Disease Management Update
Volume V, No. 44
March 19, 2009
Dear Healthcare Intelligence Network Client,
According to the most recent statistics from the CDC, 12.7 percent of births are preterm, which is defined as less than 37 weeks of gestation. This week's Disease Management Update explores some risks associated with premature births, as well as techniques being used to improve poor organ function as a result of preterm births.
A few weeks still remain to take the Disease Management Update Readership Survey and be eligible to win a free copy of "Comorbidity Care Models: Integrated Action Plans for Complex Healthcare Needs," a $117 value.
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Editor, Disease Management Update
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Table of Contents
1. Antidepressants, Depression May Raise Risk of Premature Birth
Pregnant women who had untreated major depression in all three trimesters of pregnancy, as well as those who took certain antidepressants, had preterm birth rates exceeding 20 percent, according to a study by University of Pittsburgh School of Medicine researchers. Approximately 10 to 20 percent of women struggle with symptoms of major depression during their pregnancies, but treating it can be complicated. Selective serotonin reuptake inhibitor (SSRI) antidepressants are usually the first line of depression treatment, but they can lead to unwanted outcomes such as preterm births if used continuously throughout pregnancy, the findings suggest.
Throughout this prospective study, researchers followed 238 women with no, partial, and continuous exposure to either depression or SSRI treatment during pregnancy and compared neonatal outcomes. They found that women exposed to either continuous SSRI treatment, or to continuous depression with no SSRI treatment, had comparable levels of increased risk for preterm birth at 21 and 23 percent, respectively. However, women with no exposure to either depression or SSRI medication had lower rates of preterm births, around 6 percent.
“It is well-known that the prevalence of depression in women is highest during the childbearing years, and treating the symptoms with SSRIs is a common medical therapy,” said Katherine L. Wisner, M.D., M.S., director of the Women’s Behavioral HealthCARE program at Western Psychiatric Institute and Clinic of University of Pittsburg Medical Center, associate investigator at Magee-Womens Research Institute, and professor at the University of Pittsburgh School of Medicine. “However, given the similarity in outcomes we found for continuous SSRI treatment and continuous depression, it is possible that underlying depressive disorder is a factor in preterm birth among women taking SSRIs.”
To learn more about this research, please visit:
2. Disease Management Q&A: Launching a Childhood Obesity Program
Each week, a healthcare professional responds to a reader's query on an industry issue. This week's expert is Barbara Moore, Ph.D., president and CEO of Shape Up America!, a non-profit organization.
Question: What kind of programs would have the greatest impact most quickly for childhood obesity problems? With what initiative would you start?
Response: (Barbara Moore) I would start with parenting skill building. This process should begin prior to conception. You should be counseling parents who are trying to conceive. You should also counsel pregnant women because there’s some evidence that they are more open to suggestions and behavioral lifestyle changes while they are pregnant and anticipating the birth of the new baby. There’s evidence that the pregnancy to pre-school period is a critical period for what we call self-regulation.
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3. HealthSounds Podcast: Health Coaching ROI Trends
According to Paul Terry, president and CEO of StayWell Health Management, when evaluating health coaching and population health programs, it is rare to see a return on investment in a program's first year, but generally by the second and third years, ROI begins to build. In addition to discussing ROI trends, Terry evaluates the value of self-reported data and the impact health coaching can have on an organization's productivity, presenteeism and absenteeism, and also gives some benchmarks for ROI in health coaching.
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4. Estrogen Improves Lung Function Following Preterm Birth
Estrogen may be a new postnatal therapy to improve lung function and other outcomes in preterm infants, researchers at UT Southwestern Medical Center have found in a study on primates.
Sufficient production of nitric oxide in fetal and newborn lungs is necessary for the lungs to develop and function properly. During the latter part of pregnancy, the placenta produces large amounts of estrogen that enters the fetal circulation. Another spike of estrogen occurs during labor. In prior studies in cultured cells the investigators found that estrogen activates the genes in lung cells encoding nitric oxide synthases, enzymes that produce nitric oxide. That research suggested treatment with the hormone may achieve the same results in the intact lung. Premature infants miss out on this exposure to estrogen in the womb and, as a consequence, may experience respiratory problems because they lack nitric oxide.
Administering estrogen to premature primates accomplished several things. First, the treated animals had greater abundance of nitric oxide synthases in their lungs, resulting in markedly enhanced lung function and a significantly reduced need for ventilation support. Estrogen also caused the closure of the ductus arteriosus, a shunt that connects the pulmonary artery to the aorta during the primates’ fetal development to allow blood flow to bypass the fetus’ fluid-filled lungs. In the case of full-term infants, the ductus arteriosus normally closes at the time of birth once breathing is established. In premature infants, however, it frequently fails to close resulting in further impairment in lung and heart function.
To learn more about this research, please visit:
5. Survey of the Month: Medical Homes in 2009
In less than five years, the patient-centered medical home (PCMH) model has quickly grown from a pediatrics-based concept to a care approach embraced by thousands of healthcare organizations hoping to improve care and costs for the chronically ill. Complete HIN's third annual survey on the PCMH's role in your organization and get a free executive summary of the compiled results.
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6. Treating Depression Through DM
Nearly 6 percent of men and almost 10 percent of women worldwide will experience a depressive episode in any given year, and in America alone, approximately 18.8 million adults have depression. In an e-survey from HIN, 250 healthcare professionals shared how their organizations are targeting depression as part of their DM initiatives.
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