bluuebunny/crossref_metadata_2025 huggingface dataset:
Silver Spoons and Platinum Plans: How Childhood Environment Affects Adult Health Care Decisions
Authors: Mittal Chiraag , Griskevicius Vladas
Published: August 2016

Can socioeconomic status in childhood influence desire for health coverage in adulthood? We develop and test a model that yielded two sets of findings across five experiments. First, people who grew up poor were generally less interested in health coverage compared to those who grew up wealthy. This effect was independent of people’s current level of socioeconomic status, emerged most strongly when adults were experiencing financial threat, and was mediated by differences in willingness to take risks between people from poor versus wealthy childhoods. Second, we show that this effect reverses when people are provided with base-rate information about disease. When information about the average likelihood of getting sick is made available, people who grew up poor were consistently more likely to seek health coverage than people who grew up wealthy. This effect was again strongest when people felt a sense of financial threat, and it was driven by people from poor versus wealthy childhoods differing in their perceptions of the likelihood of becoming sick. Overall, we show how, why, and when childhood socioeconomic status influences desire for health coverage.
Prosthetic Heart Valves in Pregnancy, Outcomes for Women and their Babies: A Systematic Review and Meta-analysis
Authors: Lawley C.M. , Lain S.J. , Algert C.S. , Ford J.B. , Figtree G.A. , Roberts C.L.
Published: August 2016

(BJOG. 2015;122(11):1446–1455)

An increased incidence of adverse outcomes (maternal mortality, miscarriage, thromboembolism, and obstetric hemorrhage) has been reported among pregnant women with prosthetic heart valves. Infants born to these women are also at increased risk of perinatal mortality, preterm birth, small-for-gestational-age, and congenital malformations. There have been advances in prosthetic heart valve design and medical care, leading to improved outcomes for patients with prosthetic valves. Review of the available data on recent outcomes in parturients with prosthetic heart valves is therefore required. The primary objective of this systematic review was to assess the risk of an adverse outcome in pregnant women with prosthetic heart valve(s) over the last 20 years (1995 to 2014). Absolute risk of adverse outcomes by prosthetic type and/or location was also evaluated as a secondary objective.
Lumbar Neuraxial Ultrasound for Spinal and Epidural Anesthesia: A Systematic Review and Meta-Analysis
Authors: Perlas A. , Chaparro L.E. , Chin K.J.
Published: August 2016

(Reg Anesth Pain Med. 2016;41(2):251–260)

Using an ultrasound to examine a patient’s spine prior to the administration of spinal or epidural anesthesia is a new development in regional anesthesia. Such an examination allows anesthesiologists to observe the underlying anatomy and helps improve the accuracy of needle placement. Previous reports have described spinal and epidural techniques that use ultrasound for real-time guidance, which is distinct from this ultrasound-assisted approach. This review assessed the evidence in favor of preprocedural neuraxial ultrasound as a supplementary procedure to lumbar spinal and epidural anesthesia in adults.
The Impact of Socioeconomic Position on Severe Maternal Morbidity Outcomes Among Women in Australia: A National Case-control Study
Authors: Lindquist A. , Noor N. , Sullivan E. , Knight M.
Published: August 2016

(BJOG. 2015;122(12):1601–1609)

Research conducted in Australia in 2000 determined that although there had been improvements in the health of the population over previous years, increased inequalities for socioeconomically related mortality had occurred for some conditions. Studies in other developed countries, such as the United Kingdom, have suggested that socioeconomic position may be a risk factor for poorer pregnancy outcomes. Identifying high-risk parturients is critical for the prevention of adverse pregnancy outcomes because it allows targeted interventions and intensive clinical management of specific groups of women. The Australasian Maternal Outcomes Surveillance System is based on the methodology of the UK Obstetric Surveillance System and enables research and surveillance for a range of pregnancy complications across Australia and New Zealand. This study aimed to explore the independent impact of socioeconomic position on selected severe maternal morbidities among women in Australia.
Risk Factors for and Prediction of a Difficult Neuraxial Block: A Cohort Study of 73,579 Patients from the Danish Anaesthesia Database
Authors: Stendell L. , Lundstrøm L.H. , Wetterslev J. , Itenov T.S. , Rosenstock C.V.
Published: August 2016

(Reg Anesth Pain Med. 2015;40(5):545–552)

Administering epidural, spinal, or combined epidural-spinal anesthesia can be challenging due to a variety of anatomical, technical, and pharmacological factors. As a difficult neuraxial block can result in complications, it is important that anesthesiologists be able to anticipate such an occurrence and take the necessary steps to resolve the situation. The purpose of this study was to determine how common difficult neuraxial blocks are and investigate the potential factors that might contribute to them. The investigators also sought to determine the efficacy of an accumulated risk score used to predict a difficult neuraxial block.
Antenatal Blood Pressure for Prediction of Preeclampsia, Preterm Birth, and Small for Gestational Age Babies: Development and Validation in 2 General Population Cohorts
Authors: Macdonald-Wallis C. , Silverwood R.J. , de Stavola B.L. , Inskip H. , Cooper C. , Godfrey K.M. , Crozier S. , Fraser A. , Nelson S.M. , Lawlor D.A. , Tilling K.
Published: August 2016

(BMJ. 2015;351:h5948)

Preeclampsia is one of the most common complications of pregnancy and is associated with adverse outcomes, such as maternal and fetal mortality, intrauterine growth restriction, and preterm birth. The aim of this study was to determine whether the addition of routine antenatal blood pressure measurements between 20 and 36 weeks of gestation could improve the predictive value of existing prediction models for preeclampsia and its associated adverse outcomes, which only include a blood pressure measurement from the first antenatal visit.
Progression From Severe Sepsis in Pregnancy to Death: A UK Population-based Case-control Analysis
Authors: Mohamed-Ahmed O. , Nair M. , Acosta C. , Kurinczuk J.J. , Knight M.
Published: August 2016

(BJOG. 2015;122(11):1506–1515)

Sepsis continues to be a significant cause of maternal mortality. A better understanding of the factors associated with sepsis progressing to death could help physicians identify those patients at highest risk and develop policies and management strategies that could decrease mortality. The primary aim of this study was to identify the demographic, socioeconomic, medical, obstetric, and management factors associated with progression from pregnancy related severe sepsis to death.
Human Lumbar Ligamentum Flavum Anatomy for Epidural Anesthesia: Reviewing a 3D MR-based Interactive Model and Postmortem Samples
Authors: Reina M.A. , Lirk P. , Puigdellívol-Sánchez A. , Mavar M. , Prats-Galino A.
Published: August 2016

(Anesth Analg. 2016;122:903–907)

The ligamentum flavum (LF) is an important structure for sensing loss of resistance, which is the technique used to find the epidural space when administering epidural anesthesia. However, due to individual variations, midline gaps, and inherent anatomical characteristics, there can be variations in the structure of the LF that make it difficult to accurately determine loss of resistance. The authors created an interactive 3-dimensional (3D) model of the spine using magnetic resonance imaging (MRI) images from healthy patients. In this article, they compared this reconstruction to results from cadavers to test the model and better determine the shape and structure of the LF.
Unilateral Transversus Abdominis Plane Block Catheter for the Treatment of Abdominal Wall Pain in Pregnancy
Authors: Miller E.C. , Szeto M. , Boet S.
Published: August 2016

(Reg Anesth Pain Med. 2015;40:720–722)

A transversus abdominis plane (TAP) block anesthetizes the abdominal wall from T6 to L1 and is often used on patients recovering from a variety of abdominal surgeries. This case report describes the use of a TAP block to manage abdominal wall pain in a pregnant patient, something which has not been reported until now.
Distinct Cortical Signatures Associated with Sedation and Respiratory Rate Depression by Morphine in a Pediatric Population
Authors: Montandon Gaspard , Cushing Sharon L. , Campbell Fiona , Propst Evan J. , Horner Richard L. , Narang Indra
Published: August 2016

Background

Opioid analgesia is an essential component of perioperative care, but effective analgesia can be limited by excessive sedation and respiratory depression. The cortical signatures associated with sedation by opioids and the relationship between changes in cortical activity and respiratory function are not well understood. The objectives of this study were to identify the electroencephalogram signatures of sedation and respiratory changes induced by morphine in a pediatric population after elective surgery.

Methods

After otologic surgery, patients (14.8 ± 2.8 yr, n = 10) stayed overnight for pain relief with morphine (3 to 10 mg), hydration, and clinical observation. Electroencephalogram activity and polysomnography were performed before and after morphine, and electroencephalogram spectral properties and cardiorespiratory activities were analyzed.

Results

Compared to wakefulness and non–rapid eye movement sleep, morphine reduced high-frequency β1 (13.5 to 20 Hz) and β2 (20 to 30Hz) electroencephalogram powers (n = 10) and decreased coherence between frontal and occipital β2 electroencephalogram activities (n = 9), therefore indicating that morphine induced a deep sedative state. Morphine also reduced respiratory rate by 8.3% (n = 10). Interestingly, there was a significant correlation between the reduction in β1 electroencephalogram activity and the depression in respiratory rate induced by morphine (R = 0.715, n = 10). With significant reduction in β1 power, respiratory rate was decreased by more than 25%, suggesting that reduction in cortical arousal is associated with the severity of respiratory rate depression.

Conclusions

Analgesic doses of morphine are associated with reduction in respiratory rate when accompanied by reduction in β1 electroencephalogram power, indicating a powerful effect of cortical arousal state per se in respiratory rate depression by morphine.
Unilateral Human Papillomavirus Infection and Cervical Dysplasia in a Patient With Two Cervices
Authors: Gujral Harneet , Bennett Jennifer A. , Wright Kelly N.
Published: August 2016

BACKGROUND:

In a uterine didelphys with two cervices, cervical screening may not reveal the same abnormalities.

CASE:

We present a patient with a uterine didelphys with two cervices in a single vagina after resection of a longitudinal vaginal septum at age 12. She presented with abnormal Pap test results with the right and left cervices discordant from each other. Despite both cervices sharing stroma in the midline, her right cervix was negative for human papillomavirus (HPV) and dysplasia, while her left cervix was HPV positive with high-grade cervical dysplasia on an excisional specimen.

CONCLUSION:

Uterine didelphys with shared bilateral cervices will not necessarily share the same HPV status or have concordant dysplasia.
Surgical Management of a Heterotopic Cesarean Scar Pregnancy With Preservation of an Intrauterine Pregnancy
Authors: Vetter Monica Hagan , Andrzejewski Joseph , Murnane Alan , Lang Christopher
Published: August 2016

BACKGROUND:

Spontaneously conceived heterotopic pregnancies are rare. A heterotopic cesarean scar pregnancy involves an intrauterine pregnancy and a second pregnancy in the cesarean scar. Treatment approaches include both medical and surgical management. We present a surgical approach to the treatment of a heterotopic cesarean scar pregnancy with preservation of an intrauterine gestation.

CASE:

A 29-year-old woman, gravida 4 para 1021, presented at 5 weeks of gestation with spotting. Ultrasonography revealed a heterotopic cesarean scar pregnancy. The patient underwent resection of the ectopic pregnancy through minilaparotomy in an attempt to conserve the intrauterine pregnancy. She subsequently delivered an early-term neonate.

CONCLUSION:

Laparotomy with resection of the ectopic pregnancy is an option for treatment of an early heterotopic cesarean scar pregnancy when the patient desires conservation of the intrauterine pregnancy. Excision was not associated with pregnancy complications.
Simulation Training for Forceps-Assisted Vaginal Delivery and Rates of Maternal Perineal Trauma
Authors: Gossett Dana R. , Gilchrist-Scott Douglas , Wayne Diane B. , Gerber Susan E.
Published: August 2016

OBJECTIVE:

To evaluate the association of a forceps simulation training curriculum for obstetrics residents on rates of severe perineal lacerations after forceps deliveries.

METHODS:

This was a retrospective cohort study. We created a novel simulation curriculum for forceps-assisted vaginal delivery based on the best practices of local experts, and trained all residents beginning in 2013. We then retrospectively reviewed all forceps deliveries performed in the 2.5 years after initiation of the training and the 7.5 years before the training program. We identified patients who experienced a severe perineal laceration (third- or fourth-degree) and examined the relationship of resident training status and perineal laceration. Known risk factors for lacerations were identified and a multilevel multivariable model was created including these factors as well as resident training.

RESULTS:

During the study period, we identified 6,058 forceps-assisted vaginal deliveries. We examined temporal trends in rates of forceps of severe perineal laceration. We identified a decrease in severe lacerations between 2005 and 2008, ending 5 years before the initiation of the training curriculum. These years were censored from the data, yielding a baseline observational period of 4,279 deliveries with no significant trend in laceration rate. Univariate analysis reveals a 22% reduction in severe perineal laceration (odds ratio [OR] 0.78; P=.005) among women delivered by residents who had completed forceps simulation training compared with women delivered by residents who had not. After adjusting for known maternal and delivery risk factors for perineal laceration, the magnitude of the reduction increased to 26% in the full data set model (OR 0.74; P=.002).

CONCLUSION:

A forceps simulation curriculum for obstetrics residents was associated with a significant reduction in severe perineal lacerations.
Association of Recorded Estimated Fetal Weight and Cesarean Delivery in Attempted Vaginal Delivery at Term
Authors: Froehlich Rosemary J. , Sandoval Grecio , Bailit Jennifer L. , Grobman William A. , Reddy Uma M. , Wapner Ronald J. , Varner Michael W. , Thorp John M. , Prasad Mona , Tita Alan T.N. , Saade George , Sorokin Yoram , Blackwell Sean C. , Tolosa Jorge E. ,   MSCE, for the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units (MFMU) Network
Published: August 2016

OBJECTIVE:

To evaluate the association between documentation of estimated fetal weight, and its value, with cesarean delivery.

METHODS:

This was a secondary analysis of a multicenter observational cohort of 115,502 deliveries from 2008 to 2011. Data were abstracted by trained and certified study personnel. We included women at 37 weeks of gestation or greater attempting vaginal delivery with live, nonanomalous, singleton, vertex fetuses and no history of cesarean delivery. Rates and odds ratios (ORs) were calculated for women with ultrasonography or clinical estimated fetal weight compared with women without documentation of estimated fetal weight. Further subgroup analyses were performed for estimated fetal weight categories (less than 3,500, 3,500–3,999, and 4,000 g or greater) stratified by diabetic status. Multivariable analyses were performed to adjust for important potential confounding variables.

RESULTS:

We included 64,030 women. Cesarean delivery rates were 18.5% in the ultrasound estimated fetal weight group, 13.4% in the clinical estimated fetal weight group, and 11.7% in the no documented estimated fetal weight group (P<.001). After adjustment (including for birth weight), the adjusted OR of cesarean delivery was 1.44 (95% confidence interval [CI] 1.31–1.58, P<.001) for women with ultrasound estimated fetal weight and 1.08 for clinical estimated fetal weight (95% CI 1.01–1.15, P=.017) compared with women with no documented estimated fetal weight (referent). The highest estimates of fetal weight conveyed the greatest odds of cesarean delivery. When ultrasound estimated fetal weight was 4,000 g or greater, the adjusted OR was 2.15 (95% CI 1.55–2.98, P<.001) in women without diabetes and 9.00 (95% CI 3.65–22.17, P<.001) in women with diabetes compared to those with estimated fetal weight less than 3,500 g.

CONCLUSION:

In this contemporary cohort of women attempting vaginal delivery at term, documentation of estimated fetal weight (obtained clinically or, particularly, by ultrasonography) was associated with increased odds of cesarean delivery. This relationship was strongest at higher fetal weight estimates, even after controlling for the effects of birth weight and other factors associated with increased cesarean delivery risk.
Antenatal Corticosteroids for the Prevention of Respiratory Distress Syndrome in Premature Twins
Authors: Viteri Oscar A. , Blackwell Sean C. , Chauhan Suneet P. , Refuerzo Jerrie S. , Pedroza Claudia , Salazar Ximena C. , Sibai Baha M.
Published: August 2016

OBJECTIVE:

To estimate whether antenatal corticosteroids before 34 weeks of gestation are associated with reduced incidence of respiratory distress syndrome (RDS) and composite neonatal morbidity in preterm twins.

METHODS:

This was a secondary analysis of a multicenter randomized trial for the prevention of preterm birth in multiple gestations. All liveborn, nonanomalous twins delivered between 24 0/7 and 36 6/7 weeks of gestation were included. Neonatal outcomes were compared between women who received antenatal corticosteroids and those who did not. The primary outcome was the incidence of RDS. The secondary outcome was the incidence of serious composite neonatal morbidity. Multivariable log Poisson regression with correlation adjustment between twins born to the same mother was performed for confounder control. Adjusted relative risks (RRs) are reported for study outcomes. Based on a post hoc power analysis, this study was powered to detect an RR less than 0.63 for RDS and greater than 1.43 for composite neonatal morbidity outcomes.

RESULTS:

A total of 432 women (850 neonates) were included. Only 300 (35%) neonates were born to women receiving antenatal corticosteroids. After multivariable regression, antenatal corticosteroids were not associated with a reduced incidence of RDS (81 [27%] compared with 92 [17%] neonates, adjusted RR 1.28, 95% confidence interval [CI] 0.97–1.71) or composite neonatal morbidity (87 [29%] compared with 108 [20%] neonates, adjusted RR 1.21, 95% CI 0.93–1.56). However, antenatal corticosteroids were associated with increased rates of neonatal intensive care unit admissions (235 [78%] compared with 322 [59%] neonates, adjusted RR 1.22, 95% CI 1.09–1.36) and mechanical ventilation (70 [23%] compared with 66 [12%] neonates, adjusted RR 1.52, 95% CI 1.12–2.09). Focusing analysis to newborns delivered before 34 weeks of gestation (n=311), 161 (52%) received antenatal corticosteroids. Similarly, no differences in the rate of RDS (66 [41%] compared with 68 [45%] neonates, adjusted RR 1.01, 95% CI 0.76–1.34) or composite neonatal morbidity (72 [45%] compared with 81 [54%] neonates, adjusted RR 0.95, 95% CI 0.74–1.22) were noted.

CONCLUSION:

In this cohort of preterm twins, antenatal corticosteroid administration was not associated with a reduced incidence of RDS and composite neonatal morbidity.
Smoking Before and During Pregnancy Among Women Reporting Depression or Anxiety
Authors: Tong Van T. , Farr Sherry L. , Bombard Jennifer , D'Angelo Denise , Ko Jean Y. , England Lucinda J.
Published: August 2016

OBJECTIVE:

To describe prepregnancy smoking, prenatal smoking, and prenatal cessation among women reporting and not reporting depression or anxiety.

METHODS:

We analyzed cross-sectional data from the 2009–2011 Pregnancy Risk Assessment Monitoring System, a population-based survey of women with live births (N=34,633). Smoking status was defined as self-reported prepregnancy smoking (during the 3 months before pregnancy), prenatal smoking (during the last 3 months of pregnancy), and prenatal cessation (no smoking by the last 3 months among prepregnancy smokers). Depression and anxiety status was self-reported of having either condition or both during the 3 months before pregnancy. We compared smoking prevalence by self-reported depression and anxiety status using χ2 tests and adjusted prevalence ratios.

RESULTS:

Overall, 16.9% of women in our sample reported depression, anxiety, or both during the 3 months before pregnancy. Compared with those who did not report, women who reported depression or anxiety had significantly higher prepregnancy (46.7% compared with 22.5%, P<.01) and prenatal smoking (27.5% compared with 10.5%, P<.01). A lower proportion of prepregnancy smokers who reported depression or anxiety quit smoking by the last 3 months of pregnancy than those who did not report (41.4% compared with 53.8%, P<.01). In adjusted analyses, women reporting depression or anxiety were 1.5 and 1.7 times more likely to smoke prepregnancy and prenatally, respectively, and less likely to quit smoking (adjusted prevalence ratio 0.86, 95% confidence interval 0.80–0.92).

CONCLUSION:

Women who reported depression, anxiety, or both were more likely to smoke before and during pregnancy and less likely to quit smoking during the prenatal period. Screening recommendations for perinatal depression and anxiety provide an opportunity to identify a subpopulation of women who may have a higher prevalence of smoking and to provide effective tobacco cessation interventions and mental health care.
Insect Repellants During Pregnancy in the Era of the Zika Virus
Authors: Wylie Blair J. , Hauptman Marissa , Woolf Alan D. , Goldman Rose H.
Published: August 2016

Health care providers must be equipped to provide appropriate advice to reproductive-aged patients for protection against the potentially devastating consequences of prenatal Zika virus exposure. The goal of this commentary is to summarize what is known about the safety and toxicity of N,N-diethyl-meta-toluamide (DEET) as a topical insect repellant and the pyrethroid permethrin for treatment of fabric, endorsed in the fight against Zika virus. Reviews assessing the safety and toxicity of DEET conducted by the U.S. Environmental Protection Agency and the Canadian Pest Management Regulatory Agency conclude that DEET has low acute toxicity and does not appear to pose a significant health concern to humans when used as directed. Some experimental animal and limited epidemiologic data suggest that prenatal pyrethroid exposure may adversely affect learning and behavior, but this level of evidence pales in comparison to the known risks of Zika virus to the fetal brain. The available evidence has led to the strong recommendation by the Centers for Disease Control and Prevention for use of these products by pregnant women as personal protection against mosquito bites in the fight against Zika virus infection. This message has been affirmed by our obstetrics and gynecology professional organizations. Because Zika virus is unlikely to be the last disease requiring vector control, those with environmental health expertise must continue to join with infectious disease specialists to communicate the potential vulnerability of our youngest (fetuses, infants, and young children) to vector-borne disease, both to the disease itself and to the strategies employed to mitigate the spread of such disease.
Slow progressive popliteal artery insufficiency after neglected proximal tibial physeal fracture: a case report
Authors: Shinomiya Rikuo , Sunagawa Toru , Nakashima Yuko , Nakabayashi Akihiro , Makitsubo Manami , Adachi Nobuo
Published: August 2016

Popliteal artery injury is most commonly associated with high-energy trauma, which is easily diagnosed upon initial physical examination. However, in some situations, the diagnosis of arterial injury is delayed because of slow progression of arterial insufficiency, which may lead to limb amputation. We report a rare case of popliteal arterial occlusion with the presence of arterial pulses during initial assessment, resulting from a neglected proximal ibial physis fracture. This case shows that even in the presence of foot pulses, the surgeon must consider the possibility of a popliteal artery damage whenever trauma is seen near the knee joint.
Complications Associated With Epiphysiodesis for Management of Leg Length Discrepancy
Authors: Makarov Marina R. , Dunn Samuel H. , Singer Dustin E. , Rathjen Karl E. , Ramo Brandon A. , Chukwunyerenwa Chukwudi K. , Birch John G.
Published: August 2016

Background:

Epiphysiodesis is well-established surgical treatment for the management of leg length discrepancy (LLD) in children; however, a variety of complications may occur. This study evaluates the nature, rate, and potential risk factors of complications associated with epiphysiodesis in a large patient population treated in 1 institution.

Methods:

We evaluated the medical and radiographic records of 863 children who had lower extremity epiphysiodesis to manage LLD between 1980 and 2011.

Results:

Sixty patients (7.0%) incurred complications of some type. Twenty-three patients (2.7%) had perioperative complications unrelated to physeal growth; all resolved without surgical treatment. These included 2 patients with transient intraoperative complications (laryngospasm and allergic rash), 7 with transient neurological symptoms (5 cutaneous nerve dysesthesia or numbness and 2 peroneal nerve neuropathies), and 14 with postoperative knee stiffness which resolved with therapy. Thirty-seven patients (4.3%) developed physeal growth-related complications, including 6 patients who developed overcorrection of leg length inequality (3 had contralateral epiphysiodesis to prevent overcorrection, while 3 declined), and 31 patients who developed angular deformity and/or continued growth of the physis. Of these 31 patients, 15 had reexploration of the epiphysiodesis site, 6 underwent corrective osteotomy, while in 10, no treatment was undertaken. Compared with patients who did not develop angular deformity, these 31 patients had significantly greater LLD (5.6 vs. 3.7 cm, respectively, P<0.01), were younger (10.7 vs. 11.7 in girls; 12.4 vs. 13.5 in boys; P<0.01), and were more likely to have a congenital etiology for their LLD (P<0.01).

Conclusions:

Epiphysiodesis is a safe and effective procedure for the correction of leg length inequality. The rate of complications in this study was 7.0%, the most prevalent being the development of angular deformity. Congenital etiology, younger age, and larger limb length inequalities were risk factors for the development of angular deformity. Both surgeons and families should be aware of nature and rate of complications associated with epiphysiodesis.

Level of Evidence:

Level IV.
Parents' Concerns as They Relate to Their Child's Development and Later Diagnosis of Autism Spectrum Disorder
Authors: Richards Megan , Mossey Jana , Robins Diana L.
Published: August 2016

Objective:

Data from a toddler screening study were used to examine: (1) categories of concerns regarding the development of their child reported by parents prior to diagnostic evaluation, (2) congruence of parent concerns with their child's later diagnosis, (3) the extent to which parent concern(s) were associated with the therapies their child received and types of specialists consulted, and (4) the association between the number of parental concern categories and clinical measures.

Method:

Toddlers who screened positive for autism spectrum disorder (ASD) during well-child checkups received a diagnostic evaluation and parents completed a history questionnaire (n = 532; 274 ASD, 258 non-ASD). Parents' concerns about their child's development, therapy received, and specialists consulted were coded into discrete categories.

Results:

Most parents (>90%) reported concerns about their child's development. The most common concern in both the ASD and non-ASD groups was speech/communication (78.6%). Significant differences were found between diagnostic groups in the speech/communication, restricted/repetitive behaviors, social, behavioral, and medical concern categories. Parent concerns were associated with therapies received and specialists consulted. The number of concern categories was positively associated with several ASD scores.

Conclusion:

The developmental concerns expressed by parents of undiagnosed toddlers were highly consistent with the diagnosis the child later received. Based in part on their areas of concern, parents made contact with the appropriate professionals and their children received some therapy prior to diagnosis. Finally, parents who reported concerns across different areas endorsed more symptoms during screening. Results emphasize the need for providers to elicit and take seriously parent concerns during the referral and diagnostic processes.
MACULAR HOLE FORMATION IDENTIFIED WITH INTRAOPERATIVE OCT DURING VITRECTOMY FOR VITREOMACULAR TRACTION SYNDROME
Authors: Sawaguchi Shota , Maruko Ichiro , Mikami Yuriko , Hasegawa Taiji , Koizumi Hideki , Iida Tomohiro
Published: August 2016

Purpose:

To report the identification of macular hole formation using intraoperative optical coherence tomography (OCT) during vitrectomy for vitreomacular traction syndrome.

Methods:

A 58-year-old woman with vitreomacular traction syndrome underwent the vitrectomy using the 25-gauge system with scanning the macular area using the integrated and intraoperative OCT (Rescan 700, Zeiss). When posterior vitreous detachment at the fovea was performed using a vitreous cutter, the hyperreflective tissue thought to be the rupture of the internal limiting membrane and the full-thickness macular hole were identified on the horizontal and vertical scans simultaneously in intraoperative OCT.

Results:

The procedure was completed after internal limiting membrane peeling and 25% SF6 gas tamponade for closure of macular hole. The closure was confirmed using Swept-Source OCT 1-month after surgery.

Conclusion:

It is possible to change the surgical approach using the real-time intraoperative OCT because the development of macular hole can be visualized during vitrectomy for vitreomacular traction syndrome.
Intussusception Mimicking Rectal Prolapse in a 5-Month-Old Infant
Authors: Wharton Kristin , Garcia Alejandro , Felix Michelle
Published: August 2016

Although rare, an ileocolic intussusception extending to the rectum can mimic a rectal prolapse, which may result in delayed diagnosis and treatment, thereby increasing morbidity in affected infants. Anal prolapse of an ileocolic intussusception is a rare complication of intussusception and more rarely reported in the United States than in developing countries. The aim of this case report is to identify physical exam techniques and radiological findings to distinguish between an anal prolapse intussusception versus a rectal prolapse. There needs to be a high index of suspicion of intussusception in presenting patients with a rectal prolapse in order to minimize morbidity.
A Prospective Blinded Comparison of Video Capsule Endoscopy Versus Computed Tomography Enterography in Potential Small Bowel Bleeding
Authors: Limsrivilai Julajak , Srisajjakul Sitthipong , Pongprasobchai Supot , Leelakusolvong Somchai , Tanwandee Tawesak
Published: August 2016

Goals:

To compare the efficacy of video capsule endoscopy (VCE) with computed tomography enterography (CTE) in potential small bowel (SB) bleeding, and to identify factors predictive of a high diagnostic yield for CTE.

Background:

In potential SB bleeding, CTE potentially detects some lesions missed by VCE, but few data have determined its clinical utility.

Study:

Consecutive patients with potential SB bleeding were prospectively enrolled. All underwent VCE and CTE within a 1-week interval. Definitive diagnoses were made by surgery or enteroscopy, except when a strategy of VCE and conservative management was suitable. The diagnostic yields and sensitivities of each investigation were measured.

Results:

Fifty-two patients were recruited (41 with overt and 11 with occult bleeding); 36 received a definitive diagnosis. The diagnostic yields and sensitivities of VCE and CTE were 59.6% and 30.8% (P=0.004), and 72.2% and 44.4% (P=0.052), respectively. The combined sensitivity of VCE and CTE (88.9%) was significantly greater than VCE (P=0.03) or CTE (P<0.01) alone. VCE was better for ulcers, enteritis, and angiodysplasia, whereas CTE was better for tumors and Meckel diverticula. Age below 40 years and severe bleeding were associated with a higher diagnostic yield for CTE [odds ratios (95% confidence interval)=7.3 (1.04-51.4), P=0.046 and 6.1 (1.4-25.5), P=0.014, respectively].

Conclusions:

Both investigations complement each other in the diagnosis of potential SB bleeding. CTE should be considered when VCE is negative. Age below 40 years and severe bleeding were independent predictors of a higher diagnostic yield for CTE.
The Effects of a Gluten-free Diet Versus a Hypocaloric Diet Among Patients With Fibromyalgia Experiencing Gluten Sensitivity–like Symptoms
Authors: Slim Mahmoud , Calandre Elena P. , Garcia-Leiva Juan M. , Rico-Villademoros Fernando , Molina-Barea Rocio , Rodriguez-Lopez Carmen M. , Morillas-Arques Piedad
Published: August 2016

Background and Aims:

Patients with fibromyalgia frequently present with symptoms similar to those experienced by patients with gluten-related disorders, raising the possibility that a subgroup of these patients could be experiencing underlying gluten sensitivity. This study aimed to evaluate the effects of a gluten-free diet (GFD) compared with a hypocaloric diet (HCD) among patients with fibromyalgia.

Methods:

Adult patients diagnosed with fibromyalgia were randomly allocated to receive a GFD or a HCD over a 24-week period. The primary outcome measure was the change in the number of gluten sensitivity symptoms. The following secondary outcomes were evaluated: body mass index, Revised Fibromyalgia Impact Questionnaire, Pittsburgh Sleep Quality Index, Brief Pain Inventory, Beck Depression Inventory-II, State-Trait Anxiety Inventory, Short-Form Health Survey, Patient Global Impression Scale of Severity, Patient Global Impression Scale of Improvement, and adverse events.

Results:

Seventy-five subjects were randomly allocated to receive either a GFD (n=35) or an HCD (n=40). The least squares mean change in the total number of gluten sensitivity symptoms from baseline did not differ significantly between the GFD and HCD groups (−2.44±0.40 for the GFD; −2.10±0.37 for the HCD; P=0.343). Similarly, the 2 dietary interventions did not differ in any of the remaining measured secondary outcomes. Both dietary interventions were well tolerated.

Conclusions:

Both dietary interventions were associated with similar beneficial outcomes in reducing gluten sensitivity symptoms and other secondary outcomes. However, despite its specificity, GFD was not superior to HCD in reducing the number of gluten sensitivity symptoms or secondary outcomes.
Defining Rurality in Medicare Administrative Data
Authors: Snyder John E. , Jensen Matthew , Nguyen Nguyen X. , Filice Clara E. , Joynt Karen E.
Published: August 2016

Rural beneficiaries make up nearly one quarter of the Medicare population, yet rural providers and patients face specific challenges with health and health care delivery that remain inadequately understood. Health disparities between rural and urban residents are widespread, barriers to health care in rural communities persist, and the rural health care workforce is limited. To better understand and track the relationship between rurality and performance under Medicare’s payment programs, researchers must be able to identify rural beneficiaries, providers, and hospitals. Although numerous definitions of rurality are applied across the Medicare program, empirical research is lacking comparing the different definitions of rurality and the impact of their application to quality, outcome, or costs. Definitions that recognize rurality as a graded concept, rather than a dichotomous one, hold promise. Understanding the strengths and limitations of different approaches to identifying rurality will help researchers choose the best method for their particular purpose, and help policymakers interpret studies using these approaches.
Closing the Medicare Doughnut Hole
Authors: Bonakdar Tehrani Ali , Cunningham Peter J
Published: August 2016

Background:

The Affordable Care Act (ACA) include provisions that reduce beneficiaries’ cost sharing and eventually closes the coverage gap—known as the “doughnut hole”—that was originally part of Medicare prescription drug coverage implemented in 2006.

Objectives:

This study examines changes in overall prescription drug utilization and out-of-pocket spending as well as by manufacturer type (brand vs. generic), through 2013 as a result of the doughnut hole provisions of the ACA.

Materials and Methods:

This analysis is based on data from Medical Expenditure Panel Survey and the sample for this analysis includes all individuals 55 years of age and older. A difference-in-differences methodology was adopted to measure changes in drug utilization and out-of-pocket spending among both the treatment group and the comparison group after the ACA.

Results:

The findings from this study suggest that overall out-of-pocket spending significantly decreased after closing the coverage gap, mainly because of a significant reduction in out-of-pocket spending on brand-name drugs. Conversely, the results show that generic drug utilization increased after closing the coverage gap. As expected, the effects were considerably larger for people who fell into the doughnut hole.

Conclusions:

The ACA doughnut hole provisions likely contributed to a reduction in out-of-pocket spending for prescription drugs for part D beneficiaries, especially for people who fell into the doughnut hole.
Effect of Hospital Closures on Acute Care Outcomes in British Columbia, Canada
Authors: Panagiotoglou Dimitra , Law Michael R. , McGrail Kimberlyn
Published: August 2016

Background:

In 2002 British Columbia, Canada began redistributing its hospital services.

Objective and Design:

We used administrative data and interrupted time series analyses to determine how recent hospital closures affected patient outcomes.

Subjects:

All adult acute myocardial infarction (AMI), stroke, and trauma events in British Columbia between fiscal years 1999 and 2013. Cases were patients whose closest hospital closed. Controls were matched by condition, year of event, and condition-specific hospital volume where treatment was received.

Measures:

Thirty-day mortality and hospital bypass rates.

Results:

We matched 3267 AMI, 2852 stroke, and 6318 trauma cases to 1996, 1604, and 3640 controls, respectively. The 30-day mortality rate at baseline was 7.0% [95% confidence interval (CI), 4.0%–10.1%] for AMI, 5.3% (95% CI, 2.4%–8.1%) for stroke, and 1.2% (95% CI, 0.3%–2.1%) for trauma controls. The 30-day mortality rate for cases was 14.3% (95% CI, 7.1%–21.7%) for AMI, 12.0% (95% CI, 5.1%–18.9%) for stroke, and 3.1% for trauma (95% CI, 0.9%–5.2%) cases. There was no significant change in 30-day mortality for cases, and no significant difference in change in mortality rates between cases and controls following the intervention. The difference in hospital bypass rates between cases and controls was 50.1% (95% CI, 42.3%–57.9%) for AMI, 36.2% (95% CI, 27.4%–44.9%) for stroke, and 32.2% (95% CI, 27.7%–36.8%) for trauma cases preintervention. Following the intervention, the difference in bypass rates dropped by 15.5% (95% CI, 3.5%–27.5%) for AMI, 25.3% (95% CI, 11.7%–38.8%) for stroke, and 22.7% (95% CI, 15.7%–29.6%) for trauma cases.

Conclusions:

Hospital closures did not affect patient mortality.
Immunizations in Children Requiring Warfarin Therapy
Authors: Bauman Mary E. , Hawkes Michael , Bruce Aisha , Siddons Suzanne , Massicotte Patti
Published: August 2016

Children with conditions requiring chronic warfarin therapy have increased. The importance of receiving immunizations in this population is magnified due to potential weakness in their immune response. There is concern about immunizing on therapeutic anticoagulation due to risk of hematomas and the influence of vaccine on warfarin metabolism. This study evaluated the influence of vaccines on warfarin effect as measured by the International Normalized Ratio and the clinically relevant hematomas or bruising postimmunization. There were no clinically relevant negative outcomes postimmunizations. This study demonstrates that immunizations may be safely administered to children receiving therapeutic warfarin therapy.
Correlates of well-being among caregivers of long-term community-dwelling stroke survivors
Authors: Dankner Rachel , Bachner Yaacov G. , Ginsberg Gary , Ziv Arnona , Ben David Hadar , Litmanovitch-Goldstein Dalit , Chodick Gabriel , Balicer Ran , Tanne David , Greenberg Dan
Published: August 2016

Although caregiving for stroke survivors is usually long-term, most studies on caregivers have generally involved only the first year following the event. We assessed and compared the long-term level of well-being measures among stroke survivors and their caregivers at more than 1 year following the stroke event and examined the associations between well-being, survivors’ characteristics, and caregiver burden. We interviewed a convenience sample of 51 community-dwelling stroke survivors, at least 1 year after the last stroke event, and their primary caregivers. Disability of survivors was assessed using the Barthel index and the modified Rankin Scale; health-related quality of life by the SF-36 questionnaire; and depression and anxiety using the Hospital Anxiety Depression Scale. Caregivers filled the SF-36 questionnaire, Hospital Anxiety Depression Scale questionnaire, and the Zarit Burden Interview, which assesses caregiver burden. Caregivers reported low levels of health-related quality of life and high levels of burden, anxiety, and depression. Caregivers’ anxiety level was higher than that of the survivors (7.7±5.1 vs. 5.8±4.5, respectively; P=0.02). Anxiety was the only characteristic of caregivers that was associated with overall caregiver burden. Our study suggests that there is a spillover effect of the disease on stroke patients’ primary caregivers. Intervention programs for caregivers should focus on their mental state and address their specific needs.
Relationship Between Walking Capacity, Biopsychosocial Factors, Self-efficacy, and Walking Activity in Persons Poststroke
Authors: Danks Kelly A. , Pohlig Ryan T. , Roos Margie , Wright Tamara R. , Reisman Darcy S.
Published: August 2016

Background/Purpose:

Many factors appear to be related to physical activity after stroke, yet it is unclear how these factors interact and which ones might be the best predictors. Therefore, the purpose of this study was twofold: (1) to examine the relationship between walking capacity and walking activity, and (2) to investigate how biopsychosocial factors and self-efficacy relate to walking activity, above and beyond walking capacity impairment poststroke.

Methods:

Individuals greater than 3 months poststroke (n = 55) completed the Yesavage Geriatric Depression Scale (GDS), Fatigue Severity Scale (FSS), Modified Cumulative Illness Rating (MCIR) Scale, Walk 12, Activities-Specific Balance Confidence (ABC) Scale, Functional Gait Assessment (FGA), and oxygen consumption testing. Walking activity data were collected via a StepWatch Activity Monitor. Predictors were grouped into 3 constructs: (1) walking capacity: oxygen consumption and FGA; (2) biopsychosocial: GDS, FSS, and MCIR; (3) self-efficacy: Walk 12 and ABC. Moderated sequential regression models were used to examine what factors best predicted walking activity.

Results:

Walking capacity explained 35.9% (P < 0.001) of the variance in walking activity. Self-efficacy (ΔR
2 = 0.15, P < 0.001) and the interaction between the FGA×ABC (ΔR
2 = 0.047, P < 0.001) significantly increased the variability explained. The FGA (β = 0.37, P = 0.01), MCIR (β = -0.26, P = 0.01), and Walk 12 (β = −0.45, P = 0.00) were each individually significantly associated with walking activity.

Discussion and Conclusion:

Although measures of walking capacity and self-efficacy significantly contributed to “real-world” walking activity, balance self-efficacy moderated the relationship between walking capacity and walking activity. Improving balance self-efficacy may augment walking capacity and translate to improved walking activity poststroke.

Video Abstract available for more insights from the authors (see Supplemental Digital Content 1, http://links.lww.com/JNPT/A139).
Trichomonas vaginalis and Human Immunodeficiency Virus Coinfection Among Women Under Community Supervision: A Call for Expanded T. vaginalis Screening
Authors: Davis Alissa , Dasgupta Anindita , Goddard-Eckrich Dawn , El-Bassel Nabila
Published: August 2016

Background

The United States has a large community supervision population, a growing number of whom are women. Trichomonas vaginalis infection is strongly associated with an increased risk of human immunodeficiency virus (HIV) acquisition and transmission, particularly among women, but there is a paucity of research on HIV and T. vaginalis co-infection among women under community supervision.

Methods

This article examines the prevalence of T. vaginalis infection and T. vaginalis and HIV coinfection at baseline among women under community supervision in New York City. It also examines the 12-month outcomes of women treated for T. vaginalis. Women received biological tests for HIV and T. vaginalis at baseline and 12 months follow-up.

Results

Of the 333 women tested for sexually transmitted infections, 77 women (23.1%) tested positive for T. vaginalis at baseline and 44 (13.3%) were HIV positive. Human immunodeficiency virus–positive women had significantly higher rates of T. vaginalis infection than HIV-negative women (36.4% vs 21.3%, P ≤ 0.05). Sixteen women (4.8%) were coinfected with T. vaginalis and HIV. Of the 77 women who were positive for T. vaginalis infection at baseline, 58 (75.3%) received treatment by a health care provider. Of those who received treatment, 17 (29.3%) tested positive for T. vaginalis at the 12-month follow-up.

Conclusions

Given the high prevalence of T. vaginalis among this sample of women, particularly among HIV-positive women, and high levels of reinfection or persistent infection, screening for T. vaginalis among women under community supervision may have a substantial impact on reducing HIV acquisition and transmission among this high-risk population.