Delivery Complications Associated With Prenatal Care Access for Medicaid-Insured Mothers in Rural and Urban Hospitals

CONTEXT: Pregnancy complications affect many women. It is likely that some complications can be avoided through routine primary and prenatal care of reasonable quality. PURPOSE: The authors examined access to health care during pregnancy for mothers insured by Medicaid. The access indicator is potentially avoidable maternity complications (PAMCs). Potentially avoidable maternity complications are often preventable through routine prenatal care, such as infection screening and treatment. The authors examined the risks of potentially avoidable maternity complications among rural and urban hospital deliveries for groups of mothers defined by race or ethnicity. METHODS: Data are from the year 2000 Nationwide Inpatient Sample (NIS). The stratified sample represents all discharges from 20.5% of community hospitals in the United States. The Nationwide Inpatient Sample identifies hospital locations, but not patients' areas of residence. Analyses, which accounted for the sample design, included calculation of potentially avoidable maternity complication rates by race or ethnicity, chi2, t tests, and multivariate logistic regression. FINDINGS: Within groups defined by race or ethnicity, unadjusted rates for potentially avoidable maternity complications did not differ significantly by hospital location. Holding other factors constant, potentially avoidable maternity complications were less common in rural hospitals than in urban hospitals (odds ratio, 0.78; CI, 0.62 to 0.99). In rural hospitals, African Americans had notably higher risk for potentially avoidable maternity complications than did non-Hispanic whites (odds ratio, 1.72; CI, 1.26 to 2.36). In urban hospitals, risk of potentially avoidable maternity complications was not significantly higher for African Americans. Hispanics and Asians had notably lower risks of potentially avoidable maternity complications in urban hospitals than did non-Hispanic whites. CONCLUSIONS: Providers and policymakers should work to reduce the risks of potentially avoidable maternity complications for African American women in rural areas who are insured by Medicaid.     

女性吸毒人员的吸毒因素、社会化状况及应对措施

目的:了解女性吸毒人员社会化基本状况,并对其应对方式进行分析。方法:问卷调查、个案访谈及对在册病案进行回顾性分析及采用单因素Logistic回归分析。结果:诱发女性吸毒的因素众多,采用单因素Logistic回归分析OR值2 0以上,并有显著性意义的因素有:受教育程度、职业状况、婚姻状况、好奇、同伴影响、感情受挫、寻求刺激和减肥。结论:社会化不足是导致女性吸毒、影响其戒毒和保持戒毒后操守的重要因素,有针对性地对女性吸毒人员实施有效的社会化治疗是必要和有效的。     

Hepatocellular carcinoma and polymorphisms in carcinogen-metabolizing and DNA repair enzymes in a population with aflatoxin exposure and hepatitis B virus endemicity.

High rates of hepatocellular carcinoma (HCC) in The Gambia, West Africa, are primarily due to a high prevalence of chronic hepatitis B virus infection and heavy aflatoxin exposure via groundnut consumption. We investigated genetic polymorphisms in carcinogen-metabolizing (GSTM1, GSTT1, HYL1*2) and DNA repair (XRCC1) enzymes in a hospital-based case-control study. Incident HCC cases (n = 216) were compared with frequency-matched controls (n = 408) with no clinically apparent liver disease. Although the prevalence of variant genotypes was generally low, in multivariable analysis (adjusting for demographic factors, hepatitis B virus, hepatitis C virus, and TP53 status), the GSTM1-null genotype [odds ratio (OR), 2.45; 95% confidence interval (95% CI), 1.21-4.95] and the heterozygote XRCC1-399 AG genotype (OR, 3.18; 95% CI, 1.35-7.51) were significantly associated with HCC. A weak association of the HYL1*2 polymorphism with HCC was observed but did not reach statistical significance. GSTT1 was not associated with HCC. The risk for HCC with null GSTM1 was most prominent among those with the highest groundnut consumption (OR, 4.67; 95% CI, 1.45-15.1) and was not evident among those with less than the mean groundnut intake (OR, 0.64; 95% CI, 0.20-2.02). Among participants who had all three suspected aflatoxin-related high-risk genotypes [GSTM1 null, HLY1*2 (HY/HH), and XRCC1 (AG/GG)], a significant 15-fold increased risk of HCC was observed albeit with imprecise estimates (OR, 14.7; 95% CI, 1.27-169). Our findings suggest that genetic modulation of carcinogen metabolism and DNA repair can alter susceptibility to HCC and that these effects may be modified by environmental factors.     

Tear of the distal biceps branchii tendon: A new method of ultrasound evaluation

Tear of the distal biceps brachii tendon is an uncommon injury. Ultrasound evaluation of the distal tendon using an anterior approach is often difficult because of technical factors. We describe a new method of ultrasound evaluation of the distal biceps tendon insertion. This involves a posterior approach with the forearm pronated. With pronation of the forearm, the radial tuberosity faces posteriorly, bringing the distal biceps tendon insertion into view. A surgically proven case of distal biceps tendon tear is presented to illustrate our technique.     

参麦注射液联合川芎嗪对脓毒症小鼠肝脏的保护作用

目的探讨参麦联合川芎嗪注射液对脓毒症小鼠肝脏的保护作用。方法采用盲肠结扎穿孔(Cecal ligation and puncture,CLP)方法诱导形成脓毒症。将雄性成年的昆明小鼠随机分为5组,分别是假手术组、模型组、参麦注射液治疗组、川芎嗪注射液治疗组和参麦联合川芎嗪注射液治疗组。CLP术前24,12,1 h各组小鼠分别腹腔注射参麦注射液和川芎嗪注射液或者等计量的生理盐水。观察CLP造模后24 h各组小鼠血清中肿瘤坏死因子α(TNF-α)、白介素6(IL-6)含量、谷丙转氨酶(ALT)、谷草转氨酶(AST)活性以及肝脏组织中丙二醛(MDA)、髓过氧化物酶(MPO)水平,并观察各组小鼠的存活率及其肝脏组织的病理变化。结果参麦、川芎嗪及参麦联合川芎嗪三组药物治疗组的脓毒症小鼠其死亡率、血清中炎症因子(TNF-α、IL-6)含量、肝脂质过氧化(MDA、MPO)水平、ALT/AST及其肝脏病理损伤程度均较模型组明显减轻,尤以参麦联合川芎嗪给药治疗组疗效最为显著。此外,联合给药治疗组血清中的炎症因子(TNF-α、IL-6)水平较单一用药组显著降低。结论参麦联合川芎嗪注射液较单一用药能够更有效地抑制炎症反应,提高脓毒症小鼠的存活率、减轻肝脏损伤。     

痔瘘熏洗凝胶剂药效学初步研究

目的:观察痔瘘熏洗凝胶剂的抗炎、镇痛效果.方法:选取雌性大鼠分组后通过建立角叉菜胶肛周肿胀模型,观察痔瘘熏洗凝胶剂对实验性痔疮的抗炎作用;选取雌性小鼠分组后通过热板法观察痔瘘熏洗凝胶剂的镇痛作用.结果:痔瘘熏洗剂及其改进剂型--痔瘘熏洗凝胶剂对角叉菜胶所致大鼠肛周肿胀均有显著的抑制作用,对热传导引起的疼痛有确切的镇痛作...