Barry Portnoy

A SENSITIVE DOUBLE-ISOTOPE DERIVATIVE ASSAY FOR NOREPINEPHRINE AND EPINEPHRINE. NORMAL RESTING HUMAN PLASMA LEVELS.

A sensitive and specific double-isotope dilution method for assaying norepinephrine and epinephrine separately is described. The method is based on enzymatic conversion of these two catecholamines to their respective metanephrines and was applied successfully to measurement of resting plasma concentrations of norepinephrine and epinephrine in normal subjects with the finding that norepinephrine (0.20 ± 0.08 μg/liter) normally constitutes approximately 80% of the plasma catecholamine content and epinephrine (0.05 ± 0.03 μg/liter) 20%.

Cesarean delivery on maternal request : Obstetrician-gynecologists' knowledge, perception, and practice patterns

OBJECTIVE: To examine obstetrician–gynecologists’ knowledge, opinions, and practice patterns related to cesarean delivery on maternal request. METHODS: Questionnaires were mailed to 1,031 American College of Obstetricians and Gynecologists Fellows in February 2006, with a response rate of 68%. The questionnaire queried respondents’ demographic characteristics, practices and attitudes surrounding vaginal and cesarean deliveries, knowledge and beliefs regarding the risks and benefits of elective and nonelective cesarean delivery, and counseling practices and department policies for cesarean delivery on maternal request. RESULTS: About half of respondents believe women have the right to cesarean delivery on maternal request, and a similar percentage acknowledge having performed at least one cesarean delivery on maternal request. Fifty-eight percent of respondents note an increase in patient inquiries regarding cesarean delivery over the past year, yet most of their practices do not have a policy regarding this procedure. Respondents attribute the increase in inquiries to the increase of information from the media and to convenience. Respondents cited more risks than benefits of cesarean delivery on maternal request, and nearly all discuss these risks with patients who are considering one. Females were more negative toward cesarean delivery on maternal request than males and endorsed more risks and fewer benefits. There were no relationships between assessment of risks and benefits or practice with clinician age or patient characteristics. CONCLUSION: Most obstetrician–gynecologists in this study recognized an increased demand for cesarean delivery on maternal request within their practices, while believing that the risks of this procedure outweigh the benefits. Clinicians would benefit from strong evidence regarding risks and benefits, evidence that is crucial to guiding policy making with regard to cesarean delivery on maternal request. LEVEL OF EVIDENCE: III

A Systematic Review of Evaluation in Formal Continuing Medical Education.

Introduction: Physicians spend a considerable amount of time in Continuing Medical Education (CME) to maintain their medical licenses. CME evaluation studies vary greatly in evaluation methods, levels of evaluation, and length of follow‐up. Standards for CME evaluation are needed to enable comparison among different studies and to detect factors influencing CME evaluation. Methods: A review of the CME evaluation literature was conducted on primary research studies published from January 2000 to January 2006. Studies assessing only satisfaction with CME were excluded, as were studies where fewer than 50% of the participants were practicing physicians. Thirty‐two studies were included in the analyses. Determinations were made about evaluation methods, outcome measures, and follow‐up assessment. Results: Only 2 of 32 reviewed studies addressed all evaluation levels: physician changes in knowledge and attitudes (level 2), practices (level 3), and improved patient health status (level 4). None of the studies using self‐developed instruments (n = 10) provided reliability and validity information. Only 6 studies used validated scales. Twenty studies had a follow‐up period of 6 months or less, and 11 had a follow‐up period between 1 and 2 years. Discussion: A gold standard for evaluating the effectiveness of CME would include assessment of all 4 levels of evaluation. A valid, reliable, and adaptable CME evaluation questionnaire addressing variables in the second level is needed to allow comparison of effectiveness across CME interventions. A minimum 1‐year postintervention follow‐up period may also be indicated to investigate the sustainability of intervention outcomes.

Do Latino Youth Really Want to Get Pregnant?: Assessing Pregnancy Wantedness

Despite recent declines, Latinas bear a disproportionate burden of teen births. Understanding social, cultural, and demographic factors underlying pregnancy desire among Latino adolescents is needed to design effective teen pregnancy prevention interventions. A questionnaire was completed by 794 Latino youth including a “pregnancy wantedness scale” (PWS) to assess attitudes toward an early pregnancy and socio-demographic variables. Regression analyses examined the association between these variables and PWS score. PWS scores for all groups were below but near the midpoint, suggesting ambivalence toward an early pregnancy. Being female, older, acculturated, using hormonal contraception, living with parents, and having an educated mother were significantly associated with lower PWS scores, but impacted youth differently depending on their sex and sexual experience. Multi-component Latino teen pregnancy prevention strategies should address behavioral and attitudinal differences based on sex and sexual experience and acknowledge the contribution of social determinants on pregnancy intentions.

States' use of local population health data: comparing the Behavioral Risk Factor Surveillance System and independent state health surveys.

OBJECTIVES To identify and compare key features of independent comprehensive state health surveys (SHS) with those of the Behavioral Risk Factor Surveillance System (BRFSS) for addressing the need for statewide and local population health data. METHODS We developed inclusion criteria, systematically collected information about federal and SHS that met these criteria, and obtained supplemental information from SHS leaders. RESULTS We identified comprehensive independent SHS in 11 states and BRFSS surveys in all 50 states. The independent SHS meet important statewide and local data needs, filling 3 key health data gaps in the BRFSS: lack of adequate data on special populations such as children, lack of data on specific localities, and limited depth and scope of health topics surveyed on key issues such as health insurance coverage. Unlike BRFSS, independent SHS have limited comparability with each other. CONCLUSIONS The BRFSS and independent SHS each meet some key state and local data needs but result in data gaps and inefficient use of resources. Surveys could more effectively and efficiently meet future needs for comparable data to monitor health care reform and address health disparities if they were coordinated across states and at the national, state, and local levels.