Association Between Healthcare Provider Type and Intent to Breastfeed Among Expectant Mothers.

BACKGROUND: The primary purpose of this study was to determine the association between type of healthcare provider delivering prenatal care and intent to exclusively breastfeed. METHODS: A self-report survey was administered to 455 expectant mothers. Logistic regression was performed to determine the association between prenatal care provider type [obstetrician; other primary care physician (family doctor/general practitioner/internist/or other physician); midwife/nurse midwife; more than one provider; and other] with intent to breastfeed (exclusive/non-exclusive). RESULTS: Having a midwife/nurse midwife as a prenatal care provider was associated with intent to breastfeed compared to having an obstetrician (OR 2.544, 95 % CI 1.385-4.675). There was no difference in intent between women with another primary care physician and an obstetrician. Women with another type of health care provider, no prenatal care from a health professional, or no knowledge of who is providing prenatal care were less likely to intend to breastfeed (OR 0.228, CI 0.068-0.766) as compared to those with an obstetrician. DISCUSSION/CONCLUSIONS: Provider type is associated with intent to breastfeed among pregnant women. Women's intent to breastfeed is an important predictor of breastfeeding initiation, continuation, and duration that may be assessed by healthcare providers during the prenatal period. A consideration of what features of provider care are associated with improved breastfeeding outcomes and characteristics of women seeking prenatal care with midwives may serve to formulate future prenatal care policies and education during prenatal care visits.

Suicide risk and mental health co-morbidities in a probationer population.

Mental health problems are disproportionately represented in the community corrections system with limited information on the epidemiology of mental health and correlated factors such as suicide among probationers. This study recruited 2,077 probationers who completed screeners for mental health and substance disorders and suicide risk. Results found 13% of probationers were at high risk of suicide. Those who screened positive for a mental health condition were between 2 and 8 times more likely to screen positive for suicide risk. Allocation of additional resources to mental health in the criminal justice system and to effectively coordinate existing mental health services is needed.

Paternal race/ethnicity and very low birth weight.

BACKGROUND: The purpose was to examine the association between paternal race/ethnicity and very low birth weight stratified by maternal race/ethnicity. METHODS: Birth data for Tarrant County, Texas 2006-2010 were analyzed. Very low birth weight was dichotomized as yes (<1,500 g) and no (≥1,500 g). Paternal race/ethnicity was categorized as Caucasian, African American, Hispanic, other, and missing. Missing observations (14.7%) were included and served as a proxy for fathers absent during pregnancy. Potential confounders included maternal age, education, and marital status, plurality, previous preterm birth, sexually transmitted disease during pregnancy, smoking during pregnancy, and Kotelchuck Index of prenatal care. Logistic regressions were stratified by maternal race/ethnicity. Odds ratios and 95% confidence intervals were calculated. RESULTS: Of 145,054 births, 60,156 (41.5%) were Caucasian, 22,306 (15.4%) African American, 54,553 (37.6%) Hispanic, and 8,039 (5.5%) other mothers. There were 2,154 (1.5%) very low birth weights total, with 3.1% for African American mothers and 1.2% for all other race/ethnicities. Among Caucasian mothers, African American paternal race was associated with increased odds of very low birth weight (OR = 1.52; 95% CI:1.08-2.14). Among Hispanic mothers, African American paternal race (OR = 1.66; 95% CI:1.01-2.74) and missing paternal race/ethnicity (OR = 1.65; 95% CI:1.15-2.36) were associated with increased odds of very low birth weight. CONCLUSIONS: Paternal race/ethnicity is an important predictor of very low birth weight among Caucasian and Hispanic mothers. Future research should consider paternal race/ethnicity and further explore the association between paternal characteristics and very low birth weight.

Risk of future offense among probationers with co-occurring substance use and mental health disorders.

The criminal justice system is the primary service delivery system for many adults with drug and alcohol dependence, mental health, and other health service needs. The purpose of this study was to examine the relationship between risk of future offense, mental health status and co-occurring disorders in a large substance abuse diversion probationer population. A purposive sample of 2,077 probationers completed an assessment to screen for mental health disorders, substance use disorders, risk of future crime and violence, and several demographic characteristics. Probationers who screened positive for co-occurring substance use and mental health disorders were significantly more likely to be at higher risk of future crime and violence compared to probationers who screened positive for only substance use, only a mental health disorder, or no substance use or mental health disorder. Implications for substance use and mental health service delivery are discussed, and recommendations are made for further research.

Development of Osteopathic Neuromusculoskeletal Medicine (ONMM) residency curriculum guidelines to meet Accreditation Council for Graduate Medical Education (ACGME) milestones.

CONTEXT: A memorandum of understanding was reached between the Accreditation Council for Graduate Medical Education (ACGME), the American Osteopathic Association (AOA), and the American Association of Colleges of Osteopathic Medicine (AACOM) in 2014 outlining the course for a single accreditation system for graduate medical education. This process was completed in 2020 and has included the transition of AOA-accredited neuromusculoskeletal and Osteopathic Manipulative Medicine (OMM) programs into programs now termed "Osteopathic Neuromusculoskeletal Medicine" (ONMM) under the single accreditation system. Progress through ONMM residency is evaluated on the basis of 15 ACGME milestones that encompass six core competencies. However, there are no curricular guidelines to help guide the achievement of these milestones. OBJECTIVES: The primary purpose of this study was to develop a proposed structure and content for an ONMM residency curriculum that is based on (1) the alignment of residency curriculum with ACGME milestones in one ACGME-accredited ONMM residency program, and (2) the perceived needs of residents and faculty for an ONMM residency curriculum. METHODS: A mixed-methods exploratory sequential approach with embedded design was utilized. Qualitative analysis of didactics curriculum content for the past 2 years was coded according to themes identified in the residency curriculum content, which were further coded according to ACGME milestones. Curriculum topics identified in qualitative analysis were utilized to create a questionnaire that was administered to residents and faculty (n=24) in the ONMM residency program to examine the perceived importance of each curriculum topic based on a five-point Likert scale. Open-ended questions were embedded in the questionnaire that asked how faculty and residents define ONMM and what they believe should be the purpose of an ONMM residency curriculum. RESULTS: Five themes were identified in qualitative analysis of curriculum: (1) OMM laboratory topics; (2) faculty-led activities and lecture topics; (3) resident-led activities and lecture topics; (4) research; and (5) training courses and volunteer activities. The most important perceived curriculum topics for faculty and residents were osteopathic structural examination, orthopedic exam, direct and indirect methods, osteopathic cranial manipulative medicine, pediatric OMT, common upper and lower extremity injuries, and low back pain. Each of these topics aligned well with ACGME milestones. Residents reported that integrative medicine topics such as acupuncture were a significantly more important OMM laboratory topic (mean=3.58, SD=0.996) compared to faculty (mean=2.33, SD=0.985), t (22)=-3.091, p=0.005. Study participants most commonly described ONMM in terms of the specialized knowledge required for the discipline (n=19, 79.2%) and the Tenets of Osteopathy (n=17, 70.8%), and they felt that the purpose of an ONMM residency curriculum should be to gain knowledge (n=20, 83.3%) and become a competent physician (n=19, 79.2%). CONCLUSIONS: The present findings were applied to the development of proposed ONMM residency curriculum guidelines and submitted to the American Academy of Osteopathy (AAO) for consideration. They are presented here as a resource for ONMM residencies to develop a program curriculum in alignment with individual program needs.

Improving accuracy of medication identification in an older population using a medication bottle color symbol label system.

BACKGROUND: The purpose of this pilot study was to evaluate and refine an adjuvant system of color-specific symbols that are added to medication bottles and to assess whether this system would increase the ability of patients 65 years of age or older in matching their medication to the indication for which it was prescribed. METHODS: This study was conducted in two phases, consisting of three focus groups of patients from a family medicine clinic (n = 25) and a pre-post medication identification test in a second group of patient participants (n = 100). Results of focus group discussions were used to refine the medication label symbols according to themes and messages identified through qualitative triangulation mechanisms and data analysis techniques. A pre-post medication identification test was conducted in the second phase of the study to assess differences between standard labeling alone and the addition of the refined color-specific symbols. The pre-post test examined the impact of the added labels on participants' ability to accurately match their medication to the indication for which it was prescribed when placed in front of participants and then at a distance of two feet. RESULTS: Participants appreciated the addition of a visual aid on existing medication labels because it would not be necessary to learn a completely new system of labeling, and generally found the colors and symbols used in the proposed labeling system easy to understand and relevant. Concerns were raised about space constraints on medication bottles, having too much information on the bottle, and having to remember what the colors meant. Symbols and colors were modified if they were found unclear or inappropriate by focus group participants. Pre-post medication identification test results in a second set of participants demonstrated that the addition of the symbol label significantly improved the ability of participants to match their medication to the appropriate medical indication at a distance of two feet (p < 0.001) and approached significant improvement when placed directly in front of participants (p = 0.07). CONCLUSIONS: The proposed medication symbol label system provides a promising adjunct to national efforts in addressing the issue of medication misuse in the home through the improvement of medication labeling. Further research is necessary to determine the effectiveness of the labeling system in real-world settings.

Incidental computer tomography radiologic findings through research participation in the North Texas Healthy Heart Study.

BACKGROUND: Although variation exists in the classification and practice of managing clinical findings in research, emerging views suggest that researchers bear some responsibility in the management of incidental findings. This study contributes to the documentation of the population characteristics and prevalence of medical findings incidental to research participation, specifically findings related to coronary calcium scores and computed tomography (CT) scans that investigated cardiovascular disparities in an asymptomatic population. METHODS: A total of 571 asymptomatic adult participants were recruited in the North Texas Healthy Heart Study. Participants completed a 16-slice CT scan of the heart and abdomen. Findings of radiology reports and 3 years of follow-up documentation were reviewed. RESULTS: A total of 246 clinically apparent findings were identified in 169 asymptomatic participants (32.9% of participants who completed a CT scan). Another 245 participants (48%) had findings of unknown significance, a total of 307 findings. At least 4 cases in this study led to a clinically significant intervention. CONCLUSION: Although CT scans were completed for research purposes, study procedures resulted in the diagnosis and treatment of individuals who were previously asymptomatic. Potential clinical benefits in imaging research are moderated by considerations regarding possible harm and costs resulting from uncertain findings and the use of CT scans for nonclinical purposes. The continued development of protocols for the handling of incidental findings in research and the establishment of guidelines are needed to ensure that research procedures mirror the best interests of participants.

The Association of Free Testosterone Levels in Men and Lifestyle Factors and Chronic Disease Status: A North Texas Healthy Heart Study.

PURPOSE: Hypogonadism is highly prevalent in men older than 45 years and is associated with an increased risk of chronic diseases, including obesity, metabolic syndrome, diabetes, and cardiovascular disease. The objective of this study was to determine whether lifestyle factors such as smoking, diet, and exercise are associated with reduced testosterone levels. METHODS: In this cross-sectional study, 147 men older than 44 years were recruited from a collaborative network of primary care clinics in the Dallas/Fort Worth, Texas, metropolitan area. Free testosterone levels were measured in plasma samples via an enzyme-linked immunosorbent assay-based method, and analyzed by simple and multiple linear regression in relationship to age, race/ethnicity, smoking, diet, exercise, obesity, diabetes, hypertension, and dyslipidemia. RESULTS: The participants had a mean free testosterone level of 3.1 ng/mL (standard deviation [SD] = 1.5) and mean age of 56.8 years (SD = 7.9). In simple regression analysis, free testosterone levels were associated with increased age (ß = -0.04; P = .02), diet (ß = -0.49; P = .05), diabetes (ß = -0.9; P = .003), and hypertension (ß = -0.55; P = .03) but not with race/ethnicity, smoking, exercise, obesity, or dyslipidemia. In multiple regression analysis, free testosterone values were significantly associated only with age (ß = -0.05; P = .01) and diet (ß = -0.72; P = .01). CONCLUSIONS: This study implicates diet, in addition to advanced age as a possible risk factor in the development of reduced testosterone levels.