Behavioral strategies to improve treatment participation and retention by pregnant drug-dependent women

The present study examined the utility of behavioral incentives for improving early treatment participation and retention in a sample of 91 pregnant opiate and/or cocaine dependent women enrolled in an urban, university-based drug user treatment program between 1996 and 1997. An escalating voucher incentive system was compared to standard care. The relationship between treatment participation and retention and maternal and infant outcomes were examined using logistic regression, chi-square analyses, and t-tests. Behavioral incentives did not decrease rates of very early dropout from residential treatment, although improved outpatient treatment participation and retention during the transition from residential care was noted. Behavioral strategies demonstrate utility as adjuncts to counseling for high-risk substance dependent patients. They appear ineffective, however, for improving early residential treatment participation and retention, suggesting other variables (e.g., psychiatric comorbidity) may be operating during the first 24-48 hours post treatment admission.     

The Impact of Managed Care on Drug-Dependent Pregnant and Postpartum Women and Their Children

In the shift from fee-for-service (FFS) to managed care (MC), many drug user treatment programs have eliminated all but basic services, lessening short-term costs without considering long-term consequences. This study explored maternal and infant outcomes at an urban drug user treatment center for pregnant drug-dependent women under FFS (1995) vs. MC (2000) service periods. The two groups had similar birth parameters, but the MC group had more fetal and infant deaths, decreased immunization rates, and greater incidences of social services intervention. While these data are correlational and need to be interpreted with caution, they suggest poorer outcomes for drug-exposed children under MC and invite further study of short- and long-term consequences of such change.     

Right hemicolectomy anastomotic leak study: a review of right hemicolectomy in the binational clinical outcomes registry (BCOR)

Backgrounds

Surgery remains mainstay management for colon cancer. Post-operative anastomotic leak (AL) carries significant morbidity and mortality. Rates of, and risk factors associated with AL following right hemicolectomy remain poorly documented across Australia and New Zealand. This study examines the Bowel Cancer Outcomes Registry (BCOR) to address this.

Methods

A retrospective cohort study was undertaken of consecutive BCOR-registered right hemicolectomy patients undergoing resection for colon cancer (2007–2021). The primary outcome measure was AL incidence. Clinicopathological data were extracted from the BCOR. Factors associated with AL and primary anastomosis were identified using logistic regression. AL-rate trends were assessed by linear regression.

Results

Of 13 512 patients who had a right hemicolectomy (45.2% male, mean age 72.5 years, SD 12.1), 258 (2.0%) had an AL. On multivariate analysis, male sex (OR 1.33; 95% CI 1.03–1.71) and emergency surgery (OR 1.41; 95% CI 1.04–1.92) were associated with AL. Private health insurance status (OR 0.66; 95% CI 0.50–0.88) and minimally-invasive surgery (OR 0.61; 95% CI 0.47–0.79) were protective for AL. Anastomotic technique (handsewn versus stapled) was not associated with AL (P = 0.84). Patients with higher ASA status (OR 0.47; 95% CI 0.39–0.58), advanced tumour stage (OR 0.56; 95% CI 0.50–0.63), and emergency surgery (OR 0.16; 95% CI 0.13–0.20) were less likely to have a primary anastomosis. AL-rate and year of surgery showed no association (P = 0.521).

Conclusion

The AL rate in Australia and New Zealand following right hemicolectomy is consistent with the published literature and was stable throughout the study period. Sex, emergency surgery, insurance status, and minimally invasive surgery are associated with AL incidence.     

Risk factors for coronary artery disease in Indians

Background: A case control study was carried out to study the emerging risk factors for coronary artery disease in Indians.     

History of physical abuse and periconceptional drinking in pregnant women

This study examines the relationship between physical abuse and periconceptional drinking in women presenting to a mid-Atlantic, urban hospital-based OB/GYN clinic serving a largely indigent population between April 2003 and May 2004. During their first prenatal visit, 308 women completed a screening battery that included the Abuse Assessment Screen (AAS) and measures of alcohol use, including the CAGE, T-ACE, TWEAK, and the PRIME-MD Patient Health Questionnaire (PHQ). Bivariate analyses, including odds ratios (ORs) and 95% confidence intervals (CIs), revealed that women with a history of physical abuse were more likely to report drinking alcohol within the 3 months prior to their prenatal care visit and were significantly more likely to meet criteria for risk drinking on multiple measures. A history of physical abuse appears to be associated with higher self-reported rates of periconceptional drinking in pregnant women. Study findings support the need for assessment of abuse history as a potential risk factor for alcohol use in pregnant women.