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PubMed2004

The productivity of Washington State's obstetrician-gynecologist workforce: does gender make a difference?

OBJECTIVE: To compare the practice productivity of female and male obstetrician-gynecologists in Washington State. METHODS: The primary data collection tool was a practice survey that accompanied each licensed practitioner's license renewal in 1998-1999. Washington State birth certificate data were linked with the licensure data to obtain objective information regarding obstetric births. RESULTS: Of the 541 obstetrician-gynecologists identified, two thirds were men and one third were women. Women were significantly younger than men (mean age 43.3 years versus 51.7 years). Ten practice variables were evaluated: total weeks worked per year, total professional hours per week, direct patient care hours per week, nondirect patient care hours per week, outpatient visits per week, inpatient visits per week, percent practicing obstetrics, number of obstetrical deliveries per year, percentage working less than 32 hours per week, and percentage working 60 or more hours per week. Of these, only 2 variables showed significant differences: inpatient visits per week (women 10.1 per week, men 12.8 per week, P < or =.01) and working 60 or more hours per week (women 22.1% versus men 31.5%, P < or =.05). After controlling for age, analysis of covariance and multiple logistic regression confirmed these findings and in addition showed that women worked 4.1 fewer hours per week than men (P <.01). When examining the ratio of female-to-male practice productivity in 10-year age increments from the 30-39 through the 50-59 age groups, a pattern emerged suggesting lower productivity in many variables in the women in the 40-49 age group. CONCLUSION: Only small differences in practice productivity between men and women were demonstrated in a survey of nearly all obstetrician-gynecologists in Washington State. Changing demographics and behaviors of the obstetrician-gynecologist workforce will require ongoing longitudinal studies to confirm these findings and determine whether they are generalizable to the rest of the United States. LEVEL OF EVIDENCE: II-3

Adult↗

PubMed2006

Lumbar fusion outcomes in Washington State workers' compensation.

STUDY DESIGN: Retrospective population-based cohort study. OBJECTIVE: To evaluate the influence of lumbar intervertebral fusion devices on clinical and disability outcomes among Washington State compensated workers with chronic back pain. SUMMARY OF BACKGROUND DATA: The efficacy of lumbar fusion for chronic low back pain remains controversial. Recent randomized controlled trials have shown results of fusion to be equivalent to those of structured exercise and cognitive intervention. Lumbar fusion rates, however, continue to increase nationally, fueled, in part, by introduction of new fusion devices, including intervertebral cages in 1996. It is not known whether these newer devices have improved outcomes, and particularly in compensated workers. METHODS: In this population-based retrospective cohort study, we identified Washington State injured workers who underwent lumbar fusion between 1994 and 2001 from Washington State Workers' Compensation system administrative database. All the data for this study were obtained from either the claims or medical bill payment databases. Multiple logistic regression analyses were used to examine the association between the surgical technique (interbody cages and/or instrumentation) and the risk of disability, reoperation, and complications following lumbar fusion. RESULTS: Among the 1,950 eligible subjects, fusions with cages increased from 3.6% in 1996 to 58.1% in 2001. Overall disability rate at 2 years after fusion was 63.9%, reoperation rate 22.1%, and rate for other complications 11.8%. Use of cages or instrumentation was associated with increased complication risk compared with bone-only fusions without improving disability or reoperation rates. Legal, work-related, and psychologic factors predicted worse disability. Discography and multilevel fusions predicted greater reoperation risk. Degenerative disc disease and concurrent decompression procedures predicted lower reoperation risk. CONCLUSIONS: Use of intervertebral fusion devices rose rapidly after their introduction in 1996. This increased use was associated with an increased complication risk without improving disability or reoperation rates.

Cohort Studies↗

PubMed2004

A communitywide intervention to improve outcomes and reduce disability among injured workers in Washington State.

One pressing challenge facing the U.S. health care system is the development of effective policies and clinical management strategies to address deficiencies in health care quality. In collaboration with researchers at the University of Washington, the Washington State Department of Labor and Industries has created a communitywide delivery system intervention to improve health outcomes and reduce disability among injured workers. This intervention is currently being tested in two sites in western and eastern Washington. So far, it appears to be possible to engage physicians and health care institutions in quality improvement initiatives and to form effective public-private partnerships for this purpose. Furthermore, collaborating with university researchers may help enhance the scientific rigor of the quality improvement initiative and create more opportunities for a successful evaluation.

Accidents, Occupational↗

PubMed2004

Oral health in the pediatric practice setting: a survey of Washington State pediatricians.

BACKGROUND: Pediatric health care providers may be the only source of preventive oral health education for families of young children who lack access to professional dental care. OBJECTIVE: We surveyed Washington State pediatricians in order to characterize their oral health-related educational needs and anticipatory guidance practices. METHODS: A 38-question survey was mailed to all 606 general pediatricians in Washington State. Topics included anticipatory practices and confidence in oral health-related activities. RESULTS: Of 483 eligible participants, 271 returned completed surveys (response rate: 57%). A median of 30 percent of the well-child visit was devoted to providing anticipatory guidance. A majority (83.7%) of respondents reported providing anticipatory guidance on oral health. CONCLUSION: Washington State pediatricians are already involved in providing oral health anticipatory guidance. Certain factors are identified that should be addressed to allow pediatricians to promote oral health more effectively.

Attitude of Health Personnel↗

PubMed2000

A novel multiresistant Streptococcus pneumoniae serogroup 19 clone from Washington State identified by pulsed-field gel electrophoresis and restriction fragment length patterns.

In 1997, a cluster of multiresistant invasive serogroup 19 pneumococcus infections, including two fatalities, was reported in Washington State. Further investigation identified other cases. Fourteen Washington Streptococcus pneumoniae isolates, four from Alaska, and eight isolates from eastern Canada with reduced penicillin susceptibility (MIC of > or =1 microg/ml) were included in the study. Pulsed-field gel electrophoresis (PFGE) with ApaI, SacII, and SmaI restriction enzymes and IS1167 and mef restriction fragment length polymorphism (RFLP) pattern analysis were performed. Twenty of the 26 isolates had identical or related PFGE patterns, with two or all three enzymes, and identical or related IS1167 RFLP patterns, indicating that they were genetically related. These 20 isolates contained the mef gene conferring erythromycin resistance and had identical mef RFLP patterns. The PFGE and RFLP patterns were distinct from those of six multiresistant clones previously described and suggest that a new multiresistant clone has appeared in Washington, Alaska, and eastern Canada. This newly characterized clone should be included in the Pneumococcal Molecular Epidemiology Network.

Anti-Bacterial Agents↗

PubMed2002

Child passenger safety: potential impact of the Washington State booster seat law on childcare centers.

OBJECTIVES: To examine factors associated with compliance and with perceived readiness for the new Washington State booster seat law, and to identify perceived barriers to compliance among licensed childcare centers. DESIGN/METHODS: Surveys were mailed to a random sample of 550 licensed childcare centers in Washington State, approximately nine months before the law was to go into effect. RESULTS: Only 18% of centers reported being compliant with the law at the time of the survey. Factors associated with current compliance included awareness and knowledge of the law, and being comfortable asking staff and parents to use booster seats. A lack of center-owned booster seats was associated with a lower likelihood of compliance. Only 43% of centers had already started preparing for the law, and only 48% believed they would definitely be ready in time. CONCLUSION: This study suggests that Washington State childcare centers need support and assistance to increase their knowledge of booster seats and reduce the financial costs of compliance.

Accidents, Traffic↗

PubMed1985

Implications of need-for-treatment laws: a study of Washington State's Involuntary Treatment Act.

In 1979 the State of Washington revised its civil commitment law to make it easier to hospitalize patients in need of care but not imminently dangerous to themselves or others. To assess the impact of the law, the author studied commitment patterns in Washington for two-year periods before and after the revised law went into effect. Results indicate that the number of involuntary commitments increased substantially after the law was revised, and the commitments were more likely to be based on grave disability rather than on dangerousness even if patients had engaged in violent behavior. However, the mental health system did not expand sufficiently to meet the needs of the increased patient population. Implications of Washington's experience for states considering passage of need-for-treatment legislation are discussed.

Commitment of Persons with Psychiatric Disorders↗

PubMed2005

Hypospadias in Washington State: maternal risk factors and prevalence trends.

OBJECTIVE: Maternal risk factors for hypospadias are poorly defined, and there is debate about temporal trends in hypospadias prevalence. We examined select maternal characteristics as possible risk factors for hypospadias among male offspring and evaluated yearly prevalence rates in Washington State. METHODS: We performed a population-based, case-control study using linked birth-hospital discharge data from Washington State for 1987-1997 and prevalence data for 1987-2002. All cases of hypospadias were identified on the basis of International Classification of Diseases, Ninth Revision, codes from the birth hospitalization (N = 2155). Five control subjects were randomly selected for each case subject from the remaining singleton births, frequency matched according to year of birth (N = 10775). Maternal and infant characteristics were ascertained from the birth certificate. Logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs). Yearly prevalence was determined by dividing the total number of hypospadias cases by the number of male singleton live births for each year. RESULTS: The risk of delivering an affected male infant increased with advancing maternal age; relative to women <20 years of age, those >40 years of age were at greatest risk (OR: 1.70; 95% CI: 1.17-2.48). Infants of nonwhite women were generally at decreased risk. Infants born to women with preexisting diabetes mellitus were at greater risk than those born to women without diabetes (OR: 2.18; 95% CI: 1.03-4.60); however, this was not observed for infants born to women with gestational diabetes. The birth prevalence of hypospadias in 2002 was 5.0 cases per 1000 male births, not significantly different from that in 1987. CONCLUSION: Older maternal age, white race, and preexisting diabetes were associated with increased risk of hypospadias among male offspring. The prevalence of hypospadias in Washington State did not increase significantly between 1987 and 2002.

Adult↗

PubMed1985

Prenatal care and pregnancy outcomes during the recession: the Washington State experience.

To determine whether changes in prenatal care utilization and adverse pregnancy outcomes occurred among poor residents of Washington State during the recent recession, we examined all births occurring from 1980 to 1983 to women in the poorest census tracts of the three major metropolitan counties in Washington State (N = 15,735). A comparison sample consisted of all births occurring in the highest income census tracts (N = 16,295). Because the impact of the recession was hypothesized to be greatest in 1982, rates in 1982 were compared with rates in 1980. The proportion of births receiving late or no prenatal care increased in both the low-income tracts (6.2 per cent to 8.2 per cent) and the high-income tracts (1.6 per cent to 2.3 per cent). The proportion of low birthweight infants increased only in the low-income tracts (6.3 per cent to 7.4 per cent). The prevalence of maternal anemia (hematocrit less than 30) also increased only in the low-income tracts (0.7 per cent to 1.7 per cent). While we were unable to ascertain the financial status of the individuals who suffered the adverse outcomes, the findings for the low-income census tracts are consistent with the hypothesis that an increase in adverse pregnancy outcomes occurred among the poor in Washington State during the recent recession.

Adolescent↗

PubMed1996

The regionalization of perinatal care in Wales and Washington State.

OBJECTIVES: The purpose of this study was to compare perinatal regionalization and neonatal mortality in Wales and Washington State. METHODS: The 28 hospitals in Wales and the 80 hospitals in Washington State that offered maternity services and the 218,326 births that occurred in these hospitals in 1989 and 1990 were studied. Surveys were used to identify the neonatal technology and the referral policies of each hospital, and linked data from birth and death certificates were used to examine birthweight-specific neonatal mortality rates for all babies born in these hospitals. RESULTS: Welsh district general hospitals (broadly equivalent to Level II perinatal centers in the United States) have more sophisticated neonatal technology than their Washington State counterparts and appear less likely to refer small or preterm babies to regional or subregional centers. Neonatal mortality rates were quite similar in the two settings. CONCLUSIONS: Perinatal care in Wales appears to be less regionalized than in a similar region in the United States. The relative lack of perinatal regionalization in Wales may contribute to duplication and underutilization of expensive neonatal technologies. National health care systems do not, in and of themselves, lead to optimal regionalization of services.

Birth Certificates↗

PubMed1998

Claims incidence of work-related disorders of the upper extremities: Washington state, 1987 through 1995.

OBJECTIVES: This study examined the claim incidence rate, cost, and industry distribution of work-related upper extremity disorders in Washington. METHODS: Washington State Fund workers' compensation claims from 1987 to 1995 were abstracted and categorized into general and specific disorders of gradual or sudden onset. RESULTS: Accepted claims included 100,449 for hand/wrist disorders (incidence rate: 98.2/10,000 full-time equivalents; carpal tunnel syndrome rate: 27.3), 30,468 for elbow disorders (incidence rate: 29.7; epicondylitis rate: 11.7), and 55,315 for shoulder disorders (incidence rate: 54.0; rotator cuff syndrome rate: 19.9). Average direct workers' compensation claims costs (medical treatment and indemnity) were $15,790 (median: $6774) for rotator cuff syndrome, $12,794 for carpal tunnel syndrome (median: $4190), and $6593 for epicondylitis (median: $534). Construction and food processing were among the industries with the highest rate ratios for all disorders (> 4.0). CONCLUSIONS: Upper extremity disorders represent a large and costly problem in Washington State industry. Industries characterized by manual handling and repetitive work have high rate ratios. The contingent workforce appears to be at high risk.

Absenteeism↗

PubMed2000

Reproductive health services in rural Washington State: scope of practice and provision of medical abortions, 1996-1997.

OBJECTIVES: This study explored reproductive health care in rural Washington State, reasons given by providers for not offering abortions, and providers' willingness to use medical abortifacients. METHODS: Physicians, midwives, nurse practitioners, and physician assistants in rural Washington completed an inventory of reproductive health services that they provide, whether and why they do not perform abortions, and whether they would use medical abortifacients. RESULTS: Of the respondents, 89.2% reported providing reproductive health care. Only 1.2% reported performing surgical abortions, and 26.1% indicated that they would probably prescribe medical abortifacients. CONCLUSIONS: Few providers offer surgical abortions in rural Washington. Greater numbers report a willingness to prescribe medical abortifacients.

Abortifacient Agents↗

PubMed2004

Babesia divergens-like infection, Washington State.

Most reported U.S. zoonotic cases of babesiosis have occurred in the Northeast and been caused by Babesia microti. In Washington State, three cases of babesiosis have been reported previously, which were caused by WA1 (for "Washington 1")-type parasites. We investigated a case of babesiosis in Washington in an 82-year-old man whose spleen had been removed and whose parasitemia level was 41.4%. The complete 18S ribosomal RNA gene of the parasite was amplified from specimens of his whole blood by polymerase chain reaction. Phylogenetic analysis showed the parasite is most closely related, but not identical, to B. divergens (similarity score, 99.5%), a bovine parasite in Europe. By indirect fluorescent-antibody testing, his serum reacted to B. divergens but not to B. microti or WA1 antigens. This case demonstrates that babesiosis can be caused by novel parasites detectable by manual examination of blood smears but not by serologic or molecular testing for B. microti or WA1-type parasites.

Aged↗

PubMed1992

Diploptene: an indicator of terrigenous organic carbon in Washington coastal sediments.

The pentacyclic triterpene 17 beta(H),21 beta(H)-hop-22(29)-ene (diploptene) occurs in sediments throughout the Columbia River drainage basin and off the southern coast of Washington state in concentrations comparable to long-chain plantwax n-alkanes. The same relationship is evident for diploptene and long-chain n-alkanes in soils from the Willamette Valley. Microorganisms indigenous to soils and soil erosion are indicated as the biological source and physical process, respectively, for diploptene in coastal sediments. Similarity between the stable carbon isotopic composition (delta 13CPDB) of diploptene isolated from soil in the Willamette Valley (-31.2 +/- 0.3%) and from sediments deposited throughout the Washington coastal environment (-31.2 +/- 0.5%) supports this argument. Values of delta for diploptene in river sediments are variable and 8-17% lighter, indicating that an additional biological source such as methane-oxidizing bacteria makes a significant contribution to the diploptene record in river sediments. Selective biodegradation resulting from a difference in the physicochemical association within eroded particles can explain the absence of the more-13C-depleted form of diploptene in Washington coastal sediments, but this mechanism remains unproven.

Alkanes↗

PubMed2006

Epidemiologic investigation of lead poisoning in trumpeter and tundra swans in Washington State, USA, 2000-2002.

An observational study was conducted to determine the proportionate mortality of wild trumpeter (Cygnus buccinator) and tundra (Cygnus columbianus columbianus) swans that died during the winters of 2000-02 in northwestern Washington State, USA. Among 400 swans necropsied, 81% were lead poisoned (302/365 trumpeter swans; 20/35 tundra swans). Mortality started in mid-November and peaked from late December through mid-February; swan mortality that was not associated with lead poisoning was uniformly lower throughout the winter months. Lead poisoning was 24 times more likely to be the cause of death in swans found in Whatcom County compared to swans found in other locations in northwestern Washington State (95% CI: 12.7, 47.0). Mortality attributable to lead poisoning was twice as likely in adults as in juveniles (95% CI: 1.0, 4.2). Aspergillosis was documented in 62 trumpeter and two tundra swans, including 37 swans in which mortality was caused by lead poisoning. Males were twice as likely as females to have aspergillosis (95% CI: 1.1, 3.8). Traumatic injuries were documented in 37 trumpeter and seven tundra swans, including seven trumpeter swans with concurrent lead poisoning. Dead swans found outside Whatcom County were four times more likely to have traumatic injuries compared to those found in Whatcom County (95% CI: 1.6, 10.0). Overall, lead-poisoned swans were significantly less likely to have concurrent aspergillosis or traumatic injuries. There was no apparent association between grit ingestion (total mass or mass categorized by size) and lead poisoning or number of lead shot. Not surprisingly, lead-poisoned swans were more likely to have one or more lead shot compared to swans that died from other causes (OR 294; 95% CI: 92, 1,005); lead-poisoned swans were also more likely to have one or more nontoxic shot compared to swans that were not poisoned (OR 63; 95% CI: 19, 318). The source(s) of shot are unknown but likely are in or near Whatcom County, Washington.

Animals↗

PubMedDate not supplied

Reproductive and sexual health benefits in private health insurance plans in Washington State.

CONTEXT: Although unintended pregnancy and sexually transmitted diseases (STDs) are considerable problems in the United States, private health insurance plans are inconsistent in their coverage of reproductive and sexual health services needed to address these problems. METHODS: A survey administered to a market-representative sample of 12 health insurance carriers in Washington State assessed benefit coverage for gynecologic services, maternity services, contraceptive services, pregnancy termination, infertility services, reproductive cancer screening, STD services, HIV and AIDS services, and sterilization, as well as for the existence of confidentiality policies. "Core" services in each category were defined based on U.S. Preventive Services Task Force and other recommendations. RESULTS: Of the 91 top-selling plans on which data were collected, 8% were indemnity plans, 14% were point-of-service plans, 21% were preferred-provider organization plans and 57% were health maintenance organization (HMO)-type products; they had a combined enrollment of 1.4 million individuals. Coverage of core services varied widely by type of plan. While a high proportion of plans covered core gynecologic, maternity, reproductive cancer screening, STD and HIV and AIDS services, nearly half of plans did not cover any kind of contraceptive method. Approximately 13% of female enrollees did not have core coverage for gyneco!ogic services, 19% for matemity services, 75% for contraception, 37% for sterilization and 53% for pregnancy termination; 98% of women and men were not covered for infertility treatment. Most carriers did not have specific policies for maintaining privacy of sensitive health information. Overall, benefit coverage was lower for indemnity, preferred-provider organization and HMO plans in Washington State than has previously been seen nationally. CONCLUSIONS: A sizable proportion of women and men in Washington State who rely on private-sector health insurance lack comprehensive coverage for key reproductive and sexual health services.

Family Planning Services↗

PubMed1992

Immunization practices of Washington State pediatricians--1989.

Administration of immunizations has become complicated by issues about consent, cost, and liability. To determine if these issues have changed the immunization practices of pediatricians, we surveyed pediatricians in private practice in Washington State. The survey results show that about one half of vaccines administered in pediatricians' offices are provided by the Washington State Health Department. The mean charge for administration of each parenteral vaccine was $7.02. Respondents strongly agreed that they would administer vaccine supplied by the Washington State Health Department if it was available. They also agreed that they referred patients to Health Department clinics for vaccination because of inability to pay and not because of concern about liability.

Child↗

PubMedDate not supplied

Smoking prevalence of pregnant women compared to women in the general population of Washington State.

We used two readily available sources of information to identify subgroups of pregnant Washington State women with high smoking rates. We compared smoking rates in pregnant women and women in general using information from the Washington State birth certificate collection system and the Washington State Behavioral Risk Factor Surveillance System. Smoking rates are substantially higher in young mothers 18-24 years of age than in comparable age cohorts in the general population of women in the state. In contrast, mothers 25 years of age and older smoke at lower rates than their age cohort in the general population. For multiparous women of all ages, smoking prevalence is related to age at first birth. Married women, whether pregnant or not, smoked less than unmarried women.

Adolescent↗