Working with American Indian Communities to Utilize and Improve Data for Heath Research

This session will include three presentations on data collection with American Indian communities and discuss current gaps and possible solutions. The first presentation will be on community input and utilization of data for program development. The second presentation will discuss the availability and utility of local data. The final presentation will describe existing data sources for longitudinal regional and national data that may relate to American Indian health

Influence of Assigned Reading on Senior Medical Student Clinical Performance

Objective: This Institutional Review Board-approved, prospective, observational study compared the clinical performance of senior medical students in an emergency medicine (EM) clerkship using a clinical behavioral evaluation tool in which one group had mandatory, topic specific readings and the other did not.Methods: The study took place in an urban, tertiary referral center emergency department treating 43,000 patients annually and supporting medical student clerkships and an EM residency. The grades of two groups of senior medical students participating in an elective EM clerkship were compared. Those students during the 2002-2004 academic years were not assigned mandatory, topic-specific reading for the clerkship, while those during the 2004-2007 academic years were. The groups were compared on baseline demographic information, prior academic performance, and EM clerkship grade distributions using appropriate statistical techniques, including multinomial logistic regression, chi-square tests, and Fisher’s Exact tests.Results: The control and experimental groups each had 83 subjects and were similar in baseline characteristics, except for the control group performing better than the experimental group during the basic science training of medical school (years 1-2; p=0.01). The experimental group had statistically significant more members in the EM Interest Group (EMIG; p=0.0001) and more members who went on to match in an EM residency (p=0.0007). The difference in grade distributions between the control group and experimental group was not statistically significant (p=0.40). Of note, those student members of the EMIG (p=0.0005) and those later matching to an emergency medicine residency (p<0.0001) were more likely to earn a grade of “honors” for the clerkship.Conclusion: The addition of uniform, topic-specific reading assignments to an EM senior medical student curriculum does not improve the overall clinical performance of those students as measured using a clinical behavioral evaluation tool.[WestJEM. 2009;10:23-29.

Exploring Occupational Therapy Student and Entry-Level Practitioner Perceptions of Mental Health Accommodations

Mental health concerns are prevalent among occupational therapy graduate students and entry-level practitioners entering the workforce. Prior research has highlighted that the rise in mental health concerns and the high-achieving nature of occupational therapy students impacts their success in the classroom and the clinic. While formal and informal mental health accommodations are beneficial, obtaining and implementing such accommodations has been cited as a challenging process plagued with negative stigma. This study aimed to understand the perceived effectiveness of common academic and work-related mental health accommodations for meeting the role demands that occupational therapy students and practitioners encounter in the classroom, during fieldwork and capstone, and in entry-level practice. Data were gathered from 218 occupational therapy students and entry-level practitioners who completed an electronic survey, including checklists and Likert scale items. Results include the prevalence of mental health concerns, the use of formal and informal mental health accommodations, and the perceived effectiveness of mental health accommodations in meeting the role demands of occupational therapy students and entry-level practitioners. Participants reported that the commonly prescribed mental health accommodations effectively met role demands in academic and work settings. Qualitative responses to the survey provided a deeper understanding of these perceptions and the barriers students encountered when attaining or implementing such accommodations in the classroom and clinical settings. Implications for occupational therapy education address the prevalence of mental health concerns and the barriers occupational therapy students face when attaining and implementing mental health accommodations

Birth characteristics and childhood carcinomas

BACKGROUND: Carcinomas in children are rare and have not been well studied. METHODS: We conducted a population-based case–control study and examined associations between birth characteristics and childhood carcinomas diagnosed from 28 days to 14 years during 1980–2004 using pooled data from five states (NY, WA, MN, TX, and CA) that linked their birth and cancer registries. The pooled data set contained 57 966 controls and 475 carcinoma cases, including 159 thyroid and 126 malignant melanoma cases. We used unconditional logistic regression to calculate odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS: White compared with ‘other' race was positively associated with melanoma (OR=3.22, 95% CI 1.33–8.33). Older maternal age increased the risk for melanoma (OR(per 5-year age increase)=1.20, 95% CI 1.00–1.44), whereas paternal age increased the risk for any carcinoma (OR=1.10(per 5-year age increase), 95% CI 1.01–1.20) and thyroid carcinoma (OR(per 5-year age increase)=1.16, 95% CI 1.01–1.33). Gestational age <37 vs 37–42 weeks increased the risk for thyroid carcinoma (OR=1.87, 95% CI 1.07–3.27). Plurality, birth weight, and birth order were not significantly associated with childhood carcinomas. CONCLUSION: This exploratory study indicates that some birth characteristics including older parental age and low gestational age may be related to childhood carcinoma aetiology

Maternal health conditions during pregnancy and acute leukemia in children with Down syndrome: A Children's Oncology Group study

Children with Down syndrome (DS) have about a 20-fold increased risk of developing leukemia. Early childhood infections may protect against acute lymphoid leukemia (ALL) in children with and without DS. We examined whether maternal infections and health conditions during pregnancy were associated with acute leukemia in children with DS

Infant birthweight and risk of childhood cancer: international population-based case control studies of 40 000 cases

Background: High birthweight is an established risk factor for childhood leukaemia. Its association with other childhood cancers is less clear, with studies hampered by low case numbers. Methods: We used two large independent datasets to explore risk associations between birthweight and all subtypes of childhood cancer. Data for 16 554 cases and 53 716 controls were obtained by linkage of birth to cancer registration records across five US states, and 23 772 cases and 33 206 controls were obtained from the UK National Registry of Childhood Tumours. US, but not UK, data were adjusted for gestational age, birth order, plurality, and maternal age and race/ethnicity. Results: Risk associations were found between birthweight and several childhood cancers, with strikingly similar results between datasets. Total cancer risk increased linearly with each 0.5 kg increase in birthweight in both the US [odds ratio 1.06 (95% confidence interval 1.04, 1.08)] and UK [1.06 (1.05, 1.08)] datasets. Risk was strongest for leukaemia [USA: 1.10 (1.06, 1.13), UK: 1.07 (1.04, 1.10)], tumours of the central nervous system [USA: 1.05 (1.01, 1.08), UK: 1.07 (1.04, 1.10)], renal tumours [USA: 1.17 (1.10, 1.24), UK: 1.12 (1.06, 1.19)] and soft tissue sarcomas [USA: 1.12 (1.05, 1.20), UK: 1.07 (1.00, 1.13)]. In contrast, increasing birthweight decreased the risk of hepatic tumours [USA: 0.77 (0.69, 0.85), UK: 0.79 (0.71, 0.89) per 0.5 kg increase]. Associations were also observed between high birthweight and risk of neuroblastoma, lymphomas, germ cell tumours and malignant melanomas. For some cancer subtypes, risk associations with birthweight were non-linear. We observed no association between birthweight and risk of retinoblastoma or bone tumours. Conclusions: Approximately half of all childhood cancers exhibit associations with birthweight. The apparent independence from other factors indicates the importance of intrauterine growth regulation in the aetiology of these diseases

Parental and infant characteristics and childhood leukemia in Minnesota

<p>Abstract</p> <p>Background</p> <p>Leukemia is the most common childhood cancer. With the exception of Down syndrome, prenatal radiation exposure, and higher birth weight, particularly for acute lymphoid leukemia (ALL), few risk factors have been firmly established. Translocations present in neonatal blood spots and the young age peak of diagnosis suggest that early-life factors are involved in childhood leukemia etiology.</p> <p>Methods</p> <p>We investigated the association between birth characteristics and childhood leukemia through linkage of the Minnesota birth and cancer registries using a case-cohort study design. Cases included 560 children with ALL and 87 with acute myeloid leukemia (AML) diagnoses from 28 days to 14 years. The comparison group was comprised of 8,750 individuals selected through random sampling of the birth cohort from 1976–2004. Cox proportional hazards regression specific for case-cohort studies was used to compute hazard ratios (HR) and 95% confidence intervals (CIs).</p> <p>Results</p> <p>Male sex (HR = 1.41, 95% CI 1.16–1.70), white race (HR = 2.32, 95% CI 1.13–4.76), and maternal birth interval ≥ 3 years (HR = 1.31, 95% CI 1.01–1.70) increased ALL risk, while maternal age increased AML risk (HR = 1.21/5 year age increase, 95% CI 1.0–1.47). Higher birth weights (>3798 grams) (HRALL = 1.46, 1.08–1.98; HRAML = 1.97, 95% CI 1.07–3.65), and one minute Apgar scores ≤ 7 (HRALL = 1.30, 95% CI 1.05–1.61; HRAML = 1.62, 95% CI 1.01–2.60) increased risk for both types of leukemia. Sex was not a significant modifier of the association between ALL and other covariates, with the exception of maternal education.</p> <p>Conclusion</p> <p>We confirmed known risk factors for ALL: male sex, high birth weight, and white race. We have also provided data that supports an increased risk for AML following higher birth weights, and demonstrated an association with low Apgar scores.</p

Antipsychotic Use at Adult Ambulatory Care Visits by Patients With Mental Health Disorders in the United States, 1996-2003: National Estimates and Associated Factors

Objectives: This retrospective analysis was conducted to derive national estimates of typical, atypical, and combination (typical-atypical) antipsychotic use and to examine factors associated with their use at adult (age ≫-18 years) ambulatory care visits by patients with mental health disorders in the United States. Methods: Data on adult visits with an International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code for a mental health disorder were extracted from the office-based National Ambulatory Medical Care Survey and the outpatient facilitybased National Hospital Ambulatory Medical Care Survey from 1996 through 2003. The visits were categorized according to whether use of a typical, atypical, or combination antipsychotic was mentioned (either prescribed, supplied, administered, ordered, or continued at the visits). Total weighted visit estimates, weighted visit percentages, and 95% CIs were calculated across the 3 types of visit groups. Bivariate analysis was performed on the association between selected characteristics and the 3 visit groups. Multivariate logistic regression was performed on factors associated with atypical versus typical antipsychotic use. Results: During the 8-year period, there were an estimated 47.7 million adult ambulatory care visits involving a mental health disorder and mention of an antipsychotic (weighted percent: 0.83%; 95% CI, 0.73-0.93). From 1996/1997 to 2002/2003, visits involving atypical and combination antipsychotics increased by 195% and 149%, respectively, and visits involving typical antipsychotics decreased by 71%. Men, blacks, and those with public insurance made more visits in which combination antipsychotics rather than typical or atypical antipsychotics were mentioned. Relative to typical or combination antipsychotic visits, more atypical antipsychotic visits involved antide-pressants (weighted percent: 61.23% atypical, 37.29% typical, and 38.32% combination). Fewer atypical antipsychotic visits compared with typical or combination antipsychotic visits involved psychotic disorders (weighted percent: 32.94%, 51.23%, and 69.93%, respectively) and medications for extrapyramidal symptoms (weighted percent: 6.69%, 29.95%, and 36.64%). In multivariate analyses controlling for sex, race, diagnosis of schizophrenia, region, diagnosis of anxiety, and recent years, atypical versus typical antipsychotic use was significantly less likely at visits by those aged 41 to 64 years compared with those aged 18 to 40 years (adjusted odds ratio [OR] = 0.63; 95% CI, 0.47-0.84; P = 0.002); significantly less likely at visits by those with public compared with private insurance (Medicare OR = 0.59 [95% CI, 0.40-0.88], P = 0.010; Medicaid OR = 0.44 [95% CI, 0.28-0.69], P \u3c 0.001); and significantly more likely at visits associated with depression compared with those not associated with depression (OR = 1.92; 95% CI, 1.26-2.93; P = 0.003) and those associated with bipolar disorder compared with those not associated with bipolar disorder (OR = 2.10; 95% CI, 1.32-3.36; P = 0.002). Conclusions: This retrospective analysis found more atypical than typical or combination antipsychotic use at US ambulatory care visits by adults with mental health disorders other than schizophrenia or psychoses in the period studied. Atypical versus typical antipsychotic use was significantly less likely at visits by adults aged 41 to 64 years and those with public insurance, but significantly more likely at visits by those with depression or bipolar disorder

Influence of Assigned Reading on Senior Medical Student Clinical Performance

OBJECTIVE: This Institutional Review Board-approved, prospective, observational study compared the clinical performance of senior medical students in an emergency medicine (EM) clerkship using a clinical behavioral evaluation tool in which one group had mandatory, topic specific readings and the other did not.METHODS: The study took place in an urban, tertiary referral center emergency department treating 43,000 patients annually and supporting medical student clerkships and an EM residency. The grades of two groups of senior medical students participating in an elective EM clerkship were compared. Those students during the 2002-2004 academic years were not assigned mandatory, topic-specific reading for the clerkship, while those during the 2004-2007 academic years were. The groups were compared on baseline demographic information, prior academic performance, and EM clerkship grade distributions using appropriate statistical techniques, including multinomial logistic regression, chi-square tests, and Fisher's Exact tests.RESULTS: The control and experimental groups each had 83 subjects and were similar in baseline characteristics, except for the control group performing better than the experimental group during the basic science training of medical school (years 1-2; p=0.01). The experimental group had statistically significant more members in the EM Interest Group (EMIG; p=0.0001) and more members who went on to match in an EM residency (p=0.0007). The difference in grade distributions between the control group and experimental group was not statistically significant (p=0.40). Of note, those student members of the EMIG (p=0.0005) and those later matching to an emergency medicine residency (p<0.0001) were more likely to earn a grade of "honors" for the clerkship.CONCLUSION: The addition of uniform, topic-specific reading assignments to an EM senior medical student curriculum does not improve the overall clinical performance of those students as measured using a clinical behavioral evaluation tool