Congenital Syphilis in the Medicaid Program: Assessing Challenges and Opportunities Through the Experiences of Seven Southern States.

INTRODUCTION: Rates of congenital syphilis cases are increasing, particularly among lower socioeconomic populations within the southern United States. Medicaid covers a significant portion of these births, which provides an opportunity to improve birth outcomes. This project sought to collect information from key stakeholders to assess facilitators of and barriers to Medicaid funding of prenatal syphilis screening and to provide insight into improving screening and lowering incidence through the Medicaid program. METHODS: Seven southern states (Alabama, Georgia, Kentucky, Louisiana, North Carolina, South Carolina, and Tennessee) were identified for this assessment. Researchers conducted a legal and policy analysis for each state to gather information on factors affecting congenital syphilis prevention, identify knowledge gaps, and inform the development of interview guides. Seventeen structured interviews with 29 participants were conducted to gather information on facilitators and barriers to receiving timely prenatal syphilis screening through the Medicaid program. Interview transcripts were analyzed and compared to identify key themes. RESULTS: Barriers to timely prenatal syphilis screening include varied laws among the states on the timing of screening, Medicaid reimbursement policies that may not adequately incentivize testing, Medicaid enrollment issues that affect both enrollment and continuity of care, and lack of clear understanding among providers on recommended testing. CONCLUSION: This work provides insight into systemic issues that may be affecting rates of prenatal syphilis screening and incidence among Medicaid enrollees and others in the U.S. South. To address rising congenital syphilis cases, policymakers should consider requiring third trimester syphilis screening, adopting policies to enhance access to prenatal care, adapting Medicaid payment and incentive models, and promoting collaboration between Medicaid and public health agencies.

Navigating the Intersection of PrEP and Medicaid.

The proposed national PrEP program would serve people who are uninsured as well as those enrolled in Medicaid. In this article, the authors propose a set of recommendations for the proposed program's implementers as well as state Medicaid agencies and Medicaid managed care organizations to ensure PrEP access for people enrolled in Medicaid, addressing gaps without undermining the important role of the Medicaid program in covering and promoting PrEP.

Chronic Disease Management Service Opportunities for Community Pharmacists During the COVID-19 Pandemic.

Health system disruption caused by the COVID-19 pandemic prompted public health professionals to reevaluate potential barriers and opportunities to community pharmacist provision of chronic disease management services and to identify opportunities for maximizing community pharmacists' impact. Researchers conducted semistructured interviews with representatives from chronic disease prevention and pharmacy practice and policy organizations to identify key themes across multiple interviews and novel responses of interest. Interviewees described a lack of payment models to support pharmacist-provided chronic disease management services but noted opportunities for community pharmacists to demonstrate their value in offering services they are uniquely positioned to provide and to implement better workflow solutions. Successfully demonstrating pharmacists' value and making the case for reimbursement from payors, as well as optimizing pharmacy workflow, are critical to maximizing pharmacists' impact in chronic disease prevention and management.

Hand-to-Hand Model for Bioelectrical Impedance Analysis to Estimate Fat Free Mass in a Healthy Population.

This study aimed to establish a hand-to-hand (HH) model for bioelectrical impedance analysis (BIA) fat free mass (FFM) estimation by comparing with a standing position hand-to-foot (HF) BIA model and dual energy X-ray absorptiometry (DXA); we also verified the reliability of the newly developed model. A total of 704 healthy Chinese individuals (403 men and 301 women) participated. FFM (FFMDXA) reference variables were measured using DXA and segmental BIA. Further, regression analysis, Bland-Altman plots, and cross-validation (2/3 participants as the modeling group, 1/3 as the validation group; three turns were repeated for validation grouping) were conducted to compare tests of agreement with FFMDXA reference variables. In male participants, the hand-to-hand BIA model estimation equation was calculated as follows: FFMmHH = 0.537 h²/ZHH - 0.126 year + 0.217 weight + 18.235 (r² = 0.919, standard estimate of error (SEE) = 2.164 kg, n = 269). The mean validated correlation coefficients and limits of agreement (LOAs) of the Bland-Altman analysis of the calculated values for FFMmHH and FFMDXA were 0.958 and -4.369-4.343 kg, respectively, for hand-to-foot BIA model measurements for men; the FFM (FFMmHF) and FFMDXA were 0.958 and -4.356-4.375 kg, respectively. The hand-to-hand BIA model estimating equation for female participants was FFMFHH = 0.615 h²/ZHH - 0.144 year + 0.132 weight + 16.507 (r² = 0.870, SEE = 1.884 kg, n = 201); the three mean validated correlation coefficient and LOA for the hand-to-foot BIA model measurements for female participants (FFMFHH and FFMDXA) were 0.929 and -3.880-3.886 kg, respectively. The FFMHF and FFMDXA were 0.942 and -3.511-3.489 kg, respectively. The results of both hand-to-hand and hand-to-foot BIA models demonstrated similar reliability, and the hand-to-hand BIA models are practical for assessing FFM.

Comparison of Standing Posture Bioelectrical Impedance Analysis with DXA for Body Composition in a Large, Healthy Chinese Population.

Bioelectrical impedance analysis (BIA) is a common method for assessing body composition in research and clinical trials. BIA is convenient but when compared with other reference methods, the results have been inconclusive. The level of obesity degree in subjects is considered to be an important factor affecting the accuracy of the measurements. A total of 711 participants were recruited in Taiwan and were sub-grouped by gender and levels of adiposity. Regression analysis and Bland-Altman analysis were used to evaluate the agreement of the measured body fat percentage (BF%) between BIA and DXA. The BF% measured by the DXA and BIA methods (Tanita BC-418) were expressed as BF%DXA and BF%BIA8, respectively. A one-way ANOVA was used to test the differences in BF% measurements by gender and levels of adiposity. The estimated BF%BIA8 and BF%DXA in the all subjects, male and female groups were all highly correlated (r = 0.934, 0.901, 0.916, all P< 0.001). The average estimated BF%BIA8 (22.54 ± 9.48%) was significantly lower than the average BF%DXA (26.26 ± 11.18%). The BF%BIA8 was overestimated in the male subgroup (BF%DXA< 15%), compared to BF%DXA by 0.45%, respectively. In the other subgroups, the BF%BIA8 values were all underestimated. Standing BIA estimating body fat percentage in Chinese participants have a high correlation, but underestimated on normal and high obesity degree in both male and female subjects.

Predicting body composition using foot-to-foot bioelectrical impedance analysis in healthy Asian individuals.

BACKGROUND: The objectives of this study were to develop a regression model for predicting fat-free mass (FFM) in a population of healthy Taiwanese individuals using standing foot-to-foot bioelectrical impedance analysis (BIA) and to test the model's performance in predicting FFM with different body fat percentages (BF%). METHODS: We used dual-energy X-ray absorptiometry (DXA) to measure the FFM of 554 healthy Asian subjects (age, 16-75 y; body mass index, 15.8-43.1 kg/m(2)). We also evaluated the validity of the developed multivariate model using a double cross-validation technique and assessed the accuracy of the model in an all-subjects sample and subgroup samples with different body fat levels. RESULTS: Predictors in the all-subjects multivariate model included height(2)/impedance, weight, year, and sex (FFM = 13.055 + 0.204 weight + 0.394 height(2)/Impedance - 0.136 age + 8.125 sex (sex: Female = 0, Male = 1), r(2) = 0.92, standard error of the estimate = 3.17 kg). The correlation coefficients between predictive FFM by BIA (FFMBIA) and DXA-measured FFM (FFMDXA) in female subjects with a total-subjects BF%DXA of <20 %, 20 %-30 %, 30 %-40 % and >40 % were r = 0.87, 0.90, 0.91, 0.89, and 0.94, respectively, with bias ± 2SD of 0.0 ± 3.0 kg, -2.6 ± 1.7 kg, -1.5 ± 2.8 kg, 0.5 ± 2.7 kg, and 2.0 ± 2.9 kg, respectively. The correlation coefficients between FFMBIA and FFMDXA in male subjects with a total-subjects BF%DXA of <10 %, 10 %-20 %, 20 %-30 %, and >30 % were r = 0.89, 0.89, 0.90, 0.93, and 0.91, respectively, with bias ± 2SD of 0.0 ± 3.2 kg, -2.3 ± 2.5 kg, -0.5 ± 3.2 kg, 0.4 ± 3.1 kg, and 2.1 ± 3.2 kg, respectively. CONCLUSIONS: The standing foot-to-foot BIA method developed in this study can accurately predict FFM in healthy Asian individuals with different levels of body fat.

Effect of static and dynamic stretching on vertical jump performance in collegiate women volleyball players.

The purpose of this study was to determine the effect of stretching on peak jump height during a series of vertical jumps, specifically focusing on a) static stretching (SS), b) dynamic stretching (DS) and c) no stretching (NS) performed immediately before a series of countermovement vertical jumps (CMJ). Twelve female collegiate volleyball players (mean +/- SD; age 19.5 +/- 1.1 yr; height 1.71 +/- 0.06 m; mass 71.3 +/- 8.54 kg) volunteered for this study. Data collection lasted a total of 3 weeks, and each subject performed all 3 stretching protocols, 1 session per week, with 1 week between sessions. The order of the stretching protocols was randomized for each subject. During each testing session, all subjects performed a 5-minute light jog as a warm-up, followed by 8 minutes of 1 of the stretching protocols. One minute after the completion of each protocol, 5 maximal CMJ were performed on a force platform, with each jump separated by 1 minute of passive recovery. Jump heights were calculated by integrating the vertical force trace. There were no significant differences between the SS, DS, and NS conditions for any of the jumps (p > 0.05). Despite the lack of significant effects for the group, there were notable individual responses to each of the warm-up conditions. Practitioners should be aware of the individual responses of their athletes to different types of warm-up protocols before athletic performance and the possible impact of prescribing or eliminating certain exercises.

Intersession reliability of kinematic and kinetic variables during vertical jumps in men and women.

PURPOSE: To investigate the intersession reliability of selected kinematic and kinetic variables during countermovement vertical jumps (CMJs). METHODS: Thirty-five men and 35 women performed CMJs on a force platform during four testing sessions each separated by 1 wk. Kinematic variables included time in the air (TIA), take-off velocity (TOV), total vertical displacement of the center of mass (TJH), and countermovement depth, whereas kinetic variables included positive impulse, negative impulse, vertical stiffness, and rates of force development. Systematic bias was assessed by calculating the 90% confidence interval of the change in the mean between consecutive testing sessions and between the first and final testing session for each variable. Coefficients of variation (CV) and intraclass correlation coefficients (ICC) were also calculated. RESULTS: Systematic bias was observed only for peak rate of force development during the concentric phase of the movement. For TIA, TOV, and TJH, CV values ranged from 1.7% to 6.6%, with ICC values ranging from 0.82 to 0.97. The other variables showed greater variation (CV range: 1.7% to 39.9%; ICC range: 0.04 to 0.99). Only slight gender differences were found in the reliability statistics, and the reliability of most of the variables was diminished as the time between the testing sessions was increased. CONCLUSION: Even though practitioners can expect good reliability for jump height measured from a force platform in men and women, other kinematic and kinetic variables often assessed during vertical jumps may not be reliable.

Structure-activity relationships of 111In- and 99mTc-labeled quinolin-4-one peptidomimetics as ligands for the vitronectin receptor: potential tumor imaging agents.

The integrin receptor alpha(v)beta(3) is overexpressed on the endothelial cells of growing tumors and on some tumor cells themselves. Radiolabeled alpha(v)beta(3) antagonists have demonstrated potential application as tumor imaging agents and as radiotherapeutic agents. This report describes the total synthesis of eight new HYNIC and DOTA conjugates of receptor alpha(v)beta(3) antagonists belonging to the quinolin-4-one class of peptidomimetics, and their radiolabeling with (99m)Tc (for HYNIC) and (111)In (for DOTA). Tethering of the radionuclide-chelator complexes was achieved at two different sites on the quinolin-4-one molecule. All such derivatives maintained high affinity for receptor alpha(v)beta(3) and high selectivity versus receptors alpha(IIb)beta(3), alpha(v)beta(5), alpha(5)beta(1). Biodistribution of the radiolabeled compounds was evaluated in the c-neu Oncomouse mammary adenocarcinoma model. DOTA conjugate (111)In-TA138 presented the best biodistribution profile. Tumor uptake at 2 h postinjection was 9.39% of injected dose/g of tissue (%ID/g). Activity levels in selected organs was as follows: blood, 0.54% ID/g; liver, 1.94% ID/g; kidney, 2.33% ID/g; lung, 2.74% ID/g; bone, 1.56% ID/g. A complete biodistribution analysis of (111)In-TA138 and the other radiolabeled compounds of this study are presented and discussed. A scintigraphic imaging study with (111)In-TA138 showed a clear delineation of the tumors and rapid clearance of activity from nontarget tissues.

Preliminary investigation: the impact of the NCAA Wrestling Weight Certification Program on weight cutting.

Historically, wrestling is a sport dependent on weight. Three tragic deaths in late 1997 prompted the National Collegiate Athletic Association (NCAA) to make a Wrestling Weight Certification Program (WWCP) mandatory to foster a safe competitive environment. One institution examined the impact of this program on weight cutting. Thirty-two NCAA Division I wrestlers completed the WWCP in the 1998-1999 season and 29 in 1999-2000. Eighteen (56%) of 32 wrestlers in 1998-1999 weighed in 10 or more pounds above the previous year's competition weight. Whereas, 28% weighed in 20 or more pounds above the previous year's competition weight. Weekly weight loss for the wrestlers in 1998-1999 revealed a substantial loss during the first week, possibly demonstrating the use of time-tested techniques for weight loss. However, in 1999-2000, the first week weight loss was less pronounced, with 65.8% of the weight being lost during the second half of the WWCP. Therefore, these wrestlers may be breaking the sport historic cycle of weight fluctuations through the WWCP.