Oral abstracts 3: RA Treatment and outcomesO13. Validation of jadas in all subtypes of juvenile idiopathic arthritis in a clinical setting

Background: Juvenile Arthritis Disease Activity Score (JADAS) is a 4 variable composite disease activity (DA) score for JIA (including active 10, 27 or 71 joint count (AJC), physician global (PGA), parent/child global (PGE) and ESR). The validity of JADAS for all ILAR subtypes in the routine clinical setting is unknown. We investigated the construct validity of JADAS in the clinical setting in all subtypes of JIA through application to a prospective inception cohort of UK children presenting with new onset inflammatory arthritis. Methods: JADAS 10, 27 and 71 were determined for all children in the Childhood Arthritis Prospective Study (CAPS) with complete data available at baseline. Correlation of JADAS 10, 27 and 71 with single DA markers was determined for all subtypes. All correlations were calculated using Spearman's rank statistic. Results: 262/1238 visits had sufficient data for calculation of JADAS (1028 (83%) AJC, 744 (60%) PGA, 843 (68%) PGE and 459 (37%) ESR). Median age at disease onset was 6.0 years (IQR 2.6-10.4) and 64% were female. Correlation between JADAS 10, 27 and 71 approached 1 for all subtypes. Median JADAS 71 was 5.3 (IQR 2.2-10.1) with a significant difference between median JADAS scores between subtypes (p < 0.01). Correlation of JADAS 71 with each single marker of DA was moderate to high in the total cohort (see Table 1). Overall, correlation with AJC, PGA and PGE was moderate to high and correlation with ESR, limited JC, parental pain and CHAQ was low to moderate in the individual subtypes. Correlation coefficients in the extended oligoarticular, rheumatoid factor negative and enthesitis related subtypes were interpreted with caution in view of low numbers. Conclusions: This study adds to the body of evidence supporting the construct validity of JADAS. JADAS correlates with other measures of DA in all ILAR subtypes in the routine clinical setting. Given the high frequency of missing ESR data, it would be useful to assess the validity of JADAS without inclusion of the ESR. Disclosure statement: All authors have declared no conflicts of interest. Table 1Spearman's correlation between JADAS 71 and single markers DA by ILAR subtype ILAR Subtype Systemic onset JIA Persistent oligo JIA Extended oligo JIA Rheumatoid factor neg JIA Rheumatoid factor pos JIA Enthesitis related JIA Psoriatic JIA Undifferentiated JIA Unknown subtype Total cohort Number of children 23 111 12 57 7 9 19 7 17 262 AJC 0.54 0.67 0.53 0.75 0.53 0.34 0.59 0.81 0.37 0.59 PGA 0.63 0.69 0.25 0.73 0.14 0.05 0.50 0.83 0.56 0.64 PGE 0.51 0.68 0.83 0.61 0.41 0.69 0.71 0.9 0.48 0.61 ESR 0.28 0.31 0.35 0.4 0.6 0.85 0.43 0.7 0.5 0.53 Limited 71 JC 0.29 0.51 0.23 0.37 0.14 -0.12 0.4 0.81 0.45 0.41 Parental pain 0.23 0.62 0.03 0.57 0.41 0.69 0.7 0.79 0.42 0.53 Childhood health assessment questionnaire 0.25 0.57 -0.07 0.36 -0.47 0.84 0.37 0.8 0.66 0.4

Welfare Reform, Insurance Coverage Pre-Pregnancy, and Timely Enrollment: An Eight-State Study

Implementation of the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) broke the automatic linkage between Medicaid eligibility/enrollment and welfare cash assistance for women eligible at welfare income levels. This study used data from the Pregnancy Risk Assessment Monitoring System (PRAMS) for the period 1996–1999 to examine insurance coverage of these and other pregnant women pre- and post-PRWORA. Controlling for individual characteristics and economic growth, the relative odds of having private insurance did not change while the odds of being Medicaid enrolled versus uninsured pre-pregnancy declined for welfare-eligible women post-PRWORA. The absolute effect was a decline of 7.9 percentage points in the probability of welfare-eligible women being insured. While these results apply to the early years of welfare reform, it is still likely that states can improve Medicaid outreach and enrollment of women eligible prior to pregnancy

Women's Preferences for the Location of Abortion Services: A Pilot Study in Two Chicago Clinics

Between July and December 2006, 209 women at a university-based primary care center and a freestanding abortion clinic completed a verbally administered questionnaire in which they were asked their preference for the location of early abortion services. Sixty women seeking primary care services at the university-based clinic and 149 women seeking first-trimester abortion services at an abortion clinic completed the questionnaire. Sixty-seven percent (67%) of women surveyed at the university-based primary care facility and 69% at the abortion clinic indicated a preference for abortion services from their regular health care provider. A statistically significant association (P = 0.002) was found between comfort speaking with a regular health care provider about pregnancy prevention and preference for the provision of abortion services from a regular health care provider. Women may feel more comfortable undergoing an early abortion procedure with a provider with whom they have an established relationship. The integration of early abortion services into primary care practice may increase continuity of care among women seeking an abortion

Very Low Birthweight in African American Infants: The Role of Maternal Exposure to Interpersonal Racial Discrimination

Objectives. We determined whether African American women’s lifetime exposure to interpersonal racial discrimination is associated with pregnancy outcomes. Methods. We performed a case–control study among 104 African American women who delivered very low birthweight (<1500 g) preterm (<37 weeks) infants and 208 African American women who delivered non–low-birthweight (>2500g) term infants in Chicago, Ill. Results. The unadjusted and adjusted odds ratio of very low birthweight infants for maternal lifetime exposure to interpersonal racism in 3 or more domains equaled 3.2 (95% confidence intervals=1.5, 6.6) and 2.6 (1.2, 5.3), respectively. This association tended to persist across maternal sociodemographic, biomedical, and behavioral characteristics. Conclusions. The lifelong accumulated experiences of racial discrimination by African American women constitute an independent risk factor for preterm delivery

Extent of Documented Adherence to Recommended Prenatal Care Content: Provider Site Differences and Effect on Outcomes Among Low-Income Women

Objectives: The aims of this study were to examine the relationship between prenatal care (PNC) provider site and the extent of documented adherence to recommended PNC content, and the relationship between adherence to recommended PNC content and adverse pregnancy outcomes among women in Illinois’ Medical Assistance Program (MA). Methods: Utilizing the medical record, MA claims, and birth certificate data of 374 women who gave birth in 2003 and 2004 in four high-risk communities in Chicago, crude and adjusted analyses of the relationship between provider site and the extent of documented adherence to PNC content, and between adherence to PNC content and the incidence of low birthweight (LBW) and preterm birth (PTB) were conducted. The extent of documented adherence to recommended PNC content was measured from medical records as the percentage of 19 components of standard obstetrical practice that were delivered during pregnancy, converted to a three level categorical variable (low - 50%, medium - 50-79% and high - 80% or greater). Results: The majority of women had less than 80% of the recommended PNC content documented in their medical records. Among high-risk women, a greater proportion of women served by hospitals received care in which the extent of documented adherence was high (>=80%) compared to women served by physicians’offices and federally qualified health centers (FQHCs) (p<0.05). Among low-risk women, a greater proportion of women served by FQHCs received care in which the extent of documented adherence was high compared to women served by physician’s offices and hospitals (p<0.10). Lower adherence to PNC content was significantly associated with LBW and PTB among women receiving prenatal care from physicians. Conclusions: Examination of the extent of adherence to recommended PNC content and its relationship to adverse pregnancy outcomes provides valuable data to inform potential interventions. In particular, a relationship between adherence to recommended PNC content and LBW and PTB among women receiving PNC at physicians’ offices suggests the importance of increased quality assurance and provider education efforts