Margaret L. Holland

Cost-Effectiveness of Testing for Breast Cancer Susceptibility Genes

OBJECTIVES Genetic mutations in breast cancer susceptibility genes BRCA1/2 are associated with an increased risk of breast/ovarian cancers. Cost-effective preventive measures are available for women who test positive. The objective of this study was to determine at what risk of mutation it is cost-effective to test women for BRCA1/2 mutations. METHODS A semi-Markov model accrued costs and quality-adjusted life years (QALYs) annually from the societal perspective. The estimates of health-care costs, life expectancy, likelihood of obtaining a mastectomy or oophorectomy, and patient preferences for treatment and certainty about their BRCA1/2 status were based on the literature. RESULTS At a 10% probability of mutation (the current guideline), the test strategy generated 22.9 QALYs over the lifetime and cost

Patterns of Visit Attendance in the Nurse–Family Partnership Program

118k, while the no-test strategy generated 22.7 QALYs and cost

The effects of stress on birth weight in low-income, unmarried black women.

117k. The incremental cost-effectiveness ratio of the test strategy was

Appropriate Antibiotic Use for Acute Otitis Media: What Consumers Find Using Web Searches

9k and the differences between costs and effects were not substantial. The test strategy remained cost-effective to a probability of mutation of 0%, as long as utility gained from a negative test result was 0.006 or greater. These results were sensitive to the frequency of inconclusive test results and utility gain from a negative test result. CONCLUSIONS The costs and effectiveness of both the test and no-test strategies are very similar even when there is a small probability of mutation. Current guidelines, which can be used by insurance companies to refuse coverage, could deny some women a cost-effective approach. Further research to decrease the frequency of inconclusive results could improve the cost-effectiveness of this test.

The influence of social‐developmental context and nurse visitation intervention on self‐agency change in unmarried adolescent mothers

OBJECTIVES We examined visit attendance patterns in the Memphis trial of the Nurse-Family Partnership and associations between these patterns and family characteristics, outcomes, and treatment-control differences in outcomes. METHODS We employed repeated measures latent class analysis to identify attendance patterns among the 228 mothers assigned to receive home nurse visits during pregnancy and until the child was aged 2 years, associated background characteristics, outcomes, and treatment-control differences by visit class. Home visits were conducted from June 1990 to March 1994. We collected outcome data from May 1992 to April 1994 and July 2003 to December 2006. RESULTS We identified 3 visit attendance patterns. High attenders (48%) had the most visits and good outcomes. Low attenders (33%) had the most education and the best outcomes. Increasing attenders (18%) had the fewest completed visits during pregnancy, the poorest intake characteristics, and the poorest outcomes. Treatment-control group differences varied by class, with high and low attenders having better outcomes on some measures than did their control group counterparts. CONCLUSIONS Three patterns were associated with distinct groups of mothers with different long-term outcomes. Further examination and use of patterns to classify mothers and prioritize resources may improve efficiency in the Nurse-Family Partnership.

A Home Visiting Parenting Program and Child Obesity: A Randomized Trial

OBJECTIVE Low birth weight leads to adverse health outcomes throughout life, is particularly high among Blacks, and may contribute to health disparities between Whites and Blacks in the United States. Stress is among the many potential contributors to birth weight, but key sources of stress have not yet been clearly identified. The objective of this paper is to describe the relationships between multiple sources of maternal stress and birth weight. METHODS Linear regression is used to analyze data from two control groups (n = 554) of the Nurse-Family Partnership trial in Memphis, Tennessee. Birth weight was obtained from medical records and other variables are from interviews during pregnancy (1990-1991). Four stresses were considered: abuse, anxiety, financial stress, and neighborhood disorganization. RESULTS When the four sources of stress were included together in the same model and known non-stress-related influences were controlled for, only neighborhood was a significant contributor to birth weight. When each stress was entered into the model individually, abuse, anxiety, and neighborhood disorganization were all significant. CONCLUSION These results suggest that neighborhood disorganization has the most robust impact on birth weight, whereas abuse and anxiety seem to contribute via a source of shared variance. Further research is warranted to determine appropriate interventions.

General and diabetes-specific stress in adolescents with type 1 diabetes

The use of the Internet for health information is growing, but there is little control over the timeliness of updates or the accuracy of the information. Recent changes in recommendations for the treatment of acute otitis media were made in an effort to decrease the unnecessary use of antibiotics. We conducted a systematic review of Web sites to determine if consumers are likely to find appropriate information. Only 31% of relevant Web sites found explain the new “watch and wait” recommendation, and 41% include a recommendation to finish the full course of prescribed antibiotics. Web sites that include an update date, are reviewed by a physician, provide references, and have a nonprofit-type domain are more likely to contain updated information. Physicians should be aware that their patients might visit the office with expectations based on outdated information found on the Web. Organizations making recommendations should consider how to disseminate new information through the Web.

Breastfeeding and Exposure to Past, Current, and Neighborhood Violence

Pregnancy among unmarried adolescents has been linked to negative personal control beliefs. In contrast, self-agency beliefs about control over future possibilities have been linked to delay in subsequent childbearing. In this secondary analysis, we examined factors associated with self-agency change in 429 unmarried adolescent mothers from intervention and control groups of a nurse home visitation study. Adolescent mothers who participated in a sustained relationship with a nurse made greater gains in self-agency than did control group mothers (p = .034). Adolescents with lower cognitive ability who were behind their age-appropriate grade level in school made the greatest self-agency gains.

State-Level Population Estimates of Individuals Subject to and Not Meeting Proposed Medicaid Work Requirements

The positive effects of a 27-month home visiting parenting program on overweight and obesity among 2-year-old children living in lower-income urban homes. BACKGROUND: Young children living in historically marginalized families are at risk for becoming adolescents with obesity and subsequently adults with increased obesity-related morbidities. These risks are particularly acute for Hispanic children. We hypothesized that the prevention-focused, socioecological approach of the “Minding the Baby” (MTB) home visiting program might decrease the rate of childhood overweight and obesity early in life. METHODS: This study is a prospective longitudinal cohort study in which we include data collected during 2 phases of the MTB randomized controlled trial. First-time, young mothers who lived in medically underserved communities were invited to participate in the MTB program. Data were collected on demographics, maternal mental health, and anthropometrics of 158 children from birth to 2 years. RESULTS: More children in the intervention group had a healthy BMI at 2 years. The rate of obesity was significantly higher (P < .01) in the control group (19.7%) compared with the intervention group (3.3%) at this age. Among Hispanic families, children in the MTB intervention were less likely to have overweight or obesity (odds ratio = 0.32; 95% confidence interval: 0.13–0.78). CONCLUSIONS: Using the MTB program, we significantly lowered the rate of obesity among 2-year-old children living in low-socioeconomic-status communities. In addition, children of Hispanic mothers were less likely to have overweight or obesity at 2 years. Given the high and disproportionate national prevalence of Hispanic young children with overweight and obesity and the increased costs of obesity-related morbidities, these findings have important clinical, research, and policy implications.

Low birthweight in second children after nurse home visiting

BACKGROUND Type 1 diabetes (T1D) is one of the most common chronic health conditions in adolescents in the United States. Adherence to the recommended treatment regimen has been reported as a source of stress for adolescents. AIM The purpose of this study was to examine the associations among general and diabetes-specific stress and glycemic control (HbA1c), self-management, and diabetes-specific quality of life (QOL) in adolescents with T1D. METHODS A secondary analysis of baseline data (N=320) from a randomized controlled trial was conducted. Adolescents completed validated measures of general and diabetes-specific stress, self-management, and diabetes-specific QOL. HbA1c levels were obtained from medical records. RESULTS Over 50% of the sample scored at or above criteria for high general and diabetes-specific stress. Higher general and diabetes-specific stress was significantly associated with higher HbA1c, poorer self-management activities, and lower diabetes-specific QOL. Diabetes-specific stress accounted for a significant proportion of the variance in HbA1c, while general stress did not. General and diabetes-specific stress accounted for 40% of the variance in diabetes-specific QOL. CONCLUSIONS General and diabetes-specific stress are common in adolescents with T1D. Healthcare providers must be mindful of the sources of stress that adolescents with T1D face on a daily basis. General stress and diabetes-specific stress should be differentiated and may require different interventions to improve coping and outcomes.