Background Sulfonamide antibacterials are widely used in pregnancy, but evidence about their safety is mixed. The objective of this study was to assess the association between first-trimester sulfonamide exposure and risk of specific congenital malformations. Methods Mother-infant pairs were selected from a cohort of 1.2 million live-born deliveries (2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008) at 11 US health plans comprising the Medication Exposure in Pregnancy Risk Evaluation Program. Mothers with first-trimester trimethoprim-sulfonamide (TMP-SUL) exposures were randomly matched 1:1 to (i) a primary comparison group (mothers exposed to penicillins and/or cephalosporins) and (ii) a secondary comparison group (mothers with no dispensing of an antibacterial, antiprotozoal, or antimalarial medication during the same time period). The outcomes were cardiovascular abnormalities, cleft palate/lip, clubfoot, and urinary tract abnormalities. Results We first identified 7615 infants in the TMP-SUL exposure group, of which 7595 (99%) were exposed to a combination of TMP-SUL and the remaining 1% to sulfonamides alone. After matching (1:1) to the comparator groups and only including those with complete data on covariates, there were 20 064 (n = 6688 per group) in the primary analyses. Overall, cardiovascular defects (1.52%) were the most common and cleft lip/palate (0.10%) the least common that were evaluated. Compared with penicillin/cephalosporin exposure, and no antibacterial exposure, TMP-SUL exposure was not associated with statistically significant elevated risks for cardiovascular, cleft lip/palate, clubfoot, or urinary system defects. Conclusions First-trimester TMP-SUL exposure was not associated with a higher risk of the congenital anomalies studied, compared with exposure to penicillins and/or cephalosporins, or no exposure to antibacterials.

Background Asthma is one of the most common chronic diseases in women of reproductive age, occurring in up to 8% of pregnancies. Objective Assess the prevalence of asthma medication use during pregnancy in a large diverse cohort. Methods We identified women aged 15 to 45 years who delivered a live born infant between 2001 and 2007 across 11 U.S. health plans within the Medication Exposure in Pregnancy Risk Evaluation Program (MEPREP). Using health plans’ administrative and claims data, and birth certificate data, we identified deliveries for which women filled asthma medications from 90 days before pregnancy through delivery. Prevalence (%) was calculated for asthma diagnosis and medication dispensing. Results There were 586,276 infants from 575,632 eligible deliveries in the MEPREP cohort. Asthma prevalence among mothers was 6.7%, increasing from 5.5% in 2001 to 7.8% in 2007. A total of 9.7% (n=55,914) of women were dispensed asthma medications during pregnancy. The overall prevalence of maintenance-only medication, rescue-only medication, and combined maintenance and rescue medication was 0.6%, 6.7%, and 2.4% respectively. The prevalence of maintenance-only use doubled during the study period from 0.4% to 0.8%, while rescue-only use decreased from 7.4% to 5.8%. Conclusions In this large population-based pregnancy cohort, the prevalence of asthma diagnoses increased over time. The dispensing of maintenance-only medication increased over time, while rescue-only medication dispensing decreased over time.

Non-targeted, integrated HIV screening, with test offer and order by ED nurses during patient triage, is feasible and resulted in an increased frequency of HIV screening and a threefold increase in the absolute number of newly identified HIV-positive patients.

Background/Aims: Autism spectrum disorders (ASD) are characterized by impairments in social interaction and communication, as well as restricted, stereotyped interests and behaviors. A recent study found that approximately 1 in 88 children in the U.S. were diagnosed with an ASD and that prevalence varied widely among different demographic groups. The goals of this study were to obtain accurate prevalence and incidence statistics for ASD across several large, diverse health systems and to describe the variation of these statistics across demographic factors. Methods: All members within the five participating health systems born between January 1, 1993 and December 31, 2008 with electronic claims, enrollment, or medical record information were included in the study. Information on member demographics and ASD subtypes were collected from earliest available records at each site through the end of December 31, 2010. Individuals with an ASD diagnosis from an ASD specialist or two or more ASD diagnoses from non-specialists were defined as valid cases. Results: A preliminary examination of data from one site (N = 1,271,823) found 10,114 individuals <18 years ever diagnosed with an ASD. Of those 10,114 ASD cases, 8,085 met the validation criteria and were included in final analyses. Prevalence of all ASDs in children ≤8 years old was 1.

Background Explore the use of electronic health records (EHRs) in fetal alcohol syndrome (FAS) surveillance systems. Methods Using EHRs we identified diagnoses and anthropometric measurements related to the FAS criteria developed by the Fetal Alcohol Syndrome Surveillance Network (FASSNet) among children aged 0 to 12 years. Results There were 143,393 distinct children aged between 0 and 12 years enrolled in Kaiser Permanente, Georgia, during the study period. Based on diagnoses and anthropometric measurements, 20,101 children met at least one criterion of interest, and when grouped into combinations of different criteria there were 2285 who met GROWTH+CNS criteria, 76 children who met GROWTH+FACE criteria, 107 children who met CNS+FACE criteria, and 93 children who met GROWTH+CNS+FACE criteria. The prevalence of FAS as defined by FASSNet is 1.92 per 1000 children. We linked 17,084 (85.0%) children to their mothers in the health plan; only 3% of mothers of children in the GROWTH+CNS+ FACE group had an indication of alcohol or drugs use, but they had the highest rate of depression (39%). Conclusion Data of utility in identification of FAS are readily available in EHRs and may serve as a basis for intervention with at-risk children and in planning of future FAS surveillance programs.

for IT issues. We compared differences in non-opioid prescriptions of ED providers (attendings, MLPs, and EM residents) for a 6-month time frame pre and post guidelines in 2012 and 2013.Results: Over the same period where both percentages and absolute number of opioid pills and prescriptions decreased markedly, there was a significant increase in non-opioid analgesic prescriptions, although not matching the level of opioid decrease. The total number of non-opioid prescriptions (excluding tramadol) increased by 5.7 %. Acetaminophen and NSAIDS (in aggregate) increased by 5.3 %, muscle relaxants increased by 8.2% and tramadol decreased by 9.6%. The absolute number of non-opioid analgesics pills prescribed increased by 40,608 (1.3%), with an increase of 32,846 (+1.2%) in acetaminophen and NSAIDS and an increase of 22,624 (10.1%) of muscle relaxants. There was a decrease of 14,862 (-30.3%) of tramadol.Conclusion: There was a large and clinically important increase in all non-opioid pain relievers in a large public hospital system after the introduction of opioid prescribing guidelines.

Background/Aims: Approximately 1 in 88 children in the U.S. are diagnosed with Autism Spectrum Disorder (ASD). Unfortunately, there is no identified etiology or definitive cure for ASD. Therefore, it is not surprising that many parents turn to complementary and alternative medicine (CAM) therapies for their affected children. Prior studies have suggested that CAM use is common in this population; however, these studies have been limited by small samples and an inability to assess response rates. The purpose of this analysis is to examine the prevalence and correlates of CAM use among a group of geographically-and racially/ethnically-diverse children with ASD who are enrolled in the Mental Health Research Network (MHRN) Autism Registry. Methods: A web-based survey of parents of children with ASD was implemented at 4 MHRN Autism Registry sites in order to obtain information not available in health plan databases including parents' use of CAM. Parents were asked to report what CAM therapies they have ever used/used within the past 3 months, what they have paid for these therapies and the degree to which they perceived them as harmful or helpful. The domains of CAM therapies on the survey included natural products (e.g., vitamins), mind-body medicine (e.g., acupuncture) and manipulative/body-based practices (e.g., chiropractic). Results: To date, approximately 8800 recruitment letters have been mailed and 800 surveys have been completed. Findings related to the prevalence of CAM use among this population, in addition to the correlates of CAM use (including socio-demographics, age at diagnosis, severity of ASD, medical co-morbidities, health care utilization and parental satisfaction with care) will be presented. Conclusions: We were able to successfully implement a web-based survey of parents of children with ASD across 4 MHRN sites. With 800 completed surveys (recruitment will continue through November 2012 and thus this number is expected to increase), this is the largest known population-based survey on CAM use in a population with ASD to date. Prior studies indicate that CAM use among this population is common; therefore, it is critical that providers understand this phenomenon so they can help families make well-informed health care decisions and prevent possible CAM-drug interactions.

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