Consent to Sterilization section of the Medicaid-Title XIX form: is it understandable?

INTRODUCTION: We sought to assess readability and comprehension characteristics of the Consent to Sterilization section of the Medicaid-Title XIX form (Title XIX-SCF) in order to determine if it was likely providing informed consent to the Medicaid population. MATERIALS AND METHODS: The current Title XIX-SCF was evaluated using the Readability and Processability Form (RPF). The RPF, designed to assess the format of informed consent documents, assigns points to each of 20 areas of comprehension analysis according to established scoring criteria. Finally, a modified Title XIX-SCF was developed and evaluated using the RPF. RESULTS: The overall RPF score for the current Title XIX-SCF was in the "poor" range (total=37), while the Fry reading level was at the ninth grade. The modified Title XIX-SCF scored in the "excellent" range (total=92), while the Fry reading level was at the sixth grade. CONCLUSIONS: The readability and comprehension demands of the current Title XIX-SCF exceed recommended guidelines for patient education and informed consent materials. The current Title XIX-SCF should be revised to ensure that women understand, desire and consent to permanent sterilization.     

Barriers to obtaining a desired postpartum tubal sterilization

OBJECTIVE: To determine why women do not undergo postpartum sterilization despite expressing desire during antepartum care. METHODS: In a retrospective chart review, we identified all women between March 2002 and November 2003 who requested postpartum sterilization during antepartum care but did not undergo the procedure. We report the reasons why sterilizations were not performed. RESULTS: We reviewed 6,589 prenatal care and delivery records identifying 324 women meeting inclusion criteria. One hundred and four women changed their mind. Of women still desiring sterilization at discharge, the most common reasons for not undergoing the procedure were lack of valid Medicaid sterilization consent forms [n=121; 37.3%, 95% confidence interval (CI) 32.0-42.6%]; a medical condition precluding the procedure (n=47; 14.5%, 95% CI 10.7-18.3%); lack of availability of an operating room (n=2; 6.5%, 95% CI 3.8-9.2%). CONCLUSION: We found that the Medicaid consent process, medical conditions and insufficient operating room space prevented women from having the desired surgery.     

输卵管折叠结扎法与双折结扎切除法的比较研究

目的研究对比输卵管折叠结扎法与双折结扎切除法两种绝育方法的临床效果。方法选择624例需行绝育手术的妇女为研究对象,随机平均分为两组,研究组(312例)行输卵管折叠结扎法,对照组(312例)行双折结扎切除法,对研究对象进行为期2年的随访,观察妊娠情况及并发症发生情况。结果研究组术后有1例发生宫内妊娠,失败率为0.32%,对照组有6例发生宫内妊娠,1例发生宫外孕,失败率为2.24%,差异有统计学意义(P<0.05)。研究组术后并发症发生率为6.41%,显著低于对照组的18.6%,统计学有显著性差异(P<0.05)。结论输卵管折叠结扎法是绝育手术一种比较理想的方法,术后妊娠发生率低,并发症少,值得临床推广和普及。     

利津县部分育龄妇女实施输卵管结扎术避孕10年综合效果评价

[目的]了评价实施输卵管结扎手术对妇女身体健康的影响，为今后开展工作提供可行的科学依据。[方法]2005年，对利津县1995年实施输卵管结扎手术避孕的200名育龄妇女（实验组）进行调查，并与未实施输卵管结扎手术避孕的200名育龄妇女（对照组）比较。[结果]性欲增强、性欲降低、月经期延长、月经期缩短者所占比例，实验组分别为6．5％、4．0％、8．0％、10．0％，对照组分别为5．5％、4．0％、12．0％、7．0％（P〉0．05）；白带增多、白带减少、附件炎患病率，实验组分别为5．0％、3．5％、5．0％，对照组分别为8．0％、2．5％、9．0％（P〉0．05）；子宫颈炎患病率，实验组为5．0％，对照组为11．0％（P〈0．05）；雌激素水平低于正常水平者所占比例，实验组为2．0％，对照组为2．5％（P〉0．05）；1995-2005年中，实验组无1人怀孕，对照组有38人怀孕46人次。[结论]实施输卵管结扎手术避孕的效果很好，对妇女的身体健康无不良影响。     

Medicaid and fulfillment of desired postpartum sterilization

Objective

We sought to assess fulfillment of sterilization requests while accounting for the complex interplay between insurance, clinical and social factors in a contemporary context that included both inpatient and outpatient postpartum sterilization procedures.

腹式输卵管结扎术后复通术47例临床分析

目的针对育龄妇女但已经实施输卵管结扎的患者采用复通术恢复正常妊娠状态,观察患者子宫妊娠能力以及复通效果,旨在了解手术影响因素,提升手术有效性。方法选取我院在2011年7月至2013年7月间收治的在输卵管结扎后实施复通术的患者47例,回顾性分析其临床资料,探讨输卵管炎症情况和输卵管长度对复通率、宫内妊娠率以及宫外妊娠率的影响。结果①患者炎症部位以及程度对于复通成功率而言没有显著性差异(P>0.05),但妊娠成功率与炎症状况呈相关性,双侧炎症的患者与没有炎症的患者两者间宫内妊娠几率差异有统计学意义(P<0.05),患者炎症程度越严重,有效妊娠率就越低。②患者两侧输卵管长度对于复通成功率没有明显影响(P>0.05),但在妊娠方面影响具有明显差异性(P<0.05)。结论患者炎症情况以及输卵管剩余程度均会对妊娠成功几率造成影响,炎症越严重、输卵管剩余长度越短,成功妊娠几率就越小。因此提升妊娠率的关键在于调节输卵管状态,医师应注意术中对输卵管的保护。     

输卵管外科手术在治疗输卵管性不孕中的应用

输卵管因素引起的不孕（简称输卵管性不孕）是女性不孕的首要原因,主要包括近端输卵管梗阻、输卵管绝育术和输卵管远端粘连、闭锁、积水。在辅助生殖技术占据生殖医学主导地位的今天,生殖手术在治疗输卵管性不孕中的地位并未改变。综合考虑患者的年龄、卵巢储备功能、术后输卵管功能、男方精液参数等指标后有指征地实施个体化生殖手术,不仅可以取得较满意的临床妊娠率和活产率,还可以恢复患者多次自然受孕的能力,这与我国现行生育政策更为贴合。针对输卵管病变部位的不同,采取的术式也各异,主要有近端输卵管吻合术、输卵管导丝介入术、中段输卵管吻合术、输卵管粘连分解术、输卵管伞端成形术、输卵管造口术、输卵管切除术和输卵管结扎术。     

输卵管注药绝育术有效性及安全性的前瞻性流行病学研究

本文为一项输卵管注药绝育术的前瞻性队列研究。队列1使用显影苯酚胶浆共834例,队列2使用8%阿的平苯酚糊剂871例。二年随访率98.5%。生命表法分析,第24个顺序月每100名妇女的累积成功率两队列分别为91.9%和97.4%。其间有显著性差别。绝育效果主要取决于输卵管注药后X光显影的充盈长度。多元判别分析也显示同样的结论。所有研究对象在术中和术后未见严重并发症。术后发烧,队列2 (8%)高于队列1(4.4%)。本术对月经无明显影响。研究结果表明该术是一种简便、安全、有效的女性绝育术。     

Risk factors for tubal ligation: regret and psychological effects impact of Beck Depression Inventory

OBJECTIVE: To investigate the relation of sterilization and depression in association with Beck Depression Inventory (BDI) and to analyze whether preoperative BDI scores have predictive value on satisfaction. METHODS: One hundred sixty-two women who had laparoscopic surgical sterilization were recruited into the study. Patients identified to have an intra-abdominal disease such as pelvic inflammatory disease, endometriosis or adnexal lesions, myoma uteri and previous cesarean delivery were excluded from the study. Women were administered the BDI 1 week prior to the operation and 1 year after the procedure, and patients were asked if they were satisfied with their new state of fertility. RESULTS: Mean BDI scores were 10.1+/-2.7 and 12.9+/-4.0, preoperatively and postoperatively, respectively (p<.001). The difference between preoperative and postoperative BDI scores was affected by age and satisfaction status; younger patients had significantly increased postoperative scores. Dissatisfied women had higher pre- and postoperative BDI scores (p<.001). The difference between pre- and postoperative scores was increased significantly in the dissatisfied group. Preoperative BDI score was found to be a significant predictor of satisfaction status 1 year after the operation. CONCLUSION: Preoperative application of BDI can identify women who are at greater risk for regret and dissatisfaction.     

Vasectomy: the other (better) form of sterilization

Male sterilization (vasectomy) is the most effective form and only long-acting form of contraception available to men in the United States. Compared to female sterilization, it is more efficacious, more cost-effective, and has lower rates of complications. Despite these advantages, in the United States, vasectomy is utilized at less than half the rate of female sterilization. In addition, vasectomy is least utilized among black and Latino populations, groups with the highest rates of female sterilization. This review provides an overview of vasectomy use and techniques, and explores reasons for the disparity in vasectomy utilization in the United States.     

Development and validation of a Food Preoccupation Questionnaire

ObjectiveExisting Food Preoccupation Questionnaires do not take account of food-related thoughts that have a positive emotional valence. We report on the development and validation of a questionnaire that provides independent assessments of thought frequency and emotional valence (positive, negative or neutral).MethodIn Study 1 questionnaire items were validated against a three-day diary measure with 40 males and females. In Study 2 the questionnaire was administered to 130 males and females alongside a range of other measures.ResultsThe questionnaire showed good construct validity, internal reliability, and test–retest reliability. Dieters and females scored higher on frequency and negativity subscales. There was also a significant interaction between sex and diet status on thought frequency, with females showing a stronger relationship between the two.DiscussionThe questionnaire should be useful for exploring the cognitive impact of dieting and relationships between food preoccupation, food processing biases and overeating.     

Probability of pregnancy after sterilization: a comparison of hysteroscopic versus laparoscopic sterilization

Objective

To compare the expected probability of pregnancy after hysteroscopic versus laparoscopic sterilization based on available data using decision analysis.

Study design

We developed an evidence-based Markov model to estimate the probability of pregnancy over 10 years after three different female sterilization procedures: hysteroscopic, laparoscopic silicone rubber band application and laparoscopic bipolar coagulation. Parameter estimates for procedure success, probability of completing follow-up testing and risk of pregnancy after different sterilization procedures were obtained from published sources.

Results

In the base case analysis at all points in time after the sterilization procedure, the initial and cumulative risk of pregnancy after sterilization is higher in women opting for hysteroscopic than either laparoscopic band or bipolar sterilization. The expected pregnancy rates per 1000 women at 1 year are 57, 7 and 3 for hysteroscopic sterilization, laparoscopic silicone rubber band application and laparoscopic bipolar coagulation, respectively. At 10 years, the cumulative pregnancy rates per 1000 women are 96, 24 and 30, respectively. Sensitivity analyses suggest that the three procedures would have an equivalent pregnancy risk of approximately 80 per 1000 women at 10 years if the probability of successful laparoscopic (band or bipolar) sterilization drops below 90% and successful coil placement on first hysteroscopic attempt increases to 98% or if the probability of undergoing a hysterosalpingogram increases to 100%.

Conclusion

Based on available data, the expected population risk of pregnancy is higher after hysteroscopic than laparoscopic sterilization. Consistent with existing contraceptive classification, future characterization of hysteroscopic sterilization should distinguish “perfect” and “typical” use failure rates.

Implications

Pregnancy probability at 1 year and over 10 years is expected to be higher in women having hysteroscopic as compared to laparoscopic sterilization.     

Implications of the Medicaid Undercount in a High-Penetration Medicaid State

Research Objective. This study investigates the impact of misreporting by Medicaid recipients on estimates of the uninsured in Louisiana, and is based on similar work by Call et al. in Minnesota and Klerman, Ringel, and Roth in California. With its unique charity hospital system, culture, and high poverty, Louisiana provides an interesting and unique context for examining Medicaid underreporting.
Study Design. Results are based on a random sample of 2,985 Medicaid households. Respondents received a standard questionnaire to identify health insurance status, and individual records were matched to Medicaid enrollment data to identify misreporting.
Data Sources. Data were collected by the Public Policy Research Lab at Louisiana State University using computer-assisted telephone interviewing. Using Medicaid enrollment data to obtain contact information, the Louisiana Health Insurance Survey was administered to 2,985 households containing Medicaid recipients. Matching responses on individuals from these households to Medicaid enrollment data yielded responses for 3,199 individuals.
Conclusions. Results suggest relatively high rates of underreporting among Medicaid recipients in Louisiana for both children and adults. Given the very high proportion of Medicaid recipients in the population, this may translate up to a 3 percent bias in estimates of uninsured populations.
Implications. Medicaid bias may be particularly pronounced in areas with high Medicaid enrollments. Misreporting rates and thus the bias in estimates of the uninsured may differ across areas of the United States with important consequences for Medicaid funding.
Funding Source. Louisiana Department of Health and Hospitals.     

A qualitative study of barriers to postpartum sterilization and women's attitudes toward unfulfilled sterilization requests

BACKGROUND: This longitudinal, qualitative study explores barriers to postpartum sterilization from the perspective of low-income minority women. We examine women's feelings and attitudes regarding a canceled or postponed procedure over time. STUDY DESIGN: We conducted structured, in-depth baseline interviews with 34 postpartum women with unfulfilled sterilization requests in a university hospital setting. Follow-up phone interviews were conducted at 6 weeks and 6 months postpartum. RESULTS: Reasons for unfulfilled sterilization requests included last-minute misgivings, maternal medical complications, lack of a valid Medicaid consent form, fear of the procedure and provider influence. Sense of autonomy regarding sterilization decision making and ability to obtain interval sterilization or initiate and/or successfully use reversible contraception influenced subsequent attitudes regarding an unfulfilled request. CONCLUSIONS: Sterilization counseling should include comprehensive information regarding the surgical procedure and associated risks and the development of a backup contraceptive plan, with particular emphasis on increasing contraceptive self-efficacy and autonomy in sterilization decision making.     

The use of a low-literacy version of the Medicaid sterilization consent form to assess sterilization-related knowledge in Spanish-speaking women: results from a randomized controlled trial

Objective

To learn whether a version of the Medicaid Sterilization Consent Form (SCF) adapted for populations of low-literacy can help Spanish-speaking women better understand the process and consequences of tubal sterilization.

宫腔镜联合腹腔镜治疗对输卵管性不孕症患者输卵管通畅率及宫内妊娠率的影响

目的观察宫腔镜联合腹腔镜治疗对输卵管性不孕症患者输卵管通畅率及宫内妊娠率的影响。方法选取我院2017年3月至2018年1月收治的94例输卵管性不孕症患者,随机分为对照组和观察组各47例。对照组行腹腔镜输卵管疏通术治疗,观察组行宫腔镜联合腹腔镜治疗。观察两组的输卵管通畅率、宫内妊娠率及术后并发症情况。结果与对照组相比,观察组术后3个月的输卵管总通畅率较高,术后并发症发生率较低,术后1年宫内妊娠率较高,差异均有统计学意义(P<0.05)。结论宫腔镜联合腹腔镜治疗可有效提高输卵管性不孕症患者输卵管通畅率及宫内妊娠率,且术后并发症发生率较低,具有较高的安全性,值得临床推广。     

Medicaid Primary Care Physician Fees and the Use of Preventive Services among Medicaid Enrollees

Objective

The Patient Protection and Affordable Care Act (ACA) increases Medicaid physician fees for preventive care up to Medicare rates for 2013 and 2014. The purpose of this paper was to model the relationship between Medicaid preventive care payment rates and the use of U.S. Preventive Services Task Force (USPSTF)–recommended preventive care use among Medicaid enrollees.

Data Sources/Study Session

We used data from the 2003 and 2008 Medical Expenditure Panel Survey (MEPS), a national probability sample of the U.S. civilian, noninstitutionalized population, linked to Kaiser state Medicaid benefits data, including the state Medicaid-to-Medicare physician fee ratio in 2003 and 2008.

Study Design

Probit models were used to estimate the probability that eligible individuals received one of five USPSF-recommended preventive services. A difference-in-difference model was used to separate out the effect of changes in the Medicaid payment rate and other factors.

Data Collection/Extraction Methods

Data were linked using state identifiers.

Principal Findings

Although Medicaid enrollees had a lower rate of use of the five preventive services in univariate analysis, neither Medicaid enrollment nor changes in Medicaid payment rates had statistically significant effects on meeting screening recommendations for the five screenings. The results were robust to a number of different sensitivity tests. Individual and state characteristics were significant.

Conclusions

Our results suggest that although temporary changes in primary care provider payments for preventive services for Medicaid enrollees may have other desirable effects, they are unlikely to substantially increase the use of these selected USPSTF-recommended preventive care services among Medicaid enrollees.     

The long-term health impacts of Medicaid and CHIP

This paper estimates the effect of US public health insurance programs for children on health. Previous work in this area has typically focused on the relationship between current program eligibility and current health. But because health is a stock variable which reflects the cumulative influence of health inputs, it would be preferable to estimate the impact of total program eligibility during childhood on longer-term health outcomes. I provide such estimates by using longitudinal data to construct Medicaid and CHIP eligibility measures that are observed from birth through age 18 and estimating the effect of cumulative program exposure on a variety of health outcomes observed in early adulthood. To account for the endogeneity of program eligibility, I exploit variation in Medicaid and CHIP generosity across states and over time for children of different ages. I find that an additional year of public health insurance eligibility during childhood improves a summary index of adult health by .079 standard deviations, and substantially reduces health limitations, chronic conditions and asthma prevalence while improving self-rated health.     

大学生艾滋病知识问卷的难度及区分度分析

目的评价大学生艾滋病知识问卷的难度和区分度,以便提出对不同问题的处理意见.方法难度指数、区分度指数是按难度、区分度的计算方法,对大学生艾滋病知识问卷进行难度、区分度分析与评价.结果艾滋病三大传播途径(血液、性、母婴)的题目难度偏小(P=0.91),区分度不好(D=0.15);男女之间传播概率难度偏大(P=0.17),区分度不好(D=0.17);非传播途径、安全性行为、病程等方面的题目难度适宜(平均P=0.57),区分度好或尚可(平均D=0.51).结论总体而言,大学生艾滋病知识问卷的难度、区分度较好,建议艾滋病三大传播途径和男女之间传播概率的题目不作为评价艾滋病预防教育效果的指标.