Introduction This study assesses validity of self-report for the use of major classes of illicit drugs and opioid-maintenance therapy among pregnant women at a substance abuse treatment program. Methods Analyses used data collected from 83 pregnant women in a prospective cohort study at the University of New Mexico. Study participants with a history of substance abuse were screened and, if eligible, enrolled during an early prenatal care visit. A follow-up interview was conducted shortly after delivery. Self-reported information about drug use later in pregnancy was compared with urine drug screen (UDS) results collected during the third trimester. Simple kappa (k) and prevalence-and-bias-adjusted kappa (PABAK) coefficients were calculated as the measures of agreement. Sensitivity and specificity of self-report for each drug class were estimated using UDS as the ‘gold standard’. Results The sample included a large proportion of ethnic minority (80% Hispanic/Latina and 7% American Indian) and socially disadvantaged (50% < less than high school education and 94% Medicaid-insured) pregnant women. On average, patients had 4.8 ± 3.0 urine drug screens during the third trimester. Sensitivity of self-report was low (<60%) for all classes of illicit drugs; however, marijuana and opioids demonstrated slightly higher sensitivity (57.9% and 58.3%, respectively) than other classes (<47%). Conclusions This study found substantial underreporting for all classes of illicit drugs among pregnant women in a substance abuse treatment program. Rates of underreporting are expected to be higher among the general population of pregnant women.
Background Accurate confirmation of prenatal alcohol exposure (PAE) is required as a diagnostic criterion for the majority of children adversely affected by PAE who do not manifest the physical features associated with Fetal Alcohol Syndrome. A number of ethanol biomarkers have been used to assess PAE, often with suboptimal results. The purpose of this study was to evaluate the feasibility and cost of PAE screening in newborns by measuring phosphatidylethanol (PEth) in dried blood spot (DBS) cards. Methods The feasibility of collecting an additional DBS card during routine newborn screening and the background prevalence of PAE were evaluated in a de-identified sample of newborn children delivered at the University of New Mexico Hospital. Electronic orders to collect DBS cards from newborns who continue to bleed after the routine newborn screen, glucose or hematocrit testing were initiated for all infants delivered during a 4-week timeframe. Specimens were sent to a contract laboratory for PEth analysis by liquid chromatography-tandem mass spectrometry. A cost analysis was conducted to compare the cost of PAE screening by PEth in DBS vs. PEth in conventional blood specimens and by meconium fatty acid ethyl esters (FAEE). Results From 230 collected cards, 201 (87.4%) had at least one full blood spot (amount sufficient for PEth analysis), and 6.5% had PEth >20ng/mL indicative of potential PAE in late pregnancy. PAE screening by PEth in DBS is logistically simpler and less expensive compared to two other screening approaches. Conclusions These results indicate that screening for PAE in DBS cards is a feasible procedure and that a majority of infants have enough blood after the routine heel prick to fill an additional card. Moreover, screening by PEth analysis from DBS cards is cost-efficient. The acceptability of such screening by parents and corresponding ethical issues remain to be investigated.
This study reports two years of basic data concerning University of Illinois clerkship students, their teaching faculty, and their patients at three community health centers. Students from four classes (1985, 1986, 1987, and 1988) were studied in 1985 and 1986. The faculty were family physicians, internists, and pediatricians who provided 20% of the undergraduate medical education for the last 30 months of a four-year curriculum. The study's goal was to develop estimates of the primary care teaching physicians' productivity, to compare them with the productivity of physicians not involved in teaching, and to provide estimates of revenue shortfalls that occurred for the physicians who were teaching. The estimated productivity of the teaching physicians, working 29 hours a week in ambulatory-care settings, was lower by 30-40% when they were teaching medical students than the productivity of nonteaching physicians regionally and nationally. The average patient-care revenue loss for a full-time-equivalent faculty member per full-time-equivalent student for 1985 was estimated to be $27,531 (regional comparison) or $21,143 (national comparison). The corresponding figures for 1986 were $24,294 and $21,525, respectively. The study's results should be useful to those who are planning to establish ambulatory-care delivery systems and also to directors of existing ambulatory-care delivery systems who may be contemplating accepting medical students.
obesity and the estimated YLD per 10,000 persons was 241.5. Hypertension and type 2 diabetes mellitus was the main cause of YLD (213.8 and 6.2 YLD per 10,000 persons respectively). CONCLUSIONS: Overweight and obesity are major risk factors of chronic diseases that are main causes of productivity lost. Burden of disease estimates attributable to overweight and obese can be used to inform population health monitoring, health policy formulation, health service planning and health promotion and management strategies.
Ambulatory blood pressure monitoring (ABPM) is increasingly recommended for confirming hypertension diagnosis and ongoing hypertension monitoring. However, reimbursement in the United States is variable and low compared with other advanced health care systems. We examined the reimbursement of ABPM and factors associated with successful reimbursement. A retrospective analysis of IBM MarketScan® commercial claims database was conducted for patients ≥18 years with ≥1 ABPM claim from January 2012 to December 2016. The date of first the ABPM claim was used as the index date. Per‐beneficiary ABPM episode reimbursements were calculated by aggregating all ABPM‐related reimbursements within a 30‐day post‐index window, considered as an ABPM episode. Multivariable logistic regression was used to identify predictors of successful reimbursement. Of 20 875 beneficiaries with ABPM claims, 16 920 (81.0%) were reimbursed. The median reimbursement per beneficiary for an ABPM episode was $89 (Inter Quartile Range [IQR], $62, $132), driven primarily by reimbursement for the full procedure (median, $86; IQR, $66, $110). Comparing benefit plan types, consumer‐directed health plans provided the highest median reimbursement ($96; IQR, $61, $175). Successful reimbursement was associated with female patient sex (adjusted OR [aOR], 1.20; 95% CI, 1.11‐1.28), having a health maintenance organization (aOR 2.11; 95% CI, 1.82‐2.43) or point of service (aOR 2.08; 95% CI, 1.74‐2.49) as benefit plan types, claim filing by a specialist (aOR 1.26; 95% CI, 1.14‐1.40) and services provided at an outpatient hospital (aOR 1.17; 95% CI, 1.01‐1.35). Among commercially insured Americans, our data suggest significant variability in successful reimbursement. Accordingly, more uniform criteria for ABPM reimbursement may facilitate greater use of guideline‐recommended monitoring.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.