Morbidity and Mortality of Unintentional Carbon Monoxide Poisoning: United States 2005 to 2018.

STUDY OBJECTIVE: Centers for Disease Control and Prevention conducts case surveillance through the National Notifiable Diseases Surveillance System (NNDSS). This study aimed to provide surveillance report of unintentional carbon monoxide poisoning across multiple data sources to provide baseline data for the new NNDSS carbon monoxide poisoning surveillance. METHODS: For the period 2005 to 2018, we used 4 data sources to describe unintentional carbon monoxide poisoning: exposures reported by poison centers, emergency department (ED) visits, hospitalizations, and deaths. We conducted descriptive analyses by the cause of exposure (fire, nonfire, or unknown), age, sex, season, and US census region. Additional analyses were conducted using poison center exposure case data focusing on the reported signs and symptoms, management site, and medical outcome. RESULTS: Annually, we observed 39.5 poison center exposure calls (per 1 million, nationally), 56.5 ED visits (per 1 million, across 17 states), 7.3 hospitalizations (per 1 million, in 26 states), and 3.3 deaths (per 1 million, nationally) due to unintentional carbon monoxide poisoning. For 2005 to 2018, there was a decrease in the crude rate for non-fire-related carbon monoxide poisonings from hospital, and death data. Non-fire-related cases comprised 74.0% of ED visits data, 60.1% of hospitalizations, and 40.9% of deaths compared with other unintentional causes. Across all data sources, unintentional carbon monoxide poisonings were most often reported during the winter season, notably in January and December. Children aged 0 to 9 years had the highest reported rates in poison center exposure case data and ED visits (54.1 and 70.5 per 1 million, respectively); adults older than 80 years had the highest rates of hospitalization and deaths (20.2 and 9.9 per 1 million, respectively); and deaths occurred more often among men and in the Midwest region. Poison center exposure call data revealed that 45.9% of persons were treated at a health care facility. Headaches, nausea, and dizziness/vertigo were the most reported symptoms. CONCLUSION: The crude rates in non-fire-related carbon monoxide poisonings from hospitalizations, and mortality significantly decreased over the study period (ie, 2005 to 2018). This surveillance report provides trends and characteristics of unintentional carbon monoxide poisoning and the baseline morbidities and mortality data for the Centers for Disease Control and Prevention national surveillance system of carbon monoxide poisoning.

Common and Unique Barriers to the Exchange of Administrative Healthcare Data in Environmental Public Health Tracking Program.

CDC's National Environmental Public Health Tracking Program (Tracking Program) receives administrative data annually from 25-30 states to track potential environmental exposures and to make data available for public access. In 2019, the CDC Tracking Program conducted a cross-sectional survey among principal investigators or program managers of the 26 funded programs to improve access to timely, accurate, and local data. All 26 funding recipients reported having access to hospital inpatient data, and most states (69.2%) regularly update data user agreements to receive the data. Among the respondents, 15 receive record-level data with protected health information (PHI) and seven receive record-level data without PHI. Regarding geospatial resolution, approximately 50.0% of recipients have access to the street address or census tract information, 34.6% have access to ZIP code, and 11.5% have other sub-county geographies (e.g., town). Only three states receive administrative data for their residents from all border states. The survey results will help the Tracking Program to identify knowledge gaps and perceived barriers to the use and accessibility of administrative data for the CDC Tracking Program. The information collected will inform the development of resources that can provide solutions for more efficient and timely data exchange.

Consequences of fall-induced hip fractures on cognitive function, physical activity, and mortality: Korean longitudinal study of aging 2006-2016.

BACKGROUND: Few studies have investigated the consequences of fall-induced hip fractures among healthy, community-dwelling middle-aged adults. OBJECTIVES: To investigate the effects of fall-induced hip fractures on cognitive function, activities of daily living, and mortality from the time the fractures increase. DESIGN: A secondary data analysis based on data from the Korean Longitudinal Study of Aging (2006-2016). METHODS: Participants were 8,571 people over 45 years in South Korea who had never experienced a fall-induced hip fracture by 2006. Participants were divided into a hip-fracture group (those who experienced one or more hip fractures between 2008 and 2016; N = 306), and a non-hip-fracture group (those who did not experience a hip fracture during this period; N = 8,265). A linear mixed model, Kaplan-Meier analysis, and Cox regression were used to analyze the effects of hip fractures on mortality, the Mini Mental State Examination, Activities of Daily Living, and Instrumental Activities of Daily Living scores during 2008-2016. RESULTS: In the hip-fracture group, compared to the non-fracture group, the change in Mini Mental State Examination score was significantly greater (p = 001); however, although there was a significant difference at each time point (p < .001), the cumulative difference over time was not significant (p = .560). The hip-fracture group showed a faster time to initial decline in Mini Mental State Examination scores (hazard ratio = 1.16, CI = 1.022-1.318). The hip-fracture group showed significantly larger changes in Activities of Daily Living and Instrumental Activities of Daily Living scores (p < .001), shorter time until decline began (p < .001), and larger decline as time passed (p < .001). Furthermore, the time before assistance was required from others for activities of daily living and instrumental activities of daily living was also shorter (hazard ratio = 2.18, CI= 1.728-2.759; odds ratio = 1.44, CI = 1.198-1.732). Hip fractures also increased mortality (hazard ratio = 1.42, CI = 1.013-2.002). CONCLUSIONS: Our study found that hip fractures accelerate the decline of cognitive function, physical activity, and increased mortality. Our findings can be used to develop fall-prevention programs.

Community drinking water data on the National Environmental Public Health Tracking Network: a surveillance summary of data from 2000 to 2010.

This report describes the available drinking water quality monitoring data on the Centers for Disease Control and Prevention (CDC) National Environmental Public Health Tracking Network (Tracking Network). This surveillance summary serves to identify the degree to which ten drinking water contaminants are present in finished water delivered to populations served by community water systems (CWS) in 24 states from 2000 to 2010. For each state, data were collected from every CWS. CWS are sampled on a monitoring schedule established by the Environmental Protection Agency (EPA) for each contaminant monitored. Annual mean and maximum concentrations by CWS for ten water contaminants were summarized from 2000 to 2010 for 24 states. For each contaminant, we calculated the number and percent of CWS with mean and maximum concentrations above the maximum contaminant level (MCL) and the number and percent of population served by CWS with mean and maximum concentrations above the MCL by year and then calculated the median number of those exceedances for the 11-year period. We also summarized these measures by CWS size and by state and identified the source water used by those CWS with exceedances of the MCL. The contaminants that occur more frequently in CWS with annual mean and annual maximum concentrations greater than the MCL include the disinfection byproducts, total trihalomethanes (TTHM), and haloacetic acids (HAA5); arsenic; nitrate; radium and uranium. A very high proportion of exceedances based on MCLs occurred mostly in very small and small CWS, which serve a year-round population of 3,300 or less. Arsenic in New Mexico and disinfection byproducts HAA5 and TTHM, represent the greatest health risk in terms of exposure to regulated drinking water contaminants. Very small and small CWS are the systems' greatest difficulty in achieving compliance.

Public Perceptions of Environmental Public Health Risks in the United States.

Understanding public perceptions about environmental health hazards, exposures, and health impacts can help environmental public health practitioners to target and prioritize community activities, policy needs, and communication strategies. The online cross-sectional 2013 summer wave of the ConsumerStyles survey sampled U.S. adults and used questions from the Centers for Disease Control's Environmental Public Health Tracking Program to measure public awareness of governmental efforts to track environmental exposures and links to health impacts, as well as perceptions of environmental health issues. Unadjusted and adjusted logistic regressions examined the associations between demographic characteristics and level of awareness of government environmental public health efforts or level of concern about health risks associated with environmental pollutants. Responses were received from 4033 participants, yielding a response rate of 66.0%. More than half of respondents (57.8%) noted concerns about health risks from environmental pollutants. More than one-third (40.0%) of respondents reported awareness of government efforts. Nearly 40% of respondents felt that none of the health impacts listed in the survey were related to environmental issues. Multiple logistic regression models showed that non-Hispanic blacks, other races, females, people with a college or higher education, and people living in the Midwest or South regions were more likely than their counterparts to be concerned about how the environment affects their health. Future work should focus on improving risk communication, filling the information gap on environmental health issues, and understanding how perceptions change over time.

Lessons Learned From the Environmental Public Health Tracking Sub-County Data Pilot Project.

OBJECTIVE: Small area data are key to better understanding the complex relationships between environmental health, health outcomes, and risk factors at a local level. In 2014, the Centers for Disease Control and Prevention's National Environmental Public Health Tracking Program (Tracking Program) conducted the Sub-County Data Pilot Project with grantees to consider integration of sub-county data into the National Environmental Public Health Tracking Network (Tracking Network). DESIGN: The Tracking Program and grantees developed sub-county-level data for several data sets during this pilot project, working to standardize processes for submitting data and creating required geographies. Grantees documented challenges they encountered during the pilot project and documented decisions. RESULTS: This article covers the challenges revealed during the project. It includes insights into geocoding, aggregation, population estimates, and data stability and provides recommendations for moving forward. CONCLUSION: National standards for generating, analyzing, and sharing sub-county data should be established to build a system of sub-county data that allow for comparison of outcomes, geographies, and time. Increasing the availability and accessibility of small area data will not only enhance the Tracking Network's capabilities but also contribute to an improved understanding of environmental health and informed decision making at a local level.

Maternal exposure to ozone and PM2.5 and the prevalence of orofacial clefts in four U.S. states.

BACKGROUND: While there is some evidence that maternal exposure to ambient air pollution is associated with orofacial clefts in offspring, the epidemiologic studies have been largely equivocal. We evaluated whether maternal exposure to elevated county-level ambient fine particulate matter with aerodynamic diameter ≤2.5µm (PM2.5) and ozone during early gestation was associated with a higher prevalence of orofacial clefts. METHODS: Birth data consisting of 4.7 million births from 2001 to 2007 were obtained from National Birth Defects Prevention Network for four states - Arizona, Florida, New York (excluding New York City), and Texas. The air pollution exposure assessment for gestational weeks 5-10 was based on county-level average concentrations of PM2.5 and ozone data generated using a Bayesian fusion model available through CDC's Environmental Public Health Tracking Network. Two outcomes were analyzed separately: cleft lip with or without cleft palate, cleft palate alone. In logistic regression analyses, we adjusted for factors that were suspected confounders or modifiers of the association between the prevalence of orofacial clefts and air pollution, i.e., infant sex, race-ethnicity, maternal education, smoking status during pregnancy, whether this was mother's first baby, maternal age. RESULTS: Each 10µg/m3 increase in PM2.5 concentration was significantly associated with cleft palate alone (OR =1.43, 95% CI: 1.11-1.86). There was no significant association between PM2.5 concentration and cleft lip with or without cleft palate. No associations were observed between ozone exposure and the two outcomes of orofacial clefts. CONCLUSIONS: Our study suggests that PM2.5 significantly increased the risk of cleft palate alone, but did not change the incidence of cleft lip with or without palate. Ozone levels did not correlate with incidence of orofacial clefts.

Relationship between frequency and intensity of cigarette smoking and TTFC/C among students of the GYTS in select countries, 2007-2009.

BACKGROUND: This study assessed the construct validity of a measure of nicotine dependence that was used in the Global Youth Tobacco Survey (GYTS). METHODS: Using 2007-2009 data from the GYTS, subjects from 6 countries were used to assess current smokers' odds of reporting time to first cigarette or craving positive (TTFC/C+) by the number of cigarette smoking days per month (DPM) and the number of cigarettes smoked per day (CPD). RESULTS: The percentage of GYTS smokers who reported TTFC/C+ ranged from 58.0% to 69.7%. Compared with students who smoked on 1-2 DPM, those who smoked on 3-9 DPM had 3 times the adjusted odds of reporting TTFC/C+. The adjusted odds of reporting TTFC/C+ were 3 to 7 times higher among those who smoked 10-29 DPM and 6 to 20 times higher among daily smokers. Similarly, the adjusted odds of TTFC/C+ were 3-6 times higher among those who smoked 2-5 CPD and 6 to 20 times higher among those who smoked >6 CPD, compared to those who smoked <1 CPD. CONCLUSION: Associations of TTFC/C+ prevalence with both frequency and intensity of cigarette smoking provide a construct validation of the GYTS question used to assess respondents' TTFC/C status.

Racial/ethnic differences in hospital use and cost among a statewide population of children with Down syndrome.

Children with Down syndrome (DS) use hospital services more often than children without DS, but data on racial/ethnic variations are limited. This study generated population-based estimates of hospital use and cost to 3 years of age by race/ethnicity among children with DS in Massachusetts using birth certificates linked to birth defects registry and hospital discharge data from 1999 to 2004. Hospital use (≥ 1 post-birth hospitalization and median days hospitalized birth and post-birth) and reasons for hospitalization were compared across maternal race/ethnicity using relative risk (RR) and Wilcoxon rank sums tests, as appropriate. Costs were calculated in 2011 United States dollars. Greater hospital use was observed among children with DS with Hispanic vs. Non-Hispanic White (NHW) mothers (post-birth hospitalization: RR 1.4; median days hospitalized: 20.0 vs. 11.0, respectively). Children with DS and congenital heart defects of Non-Hispanic Black (NHB) mothers had significantly greater median days hospitalized than their NHW counterparts (24.0 vs. 16.0, respectively). Respiratory diagnoses were listed more often among children with Hispanic vs. NHW mothers (50.0% vs. 29.1%, respectively), and NHBs had more cardiac diagnoses (34.1% vs. 21.5%, respectively). The mean total hospital cost was nine times higher among children with DS ($40,075) than among children without DS ($4053), and total costs attributable to DS were almost $18 million. Median costs were $22,781 for Hispanics, $18,495 for NHBs, and $13,947 for NHWs. Public health interventions should address the higher rates of hospital use and hospitalizations for respiratory and cardiac diseases among racial/ethnic minority children with DS in Massachusetts.

Temporal trends in survival among infants with critical congenital heart defects.

OBJECTIVE: To evaluate the trends in survival for infants with critical congenital heart defects (CCHDs) and to examine the potential impact of timing of diagnosis and other prognostic factors on survival. METHODS: We performed a retrospective population-based cohort study in infants born with structural congenital heart defects (CHDs) between 1979 and 2005 and ascertained by the Metropolitan Atlanta Congenital Defects Program. We estimated Kaplan-Meier survival probabilities for 12 CCHD phenotypes by birth era and timing of diagnosis among infants without noncardiac defects or chromosomal disorders and used stratified Cox proportional hazards models to assess potential prognostic factors. RESULTS: Of 1 056 541 births, there were 6965 infants with CHDs (1830 with CCHDs). One-year survival was 75.2% for those with CCHDs (n = 1336) vs 97.1% for those with noncritical CHDs (n = 3530; P < .001). One-year survival for infants with CCHDs improved from 67.4% for the 1979-1993 birth era to 82.5% for the 1994-2005 era (P < .001). One-year survival was 71.7% for infants with CCHDs diagnosed at ≤1 day of age (n = 890) vs 82.5% for those with CCHDs diagnosed at >1 day of age (n = 405; P < .001). There was a significantly higher risk of 1-year mortality for infants with an earlier birth era, earlier diagnosis, and low birth weight and whose mothers were <30 years old. CONCLUSIONS: One-year survival for infants with CCHDs has been improving over time, yet mortality remains high. Later diagnosis is associated with improved 1-year survival. These benchmark data and identified prognostic factors may aid future evaluations of the impact of pulse oximetry screening on survival from CCHDs.

The association of low socioeconomic status and the risk of having a child with Down syndrome: a report from the National Down Syndrome Project.

PURPOSE: Advanced maternal age and altered recombination are known risk factors for Down syndrome cases due to maternal nondisjunction of chromosome 21, whereas the impact of other environmental and genetic factors is unclear. The aim of this study was to investigate an association between low maternal socioeconomic status and chromosome 21 nondisjunction. METHODS: Data from 714 case and 977 control families were used to assess chromosome 21 meiosis I and meiosis II nondisjunction errors in the presence of three low socioeconomic status factors: (i) both parents had not completed high school, (ii) both maternal grandparents had not completed high school, and (iii) an annual household income of <$25,000. We applied logistic regression models and adjusted for covariates, including maternal age and race/ethnicity. RESULTS: As compared with mothers of controls (n = 977), mothers with meiosis II chromosome 21 nondisjunction (n = 182) were more likely to have a history of one low socioeconomic status factor (odds ratio = 1.81; 95% confidence interval = 1.07-3.05) and ≥2 low socioeconomic status factors (odds ratio = 2.17; 95% confidence interval = 1.02-4.63). This association was driven primarily by having a low household income (odds ratio = 1.79; 95% confidence interval = 1.14-2.73). The same statistically significant association was not detected among maternal meiosis I errors (odds ratio = 1.31; 95% confidence interval = 0.81-2.10), in spite of having a larger sample size (n = 532). CONCLUSION: We detected a significant association between low maternal socioeconomic status and meiosis II chromosome 21 nondisjunction. Further studies are warranted to explore which aspects of low maternal socioeconomic status, such as environmental exposures or poor nutrition, may account for these results.

Impact of data editing methods on estimates of smoking prevalence, Global Youth Tobacco Survey, 2007-2009.

Accuracy of self-reported data may be improved by data editing, a mechanism to produce accurate information by excluding inconsistent data based on a set number of predetermined decision rules. We compared data editing methods in the Global Youth Tobacco Survey (GYTS) with other editing approaches and evaluated the effects of these on smoking prevalence estimates. We evaluated 5 approaches for handling inconsistent responses to questions regarding cigarette use: GYTS, do-nothing, gatekeeper, global, and preponderance. Compared with GYTS data edits, the do-nothing and gatekeeper approaches produced similar estimates, whereas the global approach resulted in lower estimates and the preponderance approach, higher estimates. Implications for researchers using GYTS include recognition of the survey's data editing methods and documentation in their study methods to ensure cross-study comparability.

Trends in survival among children with Down syndrome in 10 regions of the United States.

OBJECTIVE: This study examined changes in survival among children with Down syndrome (DS) by race/ethnicity in 10 regions of the United States. A retrospective cohort study was conducted on 16,506 infants with DS delivered during 1983-2003 and identified by 10 US birth defects monitoring programs. Kaplan-Meier survival probabilities were estimated by select demographic and clinical characteristics. Adjusted hazard ratios (aHR) were estimated for maternal and infant characteristics by using Cox proportional hazard models. RESULTS: The overall 1-month and 1-, 5-, and 20-year survival probabilities were 98%, 93%, 91%, and 88%, respectively. Over the study period, neonatal survival did not improve appreciably, but survival at all other ages improved modestly. Infants of very low birth weight had 24 times the risk of dying in the neonatal period compared with infants of normal birth weight (aHR 23.8; 95% confidence interval [CI] 18.4-30.7). Presence of a heart defect increased the risk of death in the postneonatal period nearly fivefold (aHR 4.6; 95% CI 3.9-5.4) and continued to be one of the most significant predictors of mortality through to age 20. The postneonatal aHR among non-Hispanic blacks was 1.4 (95% CI 1.2-1.8) compared with non-Hispanic whites and remained elevated by age 10 (2.0; 95% CI 1.0-4.0). CONCLUSIONS: The survival of children born with DS has improved and racial disparities in infant survival have narrowed. However, compared with non-Hispanic white children, non-Hispanic black children have lower survival beyond infancy. Congenital heart defects are a significant risk factor for mortality through age twenty.

Improved survival among children with spina bifida in the United States.

OBJECTIVE: To evaluate trends in survival among children with spina bifida by race/ethnicity and possible prognostic factors in 10 regions of the United States. STUDY DESIGN: A retrospective cohort study was conducted of 5165 infants with spina bifida born during 1979-2003, identified by 10 birth defects registries in the United States. Survival probabilities and adjusted hazard ratios were estimated for race/ethnicity and other characteristics using the Cox proportional hazard model. RESULTS: During the study period, the 1-year survival probability among infants with spina bifida showed improvements for whites (from 88% to 96%), blacks (from 79% to 88%), and Hispanics (from 88% to 93%). The impact of race/ethnicity on survival varied by birth weight, which was the strongest predictor of survival through age 8. There was little racial/ethnic variation in survival among children born of very low birth weight. Among children born of low birth weight, the increased risk of mortality to Hispanics was approximately 4-6 times that of whites. The black-white disparity was greatest among children born of normal birth weight. Congenital heart defects did not affect the risk of mortality among very low birth weight children but increased the risk of mortality 4-fold among children born of normal birth weight. CONCLUSIONS: The survival of infants born with spina bifida has improved; however, improvements in survival varied by race/ethnicity, and blacks and Hispanics continued to have poorer survival than whites in the most recent birth cohort from 1998-2002. Further studies are warranted to elucidate possible reasons for the observed differences in survival.

Comprender las actitudes de los médicos hacia las personas con síndrome de Down / No disponible

Es importante comprender las actitudes de los médicos hacia las personas con síndrome de Down a causa de la influencia que los médicos tienen sobre el futuro de estas personas. Sin embargo pocos estudios han valorado dichas actitudes. Utilizando los datos de la encuesta 2008 DocStyles©, una encuesta anual on line que se realiza en Estados Unidos, evaluamos estas actitudes mediante una encuesta que incluyó preguntas sobre opiniones relacionadas con situaciones educativas y laborales de carácter inclusivo, relaciones previas con individuos con síndrome de Down, y sentimiento de comodidad al prestarles la atención médica. Aproximadamente el 20% de los participantes coincidieron en que los escolares con síndrome de Down deberían ir a escuelas especiales, y casi la cuarta parte afirmaba que incluir a escolares con síndrome de Down en clases ordinarias suponía un factor de distracción. Mientras que el 76% se sentían cómodos al atender médicamente a sus pacientes con síndrome de Down, el 9,8% se sentía incómodo, y el 14,3% mostraban un sentimiento neutro. Los resultados mostraron que las actitudes que apoyaban la inclusión y el sentimiento de confort al ofrecer atención médica fueron más frecuentes en médicos de raza blanca, no hispanos, en los que habían tenido previamente relaciones con personas con síndrome de Down, en los pediatras, y en los médicos que trabajaban en un grupo o entorno hospitalario. Estos datos ayudan a dirigir el desarrollo de los currículos y del material de adiestramiento para futuros profesionales de la salud, en relación con el síndrome de Down

No disponible

The contribution of chromosomal abnormalities to congenital heart defects: a population-based study.

We aimed to assess the frequency of chromosomal abnormalities among infants with congenital heart defects (CHDs) in an analysis of population-based surveillance data. We reviewed data from the Metropolitan Atlanta Congenital Defects Program, a population-based birth-defects surveillance system, to assess the frequency of chromosomal abnormalities among live-born infants and fetal deaths with CHDs delivered from January 1, 1994, to December 31, 2005. Among 4430 infants with CHDs, 547 (12.3%) had a chromosomal abnormality. CHDs most likely to be associated with a chromosomal abnormality were interrupted aortic arch (type B and not otherwise specified; 69.2%), atrioventricular septal defect (67.2%), and double-outlet right ventricle (33.3%). The most common chromosomal abnormalities observed were trisomy 21 (52.8%), trisomy 18 (12.8%), 22q11.2 deletion (12.2%), and trisomy 13 (5.7%). In conclusion, in our study, approximately 1 in 8 infants with a CHD had a chromosomal abnormality. Clinicians should have a low threshold at which to obtain testing for chromosomal abnormalities in infants with CHDs, especially those with certain types of CHDs. Use of new technologies that have become recently available (e.g., chromosomal microarray) may increase the identified contribution of chromosomal abnormalities even further.

Understanding physicians' attitudes toward people with Down syndrome.

Understanding attitudes of physicians toward people with Down syndrome is important because of the influence physicians have on the future of individuals with Down syndrome. However, few previous studies have assessed these attitudes. Using data from the 2008 DocStyles(©) survey, an annual online survey conducted in the United States, we assessed attitudes of physicians toward people with Down syndrome using a survey that included questions about opinions toward inclusive educational settings and workplaces, previous relationships with people with Down syndrome, and comfort in providing them with medical care. Approximately 20% of participants agreed that students with Down syndrome should go to special schools, and nearly a quarter agreed that including students with Down syndrome in regular classrooms is distracting. While 76.0% of respondents felt comfortable providing medical care to people with Down syndrome, 9.8% reported feeling uncomfortable, and 14.3% reported feeling neutral. Results showed that attitudes that supported inclusion and comfort with providing medical care were more commonly reported among non-Hispanic white physicians, those who had previous relationships with people with Down syndrome, pediatricians, and physicians working in a group or hospital setting. These data are helpful to guide the development of training materials and curricula for healthcare providers regarding Down syndrome.

Sensitivity of birth certificate reports of birth defects in Atlanta, 1995-2005: effects of maternal, infant, and hospital characteristics.

OBJECTIVES: We assessed variations in the sensitivity of birth defect diagnoses derived from birth certificate data by maternal, infant, and hospital characteristics. METHODS: We compared birth certificate data for 1995-2005 births in Atlanta with data from the Metropolitan Atlanta Congenital Defects Program (MACDP). We calculated the sensitivity of birth certificates for reporting defects often discernable at birth (e.g., anencephaly, spina bifida, cleft lip, clubfoot, Down syndrome, and rectal atresia or stenosis). We used multivariable logistic regression models to examine associations with sociodemographic and hospital factors. RESULTS: The overall sensitivity of birth certificates was 23% and ranged from 7% for rectal atresia/stenosis to 69% for anencephaly. Non-Hispanic black maternal race/ethnicity, less than a high school education, and preterm birth were independently associated with a lower probability of a birth defect diagnosis being reported on a birth certificate. Sensitivity also was lower for hospitals with > 1,000 births per year. CONCLUSIONS: The underreporting of birth defects on birth certificates is influenced by sociodemographic and hospital characteristics. Interpretation of birth defects prevalence estimates derived from birth certificate reports should take these issues into account.

Effects of nurse navigators on health outcomes of cancer patients.

BACKGROUND: Care coordination has received increased attention in recent years because it critically affects patient safety and care quality across services and settings. OBJECTIVE: The effectiveness of systematically developed nurse navigator interventions for newly diagnosed cancer patients was evaluated. METHODS: Seventy-eight patients participated in a nonequivalent control group pretest-posttest design study. The study design spanned a 3-month period for all participants. Patient outcome measures included quality of life, satisfaction with care, and length of hospital stay. RESULTS: Participants in the experimental program reported significant increases in several components of quality of life and with satisfaction with care and experienced fewer hospital stay days compared with the control group. CONCLUSION: This study provides evidence that standardized nurse navigator programs can improve patient outcomes in cancer care. IMPLICATIONS FOR PRACTICE: Positive outcomes of the reduced length of stay and improved quality of life and patient satisfaction may help transform the cancer care delivery model toward more nurse-initiated cost-effective model.

Understanding attitudes toward people with Down syndrome.

Understanding attitudes of the public toward people with Down syndrome is important because negative attitudes might create barriers to social integration, which can affect their success and quality of life. We used data from two 2008 U.S. surveys (HealthStyles(c) survey of adults 18 years or older and YouthStyles(c) survey of youth ages 9-18) that asked about attitudes toward people with Down syndrome, including attitudes toward educational and occupational inclusion and toward willingness to interact with people with Down syndrome. Results showed that many adults continue to hold negative attitudes toward people with Down syndrome: A quarter of respondents agreed that students with Down syndrome should go to special schools, nearly 30% agreed that including students with Down syndrome in typical educational settings is distracting, and 18% agreed that persons with Down syndrome in the workplace increase the chance for accidents. Negative attitudes were also held by many youth: 30% agreed that students with Down syndrome should go to separate schools, 27% were not willing to work with a student with Down syndrome on a class project, and nearly 40% indicated they would not be willing to spend time with a student with Down syndrome outside of school. Among both adult and youth, female sex and respondents with previous relationships with people with Down syndrome were consistently associated with more positive attitudes. These results may be helpful in the development of educational materials about Down syndrome and in guiding policies on educational and occupational inclusion.