Washington State journal of public health practice最新文献

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Estimating Fluoride Exposure in Rural Communities: A Case Study in Western Washington. 估算农村社区的氟化物暴露：华盛顿州西部的一个案例研究。

Washington State journal of public health practice Pub Date : 2009-01-01

Janessa M Graves, William Daniell, Frank James, Peter Milgrom

{"title":"Estimating Fluoride Exposure in Rural Communities: A Case Study in Western Washington.","authors":"Janessa M Graves, William Daniell, Frank James, Peter Milgrom","doi":"","DOIUrl":"","url":null,"abstract":"PURPOSE: Efforts to achieve national objectives for fluoridation, such as Healthy People 2010, and water quality monitoring regulations focus on public water systems and generally overlook the 15% of U.S. households with private wells. Mandated testing of public water systems and new building sites on San Juan Island, Washington revealed naturally occurring fluoride levels up to several times the EPA Maximum Contaminant Level. This study evaluated fluoride concentrations in private wells and estimated the prevalence of dental fluorosis among children to inform local stakeholders. METHODS: Primary school children were examined by a dentist for dental fluorosis, parents were surveyed about fluoride exposures, and household drinking water samples were collected to measure and map fluoride concentrations. De-identified data were analyzed using chi-square and Fisher's exact tests. RESULTS: 18.8% of examined children exhibited mild dental fluorosis, a prevalence similar to national averages. Fluoride concentrations in drinking water were 0.08 to 1.30 mg/L, below levels for health concerns, and generally (94%) below levels recommended for caries prevention. Supplemental sources of fluoride (e.g. tablets) did not account for observed fluorosis. CONCLUSIONS: Results provided community stakeholders with valuable information to support decision-making regarding fluoride levels in drinking water. Previously available information suggested potential for excessive fluoride exposure, however, these study results indicated low fluoride levels were more common. The approach used in this case study suggests a simple method of assessing the scope of fluoridation needs in communities where private water sources are common, allowing for better informed decision-making with regard to future fluoridation efforts.","PeriodicalId":89054,"journal":{"name":"Washington State journal of public health practice","volume":"2 2","pages":"22-31"},"PeriodicalIF":0.0,"publicationDate":"2009-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2898138/pdf/nihms-196970.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29113923","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Medication Management Among Medicaid Myocardial Infarction Survivors. 医疗补助心肌梗死幸存者的药物管理。

Washington State journal of public health practice Pub Date : 2008-10-01

Erica B Oberg, Annette L Fitzpatrick, William E Lafferty, James P Logerfo

{"title":"Medication Management Among Medicaid Myocardial Infarction Survivors.","authors":"Erica B Oberg, Annette L Fitzpatrick, William E Lafferty, James P Logerfo","doi":"","DOIUrl":"","url":null,"abstract":"Despite guidelines to direct appropriate medical management, the quality of care following acute myocardial infarction (AMI) may be lacking. This study characterizes medication utilization by Medicaid enrollees in the year following AMI, compares it to guidelines for secondary prevention and investigates associations with rehospitalization and survival. Using DSHS administrative claims data from Washington State, Medicaid enrollees who had an AMI in 2004 were selected. Data were de-identified and details of demographics, hospitalizations, ambulatory care, and prescriptions over the following 365 days were abstracted. Utilization of guideline-directed secondary prevention strategies was measured and associations with death and recurrent hospitalization were tested. The mortality rate was 13.4% and 38.7% were rehospitalized. Mean time to first rehospitalization was 188.6 days (SD 102.3). Prescriptions for angiotensin enzyme inhibitors or receptor blockers were initially filled by 54.0%, but year-long adherence declined to 33.3%. Beta blockers, aspirin and statins followed the same trend: 65.1% to 39.5%, 37.9% to 16.7% and 58.1% to 41.9% respectively. Twenty-two percent received all medications; 8.2% were adherent. Only the initial prescription of aspirin was significantly associated with a survival benefit (HR = 0.35, p=0.003). If the results suggested by the claims data are representative of care delivered to Medicaid enrollees, rates of application of guideline-directed medication are less than optimal. To improve survival and reduce re-hospitalization following AMI, changes in the access and delivery of healthcare could be implemented to improve medication management, both at time of discharge and over the year following AMI.","PeriodicalId":89054,"journal":{"name":"Washington State journal of public health practice","volume":"1 1","pages":"1-12"},"PeriodicalIF":0.0,"publicationDate":"2008-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3107018/pdf/nihms227471.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30218839","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0