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Fusion remains the gold standard for post-traumatic osteoarthritis after ankle fractures in many institutes. Patient-reported outcomes on long-term quality of life and functionality of talocrural arthrodesis remain relatively unknown. In literature, low patient numbers and inadequate outcome measures provide a poor foundation for patient expectation management. Additionally, the surgical approach is often omitted. This study presents a retrospective cohort of patients who underwent open or arthroscopic talocrural arthrodesis for post-traumatic arthritis between 2008 and 2019 with prospective follow-up by questionnaire. Participants completed the EuroQol 5-dimensional 3-level questionnaire (EQ-5D-3LTM), EuroQol Visual Analogue Scale (EQ-VASTM), Foot and Ankle Outcome Score Dutch Language Version (FAOS-DLV), and 4 additional questions. Thirty-five patients were included in the cohort and 32 were included for follow-up. Trauma mechanism was mainly a low fall or motor vehicle accident causing a talocrural fracture-dislocation in most cases. For open versus arthroscopic treatment respectively, patients reported a median EQ-5D-3LTM index of 0.775 and 0.775, EQ-VASTM of 80 and 88, FAOS-DLV of 57.0 and 63.9, and satisfaction of 90 and 88 out of 100 after a median of 6.0 and 6.5 years. This study is unique as it is the largest series on patient-reported outcomes in patients with post-traumatic arthrosis with validated questionnaires. In general, patients were satisfied with relatively high questionnaire scores, especially concerning pain and daily living. These functional scores are of importance when setting patient expectations regarding talocrural arthrodesis and recovery. Additionally, the subscale values may help preoperatively in weighing the intervention's advantages and disadvantages for individual patients. [ABSTRACT FROM AUTHOR]

Highlights • LP-TEM can be used to image the attachment iron nanoparticles on carbon nanofibers. • The attachment was irreversible and resulted higher loading upon oxidizing fibers. • Lab-scale as well as experiments without an electron beam confirmed this effect. Abstract By using liquid phase transmission electron microscopy (LP-TEM), the dynamics of iron oxide nanoparticle (Fe-NP) attachment to carbon nanofibers (CNFs) and oxygen functionalized CNFs (CNF-Ox) were studied in-situ. The beam effect on the stability of the sample in various liquids was examined, and it was found that toluene provided the highest stability and resolution to image both CNF supports and Fe-NPs. Flowing particles dispersed in toluene through the liquid cell allowed direct monitoring of the attachment process at ambient temperature. Using CNF-Ox as a support led to a large extent and irreversible attachment of iron nanoparticle compared to a lower extent and reversible attachment of Fe-NPs to pristine CNF, indicating the influence of surface functionalization on colloidal particle attachment. The results were confirmed by lab-scale experiments as well as experiments performed with the electron beam switched off, verifying the notion that beam effects did not affect the attachment. This study revealed previously unknown phenomena in colloidal particle - support interactions and demonstrates the power of LP-TEM technique for studying such nanoscale processes. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to describe postpartum contraceptive utilization patterns among women with OUD and evaluate the relationship between postpartum contraceptive method choice and interpregnancy interval.Methods: A retrospective cohort study was conducted with women in Pennsylvania Medicaid with a diagnosis of OUD between 2008 and 2013. Postpartum contraceptive use within 90 days after delivery was identified through claims data and categorized by effectiveness (highly-effective, effective, and no method observed). Kaplan-Meier time-to-event analyses and multivariable-adjusted marginal Cox regression models were used to evaluate the relationship between postpartum contraceptive method choice and interpregnancy interval. Multivariable logistic regression analyses were used to identify risk factors predictive of a short interpregnancy interval (≤18 months).Results: We identified 7805 women (9260 pregnancies) who had a diagnosis of OUD. Nearly three-quarters (74.5%) had no contraceptive method observed, 18.1% received an effective method, and only 7.4% received a highly-effective method (LARC or female sterilization) during the postpartum period. In Kaplan-Meier analyses, no significant differences were found in the time-to-next pregnancy interval when an effective contraceptive method vs. no contraceptive method was used. In multivariable analysis, predictors of a significantly longer interpregnancy interval were LARC use (HR 0.43, 95% CI 0.26-0.69), gestational hypertension (HR 0.80, 95% CI 0.65-0.97), and age (HR 0.95, 95% CI 0.94-0.96). Approximately 20% of women with OUD had a short interpregnancy interval.Conclusion: Few women with OUD use highly-effective postpartum contraception, which is protective against short interpregnancy intervals. [ABSTRACT FROM AUTHOR]

Background and Objectives: Research has shown a link between self-efficacy appraisals and PTSD symptoms. Less is known about the relation between perceived self-efficacy and specific PTSD symptoms such as intrusions. These two experiments tested the causal relationship between perceived self-efficacy and intrusions from a trauma film.Methods: In Experiment I, healthy student participants received a self-efficacy manipulation consisting of the recall of autobiographical memories of success (high self-efficacy condition), failure (low self-efficacy condition) or 'important' memories (control condition). Afterwards, they viewed a trauma film and recorded their intrusions of the film in the following week. In Experiment II the self-efficacy manipulation was given after the film.Results: In contrast to expectations, the high self-efficacy condition reported a higher number of intrusions relative to the low self-efficacy condition in both experiments.Limitations: The trauma film provides experimental control but precludes generalization to real-life trauma. The effect of the experimental manipulation was small. The control condition also affected mood and confidence.Conclusions: The results suggest that the relation between self-efficacy and intrusions development is causal, but not straightforward. Recalling personal memories of success before or after a traumatic event may increase the risk of developing intrusions, at least under some circumstances. Conversely, recalling past failure experiences may be protective, perhaps by preparing the individual for adversity, or prompting them to search for coping strategies that have been successful in the past. Overall, autobiographical recall involves complex processes related to the self that could be useful but need to be more fully understood. [ABSTRACT FROM AUTHOR]

The self is a multi-faceted and temporally dynamic construct reflecting representations and beliefs about identity in the past, present, and future. Clinical studies have shown that individuals with Posttraumatic Stress Disorder (PTSD) and Social Anxiety Disorder (SAD) exhibit alterations in self-related processing but these studies have focused primarily on memory. Few studies in PTSD and SAD have examined self-related processing for the present and future, and no studies have directly compared these processes across these two disorders. Individuals diagnosed with PTSD ( n = 21), SAD ( n = 21), and healthy controls ( n = 21) completed cognitive tasks related to the past, present, and future. Disorder congruent temporal alterations were found across both disorders. Further, regression analyses revealed that trauma-related memories were significantly predicted by future goals related to the trauma, whereas social anxiety-related recall was predicted by current socially anxious self-views. Thus, although self-related processing may be common in PTSD and SAD, those aspects of the self most strongly associated with disorder-congruent recall differ by disorder. Self-alterations may be modifiable and developing a better understanding of past, present, and future self-processing might aid in the development of interventions that target these process. [ABSTRACT FROM AUTHOR]

Background and Objectives: Cognitive and information processing theories of Post-Traumatic Stress Disorder (PTSD) assert that trauma intrusions are characterized by poor contextual embedding of visuospatial memories. Therefore, efficient encoding of visuospatial contextual information might protect against intrusions. We tested this idea using indices of visuospatial memory embedding along with the trauma film paradigm.Methods: Individual differences in spatial configuration learning, as well as the degree to which visual recognition memory depends on its visual encoding context (i.e., memory contextualization), were assessed in 81 healthy participants. Next, participants viewed a distressing film. Intrusions and other PTSD analogue symptoms were assessed subsequently.Results: Participants displaying stronger memory contextualization developed fewer intrusions and PTSD analogue symptoms. Spatial configuration learning was unrelated to memory contextualization and, contrary to prior findings, predicted higher levels of intrusions.Limitations: Due to the analogue design, our findings may not translate directly to clinical populations. Furthermore, due to the correlational design of the study, causal relations remain to be tested.Conclusions: Our results suggest a protective role for the ability to integrate memories in their original visual learning context against the development of PTSD symptoms. [ABSTRACT FROM AUTHOR]

Background and Objectives: To understand how memories of negative events become highly accessible in the context of trauma, we tested the hypothesis that contextual information modulates how easily intrusions can be provoked by perceptual stimuli..Methods: Healthy participants viewed pictures depicting trauma scenes either with or without accompanying moderate (i.e. survival, recovery) or severe (i.e. fatality, permanent injury) outcome information. All participants viewed the same depictions of trauma scenes. Involuntary memories for the pictures were assessed using self-report diaries and an adapted version of the Impact of Event Scales (IES). A blurred picture perceptual priming paradigm was adapted to be used as an intrusion provocation task.Results: The severe outcome group experienced a significantly higher frequency of intrusions on the intrusion provocation task in comparison to both moderate outcome and control (no-context) conditions. The severe outcome condition did not increase intrusions on the self-report diaries or the adapted IES. There was no effect of condition on ratings for the emotionality, self-relevance, valence, or seriousness of the trauma scenes.Limitations: The analogue method should not be generalized directly to incidences of real-life trauma. It was unclear why differences in intrusion frequency were found in the provocation task only. The relative amount of individual conceptual and data-driven processing adopted by the participants was not assessed.Conclusions: Manipulating contextual information that determines the meaning of sensory-perceptual features for a trauma scene can modulate subsequent intrusion frequency in response to visually similar cues. [ABSTRACT FROM AUTHOR]

The integration of tactile information, such as contact area, displacement magnitude, velocity, and acceleration, is paramount to the optimization of robotics in human-centric environments. Cost effective embeddable sensors with scalable receptive field size and strain sensitivity are not readily commercially available and would benefit investigations of in situ tissue mechanics. We describe the design and performance of a scalable sensor matrix that transduces fine parameters of strain and is made of combinable “modules”. The sensors transduce static and dynamic strains of both uniaxial and multi-dimensional nature. Modules consist of three silicon wafers placed on top of and three on the bottom of a hexagonal collar, wafers are thus positioned 120° to one another to facilitate force vector extrapolation. Analog signals from each sensor can be easily compared to neighboring sensor output to determine mechanical phenomena such as slip or shear. The smallest of our prototype multiunit matrices consisted of seven hexes in a honeycomb orientation of 4.1 mm diameter (containing 42 silicon gauges). Unamplified, unshielded output from this embodiment (3 V exc button cell) yielded 1 mV from 5 μm displacement. Transduction linearity was high ( R >0.99 nearest displacement) and exhibited nominal hysteresis. Modules may be placed upon or embedded into a multitude of materials and the size of individual hexagons may be scaled for favorable stiffness to strain ratio and to scale receptive field. Given the scalability of matrix size and resolution, we believe the sensor matrices could benefit the fields of prosthetics, robotics, and physiologic investigation of tissue mechanics. [ABSTRACT FROM AUTHOR]

Objective The aim of this cross-sectional study was to examine the validity of an integral model of the associations between life-course determinants, disease(s), frailty, and adverse outcomes in older persons who are resident in assisted living facilities. Methods Between June 2013 and May 2014 seven assisted living facilities were contacted. A total of 221 persons completed the questionnaire on life-course determinants, frailty (using the Tilburg Frailty Indicator), self-reported chronic diseases, and adverse outcomes disability, quality of life, health care utilization, and falls. Adverse outcomes were analyzed with sequential (logistic) regression analyses. Results The integral model is partially validated. Life-course determinants and disease(s) affected only physical frailty. All three frailty domains (physical, psychological, social) together affected disability, quality of life, visits to a general practitioner, and falls. Contrary to the model, disease(s) had no effect on adverse outcomes after controlling for frailty. Life-course determinants affected adverse outcomes, with unhealthy lifestyle having consistent negative effects, and women had more disability, scored lower on physical health, and received more personal and informal care after controlling for all other predictors. Conclusion The integral model of frailty is less useful for predicting adverse outcomes of residents of assisted living facilities than for community-dwelling older persons, because these residents are much frailer and already have access to healthcare facilities. Practical implications The present study showed that a multidimensional assessment of frailty, distinguishing three domains of frailty (physical, psychological, social), is beneficial with respect to predicting adverse outcomes in residents of assisted living facilities. [ABSTRACT FROM AUTHOR]

Objective: Pregnant women are at increased risk for severe morbidity and mortality due to respiratory infections like SARS-CoV-2 (COVID-19) during pregnancy1. Those with substance use disorders (SUD) may be especially vulnerable due to high rates of smoked tobacco, cannabis and methamphetamine use which adversely affect pulmonary function.2 However, little is known about differential effects of COVID-19 on pregnant women with and without SUD.Study Design: This was a retrospective cohort study of commercially insured pregnant women ages 15-44 using national administrative healthcare data from Optum's deidentified Clinformatics® Data Mart Database version 8.1 (2007-2020). Women with a delivery hospitalization between January 1, 2020-August 19, 2020 continuously enrolled in insurance for ≥8 weeks during pregnancy and 6 weeks postpartum were included. SUD was defined using ICD-10 diagnoses for ≥ 1 SUD during pregnancy including alcohol, amphetamine, cannabis, cocaine, opioid or other substance use disorder.3 COVID-19 screening and diagnosis were defined using ICD-10 coding and reporting guidelines published by the CDC.4, 5 We used T-tests, Fisher's exact tests, and quantile regression (percentiles) to examine statistical differences. This study was exempt by the University of Pittsburgh IRB because deidentified healthcare data were used.Results: Among 65,009 pregnancies, 2,616 (4.0%) had ≥1 SUD diagnosis. Almost half of the pregnant women in the cohort were non-Hispanic White (48%) and most lived in the South (41%) or the Midwest (28%) region of the United States (Table). Pregnant women with an SUD diagnosis were significantly more likely to be younger (30±6 vs 32±5; p<.05). Compared with the overall sample, non-Hispanic Black (10% vs 7%; p,.05) and non-Hispanic White (54% vs 48%; p<.05) women were overrepresented among those with SUD as opposed to Hispanic and non-Hispanic Asian women. Overall, 27% of pregnant women were screened and evaluated for COVID-19 during pregnancy or postpartum. Women without an SUD diagnosis were significantly more likely to be screened for COVID-19 during pregnancy (27% vs 24%; p<0.001) than those with an SUD. Overall, 3.4% of pregnant women were diagnosed with COVID-19, mostly (86%) in the third trimester. The prevalence of a COVID-19 diagnosis was higher among those with a SUD compared to those without an SUD (5% vs 3%; p<0.05). Further, there was a higher percentage of COVID-19 related hospitalizations among pregnant women with an SUD (36%) than those without an SUD (8%) (p<0.001). The median length of stay was one day longer among those with a SUD (3 vs 2 days; p<0.01) compared to those without an SUD. There were no COVID-19 related deaths reported during pregnancy or postpartum.Conclusion: In this national cohort, pregnant women with a SUD had a higher COVID-19 diagnosis rate than those without a SUD, despite lower screening rates. Among those with a COVID-19 diagnosis, pregnant women with a SUD had a significantly higher rate of COVID-19 related hospitalizations and longer median length of stay than those without a SUD. Efforts to improve COVID-19 screening rates and decrease morbidity associated with COVID-19 diagnosis among pregnant women with SUDs may be warranted. [ABSTRACT FROM AUTHOR]

Abstract: Background and objectives: The present study addressed the role of context information and dual-task interference during the encoding of negative pictures on intrusion development and voluntary recall. Methods: Healthy participants were shown negative pictures with or without context information. Pictures were either viewed alone or concurrently with a visuospatial or verbal task. Participants reported their intrusive images of the pictures in a diary. At follow-up, perceptual and contextual memory was tested. Results: Participants in the context group reported more intrusive images and perceptual voluntary memory than participants in the no context group. No effects of the concurrent tasks were found on intrusive image frequency, but perceptual and contextual memory was affected according to the cognitive load of the task. Limitations: The analogue method cannot be generalized to real-life trauma and the secondary tasks may differ in cognitive load. Conclusions: The findings challenge a dual memory model of PTSD but support an account in which retrieval strategy, rather than encoding processes, accounts for the experience of involuntary versus voluntary recall. [Copyright &y& Elsevier]

Abstract: Background and Objectives: Intrusive images after a traumatic event, a hallmark feature of post-traumatic stress disorder, are suggested to develop because the trauma memory is disorganized and not integrated into autobiographical memory. Unconscious Thought Theory predicts that information can be conceptually organized after a period of unconscious thought (UT), more so than after conscious thought (CT). We aimed to test the hypothesis that UT decreases intrusions and increases conceptual organization in memory. Methods: Participants were shown a stressful film and were required to perform an UT task, a CT task, or a distraction task. Intrusions of the film, intrusion qualities, and sequence memory were measured afterwards. Results: We confirmed our hypothesis that UT (versus CT or mere distraction) leads to fewer intrusions, thereby replicating earlier research. Contrary to prediction, we found no difference between the conditions on sequence memory. In addition, conscious thought appeared to increase intrusion nowness and arousal. Limitations: The analogue design and healthy participant sample prevent from generalizing results to other populations. Intrusion frequency and qualities were assessed immediately after the film thereby prohibiting us from drawing conclusions about any long-term effects. Conclusions: Engaging in unconscious thought after a stressful film can reduce intrusion frequency. This has potential implications for clinical interventions to prevent initial stress symptoms. The underlying mechanism remains unclear for now and provides an avenue for future research. [Copyright &y& Elsevier]

Abstract: This study investigated whether trauma-related stimuli are preferentially processed at the expense of ongoing processing of neutral stimuli. Participants in the experimental group viewed negative pictures (Trauma) as an analogue trauma induction. Participants in the control group viewed visually similar neutral pictures (Neutral Match). In a Rapid Serial Visual Presentation (RSVP) task participants identified two target pictures. The first target (T1) was a neutral picture, whereas the second target (T2) was a familiar negative or neutral picture or a new neutral or negative picture. In line with hypotheses, only participants in the experimental group showed preferential processing of Trauma pictures. In the experimental group, negative T2 impaired the identification of (neutral) T1 if the T2 immediately followed the T1 in the RSVP stream. The results are consistent with a processing priority of trauma-related information, apparently at the expense of the ongoing processing of neutral information. [Copyright &y& Elsevier]

In 2010, Preventing Low Birthweight celebrated it 25th anniversary. The report, one of the most influential policy statements ever issued regarding obstetric health care delivery, linked prenatal care to a reduction in low birthweight (LBW). Medicaid coverage for prenatal care services was subsequently expanded and resulted in increased prenatal care utilization. However, the rate of LBW failed to decrease. This well-intentioned expansion of prenatal care services did not change the structure of prenatal care. A single, standardized prenatal care model, largely ineffective in the prevention of LBW, was expanded to a heterogeneous group of patients with a variety of medical and psychosocial risk factors. Reinventing prenatal care as a flexible model, with content, frequency, and timing tailored to maternal and fetal risk, may improve adverse birth outcomes. Risk-appropriate prenatal care may improve the effectiveness of prenatal care for high-risk patients and the efficiency of prenatal care delivery for low-risk patients. [Copyright &y& Elsevier]

Abstract: The resting membrane potential (RMP) of most cells is not greatly influenced by the transmembrane calcium gradient because at rest, the membrane has very low permeability to calcium. We have observed, however, that the resting membrane potential of muscle cells in the larval bodywall of Drosophila melanogaster varies widely as the external calcium concentration is modified. The RMP depolarized as much as 21.8mV/mM calcium at low concentrations, and on average, about 10mV/mM across a range typical of neurophysiological investigations. The extent to which muscle RMP varies has important implications for the measurement of synaptic potentials as well. Two parameters of excitatory junctional potential (EJP) voltage were compared across a range of RMPs. EJP amplitude (ΔV) and peak voltage (maxima) change as a function of RMP; on average, a 10mV change in RMP elicits a 4–5mV change in EJP amplitude and peak voltage. The influence of the calcium gradient on resting and synaptic membrane potentials led us to investigate the endogenous ion concentrations of larval hemolymph. In addition to the major monovalent ions and calcium, we report the first voltammetric analysis of magnesium concentration in larval fruit fly hemolymph. [Copyright &y& Elsevier]

Abstract: We tested the hypothesis that intrusive visual images could develop from listening to a traumatic verbal report. Eighty-six participants listened to a traumatic verbal report under one of three conditions: while shaping plasticine (visuospatial condition), while performing articulatory suppression (verbal condition), or with no extra task (control condition). Results showed that intrusive visual images developed from listening to the traumatic report. In line with the idea that central executive processes guide encoding of information, intrusion frequency was reduced in both the visuospatial and the verbal condition compared to the no task control condition. Overall, this pattern is similar to intrusive images from a traumatic film as found in earlier studies. This study provides a valuable addition to models of posttraumatic stress disorder and autobiographical memory. Additionally, the results have potential implications for therapists working with traumatized individuals. [Copyright &y& Elsevier]

Abstract: Information processing theories of post-traumatic stress disorder (PTSD) state that intrusive images emerge due to a lack of integration of perceptual trauma representations in autobiographical memory. To test this hypothesis experimentally, participants were shown an aversive film to elicit intrusive images. After viewing, they received a recognition test for just one part of the film. The test contained neutrally formulated items to rehearse information from the film. Participants reported intrusive images for the film in an intrusion diary during one week after viewing. In line with expectations, the number of intrusive images decreased only for the part of the film for which the recognition test was given. Furthermore, deliberate cued-recall memory after one week was selectively enhanced for the film part that was in the recognition test a week before. The findings provide new evidence supporting information processing models of PTSD and have potential implications for early interventions after trauma. [Copyright &y& Elsevier]

The National Institutes of Health announced the Healthy Brain and Child Development (HBCD) study to further understanding of infant brain development. This study examined perceptions and knowledge about research among the demographic groups to be studied in HBCD. 1164 participants (n = 548 pregnant people and 616 mothers of infants < 12 months) completed anonymous, on-line surveys. Domains included research literacy, MRI knowledge, and attitudes about research incentives and biospecimen collection. Logistic regression was used to examine factors related to outcome variables. Knowledge of MRI safety was low and research literacy was high across participants. Likelihood of participation given various incentives differed between participants. Those with lower education were less likely to rate any items as increasing likelihood of participation. Substance use during pregnancy improved the model fit only for items about alternate visit structures (home and telephone visits) and confidentiality. Overall results support the feasibility of infant imaging studies, such as HBCD with respondents having high research literacy and interest in learning about their baby's development. Educating potential participants about MRI safety and providing flexible incentives for participation will improve the success of infant MRI studies. [ABSTRACT FROM AUTHOR]

Background: Pain is a multidimensional construct. The purpose of this cross-sectional, single-centre study was to evaluate the relationship between postpartum pain type with pain intensity and opioid use in people with and without opioid use disorder (OUD).Methods: Postpartum pain type was coded from McGill Pain Questionnaire and Patient-Reported Outcome Measurement Information System (PROMIS) inventories in people with or without OUD after childbirth in a 4-month period. The co-primary outcomes were pain intensity (0-10 scale) and total inpatient oxycodone (mg). Multivariable linear mixed-effects models assessed between- and within-person relationships for pain type (primary predictor) and outcomes.Results: There were 44 522 unique pain scores and types from 2610 people. Pain types were associated with pain intensity (P<0.001). Between-person comparisons showed affective pain was associated with a small but higher total oxycodone dose (difference 1.04 mg compared with no affective pain, P<0.001). Among people with OUD, within-person comparisons showed that the presence of affective pain resulted in pain scores 1 point higher than when affective pain was not present (P=0.002); between-person comparisons showed that people with affective pain had pain scores 6 points higher (P=0.048). Within-person and between-person comparisons among OUD showed that nociceptive/neuropathic pain was associated with a higher total oxycodone dose (1.6 and 11.4 mg, respectively).Conclusions: Postpartum pain type was associated with pain intensity and opioid use. Further research is required to address the multiple dimensions of postpartum pain in people with and without OUD to improve treatment of postpartum pain. [ABSTRACT FROM AUTHOR]

Background: Randomized controlled trials document the safety and efficacy of reduced frequency prenatal visit schedules and virtual visits, but real-world data are lacking. Our institution created a prenatal care delivery model incorporating these alternative approaches to continue safely providing prenatal care during the coronavirus disease 2019 pandemic.Objective: To evaluate institutional-level adoption and patient and provider experiences with the coronavirus disease 2019 prenatal care model.Study Design: We conducted a single-site evaluation of a coronavirus disease 2019 prenatal care model incorporating a reduced frequency visit schedule and virtual visits deployed at a suburban academic institution on March 20, 2020. We used electronic health record data to evaluate institution-level model adoption, defined as changes in overall visit frequency and proportion of virtual visits in the 3 months before and after implementation. To evaluate the patient and provider experience with the coronavirus disease 2019 model, we conducted an online survey of all pregnant patients (>20 weeks' gestation) and providers in May 2020. Of note, 3 domains of care experience were evaluated: (1) access, (2) quality and safety, and (3) satisfaction. Quantitative data were analyzed with basic descriptive statistics. Free-text responses coded by the 3 survey domains elucidated drivers of positive and negative care experiences.Results: After the coronavirus disease 2019 model adoption, average weekly prenatal visit volume fell by 16.1%, from 898 to 761 weekly visits; the average weekly proportion of prenatal visits conducted virtually increased from 10.8% (97 of 898) to 43.3% (330 of 761); and the average visit no-show rate remained stable (preimplementation, 4.3%; postimplementation, 4.2%). Of those eligible, 74.8% of providers (77 of 103) and 15.0% of patients (253 of 1690) participated in the surveys. Patient respondents were largely white (180 of 253; 71.1%) and privately insured (199 of 253; 78.7%), reflecting the study site population. The rates of chronic conditions and pregnancy complications also differed from national prevalence. Provider respondents were predominantly white (44 of 66; 66.7%) and female (50 of 66; 75.8%). Most patients and almost all providers reported that virtual visits improved access to care (patients, 174 of 253 [68.8%]; providers, 74 of 77 [96.1%]). More than half of respondents (patients, 124 of 253 [53.3%]; providers, 41 of 77 [62.1%]) believed that virtual visits were safe. Nearly all believed that home blood pressure cuffs were important for virtual visits (patients, 213 of 231 [92.2%]; providers, 63 of 66 [95.5%]). Most reported satisfaction with the coronavirus disease 2019 model (patients, 196 of 253 [77.5%]; providers, 64 of 77 [83.1%]). In free-text responses, drivers of positive care experiences were similar for patients and providers and included perceived improved access to care through decreased barriers (eg, transportation, childcare), perceived high quality of virtual visits for low-risk patients and increased safety during the pandemic, and improved satisfaction through better patient counseling. Perceived drivers of negative care experience were also similar for patients and providers, but less common. These included concerns that unequal access to virtual visits could deepen existing maternity care inequities, concerns that the lack of home devices (eg, blood pressure cuffs) would affect care quality and safety, and dissatisfaction with poor patient-provider continuity and inadequate expectation setting for the virtual visit experience.Conclusion: Reduced visit schedules and virtual visits were rapidly integrated into real-world care, with positive experiences for many patients and providers. Future research is needed to understand the health outcomes and care experience associated with alternative approaches to prenatal care delivery across more diverse patient populations outside of the coronavirus disease 2019 pandemic to inform broader health policy decisions. [ABSTRACT FROM AUTHOR]

Background: The contribution of substance use disorders to the burden of severe maternal morbidity in the United States is poorly understood. The objective was to estimate the independent association between substance use disorders during pregnancy and risk of severe maternal morbidity.Methods: Retrospective analysis of a weighted 53.4 million delivery hospitalizations from 2003 to 2016 among females aged>18 in the National Inpatient Sample. We constructed measures of substance use disorders using diagnostic codes for cannabis, opioids, and stimulants (amphetamines or cocaine) abuse or dependence during pregnancy. The outcome was the presence of any of the 21 CDC indicators of severe maternal morbidity. Using weighted multivariable logistic regression, we estimated the association between substance use disorders and adjusted risk of severe maternal morbidity. Because older age at delivery is predictive of severe maternal morbidity, we tested for effect modification between substance use and maternal age by age group (18-34 y vs >34 y).Results: Pregnant women with an opioid use disorder had an increased risk of severe maternal morbidity compared with women without an opioid use disorder (18-34 years: aOR: 1.51; 95 % CI: 1.41,1.61, >34 years: aOR: 1.17; 95 % CI: 1.00,1.38). Compared with their counterparts without stimulant use disorders, pregnant women with a simulant use disorder (amphetamines, cocaine) had an increased risk of severe maternal morbidity (18-34 years: aOR: 1.92; 95 % CI: 1.80,2.0, >34 years: aOR: 1.85; 95 % CI: 1.66,2.06). Cannabis use disorders were not associated with an increased risk of severe maternal morbidity.Conclusion: Substance use disorders during pregnancy, particularly opioids, amphetamines, and cocaine use disorders, may contribute to severe maternal morbidity in the United States. [ABSTRACT FROM AUTHOR]

Objective: To determine the impact of prenatal counseling regarding psychosocial risk factors on maternal behavior. Study Design: We analyzed data from 198,323 women participating in the Pregnancy Risk Assessment Monitoring System (PRAMS). The χ2 and logistic regression analyses assessed the relationship between psychosocial risk, prenatal counseling and maternal behavior. Results: The odds of receiving risk-appropriate prenatal counseling were significantly greater for participants who used alcohol (odds ratio, 1.13; 95% confidence interval, 1.08−1.17) and tobacco (odds ratio, 2.02; 95% confidence interval, 1.91−2.13). After receiving counseling, women quit using alcohol (72.9% vs 27.1%; P < .01) and tobacco (79.9% vs 20.1%; P < .01) at a significantly greater rate and women with unintended pregnancies were more likely to use postpartum contraception (83.6% vs 16.4%; P < .01) than women who were not counseled. However, no significant differences were found in the rates of intimate partner violence during pregnancy (56.1% vs 43.9%; P = .09) between women who did and did not receive counseling. Conclusion: Counseling regarding psychosocial risk factors during pregnancy may positively impact maternal behavior. [ABSTRACT FROM AUTHOR]

Cognitive models of Posttraumatic Stress Disorder (PTSD) postulate that cognitive biases in attention, interpretation, and memory represent key factors involved in the onset and maintenance of PTSD. Developments in experimental research demonstrate that it may be possible to manipulate such biases by means of Cognitive Bias Modification (CBM). In the present paper, we summarize studies assessing cognitive biases in posttraumatic stress to serve as a theoretical and methodological background. However, our main aim was to provide an overview of the scientific literature on CBM in (analogue) posttraumatic stress. Results of our systematic literature review showed that most CBM studies targeted attentional and interpretation biases (attention: five studies; interpretation: three studies), and one study modified memory biases. Overall, results showed that CBM can indeed modify cognitive biases and affect (analog) trauma symptoms in a training congruent manner. Interpretation bias procedures seemed effective in analog samples, and memory bias training proved preliminary success in a clinical PTSD sample. Studies of attention bias modification provided more mixed results. This heterogeneous picture may be explained by differences in the type of population or variations in the CBM procedure. Therefore, we sketched a detailed research agenda targeting the challenges for CBM in posttraumatic stress. [ABSTRACT FROM AUTHOR]