Is reproductive development adaptively calibrated to early experience? Evidence from a national sample of females

Many developmental theories have not been sufficiently evaluated using designs that control for unobserved familial confounds. Our long-term goal is to determine the causal structure underlying associations between early environmental conditions and later psychosocial and health outcomes. Our overall objective in this study was to further evaluate predictions derived from applications of life history theory to female reproductive development, key among them that reproductive milestones translate early environmental risk into fertility, health, and behavioral outcomes. To this end, we used female data from the National Longitudinal Survey of Youth 1979 and structural equation modeling to conduct increasingly severe tests, beginning with covariate control and then progressing to sibling control and behavioral genetic designs. After adjusting for confounds varying between sets of siblings, we did not find evidence that age at menarche reflected components of early environment or that any focal outcomes reflected early fragmented family structure (birth to age nine). Although we detected no links between measured environment and individual differences in age at sexual debut, we did find that it reflected both shared and nonshared influences in our behavior genetic models. Interestingly, delayed sexual debut (into young adulthood) reflected identification of parents as the greatest influences and forecasted an array of fertility-related outcomes. Taken together, these findings challenge theories suggesting menarche timing is adaptively calibrated to early environment. They also highlight the need for more research using sibling control and related designs to examine the roles of environments in development. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Testing Environmental Effects on Age at Menarche and Sexual Debut within a Genetically Informative Twin Design

Life-history-derived models of female sexual development propose menarche timing as a key regulatory mechanism driving subsequent sexual behavior. The current research utilized a twin subsample of the National Longitudinal Study of Adolescent to Adult Health (Add Health; n = 514) to evaluate environmental effects on timings of menarche and sexual debut, as well as address potential confounding of these effects within a genetically informative design. Results show mixed support for each life history model and provide little evidence rearing environment is important in the etiology of individual differences in age at menarche. This research calls into question the underlying assumptions of life-history-derived models of sexual development and highlights the need for more behavior genetic research in this area.

UK alcohol consumption during the COVID-19 pandemic: The role of drinking motives, employment and subjective mental health

Background Previous investigations suggest that the COVID-19 pandemic effects on alcohol consumption were heterogenous and may vary as a function of structural and psychological factors. Research examining mediating or moderating factors implicated in pandemic-occasioned changes in drinking have also tended to use single-study cross-sectional designs and convenience samples.

AIMS

First, to explore structural (changed employment or unemployment) and psychological (subjective mental health and drinking motives) correlates of consumption reported during the COVID-19 pandemic using a UK nationally representative (quota sampled) dataset. Second, to determine whether population-level differences in drinking during the COVID-19 pandemic (versus pre-pandemic levels) could be attributable to drinking motives.

METHOD

Data collected from samples of UK adults before and during the pandemic were obtained and analysed: Step1 carried out structural equation modelling (SEM) to explore data gathered during a period of social restrictions after the UK's first COVID-19-related lockdown (27 August-15 September, 2020; n = 3,798). It assessed whether drinking motives (enhancement, social, conformity, coping), employment and the perceived impact of the pandemic on subjective mental health may explain between-person differences in self-reported alcohol consumption. Step 2 multigroup SEM evaluated data gathered pre-pandemic (2018; n = 7,902) in concert with the pandemic data from step 1, to test the theory that population-level differences in alcohol consumption are attributable to variances in drinking motives.

RESULTS

Analyses of the 2020 dataset detected both direct and indirect effects of subjective mental health, drinking motives, and employment matters (e.g., having been furloughed) on alcohol use. Findings from a multigroup SEM were consistent with the theory that drinking motives explain not only individual differences in alcohol use at both time points, but also population-level increases in use during the pandemic.

CONCLUSION

This work highlights socioeconomic and employment considerations when seeking to understand COVID-19-related drinking. It also indicates that drinking motives may be particularly important in explaining the apparent trend of heightened drinking during the pandemic. Limitations related to causal inference are discussed.

A Psychometric Evaluation of the Intrasexual Competition Scale

The Intrasexual Competition Scale (ICS) measures the extent to which individuals view their interaction with same-sex others in competitive terms. Although it is frequently used in studies investigating differences in mating behavior, the factor structure of the ICS has never been confirmed. Researchers have yet to use multiple-group confirmatory factor analysis to test whether the properties of the scale are equivalent between the sexes. In Study 1, we report on an investigation in which participants' responses to the ICS were submitted to exploratory factor analysis (EFA). In Study 2A, we compared the fit of one and two-factor models from the EFA as well as two additional models, using confirmatory factor analysis with an independent sample. The best fit was obtained by a two-factor solution, which reflected: (1) respondents' feelings of frustration when intrasexual competitors are better off (Inferiority Frustration), and (2) respondents' enjoyment of being better than intrasexual competitors (Superiority Enjoyment). This model achieved a high degree of measurement invariance. In Study 2B, we found the ICS had good concurrent validity via associations with sociosexuality, mating effort, and sexual behavior. Together, these analyses suggest that the ICS is a valid measure of intrasexually competitive attitudes.

Advancing the Psychometric Study of Human Life History Indicators : K Does Not Measure Life History Speed, but Theory and Evidence Suggest It Deserves Further Attention

In this article we attend to recent critiques of psychometric applications of life history (LH) theory to variance among humans and develop theory to advance the study of latent LH constructs. We then reanalyze data (n = 4,244) previously examined by Richardson et al. (Evolutionary Psychology, 15(1), 2017, https://doi.org/10.1177/1474704916666840 to determine whether (a) previously reported evidence of multidimensionality is robust to the modeling approach employed and (b) the structure of LH indicators is invariant by sex. Findings provide further evidence that a single LH dimension is implausible and that researchers should cease interpreting K-factor scores as empirical proxies for LH speed. In contrast to the original study, we detected a small inverse correlation between mating competition and Super-K that is consistent with a trade-off. Tests of measurement invariance across the sexes revealed evidence of metric invariance (i.e., equivalence of factor loadings), consistent with the theory that K is a proximate cause of its indicators; however, evidence of partial scalar invariance suggests use of scores likely introduces bias when the sexes are compared. We discuss limitations and identify approaches that researchers may use to further evaluate the validity of the K-factor and other applications of LH to human variation.

Outcomes of an interprofessional SBIRT training program: Knowledge attainment and perceived competence for practice

BACKGROUND

One way to address substance misuse is to train health professional students in Screening, Brief Intervention, and Referral to Treatment (SBIRT), an early intervention strategy. This study evaluated a semester-long, 50-hour elective SBIRT training that blended online coursework with interprofessional experiences. Medicine, nursing, pharmacy, and social work students completed an interprofessional standardized patient experience and completed a minimum of two interprofessional SBIRT experiences at community agencies. Methods: We analyzed longitudinal data from 197 students using structural equation modeling to examine gains in knowledge and perceived competence, as well as to test if background variables predicted 30-day application of SBIRT knowledge and skills, 30-day satisfaction' 12-month frequencies of care for performing SBIRT; and number of SBIRT clients/patients served directly. Results: Overall, student SBIRT knowledge and perceived competence both increased by more than a standard deviation during the course. Students who experienced larger gains in perceived competence rated the course significantly higher in terms of relevance and usefulness and, in turn, served significantly more SBIRT clients/patients during the following year. We did not find evidence that intra-individual growth in knowledge impacted the degree to which students ultimately applied SBIRT components. Finally, students who had more previous training and experience related to substance abuse ultimately reported greater application of SBIRT knowledge and skills. Interprofessional differences included: At baseline, medicine students had significantly lower substance abuse education knowledge as compared to the other disciplines. Pharmacy and social work students were more likely to have had previous experience with motivational interviewing. Baseline perceived competence in applying SBIRT was higher in social work and nursing. Upon completion, pharmacy and medicine students had lower satisfaction with the course. Conclusions: These findings suggest that SBIRT courses can increase knowledge and perceived competence; moreover, student background characteristics, work settings, and experiences may have important effects on learning SBIRT.

Was facial width-to-height ratio subject to sexual selection pressures? A life course approach

Sexual selection researchers have traditionally focused on adult sex differences; however, the schedule and pattern of sex-specific ontogeny can provide insights unobtainable from an exclusive focus on adults. Recently, it has been debated whether facial width-to-height ratio (fWHR; bi-zygomatic breadth divided by midface height) is a human secondary sexual characteristic (SSC). Here, we review current evidence, then address this debate using ontogenetic evidence, which has been under-explored in fWHR research. Facial measurements were collected from 3D surface images of males and females aged 3 to 40 (Study 1; US European-descent, n = 2449), and from 2D photographs of males and females aged 7 to 21 (Study 2; Bolivian Tsimane, n = 179), which were used to calculate three fWHR variants (which we call fWHRnasion, fWHRstomion, and fWHRbrow) and two other common facial masculinity ratios (facial width-to-lower-face-height ratio, fWHRlower, and cheekbone prominence). We test whether the observed pattern of facial development exhibits patterns indicative of SSCs, i.e., differential adolescent growth in either male or female facial morphology leading to an adult sex difference. Results showed that only fWHRlower exhibited both adult sex differences as well as the classic pattern of ontogeny for SSCs-greater lower-face growth in male adolescents relative to females. fWHRbrow was significantly wider among both pre- and post-pubertal males in the Bolivian Tsimane sample; post-hoc analyses revealed that the effect was driven by large sex differences in brow height, with females having higher placed brows than males across ages. In both samples, all fWHR measures were inversely associated with age; that is, human facial growth is characterized by greater relative elongation in the mid-face and lower face relative to facial width. This trend continues even into middle adulthood. BMI was also a positive predictor of most of the ratios across ages, with greater BMI associated with wider faces. Researchers collecting data on fWHR should target fWHRlower and fWHRbrow and should control for both age and BMI. Researchers should also compare ratio approaches with multivariate techniques, such as geometric morphometrics, to examine whether the latter have greater utility for understanding the evolution of facial sexual dimorphism.

The Development and Psychometric Evaluation of a New Mating Effort Questionnaire

In this study, we review the psychometric literature on mating effort and find that extant instruments (1) have not been adequately evaluated in terms of internal structure and measurement invariance, and (2) disproportionately focus on mate retention and intrasexual competition tactics designed to repel competitors, relative to attraction and investment effort. To address these gaps in the literature, we carried out two studies to develop and validate a new Mating Effort Questionnaire (MEQ). In Study 1, we report a pilot study in which participants' responses to an item pool were submitted to exploratory factor analysis. In Study 2, we replicated the structure found in Study 1 using confirmatory factor analysis in an independent sample. A three-factor solution yielded the best fit. The three factors reflected respondents' allocation of energy to attracting high mate value partners when already mated, seeking out romantic partners when single, and investing in their current romantic partner and relationships. Strong partial measurement invariance held across the sexes, implying that observed scores may be used to compare them. We also found evidence of concurrent validity via associations between the MEQ and constructs such as sociosexual orientation, K-factor, mate retention behaviors, and respondents' sexual behavior. These findings suggest that the MEQ is a valid and novel measure of individual differences in mating effort which is well suited to complement existing mating effort measures.

Managing Substance Use Disorder through a Walking/Running Training Program

While emerging studies have demonstrated the benefit of exercise in Substance Use Disorder (SUD) recovery outcomes, lack of motivation to engage in exercise has been indicated as one of many perceived barriers that contribute to low recruitment and adherence rates in SUD treatment. The current study aimed to explore participants' perceptions of attending a supervised exercise program (boot camp workouts, walking/running practice, and a race event) while in treatment for SUD. A total of 109 participants were recruited to a 14-week exercise training program and 61 chose to participate in, and completed, a race at the close of the program. Interviews were conducted during weeks 6 through 14 and data were examined using Thematic Analysis. Three main themes were identified: (1) pushing forward recovery through running, (2) gaining a sense of achievement by crossing the finish line, and (3) building a sense of belonging in the program. Implications for SUD recovery programs are discussed.

Structure and longitudinal invariance of the Short Alcohol and Alcohol Problems Perception Questionnaire

Many studies have employed the Short Alcohol Attitudes Problem Perception Questionnaire (SAAPPQ) to measure professionals' attitudes toward working with people experiencing alcohol problems. However, research has not confirmed the internal structure of the SAAPPQ, leaving open the possibility that scale scores are not valid empirical proxies for underlying attitudes. It is also unclear if measurement invariance holds over time or across groups. This is an important gap in light of evidence that (a) experiences can change the structure of scales and (b) structures of some popular scales differ dramatically between groups. Thus, measurement bias may confound comparisons of composite SAAPPQ scores between measurement occasions or groups. To address these gaps in the literature, we conducted a longitudinal examination of the psychometrics of the SAAPPQ using data from 241 human services professionals-in-training. We found a four-factor structure, rather than the previously reported five factors. Configural, metric, and a strong degree of scalar invariance held longitudinally. Few factor intercorrelations were significant at time one and they strengthened over time, suggesting that the SAAPPQ should not be aggregated at higher-order levels (i.e., global scores should not be used). Findings suggest four SAAPPQ subscale scores may be used as valid proxies for attitudes toward alcohol users; however, additional confirmatory studies are needed to ensure that measurement bias does not compromise inferences based on SAAPPQ scores.

Decomposition of Mean Sex Differences in Alcohol Use Within a Genetic Factor Model

A wealth of literature suggests that normative and heavy alcohol consumption continue to follow a historical pattern of greater prevalence among males as compared to females. Some prior research suggested that sex-specific factors might explain some of this gender gap. Generally speaking, though, more recent studies have indicated that the sources of differences for most complex traits, both genetic and environmental, are similar for males and females. To the best of our knowledge, however, no studies have tested whether genetic and environmental factors common to both sexes are more often expressed in males, on average, thereby accounting for some of the mean sex difference in alcohol use. The current study used nationally representative data from American twin respondents and a multiple group genetic factor model with a mean structure to address this gap in the literature. Results provide no evidence of sex differences in covariance structure and suggest that genetic and nonshared environmental influences common to both sexes largely explain why male alcohol use is more frequent and severe, on average, than is female use. In contrast, shared environmental influences seem to play a less important role. We discuss our findings in the context of the existing literature and chart out directions for future research.

Life History Theory and Recovery From Substance Use Disorder

Recovery has emerged as an important paradigm in addictions treatment but the field has yet to achieve consensus on how it should be defined and measured. The recovery construct has been extended beyond sustained reductions in use or abstinence to enhancements in global health/well-being and also prosocial community reintegration. However, few studies have included these broader domains in their measurement of recovery and few scientific theories have been advanced to explain why reductions in substance use occasion these broader life changes. This article applies life history theory to recovery for the first time to help define recovery, advance recovery measurement, and explain why broad change across multiple life domains should facilitate sustained recovery progress. We conclude with a discussion of future directions and challenges for future research informed by our life history framework for recovery.

The Psychometrics of the Mini-K

Many published studies have employed the Mini-K to measure a single fast-slow life history dimension. However, the internal structure of the Mini-K has not been determined and it is not clear that a single higher order K-factor fits the data. It is also not clear that the Mini-K is measurement invariant across groups such as the sexes. To establish the construct validity of K as well as the broader usefulness of applying life history theory to humans, it is crucial that these psychometric issues are addressed as a part of measure validation efforts. Here we report on three studies that used latent variable modeling and data drawn from two college student samples ( ns = 361 and 300) to elucidate the psychometrics of the Mini-K. We found that (a) the Mini-K had a six dimensional first-order structure, (b) the K-factor provided a parsimonious explanation of the associations among the lower order factors at no significant cost to fit, (c) the Mini-K measured the same K-factor across the sexes, (d) K-factor means did not have the same meaning across the sexes and thus the first-order factors should be used in studies of mean sex differences, and finally, (e) the K-factor was only associated with environment and aspects of mating competition in females. Implications and future directions for life history research are discussed.

On the Psychometric Study of Human Life History Strategies

This article attends to recent discussions of validity in psychometric research on human life history strategy (LHS), provides a constructive critique of the extant literature, and describes strategies for improving construct validity. To place the psychometric study of human LHS on more solid ground, our review indicates that researchers should (a) use approaches to psychometric modeling that are consistent with their philosophies of measurement, (b) confirm the dimensionality of life history indicators, and (c) establish measurement invariance for at least a subset of indicators. Because we see confirming the dimensionality of life history indicators as the next step toward placing the psychometrics of human LHS on more solid ground, we use nationally representative data and structural equation modeling to test the structure of middle adult life history indicators. We found statistically independent mating competition and Super-K dimensions and the effects of parental harshness and childhood unpredictability on Super-K were consistent with past research. However, childhood socioeconomic status had a moderate positive effect on mating competition and no effect on Super-K, while unpredictability did not predict mating competition. We conclude that human LHS is more complex than previously suggested-there does not seem to be a single dimension of human LHS among Western adults and the effects of environmental components seem to vary between mating competition and Super-K.

From Environment to Mating Competition and Super-K in a Predominantly Urban Sample of Young Adults

Recent research suggests human life history strategy (LHS) may be subsumed by multiple dimensions, including mating competition and Super-K, rather than one. In this study, we test whether a two-dimensional structure best fit data from a predominantly urban sample of young adults ages 18-24. We also test whether latent life history dimensions are associated with environmental harshness and unpredictability as predicted by life history theory. Results provide evidence that a two-dimensional model best fit the data. Furthermore, a moderate inverse residual correlation between mating competition and Super-K was found, consistent with a life history trade-off. Our findings suggest that parental socioeconomic status may enhance investment in mating competition, that harshness might persist into young adulthood as an important correlate of LHS, and that unpredictability may not have significant effects in young adulthood. These findings further support the contention that human LHS is multidimensional and environmental effects on LHS are more complex than previously suggested. The model presented provides a parsimonious explanation of an array of human behaviors and traits and can be used to inform public health initiatives, particularly with respect to the potential impact of environmental interventions.

The Psychometric Evaluation of Human Life Histories

A recent critique of Copping, Campbell, and Muncer raised several issues concerning the validity of psychometric assessment techniques in the study of life history (LH) strategies. In this reply, some of our key concerns about relying on aggregated psychometric measures are explained, and we raise questions generally regarding the use of higher order factor structures. Responses to some of the statistical issues raised by Figueredo et al. are also detailed. We stand by our original conclusions and call for more careful consideration of instruments used to evaluate hypotheses derived from LH theory.

Interpersonal Contact and Attitudes Toward Adolescents Who Abuse Substances

Only 7.6% of adolescents in need of substance abuse treatment actually receive it. Many adolescents are hesitant to seek treatment due to public stigma (i.e., negative attitudes and beliefs of the general public toward individuals who abuse substances). However, decades of research indicate that interpersonal contact with stigmatized groups helps reduce stigma. This study used structural equations and data from 638 undergraduate students to test the relationships between students' total interpersonal contact with individuals who abuse substances and their attitudes toward those individuals. We found that total contact did not have significant effects on stigma and was associated with better helping attitudes toward adolescents who abuse alcohol but not marijuana. In addition, African Americans and females endorsed greater stigmatization of adolescents who abuse alcohol but better helping attitudes toward those who had received treatment. Increasing contact with individuals who abuse substances, irrespective of type and valence, may not be widely useful as a way of improving attitudes toward such people.

Adolescent Life History Strategy in the Intergenerational Transmission and Developmental Stability of Substance Use

Research suggests that fast life history strategy (LHS) may be a primary driver of substance use among young adults. However, a recent study reported that (a) young adult fast LHS did not subsume all theorized indicators of LHS during this period and (b) fast LHS among parents did not predict young adult fast LHS or liability for use of common substances. In this study, we used structural equations and national data to test whether these findings generalized to adolescence. In addition, given that LHS and substance use share genetic and neuropsychological bases, we examined whether fast LHS could explain the developmental stability of substance use. Overall, our results extend the findings discussed above and suggest that fast LHS fully explains the developmental stability of substance use among youth. We discuss implications for life history models, research applying life history theory and substance use, and substance abuse prevention and treatment.

School Nurses' Professional Practice in the HPV Vaccine Decision-Making Process

Because U.S. human papillomavirus (HPV) vaccination rates remain low, we evaluated school nurses' knowledge, attitudes, perceptions of their role as opinion leaders, self-efficacy, intention, and professional practice regarding the HPV vaccine and determined if these variables influenced their professional practice concerning the HPV vaccine. We utilized a cross-sectional design by recruiting Ohio Association of School Nurses (OASN) members. Participants (n = 145) completed a paper survey during the OASN annual conference. Structural equation modeling was used to examine the proposed model. Our model yielded a well-fitting solution, χ2 = 1.118 (degrees of freedom = 2, p = .57). Knowledge had positive effects on intention and self-efficacy. Attitude had a positive effect on perception of role as opinion leaders. Intention to provide HPV vaccine education had a positive effect on professional practice. To develop school nurses' practice, interventions should center on increasing knowledge, attitudes, and intention toward providing HPV vaccine education.

Life History Strategy and Young Adult Substance Use

This study tested whether life history strategy (LHS) and its intergenerational transmission could explain young adult use of common psychoactive substances. We tested a sequential structural equation model using data from the National Longitudinal Survey of Youth. During young adulthood, fast LHS explained 61% of the variance in overall liability for substance use. Faster parent LHS predicted poorer health and lesser alcohol use, greater neuroticism and cigarette smoking, but did not predict fast LHS or overall liability for substance use among young adults. Young adult neuroticism was independent of substance use controlling for fast LHS. The surprising finding of independence between parent and child LHS casts some uncertainty upon the identity of the parent and child LHS variables. Fast LHS may be the primary driver of young adult use of common psychoactive substances. However, it is possible that the young adult fast LHS variable is better defined as young adult mating competition. We discuss our findings in depth, chart out some intriguing new directions for life history research that may clarify the dimensionality of LHS and its mediation of the intergenerational transmission of substance use, and discuss implications for substance abuse prevention and treatment.

Life history strategy and young adult substance use

This study tested whether life history strategy (LHS) and its intergenerational transmission could explain young adult use of common psychoactive substances. We tested a sequential structural equation model using data from the National Longitudinal Survey of Youth. During young adulthood, fast LHS explained 61% of the variance in overall liability for substance use. Faster parent LHS predicted poorer health and lesser alcohol use, greater neuroticism and cigarette smoking, but did not predict fast LHS or overall liability for substance use among young adults. Young adult neuroticism was independent of substance use controlling for fast LHS. The surprising finding of independence between parent and child LHS casts some uncertainty upon the identity of the parent and child LHS variables. Fast LHS may be the primary driver of young adult use of common psychoactive substances. However, it is possible that the young adult fast LHS variable is better defined as young adult mating competition. We discuss our findings in depth, chart out some intriguing new directions for life history research that may clarify the dimensionality of LHS and its mediation of the intergenerational transmission of substance use, and discuss implications for substance abuse prevention and treatment.

Impulsivity links reward and threat sensitivities to substance use: a functional model

This study used structural equations modeling and undergraduate student data to examine the effects of reward and threat sensitivities on substance use, along with the extent to which impulsivity explained these effects. Our results suggest that impulsivity may translate inversely related reward and threat sensitivities into substance use, completely mediate the effect between threat sensitivity and substance use, and partially mediate the effect between reward sensitivity and substance use. Our results also suggest that individuals with a combination of higher levels on both reward and threat sensitivities may be most impulsive and vulnerable to heightened substance use. We discuss implications for research at the interface of personality and substance use and also substance abuse prevention and treatment.

Immediate Survival Focus: Synthesizing Life History Theory and Dual Process Models to Explain Substance Use

Researchers have recently applied evolutionary life history theory to the understanding of behaviors often conceived of as prosocial or antisocial. In addition, researchers have applied cognitive science to the understanding of substance use and used dual process models, where explicit cognitive processes are modeled as relatively distinct from implicit cognitive processes, to explain and predict substance use behaviors. In this paper we synthesized these two theoretical perspectives to produce an adaptive and cognitive framework for explaining substance use. We contend that this framework provides new insights into the nature of substance use that may be valuable for both clinicians and researchers.

Immediate survival focus: synthesizing life history theory and dual process models to explain substance use

Researchers have recently applied evolutionary life history theory to the understanding of behaviors often conceived of as prosocial or antisocial. In addition, researchers have applied cognitive science to the understanding of substance use and used dual process models, where explicit cognitive processes are modeled as relatively distinct from implicit cognitive processes, to explain and predict substance use behaviors. In this paper we synthesized these two theoretical perspectives to produce an adaptive and cognitive framework for explaining substance use. We contend that this framework provides new insights into the nature of substance use that may be valuable for both clinicians and researchers.

Guidance of magnetic resonance imaging and placement of skin-marker localization devices

AIM

A variety of magnetic resonance imaging (MRI)-compatible skin-marker localization devices are available on the market. MRI protocols call for the liberal use of the skin markers over the specific site of symptoms or over any palpable mass. This study investigates the usefulness of patient-assisted placement of 1 000-mg fish oil capsules as skin markers over the area of maximum localized pain, signs, or symptoms and correlates this placement with any potential underlying neuropathology or potential pain generator.

METHODS

One-hundred symptomatic patients undergoing MRI were assessed for focal or localized signs or symptoms. Under the direction of a physician and with guidance from the patient, the MRI technician placed a 1 000-mg fish-oil capsule over the area of maximum pain or signs and symptoms. Patients with poorly localized, diffuse symptoms or an area of maximal signs and symptoms outside the field of view of the MRI were not included in this study. All MRI exams were reviewed by clinical physicians and radiologists or neuroimaging physicians.

RESULTS

In all 100 cases, the images show clearly visible MRI-compatible skin-surface markers that correlate with potential underlying neuropathology.

CONCLUSION

Our results show that 1 000-mg fish-oil capsules can be used as MRI localization devices as a cost-effective alternative to more expensive commercially available devices.

Magnetic resonance angiography of the circle of Willis in patients with symptomatic intracranial neuropathology: medicare LCD L25367(R4)

Patients with symptomatic intracranial neuropathology such as atherosclerotic occlusive disease or unruptured aneurysms face high risks for morbidity and mortality. Magnetic resonance angiography of the circle of Willis is an important tool used to detect and diagnose intracranial neuropathology; however, recent changes to the Medicare local coverage determinations for this procedure threaten to compromise the physician's ability to deliver this current standard of care. Physicians can assume an important role in advocating for this lifesaving procedure on behalf of this vulnerable patient population.

Urine drug testing in the treatment of chronic noncancer pain in a Kentucky private neuroscience practice: the potential effect of Medicare benefit changes in Kentucky

BACKGROUND

Because the symptoms of drug misuse are nonspecific and difficult to detect, pain physicians have relied heavily on the results of urine drug tests to diagnose and treat chronic noncancer pain in patients who are prescribed controlled substances. However, changes in Medicare local carrier determinations for Medicare Part B providers in Connecticut, Indiana, Kentucky, and New York went into effect on July 1, 2009, whereby qualitative drug screening was no longer recognized as medically reasonable and necessary in the treatment of patients with chronic noncancer pain unless the patient presents with suspected drug overdose.

STUDY DESIGN

A retrospective review of urine drug testing services.

OBJECTIVE

To determine the extent of urine drug testing in patients with chronic noncancer pain in a large, Kentucky neuroscience practice offering pain management services combined with neurologic and neurosurgical services to better understand the potential effects of recent changes to Medicare benefits.

METHODS

An audit of services provided during 2007 was conducted using computer software.

OUTCOME MEASURES

Outcome measures included the number of practice services, number of urine drug tests by payor, and the number of noncompliant patients by payor who self-released from care.

RESULTS

Urine drug tests represented approximately 18.2% of professional medical services rendered in 2007 to patients with a diagnosis of chronic noncancer pain. Of these, UDTs represented approximately 22.2% of services provided to Medicare patients and 24.6% of services provided to Medicaid patients. In 2007, 2,081 patients with noncompliant UDTs self released from the practice against medical advice. Of these, 23.1% were enrolled in Medicare and 47.5% were enrolled in Medicaid. Approximately 40% of patients were referred to the CARE Clinic on the basis of noncompliance as indicated by UDT and/or behavioral health issues. Of these, approximately 50% remained in treatment. Urine drug tests were also instrumental in revealing that 19.6% of patients showed signs of drug abuse or addiction. Of these patients, approximately 60% were government insured.

LIMITATIONS

Not a prospective, double-blinded study. We approximated the proportion of patients potentially affected by drug abuse or addiction as the percentage of patients self releasing from medical care.

CONCLUSION

In 2007, UDTs were used as an effective tool in adherence monitoring in a private neuroscience practice in Kentucky that offers pain management services combined with neurologic and neurosurgical services. UDTs were instrumental in referring 40% of patients for evaluation and treatment by behavioral health and addiction medicine specialists. UDTs were also instrumental in discovering signs of drug abuse or addiction in 19.6% of patients. Of these patients, approximately 60% were government insured. Should the objective and reliable sign offered by UDTs be eliminated from the physician's toolbox, the physician's ability to accurately diagnose and treat these patients could be impaired.

Importance of urine drug testing in the treatment of chronic noncancer pain: implications of recent medicare policy changes in kentucky

BACKGROUND

Urine drug testing has become a widely used tool in American society for deterring illicit drug use. In the practice of medicine, urine drug testing is commonly used to help diagnose substance misuse, abuse, or addiction.

OBJECTIVE

This narrative review provides an informed perspective on the importance of urine drug testing in the medical treatment of chronic noncancer pain. The history and current uses of urine drug tests in the United States are reviewed, the prevalence and nature of prescription drug misuse is described as is related to chronic noncancer pain, and implications and considerations for practitioners are presented related to the noncancer pain diagnosis and treatment.

DISCUSSION

Practitioners are confronted with the ethical and legal dilemma of being called to adequately treat chronic pain in a culture with a high prevalence of prescription drug abuse. Yet the symptoms of drug abuse are nonspecific and therefore of limited value to the practitioner in determining patient compliance to drug treatment regimens. In contrast, urine drug testing has a reliable history, both in and out of medicine, as an independent sign of drug misuse. This sign can be used to aid in the diagnosis and treatment of drug misuse and underlying addictions to improve patient outcomes.

CONCLUSION

Regular urine drug testing should be a part of acute and chronic pain management whether or not the patient has any signs or symptoms of drug misuse.