Disparities in Perinatal and Emergency Care Receipt Among Women With Perinatal Opioid Use Disorder in Medicaid, 2007 to 2012

OBJECTIVES: This study aimed to better understand receipt of perinatal and emergency care among women with perinatal opioid use disorder (OUD) and explore variation by race/ethnicity. METHODS: We used 2007-2012 Medicaid Analytic eXtract (MAX) data from all 50 states and the District of Columbia to examine 6,823,471 deliveries for women 18 to 44 years old. Logistic regressions modeled the association between (1) OUD status and receipt of perinatal and emergency care, and (2) receipt of perinatal and emergency care and race/ethnicity, conditional on OUD diagnosis and controlling for patient and county characteristics. We used robust SEs, clustered at the individual level, and included state and year fixed effects. RESULTS: Women with perinatal OUD were less likely to receive adequate prenatal care (adjusted odds ratio [aOR], 0.45; 95% confidence interval [CI], 0.44-0.46) and attend the postpartum visit (aOR, 0.46; 95% CI, 0.45-0.47) and more likely to seek emergency care (aOR, 1.48; 95% CI, 1.45-1.51) than women without perinatal OUD. Among women with perinatal OUD, Black, Hispanic, and American Indian and Alaskan Native (AI/AN) women were less likely to receive adequate prenatal care (aOR, 0.68 [95% CI, 0.64-0.72]; aOR, 0.86 [95% CI, 0.80-0.92]; aOR, 0.71 [95% CI, 0.64-0.79]) and attend the postpartum visit (aOR, 0.85 [95% CI, 0.80-0.91]; aOR, 0.86 [95% CI, 0.80-0.93]; aOR, 0.83 [95% CI, 0.73-0.94]) relative to non-Hispanic White women. Black and AI/AN women were also more likely to receive emergency care (aOR, 1.13 [95% CI, 1.05-1.20]; aOR, 1.12 [95% CI, 1.00-1.26]). CONCLUSIONS: Our findings suggest that women with perinatal OUD, in particular Black, Hispanic, and AI/AN women, may be missing opportunities for preventive care and comprehensive management of their physical and behavioral health during pregnancy

Trends and Disparities in Perinatal Opioid Use Disorder Treatment in Medicaid, 2007-2012

We described Medicaid-insured women by receipt of perinatal opioid use disorder (OUD) treatment; and trends and disparities in treatment. Using 2007 to 2012 Medicaid Analytic eXtract data from 45 states and D.C., we identified deliveries among women with OUD. Regressions modeled the association between patient characteristics and receipt of any OUD treatment, medication for OUD (MOUD), and counseling alone during the perinatal period. Rates of any OUD treatment and MOUD for women with perinatal OUD increased over the study period, but trends differed by subgroup. Compared with non-Hispanic White women, Black and American Indian/Alaskan Native (AI/AN) women were less likely to receive any OUD treatment, and Black women were less likely to receive MOUD. Over time, the disparity in receipt of MOUD between Black and White women increased. Overall gains in OUD treatment were driven by improvements in perinatal OUD care for White women and obscured disparities for Black and AI/AN women

Effects of Age, Gender, BMI, and Anatomical Site on Skin Thickness in Children and Adults with Diabetes

<div><p>Objective</p><p>We aimed to assess the effects of age, sex, body mass index (BMI), and anatomical site on skin thickness in children and adults with diabetes.</p><p>Methods</p><p>We studied 103 otherwise healthy children and adolescents with type 1 diabetes aged 5–19 years, and 140 adults with type 1 and type 2 diabetes aged 20–85 years. The thicknesses of both the dermis and subcutis were assessed using ultrasound with a linear array transducer, on abdominal and thigh skin.</p><p>Results</p><p>There was an age-related thickening of both dermis (p&lt;0.0001) and subcutis (p = 0.013) in children and adolescents. Girls displayed a substantial pubertal increase in subcutis of the thigh (+54%; p = 0.048) and abdomen (+68%; p = 0.009). Adults showed an age-related decrease in dermal (p = 0.021) and subcutis (p = 0.009) thicknesses. Pubertal girls had a thicker subcutis than pubertal boys in both thigh (16.7 vs 7.5 mm; p&lt;0.0001) and abdomen (16.7 vs 8.8 mm; p&lt;0.0001). Men had greater thigh dermal thickness than women (1.89 vs 1.65 mm; p = 0.003), while the subcutis was thicker in women in thigh (21.3 vs 17.9 mm; p = 0.012) and abdomen (17.7 vs 9.8 mm; p&lt;0.0001). In boys, men, and women, both dermis and subcutis were thicker on the abdomen compared to thigh; in girls this was only so for dermal thickness. In both children and adults, the skin (dermis and subcutis) became steadily thicker with increasing BMI (p&lt;0.0001).</p><p>Conclusions</p><p>Skin thickness is affected by age, pubertal status, gender, BMI, and anatomical site. Such differences may be important when considering appropriate sites for dermal/subcutaneous injections and other transdermal delivery systems.</p></div

Skin thickness in boys (blue bars) and girls (red bars), according to pubertal status.

<p>****p&lt;0.0001.</p

The association of BMI SDS and BMI with thickness of skin layers in children (n = 103) and adults (n = 140), respectively.

<p>Data for females are in red and for males in blue.</p

Thickness of skin layers in abdomen (full bars) and thigh (striped bars) in males (blue) and females (red).

<p>*p&lt;0.05, **p&lt;0.01, ***p&lt;0.001, and ****p&lt;0.0001 for comparisons between abdominal and thigh measurements.</p

The Global Book : Micropublishing, Conglomerate Production, and Digital Market Structures

The contemporary book business is both globalized and digitalized, whether we are talking international bestsellers or micropublished digital-only e-books. All categories of literature have been profoundly marked by technological and social change. Despite being polar opposites, large-scale media conglomerate publishing and micropublishing are discussed jointly in the article. Globalization and digitalization are used as overarching concepts and developed in terms of promoters, gatekeepers, visibility, and discoverability. The question is how the globalization and digitalization of the book market has influenced and changed literature in circulation beyond its national or linguistic areas