Provision of Buprenorphine to Pregnant Women by For-Profit Clinics in an Appalachian City

Objectives: This study was undertaken to confirm that patient reports on buprenorphine medication-assisted therapy in for-profit buprenorphine clinics in our community were personally costly. We contacted all 17 for-profit clinics in our community and confirmed the patient reports that a significant financial payment of ≤$100 was required for each visit. We also found that tapering of buprenorphine dosage in pregnancy was offered by several of...

Birth Weight and Risk of Childhood Acute Lymphoblastic Leukemia in Arizona, Illinois, and Kentucky

Objective: To confirm the previously reported increased risk of leukemia among macrosomic children (those with birth weight >4 kg). Methods: Birth certificates of Arizona, Illinois, and Kentucky children diagnosed as having acute lymphoblastic leukemia (ALL) before age 5 years were matched with birth certificates from leukemia-free children of the same sex, race, and ethnicity who were born in the same county on or about the same day. Odds...

Contemporary Geographic Variation and Sociodemographic Correlates of Hysterectomy Rates Among Reproductive-Age Women

Objective: For decades hysterectomy rates have famously demonstrated unexplained geographic variation. The aim of this study was to identify county-level correlates of hysterectomy rates among reproductive-age women. Methods: Using county-level data from multiple sources, linked with claims-based surveillance data of every hysterectomy performed among women ages 20 to 44 in North Carolina from 2011 to 2013 (N = 7180), we explored social,...

Effects of Maternal Carbohydrate and Fat Intake on Fetal Telomere Length

Objectives: Telomere length can be affected by dietary factors in adults. We investigated the association between maternal carbohydrate and fat intake during pregnancy and telomere length in neonatal cord blood leukocytes. We hypothesized that high fat consumption and high carbohydrate consumption would be associated with shortened fetal telomere length. Methods: We collected umbilical cord blood at delivery from women admitted for labor and...

Parental Age and the Risk of Gestational Hypertension and Preeclampsia

Objectives: To determine the effect of maternal age (MA) and paternal age (PA) on the risk of gestational hypertension, preeclampsia, and eclampsia in women who delivered on the Texas–Mexico border. Methods: A cohort study using birth certificate data (singleton pregnancies, years 2005–2010) from El Paso County, Texas, was conducted. Six parental age–exposure categories were created with MA 20 to 34 years and PA younger than 35 years...

Placental Chorioangioma with Nonimmune Hydrops Fetalis

A 38-year-old woman was found to have a large placental chorioangioma. The fetus was studied using ultrasound. The pregnancy became complicated by hydrops fetalis, polyhydramnios, and abruptio placenta. The infant delivered at 29 weeks’ gestational age. The neonatal course was complicated by nonimmune hydrops fetalis, respiratory distress syndrome, anemia, pulmonary hemorrhage, intraventricular hemorrhage, necrotizing enterocolitis, and...

THAM Administration to Pediatric Trauma Patients in a Combat Zone

Objectives: Pediatric casualties made up a significant proportion of patients during the recent military conflicts in Iraq and Afghanistan. Damage control resuscitation strategies used by military physicians included rapid reversal of metabolic acidosis to mitigate its pathophysiologic consequences, primarily through hemorrhage control and volume restoration. Alkalizing agents, including tris(hydroxymethyl)aminomethane (THAM), are potential...

Brucellosis in Adults and Children: A 10-Year Case Series at Two Large Academic Hospitals in Houston, Texas

Objectives: Brucellosis is one of the most common zoonoses worldwide. Most cases in the United States occur among travelers or immigrants from endemic regions, mostly Central America. In this study, we aimed at describing and comparing the epidemiology and clinical presentation of brucellosis in pediatric and adult patients at two large tertiary care centers in Houston, Texas. Methods: We identified patients diagnosed as having brucellosis...

A Look Through Time: Historical Analysis of Obstetrics and Gynecology Texts Highlights Changes in Medicine

Objective: Our objective was to analyze systematically the preface and foreword of each edition of Williams Obstetrics and Te Linde’s Operative Gynecology to gain insight into historical changes in medicine. Methods: The preface and foreword from 24 editions of Williams Obstetrics and 11 editions of Te Linde’s Operative Gynecology were obtained. Documents were assessed for the inclusion of predefined key words or topics, including...

Commentary on “Population-Based Analysis of Patient Age and Other Disparities in the Treatment of Ovarian Cancer in Central Appalachia and Kentucky”

The article “Population-Based Analysis of Patient Age and Other Disparities in the Treatment of Ovarian Cancer in Central Appalachia and Kentucky”1 in this issue of the Southern Medical Journal describes the disparity in National Cancer Comprehensive Network (NCCN) guideline adherence in the economically depressed region of the United States known as central...

Population-Based Analysis of Patient Age and Other Disparities in the Treatment of Ovarian Cancer in Central Appalachia and Kentucky

Objectives: Adherence to National Comprehensive Cancer Network (NCCN) guidelines for ovarian cancer treatment improves patient outcomes. The aim of this study was to assess disparities associated with ovarian cancer treatment in the state of Kentucky and central Appalachia. Methods: Data on patients diagnosed as having ovarian cancer from 2007 through 2011 were extracted from administrative claims-linked Kentucky Cancer Registry data. NCCN...

Contraceptive Practices, Preferences, and Barriers Among Abortion Clients in North Carolina

Objectives: Abortion clinics provide an ideal setting for women to receive contraceptive care because the women served may not have other contacts with the health system and are at risk for unintended pregnancies. The objective of this study was to understand practices, preferences, and barriers to use of contraception for women obtaining abortions at clinics in North Carolina. Methods: We conducted a cross-sectional survey of abortion...

Practice Pattern Variation in Pediatric Eosinophilic Esophagitis in the Carolinas EoE Collaborative: A Research Model in Community and Academic Practices

Objectives: Differences in the initial management of pediatric eosinophilic esophagitis (EoE) by practice setting have not been well characterized. We aimed to characterize these differences for sites in the Carolinas EoE Collaborative (CEoEC), a multicenter network of academic and community practices. Methods: We performed a retrospective cohort study of pediatric EoE patients at five CEoEC sites: University of North Carolina (UNC) Hospital,...

Alabama Children’s Body Mass Index, Nutritional Attitudes, and Food Consumption: An Exploratory Analysis

Objectives: This study had three aims: assess the extent to which middle school children in southern Alabama were classified as overweight or obese; determine the magnitude of the relation between children’s attitudes toward healthy eating and their actual dietary choices; and examine the role of race, sex, and ZIP codes on children’s eating attitudes and behaviors. Methods: Registered dietitians took height and weight measurements of...

Postponing Childbearing and Fertility Preservation in Young Professional Women

Objectives: To evaluate young women’s awareness of ovarian reserve testing and oocyte cryopreservation (OC) and assess how testing ovarian reserve may affect the desire for fertility preservation. Methods: Three questionnaire-based observational studies were conducted among female students/young professionals 20 years of age and older. The third survey was completed after participants were offered anti-Mullerian hormone (AMH) testing. The...

On “Diagnosis of Child Maltreatment: A Family Medicine Physician’s Dilemma”

To the Editor: I recently had an opportunity to read the article ‘‘Diagnosis of Child Maltreatment: A Family Medicine Physician’s Dilemma,’’ by Eniola and Evarts,1 which appeared in the May 2017 issue of the Southern Medical Journal. Having practiced in family medicine for 935 years in rural settings as well as having a full-time practice in child abuse pediatrics for the past 12 years, I would strongly support the information and...

Comparison of Children’s Menu Items at Full- and Quick-Service Restaurants

Objectives: The proportion of food consumed by children from restaurants tripled during the last 4 decades and that coincided with the increased rate of obesity. Despite the presence of data linking quick-service (QS) food consumption to poor diet quality, studies comparing the nutrition content of the children’s menu items at QS restaurants (QSRs) with those at full-service restaurants (FSRs) are limited. The objectives of this study were to...

Risk-Reducing Salpingectomy Versus Standard Tubal Sterilization: Lessons From Offering Women Options for Interval Sterilization

Objectives: In women receiving sterilization, the removal of the entire fallopian tube, a procedure referred to as a risk-reducing salpingectomy (RRS), reduces subsequent ovarian cancer risk compared with standard tubal sterilization procedures. There are limited data on which surgical procedure women will choose when educated about the benefits of an RRS. Our objective was to study the proportion of women desiring sterilization that would...

Women’s Health Curriculum for Medical Students

Objectives: Knowledge of women’s health is important for physicians in various specialties, but training often is inadequate. The objective of this project was to develop, implement, and evaluate a women’s health curriculum for medical students at the University of Florida College of Medicine in Gainesville. Methods: After reviewing previous pertinent literature and assessing institutional factors, we developed an interdisciplinary...

Delayed Emergence in Pediatric Patients with Neurologic Disease Presenting for Ambulatory Surgery

Objectives: Management of pediatric patients with neurological diagnoses can be challenging for anesthesiologists. We sought to determine whether preexisting neurologic disease could serve as an intrinsic risk factor for prolonged emergence. Methods: Following institutional review board approval, we conducted a database search from 2012 to 2015. Included were patients aged 0 to 18 years undergoing ambulatory procedures, and carrying...