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Isbey SC, Howard MB, Abdulrahman E, Giese K, Cuchara B, Gourishankar A. Characteristics and Geographic Variation in Sudden Unexpected Infant Deaths in the District of Columbia. Am J Forensic Med Pathol 2022; 43:328-333. [PMID: 36103406 DOI: 10.1097/paf.0000000000000793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Sleep-related infant death is a major cause of infant mortality in the United States. In the District of Columbia, infant mortality varies widely among regions (2 to 14 per 1000 live births). The study objectives were to analyze the patient characteristics and related variables to sudden unexpected infant deaths at 2 pediatric emergency department (ED) sites and the geographic patterns of infant deaths and their relationship to social vulnerability. This retrospective cohort study examined infants under 1 year of age presenting with cardiac arrest at 2 ED sites from 2010 to 2020. Analysis showed 81 deaths with a median population age of 75 days (SD, 46 days). The most frequent demographics of deceased patients were African American Black (89%) with Medicaid insurance (63%), born at term gestation (66%), and without comorbidity (60%). The cause of death was most frequently undetermined (32%) and asphyxia (31%). Most cases involved bed-sharing (63%), despite more than half of those cases having a known safe sleep surface available. Infant death location showed that most deaths occurred in areas with the highest social vulnerability index, including near a community ED location. Understanding the etiologies of this geographic variability may enhance sleep-related infant death prevention strategies.
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Affiliation(s)
| | - Mary Beth Howard
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD
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2
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Miao Q, Guo Y, Erwin E, Sharif F, Berhe M, Wen SW, Walker M. Racial variations of adverse perinatal outcomes: A population-based retrospective cohort study in Ontario, Canada. PLoS One 2022; 17:e0269158. [PMID: 35772371 PMCID: PMC9246499 DOI: 10.1371/journal.pone.0269158] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 05/16/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction Racial differences in adverse maternal and birth outcomes have been studied in other countries, however, there are few studies specific to the Canadian population. In this study, we sought to examine the inequities in adverse perinatal outcomes between Black and White pregnant people in Ontario, Canada. Methods We conducted a population-based retrospective cohort study that included all Black and White pregnant people who attended prenatal screening and had a singleton birth in any Ontario hospital (April 1st, 2012-March 31st, 2019). Poisson regression with robust error variance models were used to estimate the adjusted relative risks of adverse perinatal outcomes for Black people compared with White people while adjusting for covariates. Results Among 412,120 eligible pregnant people, 10.1% were Black people and 89.9% were White people. Black people were at an increased risk of gestational diabetes mellitus, preeclampsia, placental abruption, preterm birth (<37, <34, <32 weeks), spontaneous preterm birth, all caesarean sections, emergency caesarean section, low birth weight (<2500g, <1500g), small-for-gestational-age (<10th percentile, <3rd percentile) neonates, 5-minute Apgar score <4 and <7, neonatal intensive care unit admission, and hyperbilirubinemia requiring treatment but had lower risks of elective caesarean section, assisted vaginal delivery, episiotomy, 3rd and 4th degree perineal tears, macrosomia, large-for-gestational-age neonates, and arterial cord pH≤7.1, as compared with White people. No difference in risks of gestational hypertension and placenta previa were observed between Black and White people. Conclusion There are differences in several adverse perinatal outcomes between Black and White people within the Ontario health care system. Findings might have potential clinical and health policy implications, although more studies are needed to further understand the mechanisms.
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Affiliation(s)
- Qun Miao
- Better Outcomes Registry & Network Ontario, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
- * E-mail:
| | - Yanfang Guo
- Better Outcomes Registry & Network Ontario, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
- OMNI Research Group, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Erica Erwin
- Better Outcomes Registry & Network Ontario, Ottawa, Ontario, Canada
- OMNI Research Group, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Fayza Sharif
- Better Outcomes Registry & Network Ontario, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Meron Berhe
- Better Outcomes Registry & Network Ontario, Ottawa, Ontario, Canada
| | - Shi Wu Wen
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- OMNI Research Group, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Obstetrics and Gynecology, University of Ottawa, Faculty of Medicine, Ottawa, Ontario, Canada
| | - Mark Walker
- Better Outcomes Registry & Network Ontario, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
- OMNI Research Group, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Obstetrics and Gynecology, University of Ottawa, Faculty of Medicine, Ottawa, Ontario, Canada
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Waldron MK. Parent Protector: Perceptions of NICU-to-Home Transition Readiness for NICU Parents of Black Preterm Infant. J Perinat Neonatal Nurs 2022; 36:173-185. [PMID: 35476771 DOI: 10.1097/jpn.0000000000000598] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Black infants have twice the incidence of infant mortality (IM), death before the first birthday, and preterm birth in comparison to other US racial/ethnic groups; these factors make Black infants a high-risk group. The literature on the factors impacting caregivers and home environments for these infants is sparse. The purpose of this descriptive qualitative study was to explore perceived parental readiness to care for their Black preterm infants at home after discharge from a neonatal intensive care unit (NICU). Ten NICU parents of Black preterm infants completed a structured interview and self-report questionnaires before hospital discharge; data were analyzed using descriptive and semantic content methods. Coded parent responses were categorized as Parent Protector of Infants' Health (n = 94, 29.2%); Hindrances to Parental Readiness for Transition to Home (n = 97, 30.1%), and Parent as Partner in NICU to Home Transition (n = 131, 40.6%). All parents rated themselves "confident" (n = 6) or "very confident" (n = 4) in their ability to care for their infant after NICU discharge. Partnership with the healthcare team was described as involving health information resources, effective communication, and, most importantly, support for the parental role as infant protector for transition to home for their high-risk infant after NICU discharge.
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Affiliation(s)
- Mia K Waldron
- Department of Nursing Science Professional Practice & Quality, Children's National Hospital, Washington, District of Columbia; and School of Medicine & Health Sciences, The George Washington University, Washington, District of Columbia
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Morris JM, Bertotti AM. Protocol versus practice: Deviations from guidelines in low-risk twin deliveries in the United States. Birth 2022; 49:147-158. [PMID: 34549453 DOI: 10.1111/birt.12587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 08/27/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Medical guidelines recommend vaginal delivery for low-risk twin pregnancies because cesareans increase the probability of maternal morbidity and mortality. Yet, vaginal delivery rates for twins are considerably lower than for comparable singletons. One explanation for this disparity argues that greater risk associated with twins warrants increased surgical intervention. An alternative explanation is that twin deliveries are more likely to deviate from protocols that advise vaginal birth. METHODS Using the 2017 Natality Detail File (N = 3,197,401), we measured alignment of vaginal birth and trial of labor (TOL) with the American College of Obstetricians and Gynecologists' guidelines for twin and singleton no-indicated-risk births. We calculated predicted probabilities for the population and by maternal race/ethnicity to assess whether low rates of vaginal births among twins are explained by associated risk factors, or by deviations from recommended delivery methods. RESULTS Overall, 31.2% of twins were born vaginally compared with 79.4% of singletons. Controlling for indicated risks, the predicted probability of vaginal birth for twins was 0.49 and 0.85 for singletons. The predicted probability of TOL for twins was 0.18 and 0.47 for singletons. Maternal race/ethnicity was only weakly associated with mode of delivery. These findings indicate that no-indicated-risk twin pregnancies, across maternal racial/ethnic categories, have lower probabilities of vaginal birth and TOL than would be expected with widespread adherence to current guidelines. CONCLUSIONS Given the life-threatening consequences that may result from unnecessary surgical procedures, our findings highlight the need for further research to illuminate medical and nonmedical mechanisms driving nonadherence to clinical guidelines for twin births.
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CURTIS DAVIDS, FULLER‐ROWELL THOMASE, CARLSON DANIELL, WEN MING, KRAMER MICHAELR. Does a Rising Median Income Lift All Birth Weights? County Median Income Changes and Low Birth Weight Rates Among Births to Black and White Mothers. Milbank Q 2022; 100:38-77. [PMID: 34609027 PMCID: PMC8932634 DOI: 10.1111/1468-0009.12532] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Policy Points Policies that increase county income levels, particularly for middle-income households, may reduce low birth weight rates and shrink disparities between Black and White infants. Given the role of aggregate maternal characteristics in predicting low birth weight rates, policies that increase human capital investments (e.g., funding for higher education, job training) could lead to higher income levels while improving population birth outcomes. The association between county income levels and racial disparities in low birth weight is independent of disparities in maternal risks, and thus a broad set of policies aimed at increasing income levels (e.g., income supplements, labor protections) may be warranted. CONTEXT Low birth weight (LBW; <2,500 grams) and infant mortality rates vary among place and racial group in the United States, with economic resources being a likely fundamental contributor to these disparities. The goals of this study were to examine time-varying county median income as a predictor of LBW rates and Black-White LBW disparities and to test county prevalence and racial disparities in maternal sociodemographic and health risk factors as mediators. METHODS Using national birth records for 1992-2014 from the National Center for Health Statistics, a total of approximately 27.4 million singleton births to non-Hispanic Black and White mothers were included. Data were aggregated in three-year county-period observations for 868 US counties meeting eligibility requirements (n = 3,723 observations). Sociodemographic factors included rates of low maternal education, nonmarital childbearing, teenage pregnancy, and advanced-age pregnancy; and health factors included rates of smoking during pregnancy and inadequate prenatal care. Among other covariates, linear models included county and period fixed effects and unemployment, poverty, and income inequality. FINDINGS An increase of $10,000 in county median income was associated with 0.34 fewer LBW cases per 100 live births and smaller Black-White LBW disparities of 0.58 per 100 births. Time-varying county rates of maternal sociodemographic and health risks mediated the association between median income and LBW, accounting for 65% and 25% of this estimate, respectively, but racial disparities in risk factors did not mediate the income association with Black-White LBW disparities. Similarly, county median income was associated with very low birth weight rates and related Black-White disparities. CONCLUSIONS Efforts to increase income levels-for example, through investing in human capital, enacting labor union protections, or attracting well-paying employment-have broad potential to influence population reproductive health. Higher income levels may reduce LBW rates and lead to more equitable outcomes between Black and White mothers.
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Affiliation(s)
| | | | | | - MING WEN
- University of UtahSalt Lake City
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6
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Fareed N, Swoboda CM, Lawrence J, Griesenbrock T, Huerta T. Co-establishing an infrastructure for routine data collection to address disparities in infant mortality: planning and implementation. BMC Health Serv Res 2022; 22:4. [PMID: 34974826 PMCID: PMC8722266 DOI: 10.1186/s12913-021-07393-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 11/30/2021] [Indexed: 11/20/2022] Open
Abstract
Background Efforts to address infant mortality disparities in Ohio have historically been adversely affected by the lack of consistent data collection and infrastructure across the community-based organizations performing front-line work with expectant mothers, and there is no established template for implementing such systems in the context of diverse technological capacities and varying data collection magnitude among participating organizations. Methods Taking into account both the needs and limitations of participating community-based organizations, we created a data collection infrastructure that was refined by feedback from sponsors and the organizations to serve as both a solution to their existing needs and a template for future efforts in other settings. Results By standardizing the collected data elements across participating organizations, integration on a scale large enough to detect changes in a rare outcome such as infant mortality was made possible. Datasets generated through the use of the established infrastructure were robust enough to be matched with other records, such as Medicaid and birth records, to allow more extensive analysis. Conclusion While a consistent data collection infrastructure across multiple organizations does require buy-in at the organizational level, especially among participants with little to no existing data collection experience, an approach that relies on an understanding of existing barriers, iterative development, and feedback from sponsors and participants can lead to better coordination and sharing of information when addressing health concerns that individual organizations may struggle to quantify alone. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07393-1.
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Affiliation(s)
- Naleef Fareed
- CATALYST - The Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Institute for Behavioral Medicine Research, 460 Medical Center Drive, Columbus, OH, 43210, USA. .,Department of Biomedical Informatics, College of Medicine, The Ohio State University, Institute for Behavioral Medicine Research, 460 Medical Center Drive, Columbus, OH, 43210, USA.
| | - Christine M Swoboda
- CATALYST - The Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Institute for Behavioral Medicine Research, 460 Medical Center Drive, Columbus, OH, 43210, USA.,Department of Family Medicine, College of Medicine, The Ohio State University, Institute for Behavioral Medicine Research, 460 Medical Center Drive,, Columbus, OH, 43210, USA
| | - John Lawrence
- CATALYST - The Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Institute for Behavioral Medicine Research, 460 Medical Center Drive, Columbus, OH, 43210, USA
| | - Tyler Griesenbrock
- CATALYST - The Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Institute for Behavioral Medicine Research, 460 Medical Center Drive, Columbus, OH, 43210, USA
| | - Timothy Huerta
- CATALYST - The Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Institute for Behavioral Medicine Research, 460 Medical Center Drive, Columbus, OH, 43210, USA.,Department of Biomedical Informatics, College of Medicine, The Ohio State University, Institute for Behavioral Medicine Research, 460 Medical Center Drive, Columbus, OH, 43210, USA.,Department of Family Medicine, College of Medicine, The Ohio State University, Institute for Behavioral Medicine Research, 460 Medical Center Drive,, Columbus, OH, 43210, USA
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Saddler N, Adams S, Robinson LA, Okafor I. Taking Initiative in Addressing Diversity in Medicine. CANADIAN JOURNAL OF SCIENCE, MATHEMATICS AND TECHNOLOGY EDUCATION = REVUE CANADIENNE DE L'ENSEIGNEMENT DES SCIENCES, DES MATHEMATIQUES ET DE LA TECHNOLOGIE 2021; 21:309-320. [PMID: 38624742 PMCID: PMC8294300 DOI: 10.1007/s42330-021-00154-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/20/2021] [Indexed: 04/17/2024]
Abstract
The existence of systemic racism in Canadian healthcare, among other determinants including accessible education, available occupation, and affordable housing, contributes to the racial divide in treatment and poor health outcomes for Black communities. Recent promising work has demonstrated patient-physician racial concordance in populations of colour as a potential area of focus for addressing health inequities for diverse communities. The impact of shared cultural experiences and cultural competency leads to mutual respect, trust, and improved communication between patients and physicians guiding their care. This approach is dependent on the availability of physicians of colour and similarly other healthcare providers. The Temerty Faculty of Medicine at the University of Toronto has attempted to address the deficit in its own community through a two-pronged approach: mentorship through the Community of Support (COS) and the Summer Mentorship Program (SMP), and the implementation of the Black Student Application Program (BSAP). These initiatives have significantly increased Black medical student representation and continue to have considerable impact on Black communities in the surrounding area. Through partnerships with community organizations that support the ethos of these programs, the vision of a more culturally diverse physician workforce in Canada has been reinforced. The adoption of similar programs across Canadian medical schools can lead to better representation within medicine and help contribute to a necessary culture shift within the ranks of medical institutions. These are critical steps in laying the foundation for a medical education grounded in equity, excellence, and strength in diversity, and a healthcare system that truly provides patient-centred care.
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Affiliation(s)
- Nelson Saddler
- Temerty Faculty of Medicine, University of Toronto, Medical Sciences Building, 1 King’s College Cir, Toronto, ON M5S 1A8 Canada
| | - Seana Adams
- Temerty Faculty of Medicine, University of Toronto, Medical Sciences Building, 1 King’s College Cir, Toronto, ON M5S 1A8 Canada
| | - Lisa A. Robinson
- Temerty Faculty of Medicine, University of Toronto, Medical Sciences Building, 1 King’s College Cir, Toronto, ON M5S 1A8 Canada
- Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8 Canada
| | - Ike Okafor
- Temerty Faculty of Medicine, University of Toronto, Medical Sciences Building, 1 King’s College Cir, Toronto, ON M5S 1A8 Canada
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8
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Gallardo Martínez J, Arnáez de la Cruz M, Frías Sánchez Z, del Río Romero I, Navalón Bonal Z, Polo Ballarín P, Pantoja Garrido M. ¿Es la nacionalidad de la paciente un factor influyente en el proceso de embarazo, parto y puerperio? CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2021. [DOI: 10.1016/j.gine.2020.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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9
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Blackburn J, Chapur VF, Stephens JA, Zhao J, Shepler A, Pierson CR, Otero JJ. Revisiting the Neuropathology of Sudden Infant Death Syndrome (SIDS). Front Neurol 2020; 11:594550. [PMID: 33391159 PMCID: PMC7773837 DOI: 10.3389/fneur.2020.594550] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 11/10/2020] [Indexed: 01/08/2023] Open
Abstract
Background: Sudden infant death syndrome (SIDS) is one of the leading causes of infant mortality in the United States (US). The extent to which SIDS manifests with an underlying neuropathological mechanism is highly controversial. SIDS correlates with markers of poor prenatal and postnatal care, generally rooted in the lack of access and quality of healthcare endemic to select racial and ethnic groups, and thus can be viewed in the context of health disparities. However, some evidence suggests that at least a subset of SIDS cases may result from a neuropathological mechanism. To explain these issues, a triple-risk hypothesis has been proposed, whereby an underlying biological abnormality in an infant facing an extrinsic risk during a critical developmental period SIDS is hypothesized to occur. Each SIDS decedent is thus thought to have a unique combination of these risk factors leading to their death. This article reviews the neuropathological literature of SIDS and uses machine learning tools to identify distinct subtypes of SIDS decedents based on epidemiological data. Methods: We analyzed US Period Linked Birth/Infant Mortality Files from 1990 to 2017 (excluding 1992–1994). Using t-SNE, an unsupervised machine learning dimensionality reduction algorithm, we identified clusters of SIDS decedents. Following identification of these groups, we identified changes in the rates of SIDS at the state level and across three countries. Results: Through t-SNE and distance based statistical analysis, we identified three groups of SIDS decedents, each with a unique peak age of death. Within the US, SIDS is geographically heterogeneous. Following this, we found low birth weight and normal birth weight SIDS rates have not been equally impacted by implementation of clinical guidelines. We show that across countries with different levels of cultural heterogeneity, reduction in SIDS rates has also been distinct between decedents with low vs. normal birth weight. Conclusions: Different epidemiological and extrinsic risk factors exist based on the three unique SIDS groups we identified with t-SNE and distance based statistical measurements. Clinical guidelines have not equally impacted the groups, and normal birth weight infants comprise more of the cases of SIDS even though low birth weight infants have a higher SIDS rate.
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Affiliation(s)
- Jessica Blackburn
- Division of Neuropathology, Department of Pathology, The Ohio State University College of Medicine, Columbus, OH, United States.,Division of Anatomy, Department of Biomedical Education & Anatomy, The Ohio State University College of Medicine, Columbus, OH, United States
| | - Valeria F Chapur
- Instituto de Ecoregiones Andinas (INECOA)/Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina.,Instituto de Biología de la Altura (INBIAL)/Universidad Nacional de Jujuy (UNJU), San Salvador de Jujuy, Argentina
| | - Julie A Stephens
- Department of Biomedical Informatics, Center for Biostatistics, The Ohio State University College of Medicine, Columbus, OH, United States
| | - Jing Zhao
- Department of Biomedical Informatics, Center for Biostatistics, The Ohio State University College of Medicine, Columbus, OH, United States
| | - Anne Shepler
- Division of Neuropathology, Department of Pathology, The Ohio State University College of Medicine, Columbus, OH, United States.,Franklin County Forensic Science Center, Columbus, OH, United States
| | - Christopher R Pierson
- Division of Neuropathology, Department of Pathology, The Ohio State University College of Medicine, Columbus, OH, United States.,Division of Anatomy, Department of Biomedical Education & Anatomy, The Ohio State University College of Medicine, Columbus, OH, United States.,Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, OH, United States
| | - José Javier Otero
- Division of Neuropathology, Department of Pathology, The Ohio State University College of Medicine, Columbus, OH, United States
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The Hispanic/Latinx Perinatal Paradox in the United States: A Scoping Review and Recommendations to Guide Future Research. J Immigr Minor Health 2020; 23:1078-1091. [DOI: 10.1007/s10903-020-01117-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2020] [Indexed: 10/23/2022]
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Tipene-Leach D, Abel S. Innovation to prevent sudden infant death: the wahakura as an Indigenous vision for a safe sleep environment. Aust J Prim Health 2020; 25:406-409. [PMID: 31513759 DOI: 10.1071/py19033] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 07/31/2019] [Indexed: 11/23/2022]
Abstract
The bassinet-like wahakura is an Indigenous initiative for the prevention of Sudden Unexpected Death in Infancy (SUDI). It was developed by New Zealand Māori in 2005 when Māori were rejecting the 'stop bedsharing' SUDI prevention message and the SUDI disparity between Māori and non-Māori had become entrenched. Made of native flax, the wahakura was promoted as a culturally resonant, in-bed safe sleep device that would disrupt the SUDI risk associated with 'bedsharing where there was smoking in pregnancy' without relying on smoking cessation. A significant movement of weavers and health professionals grew around the wahakura program. A body of research, including infant care surveys, retrospective case review, qualitative enquiry and a randomised controlled trial comparing wahakura and bassinet safety demonstrated the device's public health plausibility, acceptability to Māori women and its essential safety. This facilitated the distribution, by District Health Boards, of safe sleep devices, including a related device called the Pēpi-Pod, and safe sleep education to high-risk, mainly Māori, mothers. Infant mortality in New Zealand fell by 29%, primarily among Māori infants, over the period 2009-15, suggesting that Māori cultural concepts, traditional activities and community engagement can have a significant effect on ethnic inequities in infant mortality.
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Affiliation(s)
- David Tipene-Leach
- Faculty of Education, Humanities and Health Sciences, Eastern Institute of Technology, Taradale, Napier 4122, New Zealand; and Corresponding author.
| | - Sally Abel
- Kaupapa Consulting Ltd, Napier 4110, New Zealand
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12
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Hamann C, Peek-Asa C, Butcher B. Racial disparities in pedestrian-related injury hospitalizations in the United States. BMC Public Health 2020; 20:1459. [PMID: 32977801 PMCID: PMC7519548 DOI: 10.1186/s12889-020-09513-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Accepted: 09/07/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Racial/ethnic disparity has been documented in a wide variety of health outcomes, and environmental components are contributors. For example, food deserts have been tied to obesity rates. Pedestrian injuries are strongly tied to environmental factors, yet no studies have examined racial disparity in pedestrian injury rates. We examine a nationally-representative sample of pedestrian-related hospitalizations in the United States to identify differences in incidence, severity, and cost by race/ethnicity. METHODS Patients with ICD diagnosis E-codes for pedestrian injuries were drawn from the United States Nationwide Inpatient Sample (2009-2016). Rates were calculated using the United States Census. Descriptive statistics and generalized linear regression were used to examine characteristics (age, sex, severity of illness, mortality rates, hospital admissions, length of stay, total costs) associated with hospitalizations for pedestrian injuries. RESULTS The annual average of pedestrian-related deaths exceeded 5000 per year and hospitalizations exceeded 47,000 admissions per year. The burden of injury from pedestrian-related hospitalizations was higher among Black, Hispanic, and Multiracial/Other groups in terms of admission rates, costs per capita, proportion of children injured, and length of stay compared to Whites and Asian or Pacific Islander race/ethnicities. Compared to Whites, hospital admission rates were 1.92 (95% CI: 1.89-1.94) and 1.20 (95% CI: 1.19-1.21) times higher for Multiracial/Other and Blacks, respectively. Costs per capita ($USD) were $6.30, $4.14, and $3.22 for Multiracial/Others, Blacks, and Hispanics, compared to $2.88 and $2.32 for Whites and Asian or Pacific Islanders. Proportion of lengths of stay exceeding one week were larger for Blacks (26.4%), Hispanics (22.6%), Asian or Pacific Islanders (23.1%), and Multiracial/Other (24.1%), compared to Whites (18.6%). Extreme and major loss of function proportions were also highest among Black (34.5%) and lowest among Whites (30.2%). CONCLUSIONS Results from this study show racial disparities in pedestrian injury hospitalization rates and outcomes, particularly among Black, Hispanic, and Multiracial/Other race/ethnicity groups and support population and system-level approaches to prevention. Access to transportation is an indicator for health disparity, and these results indicate that access to safe transportation also shows inequity by race/ethnicity.
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Affiliation(s)
- Cara Hamann
- University of Iowa Injury Prevention Research Center, Iowa City, IA USA
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA USA
| | - Corinne Peek-Asa
- University of Iowa Injury Prevention Research Center, Iowa City, IA USA
- Department of Occupational and Environmental Health, University of Iowa College of Public Health, 145 N. Riverside Dr, S143 CPHB, Iowa City, IA 52242 USA
| | - Brandon Butcher
- University of Iowa Injury Prevention Research Center, Iowa City, IA USA
- Department of Biostatistics, University of Iowa College of Public Health, Iowa City, IA USA
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13
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Shannon MM, Clougherty JE, McCarthy C, Elovitz MA, Nguemeni Tiako MJ, Melly SJ, Burris HH. Neighborhood Violent Crime and Perceived Stress in Pregnancy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E5585. [PMID: 32756321 PMCID: PMC7432742 DOI: 10.3390/ijerph17155585] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 07/23/2020] [Accepted: 07/28/2020] [Indexed: 12/04/2022]
Abstract
Stress has been shown to adversely affect pregnancy outcomes. Neighborhood crime rates may serve as one publicly available social determinant of health for pregnancy studies that use registry or electronic health record datasets in which individual-level stress data are not available. We sought to determine whether neighborhood violent crime incidents were associated with measured perceived stress in a largely minority, urban pregnancy cohort. We performed a secondary analysis of the 1309 Philadelphia residents participating in the Motherhood and Microbiome cohort (n = 2000) with both neighborhood violent crime and Cohen's Perceived Stress Scale (PSS-14) data. Generalized linear mixed models accounting for confounding variables and geographic clustering demonstrated that, regardless of race, women with the highest quartile of neighborhood violent crime had significantly elevated odds of high stress compared to women with lower crime. We also found that Black women were more likely to have both the highest quartile of neighborhood violent crime and high stress than non-Black women. Overall, this study demonstrates that neighborhood violent crime is associated with perceived stress in pregnancy. Given disparate exposure to crime and prenatal stress by race, future work is warranted to determine whether urban neighborhood violence and/or stress reduction strategies would improve birth outcome racial disparities.
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Affiliation(s)
- Megan M. Shannon
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA;
| | - Jane E. Clougherty
- Department of Environmental and Occupational Health, Dornsife School of Public Health, Drexel University, Philadelphia, PA 19104, USA;
| | - Clare McCarthy
- Maternal and Child Health Research Center, Department of Obstetrics and Gynecology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA; (C.M.); (M.A.E.)
| | - Michal A. Elovitz
- Maternal and Child Health Research Center, Department of Obstetrics and Gynecology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA; (C.M.); (M.A.E.)
| | | | - Steven J. Melly
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA 19104, USA;
| | - Heather H. Burris
- Maternal and Child Health Research Center, Department of Obstetrics and Gynecology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA; (C.M.); (M.A.E.)
- Division of Neonatology, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
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14
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Fareed N, Swoboda CM, Jonnalagadda P, Griesenbrock T, Gureddygari HR, Aldrich A. Visualizing Opportunity Index Data Using a Dashboard Application: A Tool to Communicate Infant Mortality-Based Area Deprivation Index Information. Appl Clin Inform 2020; 11:515-527. [PMID: 32757202 PMCID: PMC7406368 DOI: 10.1055/s-0040-1714249] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 06/09/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND An area deprivation index (ADI) is a geographical measure that accounts for socioeconomic factors (e.g., crime, health, and education). The state of Ohio developed an ADI associated with infant mortality: Ohio Opportunity Index (OOI). However, a powerful tool to present this information effectively to stakeholders was needed. OBJECTIVES We present a real use-case by documenting the design, development, deployment, and training processes associated with a dashboard solution visualizing ADI data. METHODS The Opportunity Index Dashboard (OID) allows for interactive exploration of the OOI and its seven domains-transportation, education, employment, housing, health, access to services, and crime. We used a user-centered design approach involving feedback sessions with stakeholders, who included representatives from project sponsors and subject matter experts. We assessed the usability of the OID based on the effectiveness, efficiency, and satisfaction dimensions. The process of designing, developing, deploying, and training users in regard to the OID is described. RESULTS We report feedback provided by stakeholders for the OID categorized by function, content, and aesthetics. The OID has multiple, interactive components: choropleth map displaying OOI scores for a specific census tract, graphs presenting OOI or domain scores between tracts to compare relative positions for tracts, and a sortable table to visualize scores for specific county and census tracts. Changes based on parameter and filter selections are described using a general use-case. In the usability evaluation, the median task completion success rate was 83% and the median system usability score was 68. CONCLUSION The OID could assist health care leaders in making decisions that enhance care delivery and policy decision making regarding infant mortality. The dashboard helps communicate deprivation data across domains in a clear and concise manner. Our experience building this dashboard presents a template for developing dashboards that can address other health priorities.
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Affiliation(s)
- Naleef Fareed
- CATALYST – The Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio, United States
- Department of Biomedical Informatics, College of Medicine, Institute for Behavioral Medicine Research, The Ohio State University, Columbus, Ohio, United States
| | - Christine M. Swoboda
- CATALYST – The Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio, United States
| | - Pallavi Jonnalagadda
- CATALYST – The Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio, United States
- Department of Biomedical Informatics, College of Medicine, Institute for Behavioral Medicine Research, The Ohio State University, Columbus, Ohio, United States
| | - Tyler Griesenbrock
- CATALYST – The Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio, United States
| | - Harish R. Gureddygari
- CATALYST – The Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio, United States
| | - Alison Aldrich
- CATALYST – The Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio, United States
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15
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Owens-Young J, Bell CN. Structural Racial Inequities in Socioeconomic Status, Urban-Rural Classification, and Infant Mortality in US Counties. Ethn Dis 2020; 30:389-398. [PMID: 32742141 PMCID: PMC7360185 DOI: 10.18865/ed.30.3.389] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Objectives Despite improvements in infant mortality rates (IMR) in the United States, racial gaps in IMR remain and may be driven by both structural racism and place. This study assesses the relationship between structural racism and race-specific IMR and the role of urban-rural classification on race-specific IMR and Black/White racial gaps in IMR. Methods We conducted an analysis of variance tests using 2019 County Health Rankings Data to determine differences in structural racism indicators, IMR and other co-variates by urban-rural classification. We used linear regressions to determine the associations between measures of structural racism and county-level health outcomes. Results Study results suggest that racial inequities in education, work, and homeownership negatively impact Black IMR, especially in large fringe, medium, and small metro counties, and positively impact White IMR. Structural racism is also associated with Black-White gaps in IMR. Conclusions Factors related to structural racism may not be homogenous or have the same impacts on overall IMR, race-specific IMR, and racial differences in IMR across places. Understanding these differential impacts can help public health professionals and policymakers improve Black infant health and eliminate racial inequities in IMR.
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Affiliation(s)
| | - Caryn N. Bell
- African American Studies, University of Maryland, College Park, College Park, MD
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16
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Travers CP, Carlo WA, McDonald SA, Das A, Ambalavanan N, Bell EF, Sánchez PJ, Stoll BJ, Wyckoff MH, Laptook AR, Van Meurs KP, Goldberg RN, D’Angio CT, Shankaran S, DeMauro SB, Walsh MC, Peralta-Carcelen M, Collins MV, Ball MB, Hale EC, Newman NS, Profit J, Gould JB, Lorch SA, Bann CM, Bidegain M, Higgins RD. Racial/Ethnic Disparities Among Extremely Preterm Infants in the United States From 2002 to 2016. JAMA Netw Open 2020; 3:e206757. [PMID: 32520359 PMCID: PMC7287569 DOI: 10.1001/jamanetworkopen.2020.6757] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
IMPORTANCE Racial/ethnic disparities in quality of care among extremely preterm infants are associated with adverse outcomes. OBJECTIVE To assess whether racial/ethnic disparities in major outcomes and key care practices were changing over time among extremely preterm infants. DESIGN, SETTING, AND PARTICIPANTS This observational cohort study used prospectively collected data from 25 US academic medical centers. Participants included 20 092 infants of 22 to 27 weeks' gestation with a birth weight of 401 to 1500 g born at centers participating in the National Institute of Child Health and Human Development Neonatal Research Network from 2002 to 2016. Of these infants, 9316 born from 2006 to 2014 were eligible for follow-up at 18 to 26 months' postmenstrual age (excluding 5871 infants born before 2006, 2594 infants born after 2014, and 2311 ineligible infants including 64 with birth weight >1000 g and 2247 infants with gestational age >26 6/7 weeks), of whom 745 (8.0%) did not have known follow-up outcomes at 18 to 26 months. MAIN OUTCOMES AND MEASURES Rates of mortality, major morbidities, and care practice use over time were evaluated using models adjusted for baseline characteristics, center, and birth year. Data analyses were conducted from 2018 to 2019. RESULTS In total, 20 092 infants with a mean (SD) gestational age of 25.1 (1.5) weeks met the inclusion criteria and were available for the primary outcome: 8331 (41.5%) black infants, 3701 (18.4%) Hispanic infants, and 8060 (40.1%) white infants. Hospital mortality decreased over time in all groups. The rate of improvement in hospital mortality over time did not differ among black and Hispanic infants compared with white infants (black infants went from 35% to 24%, Hispanic infants went from 32% to 27%, and white infants went from 30% to 22%; P = .59 for race × year interaction). The rates of late-onset sepsis among black infants (went from 37% to 24%) and Hispanic infants (went from 45% to 23%) were initially higher than for white infants (went from 36% to 25%) but decreased more rapidly and converged during the most recent years (P = .02 for race × year interaction). Changes in rates of other major morbidities did not differ by race/ethnicity. Death before follow-up decreased over time (from 2006 to 2014: black infants, 14%; Hispanic infants, 39%, white infants, 15%), but moderate-severe neurodevelopmental impairment increased over time in all racial/ethnic groups (increase from 2006 to 2014: black infants, 70%; Hispanic infants, 123%; white infants, 130%). Rates of antenatal corticosteroid exposure (black infants went from 72% to 90%, Hispanic infants went from 73% to 83%, and white infants went from 86% to 90%; P = .01 for race × year interaction) and of cesarean delivery (black infants went from 45% to 59%, Hispanic infants went from 49% to 59%, and white infants went from 62% to 63%; P = .03 for race × year interaction) were initially lower among black and Hispanic infants compared with white infants, but these differences decreased over time. CONCLUSIONS AND RELEVANCE Among extremely preterm infants, improvements in adjusted rates of mortality and most major morbidities did not differ by race/ethnicity, but rates of neurodevelopmental impairment increased in all groups. There were narrowing racial/ethnic disparities in important care practices, including the use of antenatal corticosteroids and cesarean delivery.
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Affiliation(s)
- Colm P. Travers
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham
| | - Waldemar A. Carlo
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham
| | - Scott A. McDonald
- Statistics and Epidemiology Unit, RTI International, Research Triangle Park, North Carolina
| | - Abhik Das
- Statistics and Epidemiology Unit, RTI International, Rockville, Maryland
| | | | | | - Pablo J. Sánchez
- Nationwide Children’s Hospital, Department of Pediatrics, The Ohio State University, Columbus
| | - Barbara J. Stoll
- Children’s Healthcare of Atlanta, Grady Memorial Hospital, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Myra H. Wyckoff
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas
| | - Abbot R. Laptook
- Women and Infants’ Hospital, Department of Pediatrics, Brown University, Providence, Rhode Island
| | - Krisa P. Van Meurs
- Division of Neonatal and Developmental Medicine, Lucile Packard Children’s Hospital, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
| | | | - Carl T. D’Angio
- University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Seetha Shankaran
- Department of Pediatrics, Wayne State University, Detroit, Michigan
| | - Sara B. DeMauro
- The Children’s Hospital of Philadelphia, Department of Pediatrics, University of Pennsylvania, Philadelphia
| | - Michele C. Walsh
- Rainbow Babies and Children’s Hospital, Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio
| | | | - Monica V. Collins
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham
| | - M. Bethany Ball
- Division of Neonatal and Developmental Medicine, Lucile Packard Children’s Hospital, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
| | - Ellen C. Hale
- Children’s Healthcare of Atlanta, Grady Memorial Hospital, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Nancy S. Newman
- Rainbow Babies and Children’s Hospital, Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio
| | - Jochen Profit
- Division of Neonatal and Developmental Medicine, Lucile Packard Children’s Hospital, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
| | - Jeffrey B. Gould
- Division of Neonatal and Developmental Medicine, Lucile Packard Children’s Hospital, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
| | - Scott A. Lorch
- The Children’s Hospital of Philadelphia, Department of Pediatrics, University of Pennsylvania, Philadelphia
| | - Carla M. Bann
- Statistics and Epidemiology Unit, RTI International, Research Triangle Park, North Carolina
| | | | - Rosemary D. Higgins
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
- Department of Global and Community Health, George Mason University, Fairfax, Virginia
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17
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Mitchell EA, Yan X, Ren SY, Anderson TM, Ramirez JM, Lavista Ferres JM, Johnston R. Geographic Variation in Sudden Unexpected Infant Death in the United States. J Pediatr 2020; 220:49-55.e2. [PMID: 32061407 PMCID: PMC7995635 DOI: 10.1016/j.jpeds.2020.01.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 12/04/2019] [Accepted: 01/06/2020] [Indexed: 01/09/2023]
Abstract
OBJECTIVES To assess the geographic variation of sudden unexpected infant death (SUID) and test if variation in geographic factors, such as state, latitude, and longitude, play a role in SUID risk across the US. STUDY DESIGN We analyzed the Centers for Disease Control and Prevention's Cohort Linked Birth/Infant Death dataset (2005-2010; 22 882 SUID cases, 25 305 837 live births, rate 0.90/1000). SUID was defined as infant deaths (ages 7-364 days) that included sudden infant death syndrome, ill-defined and unknown cause of mortality, and accidental suffocation and strangulation in bed. SUID geographic variation was analyzed using 2 statistical models, logistic regression and generalized additive model (GAM). RESULTS Both models produced similar results. Without adjustment, there was marked geographic variation in SUID rates, but the variation decreased after adjusting for covariates including known risk factors for SUID. After adjustment, nine states demonstrated significantly higher or lower SUID mortality than the national average. Geographic contribution to SUID risk in terms of latitude and longitude were also attenuated after adjustment for covariates. CONCLUSION Understanding why some states have lower SUID rates may enhance SUID prevention strategies.
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Affiliation(s)
- Edwin A Mitchell
- Department of Paediatrics, Child and Youth Health, University of Auckland, Auckland, New Zealand
| | - Xiaohan Yan
- AI For Good Research Lab, Microsoft, Redmond, WA
| | | | - Tatiana M Anderson
- Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, WA
| | - Jan-Marino Ramirez
- Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, WA; Department of Neurological Surgery, University of Washington School of Medicine, Seattle, WA; Department of Pediatrics, University of Washington School of Medicine, Seattle, WA
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18
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Montoya-Williams D, Bright M, Martinez S, Echavarria M, Mercado R, Lorch S, Thompson L. Associations Between a Healthy Start Program Prenatal Risk Screening Tool and Adverse Birth Outcomes: A Study Using the Mother/Infant Dyad Screening Cohort. J Womens Health (Larchmt) 2020; 29:647-655. [PMID: 31895651 DOI: 10.1089/jwh.2019.7712] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Florida's Healthy Start Program is a statewide prenatal screening program that aims to identify pregnant women at risk of adverse birth outcomes. However, the effectiveness of this legislatively mandated prenatal risk screening tool in predicting poor birth outcomes is unknown. This study aimed to evaluate associations between risk factors self-reported on this screening tool and adverse birth outcomes. Materials and Methods: A 1-year retrospective birth cohort at a large academic referral center was created. Risk factors reported on the tool by mothers who had a preterm or low-birthweight (LBW) infant were compared with those reported by mothers who delivered full-term non-LBW infants in bivariate and multivariate analyses. All data were extracted from maternal or infant electronic health records. Results: The Mother/Infant Dyad Screening cohort consisted of 528 dyads. We identified two items on the screening tool that significantly associated with adverse birth outcomes, but which do not currently contribute to the total risk score used to identify women for referral to preventive social services. These items were feeling alone and thinking it was not a good time to be pregnant. Conclusions: Comprehensive prenatal risk screening is an underutilized strategy in medicine. Florida's mandatory self-reported, prenatal survey can identify women at risk for poor neonatal outcomes. A more nuanced understanding how women are interpreting survey items and a re-evaluation of scoring practices may allow the tool to better serve as a model for other programs seeking to identify pregnant women at risk of poor birth outcomes.
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Affiliation(s)
- Diana Montoya-Williams
- Department of Neonatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Melissa Bright
- Anita Zucker Center for Excellence in Early Childhood Studies, Gainesville, Florida
| | - Silvio Martinez
- College of Medicine, University of Florida, Gainesville, Florida
| | - Maria Echavarria
- Department of Pediatrics and University of Florida, Gainesville, Florida
| | - Rebeccah Mercado
- Department of Pediatrics and University of Florida, Gainesville, Florida
| | - Scott Lorch
- Department of Neonatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Lindsay Thompson
- Department of Pediatrics and University of Florida, Gainesville, Florida.,Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, Florida
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Abstract
Introduction: Sudden unexpected infant death is the leading cause of infant mortality with black: white infant mortality remaining at 2:1 for the last decade. Smartphone technology provides a convenient and accessible tool for injury prevention anticipatory guidance among at-risk communities. Materials and Methods: A convenience sample of pregnant teen mothers who own a smartphone. During a 1-month postnatal home visit, a safe sleep environment survey was administered, infant sleep practices were observed, and mothers trained to take and submit standard infants’ sleep environment photographs. Photographs were independently assessed for inter-rater reliability (IRR) across five sleep safety domains (primary outcome): sleep location, surface, position, presence of soft items, and hazards near the sleep area. Expert and novice coders IRR was measured using Cohen’s kappa coefficient (K). Sleep safety correlation between photographs and observation, and parent report and observation was determined. Results: Sixteen (57.1%) mothers completed the home visit. Most parents reported infants sleeping supine (78.5) in parents’ bedroom (85.9%). Photographs demonstrated sleep position, soft items without the baby present, and hanging toys had perfect agreement across all three coder pairs. Safe sleep experts’ IRR demonstrated perfect agreement for sleep location, position, and soft items. While 83.8% of parents were observed putting their infants down to sleep on their back, 78.5% of parents reported doing the same and 82.4% of the photographs demonstrated supine infant sleep position. Conclusion: Using photographs, coders can reliably categorize some key infant sleep safety aspects, and photograph sleep safety is comparable to parent report and direct observation.
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20
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Yang L, Liu X, Li Z, Zhang P, Wu B, Wang H, Hu L, Cheng G, Wang L, Zhou W. Genetic aetiology of early infant deaths in a neonatal intensive care unit. J Med Genet 2019; 57:169-177. [PMID: 31501239 DOI: 10.1136/jmedgenet-2019-106221] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 08/13/2019] [Accepted: 08/24/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Congenital anomalies are the leading cause of early neonatal death in neonatal intensive care units (NICUs), but the genetic causes are unclear. This study aims to investigate the genetic causes of infant deaths in a NICU in China. METHODS Newborns who died in the hospital or died within 1 week of discharge were enrolled from Children's Hospital of Fudan University between January 1, 2015 and December 31, 2017. Whole exome sequencing was performed in all patients after death. RESULTS There were 223 deceased newborns with a median age at death of 13 days. In total, 44 (19.7%) infants were identified with a genetic finding, including 40 with single nucleotide variants (SNVs), two with CNVs and two with both SNVs and CNVs. Thirteen (31%, 13/42) patients with SNVs had medically actionable disorders based on genetic diagnosis, which included 10 genes. Multiple congenital malformation was identified as the leading genetic cause of death in NICUs with 13 newborns identified with variants in genes related to multiple congenital malformations. For newborns who died on the first day, the most common genetic cause of death was major heart defects, while metabolic disorders and respiratory failure were more common for newborns who died in the first 2 weeks. CONCLUSION Our study shows genetic findings among early infant deaths in NICUs and provides critical genetic information for precise genetic counselling for the families. Effective therapies enable the improvement of more than a quarter of newborns with molecular diagnoses if diagnosed in time.
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Affiliation(s)
- Lin Yang
- Clinical Genetic Center, Children's Hospital of Fudan University, Shanghai, China.,Key Laboratory of Birth Defects, Children's Hospital of Fudan University, Shanghai, China
| | - Xu Liu
- Clinical Genetic Center, Children's Hospital of Fudan University, Shanghai, China.,Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China
| | - Zixiu Li
- Key Laboratory of Birth Defects, Children's Hospital of Fudan University, Shanghai, China
| | - Peng Zhang
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China
| | - Bingbing Wu
- Key Laboratory of Birth Defects, Children's Hospital of Fudan University, Shanghai, China
| | - Huijun Wang
- Key Laboratory of Birth Defects, Children's Hospital of Fudan University, Shanghai, China
| | - Liyuan Hu
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China
| | - Guoqiang Cheng
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China
| | - Laishuan Wang
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China
| | - Wenhao Zhou
- Clinical Genetic Center, Children's Hospital of Fudan University, Shanghai, China .,Key Laboratory of Birth Defects, Children's Hospital of Fudan University, Shanghai, China.,Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China.,Key Laboratory of Neonatal Diseases, Children's Hospital of Fudan University, Shanghai, China
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21
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Walker RC, Graham A, Palmer SC, Jagroop A, Tipene-Leach DC. Understanding the experiences, perspectives and values of indigenous women around smoking cessation in pregnancy: systematic review and thematic synthesis of qualitative studies. Int J Equity Health 2019; 18:74. [PMID: 31118025 PMCID: PMC6532160 DOI: 10.1186/s12939-019-0981-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Accepted: 05/10/2019] [Indexed: 12/25/2022] Open
Abstract
Background The prevalence of smoking during pregnancy among indigenous women approaches 50% and is associated with sudden infant death, pregnancy loss, preterm delivery, low birth weight, and anatomical deformity. This study aims to synthesise qualitative studies by reporting experiences, perceptions, and values of smoking cessation among pregnant indigenous women to inform potential interventions. Method A highly-sensitive search of MEDLINE, Embase, PsychINFO, and CINAHL, in conjunction with analysis of Google Scholar and reference lists of related studies was conducted in March 2018. We utilised two methods (thematic synthesis and an indigenous Māori analytical framework) in parallel to analyse data. Completeness of reporting in studies was evaluated using the Consolidated Criteria for Reporting Qualitative Studies (COREQ) framework. Results We included seven studies from Australia and New Zealand involving 250 indigenous women. Three themes were identified. Realising well-being and creating agency included giving the best start to baby, pride in being a healthy mum, female role models, and family support. Understanding the drivers for smoking included the impact of stress and chaos that hindered prioritisation of self-care, the social acceptability of smoking, guilt and feeling judged, and inadequate information about the risks of smoking. Indigenous women strongly preferred culturally responsive approaches to smoking cessation, placing value on programs designed specifically for and by indigenous people, that were accessible, and provided an alternative to smoking. Conclusion Future interventions and smoking cessation programmes might be more effective and acceptable to indigenous women and families when they harness self-agency and the desire for a healthy baby, recognise the high value of indigenous peer involvement, and embed a social focus in place of smoking as a way to maintain community support and relationships. Development and evaluation of smoking cessation programs for pregnant indigenous women and families is warranted.
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Affiliation(s)
- Rachael C Walker
- Eastern Institute of Technology, 501 Gloucester Street, Taradale, Napier, Hawke's Bay, 4112, New Zealand.
| | - Aria Graham
- Eastern Institute of Technology, 501 Gloucester Street, Taradale, Napier, Hawke's Bay, 4112, New Zealand.,Whakauae Research for Maori Health and Development, Whanganui, 4541, New Zealand
| | - Suetonia C Palmer
- Department of Medicine, University of Otago Christchurch, Christchurch, 8140, New Zealand
| | - Anita Jagroop
- Eastern Institute of Technology, 501 Gloucester Street, Taradale, Napier, Hawke's Bay, 4112, New Zealand
| | - David C Tipene-Leach
- Eastern Institute of Technology, 501 Gloucester Street, Taradale, Napier, Hawke's Bay, 4112, New Zealand
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22
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King DM, Donley T, Mbizo J, Higgins M, Langaigne A, Middleton EJ, Stokes-Williams C. The Use of a Community-Based Preconception Peer Health Educator Training Intervention to Improve Preconception Health Knowledge. J Racial Ethn Health Disparities 2019; 6:686-700. [PMID: 30838558 DOI: 10.1007/s40615-019-00567-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 01/03/2019] [Accepted: 01/25/2019] [Indexed: 12/22/2022]
Abstract
This paper highlights the use of an adapted Office of Minority Health (OMH) Preconception Health Peer Educator program to address persistent infant mortality health disparities. The community-based Attack Infant Mortality (AIM Escambia) initiative was established to increase preconception health knowledge among African American women at risk for adverse birth outcomes. Participants (N = 122) attended a 6-h AIM peer educator training, completed pretest and posttest questionnaires about their health knowledge, health attitudes, and planned engagement in health behaviors. Study results support the use of preconception health education training to inform health knowledge, health attitudes, and planned health sharing behaviors. Multidisciplinary collaborations and targeted interventions should be considered when seeking to improve community health conditions and increase health knowledge and health literacy for minority populations.
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Affiliation(s)
- Dione Moultrie King
- Department of Social Work, University of Alabama at Birmingham, Birmingham, AL, 35294, USA.
| | - Tiffany Donley
- Department of Population Health, NYU Langone Health, New York, NY, 10016, USA
| | - Justice Mbizo
- Usha Kundu, MD College of Health, Department of Public Health, University of West Florida, Pensacola, FL, 32514, USA
| | - Melody Higgins
- School of Social Work, University of Alabama, Tuscaloosa, AL, 35487, USA
| | - Anika Langaigne
- Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL, 33199, USA
| | - Erica Jordan Middleton
- Department of Psychological Health & Learning Sciences, University of Houston, Houston, TX, 77004, USA
| | - Charu Stokes-Williams
- Family Medicine Residency Clinic, 55th Medical Group, United States Air Force, 2501 Capehart Rd, Bellevue, NE, 68113, USA
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Khan SQ, Berrington de Gonzalez A, Best AF, Chen Y, Haozous EA, Rodriquez EJ, Spillane S, Thomas DA, Withrow D, Freedman ND, Shiels MS. Infant and Youth Mortality Trends by Race/Ethnicity and Cause of Death in the United States. JAMA Pediatr 2018; 172:e183317. [PMID: 30285034 PMCID: PMC6583035 DOI: 10.1001/jamapediatrics.2018.3317] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
IMPORTANCE The United States has higher infant and youth mortality rates than other high-income countries, with striking disparities by racial/ethnic group. Understanding changing trends by age and race/ethnicity for leading causes of death is imperative for focused intervention. OBJECTIVE To estimate trends in US infant and youth mortality rates from 1999 to 2015 by age group and race/ethnicity, identify leading causes of death, and compare mortality rates with Canada and England/Wales. DESIGN, SETTING, AND PARTICIPANTS This descriptive study analyzed death certificate data from the US National Center for Health Statistics, Statistics Canada, and the UK Office of National Statistics for all deaths among individuals younger than 25 years. The study took place from January 1, 1999, to December 31, 2015, and analyses started in September 2017. EXPOSURES Race/ethnicity. MAIN OUTCOMES AND MEASURES Average annual percent changes in mortality rates from 1999 to 2015 and absolute rate change between 1999 to 2002 and 2012 to 2015 for each age group, race/ethnicity, and cause of death. RESULTS Among individuals from birth to age 24 years, 1 169 537 deaths occurred in the United States, 80 540 in Canada, and 121 183 in England/Wales from 1999 to 2015. In the United States, 64% of deaths occurred in male individuals and 52.6% occurred in white individuals (25.1% deaths occurred in black individuals and 17.9% in Latino individuals). All-cause mortality declined for all age groups (infants younger than 1 year [38.5% of deaths], children aged 1-9 years [10.6%], early adolescents aged 10-14 years [5%], late adolescents aged 15-19 years [17.7%], and young adults aged 20-24 years [28.1%]) in the United States, Canada, and England/Wales from 1999 to 2015. However, rates were highest in the United States. Within the United States, annual declines in all-cause mortality rates occurred among all age groups of black, Latino, and white individuals, except for white individuals aged 20 to 24 years, whose rates remained stable. Mortality rates declined across most major causes of death from 1999 to 2002 and 2012 to 2015, with notable declines observed for sudden infant death syndrome, unintentional injury death, and homicides. Among infants, unintentional suffocation and strangulation in bed increased (difference between 2012-2015 and 1999-2002 range, 6.11-29.03 per 100 000). Further, suicide rates among Latino and white individuals aged 10 to 24 years (range, 0.21-2.63 per 100 000) and black individuals aged 10 to 19 years (range, 0.10-0.45 per 100 000) increased, as did unintentional injury deaths in white young adults (0.79 per 100 000). The rise in unintentional injury deaths is attributed to increases in drug poisonings and was also observed in black and Latino young adults. CONCLUSIONS AND RELEVANCE Mortality rates in the United States have generally declined for infants and youths from 1999 to 2015 owing to reductions in sudden infant death syndrome, unintentional injury death, and homicides. However, US mortality rates remain higher than Canada and England/Wales, with particularly elevated rates among black and American Indian/Alaskan Native youth. Further, there is a concerning increase in suicide and drug poisoning death rates among US adolescents and young adults.
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Affiliation(s)
- Sahar Q. Khan
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
| | | | - Ana F. Best
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
| | - Yingxi Chen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
| | | | - Erik J. Rodriquez
- Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | - Susan Spillane
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
| | - David A. Thomas
- Division of Epidemiology, Services and Prevention Research, National Institute on Drug Abuse, Bethesda, Maryland
| | - Diana Withrow
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
| | - Neal D. Freedman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
| | - Meredith S. Shiels
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
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Basu R, Rau R, Pearson D, Malig B. Temperature and Term Low Birth Weight in California. Am J Epidemiol 2018; 187:2306-2314. [PMID: 29901701 DOI: 10.1093/aje/kwy116] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 05/25/2018] [Indexed: 11/12/2022] Open
Abstract
Few investigations have explored temperature and birth outcomes. In a retrospective cohort study, we examined apparent temperature, a combination of temperature and relative humidity, and term low birth weight (LBW) among 43,629 full-term LBW infants and 2,032,601 normal-weight infants in California (1999-2013). The California Department of Public Health provided birth certificate data, while meteorological data came from the California Irrigation Management Information System, US Environmental Protection Agency, and National Centers for Environmental Information. After considering several temperature metrics, we observed the best model fit for term LBW over the full gestation (per 10-degrees-Fahrenheit (°F) increase in apparent temperature, 13.0% change, 95% confidence interval: 4.1, 22.7) above 55°F, and the greatest association was for third-trimester exposure above 60°F (15.8%, 95% confidence interval: 5.0, 27.6). Apparent temperature during the first month of pregnancy exhibited no significant risk, while the first trimester had a significantly negative association, and second trimester, last month, and last 2 weeks had slightly increased risks. Mothers who were black or older, delivered male infants, or gave birth during the warm season had infants at the highest risks. This study provides further evidence for adverse birth outcomes from heat exposure for vulnerable subgroups of pregnant women.
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Affiliation(s)
- Rupa Basu
- Air and Climate Epidemiology Section, Office of Environmental Health Hazard Assessment, California Environmental Protection Agency, Oakland, California
- Department of Environmental Health Sciences, School of Public Health, University of California, Berkeley, Berkeley, California
| | - Reina Rau
- Department of Environmental Health Sciences, School of Public Health, University of California, Berkeley, Berkeley, California
| | - Dharshani Pearson
- Air and Climate Epidemiology Section, Office of Environmental Health Hazard Assessment, California Environmental Protection Agency, Oakland, California
| | - Brian Malig
- Air and Climate Epidemiology Section, Office of Environmental Health Hazard Assessment, California Environmental Protection Agency, Oakland, California
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Swoboda CM, Benedict JA, Hade E, McAlearney AS, Huerta TR. Effectiveness of an infant mortality prevention home-visiting program on high-risk births in Ohio. Public Health Nurs 2018; 35:551-557. [PMID: 30264408 DOI: 10.1111/phn.12544] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 07/13/2018] [Accepted: 08/09/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The Ohio Infant Mortality Reduction Initiative (OIMRI) is a home-visiting program that aims to reduce infant mortality among infants of high-risk black women. This study examined birth outcomes among OIMRI participants and compared program participants to matched non-OIMRI women. DESIGN Program data were linked to birth records, death records, and Medicaid claims data. Propensity score matching was used to match program participants with like women in Ohio. SAMPLE The sample consisted of 2,837 black mothers from 14 counties in Ohio. MEASUREMENTS Infant mortality, causes of death, and birth weight were examined. RESULTS There were 25 deaths among 2,837 OIMRI participants from 2010 to 2015, for an infant mortality rate of 8.8 deaths per 1,000 live births (95% CI 5.4-12.2). Among those women who participated in OIMRI, three fewer deaths per 1,000 births within the first year of life were estimated compared to those not in OIMRI; however, this was not statistically significant. CONCLUSIONS The number of infant deaths among women enrolled in the OIMRI program was not significantly different from those who did not participate in OIMRI. Programs like OIMRI cannot singlehandedly address the infant mortality disparity but may help prevent some infant mortality risks.
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Affiliation(s)
| | - Jason A Benedict
- Center for Biostatistics, The Ohio State University, Columbus, Ohio
| | - Erinn Hade
- Department of Biomedical Informatics & Center for Biostatistics, The Ohio State University, Columbus, Ohio
| | | | - Timothy R Huerta
- Departments of Family Medicine & Biomedical Informatics, The Ohio State University, Columbus, Ohio
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Garcia R, Ali N, Griffiths M, Randhawa G. Understanding the consumption of folic acid during preconception, among Pakistani, Bangladeshi and white British mothers in Luton, UK: a qualitative study. BMC Pregnancy Childbirth 2018; 18:234. [PMID: 29902973 PMCID: PMC6003022 DOI: 10.1186/s12884-018-1884-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 06/05/2018] [Indexed: 01/28/2023] Open
Abstract
Background To review the similarities and differences in Pakistani, Bangladeshi and White British mothers health beliefs (attitudes, knowledge and perceptions) and health behaviour regarding their consumption of folic acid pre-conception, to reduce the risk of neural tube defects. Methods Our study used a descriptive qualitative research approach, implementing face-to-face focus group discussions with Pakistani, Bangladeshi or White British mothers (normal birth outcomes and mothers with poor birth outcomes) and semi-structured interviews or focus groups with service providers using semi-structured topic guides. This method is well suited for under researched areas where in-depth information is sought. There were three sample groups:Pakistani, Bangladeshi and White British mothers with normal birth outcomes (delivery after 37 weeks of gestation, in the preceding 6 to 24 months, weighing 2500 g and living within a specified postcode area in Luton, UK). Pakistani Bangladeshi and white British bereaved mothers who had suffered a perinatal mortality (preceding 6 to 24 months, residing within a specificied postcode area). Healthcare professionals working on the local maternity care pathway (i.e. services providing preconception, antenatal, antepartum and postpartum care).
Transcribed discussions were analysed using the Framework Analysis approach. Results The majority of mothers in this sample did not understand the benefits or optimal time to take folic acid pre-conception. Conversely, healthcare professionals believed the majority of women did consume folic acid, prior to conception. Conclusions There is a need to increase public health awareness of the optimal time and subsequent benefits for taking folic acid, to prevent neural tube defects. Electronic supplementary material The online version of this article (10.1186/s12884-018-1884-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Rebecca Garcia
- The School of Healthcare Practice, University of Bedfordshire, Putteridge Bury, Hitchin Road, Luton, Luton, LU2 8LE, England.
| | - Nasreen Ali
- The Institute For Health Research, University of Bedfordshire, Putteridge Bury, Hitchin Road, Luton, Luton, LU2 8LE, England
| | - Malcolm Griffiths
- Luton & Dunstable University Hospital NHS Foundation Trust, Lewsey Rd, Luton, LU4 0DZ, England
| | - Gurch Randhawa
- The Institute For Health Research, University of Bedfordshire, Putteridge Bury, Hitchin Road, Luton, Luton, LU2 8LE, England
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The contribution of gestational age, area deprivation and mother's country of birth to ethnic variations in infant mortality in England and Wales: A national cohort study using routinely collected data. PLoS One 2018; 13:e0195146. [PMID: 29649290 PMCID: PMC5896919 DOI: 10.1371/journal.pone.0195146] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 03/16/2018] [Indexed: 02/03/2023] Open
Abstract
Objectives We aimed to describe ethnic variations in infant mortality and explore the contribution of area deprivation, mother’s country of birth, and prematurity to these variations. Methods We analyzed routine birth and death data on singleton live births (gestational age≥22 weeks) in England and Wales, 2006–2012. Infant mortality by ethnic group was analyzed using logistic regression with adjustment for sociodemographic characteristics and gestational age. Results In the 4,634,932 births analyzed, crude infant mortality rates were higher in Pakistani, Black Caribbean, Black African, and Bangladeshi infants (6.92, 6.00, 5.17 and 4.40 per 1,000 live births, respectively vs. 2.87 in White British infants). Adjustment for maternal sociodemographic characteristics changed the results little. Further adjustment for gestational age strongly attenuated the risk in Black Caribbean (OR 1.02, 95% CI 0.89–1.17) and Black African infants (1.17, 1.06–1.29) but not in Pakistani (2.32, 2.15–2.50), Bangladeshi (1.47, 1.28–1.69), and Indian infants (1.24, 1.11–1.38). Ethnic variations in infant mortality differed significantly between term and preterm infants. At term, South Asian groups had higher risks which cannot be explained by sociodemographic characteristics. In preterm infants, adjustment for degree of prematurity (<28, 28–31, 32–33, 34–36 weeks) fully explained increased risks in Black but not Pakistani and Bangladeshi infants. Sensitivity analyses with further adjustment for small for gestational age, or excluding deaths due to congenital anomalies did not fully explain the excess risk in South Asian groups. Conclusions Higher infant mortality in South Asian and Black infants does not appear to be explained by sociodemographic characteristics. Higher proportions of very premature infants appear to explain increased risks in Black infants but not in South Asian groups. Strategies targeting the prevention and management of preterm birth in Black groups and suboptimal birthweight and modifiable risk factors for congenital anomalies in South Asian groups might help reduce ethnic inequalities in infant mortality.
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Hodges NL, Anderson SE, McKenzie LB, Katz ML. Certified Nurse-Midwives' Knowledge, Attitudes, and Behaviors About Infant Safe Sleep. J Midwifery Womens Health 2018. [PMID: 29533511 DOI: 10.1111/jmwh.12706] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Little is known about the knowledge, attitudes, and behaviors of certified nurse-midwives related to sudden infant death syndrome and infant safe sleep. However, this population is an important and trusted source of information for pregnant women and may provide guidance on infant care. We explored these topics with certified nurse-midwives to identify potential barriers as well as enabling and reinforcing factors associated with providing infant safe sleep education in the prenatal health care environment. METHODS Participants in this cross-sectional survey study were certified nurse-midwives who provide prenatal health care to women in Ohio. Surveys were mailed to all certified nurse-midwives listed with the licensing registry of the Ohio Board of Nursing (N = 333). RESULTS A total of 153 eligible respondents completed the survey for a response rate of 55%. Most participants had at least some knowledge of the infant safe sleep recommendations from the American Academy of Pediatrics, and two-thirds had positive attitudes about providing infant safe sleep education in the prenatal environment. Many participants (61%) perceived that there were barriers to providing prenatal infant safe sleep education, but nearly all (94%) indicated that they were interested in providing this education to their patients. Positive attitudes about providing infant safe sleep education were predictive of whether they discussed this topic with their patients. DISCUSSION Certified nurse-midwives routinely provide guidance on infant care, and it is important that they are familiar with current evidence-based recommendations on infant safe sleep. They should be supported in their desire to provide infant safe sleep education to their prenatal patients. In addition, efforts should be made to improve attitudes and social norms related to providing infant safe sleep education in the prenatal environment.
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Mapping Geographic Variation in Infant Mortality and Related Black-White Disparities in the US. Epidemiology 2018; 27:690-6. [PMID: 27196804 DOI: 10.1097/ede.0000000000000509] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND In the US, black infants remain more than twice as likely as white infants to die in the first year of life. Previous studies of geographic variation in infant mortality disparities have been limited to large metropolitan areas where stable estimates of infant mortality rates by race can be determined, leaving much of the US unexplored. METHODS The objective of this analysis was to describe geographic variation in county-level racial disparities in infant mortality rates across the 48 contiguous US states and District of Columbia using national linked birth and infant death period files (2004-2011). We implemented Bayesian shared component models in OpenBUGS, borrowing strength across both spatial units and racial groups. We mapped posterior estimates of mortality rates for black and white infants as well as relative and absolute disparities. RESULTS Black infants had higher infant mortality rates than white infants in all counties, but there was geographic variation in the magnitude of both relative and absolute disparities. The mean difference between black and white rates was 5.9 per 1,000 (median: 5.8, interquartile range: 5.2 to 6.6 per 1,000), while those for black infants were 2.2 times higher than for white infants (median: 2.1, interquartile range: 1.9-2.3). One quarter of the county-level variation in rates for black infants was shared with white infants. CONCLUSIONS Examining county-level variation in infant mortality rates among black and white infants and related racial disparities may inform efforts to redress inequities and reduce the burden of infant mortality in the US.
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Infant Safe Sleep: A Survey of the Knowledge, Attitudes, and Behaviors of Obstetric Physicians. J Community Health 2017; 43:488-495. [PMID: 29129033 DOI: 10.1007/s10900-017-0441-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Obstetricians may be a pregnant woman's primary professional source of information about her infant prior to the birth, but infant safe sleep knowledge, attitudes and behaviors of this population are unknown. This study explores obstetric physicians' knowledge, attitudes, and behaviors related to Sudden Infant Death Syndrome and infant safe sleep and identifies barriers as well as enabling and/or reinforcing factors associated with providing infant safe sleep education in the prenatal environment. A cross-sectional survey was conducted with obstetric physicians who provide prenatal healthcare to women in Ohio. Surveys were sent to all licensed physicians included in the registry of the State Medical Board of Ohio with "obstetrics," "obstetrics and gynecology," or "maternal and fetal medicine" as their primary specialty (n = 1771). The response rate was 30%, with 418 physicians included in the analysis. Many participants were knowledgeable about infant safe sleep recommendations; however, only 55% indicated that it was important for obstetric physicians to discuss Sudden Infant Death Syndrome and/or infant safe sleep with prenatal patients. Many participants (70%) perceived barriers to providing infant safe sleep education, however most (82%) indicated interest in doing so. Participants' knowledge and attitudes were significant predictors of whether they discuss this topic with patients. Obstetric physicians can influence the infant safe sleep decisions that women make. Improving obstetricians' knowledge and attitudes about infant safe sleep and supporting physicians who wish to provide education on this topic may help to ensure that women are receiving frequent and consistent infant safe sleep messaging throughout the prenatal period.
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Parks SE, Erck Lambert AB, Shapiro-Mendoza CK. Racial and Ethnic Trends in Sudden Unexpected Infant Deaths: United States, 1995-2013. Pediatrics 2017; 139:e20163844. [PMID: 28562272 PMCID: PMC5561464 DOI: 10.1542/peds.2016-3844] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/17/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Immediately after the 1994 Back-to-Sleep campaign, sudden unexpected infant death (SUID) rates decreased dramatically, but they have remained relatively stable (93.4 per 100 000 live births) since 2000. In this study, we examined trends in SUID rates and disparities by race/ethnicity since the Back-to-Sleep campaign. METHODS We used 1995-2013 US period-linked birth-infant death data to evaluate SUID rates per 100 000 live births by non-Hispanic white (NHW), non-Hispanic black (NHB), Hispanic, American Indian/Alaska Native, and Asian/Pacific Islander racial/ethnic groupings. To examine racial/ethnic disparities, we calculated rate ratios with NHWs as the referent group. Unadjusted linear regression was used to evaluate trends (P < .05) in rates and rate ratios. The distribution and rates of SUID by demographic and birth characteristics were compared for 1995-1997 and 2011-2013, and χ2 tests were used to evaluate significance. RESULTS From 1995 to 2013, SUID rates were consistently highest for American Indian/Alaska Natives, followed by NHBs. The rate for NHBs decreased significantly, whereas the rate for NHWs also declined, but not significantly. As a result, the disparity between NHWs and NHBs narrowed slightly. The SUID rates for Hispanics and Asian/Pacific Islanders were lower than the rates for NHWs and showed a significant decrease, resulting in an increase in their advantage over NHWs. CONCLUSIONS Each racial/ethnic group showed a unique trend in SUID rates since the Back-to-Sleep campaign. When implementing risk-reduction strategies, it is important to consider these trends in targeting populations for prevention and developing culturally appropriate approaches for racial/ethnic communities.
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Affiliation(s)
- Sharyn E Parks
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia; and
| | | | - Carrie K Shapiro-Mendoza
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia; and
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Relations between neighbourhood socioeconomic status and birth outcomes are mediated by maternal weight. Soc Sci Med 2017; 175:143-151. [DOI: 10.1016/j.socscimed.2016.12.041] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 12/24/2016] [Accepted: 12/28/2016] [Indexed: 12/22/2022]
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Baddock SA, Tipene-Leach D, Williams SM, Tangiora A, Jones R, Iosua E, Macleod EC, Taylor BJ. Wahakura Versus Bassinet for Safe Infant Sleep: A Randomized Trial. Pediatrics 2017; 139:peds.2016-0162. [PMID: 28044049 DOI: 10.1542/peds.2016-0162] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/27/2016] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To compare an indigenous sleep device (wahakura) for infants at high risk for sudden unexpected death with a bassinet, for measures of infant sleep position, head covering, breastfeeding, bed-sharing, and maternal sleep and fatigue. METHODS A total of 200 mainly Māori pregnant women were recruited from deprived areas of New Zealand. They were randomized to receive a bassinet or wahakura and asked to sleep the infant in this device from birth. Questionnaires at 1, 3, and 6 months and an overnight infrared video in the home at 1 month were completed. RESULTS An intention-to-treat and an "as-used" analysis of questionnaires showed no group differences at 1, 3, and 6 months in infant-adult direct bed-sharing (7% vs 12%, P = .24 at 1 month), and at the 6-month interview, the wahakura group reported twice the level of full breastfeeding (22.5% vs 10.7%, P = .04). Maternal sleep and fatigue were not significantly different between groups. Video identified no increase in head covering, prone/side sleep position, or bed-sharing in the wahakura group, either from intention-to-treat analysis, or when analyzed for actual sleep location. CONCLUSION There were no significant differences in infant risk behaviors in wahakura compared with bassinets and there were other advantages, including an increase in sustained breastfeeding. This suggests wahakura are relatively safe and can be promoted as an alternative to infant-adult bed-sharing. Policies that encourage utilization are likely to be helpful in high-risk populations.
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Affiliation(s)
- Sally A Baddock
- School of Midwifery, Otago Polytechnic, Dunedin, New Zealand; .,Departments of Women's and Children's Health, and
| | | | | | | | | | | | | | - Barry J Taylor
- Departments of Women's and Children's Health, and.,Dean's Department, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
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Pease A, Ingram J, Blair PS, Fleming PJ. Factors influencing maternal decision-making for the infant sleep environment in families at higher risk of SIDS: a qualitative study. BMJ Paediatr Open 2017; 1:e000133. [PMID: 29637151 PMCID: PMC5862195 DOI: 10.1136/bmjpo-2017-000133] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 07/24/2017] [Accepted: 07/26/2017] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Qualitative interviews with mothers of babies at higher risk of sudden infant death syndrome (SIDS) were carried out to understand their views and decision-making process on the infant sleep environment and safe sleep messages. DESIGN AND SETTING Twenty semi-structured interviews were conducted between February and November 2014 in deprived areas of Bristol, UK. Mothers were asked about their decision-making for the infant sleep environment and safe sleep messages including infant sleep position, co-sleeping, smoking, dummy use, feeding and disrupted routines. The interviews were transcribed, coded and thematic analysis carried out. PARTICIPANTS Participants were invited based on an algorithm developed in a previous SIDS case control study that identified an increased risk of SIDS from four demographic characteristics: young maternal age, smoking during pregnancy, three or more children, and a measure of deprivation. The presence of three, or more characteristics led to being invited to take part in the qualitative study. RESULTS Factors influencing mothers' adherence to the safe sleep messages included previous experience and the credibility of the advice given. They described disrupted routines that led to risky scenarios with a belief that occasional risks were acceptable. Where circumstances made following the advice more difficult they found alternative strategies to reduce the risk, including the use of movement monitors, regular checking and a belief that lighter maternal sleep in the presence of a baby was protective. CONCLUSIONS Safer sleep messages should be tailored to fit with the lived realities of mothers, especially those at higher risk. The traditional list of 'do's' and 'don'ts' was not well accepted by this group. Interventions that seek to influence this higher-risk group should acknowledge mothers' own protective instincts and consider their beliefs and understanding behind the safer sleep messages if they are to be effective and encourage this group to change.
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Affiliation(s)
- Anna Pease
- Centre for Child and Adolescent Health, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Jenny Ingram
- Centre for Child and Adolescent Health, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Peter S Blair
- Centre for Child and Adolescent Health, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Peter J Fleming
- Centre for Child and Adolescent Health, School of Social and Community Medicine, University of Bristol, Bristol, UK
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Wilson‐Mitchell K, Handa M. Infusing Diversity and Equity Into Clinical Teaching: Training the Trainers. J Midwifery Womens Health 2016; 61:726-736. [DOI: 10.1111/jmwh.12548] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 07/26/2016] [Accepted: 07/29/2016] [Indexed: 11/30/2022]
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Bai Y, Saint-Maurice PF, Welk GJ, Allums-Featherston K, Candelaria N. Explaining Disparities in Youth Aerobic Fitness and Body Mass Index: Relative Impact of Socioeconomic and Minority Status. THE JOURNAL OF SCHOOL HEALTH 2016; 86:787-793. [PMID: 27714871 DOI: 10.1111/josh.12434] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 02/29/2016] [Accepted: 03/06/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND To advance research on youth fitness promotion it is important to understand factors that may explain the disparities in fitness. METHODS We evaluated data from the FitnessGram NFL PLAY60 Partnership Project to examine school factors influencing aerobic capacity (AC) and body mass index (BMI) in schoolchildren. Individual observations for AC (157,971 students from 675 schools) and BMI (178,274 students from 630 schools) were aggregated to compute the percentage of students achieving the Healthy Fitness Zone (HFZ). We examined achievements using adjusted linear regression models with socioeconomic status (SES), minority status, region, enrollment, and grade as factors. RESULTS The mean HFZ for AC and BMI were 51.6% and 56.9%, respectively. SES, minority status, and enrollment were all significantly associated with AC HFZ among boys, and SES and enrollment were significant predictors of AC HFZ in girls. SES and location were significantly related to BMI HFZ among boys but only SES significantly predicted BMI HFZ in girls. Schools with higher SES had higher AC and BMI HFZ achievements. CONCLUSIONS SES was consistently associated with health-related fitness, independent of sex, but not minority status.
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Affiliation(s)
- Yang Bai
- Department of Rehabilitation and Movement Science, University of Vermont, 305 Rowell Building, Burlington, VT 05405.
| | - Pedro F Saint-Maurice
- Department of Kinesiology, Iowa State University, 283 Forker Building, Ames, IA 50010.
| | - Gregory J Welk
- Department of Kinesiology, Iowa State University, 257 Forker Building, Ames, IA 50010.
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Ayoola AB, Zandee GL, Adams YJ. Women's Knowledge of Ovulation, the Menstrual Cycle, and Its Associated Reproductive Changes. Birth 2016; 43:255-62. [PMID: 27157718 DOI: 10.1111/birt.12237] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/06/2016] [Indexed: 12/29/2022]
Abstract
BACKGROUND The purpose of this study was to examine women's knowledge of female reproduction-anatomy, hormones and their functions, ovulation, the menstrual cycle and its associated reproductive changes, conception, and signs of pregnancy. METHODS A survey was completed by 125 women of childbearing age as part of a larger "Women's Health Promotion Program." Descriptive statistics, mainly univariate and bivariate analyses were conducted using STATA 13. RESULTS The women in the study were ages 18-51 years, 52.0 percent were Hispanic, 36.0 percent African American, and 12.0 percent White. The majority, 70.4 percent, had a household income of less than $20,000, 58.4 percent were not married, 83.2 percent were not trying to get pregnant at the time, and 37.6 percent had sexual intercourse that may have put them at risk for pregnancy in the past month. Less than one-third knew about the reproductive hormones. Over 80.0 percent knew their reproductive anatomy, 68.8 percent were not keeping any log to track their menstrual flow, 53.6 percent did not know when their next menstruation would be, and 49.6 percent did not know the average number of days for a regular menstrual cycle. Many did not know what ovulation is (47.2%), the ovulation timing (67.2%), the number of eggs released from an ovary each month (79.2%), and how long an egg or sperm could live in a woman's body (62.4%). CONCLUSIONS Reproductive knowledge should be assessed during preconception visits and women should be taught comprehensive reproductive education-not just selected topics-to be adequately equipped to make informed reproductive decisions.
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Affiliation(s)
| | - Gail L Zandee
- Department of Nursing, Calvin College, Grand Rapids, MI, USA
| | - Yenupini J Adams
- College of Nursing, Michigan State University, East Lansing, MI, USA
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Noll AC, Miller NA, Smith LD, Yoo B, Fiedler S, Cooley LD, Willig LK, Petrikin JE, Cakici J, Lesko J, Newton A, Detherage K, Thiffault I, Saunders CJ, Farrow EG, Kingsmore SF. Clinical detection of deletion structural variants in whole-genome sequences. NPJ Genom Med 2016; 1:16026. [PMID: 29263817 PMCID: PMC5685307 DOI: 10.1038/npjgenmed.2016.26] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Revised: 06/22/2016] [Accepted: 06/22/2016] [Indexed: 12/13/2022] Open
Abstract
Optimal management of acutely ill infants with monogenetic diseases requires rapid identification of causative haplotypes. Whole-genome sequencing (WGS) has been shown to identify pathogenic nucleotide variants in such infants. Deletion structural variants (DSVs, >50 nt) are implicated in many genetic diseases, and tools have been designed to identify DSVs using short-read WGS. Optimisation and integration of these tools into a WGS pipeline could improve diagnostic sensitivity and specificity of WGS. In addition, it may improve turnaround time when compared with current CNV assays, enhancing utility in acute settings. Here we describe DSV detection methods for use in WGS for rapid diagnosis in acutely ill infants: SKALD (Screening Konsensus and Annotation of Large Deletions) combines calls from two tools (Breakdancer and GenomeStrip) with calibrated filters and clinical interpretation rules. In four WGS runs, the average analytic precision (positive predictive value) of SKALD was 78%, and recall (sensitivity) was 27%, when compared with validated reference DSV calls. When retrospectively applied to a cohort of 36 families with acutely ill infants SKALD identified causative DSVs in two. The first was heterozygous deletion of exons 1–3 of MMP21 in trans with a heterozygous frame-shift deletion in two siblings with transposition of the great arteries and heterotaxy. In a newborn female with dysmorphic features, ventricular septal defect and persistent pulmonary hypertension, SKALD identified the breakpoints of a heterozygous, de novo 1p36.32p36.13 deletion. In summary, consensus DSV calling, implemented in an 8-h computational pipeline with parameterised filtering, has the potential to increase the diagnostic yield of WGS in acutely ill neonates and discover novel disease genes.
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Affiliation(s)
- Aaron C Noll
- Center for Pediatric Genomic Medicine, Children's Mercy Kansas City, Kansas City, MO, USA.,Heartland Institute for Clinical and Translational Research, University of Kansas Medical Center, Kansas City, KS, USA.,Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Neil A Miller
- Center for Pediatric Genomic Medicine, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Laurie D Smith
- Center for Pediatric Genomic Medicine, Children's Mercy Kansas City, Kansas City, MO, USA.,Heartland Institute for Clinical and Translational Research, University of Kansas Medical Center, Kansas City, KS, USA.,Department of Pediatrics, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Byunggil Yoo
- Center for Pediatric Genomic Medicine, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Stephanie Fiedler
- Department of Pathology, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Linda D Cooley
- Department of Pediatrics, University of Missouri-Kansas City, Kansas City, MO, USA.,Department of Pathology, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Laurel K Willig
- Center for Pediatric Genomic Medicine, Children's Mercy Kansas City, Kansas City, MO, USA.,Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO, USA.,Department of Pediatrics, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Josh E Petrikin
- Center for Pediatric Genomic Medicine, Children's Mercy Kansas City, Kansas City, MO, USA.,Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO, USA.,Department of Pediatrics, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Julie Cakici
- Rady Children's Institute for Genomic Medicine, San Diego, CA, USA
| | - John Lesko
- Center for Pediatric Genomic Medicine, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Angela Newton
- Center for Pediatric Genomic Medicine, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Kali Detherage
- Center for Pediatric Genomic Medicine, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Isabelle Thiffault
- Center for Pediatric Genomic Medicine, Children's Mercy Kansas City, Kansas City, MO, USA.,Department of Pediatrics, University of Missouri-Kansas City, Kansas City, MO, USA.,Department of Pathology, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Carol J Saunders
- Center for Pediatric Genomic Medicine, Children's Mercy Kansas City, Kansas City, MO, USA.,Department of Pediatrics, University of Missouri-Kansas City, Kansas City, MO, USA.,Department of Pathology, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Emily G Farrow
- Center for Pediatric Genomic Medicine, Children's Mercy Kansas City, Kansas City, MO, USA.,Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO, USA.,Department of Pediatrics, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Stephen F Kingsmore
- Heartland Institute for Clinical and Translational Research, University of Kansas Medical Center, Kansas City, KS, USA.,Rady Children's Institute for Genomic Medicine, San Diego, CA, USA
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Nypaver CF, Shambley-Ebron D. Using Community-Based Participatory Research to Investigate Meaningful Prenatal Care Among African American Women. J Transcult Nurs 2016; 27:558-566. [DOI: 10.1177/1043659615587587] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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40
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Drassinower D, Friedman AM, Običan SG, Levin H, Gyamfi-Bannerman C. Prolonged latency of preterm prelabour rupture of membranes and neurodevelopmental outcomes: a secondary analysis. BJOG 2016; 123:1629-35. [DOI: 10.1111/1471-0528.14133] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2016] [Indexed: 11/28/2022]
Affiliation(s)
- D Drassinower
- Division of Maternal-Fetal Medicine; Department of Obstetrics and Gynecology; Columbia University Medical Center; New York NY USA
| | - AM Friedman
- Division of Maternal-Fetal Medicine; Department of Obstetrics and Gynecology; Columbia University Medical Center; New York NY USA
| | - SG Običan
- Division of Maternal-Fetal Medicine; Department of Obstetrics and Gynecology; Columbia University Medical Center; New York NY USA
| | - H Levin
- Division of Maternal-Fetal Medicine; Department of Obstetrics and Gynecology; Columbia University Medical Center; New York NY USA
| | - C Gyamfi-Bannerman
- Division of Maternal-Fetal Medicine; Department of Obstetrics and Gynecology; Columbia University Medical Center; New York NY USA
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Perinatal Disparities Between American Indians and Alaska Natives and Other US Populations: Comparative Changes in Fetal and First Day Mortality, 1995-2008. Matern Child Health J 2016; 19:1802-12. [PMID: 25663653 DOI: 10.1007/s10995-015-1694-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
To compare fetal and first day outcomes of American Indian and Alaskan Natives (AIAN) with non-AIAN populations. Singleton deliveries to AIAN and non-AIAN populations were selected from live birth-infant death cohort and fetal deaths files from 1995-1998 and 2005-2008. We examined changes over time in maternal characteristics of deliveries and disparities and changes in risks of fetal, first day (<24 h), and cause-specific deaths. We calculated descriptive statistics, odds ratios and confidence intervals, and ratio of odds ratios (RORs) to indicate changes in disparities. Along with black mothers, AIANs exhibited the highest proportion of risk factors including the highest proportion of diabetes in both time periods (4.6 and 6.5 %). Over time, late fetal death for AIANs decreased 17 % (aOR = 0.83, 95 % CI 0.72-0.97), but we noted a 47 % increased risk over time for Hispanics (aOR = 1.47, 95 % CI 1.40-1.55). Our data indicated no change over time among AIANs for first day death. For AIANs compared to whites, increased risks and disparities persisted for mortality due to congenital anomalies (ROR = 1.28, 95 % CI 1.03-1.60). For blacks compared to AIANs, the increased risks of fetal death (2005-2008: aOR = 0.60, 95 % CI 0.53-0.68) persisted. For Hispanics, lower risks compared to AIANs persisted, but protective effect declined over time. Disparities between AIAN and other groups persist, but there is variability by race/ethnicity in improvement of perinatal outcomes over time. Variability in access to care and pregnancy management should be considered in relation to health equity for fetal and early infant deaths.
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Char DS. How should whole-genome sequencing be implemented in children? A consideration of the current limitations. Per Med 2016; 13:33-42. [DOI: 10.2217/pme.15.44] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
In children, whole-genome sequencing (WGS) is envisioned as a tool to improve diagnosis of undiagnosed diseases and to improve population-based screening. Pilot applications have shown benefits: genomic information has been used as a diagnostic aid; pharmacogenomics can reduce medicine-related adverse events; advanced knowledge of the potential for later-onset disease can target tests and appropriate therapies. However, emerging technical, conceptual and ethical challenges may limit WGS from fulfilling the current vision for future applications. WGS platforms still struggle with reliability and accuracy. The role of the genome in long-term organismal function and disease is still being established. Ethical implications of WGS in both undiagnosed disease and population screening, particularly potential impacts of testing on children and their families are still unresolved.
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Affiliation(s)
- Danton S Char
- Department of Anesthesiology, Stanford University School of Medicine, Division of Pediatric Cardiac Anesthesia, H3580, Stanford University Medical Center, 300 Pasteur Drive, Stanford, CA 94305, USA
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Lorch SA, Enlow E. The role of social determinants in explaining racial/ethnic disparities in perinatal outcomes. Pediatr Res 2016; 79:141-7. [PMID: 26466077 DOI: 10.1038/pr.2015.199] [Citation(s) in RCA: 94] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 08/23/2015] [Indexed: 11/09/2022]
Abstract
In the United States, there continue to be significant racial/ethnic disparities in preterm birth (PTB) rates, infant mortality, and fetal mortality rates. One potential mediator of these disparities is social determinants of health, including individual socioeconomic factors; community factors such as crime, poverty, housing, and the racial/ethnic makeup of the community; and the physical environment. Previous work has identified statistically significant associations between each of these factors and adverse pregnancy outcomes. However, there are recent studies that provide new, innovative insights into this subject, including adding social determinant data to population-based datasets; exploring multiple constructs in their analysis; and examining environmental factors. The objective of this review will be to examine this recent research on the association of each of these sets of social determinants on racial/ethnic disparities PTB, infant mortality, and fetal mortality to highlight potential areas for targeted intervention to reduce these differences.
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Affiliation(s)
- Scott A Lorch
- Division of Neonatology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Pediatrics, The Children's Hospital of Philadelphia and the Perelman School of Medicine at The University of Pennsylvania, Philadelphia, Pennsylvania.,Center for Outcomes Research, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Elizabeth Enlow
- Department of Pediatrics, The Children's Hospital of Philadelphia and the Perelman School of Medicine at The University of Pennsylvania, Philadelphia, Pennsylvania
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Mukamal KJ, Tremaglio J, Friedman DJ, Ix JH, Kuller LH, Tracy RP, Pollak MR. APOL1 Genotype, Kidney and Cardiovascular Disease, and Death in Older Adults. Arterioscler Thromb Vasc Biol 2015; 36:398-403. [PMID: 26634651 DOI: 10.1161/atvbaha.115.305970] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 10/29/2015] [Indexed: 01/09/2023]
Abstract
OBJECTIVE We sought to evaluate the cardiovascular impact of coding variants in the apolipoprotein L1 gene APOL1 that protect against trypanosome infection but have been associated with kidney disease among African Americans. APPROACH AND RESULTS As part of the Cardiovascular Health Study, a population-based cohort of Americans aged ≥65 years, we genotyped APOL1 polymorphisms rs73885319 and rs71785153 and examined kidney function, subclinical atherosclerosis, and incident cardiovascular disease and death over 13 years of follow-up among 91 African Americans with 2 risk alleles, 707 other African Americans, and 4964 white participants. The high-risk genotype with 2 risk alleles was associated with 2-fold higher levels of albuminuria and lower ankle-brachial indices but similar carotid intima-media thickness among African Americans. Median survival among high-risk African Americans was 9.9 years (95% confidence interval [CI], 8.7-11.9), compared with 13.6 years (95% CI, 12.5-14.3) among other African Americans and 13.3 years (95% CI, 13.0-13.6) among whites (P=0.03). The high-risk genotype was also associated with increased risk for incident myocardial infarction (adjusted hazard ratio 1.8; 95% CI, 1.1-3.0) and mortality (adjusted hazard ratio 1.3; 95% CI 1.0-1.7). Albuminuria and risk for myocardial infarction and mortality were nearly identical between African Americans with 0 to 1 risk alleles and whites. CONCLUSIONS APOL1 genotype is associated with albuminuria, subclinical atherosclerosis, incident myocardial infarction, and mortality in older African Americans. African Americans without 2 risk alleles do not differ significantly in risk of myocardial infarction or mortality from whites. APOL1 trypanolytic variants may account for a substantial proportion of the excess risk of chronic disease in African Americans.
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Affiliation(s)
- Kenneth J Mukamal
- From the Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (K.J.M., J.T., D.J.F., M.R.P.); Veterans Affairs San Diego Healthcare System and Division of Nephrology-Hypertension, University of California San Diego School of Medicine (J.H.I.); Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, PA (L.H.K.); and Department of Pathology and Laboratory Medicine, University of Vermont, Burlington (R.P.T.).
| | - Joseph Tremaglio
- From the Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (K.J.M., J.T., D.J.F., M.R.P.); Veterans Affairs San Diego Healthcare System and Division of Nephrology-Hypertension, University of California San Diego School of Medicine (J.H.I.); Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, PA (L.H.K.); and Department of Pathology and Laboratory Medicine, University of Vermont, Burlington (R.P.T.)
| | - David J Friedman
- From the Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (K.J.M., J.T., D.J.F., M.R.P.); Veterans Affairs San Diego Healthcare System and Division of Nephrology-Hypertension, University of California San Diego School of Medicine (J.H.I.); Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, PA (L.H.K.); and Department of Pathology and Laboratory Medicine, University of Vermont, Burlington (R.P.T.)
| | - Joachim H Ix
- From the Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (K.J.M., J.T., D.J.F., M.R.P.); Veterans Affairs San Diego Healthcare System and Division of Nephrology-Hypertension, University of California San Diego School of Medicine (J.H.I.); Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, PA (L.H.K.); and Department of Pathology and Laboratory Medicine, University of Vermont, Burlington (R.P.T.)
| | - Lewis H Kuller
- From the Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (K.J.M., J.T., D.J.F., M.R.P.); Veterans Affairs San Diego Healthcare System and Division of Nephrology-Hypertension, University of California San Diego School of Medicine (J.H.I.); Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, PA (L.H.K.); and Department of Pathology and Laboratory Medicine, University of Vermont, Burlington (R.P.T.)
| | - Russell P Tracy
- From the Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (K.J.M., J.T., D.J.F., M.R.P.); Veterans Affairs San Diego Healthcare System and Division of Nephrology-Hypertension, University of California San Diego School of Medicine (J.H.I.); Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, PA (L.H.K.); and Department of Pathology and Laboratory Medicine, University of Vermont, Burlington (R.P.T.)
| | - Martin R Pollak
- From the Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (K.J.M., J.T., D.J.F., M.R.P.); Veterans Affairs San Diego Healthcare System and Division of Nephrology-Hypertension, University of California San Diego School of Medicine (J.H.I.); Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, PA (L.H.K.); and Department of Pathology and Laboratory Medicine, University of Vermont, Burlington (R.P.T.)
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Abstract
Nurse scientists are increasingly recognizing the necessity of conducting research with community groups to effectively address complex health problems and successfully translate scientific advancements into the community. Although several barriers to conducting research with community groups exist, community-based participatory research (CBPR) has the potential to mitigate these barriers. CBPR has been employed in programs of research that respond in culturally sensitive ways to identify community needs and thereby address current health disparities. This article presents case studies that demonstrate how CBPR principles guided the development of (a) a healthy body weight program for urban, underserved African American women; (b) a reproductive health educational intervention for urban, low-income, underserved, ethnically diverse women; and (c) a pilot anxiety/depression intervention for urban, low-income, underserved, ethnically diverse women. These case studies illustrate the potential of CBPR as an orientation to research that can be employed effectively in non-research-intensive academic environments.
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Guerrero N, Mendes de Leon CF, Evans DA, Jacobs EA. Determinants of trust in health care in an older population. J Am Geriatr Soc 2015; 63:553-7. [PMID: 25752478 PMCID: PMC4373974 DOI: 10.1111/jgs.13316] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To explore differences in sociodemographic and psychological correlates of institutional trust in health care in an aging population of African Americans and non-Hispanic whites. DESIGN Cross-sectional survey data from the longitudinal Chicago Health and Aging Project. SETTING Population-based study of three communities in the Chicago area. PARTICIPANTS African Americans (n=2,284) and non-Hispanic whites (1,354) with a mean age of 79.3. MEASUREMENTS Demographic factors, socioeconomic status (SES), healthcare access, cynical hostility, perceived discrimination, depression, and institutional trust in health care. RESULTS African Americans reported substantially lower healthcare trust than non-Hispanic whites (P<.001). After adjustment for demographic variables and SES, only race (P<.001) and age (P=.008) were significantly associated with healthcare trust scores. The association between race and healthcare trust was slightly attenuated after adjusting for cynical hostility, depressive symptoms, and perceived discrimination (P<.001). Each of these variables was negatively associated with healthcare trust, and together these accounted for approximately 15% of racial differences in healthcare trust. CONCLUSION Psychological factors, not demographic characteristics, SES, or healthcare factors, appear to contribute the most to disparities in healthcare trust between older African Americans and non-Hispanic whites.
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Affiliation(s)
- Natalie Guerrero
- University of Wisconsin School of Medicine and Public Health; Madison, WI
| | | | - Denis A. Evans
- Department of Medicine & Rush Institute for Aging, Rush University Medical School; Chicago, IL
| | - Elizabeth A. Jacobs
- University of Wisconsin School of Medicine and Public Health; Madison, WI
- Division of General Internal Medicine & Departments of Medicine and Population Health Sciences; Madison, WI
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Chu T, Hackett M, Kaur N. Housing influences among sleep-related infant injury deaths in the USA. Health Promot Int 2015; 31:396-404. [PMID: 25724752 DOI: 10.1093/heapro/dav012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
This article examines the role of housing conditions in sleep-related infant injury death, a leading cause of infant mortality in the USA. The use of an unsafe sleep surface is a major risk factor for sleep-related infant injury. This exploratory study examined contextual circumstances, specifically those related to the physical environment, which may contribute to caregivers' decisions to place an infant on an unsafe sleep surface. It employed a retrospective review of 255 sleep-related infant injury death cases in a large urban area from 2004 to 2010 where an infant was found sleeping on an unsafe sleep surface, including 122 cases where a crib or bassinet was identified in the home. Quantitative findings indicated no differences in demographic or risk characteristics between infants with cribs or bassinets and those without them. Qualitative findings suggested the lack of crib or bassinet use may be related to environmental factors influenced by poverty, specifically crowded living space, room temperature and vermin infestation. This study suggests that infants may be at risk of sleep-related injury deaths even when a crib or bassinet is present in the home and supports the consideration of housing conditions in health promotion efforts to reduce infant mortality. Understanding environmental factors that may contribute to infants sleeping on an unsafe surface can help maternal child health and public health professionals develop more appropriate interventions that address deleterious living conditions.
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Affiliation(s)
- Tracy Chu
- Department of Health and Nutrition Sciences, Brooklyn College, City University of New York, 2900 Bedford Avenue, Brooklyn, NY 11210, USA
| | - Martine Hackett
- Department of Health Professions, Hofstra University, 130 Hofstra Dome, Hempstead, NY 11549, USA
| | - Navpreet Kaur
- Department of Health Professions, Hofstra University, 130 Hofstra Dome, Hempstead, NY 11549, USA
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Racial and ethnic disparities in personal capital during pregnancy: findings from the 2007 Los Angeles Mommy and Baby (LAMB) study. Matern Child Health J 2014; 18:209-222. [PMID: 23504131 DOI: 10.1007/s10995-013-1256-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The objectives of this study were to determine if racial and ethnic differences in personal capital during pregnancy exist and to estimate the extent to which any identified racial and ethnic differences in personal capital are related to differences in maternal sociodemographic and acculturation characteristics. Data are from the 2007 Los Angeles Mommy and Baby study (n = 3,716). Personal capital comprised internal resources (self-esteem and mastery) and social resources (partner, social network, and neighborhood support) during pregnancy. The relationships between race/ethnicity and personal capital were assessed using multivariable generalized linear models, examining the impact of sociodemographic and acculturation factors on these relationships. Significant racial and ethnic disparities in personal capital during pregnancy exist. However, socioeconomic status (i.e., income and education) and marital status completely explained Black-White disparities and Hispanic-White disparities in personal capital, whereas acculturation factors, especially nativity and language spoken at home, partially mediated the disparities in personal capital between Asian/Pacific Islander women and White women. Findings suggest that the risks associated with low socioeconomic status, single motherhood, and low acculturation, rather than race or ethnicity, contribute to low personal capital for many pregnant women. As personal capital during pregnancy may influence subsequent maternal and child health outcomes, the development of interventions should consider addressing sociodemographic and acculturation factors in order to reduce racial and ethnic disparities in personal capital and ultimately in poor maternal and child health outcomes.
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Abstract
OBJECTIVE Intestinal failure (IF) is a rare, devastating condition associated with significant morbidity and mortality. We sought to determine whether ethnic and racial differences were associated with patient survival and likelihood of receiving an intestinal transplant in a contemporary cohort of children with IF. METHODS This was an analysis of a multicenter cohort study with data collected from chart review conducted by the Pediatric Intestinal Failure Consortium. Entry criteria included infants ≤ 12 months receiving parenteral nutrition (PN) for ≥ 60 continuous days and studied for at least 2 years. Outcomes included death and intestinal transplantation (ITx). Race and ethnicity were recorded as they were in the medical record. For purposes of statistical comparisons and regression modeling, categories of race were consolidated into "white" and "nonwhite" children. RESULTS Of 272 subjects enrolled, 204 white and 46 nonwhite children were available for analysis. The 48-month cumulative incidence probability of death without ITx was 0.40 for nonwhite and 0.16 for white children (P < 0.001); the cumulative incidence probability of ITx was 0.07 for nonwhite versus 0.31 for white children (P = 0.003). The associations between race and outcomes remained after accounting for low birth weight, diagnosis, and being seen at a transplant center. CONCLUSIONS Race is associated with death and receiving an ITx in a large cohort of children with IF. This study highlights the need to investigate reasons for this apparent racial disparity in outcome among children with IF.
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Tipene-Leach D, Baddock S, Williams S, Jones R, Tangiora A, Abel S, Taylor B. Methodology and recruitment for a randomised controlled trial to evaluate the safety of wahakura for infant bedsharing. BMC Pediatr 2014; 14:240. [PMID: 25262145 PMCID: PMC4263060 DOI: 10.1186/1471-2431-14-240] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2014] [Accepted: 08/28/2014] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Sudden Unexpected Death in Infancy (SUDI) has persistent high rates in deprived indigenous communities and much of this mortality is attributable to unsafe sleep environments. Whilst health promotion worldwide has concentrated on avoidance of bedsharing, the indigenous Māori community in New Zealand has reproduced a traditional flax bassinet (wahakura) designed to be used in ways that include bedsharing. To date there has been no assessment of the safety of this traditional sleeping device. METHODS/DESIGN This two arm randomised controlled trial is being conducted with 200 mother-baby dyads recruited from Māori communities in areas of high deprivation in the Hawkes Bay, New Zealand. They are randomised to wahakura or bassinet use and investigation includes questionnaires at baseline (pregnancy), when baby is 1, 3, and 6 months, and an overnight video sleep study at 1 month with monitoring of baby temperature and oxygen saturation, and measurement of baby urinary cotinine and maternal salivary oxytocin. Outcome measures are amount of time head covered, amount of time in thermal comfort zone, number of hypoxic events, amount of time in the assigned sleep device, amount of time breastfeeding, number of parental (non-feed related) touching infant events, amount of time in the prone sleep position, the number of behavioural arousals and the amount of time infant is awake overnight. Survey data will compare breastfeeding patterns at 1, 3, and 6 months as well as data on maternal mind-mindedness, maternal wellbeing, attachment to baby, and maternal sleep patterns. DISCUSSION Indigenous communities require creative SUDI interventions that fit within their prevailing world view. This trial, and its assessment of the safety of a wahakura relative to a standard bassinet, is an important contribution to the range of SUDI prevention research being undertaken worldwide. TRIALS REGISTRATION Australian New Zealand Clinical Trials Registry: ACTRN12610000993099 Registered 16th November 2010.
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Affiliation(s)
- David Tipene-Leach
- />Women’s and Children’s Health, Dunedin School of Medicine, University of Otago, PO Box 913, Dunedin, New Zealand
| | - Sally Baddock
- />School of Midwifery, Otago Polytechnic, Dunedin, New Zealand
| | - Sheila Williams
- />Preventive & Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Raymond Jones
- />Women’s and Children’s Health, Dunedin School of Medicine, University of Otago, PO Box 913, Dunedin, New Zealand
| | - Angeline Tangiora
- />Women’s and Children’s Health, Dunedin School of Medicine, University of Otago, PO Box 913, Dunedin, New Zealand
| | - Sally Abel
- />Kaupapa Consulting Ltd, 52 Vigor Brown St, Napier, New Zealand
| | - Barry Taylor
- />Women’s and Children’s Health, Dunedin School of Medicine, University of Otago, PO Box 913, Dunedin, New Zealand
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