Assessment of graduate public health education in Nepal and perceived needs of faculty and students.

Background: Despite the large body of evidence suggesting that effective public health infrastructure is vital to improving the health status of populations, many universities in developing countries offer minimal opportunities for graduate training in public health. In Nepal, for example, only two institutions currently offer a graduate public health degree. Both institutions confer only a general Masters in Public Health (MPH), and together produce 30 graduates per year.

Recent combined hormonal contraceptives (CHCs) and the risk of thromboembolism and other cardiovascular events in new users.

Background: Combined hormonal contraceptives (CHCs) place women at increased risk of venous thromboembolic events (VTEs) and arterial thrombotic events (ATEs), including acute myocardial infarction and ischemic stroke. There is concern that three recent CHC preparations [drospirenone-containing pills (DRSPs), the norelgestromin-containing transdermal patch (NGMN) and the etonogestrel vaginal ring (ETON)] may place women at even higher risk of thrombosis than other older low-dose CHCs with a known safety profile.

Study Design: All VTEs and all hospitalized ATEs were identified in women, ages 10-55 years, from two integrated health care programs and two state Medicaid programs during the time period covering their new use of DRSP, NGMN, ETON or one of four low-dose estrogen comparator CHCs.

ADHD drugs and serious cardiovascular events in children and young adults.

Background: Adverse-event reports from North America have raised concern that the use of drugs for attention deficit-hyperactivity disorder (ADHD) increases the risk of serious cardiovascular events.

Methods: We conducted a retrospective cohort study with automated data from four health plans (Tennessee Medicaid, Washington State Medicaid, Kaiser Permanente California, and OptumInsight Epidemiology), with 1,200,438 children and young adults between the ages of 2 and 24 years and 2,579,104 person-years of follow-up, including 373,667 person-years of current use of ADHD drugs. We identified serious cardiovascular events (sudden cardiac death, acute myocardial infarction, and stroke) from health-plan data and vital records, with end points validated by medical-record review.

Frequency of purchase and associated costs of assistive technology for Washington State Medicaid program enrollees with spina bifida by age.

Background: Assistive technology (AT) is one strategy to mitigate or eliminate barriers to independence for individuals with disabilities, including those with spina bifida (SB). However, little is known about current use and costs of AT for people with SB, including the cost burden to medical insurance payees.

Objective: The aim of this study was to evaluate frequency of AT purchases and their associated costs for individuals with SB covered by the Washington State Medicaid program.

Factors associated with underweight and stunting among children in rural Terai of eastern Nepal.

Malnutrition continues to affect a large proportion of children in the developing world. The authors undertook this study to identify biologic, socioeconomic, and health care factors associated with underweight and stunting in young children in an the eastern Tarai (plains) district of Nepal. Data were collected via questionnaires from mothers of 443 children aged 6 to 36 months in Sunsari district.

Predicting time to subsequent pregnancy.

Objectives: Women in poverty may benefit from avoiding closely spaced pregnancies. This study sought to identify predictive factors that could identify women at risk for closely spaced pregnancies.

Methods: We studied 20,028 women receiving welfare (cash assistance) from Washington State.

Income inequality and pregnancy spacing.

We examined the relationship between county-level income inequality and pregnancy spacing in a welfare-recipient cohort in Washington State. We identified 20,028 welfare-recipient women who had at least one birth between July 1, 1992, and December 31, 1999, and followed this cohort from the date of that first in-study birth until the occurrence of a subsequent pregnancy or the end of the study period. Income inequality was measured as the proportion of total county income earned by the wealthiest 10% of households in that county compared to that earned by the poorest 10%.

What factors are associated with achieving high continuity of care?

Background And Objectives: Although continuity of care has been found to be associated with improved health outcomes in children, little is known about what factors predict having consistent contact with a pediatric provider. This study explored what patient, family, provider, and system factors are associated with high continuity of both total and well-child care.

Methods: This cross-sectional study involved 759 patients presenting to a primary care pediatric clinic.

Continuity of care is associated with well-coordinated care.

Context: The importance of continuity of care as a means to promote care coordination remains controversial.

Objective: To determine if there is an association between having an objective measure of continuity of care and parental perception that care is well coordinated.

Design: Cross-sectional study.

The clinical and economic consequences of screening young men for genital chlamydial infection.

Background: Wide-scale application of urine-based screening of asymptomatic men for chlamydial infection has not been thoroughly assessed.

Goal: The goal was to compare clinical and economic consequences of three strategies: (1). no screening, (2).

Hip fracture incidence in nursing home residents and community-dwelling older people, Washington State, 1993-1995.

Objectives: To establish and validate a method of linking data from the Minimum Data Set (MDS) and Medicare hospital claims, to estimate hip fracture incidence rates for Medicare beneficiaries aged 65 and older in Washington State, and to compare the incidence rates of hip fractures in nursing home and non-nursing home residents.

Design: Retrospective analysis of Medicare population-based enrollment, hospital claims, and nursing home administrative data sets.

Setting: Nursing home and non-nursing home setting.

Adolescent quality of life, part I: conceptual and measurement model.

Few quality of life instruments exist that focus on the positive aspects of adolescence, incorporate adolescents' perspectives and language, and apply to both general and vulnerable populations. With these goals in mind, a conceptual and measurement model was developed using inductive qualitative methods to guide construction of the Youth Quality of Life Instrument-Research Version (YQOL-R). A conceptual model with four domains-Sense of Self, Social Relationships, Environment, and General Quality of Life-is reported.

Continuity of care is associated with high-quality careby parental report.

Context: The benefits of continuity of pediatric care remain controversial.

Objective: To determine whether there is an association between having a continuous relationship with a primary care pediatric provider and improved quality of care by parental report.

Design: Cross-sectional study.

Health care use by children diagnosed as having developmental delay.

Background: Although children with developmental delay are known to have increased health care use, it is unclear what proportion of that health care use is related to associated chronic health conditions.

Objectives: To assess the prevalence of isolated developmental delay and to determine the role of developmental delay in health care use controlling for chronic health conditions.

Design: Retrospective cohort study using Washington State Medicaid claims records from November 1, 1990, to December 31, 1997, an administrative data set that contains both International Classification of Diseases, Ninth Revision, Clinical Modification codes and billed services.