The evolution of fetal protection policies

This article examines the evolution of fetal protection policies (FPPs) by detailing their historical legacy and a range of contemporary social forces that have contributed to their maintenance. It is based on a case study of the 1977 U.S. Department of Labor, Occupational Safety and Health Administration (OSHA) hearings to revise the industrial lead standard, the 1991 U.S. Supreme Court decision that such policies are unconstitutional ( United Auto Workers v. Johnson Controls , 1991), and the case law preceding that decision. A primary issue is the notion that women and fetuses are disproportionately susceptible to lead. This study reveals the ways in which this belief is framed, disputed, and appropriated by various parties to the fetal protection policy debate. Implications of this case study for family health policy are also discussed.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/44656/1/10834_2006_Article_BF02353687.pd

Explaining the gender gap in help to parents: The importance of employment

Although it is well established that adult daughters spend more time giving assistance to their parents than do sons, the sources of this gender gap are not well understood. This paper asks: To what extent can this gap be explained by structural variation, especially the different rates of employment and kinds of jobs that women and men tend to hold? Using data from the National Survey of Families and Households (N= 7,350), the paper shows that both employment status and job characteristics, especially wages and self-employment, are important factors in explaining the gender gap in the help given to parents and that these operate similarly for women and men

Provider Experiences With the Identification, Management, and Treatment of Co-occurring Chronic Noncancer Pain and Substance Use in the Safety Net

BACKGROUND: In the US and internationally, providers have adopted guidelines on the management of prescription opioids for chronic non-cancer pain (CNCP). For “high-risk” patients with co-occurring CNCP and a history of substance use, guidelines advise providers to monitor patients using urine toxicology screening tests, develop opioid management plans, and refer patients to substance use treatment. OBJECTIVE: We report primary care provider experiences in the safety net interpreting and implementing guideline recommendations for patients with CNCP and substance use. METHODS: We interviewed primary care providers who work in the safety net (N=23) on their experiences managing CNCP and substance use. We analyzed interviews using a content analysis method. RESULTS: Providers found management plans and urine toxicology screening tests useful for informing patients about clinic expectations of opioid therapy and substance use. However, they described that guideline-based clinic policies had unintended consequences, such as raising barriers to open, honest dialogue about substance use and treatment. While substance use treatment was recommended for “high-risk” patients, providers described lack of integration with and availability of substance use treatment programs. CONCLUSIONS: Our findings indicate that clinicians in the safety net found guideline-based clinic policies helpful. However, effective implementation was challenged by barriers to open dialogue about substance use and limited linkages with treatment programs. Further research is needed to examine how the context of safety net settings shapes the management and treatment of co-occurring CNCP and substance use

Brief Report

BackgroundChronic pain occurs in up to 85% of persons living with HIV and is commonly treated with long-term opioid therapy (LTOT). We investigated the impact of chronic pain and LTOT on HIV outcomes.MethodsThis was prospective cohort study conducted between July 2015 and July 2016 in 5 HIV primary care clinics. Chronic pain was defined as ≥moderate pain for ≥3 months on the Brief Chronic Pain Questionnaire. Chronic pain and LTOT were assessed at an index visit. Suboptimal retention, defined as at least one "no-show" to primary care, and virologic failure were measured over the subsequent year. Multivariable logistic regression models were built for each outcome adjusting for site.ResultsAmong 2334 participants, 25% had chronic pain, 27% had suboptimal retention, 12% had virologic failure, and 19% were prescribed LTOT. Among individuals not on LTOT, chronic pain was associated with increased odds of suboptimal retention [adjusted odds ratio (aOR) 1.46, 95% confidence interval (CI): 1.10 to 1.93, P = 0.009] and virologic failure (aOR 1.97, 95% CI: 1.39 to 2.80, P < 0.001). Among individuals with chronic pain, there was no association between LTOT and retention, but LTOT was associated with lower rates of virologic failure (aOR 0.56, 95% CI: 0.33 to 0.96, P = 0.03).ConclusionsChronic pain in participants not on LTOT was associated with virologic failure. This reinforces the need to identify effective chronic pain treatments for persons living with HIV and investigate their impact on HIV outcomes. The apparent protective association between LTOT and virologic failure in those with pain merits further exploration