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Benzodiazepine (BZD) prescription rates have increased over the past decade in the United States. Available literature indicates that sociodemographic factors may influence diagnostic patterns and/or prescription behaviour. Herein, the aim of this study is to determine whether the gender of the prescriber and/or patient influences BZD prescription.
Cross-sectional study using data from the Florida Medicaid Managed Medical Assistance Program from January 1, 2018 to December 31, 2018. Eligible recipients ages 18 to 64, inclusive, enrolled in the Florida Medicaid plan for at least 1 day, and were dually eligible. Recipients either had a serious mental illness (SMI), or non-SMI and anxiety.
Total 125 463 cases were identified (i.e., received BZD or non-BZD prescription). Main effect of patient and prescriber gender was significant F(1, 125 459) = 0.105, P = 0 .745, partial η2 < 0.001. Relative risk (RR) of male prescribers prescribing a BZD compared to female prescribers was 1.540, 95% confidence intervals (CI) [1.513, 1.567], whereas the RR of male patients being prescribed a BZD compared to female patients was 1.16, 95% CI [1.14, 1.18]. Main effects of patient and prescriber gender were statistically significant F(1, 125 459) = 188.232, P < 0.001, partial η2 = 0.001 and F(1, 125 459) = 349.704, P < 0.001, partial η2 = 0.013, respectively.
Male prescribers are more likely to prescribe BZDs, and male patients are more likely to receive BZDs. Further studies are required to characterize factors that influence this gender-by-gender interaction.
The 2013 Infection Prevention and Control (IP&C) Guideline for Cystic Fibrosis (CF) was commissioned by the CF Foundation as an update of the 2003 Infection Control Guideline for CF. During the past decade, new knowledge and new challenges provided the following rationale to develop updated IP&C strategies for this unique population:
1. The need to integrate relevant recommendations from evidence-based guidelines published since 2003 into IP&C practices for CF. These included guidelines from the Centers for Disease Control and Prevention (CDC)/Healthcare Infection Control Practices Advisory Committee (HICPAC), the World Health Organization (WHO), and key professional societies, including the Infectious Diseases Society of America (IDSA) and the Society for Healthcare Epidemiology of America (SHEA). During the past decade, new evidence has led to a renewed emphasis on source containment of potential pathogens and the role played by the contaminated healthcare environment in the transmission of infectious agents. Furthermore, an increased understanding of the importance of the application of implementation science, monitoring adherence, and feedback principles has been shown to increase the effectiveness of IP&C guideline recommendations.
2. Experience with emerging pathogens in the non-CF population has expanded our understanding of droplet transmission of respiratory pathogens and can inform IP&C strategies for CF. These pathogens include severe acute respiratory syndrome coronavirus and the 2009 influenza A H1N1. Lessons learned about preventing transmission of methicillin-resistant Staphylococcus aureus (MRSA) and multidrug-resistant gram-negative pathogens in non-CF patient populations also can inform IP&C strategies for CF.
This book evaluates the effectiveness of prenatal care interventions and provides a framework for prenatal care that looks beyond the limited perspective of immediate neonatal outcomes. Ultimately, this book seeks to improve the content and the implementation of prenatal care by shifting the focus away from short-term technocentric medical advances to concentrate on the broader public health issues. A unique aspect of this book is its focus on the effectiveness of prenatal care interventions on longer-term benefits for women and children's health. Traditional medical interventions, as well as social support and behavioral interventions during prenatal care are reviewed. Effectiveness is considered within the context of its implications for public policy and service delivery. This book is an important resource for maternal and child health professionals, policy makers and health care managers because it provides evidence of the prenatal care services that improve the long-term health of women and children.
Over the past 30 years, the United States has experienced a major decrease in infant mortality, especially mortality in the neonatal period. Despite this dramatic change, the United States remains at a very disadvantaged position among industrialized countries when they are ranked by infant mortality rate. This situation reflects the conjunction of two trends. The first is the increasing technological sophistication and success of perinatal services in sustaining the survival of ever tinier infants (Richardson et al., 1998). The second trend, which offsets the first, is the persistence of high rates of low birth weight and prematurity, and even increases in rates of such births among African Americans. Another contributing factor is the persistence of a steady rate of major congenital malformations. Despite the fact that most industrialized countries experience similar malformation rates, they have been able to reduce the percentage of preterm deliveries while also incorporating technological interventions into the care of those who are born prematurely (Guyer et al., 1996).
The strategy that has been advocated to reduce the rate of preterm and low birth weight births in the U.S. reflects a short-term, clinical approach that consists of increasing access to early and regular prenatal care (IOM, 1985, 1988). Advocates for changing financial and other barriers to prenatal care base their arguments on conclusions of cost-effectiveness of prenatal care in changing birth weight or duration of gestation (Gorsky and Colby, 1989; IOM, 1985; Korenbrot, 1984).
The conference that formed the basis for this book was motivated in large part by recurrent questions in the literature regarding the value of prenatal care. Research has examined whether efforts to improve the access of pregnant women to timely prenatal care have been a successful means of improving birth outcomes. Although some reports have enthusiastically supported the accomplishments of prenatal care (IOM, 1985); others have stressed the equivocal nature of the empirical evidence, and their conclusions have been more guarded (Alexander and Korenbrot, 1995; Kogan et al., 1998; Fiscella, 1995).
Some of the more pointed commentaries on the value of prenatal care have occurred in the context of articles addressing cost-effectiveness. Several influential reports and studies have concluded that prenatal care is a cost-effective intervention based on its impact on specific adverse outcomes of pregnancy, namely low birth weight and prematurity. These studies have calculated the monetary savings resulting from the use of prenatal care (IOM, 1985; Gorsky and Colby, 1989; Korenbrot, 1984; Schramm, 1992), figures readily cited in policy debates. However, other authors have sharply contested these conclusions regarding cost-effectiveness (Huntington and Connell, 1994).
Here, we examine some of the issues relevant to assessing the value of prenatal care that have been highlighted in this book. The premise of this book, as described in the Introduction, is that the arguments for and the critiques of the effectiveness and cost-effectiveness of prenatal care are based on a very narrow conceptualization of both prenatal care and the relevant outcomes.