Objective To examine the relationship between preconception counseling (PCC) on folic acid and folic acid use and reasons for non-use. Methods We analyzed Maryland Pregnancy Risk Assessment Monitoring System (PRAMS) survey responses from women with live births from 2009-2011. Multivariable weighted logistic regression models (n=4426) adjusting for maternal sociodemographics were used to explore the associations between PCC receipt and folic acid use and reasons for non-use. Results Less than 30% of women received folic acid PCC and only 32% of women took folic acid daily prepregnancy. The most common reasons for non-use were “not planning pregnancy” (61%) and “didn't think needed to take” (41%). PCC receipt was associated with three times the odds of folic acid use (adjusted odds ratio [aOR] 3.17, 95% CI 2.48-4.06) and half the odds of reporting “didn't think needed to take” (aOR 0.47, 95% CI 0.28-0.78) as a reason for non-use. Conclusions Folic acid use remains low. Folic acid PCC was associated with increased folic acid use but few women received it. Our data support initiatives to promote provision of folic acid PCC to all women of childbearing age.

ELH-related pathology appears to focus initially on the apical spiral ganglion and the degree of deterioration correlates well with the severity of ELH. These findings mirror some reports in the human condition, and imply that the mechanism of cochlear injury in ELH and secondary dysfunction appears to be a neural toxicity that begins in the apex of the cochlea.

Catastrophic medical malpractice payouts, $1 million or greater, greatly influence physicians' practice, hospital policy, and discussions of healthcare reform. However, little is known about the specific characteristics and overall cost burden of these payouts. We reviewed all paid malpractice claims nationwide using the National Practitioner Data Bank over a 7-year period (2004-2010) and used multivariate regression to identify risk factors for catastrophic and increased overall payouts. Claims with catastrophic payouts represented 7.9% (6,130/77,621) of all paid claims. Factors most associated with catastrophic payouts were patient age less than 1 year; quadriplegia, brain damage, or lifelong care; and anesthesia allegation group. Compared with court judgments, settlement was associated with decreased odds of a catastrophic payout (odds ratio, 0.31; 95% confidence interval [CI], 0.22-0.42) and lower estimated average payouts ($124,863; 95% CI, $101,509-144,992). A physician's years in practice and previous paid claims history had no effect on the odds of a catastrophic payout. Catastrophic payouts averaged $1.4 billion per year or 0.05% of the National Health Expenditures. Preventing catastrophic malpractice payouts should be only one aspect of comprehensive patient safety and quality improvement strategies. Future studies should evaluate the benefits of targeted interventions based on specific patient safety event characteristics.