Kristine Lykens

Ethical issues in predictive genetic testing: a public health perspective

As a result of the increase in genetic testing and the fear of discrimination by insurance companies, employers, and society as a result of genetic testing, the disciplines of ethics, public health, and genetics have converged. Whether relatives of someone with a positive predictive genetic test should be notified of the results and risks is a matter urgently in need of debate. Such a debate must encompass the moral and ethical obligations of the diagnosing physician and the patient. The decision to inform or not will vary depending on what moral theory is used. Utilising the utilitarian and libertarian theories produces different outcomes. The principles of justice and non-maleficence will also play an important role in the decision.

Pulmonary impairment after tuberculosis and its contribution to TB burden

BackgroundThe health impacts of pulmonary impairment after tuberculosis (TB) treatment have not been included in assessments of TB burden. Therefore, previous global and national TB burden estimates do not reflect the full consequences of surviving TB. We assessed the burden of TB including pulmonary impairment after tuberculosis in Tarrant County, Texas using Disability-adjusted Life Years (DALYs).MethodsTB burden was calculated for all culture-confirmed TB patients treated at Tarrant County Public Health between January 2005 and December 2006 using identical methods and life tables as the Global Burden of Disease Study. Years of life-lost were calculated as the difference between life expectancy using standardized life tables and age-at-death from TB. Years lived-with-disability were calculated from age and gender-specific TB disease incidence using published disability weights. Non-fatal health impacts of TB were divided into years lived-with-disability-acute and years lived-with-disability-chronic. Years lived-with-disability-acute was defined as TB burden resulting from illness prior to completion of treatment including the burden from treatment-related side effects. Years lived-with-disability-chronic was defined as TB burden from disability resulting from pulmonary impairment after tuberculosis.ResultsThere were 224 TB cases in the time period, of these 177 were culture confirmed. These 177 subjects lost a total of 1189 DALYs. Of these 1189 DALYs 23% were from years of life-lost, 2% were from years lived-with-disability-acute and 75% were from years lived-with-disability-chronic.ConclusionsOur findings demonstrate that the disease burden from TB is greater than previously estimated. Pulmonary impairment after tuberculosis was responsible for the majority of the burden. These data demonstrate that successful TB control efforts may reduce the health burden more than previously recognized.

Factors for Accessing a Medical Home Vary Among CSHCN from Different Levels of Socioeconomic Status

Purpose The purpose of this research study was to identify factors that are associated with receiving care in a medical home for children with special health care needs (CSHCN) and to identify how these factors vary among different socioeconomic levels. Methods Data were obtained from the National Survey of Children with Special Health Care Needs, 2000–2002. Access to a medical home was derived using an algorithm. This survey analysis also included demographic characteristics, geographical location of household, severity of condition, and social factors. Multiple logistic regression models were constructed for socioeconomic status (SES) levels defined by federal poverty level (FPL): <133%; 133–199%; 200–299%; ≥300%. Results Age group was significant in all but the 200–299% of FPL stratum. Severity of condition was significant in all strata. Race was significant in all but the ≥300% stratum. Maternal education was borderline significant in the lowest and highest strata. Insurance type/status was significant in all but the 133–199% of FPL stratum. Geographical location was significant in the lowest and highest strata. The language of the interview was only significant in the lowest stratum. The relationship of the respondent to the child was significant in the middle two strata. The total number of adults in the household was significant in the highest stratum, and the total number of children in the household was significant in the 200–299% of FPL stratum. Conclusions Factors affecting access to a medical home differed among socioeconomic groups. Future research should explore the CSHCN population by income groups to better serve this population.

Do Unmet Needs Differ Geographically for Children with Special Health Care Needs

The purpose of this study was to identify geographic differences in health indicators for children with special health care needs (CSHCN). It was hypothesized that geographic differences in unmet health care needs exist among CSHCN by region in the United States. Data were obtained from the National Survey of Children with Special Health Care Needs, 2005–2006. Nine variables representing unmet needs were analyzed by geographic region. The region with the highest percent of unmet needs was identified for each service. Logistic regression was utilized to determine differences by region after controlling for age, gender, ethnicity, race, federal poverty level, relationship of responder to child, insurance status, severity of condition, and size of household. A total of 40,723 CSHCN were represented. Crude analysis demonstrated that the greatest unmet need for routine preventive care, specialist care, prescription medications, physical/occupational/speech therapy, mental health care, and genetic counseling occurred in the West. The greatest unmet need for preventive dental care, respite care, and vision care occurred in the South. Significant differences between regions remained for six of the nine services after controlling for potential confounders. Geographic differences in unmet health care needs exist for CSHCN. Further delving into these differences provides valuable information for program and policy planning and development. Meeting the needs of CSHCN is important to reduce cost burden and improve quality of life for the affected child and care providers.

The effects of media exposure on alcohol consumption patterns in African American males.

Abstract Objectives: The study examined the role of media exposure, ethnicity, mood/affect, socio-demographic factors and religion on alcohol consumption patterns. Methods: Secondary analysis of the General Social Survey (GSS), 1972-2002 cumulative data file was used to provide quantitative estimates of the relationship between media exposure, ethnicity, mood/affect, socio-demographic factors and religion. The sample consisted of (n = 13,742) White subjects and (n = 2,192) African American subjects. Results: Watching television and reading the newspaper were significant predictors of alcohol use. Watching television had a positive significant effect on alcohol use and abuse; but only in the absence of religiosity. Race did not have a significant effect on alcohol use or abuse. The survey year had significant effects on media use. Conclusion: This research has significant policy implications in explaining predictors of alcohol use and abuse as well as protective factors for this behavior.

Organizational Culture in a Terminally Ill Hospital

Abstract This study analyzed an organizational culture in a community hospital in Texas to measure organizational culture change and its impact on Patient Satisfaction (PS). The study employed primary and secondary data, combining quantitative and qualitative methods for a case study. Participant observation was used and archival data were collected to provide a better understanding of the organizational culture and the context in which change was taking place. This study also applied a “Shared Vision” of the organization as the central process in bringing forth the knowledge shared by members of the community hospital who were both subjects and research participants. The results from the study suggest an increase in PS due to the shared vision of one subculture within the hospital. There were powerful subcultures in this organization based on occupation and specialization, and their interests and functional orientations were not conducive to a systems approach. Hospital management was conducted in “silos” and there was lack of feedback between organizational levels of the hospital, especially in financial management, with organizational dysfunctionality in reacting and adapting to the health care market.

Barriers to Women's Cardiovascular Risk Knowledge

Cardiovascular disease (CVD) is the leading cause of death for women in the United States, resulting in a greater emphasis on research and methods for addressing issues relating to this health problem both nationally and worldwide. The authors’ purpose was to identify barriers to womens cardiovascular risk knowledge, both personal and organizational, through key informant interviews of health leaders at 10 community health organizations. Analysis showed an overall lack of awareness of CVD risk for women. Culture, finance, and lack of awareness and easily accessible programs implicated the importance of physicians as health care providers and educators for women patients.

Exploring the relationship between adverse childhood experiences and oral health-related quality of life: Adverse childhood experiences and oral health-related quality of life

OBJECTIVES Evidence indicates that adverse childhood experiences (ACEs) have destructive impacts on quality of life, health outcomes, and health-care expenditures. Studies further demonstrate a dose-response relationship between the number of ACEs and risk for experiencing chronic illness, such as oral diseases later in life. Research is scarce on the prioritization of contextualized public health interventions addressing this important threat. METHODS Cross-sectional data from 2011 to 2012 National Survey of Childrens Health (NSCH) provided a nationally representative sample of children in the United States, ages 1-17 for dentate status (n = 61,530). The dependent variables identified untreated oral health-care needs and preventive dental utilization. The key independent variables included exposure to parental death, parental divorce, parental incarceration, mental health illnesses, domestic violence, neighborhood violence, and racial discrimination. Exogenous variables included age, sex, race/ethnicity, number of children in household, socioeconomic status proxies, health insurance status, and special health needs. The data, when adjusted for complex survey design, proportionately represent children in the United States. RESULTS Unadjusted and adjusted logistic regressions revealed varying magnitudes of significance across diverse racial and ethnic profiles. Exposures to parental divorce and parental death particularly exhibited critical magnitudes of influence, compared to all other ACEs. CONCLUSIONS In keeping with the Pareto Principle, exposure to certain ACEs, namely parental divorce and parental death, potentially introduces more profound social and health-related consequences later in life. Therefore, contextualized interventions should prioritize public health efforts to address households burdened with exposure to parental divorce and/or parental death.