Deployment Among Active-Duty Military Women and Pregnancy-Related Hypertensive Disorders.

INTRODUCTION: Today women comprise 15% of the U.S. active-duty military, but are often overlooked in research of the Armed Forces. While some of the challenges faced by women are similar to men, they encounter unique stressors, including pregnancy-related issues. Hypertensive disorders of pregnancy (HDPs) affect 5-10% of pregnancies annually and have been linked to maternal stress, but no studies have assessed the impact of maternal military deployment on HDP incidence. Thus, the purpose of the current study was to quantify the risk of HDP among active-duty U.S. military mothers who deployed in the post-9/11/2001 era. MATERIALS AND METHODS: We conducted a retrospective cohort study using a U.S. Department of Defense database comprised of all active-duty women who gave birth to their first, live-born singleton infant using Tricare from January 1, 2004 to December 31, 2008. The database included records for maternal/infant birth hospitalizations and deployment. HDP was defined with ICD-9-CM codes in the maternal birth hospitalization record. We evaluated the risk of HDP associated with several deployment measures for the cohort overall and among racial/ethnic groups: (1) deployment in general (yes vs. no); (2) timing of deployment ending prior to birth (<12 months or ≥12 months prior vs. non-deployed); and, (3) cumulative time spent deployed since 9/11/2001. We used multivariable logistic regression and reported odds-ratios (OR) and 95% confidence intervals (CI). We also explored meaningful categorization of certain continuous deployment measures associated with HDP incidence. The study was approved by the University of South Florida Institutional Review Board. RESULTS: There were a total of 36,667 births and 13.4% of mothers experienced at least one HDP. No increased risk of HDP was observed for deployed mothers compared with non-deployed mothers in the complete cohort (OR = 1.02, 95% CI: 0.95-1.09), but cumulative deployment length ≥1 year was identified as a potential risk factor for HDP vs. <1 year deployment (OR = 1.17, 95% CI: 1.00-1.36). CONCLUSION: Our study was the first to quantify the incidence of HDP among active-duty military women giving birth to their first child. It was slightly higher than in the general population, but deployment overall is seemingly not responsible for the elevated incidence.

Assessing the economic impact of paternal involvement: a comparison of the generalized linear model versus decision analysis trees.

Lack of paternal involvement has been shown to be associated with adverse pregnancy outcomes, including infant morbidity and mortality, but the impact on health care costs is unknown. Various methodological approaches have been used in cost minimization and cost effectiveness analyses and it remains unclear how cost estimates vary according to the analytic strategy adopted. We illustrate a methodological comparison of decision analysis modeling and generalized linear modeling (GLM) techniques using a case study that assesses the cost-effectiveness of potential father involvement interventions. We conducted a 12-year retrospective cohort study using a statewide enhanced maternal-infant database that contains both clinical and nonclinical information. A missing name for the father on the infant's birth certificate was used as a proxy for lack of paternal involvement, the main exposure of this study. Using decision analysis modeling and GLM, we compared all infant inpatient hospitalization costs over the first year of life. Costs were calculated from hospital charges using department-level cost-to-charge ratios and were adjusted for inflation. In our cohort of 2,243,891 infants, 9.2% had a father uninvolved during pregnancy. Lack of paternal involvement was associated with higher rates of preterm birth, small-for-gestational age, and infant morbidity and mortality. Both analytic approaches estimate significantly higher per-infant costs for father uninvolved pregnancies (decision analysis model: $1,827, GLM: $1,139). This paper provides sufficient evidence that healthcare costs could be significantly reduced through enhanced father involvement during pregnancy, and buttresses the call for a national program to involve fathers in antenatal care.

Cutting-edge technology for public health workforce training in comparative effectiveness research.

A critical mass of public health practitioners with expertise in analytic techniques and best practices in comparative effectiveness research is needed to fuel informed decisions and improve the quality of health care. The purpose of this case study is to describe the development and formative evaluation of a technology-enhanced comparative effectiveness research learning curriculum and to assess its potential utility to improve core comparative effectiveness research competencies among the public health workforce. Selected public health experts formed a multidisciplinary research collaborative and participated in the development and evaluation of a blended 15-week comprehensive e-comparative effectiveness research training program, which incorporated an array of health informatics technologies. Results indicate that research-based organizations can use a systematic, flexible, and rapid means of instructing their workforce using technology-enhanced authoring tools, learning management systems, survey research software, online communities of practice, and mobile communication for effective and creative comparative effectiveness research training of the public health workforce.

Prevalence of major infections and adverse outcomes among hospitalized. ST-elevation myocardial infarction patients in Florida, 2006.

BACKGROUND: ST-elevation myocardial infarction (STEMI) patients have risk factors and co-morbidities and require procedures predisposing to healthcare acquired infections (HAIs). As few data exist on the extent and consequences of infections among these patients, the prevalence, predictors, and potential complications of major infections among hospitalized STEMI patients at all Florida acute care hospitals during 2006 were analyzed. METHODS: Sociodemographic characteristics, risk factors, co-morbidities, procedures, complications, and mortality were analyzed from hospital discharge data for 11, 879 STEMI patients age ≥ 18 years. We used multivariable logistic regression modeling to examine and adjust for multiple potential predictors of any infection, bloodstream infection (BSI), pneumonia, surgical site infection (SSI), and urinary tract infection (UTI). RESULTS: There were 2,562 infections among 16.6% of STEMI patients; 6.2% of patients had ≥2 infections. The most prevalent HAIs were UTIs (6.0%), pneumonia (4.6%), SSIs (4.1%), and BSIs (2.6%). Women were at 29% greater risk, Blacks had 23% greater risk, and HAI risk increased 11% with each 5 year increase in age. PCI was the only protective major procedure (OR 0.81, 95% CI, 0.69-0.95, p < .05). HAI lengthened hospital stays. STEMI patients with a BSI were almost 5 times more likely (31.3% vs. 6.5%, p < .0001), and those with pneumonia were 3 times more likely (19.6% vs. 6.5%, p < .0001) to die before discharge. CONCLUSIONS: The protective effect of PCI on risk of infection is likely mediated by its many benefits, including reduced length of hospitalizations.