of daytime sleepiness
as part of an overnight study protocol.
A composite score was calculated from the MEQ and standard
cut points were used to create four strata on preference, (early morning,
morning, no preference and evening).
Logistic regression was used to estimate odds ratios and 95%
confidence intervals for frequent (often or always) insomnia and sleepiness
problems and MEQ strata, adjusted for age and sex.
Results: Eveningness was associated with more difficulty falling asleep
(OR = 4.2, CI 1.7-10.8), excessive daytime sleepiness (OR=4.1 , CI 1.7-10.0) and not feeling rested (OR=2.69, CI 1.22-5.95).
Eveningness did not correlate with
other insomnia symptoms: trouble falling back asleep (OR=1.0, CI 0.4-2.6),
waking repeatedly (OR=0.56, CI .2-1.4), or waking too early (OR=.6
CI 0.2-1.8).
Conclusions:
Our findings suggest that persons with eveningness,
relative to morningness tendencies have more difficulties in adapting
to the sleep and wake schedules that typify middle-aged men and women. It is possible that sleep onset insomnia in
eveningness types compromises sleep length among those who
must adhere to a typical early morning wake time, and leads to daytime
sleepiness.
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►Poster 4, Location 10
Characteristics of School Sanctioned Sports: Participation
and Attrition in Wisconsin Public High Schools
Matt Landis
Background: Participation
in regular physical activity produces both physical and psychological
benefits, and specific to high schools, evidence suggests student
athletes develop a different set of skills, aspirations, and perceptions
of risk when compared to their non-participating peers. High school sanctioned sports programs constitute
a main avenue for students to maintain regular physical activity.
However, as Wisconsin students pass through high school, attrition in high school sports may
impede the development of these qualities.
Therefore, understanding patterns of attrition is the first
step to understanding how high schools can maximize the benefits of
sports participation to the student body.
Objective and Rationale: To examine participation and attrition among school endorsed
and school organized sports programs in Wisconsin. Attrition in
high school sanctioned sports may not always succeed in encouraging
lifelong sports participation. Those
students not making adequate progress, or lacking the necessary degree
of competitive spirit may be sidelined or even cut, diminishing the
likelihood of continued active engagement.
Examining attrition rates yields new policy and curriculum
considerations for schools and communities.
Methods: WIAA
data were obtained for four years (1999-2000 to 2003-2004) and linked
with Department of Public Instruction data follow a cohort of student
athletes from freshman to senior year.
This research will:
·
examine changes in participation by
number of participants as well as by changes in participation rate
·
examine change by season, sport, gender,
grade size, ethnic component, and by sport type (team vs. individual)
·
identify policy considerations of attrition
among high school sports
Results: During
the freshman year (1999-2000), WIAA reports that over 53,417 individuals
compete in some high school sport.
Three years later (2003-2004), the same group of schools report
only 29,480 individuals competing in either a fall, winter, spring
or summer sport.
Attrition rates among
men’s and women’s sports are similar.
For the 12 men’s sports, the overall average percent decline
in number of participants is 31%, and among the 11 women’s sports
(women’s hockey not reported in 1999-2000), the number of participants
falls by 28%.
Conclusions: If
lifelong physical activity and other physical and psychological benefits
are to be encouraged through high school sports, reasons for attrition
should be examined. Educators
should reconsider the role of sports in the educational experience. Math is taught at advanced, normal, and remedial
levels. Why aren’t similar
choices offered for school-sanctioned sports?
Future research: Incorporate school/community level data and build models to explore predictors
of participation and attrition.
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►Poster
5, Location 11
Geographic
Variation in Traffic Injury Risk Factors and Outcome among Children
aged 0-18 in Wisconsin, 1992-2001
Hui
Guan, Janine Clemmons, Maureen Durkin, Jane McElroy, Wayne Bigelow
Background
Motor
vehicle collision (MVC) remains the leading cause of death and injury
among children under 18 years old in Wisconsin and the U.S.
Outcome
after sustaining traffic injuries is related to important risk factors,
including some preventable factors, such use of safety equipment,
alcohol, and the distance from trauma care.
Examining
the geographic variations in safety equipment use, alcohol, and the
distance to trauma care will help distribute limited resources and
implement prevention programs in those areas in need.
Objectives
To
examine the incidence of traffic related death and injury among children
less than 18 years old in Wisconsin for over a ten-year time period
1992 - 2001.
To
visually describe the geographic variations in safety equipment use,
alcohol and case fatality of severely injured children by GIS maps.
Poster 6, Location
12
Sleep Problems and Usual Alcohol Consumption: A Population-Based
Study of Men and Women
Diane
Austin, Paul E. Peppard, Richard L. Brown and Terry Young.
Introduction:
We investigated
the relationship of usual alcohol consumption with self-reported sleep
problems and habits in 527 women and 599 men in the Wisconsin Sleep
Cohort Study.
Methods: Participants reported sleep problems (difficulty falling asleep, difficulty getting back to sleep after awakening,
waking repeatedly) and sleep habits (time to fall asleep). Sleep
problems occurring ≥ 5 times/month were considered “frequent.”
Weekly consumption of alcoholic beverages, as well as smoking status
and medication use were assessed
by health questionnaire. Drinks per week were categorized as: 0, 1-6,
7-13, or 14+.
Sleep problems were
modeled using logistic regression/GEE. Time to fall asleep
was modeled using linear mixed models. All models were adjusted for
age, BMI, smoking status, and medications. Separate models were fit
for men and women.
Results: Men and women differed in alcohol consumption and sleep
problems, with 9% of women vs. 26% of men consuming 7 or more drinks/week,
but more women reporting frequent sleep problems.
Men who drank 7-13
drinks/week vs. 0 had lowered odds of difficulty falling asleep
(OR = 0.34, 95% CI: 0.15 - 0.74); there was no relationship in women
(OR = 0.98, 95% CI = 0.41 – 2.37). Men who drank 14+ drinks/week had
increased odds of difficulty getting back to sleep (OR = 2.14,
95% CI: 1.04 - 4.42); women had increased, but non-significant odds
(OR = 1.54, 95% CI: 0.58 - 4.08). There were no significant relationships
between these two sleep problems and other levels of alcohol consumption
or between alcohol consumption and waking repeatedly or time
to fall asleep.
Conclusions: For men, 7-13 drinks/week was associated with reduced
difficulty initiating sleep and 14+ drinks/week
was associated with increased sleep disturbance later in the night.
For women, alcohol was not significantly related to sleep problems,
though few women reported higher levels of alcohol use.
Support: Grants
R01HL62252, RR03186, and R01AG14124 from the National Institutes of
Health and Grant #051511 from the Robert Wood Johnson Foundation
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►Poster
7, Location 18
Factors Affecting Patient Response to Symptoms after Outpatient
Surgery
Brian Harahan, Maureen
Smith, Ann Schoofs Hundt,
Scott Springman, Pascale Carayon
Over 60% of surgical
procedures in the U.S. are performed in ambulatory settings.
This growing trend places increasing amounts of responsibility
on patients to self-manage their follow-up care as more complex procedures
are performed and more complicated patients get these procedures. Increased age and comorbidity may predispose
a patient to adverse outcomes. Our
objective is to explore the effect that age and comorbidity have on
patient response to post-surgical symptoms. Data were obtained from
patients, N=342, undergoing ophthalmic, open joint, otolaryngological,
or intra-extra-abdominal ambulatory surgery from four outpatient care
centers in a mid-sized midwestern community. Nurses queried patients by telephone at least
seven days after discharge on the incidence of twenty-one possible
symptoms and whether the patient contacted a provider for each symptom. Symptoms were categorized prior to analysis
into high risk (e.g., shortness of breath, chest pain), moderate risk
(e.g., eating problems), and low risk (e.g., coughing) based on expert
opinion. Data on comorbidities were summarized using
the Charlson Comorbidity Index. The dependent
variable was, “Did you attempt to contact your regular doctor, surgeon's
office or the outpatient surgery center, for each symptom.” Analysis
was conducted at the symptom level accounting for clustering within
patients. Logistic regression was used to examine the
relationship of the dependent variable to symptom risk, age and the
Charlson index, controlling for gender, education, type of
procedure, and presence of a permanent caretaker. 342 patients aged 18-95, 39% greater than 65,
responded to the survey. 150
patients, 30% greater than 65 years old, were selected for analysis
because they contacted a health provider for a new or worsening symptom. 284 new or worsened symptoms were reported at
the surgery center or after discharge. Twenty-four percent of symptoms
were reported by respondents older than 65 years.
The probability of provider contact increased significantly
for high risk compared to low risk symptoms (odds ratio=3.76, 95%
confidence interval=1.53-9.28). The
data are suggestive that patients over the age of 65 years are less
likely to contact their provider for high risk symptoms, but this
study lacked the statistical power to permit a firm conclusion.
There was no evidence that patients with higher comorbidity
levels were more likely to contact a provider for high risk symptoms.
Older patients are likely at higher risk for adverse events
related to post-surgical complications and further research should
evaluate whether older patients are less likely to respond appropriately
to high risk symptoms.
Poster 8 Location 19
Sleep-Disordered
Breathing and Usual Alcohol Consumption: A Population-Based Study
Paul
E. Peppard, Diane Austin, Richard L. Brown and Terry Young.
INTRODUCTION. Alcohol use, especially near bedtime, may exacerbate
sleep-disordered breathing (SDB). This epidemiologic analysis from
the Wisconsin Sleep Cohort Study examines the cross-sectional association
of SDB with “usual” alcohol consumption habits while adjusting for
potential “acute” effects of alcohol consumed just prior to SDB assessment.
METHODS. The apnea-hypopnea index (AHI,
events/hour), a measure of SDB severity, was determined by in-laboratory
polysomnography on a sample of 1516 adults. AHI>5 defined
“mild or worse” SDB. Usual weekly and “acute” (the evening prior to
polysomnography) alcohol consumption were assessed by questionnaire.
Categories of consumption were defined by grams of alcohol per kilogram
of body mass. Generalized linear (regression) models estimated odds
ratios (OR) for SDB in persons with varying categories of alcohol
consumption, adjusting for “acute” alcohol consumption, age, body
mass index, a variety of medications, and smoking.
RESULTS. Relative to men who consumed no alcohol, men who consumed
from >0 to <0.5 g/kg per day had 23% greater odds of SDB (OR=1.23,
95% CI=0.95-1.60, p=0.1); men who consumed >0.5 g/kg per day had
3.09 times greater odds (95% CI=1.47-6.47, p=0.003). There was a significant
increasing trend in the odds ratios (p=0.002). Alcohol-consuming women
showed no increased risk of SDB. Relative to women who consumed no
alcohol, women who consumed >0 to <0.5 g/kg per day manifested
no difference in risk (OR=0.93, 95% CI=0.69-1.25). None of the 18
women reporting alcohol consumption >0.5 g/kg per day had SDB.
CONCLUSION. In men, independent of alcohol consumption on the evening
of SDB evaluation, increased usual alcohol consumption was associated
with increased risk of mild or worse SDB. There were too few women
reporting high levels of alcohol consumption to fully address the
association in women. Persons with SDB might benefit from generally
moderated alcohol consumption and not just avoidance near bedtime.
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►Poster
9, Location 20
Using Local Data to Monitor Obesity Rates in Wisconsin
Counties, 1994-2003
Casey
L. Schumann, BS, Patrick L. Remington, MD, MPH
Introduction: County-level obesity estimates are necessary
for planning and evaluating community-based interventions to improve
nutrition and increase physical activity.
However, the quality of these data have
never been examined.
Objectives: The purpose of this study is
to evaluate the reliability of the county-level obesity prevalence
estimates from Wisconsin’s 72 counties and to highlight the variation of obesity
among Wisconsin counties.
Methods: The obesity prevalence data for each county in
Wisconsin were obtained from the Wisconsin
Behavioral Risk Factor Survey from 1994 to 2003. During this 10-year
period, 26,635 residents were interviewed by telephone, with sample
sizes ranging from 6,586 in Milwaukee County, to 15 in
Menominee County. The number of counties with
reliable estimates, using standards of sample size > 50
and > 300, were compared.
Results: Obesity in Wisconsin increased 19% from 1994 to
2003, but appears to be leveling off.
The 10-year obesity prevalence was able to be determined for
68 of Wisconsin’s 72 counties, ranging from
9.7% in Bayfield County to 29% in
Langlade County. Data from the BRFSS are reliable for 1-, 3-,
and 5-year periods for 4, 24, and 43 counties, respectively, using
a minimum sample size of 50. Using
a minimum sample size of 300, data are reliable for only 1, 4, and
5 counties for annual, and 3- and 5-year moving averages, respectively.
Conclusions: Local obesity
data exist for every county in Wisconsin, though sparsely populated
counties may need to combine several years of data for a more reliable
estimate. The absolute prevalence estimates for all counties should
be interpreted in the context of community characteristics, and may
represent minimum estimates due to self-reported data.
However, the data are valuable for surveillance, resource allocation,
community-based planning, and policy-making.
Poster 10, Location 24
Racial/ Ethnic, & Gender Differences in Job Strain
Over the Life Course and Changes in Behavioral Determinants of Health
& Mortality
Margaret M. Weden
Purpose: Relate racial/ethnic
and gender differences in work-related psychosocial exposures over
adulthood to differences in behavioral determinants of chronic disease,
disability, and premature mortality.
Methods: Exposure to job
strain in the US during the 1990s is measured by occupation using the
demand/control framework (Karasek &
Theorell 1990) in the National Survey of Midlife Development
in the United States and then imputed into the U.S. National Longitudinal
Survey of Youth (NLSY79). The NLSY79 follows a cohort of adolescents
in 1979 biannually through to 2000. Exposure to job strain is related
to the likelihood of changes in health determinants (i.e. tobacco
use and BMI) using discrete-time hazards models. The models adjust
for material and social resources also differentiated by occupation
(i.e. education, salary, benefits, co-worker/supervisor support).
Findings: Men and women
(regardless of race or ethnicity) most commonly work in passive jobs
in adolescence. With increasing age, European American men become
more heavily concentrated in active jobs, European American women
and Hispanic women become concentrated in active jobs, and Hispanic
men become concentrated in low strain jobs. In contrast, African American
women remain in passive jobs or transition into high strain jobs,
and African American men remain the most likely to be in passive jobs.
The job strain categories have unique relationships with health determinants
by race/ethnicity and gender, even after controlling for material
and social resources. These are instructive for understanding racial,
ethnic and gender disparities in health.
Conclusions: The analyses
underscore the relevance of policy that increases human capital, reducing
racial, ethnic and gender differences in the likelihood of transitioning
out of passive jobs. It also highlights the need for workplace health
programs that extend beyond individual interventions to address high
strain workplace conditions.
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►Poster 11, Location 25
The patient journey in outpatient surgery: Information
flow and the quality chasm
Kara Schultz1,2, Pascale Carayon1,2, Ann Hundt2,
Scott Springman3
1Department of Industrial
and Systems Engineering, 2Center for Quality and Productivity Improvement,
3Department of Anesthesiology, University of Wisconsin-Madison
Background: Many
of the complexities that exist within the outpatient surgery process
significantly impact the quality and safety of care patients receive.
The preoperative stages of this process are particularly complex as
multiple care providers prepare the patient and patient information
for surgery. Patients encountering the outpatient surgery process
experience a number of transitions of care, between care providers
as well as between care settings and between departments within the
hospital. Important patient information is often not available until
the night before or the day of surgery and “last minute” information
tends to be incomplete, leaving little time to obtain further information
or to modify patient care to minimize risk for the patient. The result
is poor preparation for surgery, increased potential for patient harm
and surgery delays and cancellations.
Methods: A study
examining these complexities, the reasons why they occur, and the
impact they have on patient care, was conducted in an outpatient surgery
center. The objective of this study was to observe the transitions
and information flow that occurred during the patient journey through
the different stages of the preoperative process and, in turn, identify
breakdowns in the flow of information and the resulting consequences
for providers and patients.
Four data collection
methods were employed to obtain data on the patient journey: employee
shadowing, patient shadowing, clinic observation, and dictated feedback
from employees.
Discussion: Data
collected in this study were used to identify various facilitators
and obstacles present in the outpatient surgery preoperative process,
many of which have considerable consequences for patients due to poor
information flow. The Institute of Medicine’s 2001 report, Crossing the
Quality Chasm: A New Health System for the 21st Century, recommended
that healthcare systems pursue the following six aims for improving
the quality of care: patient safety, patient centeredness, efficiency,
effectiveness, equity, and timeliness. The findings from this study
illustrate the current expanse of this chasm in outpatient surgery
care for each of the six aims and the work that needs to be done in
closing this gap and improving patient care.
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►Poster
12, Location 26
Psychological traits and preference for control over
health care decisions
K.
Flynn, M. Smith
Little is known about the importance of long-standing
psychological traits in preferences for control over healthcare decisions.
If preferences are related to underlying psychological traits, the
effectiveness of attempts to empower patients through increased shared
decision making (e.g., decision aids) may be limited because some
patients cannot be motivated to participate.
Data are from the first three random replicates of
the 2003 Wisconsin Longitudinal Study, a 1/3 random sample of graduates
from Wisconsin high schools in 1957 (N=10,317)
who have been followed via telephone and mail surveys for 46 years.
The dependent variable representing preference for control over decision-making
was, “The important medical decisions should be made by my doctor,
not by me,” coded on a five-point scale from “strongly agree” to “strongly
disagree.” Psychological traits, collected in 1992, included the five-factor
model of personality (extraversion, openness, conscientiousness, neuroticism,
agreeableness) and Ryff’s six-factor model
of psychological well-being (autonomy, environmental mastery, personal
growth, positive relations, purpose in life, self-acceptance). Multinomial
logistic regression adjusted for potential confounders including patient,
provider, and relationship characteristics.
Of 1279 respondents aged 63-65, 24% preferred doctor
control over important medical decisions, 20% were neutral, and the
remaining 56% preferred personal control. After adjustment, increasing
openness (OR=1.10, 95%CI=1.03-1.17), autonomy (OR=1.09, CI=1.03-1.16),
and personal growth (OR=1.10, CI=1.03-1.18) were associated with preference
for personal control compared to doctor control. Other variables significantly
associated with preference for personal control included female gender,
increased education, and lack of chronic joint problems. Autonomy
and self-acceptance were significantly associated with neutral preference
for control compared to doctor control.
Respondents varied in their preferences for control
over healthcare decisions. For the near elderly, psychological traits
measured a decade previously strongly predicted decision making preferences,
supporting future investigations of the role of long-standing psychological
traits in empowering individual patients for shared decision making.
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Poster 13, Location 27
Using Community Action Research to Improve Understanding
of Neighborhood Social Capital for Population Health
Richard M. Carpiano,
Ph.D., M.A., M.P.H.
In recent years, interest
in the concept of neighborhood social capital has substantially increased
within population health and social epidemiology. However, due to
current dominant theoretical approaches and the research questions
that they motivate, research has tended to overlook a variety of issues
that have implications for understanding the potential relevance of
social capital for population health. Additionally, quantitative
research of these issues is restricted by a lack of appropriate measures
in existing community health surveys, where social capital measures
have been informed by these dominating perspectives. This poster
will detail the development and design of an on-going community-based
action research project in Milwaukee that uses a variety of qualitative
methods in aiming to: (1) better understand the role of social capital
in fostering, maintaining, or even constraining residential quality
of life and (2) ultimately contribute to more informed, theoretically-driven
investigations of the health-promoting and health-damaging characteristics
of neighborhoods and local areas.
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►Poster 14, Location 29
Caring for the Underserved: Preceptor Knowledge Attitudes
and Behaviors
E Cox, MD,MS, R Koscik, PhD, C Olson, PhD, A Behrmann,
MD, G McIntosh, MD,MPH and P Kokotailo,
MD,MPH
Background: The
need to increase numbers of providers caring for the underserved has
led to calls for curriculum development. Studies demonstrate lack
of knowledge as a barrier, but poor attitudes also limit our ability
to provide care to the underserved. Faculty role models can influence
trainees, yet preceptor knowledge, attitudes and behaviors
related to caring for the underserved remain unexplored.
Objective: To
examine preceptor knowledge, attitudes and behaviors (clinical and
mentoring) related to caring for the underserved.
Design/Methods:
Pediatricians (n=85) who precept third-year medical students were
recruited to complete a survey assessing MD characteristics (age,
race, prior underserved experience, specialty), knowledge (8 one-point
items), attitudes (26 items on a 4 point scale, 1=most negative to
4=most positive) and behaviors (10 clinical activities rated as yes/no
for preceptor performance and for having mentored students performance)
related to caring for underserved patients. Fisher s exact tests,
t-tests and analysis of variance were utilized to explore these outcomes
and their associations with MD characteristics.
Results: 54 preceptors
(64%) responded to the survey. The mean (SD) knowledge score was 5.6
(1.6) of 8 possible points while the mean attitude score was 3.1(0.3)
of the maximum 4. Preceptors reported performing 7.9(1.1) of the 10
surveyed clinical behaviors yet reported mentoring students performance of only 2.3(2.6) such activities.
Preceptors who were in primary care (n=26) showed higher knowledge
scores than those in specialty care (n=27); 6.1(1.2) versus 5.2(1.8)
respectively, p<0.05. No other associations were seen between outcomes
and preceptor characteristics.
Conclusions:
Preceptors demonstrated positive attitudes toward caring for the underserved
and performed many clinical behaviors necessary to provide such care,
yet exhibited knowledge deficits as well as gaps between their own
performance and their mentoring activities with students. The results
demonstrate the need for faculty development in the area of underserved
care, particularly among faculty in the pediatric specialties.
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►Poster
15, Location 30
Serving the Underserved:
Evaluation of a Web-Based Curriculum
Elizabeth D Cox, R L Koscik, A T Behrmann,
C A Olson, M A Hambrecht and P K Kokotailo.
Background: Curricula that address care for the underserved
have been encouraged, but reports of development and evaluation of
such curricula are few. The University of
Wisconsin Medical School has implemented a novel web-based curriculum
addressing care for the underserved.
Objective: To assess changes in medical students knowledge and attitudes
after a web-based curriculum addressing care for the underserved.
Design/Methods: Third-year medical students on the pediatric
clerkship were randomly assigned to control (C), faculty-led (FL),
or web-based (WB) curricula focusing on screening and resources for
the underserved. All groups received topic relevant readings. FL students
also received two didactic hours on recognizing underserved health
needs utilizing the I CARE screening tool (Table 1) and accessing
resources to address needs. WB students received web-based instruction
which parallels content of the FL sessions. FL and WB students transferred
skills to practice by working with an underserved family to identify/prioritize
health needs and access resources to address needs. Pre- and post-tests
assessed knowledge (18 items about interpreter services, the ICARE
screen and resources) and attitudes (26 items about responsibility,
desire, satisfaction and self efficacy in working with the underserved,
4 point Likert, 1= strongly disagree to
4=strongly agree).
Results: Fifty-one medical students have participated; 19 C,
19 FL, and 13 WB with no significant differences in group demographics.
Mean pre-test knowledge score was 4.9 of 18 total.
FL and WB students significantly improved their knowledge by 7.6 and
6.6 points respectively compared to C students 1.1 point gains (p<0.001).
WB and FL students did not differ significantly in knowledge gains
nor did student attitudes between groups.
Conclusions: Preliminary results indicate that WB and FL curricula
improved medical student knowledge. Future work will determine the
most effective teaching method by comparing knowledge and attitude
outcomes for FL and WB curricula. This curriculum could easily be
modified for use with students in other disciplines.
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►Poster 16, Location 31
Diastolic blood pressure levels in children vary widely
between population studies
Kirstie
K. Danielson, Mari Palta PhD
Measuring blood pressure
(BP) in children has become an important public health practice because
early BP may be a predictor of later cardiovascular disease. New hypertension
guidelines were recently published by the National Institutes of Health,
based on the 2004 Fourth Report on High BP in Children, which combines
data from several previous studies.
We present separately the data from this report and others
on BP levels in children from the last 30 years including the 1993
BP Nomograms for Children, and the Second
(II, 1976-1980), Third (III, 1988-1994), and 1999-2000 National Health
and Nutrition Examination Surveys (NHANES).
Our analysis indicates that there was little difference in
absolute levels of systolic BP by age between reports.
However, there was substantial variation in absolute levels
of diastolic BP (DBP) (phase five) by age between reports. For example,
for girls 9-11 years old, mean DBP ranged from 44-64 mmHg. DBPs
were significantly lower in NHANES III compared to NHANES II and 1999-2000
for white boys and girls 6-17 years old.
DBPs were also lower in the 2004 Report compared to the 1993
Report for a combination of white and nonwhite boys and girls 1-12
years old. NHANES III had the
lowest DBPs compared to the other reports. These results indicate that there remains substantial
methodological difficulty in measuring DBP in children that limit
its clinical use. Furthermore, the most recent reports did not demonstrate
the highest DBP. Recent research
indicating a temporal increase in DBP in children should therefore
be interpreted cautiously.
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Poster 17, Location 32
The Case for Limited Malignant Potential Breast Cancer:
Results from the Wisconsin Breast Cancer Epidemiology Simulation model.
Dennis G. Fryback,
PhD1, Marjorie A. Rosenberg, PhD2, Natasha K. Stout, PhD3, Amy Trentham-Dietz,
PhD1, Patrick L. Remington, MD, MPH1, Vipat
Kuruchittham, MSIE1, Polly Newcomb, PhD4, and Polun Chang, PhD5.
(1) University of Wisconsin,
Population Health Sciences, Madison, WI, (2) University of Wisconsin,
Actuarial Science and Risk Management, and Biostatistics and Medical
Informatics, Madison, WI, (3) Harvard Center for Risk Analysis, Harvard
School of Public Heatlh; (4) Fred Hutchinson Cancer Center, Seattle, WA; (5)
National Yang-Ming University, Institute of Health Informatics and
Decision Making, Taipei 11221, Taiwan
Purpose.
The sharp rise in early stage breast cancer incidence in the past
20 years is generally attributed to screening mammography. However
sustained high incidence levels with plateaus in late-stage incidence
led us to ask where all these cancers were before the advent of widespread
screening. Accounting for this, we can now flesh out an explanation
sketched over a decade ago: the Limited Malignant Potential (LMP)
breast cancer hypothesis.
Method.
A discrete event simulation of female breast cancer epidemiology from
1975-2000 was constructed. The simulation incorporates data about
mammography dissemination, dissemination of adjuvant therapy, and
improvements in mammography operating characteristics as well as secular
improvements in female longevity over this time period. The simulation
parameters for breast cancer natural history were heuristically manipulated
in the context of these other simulation components in order to fit
observed age- and historical stage-specific breast cancer surveillance
data across the 25 years from 1975-2000. Computationally intensive
parameter sampling experiments were conducted to assess likelihood
of alternatives to the heuristically “best” solution.
Results.
A large pool of occult breast cancers must exist to become incident
breast cancers. The simulation balances the size of this pool and
the assumed natural history of breast cancer against long run patterns
of care data for diffusion of screening mammography and surveillance
data regarding disease incidence and mortality. The “best fit” lead
us to conclude 42% of all biologically initiated breast cancer is
LMP; sampling experiments rule out substantial likelihood this fraction
is under 30% or more than 55%. LMP tumors start with small focus (<.2
cm diameter) and grow to a maximum of approximately 1 cm diameter.
If not detected in a span of about 2 years, they will recede and disappear.
They never present a lethal threat to the host. In
the year 2000 LMP breast cancers accounted for 30% of incident, clinically
localized breast cancers and 44% of incident in situ disease.
LMP breast cancers presently cannot be discerned histologically
from in situ or early localized invasive cancer.
Discussion. Our calculations support the conclusion that a substantial
fraction of diagnosed early stage breast cancer is LMP representing
over-diagnosis. If true, the LMP hypothesis makes the value of developing
a test to distinguish LMP from non-LMP breast cancers large.
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Poster 18, Location
34
First-degree family history of cancer in relation to ovarian
cancer risk.
H. Nichols, A. Trentham-Dietz,
K. Egan, J. Hampton, P. Newcomb
University of Wisconsin,
Madison, WI; Vanderbilt University School of Medicine, Nashville,
TN and Fred Hutchinson Cancer Research Center, Seattle, WA
We investigated ovarian
cancer risk in relation to first-degree family cancer history in a
large population-based case-control study.
Female residents of Wisconsin
and Massachusetts with a new diagnosis of ovarian cancer (N=505) were reported
to statewide tumor registries in 1998-2001. Similarly aged female controls (N=3,215) were
randomly selected from population lists.
Family history of cancer and other risk factor information
was collected through structured interviews.
The adjusted odds ratio of ovarian cancer risk decreased according
to increasing parity, oral contraceptive use, and tubal
ligation. Hormone replacement
therapy, body mass index, cigarette smoking, education, and were not
associated with ovarian cancer risk.
We observed an increase in ovarian cancer risk among women
with a positive first-degree family history of ovarian (OR=2.0; 95%
CI: 1.2, 3.2), breast (OR=1.3; 95% CI: 1.0,1.7),
or prostate (OR=1.4; 95% CI: 1.0, 2.0) cancer compared to women with
a negative family history at each cancer site. Family history of colorectal
cancer was not associated with ovarian cancer risk.
Compared to women who had a negative family history of breast
and ovarian cancer, women who had a positive family history for both
had 5.7 times the risk of ovarian cancer (95% CI: 2.3, 13.7).
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Poster 19, Location
35
Isolated REM Apnea/Hypopnea
Index as a predictor for developing Sleep-Disordered Breathing in
women
Andrea G. Peterson,
Diane Austin, Terry Young
Introduction:
Little is known concerning the natural history of sleep-disordered
breathing (SDB) that occurs primarily during REM-stage sleep. Some
studies indicate that isolated SDB in REM may be more prevalent in
women and suggest this condition may be less severe than SDB pervading
all sleep stages. We investigated the relationship of initial REM-isolated
Apnea/Hypopnea Index (AHI) to SDB progression
over a 3-year period in midlife women enrolled in the Women's Sleep
Study, a subset of the Wisconsin Sleep Cohort Study.
Methods: Among the women
who had been followed for 3 or more years, 65 had a total AHI <5
based on total sleep time (REM and non-REM) for their 2 polysomnography
studies during year 1. Using logistic regression, REM AHI for year
1 was investigated as a predictor of progression to a mean total AHI
of 5 for the four studies during years 2 and 3.
Results: Among women with
total AHI <5 during year 1, initial REM AHI was a strong predictor
for total AHI to increase to 5, even when controlling for initial age and BMI. An increase in 1
event per hour of initial REM AHI resulted in an OR = 2.1 (95% C.I.=
1.4 - 3.2) for having a mean total AHI 5 for years 2 and 3. The average initial REM AHI for those women whose
total AHI increased to 5 was 8.7, versus an initial REM AHI = 2.9 for the women with follow-up
total AHI that remained <5. Of the 11 women who had a follow-up
total AHI 5, ten had an initial REM AHI >5.
Conclusion: In women, SDB
in REM in the absence of a total AHI >5 is a risk factor for developing
SDB that pervades all sleep stages.
Support: NIH grants:
HL62252, AG14124
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Poster 20, Location 36
Psychological well-being, sleep, and interleukin-6 regulation
in aging women
Elliot Friedman1, Gayle Love2, Mary Hayney3, Burton Singer2,4, and
Carol Ryff2
1Robert Wood Johnson Health & Society Scholars Program and Department
of Population Health Sciences, 2Institute on Aging, 3School of Pharmacy,
University of Wisconsin, Madison; 4Office of Population Studies, Princeton
University
Interleukin-6 (IL-6) is a pro-inflammatory factor that has been
prospectively associated with a variety of age-related disorders,
such as heart disease, type II diabetes, and Alzheimer’s Disease.
IL-6 levels in the blood are also increased in conjunction with chronic
stress, depression, low socioeconomic position, and poor sleep quality.
We recently showed that psychological well-being – specifically high
quality social relationships – was associated with lower plasma IL-6
levels in aging women. In this analysis we examine the interrelationships
of positive relationships, IL-6, and sleep in the same women. We predicted
that sleep quality would mediate the relationship between social relationships
and plasma IL-6 levels, but multivariate regression analyses showed
that sleep quality and positive relationships independently predicted
plasma IL-6 levels. Additional analyses revealed a significant interaction
between sleep and social ties, suggesting that relationship quality
mitigated the relationship between sleep and plasma IL-6. These data
suggest that psychological well-being might constitute a protective
factor against increases in IL-6 that are typically associated with
aging.
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Poster 21, Location
37
Factors associated with bone mineral density (BMD) in
premenopausal women with type 1 diabetes: a pilot study
A. Danielski;
K.K. Danielson; M. Palta, PhD
Women with type 1 diabetes
have a higher prevalence of decreased bone mineral density (BMD),
an important predictor of future fracture risk. However, it is unclear
which factors affect BMD in these women.
We measured BMD in premenopausal women with type 1 diabetes and investigated
associations with diabetes care, anthropomorphic and demographic measures,
health behaviors, family history, and reproductive/hormonal factors. Data were collected in a pilot study of 20 women
with type 1 diabetes recruited from three Madison-area diabetes clinics. During the visit, each woman had a BMD scan
of her ankles, a blood sample drawn and brief physical. Two health
questionnaires were administered.
This research and future studies could help prevent and treat
decreased BMD in premenopausal women with type 1 diabetes.
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Poster 22, Location 38
Public Participation and Policy Making: Why are some states
more actively engaging the public?
Dorothy Daley
Public participation
is becoming an increasingly common component of environmental decision-making.
A substantial body of research explores why citizens become involved
in environmental protection, as well as examining the impact of increased
citizen involvement. However, we know far less about why government
institutions develop mechanisms to formally include public participation
in decision making. In this paper, I model the determinants
of public participation provisions in state hazardous waste programs
over time. I use random effects logistic regression to understand
the relative influence of internal state characteristics and diffusion
forces on policy adoption. The results suggest that, in keeping
with past work on policy adoption, both internal determinants and
external factors are important predictors of state decision-making.
Current environmental conditions, liberal citizenry, a strong manufacturing
base and urbanization are all associated with an increased likelihood
of a state developing formal public participation provisions.
Diffusion forces are also significant, but not as predicted.
Over time, states are less likely to develop formal participation
mechanisms if neighboring and nearby states have already adopted these
policies.
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►Poster
23, Location 41
The Chronic Care
Model: Diabetes Quality Improvement for Health Plans in
Wisconsin
Kelly L Stolzmann,
BS; Robert Stone-Newsom, PhD; Jenny L Camponeschi,
MS; Jessica M Bartell,
MD, MS; Patrick L Remington,
MD, MPH.
Background: Research has shown that health systems can be designed
to improve the quality of care for diabetes.
Since 1998, the University of
Wisconsin Population Health Institute and the Diabetes Control Program at the Wisconsin
Division of Public Health have collaborated with Wisconsin’s health plans to monitor trends in the quality of diabetes
care. In this study, we examined the relationship between health plan
processes and the quality of diabetes care.
Objectives: To determine the
relationship between structural and process initiatives applied by
Wisconsin health plans in caring for persons with diabetes, and explore if a relationship
exists between these initiatives and the quality of diabetes care,
as assessed by the HEDIS® Comprehensive Diabetes Care measures.
Methods: Quality of diabetes care was ascertained using HEDIS®
Comprehensive Diabetes Care measures collected annually from 15 health
plans in Wisconsin from 1999-2003.
These HEDIS® measures reflect diabetes care related to glucose
testing and control, lipid testing and control, retinal eye exams,
and kidney function. In order to explore the variation in HEDIS®
scores among health plans, the coordinators at each health plan were
surveyed to determine the structural and process components of each
plan. The survey questions were modeled after the six components of
the Chronic Care Model (CCM), a system of organizing health plans
to improve quality of care.
Results: The quality of
diabetes care improved during the study period, but quality continued
to vary between health plans. For
example, LDL-C controlled improved from 43% in 1999 to 67% in 2003;
however, scores ranged from 43% to 79% in 2003. The survey revealed
many processes in place within health plans in Wisconsin. For example,
health plans: utilize an electronic diabetes registry (79%), distribute
personal care cards (71%), and mail educational materials to patients
(71%). Health plans that utilize these processes have higher average
composite HEDIS® scores compared to plans that do not, for 1999-2003
HEDIS® data.
Conclusions: Health plans that
implement specific organizational changes, similar to those included
in the CCM, may improve HEDIS® measures and increase the quality of
care received by persons with diabetes.
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Poster 24, Location
43
Between
hospital variation and NICU outcomes in a statewide cohort of very
low birth weight infants born in 2003
Mari Palta, Aggie Albanese, Kathleen Madden, Mona
Sadek-Badawi
The
Newborn Lung Project is a statewide cohort study aiming to enroll
and follow all very low birth weight (VLBW, <1500g) children
born in Wisconsin in 2003 and 2004. VLBW neonates
and infants are at risk for a range of complications. Respiratory
illness from lung immaturity is common, and of major interest in our
NHLBI funded project. We established data collection by neonatal nurses
at 16 (of 17 Level III in Wisconsin) NICUs.
Abstracted de-identified baseline data on all 2003 NICU admissions
are now nearly complete, and are available for 706 infants whereof
12% died.
We
consider variation between hospitals in bronchopulmonary
dysplasia (BPD). This pulmonary outcome
is defined by NIH criteria based on oxygen supplementation up to 36
weeks post menstrual age, and is classified into mild, moderate and
severe. Studies, including those of our previous cohort up to age
12 years have shown that BPD can lead to significant long term respiratory
sequelae.
Analyses
of BPD were limited to 557 infants less or equal to 32 weeks gestational
age, as only one infant with gestational age above 32 weeks fulfilled
the diagnostic criteria. We consider between hospital variation and
the effect of case mix as defined by birth weight, gestational age
and the SNAP-II index. The SNAP II is a validated score of physiological
markers during the first 12 hours of life. We also present preliminary
results on variation in therapeutic approaches that are thought related
to risk for BPD.
We
find that both “mild or worse” and “moderate or worse” BPD incidence
varied significantly between hospitals (p=0.02 for both), with ranges
of 27% to 88% and 11% to 75%, respectively. However, removing hospitals
with fewer than 20 neonates below 32 weeks gestational age reduced
the ranges to 27% to 60% and 15% to 35%, respectively (no longer significant
variation). Two small, only recently level III,
NICUs had the highest BPD rates. The 3 case
mix indicators showed strong and consistent relationships with both
severity levels of BPD within and between hospitals. Supplemental
oxygen level at 24 hours of life showed a stronger relationship with
the same outcomes between than within hospitals, and may be a marker
for early interventions that affect BPD incidence.
We
conclude that outcomes from small NICUs
have strong influence on variation and are difficult to interpret,
that case mix is a strong determinant of BPD incidence and that early
interventions deserve further investigation.
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►Poster
25, Location 44
Models to predict
length of hospital stay and associated charges for Very Low Birth
Weight infants
Parthiv Vora, M.S., Mari Palta, Ph.D.,
Aggie Albanese, B.S., Mona Sadek, M.B.B.Ch.
The length of stay
in hospitals for Very Low Birth Weight (VLBW) infants is a major contributor
to the high charges of neonatal care. VLBW infants are at an increased
risk of developing postnatal complications such as bronchopulmonary
dysplasia (BPD), intraventricular
hemorrhage (IVH), respiratory distress syndrome (RDS) etc, which may
contribute to their long stays and hence their high hospital charges.
The aim of this study was to develop models to predict the length
of stay and charges associated with the initial hospital stay for
VLBW infants. The data were obtained from the Newborn Lung Project,
a multi center study of all neonates weighing less than 1501 g at
birth in 16 NICU’s in Wisconsin. The sample consists of 585 VLBW surviving infants born
in 2003 having mean birth weight of 1110 g, mean gestational age of
29 wks and mean length of hospital stay of 59 days. Eleven factors
were found to be predictive of length of hospital stay. The most significant
factors were birth weight and gestational age, which accounted for
64 % and 65 % of the variability respectively. Overall this model
explained 84 % of the variability and had a good fit when compared
with the observed length of stay (except for hospital stays greater
than 120 days). A subset of the VLBW sample (63 infants) for whom
data for hospital charges were available, were used to determine predictors
for hospital charges. This model explained 83 % of the variability
in hospital charges, with birth weight, gestational age, respiratory
distress syndrome (RDS) and bronchopulmonary
dysplasia (BPD) being the significant predictors.
Overall, infant baseline characteristics: birth weight and gestational
age, as well as early postnatal respiratory complications were the
most significant predictors for length of stay and hospital charges.
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Poster 26 Location
45
Logistic
Regression Tree Analysis in the Newborn Lung Project
Mari
Palta, Mona Sadek, Aggie Albanese and Ruifeng Xu
We illustrate the use of regression trees for predicting
a clinical outcome, using data from the Newborn Lung Project. a multi center study of all neonates weighing less than 1501
g at birth in 16 NICUs in
Wisconsin. The sample consists of 619
surviving VLBW infants born in 2003.
Our
aim is to predict moderate or worse bronchopulmonary
dysplasia (BPD) as defined by NIH criteria. BPD is a chronic
lung disease that becomes manifest by 36
weeks post menstrual age and can lead to long term respiratory problems.
The predictors include: antenatal steroid therapy that speeds up lung
development, sex, race, hospital, birth weight, gestational age, Score
for Neonatal Acute Physiology-II (SNAP-II) and early neonatal characteristics.
A logistic regression tree was fit using the LOTUS
package, which is similar to CART, but has the advantage of negligible
bias in variable selection. The algorithm minimizes the cross-validation
estimate of the predicted deviance, which is in a sense prediction
error. Compared to regular logistic regression, the logistic tree
approach is better at identifying subgroups and interaction effects,
but may turn out to be more difficult to interpret in terms of the
overall picture, as variables can enter at different levels.
The
results show birth weight to be a major predictor, and SNAP-II to
be a very important one. For those of lower birth weight, higher gestational
age reduces and antenatal steroids increase the risk for BPD. Thus
the effect of antenatal steroids is opposite of that expected, but
can possibly be explained by the chronology of lung maturation. Larger
infants, who do not receive supplemental oxygen at 24 hours
are at extremely low risk for BPD. Hospital only matters for large
infants who are exposed to supplemental oxygen. The logistic tree
failed to detect a significant finding from ordinary logistic regression,
namely that antenatal steroids lower risk of BPD among infants at
higher gestational age.
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Poster 27, Location 46
Evaluation of the Wisconsin Tuberculosis Program’s Progress
towards Documentation of Treatment Improvement and Completion of Treatment
in Active Cases of Reported Tuberculosis, Wisconsin 2000-2002
Monica L Monteon1,
Christine M Arcari1, Patrick L Remington1, Marty S Kanarek1,2, Tanya
V Oemig3
1Department of Population
Health Sciences, University of Wisconsin—Madison, 2Gaylord Nelson
Institute for Environmental Studies, 3 Tuberculosis Program, Bureau
of Communicable Disease, Division of Public Health, State of Wisconsin
Department of Health and Family Services
Objective: The
Wisconsin Strategic Plan for the Elimination of Tuberculosis (TB)
set goals of treatment completion at 90% and documentation of treatment
improvement at 95% for all reported cases of TB. The objective
of this study is to measure the success in achieving these goals.
Methods: Data
were abstracted from patient charts maintained by the Wisconsin TB
Program. Treatment completion was considered for patients indicated
for completion in <12 months. Documentation of treatment
improvement included therapy adherence, culture conversion, and chest
x-ray improvement for pulmonary cases and therapy adherence and clinical
improvement for extrapulmonary cases.
Results: A
total of 249 TB cases were reported in Wisconsin between 2000 and 2002. Treatment completion was
determined in 204 patients (148 pulmonary cases and 56 extrapulmonary
cases) and 170 (87.1%) completed treatment in <12 months.
There was a significant difference in treatment completion by site
of disease, 89.9% for pulmonary cases and 66.1% for extrapulmonary
cases (p<0.01). Documentation of treatment improvement was 61.2%
among pulmonary cases and 83.6% among extrapulmonary
cases (p<0.01). There was a significant decrease in the documentation
rates for pulmonary patients during the study period (p<0.01).
Conclusions:
Barriers in Wisconsin need to be identified if we are to progress toward elimination
of TB. While the goal of 90% treatment completion of all cases was
nearly accomplished the goal of 95% documentation of treatment improvement
was not achieved. This is important because case management
of TB is necessary for control and prevention of TB in the United States.
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Poster 28, Location
47
Program Evaluation: A Tool for Tribal Communities
Charlanne
J. FitzGerald, MPH and Kit R. Van Stelle, MA
The poster, Program
Evaluation: A Tool for Tribal Communities presents multiple reasons
for doing program evaluations, steps in conducting evaluations, a
list of challenges and rewards that result from evaluation studies,
and key evaluation components for tribal communities.
In 2004, the Researchers’ evaluation projects encompassed all
Wisconsin tribal communities and included Honoring Our Children, Native
American HIV/AIDS Prevention Supplement, Evidence-Based Medicine Clinical
Management of Patients with Chronic Conditions, and the Anishinaabek
Juvenile Justice Project. Prior
projects at tribal sites are also described, including program evaluations
in community health, nutrition, tobacco abuse prevention, substance
abuse treatment, substance abuse prevention, and pregnancy prevention.
