Introduction: Diagnostic testing is common in the emergency department. The value of some testing is questionable. The purpose of this study was to assess how varying levels of benefit, risk, and costs influenced an individual’s desire to have diagnostic testing.
Methods: A survey through Amazon Mechanical Turk presented hypothetical clinical situations: low risk chest pain and minor traumatic brain injury. Each scenario included three given variables (benefit, risk, and cost), that was independently randomly varied over four possible values (0.1%, 1%, 5%, 10% for benefit and risk and $0, $100, $500, and $1000 for the individual’s personal cost for receiving the test). Benefit was defined as the probability of finding the target disease (traumatic intracranial hemorrhage or acute coronary syndrome).
Results: A total of 1000 unique respondents completed the survey. Increasing benefit from 0.1% to 10%, the percent of respondents who accepted a diagnostic test went from 28.4% to 53.1%. [OR: 3.42 (2.57-4.54)] As risk increased from 0.1% to 10%, this number decreased from 52.5% to 28.5%. [OR: 0.33 (0.25-0.44)] Increasing cost from $0 to $1000 had the greatest change of those accepting the test from 61.1% to 21.4%, respectively. [OR: 0.15 (0.11-0.2)]
Conclusions: The desire for testing was strongly sensitive to the benefits, risks and costs. Many participants wanted a test when there was no added cost, regardless of benefit or risk levels, but far fewer elected to receive the test as cost increased incrementally. This suggests that out of pocket costs may deter patients from undergoing diagnostic testing with low potential benefit.
OBJECTIVE—Genital tract infection accounts for ~ 25–40% of all pre-term births. We sought to
assess the relationship between preterm birth and selected vaginal bacterial taxa associated with
preterm birth either directly or through their association with bacterial vaginosis (BV).
STUDY DESIGN—Vaginal fluid for Gram stain was collected between 17 and 22 weeks
gestation as part of a randomized trial of ultrasound-indicated cerclage for preterm birth
prevention in women at high risk for recurrent spontaneous preterm birth. Bacterial DNA was
extracted from the Gram stain slides and analyzed using quantitative PCR.
RESULTS—Among the 499 participants, Mycoplasma was positively correlated with increased
risk of preterm (RR = 1.83; 95% CI: 1.52,2.22) as was Mobiluncus (RR=1.36; 95% CI: 1.07, 1.73)
and Atopobium (RR=1.44; 95% CI: 1.1, 1.87). However, there were strong interactions between
race/ethnic group and the presence of these and other individual taxa on risk of preterm birth. By
contrast, BVAB3 was consistently associated with a reduction in risk of preterm birth for all
racial/ethnic groups (0.55; 95%CI: 0.39, 0.78).
CONCLUSIONS—BV is characterized by a reduction of Lactobacillus, and lactic acid
producing bacteria and the presence of Mobiluncus; we found these factors and presence of
Mycoplasma to be associated with increased risk of preterm birth. By contrast, the presence of a
recently identified organism sufficient to cause BV, BVAB3, decreased risk of preterm birth.
These findings give insight into why treating BV has mixed impact on risk of preterm birth.
We examined the community ecology of vaginal microbial samples taken from pregnant women with previous preterm birth experience to investigate whether targeted pathogenic and commensal bacteria are related to risk of preterm birth in the current pregnancy. We found a significant correlation between the community structure of selected bacteria and birth outcome, but the correlation differed among self-reported racial/ethnic groups. Using a community ordination analysis, we observed infrequent co-occurrence of Mycoplasma and bacteria vaginosis associated bacteria 3 (BVAB3) among black and Hispanic participants. In addition, we found that the vaginal bacteria responded differently in different racial/ethnic groups to modifications of maternal behavioral (ie, douching and smoking) and biological traits (ie, body mass index [BMI]). Even after accounting for these maternal behaviors and traits, the selected vaginal bacteria was significantly associated with preterm birth among black and Hispanic participants. By contrast, white participants did not exhibit significant correlation between microbial community and birth outcome. Findings from this study affirm the necessity of considering women’s race/ethnicity when evaluating the correlation between vaginal bacteria and preterm birth. The study also illustrates the importance of studying the vaginal microbiota from an ecological perspective, and demonstrates the power of ecological community analysis to improve understanding of infectious disease.
This is the post-randomization shortest cerclage measurement of each participant who entered the randomization (which means their cerclage measurement was less than 25mm at one of the visits). The data were provided by John Owens from U Alabama. No codebook was associated with it.
This is the clinical data and vaginal measurement data U of Alabama provided. The column names are fairly self-explanatory. There was not an original data codebook associated with it. There has been some email exchanges to clarify several variables, which is recorded in the Word file "cerclage_owenscodebook.doc".
This is the bacterial DNA data extracted from the gram stain slides. The targeted bacteria genera and species include: Atopobium spp., bacterial vaginosis-associated bacterium (BVAB) types 1, 2 and 3 in the order Clostridiales, Escherichia coli, Gardnerella vaginalis, Group B Streptococcus, Lactobacillus spp., Mobiluncus spp., Mycoplasma spp., and Ureaplasma spp. We also used a primer set for Lactic Acid Bacteria (LAB) that includes lactic acid producing bacteria of the genera Lactobacillus, Pediococcus, Leuconostoc, and Weissella. We calculated the relative proportion of each bacterial taxon using the bacterial copies measured by each specific bacteria primer divided by the total bacterial copies. The limit of detection was 100 copies and readings lower than the limit were considered negative