While poor neonatal adaptation syndrome (PNAS) has been particularly well described among infants exposed to antidepressants, specifically selective serotonin reuptake inhibitors (SSRIs) and ...serotonin-norepinephrine reuptake inhibitors (SNRIs), this is not the case for second-generation antipsychotics (SGAs). In 2011, the US Food and Drug Administration (FDA) issued a drug safety warning regarding fetal antipsychotic exposure and risk for PNAS and extrapyramidal symptoms (EPS). The primary objective of this study was to examine the risk for PNAS among infants exposed to SGAs compared to SSRI/SNRI-exposed infants, leveraging the prospective, longitudinal design of the National Pregnancy Registry for Psychiatric Medications (NPRPM).
The NPRPM is a prospective pharmacovigilance program in which pregnant women, aged 18-45 years, are enrolled and followed prospectively. Medical records were systematically reviewed and data abstracted using a checklist of PNAS and EPS symptoms specifically outlined in the FDA drug safety warning. The two study groups included infants exposed to an SGA during pregnancy and infants exposed to an SSRI/SNRI during pregnancy. The primary outcome was the presence of at least one or more PNAS symptoms during the first month of life. Other neonatal outcomes following exposure to the medication of interest, including preterm birth, neonatal intensive care unit (NICU) admission, rates of EPS, and whether infants were discharged home with their mothers, are also reported.
Of the 2,145 women enrolled in this study as of December 16, 2020, a total of 373 women and their infants (n = 384) were eligible for inclusion (n = 193 SGA-exposed infants and 191 SSRI/SNRI-exposed infants). Among SGA-exposed infants, 32.6% (63/193) experienced at least 1 PNAS sign compared to 34.6% of infants (66/191) in the SSRI/SNRI-exposed group. The majority of infants in each group showed no symptoms of PNAS. No differences were observed between the two groups with respect to rates of preterm birth, NICU admission, prevalence of EPS, and timing of infants being discharged home with their mothers.
PNAS symptomatology was comparable among infants exposed prenatally to an SGA or to an SSRI/SNRI. These preliminary findings provide an estimated risk of PNAS among infants exposed to SGAs of roughly 30%. Interestingly, these findings are also consistent with estimates in the literature of PNAS in SSRI/SNRI-exposed infants, suggesting a possible common pathway underlying this phenomenon.
ClinicalTrials.gov identifier: NCT01246765.
Purpose
This research sought to determine whether there is a relationship between claimants’ expected time to return to work (RTW) as recorded by claims managers and compensated days of work ...disability.
Methods
We utilized workers’ compensation data from a large, United States-based insurance company. RTW expectations were collected within 30 days of the claim being reported and these were compared with the termination of total temporary indemnity payments. Bivariate and hierarchical regression analyses were conducted.
Results
A significant relationship between expected time to RTW and compensated disability duration was observed. The unadjusted correlation between work-disability duration and expected time to RTW was .25 (
p
< .001). Our multivariate model explained 29.8 % of the variance, with expected time to RTW explaining an additional 9.5 % of the variance in work-disability duration beyond what was explained by the covariates.
Conclusion
The current study’s findings support the hypothesis that claimant RTW estimates as recorded by claims managers are significantly related to compensated-disability duration, and the relationship is maintained after controlling for variance that can be explained by other variables available within workers’ compensation databases.
A lack of human interaction and environmental control in Internet‐based data collection have been suggested as possible antecedents of careless responding, which occurs when participants respond to ...survey items without regard for item content. To address these possible antecedents, this study investigated whether survey proctoring deterred careless response in an undergraduate sample by reducing environmental distractions. The study randomly assigned respondents to one of three proctoring conditions: remote online un‐proctored, remote online virtually proctored, and in‐person classroom proctored. Data quality was examined via nine careless response indicators. Analyses indicated that proctor presence had effects on a small number of careless response indicators. Virtually proctored participants performed better than un‐proctored participants on one of nine careless response indicators, and in‐person proctored participants performed better on two careless response indicators compared to un‐proctored participants. Environmental distraction fully mediated the relationship between in‐person proctor presence and self‐reported diligence. Implications for survey administration are discussed.
Summary
Eosinophilic esophagitis (EoE) is an esophageal allergic inflammatory disorder often presenting with infant/toddler gastroesophageal reflux symptoms refractory to treatment, including acid ...suppression trials with histamine H2 antagonists and proton pump inhibitors. We propose to evaluate the impact of infant acid suppressant exposure in EoE. Geisinger’s pediatric EoE cases were matched to controls (1:5 EoE case control ratio) using age, race, sex, and ages at other diagnoses of asthma, eczema, and environmental allergies, totaling 526 EoE cases and 2,630 controls. Comparisons between EoE cases and matched controls were tested with regard to rates of acid suppression use with H2 antagonists and PPIs during infancy. Our analyses found the use of acid suppression in infancy was positively associated with EoE: PPI (5.7% EoE cases vs. 1.6% controls; P < 0.0001), H2 antagonists (8.8% EoE cases vs. 4.5% controls; P < 0.0001). Additionally, analysis of EoE cases using acid suppression during infancy indicated a likelihood for the diagnosis with EoE at an earlier age. Early acid suppression use in infants is significantly associated with the diagnosis of EoE in childhood in this well-matched retrospective cohort study. The potential link warrants additional investigation. Our study further reinforces the evidence-based stewardship of acid suppressant use, especially in our most vulnerable populations.
Healthcare providers have key roles in the prevention of, detection of, and interventions for human trafficking. Yet caring for trafficked persons is particularly challenging: patients whose ...identities are unknown, unreliable, or false could receive subpar care from providers delivering care in a vacuum of relevant information. The application of precision medicine principles and integration of biometric data (including genetic information) could facilitate patient identification, enable longitudinal medical records, and improve continuity and quality of care for this vulnerable patient population. Scant empirical data exist regarding healthcare system preparedness and care for the needs of this vulnerable population nor data on perspectives on the use and risks of biometrics or genetic information for trafficked patients.
To address this gap, we conducted mixed-methods research involving semi-structured interviews with key informants, which informed a subsequent broad survey of physicians and registered nurses.
Our findings support the perception that trafficked persons obtain care yet remain unnoticed or undocumented in the electronic health record. Our survey findings further reveal that healthcare providers remain largely unaware of human trafficking issues and are inadequately prepared to provide patient-centered care for trafficked and unidentified patients.
Meaningful efforts to design and implement precision medicine initiatives in an inclusive way that optimizes impacts are unlikely to succeed without concurrent efforts to increase general awareness of and preparedness to care for trafficked persons. Additional research is needed to examine properly the potential utility for biometrics to improve the delivery of care for trafficked patients.
Purpose: Workers' own expectations for return to work consistently predict work status. To advance the understanding of the relationship between RTW expectations and outcomes, we reviewed existing ...measures to determine those which we felt were the most likely to capture the construct. Method: A comprehensive search of the work-disability rehabilitation literature was undertaken. The review of the measures was conducted in three steps: first, a review of terminology; second, an examination of whether a time reference was included; third, an evaluation of ease of comprehension, and applicability across contexts. Results: A total of 42 different measures were identified. One of the most striking findings was the inconsistency in terminology. Measures were also limited by not including a time reference. Problems were also identified with regards to ease of understanding, utility of response options, and applicability in a wide variety of research and applied settings. Conclusions: Most previously used measures contain elements that potentially limit utility. However, it would seem that further development can overcome these, resulting in a tool that provides risk prediction information, and an opportunity to start a conversation to help identify problems that might negatively impact a worker's movement through the RTW process and the outcomes achieved.
Implications for Rehabilitation
Return to work is an integral part of workplace injury management.
The capture of RTW expectations affords a way to identify the potential for less than optimal RTW processes and outcomes.
A mismatch between an injured worker's expectations and what other stakeholders might expect suggests that efforts could be made to determine what is causing the injured worker's concerns.
Once underling issues are identified, work can be put into resolving these so that the worker's return to the workplace is not impeded.
Let Their Voices Be Seen Young, Amanda J.; Richardson, Frances; Fitzgerald, Dawn ...
Annals of emergency medicine,
September 2020, 2020-09-00, 20200901, Volume:
76, Issue:
3
Journal Article
Peer reviewed
Open access
The mutual distrust, in part caused by misunderstanding and bias, between sickle cell disease (SCD) patients and emergency department (ED) clinicians has been widely documented in the SCD literature. ...This study seeks to illustrate the perceptions and experiences of adult sickle cell patients who have had at least 1 ED experience in the last 2 years.
Qsource, a nonprofit health care consultancy based in Tennessee, used photovoice, a qualitative research method, to facilitate the representation of patients’ experiences in living with SCD. Photovoice has participants document their experiences through photography and then, as a group, discuss and analyze the emotional state behind the photographs. Eight participants with SCD took 25 photographs during 4 weeks. Then, in a 2-hour critical dialogue, participants identified recurring themes through consensus.
Participants identified 6 themes that emerged from their discussion: unpredictability of SCD, fickleness of time, coping with pain, proximity to death, avoidance of the ED, and need for improved communication. They expressed their wish to be active participants in their care, and many described a fear of death, which is exacerbated by a lack of control in the ED setting.
Factors such as poor patient experience and misunderstanding may contribute to delays in seeking care for SCD patients. This may, in turn, escalate pain crises and increase the likelihood of hospital admission. We believe that photovoice may be a new means to educate ED clinicians on SCD patient perceptions, ultimately resulting in better ED care.
To define technology and social media use among rural upper-extremity patients. In addition, we aimed to assess how patients use social media in relation to health care and their willingness to ...participate in telemedicine programs.
An anonymous multiple-choice written survey was administered to 550 upper-extremity patients at 4 rural outreach clinics. Demographic information was obtained, as was social media use, habits and interests. We compared both users and nonusers of social media to define demographic differences between these groups.
A total of 412 patients completed surveys and were included in our analysis (75%); 225 reported using social media (55%). Of the respondents, 67% had a high school education or less and 60% reported an income of less than $50,000/y with an unemployment rate of 58%. In addition, 28% reported not owning a smartphone and 20% lacked home Internet access. Multivariable regression demonstrated that age, female sex, and home Internet access were all independently associated with increased social media use. Facebook was the most frequently used social media platform. Moreover, 42% were interested in telemedicine and social media users were significantly more likely to be interested in telemedicine programs compared with non-social media users.
Within a population of rural and economically disadvantaged upper-extremity patients, 55% currently use social media; 32% used these platforms to research health conditions. Whereas younger female patients with home Internet access were more likely to use social media, older patients were more likely to use these platforms to research health conditions.
As more health information moves on-line and as telemedicine programs continue to evolve, some rural upper-extremity patients may still have technological barriers in the form of smartphone and computer ownership as well as a lack of home Internet access.
Most next-generation sequencing platforms permit acquisition of high-throughput DNA sequences, but the relatively short read length limits their use in genome assembly or finishing. Illumina has ...recently released a technology called Synthetic Long-Read Sequencing that can produce reads of unusual length, i.e., predominately around 10 Kb. However, a systematic assessment of their use in genome finishing and assembly is still lacking. We evaluate the promise and deficiency of the long reads in these aspects using isogenic C. elegans genome with no gap. First, the reads are highly accurate and capable of recovering most types of repetitive sequences. However, the presence of tandem repetitive sequences prevents pre-assembly of long reads in the relevant genomic region. Second, the reads are able to reliably detect missing but not extra sequences in the C. elegans genome. Third, the reads of smaller size are more capable of recovering repetitive sequences than those of bigger size. Fourth, at least 40 Kbp missing genomic sequences are recovered in the C. elegans genome using the long reads. Finally, an N50 contig size of at least 86 Kbp can be achieved with 24 × reads but with substantial mis-assembly errors, highlighting a need for novel assembly algorithm for the long reads.
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