Search

Purpose Describe how Ohio and Massachusetts explored severe maternal morbidity (SMM) data, and used these data for increasing awareness and driving practice changes to reduce maternal morbidity and mortality. Description For 2008-2013, Ohio used de-identified hospital discharge records and International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes to identify delivery hospitalizations. Massachusetts used existing linked data system infrastructure to identify delivery hospitalizations from birth certificates linked to hospital discharge records. To identify delivery hospitalizations complicated by one or more of 25 SMMs, both states applied an algorithm of ICD-9-CM diagnosis and procedure codes. Ohio calculated a 2013 SMM rate of 144 per 10,000 delivery hospitalizations; Massachusetts calculated a rate of 162. Ohio observed no increase in the SMM rate from 2008 to 2013; Massachusetts observed a 33% increase. Both identified disparities in SMM rates by maternal race, age, and insurance type. Assessment Ohio and Massachusetts engaged stakeholders, including perinatal quality collaboratives and maternal mortality review committees, to share results and raise awareness about the SMM rates and identified high-risk populations. Both states are applying findings to inform strategies for improving perinatal outcomes, such as simulation training for obstetrical emergencies, licensure rules for maternity units, and a focus on health equity. Conclusion Despite data access differences, examination of SMM data informed public health practice in both states. Ohio and Massachusetts maximized available state data for SMM investigation, which other states might similarly use to understand trends, identify high risk populations, and suggest clinical or population level interventions to improve maternal morbidity and mortality., Author(s): Elizabeth J. Conrey [sup.1] [sup.2] , Susan E. Manning [sup.1] [sup.3] [sup.4] , Cynthia Shellhaas [sup.2] [sup.5] , Nicholas J. Somerville [sup.4] [sup.6] , Sarah L. Stone [sup.4] [sup.7] [...]

Objectives To describe statewide SMM trends in Iowa from 2009 to 2014 and identify maternal characteristics associated with SMM, overall and by age group. Methods We used 2009-2014 linked Iowa birth certificate and hospital discharge data to calculate SMM based on a 25-condition definition and 24-condition definition. The 24-condition definition parallels the 25-condition definition, but excludes blood transfusions. We calculated SMM rates for all delivery hospitalizations (N = 196,788) using ICD-9-CM diagnosis and procedure codes. We used log-binomial regression to assess the association of SMM with maternal characteristics, overall and stratified by age groupings. Results In contrast to national rates, Iowa's 25-condition SMM rate decreased from 2009 to 2014. Based on the 25-condition definition, SMM rates were significantly higher among women 34 years compared to women 25-34 years. Blood transfusion was the most prevalent indicator, with hysterectomy and disseminated intravascular coagulation (DIC) among the top five conditions. Based on the 24-condition definition, younger women had the lowest SMM rates and older women had the highest SMM rates. SMM rates were also significantly higher among racial/ethnic minorities compared to non-Hispanic white women. Payer was the only risk factor differentially associated with SMM across age groups. First trimester prenatal care initiation was protective for SMM in all models. Conclusions High rates of blood transfusion, hysterectomy, and DIC indicate a need to focus on reducing hemorrhage in Iowa. Both younger and older women and racial/ethnic minorities are identified as high risk groups for SMM that may benefit from special consideration and focus., Author(s): Brittni N. Frederiksen [sup.1] [sup.2] [sup.7] , Catherine J. Lillehoj [sup.3] , Debra J. Kane [sup.1] [sup.4] , Dave Goodman [sup.5] , Kristin Rankin [sup.6] Author Affiliations: (1) Iowa [...]

Recent explorations into mind and movement utilizing advanced brain imaging techniques (e.g., fMRI, MEG, PET) have rekindled interest in the anti-saccade task, which allows one to examine movement planning and execution with minimal disruption due to movement artifacts. We investigate two variations of the anti-saccade task, which we describe as the reflex task and the memory task. In both, participants perform rapid eye movements to either a target (pro) or to its symmetrically opposite position (anti). In the reflex task, participants are first told the type of saccade task to perform, and are then shown a target to which they make an immediate pro- or anti-saccade. Prior to performing an anti-saccade in this task, a participant must presumably first inhibit a pro-saccade. In the memory task, after participants are briefly shown a target, they are given the instruction to execute a pro- or anti-saccade task for that target. This presumably requires the participant to keep both the target position and its symmetrically opposite image in memory until the instruction is shown, and also to demonstrate choice of action. This experiment was designed to quantitatively evaluate the reaction times these two different paradigms invoke in human subjects. Twenty-four student volunteers performed 60 trials in either a reflex or memory-based paradigm, and either random or blocked ordering of pro- and anti-tasks. The reflex and memory paradigms were identical except for the sequence of stimuli presentation. A mixed-model ANOVA of response times revealed that the memory-based paradigm invokes significantly slower reaction times than the reflex-based paradigm (383 ms vs. 266 ms, p < .01). As expected, the blocked ordering resulted in significantly faster reactions than the random ordering (304 ms vs. 346 ms, p < .01), for both pro- and anti-saccade tasks. Finally, we found that the reflex-based paradigm combined with an unmixed presentation of tasks resulted in the greatest within-subject contrast between pro- and anti-saccade reaction times. This research supported by CIHR. [ABSTRACT FROM AUTHOR]