Low birth weight in Kansas.

CONTEXT: Low birth weight (LBW) is associated with infant morbidity and mortality. This is the first study of LBW in Kansas using vital statistics to determine maternal and health care system factors associated with LBW. OUTCOMES: Low birth weight. OBJECTIVE: Determine if prenatal care, maternal socio-demographic or medical factors, or insurance status were associated with LBW. METHODS: Birth certificate data were merged with Medicaid eligibility data and subjected to logistic regression analysis. RESULTS: Of the 37,081 single vaginal births, LBW rates were 5.5% overall, 10.8% for African Americans, and 5% for White Americans. Lacking private insurance was associated with 34% more LBW infants (AOR 1.34; 95% CI 1.13-1.58), increased comorbidity, and late or less prenatal care. Low birth weight was associated with maternal medical comorbidity and with previous adverse birth outcomes. CONCLUSIONS: Insurance status, prenatal care, and maternal health during pregnancy are associated with LBW. Private insurance was consistently associated with more prenatal care and better outcomes. This study has important implications regarding health care reform.

Bibliometric measures and National Institutes of Health funding at colleges of osteopathic medicine, 2006-2010.

CONTEXT: During the past 20 years, colleges of osteopathic medicine (COMs) have made several advances in research that have substantially improved the osteopathic medical profession and the health of the US population. Furthering the understanding of research at COMs, particularly the factors influencing the attainment of extramural funds, is highly warranted and coincides with the missions of most COMs and national osteopathic organizations. OBJECTIVES: To describe bibliometric measures (numbers of peer-reviewed publications [ie, published articles] and citations of these publications, impact indices) at COMs from 2006 through 2010 and to examine statistical associations between these measures and the amount of National Institutes of Health (NIH) research funds awarded to COMs in 2006 and 2010. METHODS: A customized, systematic search of the Web of Science database was used to obtain bibliometric measures for 28 COMs. For the analyses, the bibliometric measures were summed or averaged over a 5-year period (2006 through 2010). The NIH database was used to obtain the amount of NIH funds for research grants and contracts received by the 28 COMs. Bivariate and multivariate statistical procedures were used to explore relationships between bibliometric measures and NIH funding amounts. RESULTS: The COMs with 2010 NIH funding, compared with COMs without NIH funding, had greater numbers of publications and citations and higher yearly average impact indices. Funding from the NIH in 2006 and 2010 was positively and significantly correlated with the numbers of publications, citations, and citations per publication and impact indices. The regression analysis indicated that 63.2% and 38.5% of the total variance in 2010 NIH funding explained by the model (adjusted R(2)=0.74) was accounted for by 2006 NIH funding and the combined bibliometric (ie, publications plus citations), respectively. CONCLUSION: Greater scholarly output leads to the procurement of more NIH funds for research at COMs.

Research funding at colleges of osteopathic medicine in the United States.

CONTEXT: Research is a vital component of a college of osteopathic medicine (COM) portfolio. Previous studies have described research activity at COMs from 1989 through 2004 using data from surveys of COM administrators conducted by the American Association of Colleges of Osteopathic Medicine (AACOM). However, these studies had limitations. OBJECTIVES: To address the limitations of previous studies and to provide more depth of understanding regarding research activity at COMs by (1) documenting changes in research funding at COMs from 2004 to 2009 according to the funding agencies, principal investigators' degrees, and areas of study after considering inflation and (2) examining predictors of research funding at COMs. METHODS: Information about 2004 and 2009 active research grants and contracts, research expenditures, and COM characteristics was obtained from AACOM databases. Descriptive statistics are presented for 20 COMs that completed the survey in both years. The 2004 dollar values were adjusted for the rate of inflation (13.57%). Bivariate and multivariate analyses were used to explore associations between school characteristics (eg, number of faculty), research expenditures, and research funding outcomes (total amount and number of awards) for all COMs completing the survey in 2009 (n=26). RESULTS: From 2004 to 2009, the total amount of awards increased from 115.2 million to 216.6 million, and the number of awards increased from 450 to 665. Funding rose substantially from foundations (336%), to PhD-DO principal investigators (909%), and for osteopathic manipulative medicine (60%). Total award amounts were positively associated with both research expenditures (P<.001) and the number of faculty (P<.001). Larger research expenditures also were related to securing a greater number of awards (P<.001). CONCLUSION: Research activity at COMs continues to advance partly because of investments in research and faculty made by COMs.

Screening adults for depression in primary care: A position statement of the American College of Preventive Medicine.

The American College of Preventive Medicine (ACPM) maintains that primary care providers should screen all adults for depression and that all primary care providers should have systems in place, either within the primary care setting itself or through collaborations with mental health professionals, to ensure the accurate diagnosis and treatment of this condition. The earliest and best opportunities to identify depression are in the clinics of primary care providers. Thus, the ACPM supports the recommendations of the US Preventive Services Task Force (USPSTF), and further suggests that all primary care practices should have such systems of care in place.

Clinical practice characteristics of osteopathic and allopathic primary care physicians at academic health centers: results from the National Ambulatory Medical Care Survey.

PURPOSE: To explore characteristics of patient visits to osteopathic physicians (DOs) and allopathic physicians (MDs) in the provision of ambulatory primary care services at academic health centers (AHCs) relative to non-AHC sites. METHOD: Physicians report patient visits to the National Ambulatory Medical Care Survey (NAMCS). The authors used NAMCS data (2002-2006) to statistically estimate, characterize, and compare patient visits of four physician provider type- and AHC site-specific subgroups: DOs and MDs at non-AHC sites, and DOs and MDs at AHC sites. RESULTS: The 134,369 patient visits reported in the NAMCS database represented 4.57 billion physician office visits after the authors applied patient weights. These visits included 2.03 billion primary care patient visits (205.1 million DO visits and 1.77 billion MD visits at non-AHC sites; 5.8 million DO visits and 52.3 million MD visits at AHC sites). Practicing at an AHC site appeared to change the dynamic of the patient visit to an osteopathic physician. Most notably, these changes involved patient demographics (sex), patient visit context (practice metropolitan statistical area status, patient symptom chronicity, and injury as reason for the visit), and medical management (diagnostic testing, frequency and intensity of ordering drugs, and use of osteopathic manipulative treatment). CONCLUSIONS: Evidence suggests that osteopathic physicians in community, non-AHC settings offer a more distinctive osteopathic approach to primary care than osteopathic physicians at AHC sites, which both indicates a need for further research to explain this phenomenon and has potentially important implications for osteopathic medical education.

Assessing awareness, knowledge and use of folic acid in Kansas women between the ages of 18 and 44 years.

UNLABELLED: Taking folic acid daily, before and during early pregnancy, has been proven to reduce neural tube birth defects (NTD). Unfortunately, many women fail to take it daily as recommended. OBJECTIVES: To assess women's self-reported awareness, knowledge and use of folic acid. Methods Data were obtained by cross-sectional, random digit-dialing, computer-assisted telephone interviews with 250 women in Kansas. Associations were determined by chi-squared analysis. RESULTS: Eighty-eight percent of childbearing age women in Kansas have a general awareness of folic acid, 20% have knowledge that it reduces birth defects, but only 25% report taking it daily. Awareness was associated with high school or greater education (P < .0001), incomes over $25,000 (P = 0.0003), being married (P = 0.0035), being white (P = 0.0135), having health insurance (P = 0.0152) and being capable of pregnancy (P = 0.0119). Knowledge that folic acid reduces birth defects was associated with being aware of the USPHS recommendation (P < .0001), being capable of pregnancy (P = 0.0043), being pregnant (P = 0.0061), and being aware of folic acid (P = 0.0379). Taking folic acid daily was associated with currently being pregnant (P = 0.0126). CONCLUSIONS: Women less likely to take folic acid on a daily basis were young, non-Caucasians who reported less education, less income and no health insurance. Based upon these data, multi-level education campaigns that specifically target lower-SES women should be considered.

Secular trends in excess fetal and infant mortality using perinatal periods of risk analysis.

Perinatal periods of risk (PPOR) provide an alternative analytical approach to studying infant mortality. Results can be used to focus community activities to improve infant and maternal health. This article demonstrates the use of PPOR to monitor trends in excess fetal and infant mortality related to disparities associated with race and ethnicity in Kansas City, MO (KC). Based on a comparison of PPOR analyses for 1996-2000 and 2001-2005, there was a 30% reduction in excess fetal and infant mortality in Kansas City and reductions for both non-Hispanic blacks (17%) and non-Hispanic whites (66.7%). However, the disparity ratio for excess mortality rates between non-Hispanic blacks and non-Hispanic whites nearly doubled. Prematurity, the most frequent cause of infant mortality in Kansas City during 2001-2005 accounted for 42.5% of the infant deaths. Being a teenage mother; having less than a high-school education; being unmarried; having an unintended pregnancy; being obese preconceptually; being diabetic; using substances such as tobacco or drugs during pregnancy; receiving late, inadequate or intermediate amounts of prenatal care; having a multifetal pregnancy; having a primary elective cesarean section; delivering a preterm infant or having a male infant; and being enrolled in Medicaid all increased the risk of infant death.

Research funding at colleges of osteopathic medicine: 15 years of growth.

CONTEXT: Colleges of osteopathic medicine (COMs) trying to stimulate research and develop research infrastructures must overcome the challenge of obtaining adequate funding to support growing research interests. The authors examine changes in research funding at COMs during the past 15 years. OBJECTIVES: To track 1999-2004 data on COM research funding, COM faculty size, educational backgrounds of principal investigators receiving funding, and funding institutions. To compare these data with published results from 1989 to 1999. METHODS: Data on number of grants, funding amounts by extramural source, percent of total dollars by extramural source, percent of total dollars by COM, and total amount of extramural funding were obtained from the American Association of Colleges of Osteopathic Medicine databases. Data on the Osteopathic Research Center (ORC) were obtained from the ORC's databases. RESULTS: Research, both in terms of number of grants and funding amounts within the osteopathic medical profession, increased substantially from 1999 to 2004. The largest single source of funding remained the National Institutes of Health. The number of COMs whose research funding exceeded $1 million annually more than doubled, increasing from 5 in 1999 to 12 in 2004. The osteopathic medical profession's decision to direct research dollars into a national research center devoted to research specific to osteopathic manipulative medicine resulted in an almost eightfold return on initial investment in 4 years. CONCLUSIONS: The amount of research productivity at a COM may be aligned with the size of the COM's full-time faculty, suggesting that once "critical mass" for teaching, service, and administration are achieved, a productive research program can be realized. Expanding the evidence base for those aspects of medicine unique to the osteopathic medical profession is dependent on the future growth of research.

Physician counseling to prevent overweight in children and adolescents: American College of Preventive Medicine position statement.

The American College of Preventive Medicine (ACPM) this position statement is intended to guide physicians in counseling children and adolescents to prevent overweight. Rigorous reviews of the published literature have found insufficient evidence to permit the development of formal recommendations by the US Preventive Services Task Force and others. However, numerous public health and physician organizations have developed recommendations on the basis of expert opinion, professional judgment, and the available scientific evidence. This article presents the position of the ACPM in light of these ambiguities. The ACPM will review and modify its recommendations as new scientific evidence emerges.

Perinatal periods of risk analysis of infant mortality in Jackson County, Missouri.

The perinatal periods of risk (PPOR) methodology provides an easy-to-use analytical approach to infant mortality that helps focus community initiatives for improving maternal and infant health. Because few analyses have been published, many public health practitioners may be unfamiliar with PPOR. This article demonstrates the application of PPOR analysis using infant mortality in Jackson County, Missouri. While the PPOR consists of two phases, this analysis was restricted to the initial phase of the overall process. The second phase builds on the initial findings and prioritizes the contributing factors of fetal/infant mortality so that targeted interventions can be developed. For Jackson County, the PPOR analysis found that racial and geographic disparities existed and, for very low-birth-weight infants, different interventions strategies may be needed on the basis of race. In addition, a mother who experienced a fetal or infant death was more likely to have had a medical risk factor, to have smoked cigarettes, to have started prenatal care after the first trimester or received no prenatal care, and to have been nulliparous.

The effect of health compromising behaviors on preterm births.

OBJECTIVES: The objective of our study was to determine whether there were combined effects of smoking, alcohol, and illicit drug use during pregnancy on the frequency of preterm births, and if so, the magnitude of the association after adjusting for confounding factors. METHODS: We conducted a retrospective cohort study of singleton live births in Kansas City, Missouri from 1990-2002. We defined health compromising behaviors as the use of cigarettes, alcohol, and illicit drugs. The effect of these behaviors on preterm births was considered for each substance individually, and in combination. The rates of preterm births for these groups were calculated. Using logistic regression, adjusted odds ratios were used to estimate the relative risk of preterm births among these groups. RESULTS: Over 13% of infants born to women who smoked were preterm, compared to 9.6% for non-smokers. Of infants born to women who reported alcohol use, 17.3% were preterm compared to 10.1% for non-drinkers. Smoking and alcohol use in combination was associated with 18.0% preterm births, while alcohol and drug use in combination was associated with 20.8% preterm births. The use of all three substances was associated with 31.4% preterm births. CONCLUSION: Women who engaged in health compromising behaviors during pregnancy showed an increased proportion of preterm births compared to those who did not. There is significant interaction between these behaviors leading to higher rates of preterm births than predicted by their additive effects. To decrease preterm births, we must deal with the effects of smoking, drinking, and drug use simultaneously.

Perinatal periods of risk: analysis of fetal-infant mortality rates in Kansas City, Missouri.

OBJECTIVES: The Perinatal Periods of Risk (PPOR) technique was used to analyze resident fetal and infant death data from Kansas City, Missouri, for the period 1998-2002. Results offer important information that can be used to develop community-based prevention strategies related to racial/ethnic disparities in infant mortality rates (IMR). METHODS: The PPOR approach for fetal and infant mortality can be mapped by birthweight at delivery and time of death into four strategic prevention areas: 1) Maternal Health/Prematurity (MHP), 2) Maternal Care (MC), 3) Newborn Care (NC), and 4) Infant Health (IH). For this analysis, all fetal and infant death certificates from the metropolitan Kansas City area were linked to their birth certificates and those associated with residents of Kansas City, Missouri, proper were used to create the dataset used in this analysis. Due to the small number of fetal and infant deaths among other ethnic groups, the analysis was restricted to a comparison of the disparity of IMR between Blacks, Whites, and a national non-Hispanic white reference group. The Kitagawa formula was used to determine contribution to excess deaths from birthweight-specific mortality and birthweight distribution rates. Logistic regression techniques were used to identify risk factors for death among Black fetuses and infants with very low birthweights and also deaths due to sudden infant death syndrome (SIDS). RESULTS: The PPOR analysis showed that of the excess deaths among black infants, when compared to a national reference group, 47% was attributable to MHP and another 29% was attributable to IH. Differences in MC and NC only accounted for 27 and 8% of the total excess deaths. During the study period, rates of sudden infant death syndrome (SIDS) were found to be significantly higher among Blacks as compared to Whites (2.12 vs. 0.81 per 1,000). An analysis of maternal characteristics for SIDS deaths among blacks using a step-wise logistic regression model, found that maternal age less than 20 years old, previous births, inadequate prenatal care, and being a Medicaid recipient were significant-adjusted odds ratios of 23.7 (95% Cl 10.48, 53.67), 8.4 (95% Cl 3.64, 19.21), 2.9 (95% Cl 1.38, 6.05) and 2.5 (95% Cl 1.04, 5.84), respectively. CONCLUSIONS: PPOR is an easy to use approach that helps focus community initiatives for improving maternal and infant health. In Kansas City, Missouri, efforts to further lower IMR in blacks can be achieved through the reduction of risk factors affecting maternal health and through maternal education to improve infant health.

Prenatal care and infant birth outcomes among Medicaid recipients.

Infant morbidity due to low birth weight and preterm births results in emotional suffering and significant direct and indirect costs. African American infants continue to have worse birth outcomes than white infants. This study examines relationships between newborn hospital costs, maternal risk factors, and prenatal care in Medicaid recipients in an impoverished rural county in South Carolina. Medicaid African American mothers gave birth to fewer preterm infants than did non-Medicaid African American mothers. No differences in the rates of preterm infants were noted between white and African American mothers in the Medicaid group. Access to Medicaid services may have contributed to this reduction in disparities due to race. Early initiation of prenatal care compared with later initiation did not improve birth outcomes. Infants born to mothers who initiated prenatal care early had increased morbidity with increased utilization of hospital services, suggesting that high-risk mothers are entering prenatal care earlier.

Research at US colleges of osteopathic medicine: a decade of growth.

Although research is a critical component of academic medicine, it has not been a significant component of osteopathic medicine. For years, leaders in the osteopathic medical profession have called for increased research in osteopathic medical schools. The need for cost-effective clinical practice leading to improved clinical outcomes creates a necessity for conducting well-designed clinical outcomes research related to osteopathic practice. The authors assess the growth in research at osteopathic academic medical centers from 1989-1999. The amounts of extramural funding at each school, sources of funding, types of research funded, departments funded, and investigators' degree types are also assessed. During the 10 years analyzed, total research funding increased 37%. Twenty-five percent of the grants and 55% of the funding to colleges of osteopathic medicine were from the National Institutes of Health. Most (63%) grants were awarded to PhD faculty. Most research was conducted in the basic biomedical sciences. Clinical research related to osteopathic practices appears to be a relatively minor component of research at osteopathic medical centers.