Longitudinal Evaluation of a Deprescribing Protocol in Skilled Nursing Facilities.

Objective: To determine whether a deprescribing effort reduced several key classes of medications, and the overall number of medication classes per patient, among long-term residents of skilled nursing facilities (SNFs). Design: Retrospective, longitudinal pre/post evaluation. Data from before and during the implementation of the deprescribing effort (2017 through 2019) were compared with data from the post-intervention year (2020). Setting and Patients: Long-term resident data reported through annual comprehensive reviews conducted at two SNFs located in central New York State between 2017 and 2020 (N = 12,144). Interventions: Multifaceted, interdisciplinary deprescribing effort to reduce medications in SNF residence including clinician education, guideline development, and individual chart reviews began in 2019. Results: The mean number of medications prescribed per resident was lower at both facilities after the intervention (mean = 1.74 at both facilities) versus preintervention (1.90 at Facility 1, 1.86 at Facility 2). Significant decreases were observed in the usage rates for diuretics (-4.2%; P = 0.001), opioids (-3.8%; P = 0.001), and antipsychotics (-2.4%; P = 0.010). The raw antidepressant usage rate increased by 1.5% after the intervention but the change was not significant. Effects were robust to covariate adjustment. Conclusion: A combined, comprehensive approach to deprescribing was associated with a reduction in the overall number of medication classes per resident and in several key classes of medications. Additional research with more data and covariate control is in progress for verification of these findings.

Use of open-text responses to recode categorical survey data on postpartum contraception use among women in the United States: A mixed-methods inquiry of Pregnancy Risk Assessment Monitoring System data.

BACKGROUND: Postpartum contraception prevents unintended pregnancies and short interpregnancy intervals. The Pregnancy Risk Assessment Monitoring System (PRAMS) collects population-based data on postpartum contraception nonuse and reasons for not using postpartum contraception. In addition to quantitative questions, PRAMS collects open-text responses that are typically left unused by secondary quantitative analyses. However, abundant preexisting open-text data can serve as a resource for improving quantitative measurement accuracy and qualitatively uncovering unexpected responses. We used PRAMS survey questions to explore unprompted reasons for not using postpartum contraception and offer insight into the validity of categorical responses. METHODS AND FINDINGS: We used 31,208 categorical 2012 PRAMS survey responses from postpartum women in the US to calculate original prevalences of postpartum contraception use and nonuse and reasons for contraception nonuse. A content analysis of open-text responses systematically recoded data to mitigate survey bias and ensure consistency, resulting in adjusted prevalence calculations and identification of other nonuse themes. Recoded contraception nonuse slightly differed from original reports (21.5% versus 19.4%). Both calculations showed that many respondents reporting nonuse may be at a low risk for pregnancy due to factors like tubal ligation or abstinence. Most frequent nonuse reasons were not wanting to use birth control (27.1%) and side effect concerns (25.0%). Other open-text responses showed common themes of infertility, and breastfeeding as contraception. Comparing quantitative and qualitative responses revealed contradicting information, suggesting respondent misinterpretation and confusion surrounding the term "pregnancy prevention." Though this analysis may be limited by manual coding error and researcher biases, we avoided coding exhaustion via 1-hour coding periods and validated reliability through intercoder kappa scores. CONCLUSIONS: In this study, we observed that respondents reporting contraception nonuse often described other methods of pregnancy prevention and contraception barriers that were not included in categorical response options. Open-text responses shed light on a more comprehensive list of pregnancy prevention methods and nonuse options. Our findings contribute to survey questions that can lead to more accurate depiction of postpartum contraceptive behavior. Additionally, future use of these qualitative methods may be used to improve other health behavior survey development and resulting data.

Utilization of palliative care and acute care services in older adults with advanced cancer.

OBJECTIVES: There is a gap in knowledge regarding the rates of utilization of palliative care services (PCS) and acute care services (ACS) among older patients with advanced cancer close to end of life. We analyzed the utilization of these services among older adults (65 years and older) and compared them to those in younger adults (40-64 years) with advanced cancer. MATERIALS AND METHODS: A retrospective chart review of 567 veterans who died with advanced cancer between 2002 and 2009 and utilized PCS and ACS prior to death was conducted after IRB approval. To assess PCS utilization, we studied the mean duration between day of hospice referral and time of death (DOR) and the mean length of stay with hospice (LoS). The frequency of emergency room visits (ERVLM), hospital admissions (HALM), and ICU admissions (ICULM) in the last month of life was used as a measure for ACS. The differences among older and younger patients were compared using two sample t-tests. RESULTS: Older adults had earlier referral to PCS [mean DOR: 47.3 versus 34.5 days, p=0.015], longer stay with hospice [mean LoS: 32.5 versus 20.2 days, p=0.007], fewer hospital [HALM: 0.7 versus 0.9, p=0.043], and ICU admissions [ICULM: 0.1 versus 0.2, p=0.030] per patient. The proportion of patients utilizing ER visits [53.5 % versus 59.5%, p=0.173] and hospital admissions [58.6% versus 65.1%, p=0.13] in the last month of life was similar in both age groups with fewer older adults utilizing ICU care [13.2% versus 19.5%, p=0.047]. CONCLUSION: Older patients with cancer are likely to be referred to PCS earlier than younger patients and spend a longer duration with PCS prior to death. However, there continues to be significant utilization of ACS in all patients with advanced cancer. Better understanding of the goals of care in older adults with cancer and education of oncology providers regarding the need to utilize and integrate palliative care services earlier in the course of disease is imperative.

Aromatase inhibitor (anastrozole) affects growth of endometrioma cells in culture.

OBJECTIVE: To study the effects of aromatase inhibitor (anastrozole) on the growth and estradiol secretion of endometrioma cells in culture. DESIGN: Endometrioma cells are grown in vitro until maximum growth before used in this study. This was done in the research laboratory for tissue culture, in an academic hospital. INTERVENTIONS: Testosterone at a concentration of 10 µg/mL was added as a substrate for the intracellular aromatase. In addition, aromatase inhibitor was added at a concentration of 200 and 300 µg/mL. The effect on cell growth and estradiol secretion is evaluated using Student's t-test. RESULTS: The use of testosterone increased estradiol secretion by endometrioma cells in culture. The use of aromatase inhibitor significantly inhibited the growth of endometrioma cells, and estradiol secretion. CONCLUSION: Aromatase inhibitor (anastrozole) may be an effective treatment for endometriosis due to inhibition of cellular aromatase.

It takes at least two: male partner factors, racial/ethnic disparity, and Chlamydia trachomatis among pregnant women.

Chlamydia trachomatis (CT), the most prevalent sexually transmitted infection in the United States, disproportionately infects women and people of color. This study aimed to identify risk factors for racial and ethnic disparities for CT infection, re-infection, and persistent infection among pregnant women. We present a secondary analysis of births from a retrospective cohort study in Syracuse, NY from January 2000 through March 2002. African American women [OR 3.35 CI (2.29, 4.92)], Latin American women [OR 4.35 CI (2.52, 7.48)], unmarried women [OR 7.57 CI (4.38, 13.10)], and teen mothers [OR 3.87 CI (2.91, 5.16)] demonstrated statistically significant increased risk for infection. In multivariate analyses that included male partner variables, father's race/ethnicity but not the mother's race/ethnicity remained statistically associated with CT. Despite near universal rates of screening pregnant women, challenges to CT control remain and reflect barriers to testing and treatment of male partners.

The paternal component of the "healthy migrant" effect: fathers' natality and infants' low birth weight.

This study examines the predictors of birth outcomes among women of European and African ancestry and considers the birthplace of the babies' fathers (foreign born vs. native born) as a protective factor. This is a secondary data analysis of 146,431 singleton births among women of European and African ancestry, both native-born and foreign-born, in a 21 birth hospital region of Central New York State from 1996 to 2003. Foreign born fathers were found to have 15% fewer low birth weight infants than US-born fathers, after controlling for the race and birthplace of the mother, tobacco use and Medicaid. Although this secondary data analysis does not allow us to determine the social determinants of the better birth outcomes among infants of foreign born fathers, it does demonstrate that fathers matter and that foreign born fathers are associated with reduced low birth weight in their infants.

Effects of intimate partner violence on pregnancy trauma and placental abruption.

AIMS: Intimate partner violence (IPV) during pregnancy increases women's risk of pregnancy complications and adverse birth outcomes. The goal of this study was to examine the association between IPV and prenatal trauma and placental abruption during pregnancy. METHODS: Prenatal and hospital obstetrical charts were reviewed for 2873 women who gave birth between January 2000 and March 2002 in a Northeastern city. We examined associations among sociodemographic characteristics, health-related variables, IPV, and pregnancy trauma and placental abruption using univariate and multivariate logistic regression. RESULTS: Of the 2873 women in the analyses, 105 (3.7%) reported IPV during prenatal care. After controlling for sociodemographic variables; tobacco, alcohol, and drug use; preeclampsia; and gestational diabetes during pregnancy, women who reported IPV also had higher odds of pregnancy trauma and placental abruption (adjusted odds ratio [OR] 32.08, 95% confidence interval [CI] 14.33-71.80, p < 0.01, and OR 5.17, 95% CI 1.37-19.51, p < 0.05, respectively). CONCLUSIONS: This study found that IPV is a significant and independent risk factor for pregnancy trauma and placental abruption after controlling for factors typically associated with these outcomes. This study has implications for partner violence screening and intervention policies among pregnant women and highlights the importance of making distinctions about the type of IPV that women experience.

Environmental injustice: childhood lead poisoning, teen pregnancy, and tobacco.

PURPOSE: This study investigates the persistent relationships between childhood lead exposure, repeat teen pregnancy, and tobacco use in a sample of teenage females in Syracuse, NY. METHODS: We analyzed the association of childhood lead poisoning with repeat pregnancy and tobacco use among 536 teens (aged 15-19 years) in Syracuse, NY, who received services at Syracuse Healthy Start between 1998 and 2002. RESULTS: The mothers' childhood lead exposure, controlling for race, age, and Medicaid status, was associated with repeat teen pregnancy and tobacco use. CONCLUSION: Long-term negative health outcomes associated with childhood lead exposure should not be underestimated. This study helps to shore up prior research that found lead poisoning to have a long-lasting impact on children's functioning and healthy development. Policy efforts focused on neighborhood development and health education continue to be sorely needed.