Hesterbuch3876

4). The obstetric comorbidity index that is most often used may be undervaluing the degree of association with SMM.

Hospital discharge diagnosis files and birth certificate records can have misclassifications and may not include all relevant clinical data or social determinants. The period for analysis ended in 2014 to avoid the transition to the International Classification of Diseases, 10th Revision, Clinical Modification, and therefore missed more recent years.

Obstetric and, particularly, medical comorbid conditions are increasing among women who develop SMM. The maternal comorbidity index is a promising tool for patient risk assessment and case-mix adjustment, but refinement of factor weights may be indicated.

National Institutes of Health.

National Institutes of Health.

Skilled, high-quality health providers and birth attendants are important for reducing maternal mortality.

To assess whether U.S. regional variations in maternal mortality rates relate to health workforce availability.

Comparison of regional variations in maternal mortality rates and women's health provider rates per population and identification of a relationship between these measures.

U.S. health system.

Women of child-bearing age and women's health providers, as captured in federal data sources from the Centers for Disease Control and Prevention, Census Bureau, and Health Resources and Services Administration.

Regional-to-national rate ratios for maternal mortality and women's health provider availability, calculated per population for women of reproductive age. Provider availability was examined across occupations (obstetrician-gynecologists, internal medicine physicians, family medicine physicians, certified nurse-midwives), in service-based categories (birth-attending and primary care proviers.

None.

None.Maternal mortality and severe maternal morbidity are critical health issues in the United States, with unacceptably high rates and racial, ethnic, and geographic disparities. Various factors contribute to these adverse maternal health outcomes, ranging from patient-level to health system-level factors. Furthermore, a majority of pregnancy-related deaths are preventable. This review briefly describes the epidemiology of maternal mortality and severe maternal morbidity in the United States and discusses selected initiatives to reduce maternal mortality and severe maternal morbidity in the areas of data and surveillance; clinical workforce training and patient education; telehealth; comprehensive models and strategies; and clinical guidelines, protocols, and bundles. Related Health Resources and Services Administration initiatives are also described.

Early prenatal care is vital for improving maternal health outcomes and health behaviors, but medically vulnerable and underserved populations are less likely to begin prenatal care in the first trimester. In 2017, the Health Center Program provided safety-net care to more than 27 million persons, including 573026 prenatal patients, at approximately 12000 sites across the United States and U.S. jurisdictions. As part of a mandatory reporting requirement, health centers tracked whether patients initiated prenatal care in their first trimester of pregnancy.

To identify health center characteristics associated with the initiation of prenatal care in the first trimester, as well as actionable steps policymakers, providers, and health centers can take to promote early initiation of prenatal care.

Secondary analysis of cross-sectional data from the 2017 Uniform Data System.

The United States and 8 U.S. jurisdictions.

Health center grantees with prenatal patients (

= 1281).

Multinomial logistic regressiNew England, provision of prenatal care to women living with HIV, and more uninsured patients or patients eligible for both Medicare and Medicaid).

The data set is at the health center grantee level and does not contain information on timing or quality of follow-up prenatal care.

Most health centers met the Healthy People 2020 baseline, but opportunities for improvement remain and the Healthy People 2020 target is still a challenge for many health centers. Policymakers, providers, and health centers can learn from high-achieving centers to promote early initiation of prenatal care among medically vulnerable and underserved populations.

Health Resources and Services Administration.

Health Resources and Services Administration.

Opioid and psychotropic prescriptions are common during pregnancy. Little is known about coprescriptions of both medications in this setting.

To describe opioid prescription among women who are prescribed psychotropics compared with women who are not.

Cross-sectional study.

U.S. commercial insurance beneficiaries from MarketScan (2001 to 2015).

Pregnant women at 22 weeks' gestation or greater who were insured continuously for 3 months or more before pregnancy through delivery.

Opioid prescription, dosage thresholds (morphine milligram equivalents [MME] of≥50/day and≥90/day), number of opioid agents (≥2), and duration (≥30 days) among those with and without prescription of psychotropics, from 2011 to 2015.

Among 958980 pregnant women, 10% received opioids only, 6% psychotropics only, and 2% opioids with coprescription of psychotropics. Opioid prescription was higher among women prescribed psychotropics versus those who were not (26.5% vs. 10.7%). selleckchem From 2001 to 2015, psychotropic prescription overaents.

Opioids are frequently coprescribed with psychotropic medication during pregnancy and are associated with antepartum hospitalization. A substantial proportion of pregnant women are prescribed opioids at doses that increase overdose risk and exceed daily recommendations.

None.

None.

Untreated mental health (MH) concerns have significant implications for college students. This study examined the efficacy of a video contact intervention targeting students' intentions to seek counseling.

One-hundred and sixty-three college students (



= 21.05,

 = 2.20) from a Mid-Atlantic university participated. The sample was predominantly female (74%). Method Students were randomly assigned to view a student-targeted contact video (ie, clips from college students who share their mental health experiences), a MH comparison contact video, or a non-MH comparison video. Intentions to seek counseling and psychological distress were measured pretest and post-test.

Intentions to seek counseling significantly increased from pretest to post-test in the student-targeted contact video condition (

[1, 156] = 22.75,

< .001, partial



= .13), but not in the comparison conditions. Further, this effect was only observed among participants who reported preexisting psychological distress (

[1, 153] = 28.