Birth Outcomes for Medically High-Risk Pregnancies: Comparing Group to Individual Prenatal Care

OBJECTIVES

 Group prenatal care models were initially designed for women with medically low-risk pregnancies, and early outcome data focused on these patient populations. Pregnancy outcome data for women with medically high-risk pregnancies participating in group prenatal care is needed to guide clinical practice. This study compares rates of preterm birth, low birth weight, and neonatal intensive care unit admissions among women with medical risk for poor birth outcomes who receive group versus individual prenatal care.

STUDY DESIGN

 This retrospective cohort study uses vital statistics data to compare pregnancy outcomes for women from 21 obstetric practices participating in a statewide expansion project of group prenatal care. The study population for this paper included women with pregestational or gestational hypertension, pregestational or gestational diabetes, and high body mass index (BMI > 45 kg/m2). Patients were matched using propensity scoring, and outcomes were compared using logistic regression. Two levels of treatment exposure based on group visit attendance were evaluated for women in group care: any exposure (one or more groups) or minimum threshold (five or more groups).

RESULTS

 Participation in group prenatal care at either treatment exposure level was associated with a lower risk of neonatal intensive care unit (NICU) admissions (10.2 group vs. 13.8% individual care, odds ratio [OR] = 0.708, p < 0.001). Participating in the minimum threshold of groups (five or more sessions) was associated with reduced risk of preterm birth (11.4% group vs. 18.4% individual care, OR = 0.569, p < 0.001) and NICU admissions (8.4% group vs. 15.9% individual care, OR = 0.483, p < 0.001). No differences in birth weight were observed.

CONCLUSION

 This study provides preliminary evidence that women who have or develop common medical conditions during pregnancy are not at greater risk for preterm birth, low birth weight, or NICU admissions if they participate in group prenatal care. Practices who routinely exclude patients with these conditions from group participation should reconsider increasing inclusivity of their groups.

KEY POINTS

· This study compares outcomes for women who receive group versus individual prenatal care. · The study population was limited to women with diabetes, hypertension, and/or high BMI.. · Group participants did not have higher rates of preterm birth, low birth weight, or NICU admissions..

Randomized Controlled Trial on the Effect of Group Versus Individual Prenatal Care on Psychosocial Outcomes

OBJECTIVE

To assess the effect of group prenatal care (GPNC) compared with individual prenatal care (IPNC) on psychosocial outcomes in late pregnancy, including potential differences in outcomes by subgroups.

DESIGN

Randomized controlled trial.

SETTING

An academic medical center in the southeastern United States.

PARTICIPANTS

A total of 2,348 women with low-risk pregnancies who entered prenatal care before 20 6/7 weeks gestation were randomized to GPNC (n = 1,175) or IPNC (n = 1,173) and stratified by self-reported race and ethnicity.

METHODS

We surveyed participants during enrollment (M = 12.21 weeks gestation) and in late pregnancy (M = 32.51 weeks gestation). We used standard measures related to stress, anxiety, coping strategies, empowerment, depression symptoms, and stress management practices in an intent-to-treat regression analysis. To account for nonadherence to GPNC treatment, we used an instrumental variable approach.

RESULTS

The response rates were high, with 78.69% of participants in the GPNC group and 83.89% of participants in the IPNC group completing the surveys. We found similar patterns for both groups, including decrease in distress and increase in anxiety between surveys and comparable levels of pregnancy empowerment and stress management at the second survey. We identified greater use of coping strategies for participants in the GPNC group, particularly those who identified as Black or had low levels of partner support.

CONCLUSION

Group prenatal care did not affect stress and anxiety in late pregnancy; however, the increased use of coping strategies may suggest a benefit of GPNC for some participants.

PSII-B-27 miRNA transcriptome of lamb skeletal muscle during hypertrophic growth from mid-gestation to market weight

The objective of this study was to characterize the miRNA transcriptome of the longissimus muscle during skeletal muscle hypertrophy. Longissimus samples were collected from Suffolk x Texel cross sheep at six developmental time points: Prenatal [gd 85 (PN1), 110 (PN2), and 133 (PN3)] and postnatal [preweaning (d 40; PW1), weaning (d 65; PW2), and maturity (57 kg; MKT)]. Total RNA was extracted for miRNA sequencing. Data were analyzed using a priori comparisons PN1 vs. PN2, PN2 vs. PN3, PN3 vs. PW1, PW1 vs. PW2, PW2 vs. MKT to examine stages of muscle hypertrophy. One hundred forty-two miRNAs were differentially expressed between the 5 comparisons made. The stage from PN3 to PW1 had the most differentially expressed miRNA (115). Examination of the differentially expressed miRNA also showed that 4 miRNA, miR-154a-3p, miR-3956-5p, miR-410-3p, and miR-431, had a log fold change greater than 3 and miR-22-3p had a log fold change greater than 4. Target genes of differentially expressed miRNA were identified and the functional associations of genes were assessed with GOseq. Between all 5 comparisons made, 195 terms were significantly enriched, 86 were from biological process, 42 were from cellular component, and 67 were from molecular function. The miRNA transcriptome of skeletal muscle changes with advancing development and the period from gd133 to d40 appears to have increased transcriptome alteration.

Transitioning From Detoxification to Substance Use Disorder Treatment: Facilitators and Barriers

Although successful transitions from detoxification to substance use disorder treatment are associated with improved outcomes, many detoxification patients do not initiate treatment. This qualitative study informs detoxification and addiction treatment providers, and health systems, about how to improve detoxification to treatment transitions, by reporting detoxification providers' views of transition facilitators and barriers. The sample consisted of 30 providers from 30 Veterans Health Administration detoxification programs. Themes regarding transition facilitators and barriers emerged at the patient, program (detoxification programs, and addiction programs), and system levels. Detoxification program-level practices of discharge planning, patient education, and rapport building were reported as facilitating the transition to treatment. Six themes captured transition facilitators within addiction treatment programs: the provision of evidence-based practices, patient-centered care, care coordination, aftercare, convenience, and a well-trained and professional staff. This study expands previous literature on detoxification and addiction treatment by systematically and qualitatively examining factors that promote and hinder treatment initiation after inpatient and outpatient detoxification, from a provider perspective, in an era of health care reform and expanded substance use disorder treatment.

The Availability and Utility of Services to Address Risk Factors for Recidivism among Justice-Involved Veterans

The availability and utility of services to address recidivism risk factors among justice-involved veterans is unknown. We explored these issues through qualitative interviews with 63 Specialists from the Department of Veterans Affairs' (VA) Veterans Justice Programs. To guide the interviews, we utilized the Risk-Need-Responsivity (RNR) model of offender rehabilitation. Specialists reported that justice-involved veterans generally have access to services to address most RNR-based risk factors (substance abuse; lack of positive school/work involvement; family/marital dysfunction; lack of prosocial activities/interests), but have less access to services targeting risk factors of antisocial tendencies and associates and empirically-based treatments for recidivism in VA. Peer-based services, motivational interviewing/cognitive-behavioral therapy, and Veterans Treatment Courts were perceived as useful to address multiple risk factors. These findings highlight potential gaps in provision of evidence-based care to address recidivism among justice-involved veterans, as well as promising policy-based solutions that may have widespread impact on reducing recidivism in this population.

Beyond risky alcohol use: screening non-medical use of prescription drugs at National Alcohol Screening Day

INTRODCUTION

Recent epidemiological data has indicated an increasing trend in the non-medical use of prescription drugs (NMUPD) among college students. NMUPD has shown a strong relationship with heavy alcohol use and associated negative consequences. Despite the trends and association with other risky behavior, there remain large gaps in the literature regarding this hazardous behavior. To date, no study has examined the prevalence of NMUPD among student attending National Alcohol Screening Day (NASD), and few studies have explored motives contributing to NMUPD, as well as the relationship between motives, NMUPD, and alcohol use.

METHODS

The current study examined the prevalence and motives for NMUPD among undergraduate students (N=128) attending NASD.

RESULTS

Overall, 42% of the sample reported NMUPD at least once in their lifetime, 29.7% at least once in the past year, and 18.0% reported simultaneously engaging in alcohol consumption and NMUPD. Pain relievers were the most frequently used drug class for lifetime use, and stimulants were the most frequently reported for past year use. Most students reported NMUPD for functional reasons. Students that engaged in binge drinking were three times more likely to report NMUPD.

CONCLUSIONS

The findings from the current study suggest that events like NASD may provide a platform for screening and discussing NMUPD, and its associated risk with heavy alcohol use.

The aunt and uncle effect: an empirical evaluation of the confounding influence of full sibs of parents on pedigree reconstruction

This study used simulations and a known two-generation pedigree of chinook salmon (Oncorhynchus tshawytscha) to evaluate the effect of full sibs of parents on pedigree reconstruction. Parentage analysis was conducted on 100 parent pair-offspring relationships from pedigrees with unrelated (simulation) and related (chinook salmon) candidate parents. Parentage assignment success for the chinook salmon was lower than in the simulated populations. For example, the six most variable loci (mean H(E) = 0.87) provided a mean of 97% unambiguous assignments in the simulated population and 67% unambiguous assignments for the chinook salmon. Estimates of the pairwise relatedness coefficient ((xy)) for most nonexcluded false parents and true parents of chinook salmon offspring exceeded 0.50. These results support the conclusion that closely related candidate parents decrease the power of genetic markers for pedigree reconstruction based on exclusion. Ambiguous parentage may be resolved using single parent- and parent pair-offspring likelihood analysis, however, these methods should be used with caution and they are not replacements for using more loci when many candidate parents are full sibs.

A preschool program for safety and injury prevention delivered by home visitors

OBJECTIVE

To evaluate the feasibility, acceptability, and effectiveness of an injury prevention program delivered by school based home visitors to the families of low income children attending preschool enrichment programs in Washington State.

STUDY SAMPLE

The families of children attending preschool Head Start programs in two regions were eligible. A total of 213 families (77.8% of those eligible) from intervention sites, and 149 families (71.9% of those eligible) from concurrent comparison sites, agreed to participate and completed the trial.

INTERVENTION

Trained school personnel conducted home safety inspections as part of a planned home visit. Intervention families were offered educational materials as well as smoke detectors, batteries, ipecac, and age appropriate car safety restraints based on results of the home inspection.

EVALUATION METHODS

At a repeat home visit three months later, the proportion of families with a positive change in injury prevention knowledge or behavior among those in the intervention group was compared with the proportion in the comparison group. Smoke detector presence and function were observed.

RESULTS

Among families without a working smoke detector at baseline, the intervention was associated with an increased probability of having a working detector at follow up (relative risk (RR) 3.3, 95% confidence interval (CI) 1.3 to 8.6). Intervention families were also more likely to report the presence of ipecac in the home (RR 4.7, 95% CI 3.0 to 7.3) at follow up and to have obtained an age appropriate booster seat (RR 4.1, 95% CI 1.9 to 8.8). The program was acceptable to client families and to the home visitors who conducted the intervention.

CONCLUSIONS

Among the families of low income children enrolled in preschool enrichment programs, home safety inspections and the distribution of safety supplies by school based home visitors appears to improve knowledge and behavior related to poisoning, smoke detector installation, and car safety seat use over three months of follow up.

Fatal visceral and neural sarcocystosis in dogs

This paper describes acute visceral and neural sarcocystosis in four dogs. One animal was simultaneously infected with distemper virus, and another with Blastomyces dermatitidis. Schizonts and merozoites of Sarcocystis canis were found in the lesions. 1999 W.B. Saunders and Company Ltd.

Ultrasonographic appearance of exogenous isobutane gas in the mammary glands of dairy cows

OBJECTIVE

To determine whether exogenous isobutane gas infused into the udders of dairy cattle could be detected ultrasonographically, and if so, what effects volume of gas infused and infusion pressure had on how long after infusion exogenous isobutane gas could be detected.

DESIGN

Randomized block design.

ANIMALS

8 Holstein cows 28 to 32 days after parturition.

PROCEDURE

In each cow, 1 mammary gland was not treated and the other 3 received 1 of 3 treatments by means of intramammary infusion: low volume-high pressure, low volume-low pressure, and high volume-high pressure infusion of isobutane gas. Mammary glands were examined ultrasonographically 1 hour before and 1, 3, 12, 24, 36, 48, 72, and 96 hours after treatment.

RESULTS

After intramammary infusion of isobutane gas, bright echoes and associated acoustic shadows were seen ultrasonographically; echoes were no longer seen 72 hours after gas infusion. Percentages of mammary glands in which bright echoes were detected were not significantly different among the 3 treatment groups at any time during the study.

CONCLUSIONS AND CLINICAL RELEVANCE

Results suggest that exogenous isobutane gas infused into the mammary glands to enhance the appearance of the udder of show dairy cattle can be readily detected by ultrasonography.

Bicycle helmet promotion among low income preschool children

OBJECTIVE

To evaluate the effectiveness of a multifaceted bicycle helmet promotion program for low income children attending preschool enrichment programs throughout Washington State.

STUDY SAMPLE

Preschool Head Start programs that conducted routine home visits among their enrolled families at least five times during the school year were eligible. Eighteen sites and 880 children met this criterion and were able and willing to carry out evaluation activities. Two hundred children were from control sites where no helmet promotion activities were carried out.

INTERVENTION

Classroom activities with children, education of parents during school meetings and home visits, fitting and distribution of helmets, a bicycle skills and safety "rodeo" event, and requiring children to wear helmets while riding on school grounds.

EVALUATION METHODS

Regularly scheduled home visits were used to observe helmet use of enrolled preschool children before and after the promotion program. Home visitors requested parental permission for enrolled children to ride, and then noted whether the child wore a helmet.

RESULTS

Helmet use in the intervention group more than doubled, from 43% to 89%, while use in the control group increased from 42% to 60% (p < 0.05 for intervention group changes v control group changes).

CONCLUSIONS

This multifaceted helmet promotion program successfully increased helmet use. Similar home visit protocols may be useful to evaluate the impact of other injury intervention programs.

Handgun purchase trends, Washington state: differences by age of buyer

STUDY OBJECTIVES

To examine trends in legal handgun purchases from federally licensed dealers and specifically to describe recent changes in age and gender of purchaser and caliber of handguns purchased.

METHODS

A cohort study was performed of the adult population of Washington state from 1950 through 1992 using a state dealer record of handgun sales database. The purchase of handguns from licensed dealers was expressed as the number purchased per 100,000 population per year.

RESULTS

The handgun purchase rate increased for the total population between 1950 and 1992, from 169 to 2,076 per 100,000 persons. Between 1983 and 1992, the purchase rate among men aged 21 to 24 years increased 184%; among women of this age group, the rate increased 127%. Among men aged 21 to 24 years, the rate of 9 mm handgun purchases increased 1,682% between 1983 and 1992, the greatest increase for any age-caliber category.

CONCLUSION

The greatest increase in rate of legal handgun purchases in Washington state from 1983 through 1992 was among the youngest purchasers. Sales of 9 mm handguns increased most rapidly, especially among the youngest buyers.

A comparison of measured and calculated output for highly blocked photon fields

The present work measured the accuracy of VAX monitor unit calculations currently used for highly blocked photon fields at The University of Texas M. D. Anderson Cancer Center. The VAX program is an in-house computer program that calculates the setting for linear accelerator photons that is needed to deliver a prescribed dose to a muscle miniphantom located on the beam's central axis at a prescribed depth beneath the surface in water. Monitor unit settings were computed for the Varian 2100 with multileaf collimation using 6 MV and 18 MV photons at a depth of 10 cm with different blocking ratios. Concentric and lateral blocking methods were used. Measurements were taken with an ion chamber and then compared with the VAX calculations with off-axis factors and peak scatter factors added in that are not available in the program. The results showed less than 2% difference for the concentric fields containing no more than 80% blocking and an equivalent square of at least 3.5 cm for 6 MV and 5 cm for 18 MV X-rays. For the lateral fields with the central axis blocked, less than 2% difference was found when blocking was 80% or less and the equivalent square was no less than 3.5 cm for 6 MV X-rays. For 18 MV X-rays, the maximum blocking and minimum equivalent square were 60% and 5 cm for 2% accuracy. This confirmed that the VAX system currently in use is accurate unless a very large amount of blocking is present or the central axis is blocked in very small fields. Previous research done at dmax with similar blocking ratios produced similar results.

Safe storage of handguns. What do the police recommend?

OBJECTIVE

To ascertain the specific suggestions that local police departments in the United States give to parents who ask for advice about methods to safely store handguns.

METHODS

A cross-sectional, semistructured telephone survey was administered to a sample of 102 police departments in the United States in cities with populations of 10,000 or more, selected within blocks of cities of similar population size. An investigator, posing as a parent of 3-year-old and 10-year-old children, called departments seeking specific advice on how to safely store a handgun acquired for protection.

RESULTS

Usable responses were generated for 93 (91%) of the departments sampled. Only 3 departments (3.2%) refused to give advice over the telephone. The most commonly suggested storage methods were trigger locks (55 departments [59%]), portable lockboxes for handguns (48 [52%]), and the separation of guns from ammunition (30 [32%]). Seven percent of departments suggested removing the gun from the household. Over half of those suggesting trigger locks and lockboxes considered these devices safe (35 [64%] for trigger locks and 27 [56%] for lockboxes) and yet rapidly accessible to an adult (36 [65%] for trigger locks and 36 [75%] for lockboxes). Responding police officers most commonly reported using the following storage methods at home: no storage method (31 [38%]), portable lockboxes (23 [28%]), out-of-reach location (11 [13%]), separation of gun and ammunition (10 [12%]), and trigger locks (5 [6%]).

CONCLUSIONS

Trigger locks are frequently recommended but infrequently used by police themselves at home. Portable lockboxes are frequently recommended as well as used by police.

Agreement between measures of pulmonary artery and tympanic temperatures

The purposes of this study were to compare pulmonary artery, oral, axillary, and two tympanic temperatures and test agreement between measures of pulmonary artery and tympanic temperatures in a convenience sample of 32 Intensive Care Unit patients. The correlation coefficients for pulmonary artery and oral, axillary, and tympanic temperatures were moderate to strong and significant at the p < .01 level. However, intraclass correlation coefficients estimated the intermethod reliability and were below the .75 criterion of acceptability. Thus, one method of temperature measurement could not be interchanged for another.

Implementation and acceptance of outreach telephone counseling for smoking cessation with nonvolunteer smokers

Brief supportive telephone counseling is a promising adjunct to self-help smoking cessation programs. This article reports rates of participation, predictors of participation, and content of telephone counseling calls with nonvolunteer smokers who were identified through health surveys administered to a random sample of enrollees in a health maintenance organization. Eighty-six percent of smokers accepted at least one of three counselor calls; 66% accepted all three calls. Baseline characteristics associated with acceptance of calls included being female and greater average length of time to the first cigarette of the day. Acceptance did not differ significantly by stage of cessation. First calls with smokers who accepted all three calls were longer and were more likely to be with smokers who were willing to take a specific next action step. Overall, 12% of the sample reported having quit smoking by the third counseling call, with the highest quit rate (23%) among smokers who, at baseline, were planning to quit in the next month. Implications for large-scale interventions with smokers in health care and other organizations are discussed.

Thymic dysfunction in chronic lymphocytic leukemia

Chronic lymphocytic leukemia (CLL) is, in the great majority of cases, a neoplastic proliferation of B cells. The associated immunologic dysfunction accounts for many of the clinically associated phenomenon such as infection and second malignancies. Much of this dysfunction has been attributed to poor B-cell function. Functional impairment of the T-cell component is currently being elucidated. In the investigation of B cells. The associated immunologic dysfunction accounts for many of the clinically associated phenomenon such as infection and second malignancies. Much of this dysfunction has been attributed to poor B-cell function. Functional impairment of the T-cell component is currently being elucidated. In the investigation of B cells. The associated immunologic dysfunction accounts for many of the clinically associated phenomenon such as infection and second malignancies. Much of this dysfunction has been attributed to poor B-cell function. Functional impairment of the T-cell component is currently being elucidated. In the investigation of B cells. The associated immunologic dysfunction accounts for many of the clinically associated phenomenon such as infection and second malignancies. Much of this dysfunction has been attributed to poor B-cell function. Functional impairment of the T-cell component is currently being elucidated. In the investigation of B cells. The associated immunologic dysfunction accounts for many of the clinically associated phenomenon such as infection and second malignancies. Much of this dysfunction has been attributed to poor B-cell function. Functional impairment of the T-cell component is currently being elucidated. In the investigations reported herein, we further demonstrate the immune deficiency of CLL by measuring proliferation and immunoglobulin synthesis in response to mitogens. Stimulation of various cell fractions indicates that in certain cases there is deficient T-helper, while others T function appears intact. In 2 of 4 cases tested there was augmentation of ig synthesis when the CLL cells were cocultured with thymic epithelium. The implications of such in vitro modulation are discussed.

Metabolism and biliary excretion of 2,4,5,2',4',5'-hexachlorobiphenyl in the rhesus monkey (Macaca mulatta)

The metabolism and biliary excretion of 3H-2, 4, 5, 2', 4', 5'hexachlorobiphenyl (HCB) were studied in two rhesus monkeys (Macaca mulatta), a young, mature female and a juvenile male. This compound is a major constituent of those commercial polychlorinated biphenyl (PCB) mixtures with high chlorine content, and it is also a prevalent PCB analogue in human adipose tissue. Following cannulation of the common bile duct and duodenum, allowing collection of a known fraction of bile with return of the remaining bile into the duodenum, the animals received 3H-HCB (1 gm/kg body weight) by gastric intubation. Bile was collected daily for 3 weeks. During the 3-week period, 1.3% and 4% (from the female and male, respectively) of the administered radioactivity were excreted in the bile. As has been demonstrated for other species, the monkey apparently metabolizes and excretes HCB at a rate slower than for compounds containing two adjacent unsubstituted carbons. Approximately 2% of the bile radioactivity in the adult female and 12% in the juvenile male were extracted with organic solvents. Thin layer chromatography (TLC), using a benzene:ethyl acetate (12:1) solvent system, of the organic extracts of bile separated four major regions of radioactivity designated as I, II, II, and IV with Rf values of 0.86, 0.67, 0.58, and 0.00, respectively. Region I consisted of the parent HCB, which was identified by analysis with gas chromatography-mass spectrometry (GC-MS). Region II consisted of a metabolite identified as 2,4,5,2',4',5'-hexachloro-3-hydroxybiphenyl (OH-HCB) by analysis with GC-MS of the methylated derivative of the metabolite. Region III probably contained a more polar metabolite, which has not yet been identified. Region IV contained an even more polar material, probably including conjugates of HCB metabolites. Release of OH-HCB from the water-soluble fraction of bile in the presence of beta-glucuronidase and lack of release of OH-HCB in presence of beta-glucuronidase with saccharo-1, 4-lactone (a beta-glucuronidase inhibitor) or in the presence of aryl sulfatase with saccharo-1, 4-lactone provided evidence of water-soluble, glucuronic acid conjugates of OH-HCB in the bile. The hexachlorobiphenyl was excreted in the bile as HCB, OH-HCB, and water-soluble conjugates of HCB metabolites, probably including 2,4,5,2',4',5'-hexachloro-3-hydroxybiphenyl glucuronide. The metabolism of HCB may or may not include the formation of an arene oxide.

Physical therapy rationale for physical therapy

Physical therapy is applied to relieve airway obstruction and to decrease the ventilatory effects of increased resistance to flow. The most direct method for reducing resistance through airways and collateral channels for ventilation is to increase lung volume. It is possible to vary the distribution of alveolar volume and airflow by changing the gradient of pleural pressure and the inspiratory flows. Results of physical therapy are frequently difficult to assess, especially if the simplest of end points, such as volume of sputum and arterial blood gases, are used. For example, the volume of sputum may not accurately reflect mucociliary transport either during or after a period of sputum collection, especially if cough is encouraged. Furthermore, arterial blood gases, like measures of airway resistance, may be insensitive indicators of changes in peripheral airways, especially if homeostatic mechanisms for maintaining ventilation-perfusion relationships are effective.

Hydatid disease in a mandrill baboon

Hydatidosis has been described in many species of domestic and wild mammals, including primates. Among the latter reported to have been infected are rhesus monkeys, orangutans, and savannah and drill baboons. This is a case report of hydatid disease due to Echinococcus granulosus in a mandrill baboon (Mandrillus sphinx).

Myelographic appearance of meningo-vascular lymphoma involving cauda equina

The myelographic pattern of diffuse meningo-vascular infiltration of the cauda equina is presented as characterized by marked enlargement of the nerve root shadows and occasional nodulation. This appearance, when coupled with appropriate clinical and laboratory findings, allows a specific diagnosis to be made.