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As part of an international public health partnership formed in 2001 we assessed the impact of Project Northland in Croatia--an adolescent alcohol school-based prevention intervention implemented in Split--on students. The curriculum was implemented in 13 randomly selected schools with another 13 schools serving as controls. The evaluation included quantitative and qualitative methods, using pre/post-tests to compare intervention and controls and follow-up focus groups with parents and teachers. Quantitative data showed the intervention was more successful in changing attitudes in the first two years, but had less impact on older students. Qualitative data suggest benefits from the program overall. Given the intervention was successful in the earlier grades it should be initiated earlier to have a greater impact. Challenges and lessons learned are offered. [ABSTRACT FROM AUTHOR]

Problem: Persons with opioid use disorder (OUD) often lack social support, which is associated with improved recovery outcomes., Background: In the last two decades, the rate of opioid use disorder (OUD) among pregnant people has quadrupled., Question: This study aimed to describe the prenatal and postpartum social support networks and needs of persons with OUD and assess perceived acceptability of community-based social supports such as doulas., Methods: This mixed methods study utilized quantitative and qualitative data to understand social support structures and needs. Data was collected through surveys -demographics and social mapping; Adverse Childhood Experiences (ACE) tool; Connor Davidson Resilience 25-item (CDRS-25) scale- and a semi-structured interview. A total of 34 participants from a single urban opioid treatment program consented to participate., Findings: Participants were on average 34.9 years old, White (64.7%), and unemployed (91.2%). Participants described small perinatal social support networks, which decreased in size from the prenatal to postpartum period. Only half (52.9%) reported adequate prenatal and postpartum social support. Doulas and peer recovery support specialists were perceived as valuable in perinatal health, social support, and recovery domains, with interest in doulas seen particularly amongst those with fewer reported supports., Discussion: The scarcity of prenatal and postpartum social support among persons with OUD is critical to address, given the increased risk of relapse during the postpartum period which has implications for the maternal child dyad., Conclusion: Due to multiple disparities in prenatal and postpartum social support (small networks, inadequate support), doulas represent a trusted community-based support to be integrated into healthcare teams to address maternal morbidity/mortality associated with opioid use., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: Underutilization of primary care and receipt of preventive health services have been reported among women with opioid use disorder. The aim of this study was to describe perceptions of primary care among women in treatment for opioid use disorder., Methods: Between May and June 2022, 27 women who were receiving treatment for opioid use disorder from one opioid treatment program participated in this study. Participants completed one data collection session which involved a brief questionnaire followed by a semi-structured interview. Participants were asked questions about their overall experience with primary care as well as perceived facilitators and barriers to primary care utilization and quality. Interview transcripts were analyzed using an inductive thematic approach., Results: Three themes emerged from the interviews within the domain of "Facilitators to Primary Care," including: (1) coordination of care, (2) continuity of care, and (3) relationship with health care providers. Four themes emerged from the interviews within the domain of "Barriers to Primary Care," including: (1) perceived judgment from health care providers, (2) childcare needs, (3) issues related to location, and (4) issues related to time., Conclusion: Approaches to primary care that help alleviate barriers to care and highlight the aspects of care that are valued may improve quality and utilization of care, thus enhancing the health and well-being of a vulnerable population., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objectives: Recent trends demonstrate increases in the rates of opioid use among pregnant and parenting women. Treatment for pregnant people with opioid use disorder (OUD) includes medications for OUD, like methadone, as well as comprehensive support services. Still, inpatient treatment engagement is suboptimal and treatment drop out is common. There is little research examining the maternal perspective of the inpatient methadone initiation experience. The primary aim of this qualitative methods study was to explore patient experience and perspective of the inpatient methadone initiation period., Methods: All participants were recruited from a single urban university affiliated hospital and OUD treatment program. Data were collected from 30 maternal participants in OUD treatment about their inpatient methadone initiation experience while pregnant using semistructured interviews. Thematic analyses were conducted using an inductive approach after an iterative process of code development and application among a multidisciplinary team of 3 coders. Validity was accounted for through 2 participant feedback interviews and study team review and discussion of findings., Results: Four themes emerged from the maternal interview data: (1) Barriers to Inpatient Methadone Initiation, (2) Facilitators to Inpatient Methadone Initiation, (3) Transition From Hospital Inpatient to Outpatient or Residential OUD Treatment Services, and (4) Opportunities for Enhanced Clinical Support., Conclusion: Maternal participants reported multiple barriers and facilitators to inpatient care during methadone initiation, highlighting opportunities for improvement to effectively engage pregnant individuals in treatment., Competing Interests: The authors report no conflicts of interest., (Copyright © 2023 American Society of Addiction Medicine.)

Background: The opioid crisis is a public health issue, contributing to poor maternal child health outcomes. A Mindfulness Based Parenting (MBP) intervention, part of the "Practicing Safety Mindfulness Project for Mothers in Drug Treatment" (PSMDT) study, was previously tested as an intervention to mitigate stress and improve parenting domains in a sample of parenting women in treatment for substance use disorder., Methods: Qualitative data from focus groups and Mindfulness Based Parenting group teacher process notes were analyzed to understand how participants applied mindfulness to their daily lives and how mindfulness affected their relationship with their child(ren)., Results: Thematic analyses revealed three overarching major themes: 1) Supportive Tools to Assist with Bringing Mindfulness into Daily Living; 2) Application of Embodied Tenets of Mindfulness to Perspective and Behavior and 3) Mindfulness Based Parenting and Recovery. Transference of mindfulness skills to parenting was evident through both focus group and process note data, illustrating how mindfulness behaviors were incorporated into family life. Data also revealed how tools utilized in the MBP intervention affected participant recovery., Conclusions: MBP intervention shows utility in improving parenting and recovery domains. Data from this study will inform future iterations of this intervention and this contextual analysis can be used to inform other recovery programs looking to utilize mindfulness as an adjunctive treatment., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Background: Pregnant women who have substance use disorders (SUDs) are at increased risk of preterm birth, fetal mortality, and inadequate prenatal care and have higher rates of childhood trauma than their counterparts without SUDs. Doulas have been utilized with other vulnerable populations who experience trauma to increase perinatal healthcare utilization, provide emotional support, and improve birth outcomes. The objective of the current study was to examine, in women with opioid use disorder (OUD), perceptions of working with a doula in the perinatal period., Methods: Eligible participants were ≥ 18 years old, in OUD treatment, and were pregnant or recently delivered (child ≤ 3 months of age). Semi-structured interviews were used to collect tacit data on the woman's experience working with a doula during the perinatal period. All one-hour interviews were conducted over the phone and transcribed verbatim by a HIPAA compliant transcription service. Transcripts were reviewed independently by 4 coders using open coding procedures, constant comparative method of grounded theory, and inductive thematic analysis. Demographic data and history of childhood trauma information (Adverse Childhood Experiences Tool) were collected with a phone survey prior to the interview., Results: Participants' (N = 23) were 32.5 years of age (4.1 SD), with the majority Caucasian (71.4%), Non-Hispanic (71.4%) and Medicaid recipients (100%). Participants reported a mean of 5.61 (SD=2.93) adverse childhood experiences, indicating a significant trauma burden. Major themes uncovered in the interview transcripts revealed emotional and OUD recovery support provided by the doula and increased maternal health literacy and self-advocacy. The presence of a doula during labor/delivery reduced maternal perceptions of stigma they perceived from their healthcare providers., Conclusion: Doula engagement was associated with perceptions of increased emotional support, health literacy and self-advocacy in maternal health among women with OUD, which is significant given this population's trauma histories. This preliminary research has significant implications for improving the health of the mother child dyad affected by maternal OUD., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Pharmacovigilance is the science of monitoring the effects of medicinal products to identify and evaluate potential adverse reactions and provide necessary and timely risk mitigation measures. Intelligent automation technologies have a strong potential to automate routine work and to balance resource use across safety risk management and other pharmacovigilance activities. While emerging technologies such as artificial intelligence (AI) show great promise for improving pharmacovigilance with their capability to learn based on data inputs, existing validation guidelines should be augmented to verify intelligent automation systems. While the underlying validation requirements largely remain the same, additional activities tailored to intelligent automation are needed to document evidence that the system is fit for purpose. We propose three categories of intelligent automation systems, ranging from rule-based systems to dynamic AI-based systems, and each category needs a unique validation approach. We expand on the existing good automated manufacturing practices, which outline a risk-based approach to artificially intelligent static systems. Our framework provides pharmacovigilance professionals with the knowledge to lead technology implementations within their organizations with considerations given to the building, implementation, validation, and maintenance of assistive technology systems. Successful pharmacovigilance professionals will play an increasingly active role in bridging the gap between business operations and technical advancements to ensure inspection readiness and compliance with global regulatory authorities.

We examined the self-reported adulthood impact of adverse childhood experiences (ACE's), including both the amount (magnitude) and type (valence positive or negative) of impact reported, in order to characterize variability in impact ratings, as well as to quantify their predictive ability with respect to health outcomes. We descriptively characterized impact by type of event and analyzed associations between impact ratings and demographic characteristics of respondents to explore resilience. We also analyzed the relationships between impact ratings and health outcomes. We found that, while there was wide variability in impact ratings, emotional abuse was rated as the most impactful in magnitude, and sexual and emotional abuse were rated as the most negatively impactful in terms of valence. We further found that impact ratings are predictive of adult health outcomes above and beyond the experience of the events alone. We conclude that perceived impact is a potentially important variable to include when self-reported ACEs are assessed.

Background and Objectives: For children with intrauterine opioid exposure (IOE), well-child care (WCC) provides an important opportunity to address medical, developmental, and psychosocial needs. We evaluated WCC adherence for this population., Methods: In this retrospective cohort study, we used PEDSnet data from a pediatric primary care network spanning 3 states from 2011 to 2016. IOE was ascertained by using physician diagnosis codes. WCC adherence in the first year was defined as a postnatal or 1-month visit and completed 2-, 4-, 6-, 9-, and 12-month visits. WCC adherence in the second year was defined as completed 15- and 18-month visits. Gaps in WCC, defined as ≥2 missed consecutive WCC visits, were also evaluated. We used multivariable regression to test the independent effect of IOE status., Results: Among 11 334 children, 236 (2.1%) had a diagnosis of IOE. Children with IOE had a median of 6 WCC visits (interquartile range 5-7), vs 8 (interquartile range 6-8) among children who were not exposed ( P < .001). IOE was associated with decreased WCC adherence over the first and second years of life (adjusted relative risk 0.54 [ P < .001] and 0.74 [ P < .001]). WCC gaps were more likely in this population (adjusted relative risk 1.43; P < .001). There were no significant adjusted differences in nonroutine primary care visits, immunizations by age 2, or lead screening., Conclusions: Children <2 years of age with IOE are less likely to adhere to recommended WCC, despite receiving on-time immunizations and lead screening. Further research should be focused on the role of WCC visits to support the complex needs of this population., Competing Interests: POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose., (Copyright © 2020 by the American Academy of Pediatrics.)

Background : Many women in treatment for opioid use disorder (OUD) also experience mental health co-morbidities. Mindfulness intervention has demonstrated effectiveness for improving mental health in the general population, but has not been tested with female populations in OUD treatment. The purpose of this study was to describe characteristics associated with participation in a mindfulness intervention provided to women in treatment for OUD, and also to evaluate the effectiveness of a mindfulness intervention on depression symptoms. Aims : To evaluate participation characteristics associated with a mindfulness intervention and to assess the impact of a mindfulness intervention on depression symptoms for women with OUD. Methods : A secondary data analysis of a mindfulness intervention with women in treatment for OUD was accomplished. Bivariate analysis was conducted to determine any sociodemographic variables associated with intervention participation. Depression scores were assessed pre and post intervention using paired samples t tests for the intervention group ( n  = 65) and the control group ( n  = 8). Results : A 45% of women in the study reported moderate to severe depression symptoms at baseline, and 63% reported high levels of childhood trauma. There was a significant decrease in depression scores ( M  = 3.6 [1.2,6.1]) following the mindfulness intervention for the intervention group ( t (64) = 3.1, p = .003). Participants entering the intervention group with moderate to severe depression scores experienced the most significant decrease in depression symptoms ( M  = 6.6, SD = 13.5), ( t (64) = -2.1, p < .05). Conclusions : Women in treatment for OUD experience high levels of depression symptoms and past trauma, and mindfulness is a feasible intervention for OUD populations which may improve depression symptoms.

The healthcare industry, and specifically the pharmacovigilance industry, recognizes the need to support the increasing amount of data received from individual case safety reports (ICSRs). To cope with this increase, more healthcare and qualified professionals are required to capture and evaluate the data. To address the evolving landscape, it will be necessary to embrace assistive technologies such as artificial intelligence (AI) at scale. AI in the field of pharmacovigilance will possibly result in the transformation of the drug safety (DS) professional's daily work life and their career development. Celgene's Global Drug Safety and Risk Management (GDSRM) function has established a series of work activities to drive innovation across the pharmacovigilance value chain (Celgene Chrysalis Fact Sheet. https://www.celgene.com/newsroom/media-library/chrysalis-fact-sheet/, 2018). The development of AI in pharmacovigilance raises questions about the possible changes in DS professionals' lives, who may find themselves curious about their future roles in a workplace assisted by AI. We discuss the current state of pharmacovigilance and the DS professional, AI in pharmacovigilance and the potential skillsets a DS professional may require when working with AI. We also describe the results of research conducted at Celgene GDSRM. The objective of the research was to understand the thoughts of pharmacovigilance professionals about their jobs. These results are provided in the form of aggregated responses to interview questions based on a 12-part questionnaire [see the Electronic Supplementary Material (ESM)]. A sample of six DS professionals representing various areas of pharmacovigilance operations were asked a range of questions about their backgrounds, current roles and future expectations. The DS professionals interviewed were, overall, enthusiastic about their job roles potentially changing with AI enhancements. Interviewees suggested that AI would allow for pharmacovigilance resources, time, and skills to shift the work from a volume-based to a value-based focus. The results suggest that pharmacovigilance professionals wish to use their qualifications, skillsets and experience in work that provides more value for their efforts. Machine learning algorithms have the potential to enhance DS professionals' decision-making processes and support more efficient and accurate case processing.

Introduction: Pharmacovigilance (PV) detects, assesses, and prevents adverse events (AEs) and other drug-related problems by collecting, evaluating, and acting upon AEs. The volume of individual case safety reports (ICSRs) increases yearly, but it is estimated that more than 90% of AEs go unreported. In this landscape, embracing assistive technologies at scale becomes necessary to obtain a higher yield of AEs, to maintain compliance, and transform the PV professional work life., Aim: The aim of this study was to identify areas across the PV value chain that can be augmented by cognitive service solutions using the methodologies of contextual analysis and cognitive load theory. It will also provide a framework of how to validate these PV cognitive services leveraging the acceptable quality limit approach., Methods: The data used to train the cognitive service were an annotated corpus consisting of 20,000 ICSRS from which we developed a framework to identify and validate 40 cognitive services ranging from information extraction to complex decision making. This framework addresses the following shortcomings: (1) needing subject-matter expertise (SME) to match the artificial intelligence (AI) model predictions to the gold standard, commonly referred to as 'ground truth' in the AI space, (2) ground truth inconsistencies, (3) automated validation of prediction missing context, and (4) auto-labeling causing inaccurate test accuracy. The method consists of (1) conducting contextual analysis, (2) assessing human cognitive workload, (3) determining decision points for applying artificial intelligence (AI), (4) defining the scope of the data, or annotated corpus required for training and validation of the cognitive services, (5) identifying and standardizing PV knowledge elements, (6) developing cognitive services, and (7) reviewing and validating cognitive services., Results: By applying the framework, we (1) identified 51 decision points as candidates for AI use, (2) standardized the process to make PV knowledge explicit, (3) embedded SMEs in the process to preserve PV knowledge and context, (4) standardized acceptability by using established quality inspection principles, and (5) validated a total of 126 cognitive services., Conclusion: The value of using AI methodologies in PV is compelling; however, as PV is highly regulated, acceptability will require assurances of quality, consistency, and standardization. We are proposing a foundational framework that the industry can use to identify and validate services to better support the gathering of quality data and to better serve the PV professional.

Background The RE-AIM framework was applied to the Mindfulness Based Parenting (MBP) intervention to evaluate the feasibility and effectiveness of this innovative trauma informed model in a drug treatment program. The MBP intervention is aimed at mitigating the stress experienced by women in treatment for substance use disorders, and thereby improving parenting and dyadic attachment between mother and child. Methods This was a single arm pre-test post-test design using repeated measure data collected between 2013 and 2016. The design also includes comprehensive process and impact evaluation data. Participants were 120 parenting women enrolled in an opioid treatment program between 2013 and 2016 in Philadelphia, PA. The MBP intervention included weekly 2-h MBP group sessions over 12 weeks, including three dyadic sessions with their child. The main outcomes of this study include the five facets of RE-AIM: Reach, Effectiveness, Adoption, Implementation, and Maintenance. Results The MBP intervention was associated with improvements in parenting across participants. Data showed implementation and sustainability are contingent upon a strong multidisciplinary team and clinical staff support and "buy-in". Iterative adaptations of interventions used in the general population may be necessary when working with a traumatized population burdened by low literacy levels, trauma history and co-occurring disorders. Conclusions MBP is a feasible and effective intervention for improving parenting and dyadic attachment between women with opioid use disorder and their children, and may be useful for other programs that serve parenting women with substance use disorders.

Pediatric primary care providers play a critical role in managing obesity yet often lack the resources and support systems to provide effective care to children with obesity. The objective of this study was to identify system-level barriers to managing obesity and resources desired to better managing obesity from the perspective of pediatric primary care providers. A 64-item survey was electronically administered to 159 primary care providers from 26 practices within a large pediatric primary care network. Bivariate analyses were performed to compare survey responses based on provider and practice characteristics. Also factor analysis was conducted to determine key constructs that effect pediatric interventions for obesity. Survey response rate was 69% ( n = 109), with the majority of respondents being female (77%), physicians (67%), and without prior training in obesity management (74%). Time constraints during well visits (86%) and lack of ancillary staff (82%) were the most frequently reported barriers to obesity management. Information on community resources (99%), an on-site dietitian (96%), and patient educational materials (94%) were most frequently identified as potentially helpful for management of obesity in the primary care setting. Providers who desired more ancillary staff were significantly more likely to practice in clinics with a higher percentage of obese, Medicaid, and Hispanic patients. Integrating ancillary lifestyle expert support into primary care practices and connecting primary care practices to community organizations may be a successful strategy for assisting primary care providers with managing childhood obesity, especially among vulnerable populations.

Introduction: Regulations are increasing the scope of activities that fall under the remit of drug safety. Currently, individual case safety report (ICSR) collection and collation is done manually, requiring pharmacovigilance professionals to perform many transactional activities before data are available for assessment and aggregated analyses. For a biopharmaceutical company to meet its responsibilities to patients and regulatory bodies regarding the safe use and distribution of its products, improved business processes must be implemented to drive the industry forward in the best interest of patients globally. Augmented intelligent capabilities have already demonstrated success in capturing adverse events from diverse data sources. It has potential to provide a scalable solution for handling the ever-increasing ICSR volumes experienced within the industry by supporting pharmacovigilance professionals' decision-making., Objective: The aim of this study was to train and evaluate a consortium of cognitive services to identify key characteristics of spontaneous ICSRs satisfying an acceptable level of accuracy determined by considering business requirements and effective use in a real-world setting. The results of this study will serve as supporting evidence for or against implementing augmented intelligence in case processing to increase operational efficiency and data quality consistency., Methods: A consortium of ten cognitive services to augment aspects of ICSR processing were identified and trained through deep-learning approaches. The input data for model training were 20,000 ICSRs received by Celgene drug safety over a 2-year period. The data were manually made machine-readable through the process of transcription, which converts images into text. The machine-readable documents were manually annotated for pharmacovigilance data elements to facilitate the training and testing of the cognitive services. Once trained by cognitive developers, the cognitive services' output was reviewed by pharmacovigilance subject-matter experts against the accepted ground-truth for correctness and completeness. To be considered adequately trained and functional, each cognitive service was required to reach a threshold of F 1 or accuracy score ≥ 75%., Results: All ten cognitive services under development have reached an evaluative score ≥ 75% for spontaneous ICSRs., Conclusion: All cognitive services under development have achieved the minimum evaluative threshold to be considered adequately trained, demonstrating how machine-learning and natural language processing techniques together provide accurate outputs that may augment pharmacovigilance professionals' processing of spontaneous ICSRs quickly and accurately. The intention of augmented intelligence is not to replace the pharmacovigilance professional, but rather support them in their consistent decision-making so that they may better handle the overwhelming amount of data otherwise manually curated and monitored for ongoing drug surveillance requirements. Through this supported decision-making, pharmacovigilance professionals may have more time to apply their knowledge in assessing the case rather than spending it performing transactional tasks to simply capture the pertinent data within a safety database. By capturing data consistently and efficiently, we begin to build a corpus of data upon which analyses may be conducted and insights gleaned. Cognitive services may be key to an organization's transformation to more proactive decision-making needed to meet regulatory requirements and enhance patient safety., Competing Interests: Danielle Abatemarco, Sameen Desai, Bruno Assuncao, Niki Tetarenko, Karolina Danysz, Ruta Mockute, Mark Widdowson, Nicole Fornarotto, Sheryl Beauchamp, Salvatore Cicirello, and Edward Mingle were employed by Celgene Corporation at the time this research was completed. Sujan Perera and Sheng Hua Bao were employed by IBM at the time this research was completed.All human subject data used in this research was stored and shared securely.

Objectives: Mothers with opioid use disorder are at high risk for maladaptive parenting. The present observational study aimed to measure the impact of a trauma-informed mindfulness-based parenting (MBP) intervention on quality of parenting behaviors of mothers primarily with opioid use disorders as well as examine associations between exposure to adverse childhood experiences and self-reported mindful parenting., Methods: A pretest posttest design was used with repeated measures. A total of 160 women were recruited from a substance use treatment program into the 12-week-long group-based intervention comprised didactic and experiential mindfulness activities. The Keys to Interactive Parenting Scale (KIPS) measured quality of parenting behavior, the Adverse Childhood Experiences Tool captured history of exposure to childhood trauma, and the Interpersonal Mindfulness in Parenting (IM-P) scale measured the degree of mindful parenting. Analyses were conducted using multilevel modeling., Results: The MBP intervention resulted in clinically significant improvements in KIPS total and all subscale scores and an IM-P total score. Data showed higher baseline Adverse Childhood Experiences and higher program attendance significantly predicted improved overall quality of parenting behaviors at a greater rate over time. Higher IM-P scores were associated with greater rate of improvement in KIPS total and all subscale scores., Conclusions: Study findings suggest a trauma-informed MBP intervention for parenting women with opioid use disorders is associated with significant clinical improvements in quality of parenting behavior. Results of this model show promise in supporting parenting of mothers receiving treatment for opioid use disorders to enhance bonding and parenting.

Background: Current pharmacologic treatment of the neonatal abstinence syndrome with morphine is associated with a lengthy duration of therapy and hospitalization. Buprenorphine may be more effective than morphine for this indication., Methods: In this single-site, double-blind, double-dummy clinical trial, we randomly assigned 63 term infants (≥37 weeks of gestation) who had been exposed to opioids in utero and who had signs of the neonatal abstinence syndrome to receive either sublingual buprenorphine or oral morphine. Infants with symptoms that were not controlled with the maximum dose of opioid were treated with adjunctive phenobarbital. The primary end point was the duration of treatment for symptoms of neonatal opioid withdrawal. Secondary clinical end points were the length of hospital stay, the percentage of infants who required supplemental treatment with phenobarbital, and safety., Results: The median duration of treatment was significantly shorter with buprenorphine than with morphine (15 days vs. 28 days), as was the median length of hospital stay (21 days vs. 33 days) (P<0.001 for both comparisons). Adjunctive phenobarbital was administered in 5 of 33 infants (15%) in the buprenorphine group and in 7 of 30 infants (23%) in the morphine group (P=0.36). Rates of adverse events were similar in the two groups., Conclusions: Among infants with the neonatal abstinence syndrome, treatment with sublingual buprenorphine resulted in a shorter duration of treatment and shorter length of hospital stay than treatment with oral morphine, with similar rates of adverse events. (Funded by the National Institute on Drug Abuse; BBORN ClinicalTrials.gov number, NCT01452789 .).

Objective: Maternal obesity is associated with increased risk of large-for-gestational-age (LGA) and small-for-gestational-age (SGA) births. Both are related to childhood obesity. This study considers that the patterns of gestational weight gain (GWG) may help to disentangle these competing risks., Methods: Patterns of GWG were characterized among a cohort of women with overweight or obesity (n = 651). Polytomous logistic regression models were tested for associations between GWG patterns and birth weight outcomes: SGA (<10th) and LGA (>90th percentile)., Results: Rates of SGA were higher than those for LGA (14.9% vs. 7.8%). Four GWG patterns were identified: consistently high (29%), early adequate/late high (33%), consistently adequate (18%), and consistently low (20%). Risk of LGA was highest in women with consistently high GWG (adjusted odds ratio [OR] 4.62 [1.53, 13.96]), and risk was elevated, but with lower magnitude, among women with early adequate/late high gains (OR 3.07 [1.01, 9.37]). High GWG before 20 weeks, regardless of later gain, was related to LGA. Low gain before 20 weeks accompanied by high gain later may be associated with reduced SGA risk (0.55 [0.29, 1.07])., Conclusions: The pattern of weight gain during pregnancy may be an important contributor to or marker of abnormal fetal growth among women with overweight or obesity., (© 2015 The Obesity Society.)

Health promotion and disease prevention must be addressed in medical education, and the assessment of future physicians' health preventive perceptions and behaviors is a critical step in the process. We conducted a cross-sectional survey of 512 medical students enrolled during the 1992-1993 academic year. Outcome measures were self-reported health behaviors and ratings of the importance of prevention. Overall, results indicated that the preponderance of respondents are engaging in healthy behaviors; however, some high-risk behaviors, such as drinking and driving and possible binge drinking, were reported by at least 15% of the respondents. Significant differences were detected regarding students' perceptions; a linear decreasing trend was noted with first-year students rating the importance of prevention the highest and fourth-year students rating it the lowest. Additionally, this study attempted to correlate health behaviors with perceptions. The results show significant relationships between student-reported behaviors and corresponding perceptions. Even though this cohort is healthy overall, some students are engaging in behaviors that are not conducive to maintaining a healthy lifestyle. It is important to identify and address negative health behaviors in this population, not only in terms of personal health, but also in its effect on their interaction with future patient populations. The attrition of interest in prevention during undergraduate medical training is cause for concern; future clinical practice will be strongly motivated by their perceptions. Medical schools should identify health issues and assess preventive health perceptions among students in order to facilitate the adoption of preventive practices by future physicians. Medical Subject Headings (MeSH): health promotion, prevention, medical students, health behavior.

Given the occupational risks of hazardous waste workers, this study was conducted to explore possible differences in medical surveillance practices among blue and white collar workers. Demographic and medical surveillance data were collected from 636 white collar and 206 blue collar trainees, enrolled in health and safety training courses. Overall, 4.5% of the trainees reported being ill or injured because of hazardous substances. Significant differences (P < .0001) were noted between groups; blue collar trainees were more likely to have been ill or injured. Differences also existed for medical surveillance enrollment; 32% of the white collar trainees report enrollment compared to 19% of the blue collar trainees (P = .004). This study indicates that blue collar trainees are more likely to be injured and less likely to be enrolled in medical surveillance programs. Issues of illness and injury, as well as medical surveillance enrollment, must be addressed; ensuring that all workers receive medical surveillance needed to prevent occupational illness in the hazardous waste field.