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Palmer LD, Peterson JD, Evans JK, Nelson MH, Asrani S, Thompson AC. Posterior Vitreous Detachment and Risk of Neovascular Glaucoma in Eyes with Prior Retinal Vascular Occlusions. Ophthalmol Ther 2024:10.1007/s40123-024-01039-1. [PMID: 39342534 DOI: 10.1007/s40123-024-01039-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2024] [Accepted: 09/16/2024] [Indexed: 10/01/2024] Open
Abstract
INTRODUCTION To investigate the impact of posterior vitreous detachment (PVD) on the risk of developing neovascular glaucoma (NVG) in eyes with occlusions of the retinal artery (RAO) or retinal vein (RVO). METHODS Single-center retrospective case-control study of adults with a history of RVO/RAO. Cases (N = 101) who developed NVG were age and sex matched 1:2 to controls who did not develop NVG (N = 202). Multivariable logistic regression was used to estimate the association between history of PVD and risk of NVG while controlling for other related demographic or clinical factors. RESULTS In initial bivariate analyses, there was no difference in risk of NVG based on eye, lens status, hypertension, history of panretinal photocoagulation (PRP), or retinal surgery (all p > 0.10), a borderline difference based on diabetic retinopathy (DR) (p = 0.06) and prior anti-vascular endothelial growth factor (anti-VEGF) treatment (p = 0.08), and a significant difference based on race/ethnicity, type of vascular event, and PVD status (all p < 0.05). In the final multivariable model, patients without PVD were significantly more likely to develop NVG (OR = 3.07, p = 0.0001) independent of the other covariates. Risk of NVG was greater in those with DR (OR = 1.98, p = 0.0440) and in those with central RVO vs. branch RVO/hemiretinal RVO (OR = 5.77, p < 0.0001). Non-White/Non-Hispanics (OR = 2.56, p = 0.0051) and Hispanics (OR = 3.65, p = 0.0288) were more likely than White patients to develop NVG. CONCLUSIONS Progression to NVG after retinal vascular occlusion is more likely in Non-White/Hispanic patients, those with concomitant DR, and those with CRVO/CRAO. The absence of PVD increases the risk for NVG. Further studies are necessary to understand this relationship.
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Affiliation(s)
- Laura D Palmer
- Wake Forest University School of Medicine, 475 Vine St, Winston Salem, NC, 27101, USA
| | - Jared D Peterson
- Wake Forest University School of Medicine, 475 Vine St, Winston Salem, NC, 27101, USA
- Department of Surgical Ophthalmology, Atrium Health Wake Forest Baptist Medical Center, Winston Salem, NC, USA
| | - Joni K Evans
- Department of Biostatistics and Data Science, Wake Forest University, Winston Salem, NC, USA
| | - Mark H Nelson
- Wake Forest University School of Medicine, 475 Vine St, Winston Salem, NC, 27101, USA
- Department of Surgical Ophthalmology, Atrium Health Wake Forest Baptist Medical Center, Winston Salem, NC, USA
| | - Sanjay Asrani
- Department of Ophthalmology, Duke University School of Medicine, Durham, NC, USA
| | - Atalie C Thompson
- Wake Forest University School of Medicine, 475 Vine St, Winston Salem, NC, 27101, USA.
- Department of Surgical Ophthalmology, Atrium Health Wake Forest Baptist Medical Center, Winston Salem, NC, USA.
- Department of Ophthalmology, Duke University School of Medicine, Durham, NC, USA.
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Hager E, Lavage DR, Shirriel J, Catov J, Miller E, Krishnamurti T. A Model for Engaging Citizen Scientists: A Community-Partnered Research Collaboration to Address Inequities for Black Birthing People. Matern Child Health J 2024; 28:1495-1505. [PMID: 39112837 DOI: 10.1007/s10995-024-03974-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2024] [Indexed: 08/29/2024]
Abstract
PURPOSE Co-creation of a citizen-science research initiative with a collaborative team of community members and university-based scientists to address regional disparities in maternal and fetal health outcomes for Black birthing people. DESCRIPTION Citizen scientist-led projects, where community members actively contribute to each discovery step, from setting a research agenda to collecting data and disseminating results, can extend community participatory research initiatives and help reconceptualize traditional research processes. The Pregnancy Collaborative is a citizen-science research initiative and one of nine scientific committees of The Pittsburgh Study-a longitudinal, community-partnered study designed to bring together collaborators to improve child thriving. ASSESSMENT Ten community members and five university-based scientists participated during all phases of developing a citizen-scientist collaboration over an initial two-and-a-half-year period. Phases include forming the Pregnancy Collaborative and group research ethics training; co-creating a research agenda grounded in shared principles; and community-partnered data collection, analysis, and dissemination. These phases produced three key co-designed products: (1) a mission and vision statement of the Pregnancy Collaborative, (2) a Collaborative-endorsed research agenda, and (3) a citizen-scientist-executed research survey. CONCLUSION Lessons learned from the formation of the Pregnancy Collaborative highlight the importance of equitable power distribution through bidirectional knowledge sharing and by centering intellectual effort, lived experience, and tools and resources of those affected by health inequities. Using a citizen science approach to co-designing and executing research helps us move maternal health inequity work from "research on" to "research with."
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Affiliation(s)
- Erricka Hager
- Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh, 130 DeSoto Street, Pittsburgh, PA, 15261, USA.
| | - Daniel R Lavage
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA
| | - Jada Shirriel
- Healthy Start, Inc., 400 N. Lexington Street, Pittsburgh, PA, 15208, USA
| | - Janet Catov
- Magee-Womens Research Institute, University of Pittsburgh, 300 Halket Street, Suite 2315, Pittsburgh, PA, 15213, USA
- Department of Epidemiology, School of Public Health, University of Pittsburgh, 130 DeSoto Street, Pittsburgh, PA, 15261, USA
| | - Elizabeth Miller
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA
| | - Tamar Krishnamurti
- Division of General Internal Medicine, Center for Innovative Research on Gender Health Equity (CONVERGE), University of Pittsburgh, Pittsburgh, PA, USA
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Nypaver C, Yeager A. Innovations in Preconception Care: Optimizing Health for All Individuals. J Midwifery Womens Health 2024. [PMID: 39104297 DOI: 10.1111/jmwh.13681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 06/25/2024] [Indexed: 08/07/2024]
Abstract
Optimizing the overall health of individuals prior to pregnancy can improve both pregnancy and lifelong health outcomes. Despite extremely high financial expenditure on birth in the United States, maternal and infant mortality rates continue to rise. Moreover, significant racial and ethnic disparities persist in perinatal health outcomes. Preconception care, or health care provided before or between pregnancies, has the capacity to meet these challenges. Preconception care can be integrated into every health care visit, including visits with primary care, reproductive health, and mental health care clinicians. Increasing awareness among clinicians of the benefits of preconception care and equipping them with innovative strategies to implement this care into practice, the number of people receiving optimal care could be increased. Recent innovations in preconception care include group care, health applications (apps), reminders in electronic health records, social marketing campaigns, social media movements, community-based partnerships, health care policy and access, and improving public and clinician education on preconception health topics. Ultimately, improving preconception health is best done in partnership between the consumer and clinician. Midwives, whose care is person-centered and partnership-focused, are well positioned to champion the innovation and implementation of equitable preconception care. The purpose of this State of the Science review, therefore, is to synthesize the literature on recent evidence-based innovations that may be used to improve preconception health and counseling.
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Rokicki S, McConnell M. Racial and Socioeconomic Disparities in Preconception Health Risk Factors and Access to Care. J Womens Health (Larchmt) 2024; 33:1063-1071. [PMID: 38563909 DOI: 10.1089/jwh.2023.0560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
Background: Black birthing people have significantly higher risks of maternal mortality and morbidity compared with White people. Preconception chronic conditions increase the risk of adverse pregnancy outcomes, yet little is known about disparities in preconception health. This study applies an intersectional framework to examine the simultaneous contributions of racial marginalization and economic deprivation in determining disparities in preconception risk factors and access to care. Methods: Using data from the Pregnancy Risk Assessment Monitoring System, 2016-2020 (N = 123,697), we evaluated disparities by race and income in self-reported preconception hypertension, diabetes, obesity, depression, and smoking, as well as preconception insurance coverage and utilization of health care. We estimated linear regression models and calculated predicted probabilities. Results: Black respondents experienced higher probabilities of preconception obesity and high blood pressure at every income level compared with White respondents. Higher income did not attenuate the probability of obesity for Black respondents (linear trend p = 0.21), as it did for White respondents (p < 0.001). Conversely, while White respondents with low income were at higher risk of preconception depression and smoking than their Black counterparts, higher income was strongly associated with reduced risk, with significantly steeper reductions for White compared with Black respondents (difference in trends p < 0.001 for both risk factors). White respondents had higher probabilities of utilizing preconception care across all income levels, despite similar probabilities of insurance coverage. Conclusions: Higher income does not protect against the risk of preconception obesity and other preconception risk factors for Black birthing people as it does for White birthing people. Results point to the need to consider multiple forms of intersecting structural factors in policy and intervention research to improve preconception and maternal health.
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Affiliation(s)
- Slawa Rokicki
- Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Piscataway, New Jersey, USA
- Department of Global Health & Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Margaret McConnell
- Department of Global Health & Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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Rice H, Collins C, Cherney E. Beyond Birth Work: Addressing Social Determinants of Health With Community Perinatal Support Doulas. Clin Nurs Res 2024; 33:316-325. [PMID: 38600831 DOI: 10.1177/10547738241244590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Abstract
Adverse maternal and infant health outcomes among African Americans are increasingly recognized as indicators of a critical public health crisis in the United States. Research has found that stress is related to structural racism and the social determinants of health (SDOH) that cause avoidable, unfair inequities in resources, education, power, and opportunities across ethnic groups. This paper describes the SDOH needs and experiences of pregnant Black women from the perspective of doulas and Birthing Beautiful Communities (BBC) clients. The design was a qualitative description, using data collected over time (2017-2018, 2020-2021, and 2023). This study took place in Cleveland and Akron, Ohio and the sample included 58 clients, 26 doulas, and 2 resource intake specialist assistants (RISAs). Qualitative data included individual client interviews, three doula focus groups, and one interview with two BBC RISAs. Three coders used content analysis to deductively identify SDOHs and calculate the number of interviews that contained information about specific SDOHs. Although the sample reported issues with all SDOH, particular ones caused a cascade of SDOH effects. Transportation issues, for example, impeded women from being able to make it to work, doctor's appointments, and to purchase essential baby items (e.g., food, infant supplies). An inability to work-whether because of transportation challenges or pregnancy-related health complications-led to unstable housing and an inability to deal with transportation challenges. Many clients mentioned that housing was a major issue, with many clients experiencing housing instability. Implications include ensuring SDOH information is collected from a trusted source who can advocate and ensure access to a wide range of local resources, ensuring policies protect pregnant women from experiencing a cascade of SDOH that may contribute to continuing health disparate infant and maternal health outcomes in African American women.
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Kim H, Mahmood A, Kedia S, Ogunsanmi DO, Sharma S, Wyant DK. Impact of Residential Segregation on Healthcare Utilization and Perceived Quality of Care Among Informal Caregivers in the United States. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-02018-9. [PMID: 38758399 DOI: 10.1007/s40615-024-02018-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 04/10/2024] [Accepted: 05/06/2024] [Indexed: 05/18/2024]
Abstract
This study aimed to investigate the impact of racial residential segregation on healthcare utilization and perceived quality of care among informal caregivers in the US. It further assessed potential variations in the estimated impact across caregivers' race and socioeconomic status. We used data from the Health Information National Trends Survey Data Linkage Project (fielded in 2020) for a sample of 583 self-identified informal caregivers in the US. Fitting a series of regression models with the maximum likelihood estimation, we computed the beta coefficients (β) of interest and their associated Wald 95% confidence limits (CI). Caregivers who resided in areas with higher segregation, compared to those living in lower segregated areas, were less likely to visit a healthcare professional [β = - 2.08; Wald 95%CI - 2.093, - 2.067] (moderate); [β = - 2.53; Wald 95%CI - 2.549, - 2.523] (high)]. Further, caregivers residing in moderate [β = - 0.766; Wald 95%CI - 0.770, - 0.761] and high [β = - 0.936; Wald 95%CI - 0.941, - 0.932] segregation regions were less likely to perceive a better quality of care compared to those located in low segregation areas. Moreover, as segregation level increased, Black caregivers were less likely to see a health professional, less frequently used healthcare services, and had poorer perceived healthcare quality when compared to Whites. Our findings indicate that higher residential segregation is associated with lower healthcare utilization, such as visiting a healthcare professional, and poorer perceived healthcare quality among informal caregivers. Given the essential role of informal caregivers in the current healthcare system, it is vital to investigate and address challenges associated with access to and quality of essential healthcare services to improve caregivers' health and well-being, specifically for caregivers of minority backgrounds.
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Affiliation(s)
- Hyunmin Kim
- College of Nursing and Health Professions, School of Health Professions, The University of Southern Mississippi, Hattiesburg, MS, USA
| | - Asos Mahmood
- Center for Health System Improvement, College of Medicine, University of Tennessee Health Science Center, 956 Court Ave Avenue, Ste D222A, Memphis, TN, 38103, USA.
- Department of Medicine-General Internal Medicine, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA.
| | - Satish Kedia
- Division of Social and Behavioral Sciences, School of Public Health, The University of Memphis, Memphis, TN, USA
| | - Deborah O Ogunsanmi
- Tennessee Population Health Consortium and Institute for Health Outcomes and Policy Research, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Sadikshya Sharma
- College of Nursing and Health Professions, School of Health Professions, The University of Southern Mississippi, Hattiesburg, MS, USA
| | - David K Wyant
- Jack C. Massey College of Business, Frist College of Medicine, Belmont University, Nashville, TN, USA
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Moustafa ASZ, Yimer W, Perry A, Solis L, Belk S, Morris R, Spencer SK, Rana S, Wallace K. Report from a text-based blood pressure monitoring prospective cohort trial among postpartum women with hypertensive disorders of pregnancy. BMC Pregnancy Childbirth 2024; 24:340. [PMID: 38702619 PMCID: PMC11067202 DOI: 10.1186/s12884-024-06511-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 04/11/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND Hypertensive disorders of pregnancy are a main cause of maternal morbidity and mortality in the United States and worldwide, and it is estimated that approximately 60% of maternal deaths in the United States occur during the postpartum period. The utilization of telehealth modalities such as home blood pressure monitoring has shown improvement in blood pressure control and adherence with follow up visits. Our study sought to determine if standardized education improved patient hypertension knowledge and if this when combined with home blood pressure telemonitoring increased participants' postpartum self-blood pressure monitoring and postpartum visit attendance. METHODS This is an Institutional Review Board approved prospective cohort study conducted at the University of Mississippi Medical Center. Women with a hypertensive disorder of pregnancy who met the inclusion criteria and provided written informed consent to participate were enrolled. Participants received a baseline pre-education questionnaire designed to assess their knowledge of their hypertensive diagnosis, hypertension management, and postpartum preeclampsia (PreE). Participants then received standard education, a blood pressure monitor, and were scheduled a follow-up visit during the first 10 days following discharge. Remote home blood pressure monitoring was performed via text messages and voice calls for 6-weeks postpartum. At the conclusion of the study, participants repeated their original questionnaire. RESULTS 250 women provided informed consent to participate in the study and were included in this analysis. Relative to the baseline survey, there was a significant increase (p = 0.0001) in the percentage of correct responses. There was not an association between study engagement and percentage of correct responses on end of study questionnaire (p = 0.33) or postpartum visit attendance (p = 0.69). Maternal age was found to drive study engagement, even when adjusted for community-level distress (p = 0.03) and maternal race (p = 0.0002). CONCLUSION Implementing a standardized postpartum education session was associated with improvement in patient's knowledge. Further studies are needed with more longitudinal follow up to assess if this program would also result in improved long-term outcomes and decreased hospital readmission rates. TRIAL REGISTRATION NCT04570124.
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Affiliation(s)
- Ahmed S Z Moustafa
- Department of Obstetrics & Gynecology, University of Mississippi Medical Center, Jackson, MS, USA
| | - Wondwosen Yimer
- Department of Data Science, University of Mississippi Medical Center, Jackson, MS, USA
| | - Ana Perry
- Department of Obstetrics & Gynecology, University of Mississippi Medical Center, Jackson, MS, USA
| | - Lucia Solis
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Sheila Belk
- Department of Pharmacology &Toxicology, University of Mississippi Medical Center, Jackson, MS, USA
| | - Rachael Morris
- Department of Obstetrics & Gynecology, University of Mississippi Medical Center, Jackson, MS, USA
| | - Shauna-Kay Spencer
- Department of Pharmacology &Toxicology, University of Mississippi Medical Center, Jackson, MS, USA
| | - Sarosh Rana
- Department of Obstetrics & Gynecology, University of Chicago, Chicago, IL, USA
| | - Kedra Wallace
- Department of Obstetrics & Gynecology, University of Mississippi Medical Center, Jackson, MS, USA.
- Department of Pharmacology &Toxicology, University of Mississippi Medical Center, Jackson, MS, USA.
- Myrlie Evers Williams Institute for the Elimination of Health Disparities, University of Mississippi Medical Center, Jackson, MS, USA.
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Marcellus L, Amundsen M. Equity Matters: Introduction to a New Column. Neonatal Netw 2024; 43:179-181. [PMID: 38816224 DOI: 10.1891/nn-2023-0078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
"Equity Matters" is a new column for Neonatal Network designed to further explore and apply the concept of health equity as it relates to supporting neonatal health and family well-being. In this initial column, an overview of health equity and determinants of health is provided. Two frameworks-the Healthy People 2030 strategy (U.S. Department of Health and Human Services) and the American Hospital Association equity roadmap and health equity transformation model-are introduced. Five domains of determinants will be explored in future columns: economic stability, education, social and community context, health and health care, and neighborhood and built environment. The domains of each determinant will be described to provide theoretical and practical approaches to support integration into nursing practice. Neonatal nurses are positioned to recognize health inequities for new families, critically analyze their relationship with the determinants of health, and advocate for strategies to promote health and well-being.
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Horan H, Thompson A, Willard K, Mobley E, McDaniel J, Robertson E, McIntosh S, Albright DL. Social Determinants Associated with Substance Use and Treatment Seeking in Females of Reproductive Age in the United States. J Womens Health (Larchmt) 2024; 33:584-593. [PMID: 38533906 DOI: 10.1089/jwh.2023.0559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024] Open
Abstract
Introduction: Females of reproductive age (FoRA; 15-49 years) are the demographic most likely to be diagnosed with a substance use disorder. Preventative treatment prior to or during pregnancy is critical. Stigma and social inequities can delay access to care. There is limited research examining social determinants of health (SDoH) and how they are related to substance use and treatment seeking in this demographic. Methods: We analyzed the 2016-2019 data from the United States National Survey on Drug Use and Health using multivariable logistic regression models. Statistically significant variables were conceptually linked to the Office of Disease Prevention and Health Promotion's (ODPHP's) SDoH framework's five domains. Results: From a total sample of 1,477,336 (weighted) pregnant people and 39,600,523 (weighted) FoRA, substance use was reported by 879,209 (2.14% [95% confidence interval = 2.13-2.15]). Pregnancy status was not associated with substance use or treatment seeking. Past-month substance use was associated with high educational attainment, an annual income <$20,000, a history of criminality, low religiosity, and having health insurance. Past-month treatment-seeking behavior was associated with older age, an annual income >$20,000, a history of criminality, and greater religiosity. Behavioral health support seeking in the past month was associated with some college education. Higher depression severity was associated with all the three models. Conclusions: Using the ODPHP's SDoH framework, we begin to elicit critical connections that can describe substance use and treatment-seeking practices in FoRA. We encourage additional research to inform public health, health care, behavioral health, and other support service programming.
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Affiliation(s)
- Holly Horan
- The University of Alabama at Birmingham, Heersink School of Medicine, Department of Obstetrics and Gynecology, Birmingham, Alabama, USA
| | - Alyssa Thompson
- The University of Alabama, College of Liberal Arts and Sciences, Department of Anthropology, Tuscaloosa, Alabama, USA
| | - Kendall Willard
- The University of Alabama, College of Human and Environmental Sciences, Public Health - Health Professions Concentration, Tuscaloosa, Alabama, USA
| | - Emmily Mobley
- The University of Alabama, College of Liberal Arts and Sciences, Department of Anthropology, Tuscaloosa, Alabama, USA
| | - Justin McDaniel
- Southern Illinois University, School of Human Sciences, Public Health Program, Carbondale, Illinois, USA
| | - Ellen Robertson
- The University of Alabama, VitAL Program, Tuscaloosa, Alabama, USA
| | - Shanna McIntosh
- The University of Alabama, VitAL Program, Tuscaloosa, Alabama, USA
| | - David L Albright
- The University of Alabama, VitAL Program, Tuscaloosa, Alabama, USA
- The University of Alabama, College of Arts and Sciences, Department of Political Science, Tuscaloosa, Alabama, USA
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Alur P, Holla I, Hussain N. Impact of sex, race, and social determinants of health on neonatal outcomes. Front Pediatr 2024; 12:1377195. [PMID: 38655274 PMCID: PMC11035752 DOI: 10.3389/fped.2024.1377195] [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: 01/26/2024] [Accepted: 03/22/2024] [Indexed: 04/26/2024] Open
Abstract
Despite the global improvements in neonatal outcomes, mortality and morbidity rates among preterm infants are still unacceptably high. Therefore, it is crucial to thoroughly analyze the factors that affect these outcomes, including sex, race, and social determinants of health. By comprehending the influence of these factors, we can work towards reducing their impact and enhancing the quality of neonatal care. This review will summarize the available evidence on sex differences, racial differences, and social determinants of health related to neonates. This review will discuss sex differences in neonatal outcomes in part I and racial differences with social determinants of health in part II. Research has shown that sex differences begin to manifest in the early part of the pregnancy. Hence, we will explore this topic under two main categories: (1) Antenatal and (2) Postnatal sex differences. We will also discuss long-term outcome differences wherever the evidence is available. Multiple factors determine health outcomes during pregnancy and the newborn period. Apart from the genetic, biological, and sex-based differences that influence fetal and neonatal outcomes, racial and social factors influence the health and well-being of developing humans. Race categorizes humans based on shared physical or social qualities into groups generally considered distinct within a given society. Social determinants of health (SDOH) are the non-medical factors that influence health outcomes. These factors can include a person's living conditions, access to healthy food, education, employment status, income level, and social support. Understanding these factors is essential in developing strategies to improve overall health outcomes in communities.
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Affiliation(s)
- Pradeep Alur
- Penn State College of Medicine, Hampden Medical Center, Enola, PA, United States
| | - Ira Holla
- Department of Pediatrics, University of Mississippi Medical Center, Jackson, MS, United States
| | - Naveed Hussain
- Department of Pediatrics, Connecticut Children’s, Hartford, CT, United States
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Pouget ER, Feyissa GT, Wong T. Inequity in US Racial/Ethnic Infant Health and Birth Outcomes: The Role of the Adult Sex Ratio as a Potential Indicator of Structural Anti-Black Racism. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-01984-4. [PMID: 38528178 DOI: 10.1007/s40615-024-01984-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 03/07/2024] [Accepted: 03/17/2024] [Indexed: 03/27/2024]
Abstract
BACKGROUND Structural racism accounts for inequity in health outcomes in ways that are difficult to measure. To conduct more actionable research and measure the impact of intervention programs, there is a need to develop indicator measures of structural racism. One potential candidate is the Adult Sex Ratio (ASR), which was identified by Du Bois as an important indicator of social life functioning over 100 years ago and has remained significant up to the present day. This study investigated the utility of this measure. METHODS We compared birth/infant health outcomes using the US 2000 Linked Birth/Infant Death Cohort Data Set matched with 2000 Census data on adult sex ratios in multilevel logistic regression models, stratified by the racial/ethnic category of the mothers. RESULTS In an adjusted model, the odds of infant death was 21% higher among non-Hispanic Black (NHB) women living in counties in the lowest ASR tertile category when compared to their counterparts in counties in the highest ASR tertile. Similarly, the odds of giving birth to a preterm or a low birth weight infant were each 20% higher among NHB women living in counties in the lowest ASR tertile compared to their counterparts in counties in the highest ASR tertile. CONCLUSION ASRs may serve as a useful indicator of anti-Black structural racism at the local level. More research is needed to determine the circumstances under which this factor may serve to improve assessment of structural racism and facilitate health equity research.
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Affiliation(s)
- Enrique R Pouget
- Department of Health and Nutrition Sciences, Brooklyn College, The City University of New York, 2900 Bedford Avenue, Brooklyn, NY, 11210, USA.
| | - Garumma T Feyissa
- Department of Health and Nutrition Sciences, Brooklyn College, The City University of New York, 2900 Bedford Avenue, Brooklyn, NY, 11210, USA
| | - Tracy Wong
- Department of Health and Nutrition Sciences, Brooklyn College, The City University of New York, 2900 Bedford Avenue, Brooklyn, NY, 11210, USA
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Sharps P, Mahoney D. Maternal health disparities: Challenges and recommendations to achieving equity and justice. J Adv Nurs 2024. [PMID: 38361425 DOI: 10.1111/jan.16098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 02/01/2024] [Indexed: 02/17/2024]
Affiliation(s)
- Phyllis Sharps
- Johns Hopkins School of Nursing, Baltimore, Maryland, USA
| | - Diane Mahoney
- University of Kansas School of Nursing, Kansas City, Kansas, USA
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13
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Scher MS, Agarwal S, Venkatesen C. Clinical decisions in fetal-neonatal neurology II: Gene-environment expression over the first 1000 days presenting as "four great neurological syndromes". Semin Fetal Neonatal Med 2024; 29:101522. [PMID: 38637242 DOI: 10.1016/j.siny.2024.101522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Abstract
Interdisciplinary fetal-neonatal neurology (FNN) training considers a woman's reproductive and pregnancy health histories when assessing the "four great neonatal neurological syndromes". This maternal-child dyad exemplifies the symptomatic neonatal minority, compared with the silent majority of healthy children who experience preclinical diseases with variable expressions over the first 1000 days. Healthy maternal reports with reassuring fetal surveillance testing preceded signs of fetal distress during parturition. An encephalopathic neonate with seizures later exhibited childhood autistic spectrum behaviors and intractable epilepsy correlated with identified genetic biomarkers. A systems biology approach to etiopathogenesis guides the diagnostic process to interpret phenotypic form and function. Evolving gene-environment interactions expressed by changing phenotypes reflect a dynamic neural exposome influenced by reproductive and pregnancy health. This strategy considers critical/sensitive periods of neuroplasticity beyond two years of life to encompass childhood and adolescence. Career-long FNN experiences reenforce earlier training to strengthen the cognitive process and minimize cognitive biases when assessing children or adults. Prioritizing social determinants of healthcare for persons with neurologic disorders will help mitigate the global burden of brain diseases for all women and children.
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Affiliation(s)
- Mark S Scher
- Pediatrics and Neurology, Rainbow Babies and Children's Hospital Case Western Reserve University School of Medicine, USA.
| | - Sonika Agarwal
- Neurology and Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, USA.
| | - Charu Venkatesen
- Neurology and Pediatrics, Cincinnati Children's Hospital, Cincinnati School of Medicine, USA.
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14
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Fox-Harding C. Maternal Health Considerations: Highlighting and advancing opportunities for improved maternal health. WOMEN'S HEALTH (LONDON, ENGLAND) 2024; 20:17455057241253931. [PMID: 38797986 PMCID: PMC11129565 DOI: 10.1177/17455057241253931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 04/15/2024] [Accepted: 04/23/2024] [Indexed: 05/29/2024]
Abstract
The special collection on Maternal Health Considerations offers a comprehensive exploration of critical issues surrounding maternal well-being across diverse contexts and disciplines. Recognising that maternal health extends beyond the physiological realm, this collection delves into the multifaceted dimensions of maternal well-being, including physical, mental, and socio-ecological factors. The collection comprises a series of interdisciplinary studies that investigate various facets of maternal health, from conception to postpartum stages. It addresses the complex interplay between biological, psychological, and socio-cultural determinants that influence maternal health outcomes. By adopting a holistic approach, the contributors shed light on the interconnectedness of maternal well-being. Key themes explored within this collection include the impact of prenatal care on maternal and neonatal health outcomes, as well as the role of mental health in shaping maternal experiences. In addition, the collection presents innovative recommendations to enhancing maternal well-being, such as community-based interventions, technological advancements, and future policy considerations. Furthermore, the special collection emphasises the significance of culturally sensitive care in promoting maternal health. It highlights the need for tailored interventions that respect the diversity of maternal experiences across different ethnic, racial, and socioeconomic groups. Contributors to this collection employ a range of methodologies, including qualitative and quantitative research case studies, which provide an intricate overview of the current state of maternal health research. The collection also offers valuable insights for policymakers, healthcare practitioners, researchers, and advocates working towards improving maternal health outcomes worldwide. It serves as a vital resource for contributing to our understanding of the complexities surrounding maternal well-being. It offers a platform for critical dialogue and collaborative efforts aimed at promoting holistic maternal health.
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Affiliation(s)
- Caitlin Fox-Harding
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
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15
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Haiman MD, Cubbin C. Impact of Geography and Rurality on Preconception Health Status in the United States. Prev Chronic Dis 2023; 20:E101. [PMID: 37943727 PMCID: PMC10684287 DOI: 10.5888/pcd20.230104] [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: 11/12/2023] Open
Abstract
Introduction Maternal illness and death are largely preventable; however, the field of preconception health needs further study. Geographic region and rurality play a large role in maternal health, and an understanding of the effect of these 2 factors at the individual level could prevent future adverse maternal health outcomes. Methods We developed an abbreviated index of preconception health risk (diabetes, hypertension, body weight, mental health, unintended pregnancy, HIV, alcohol and nicotine use, nutrition, physical activity, receipt of the influenza vaccine) by using data from the 2019 Behavioral Risk Factor Surveillance System (BRFSS). A score of 1 was assigned for each behavior factor classified as unhealthy and a score of 0 for each factor classified as healthy, for a total potential score of 11. Respondent women from the 37 states that included the BRFSS family planning supplemental module who were aged 18 to 44 years who could become pregnant (N = 25,999) were included. We used univariate and multivariate regression models to assess the relationship between sociodemographic factors (age, race or ethnicity, relationship status, insurance status, education, income, and rurality and region) and preconception health, with a primary focus on rurality and region. Results The average preconception health risk index score among participants was 3.5, with higher average scores in rural areas than in urban areas. All factors were independently associated with preconception health. Compared with women living in the urban Northeast, women living in all rural and region groups, except the rural West, had increased preconception health risk. Conclusion Preconception health scores from our study showed that, on average, a person had more than 3 risk factors or behaviors. Given the current state of reproductive health policy in the United States, increased efforts are needed to address preconception health.
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Affiliation(s)
- Madison D Haiman
- Steve Hicks School of Social Work, The University of Texas at Austin
| | - Catherine Cubbin
- Steve Hicks School of Social Work, The University of Texas at Austin
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16
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Van Baak B, Powell A, Fricas J, Caupain Sanderson A. Essential Nursing Actions to Reduce Inequities for Black Women in the Perinatal Period. J Obstet Gynecol Neonatal Nurs 2023; 52:454-466. [PMID: 37597534 DOI: 10.1016/j.jogn.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 07/10/2023] [Accepted: 07/12/2023] [Indexed: 08/21/2023] Open
Abstract
Perinatal nurses play a critical role in the care of, advocacy for, and research with Black women in the perinatal period. Despite awareness of inequities in the perinatal health care system that stem from racism in the United States, many nurses report feeling detached from the crisis. In this critical commentary, we provide a five-step nursing action guide to address this health disparity that is aligned with the Future of Nursing report and the American Nurses Association Code of Ethics. We recommend nursing activities in each step: understand drivers of health inequities among Black women, reflect on implicit bias, use respectful care frameworks with Black women, conduct ethical research, and advocate for change. The article includes a sharable and printable action sheet that can be used in the work environment to remind nurses of their roles in enacting change.
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17
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Renbarger KM, Abebe S, Place JM, Goldsby E, Hall G, Kroot A. Perspectives of Infant Mortality from African American Community Members. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2023; 4:423-430. [PMID: 37638331 PMCID: PMC10457606 DOI: 10.1089/whr.2023.0017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/27/2023] [Indexed: 08/29/2023]
Abstract
Introduction Infant mortality (IM) is often used to determine overall population health and well-being. Health disparities exist with African American (AA) infants having higher rates of IM than White infants. The purpose of this study was to examine the knowledge, attitudes, and perceptions of members in an AA community regarding IM, which can be used to develop interventions. Methods A qualitative descriptive design guided this study. A county in the state of Indiana was the setting from which the researchers enrolled participants in this study. The participants consisted of 16 AA community members who were recruited from a local agency and who had completed an educational program on IM. Through semistructured phone interviews, participants described their understanding of IM. The data analysis of the transcribed interviews was performed via content analysis to yield overall themes from the data. Results The analysis identified three themes describing AA Community members' perspectives on IM: (1) Shying Away from the Topic of Infant Mortality; (2) Receiving Misinformation from Family Members; and (3) Considering Infant Mortality as Unpreventable. Discussion The findings of this study suggest that participants avoided the topic of IM, often received misinformation from family members, and believed infant death could not be prevented. Health care providers should have an open and culturally competent discussion about issues of IM, engage family members, and support community-based initiatives and education for members in AA communities.
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Affiliation(s)
| | - Sheila Abebe
- Department of Public Health, Ball State University, Muncie, Indiana, USA
| | - Jean Marie Place
- Department of Nursing and Ball State University, Muncie, Indiana, USA
| | - Elizabeth Goldsby
- Department of Nursing and Ball State University, Muncie, Indiana, USA
| | - Gabe Hall
- School of Nursing, Ball State University, Muncie, Indiana, USA
| | - Adam Kroot
- School of Nursing, Ball State University, Muncie, Indiana, USA
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18
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Kelleher KJ, Hoagwood K, Walker DK, Kaminski JW, Gardner W, Fox EG. Vital Signs for Pediatric Health: Infant Mortality. NAM Perspect 2023; 2023:202306a. [PMID: 37916061 PMCID: PMC10617997 DOI: 10.31478/202306a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Affiliation(s)
| | | | | | - Jennifer W Kaminski
- Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities
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19
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Frank TL, Jabbari J, Roll S, Ferris D, Terada T, Gilbert A, McDermott L. Connecting the Dots between Barriers to W.I.C. Access and Adult and Child Food Insecurity: A Survey of Missouri Residents. Nutrients 2023; 15:2496. [PMID: 37299459 PMCID: PMC10255678 DOI: 10.3390/nu15112496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 05/20/2023] [Accepted: 05/22/2023] [Indexed: 06/12/2023] Open
Abstract
Background. Previous research has explored the impact of W.I.C. on recipients' health, but less is known about the connection between barriers to W.I.C. access and health outcomes. We fill in a gap in the literature by studying the relationship between barriers to Special Supplemental Nutrition Program for Women, Infants, and Children (W.I.C.) access and adult and child food insecurity. Methods. After survey administration, we analyzed a cross-sectional sample of 2244 residents in Missouri who have used W.I.C. or lived in a household with a W.I.C. recipient in the past three years. We ran logistic regression models to understand the relationships among barriers to W.I.C. utilization, adult food insecurity, and child food insecurity. Results. Having special dietary needs (for adults), lacking access to technology, encountering inconvenient clinic hours of operation, and experiencing difficulties taking off work were associated with increased adult food insecurity. Difficulties finding WIC-approved items in the store, technological barriers, inconvenient clinic hours, difficulties taking off work, and finding childcare were associated with increased child food insecurity. Conclusion. Barriers to accessing and utilizing W.I.C. are associated with adult and child food insecurity. However, current policies suggest promising approaches to curbing these barriers.
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Affiliation(s)
- Tyler L. Frank
- Social Policy Institute, Brown School, Washington University in St. Louis, 1 Brookings Drive, St. Louis, MO 63130, USA; (T.L.F.); (S.R.); (D.F.); (T.T.); (A.G.)
| | - Jason Jabbari
- Social Policy Institute, Brown School, Washington University in St. Louis, 1 Brookings Drive, St. Louis, MO 63130, USA; (T.L.F.); (S.R.); (D.F.); (T.T.); (A.G.)
| | - Stephen Roll
- Social Policy Institute, Brown School, Washington University in St. Louis, 1 Brookings Drive, St. Louis, MO 63130, USA; (T.L.F.); (S.R.); (D.F.); (T.T.); (A.G.)
| | - Dan Ferris
- Social Policy Institute, Brown School, Washington University in St. Louis, 1 Brookings Drive, St. Louis, MO 63130, USA; (T.L.F.); (S.R.); (D.F.); (T.T.); (A.G.)
| | - Takeshi Terada
- Social Policy Institute, Brown School, Washington University in St. Louis, 1 Brookings Drive, St. Louis, MO 63130, USA; (T.L.F.); (S.R.); (D.F.); (T.T.); (A.G.)
| | - Amanda Gilbert
- Social Policy Institute, Brown School, Washington University in St. Louis, 1 Brookings Drive, St. Louis, MO 63130, USA; (T.L.F.); (S.R.); (D.F.); (T.T.); (A.G.)
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20
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Sferra SR, Salvi PS, Penikis AB, Weller JH, Canner JK, Guo M, Engwall-Gill AJ, Rhee DS, Collaco JM, Keiser AM, Solomon DG, Kunisaki SM. Racial and Ethnic Disparities in Outcomes Among Newborns with Congenital Diaphragmatic Hernia. JAMA Netw Open 2023; 6:e2310800. [PMID: 37115544 PMCID: PMC10148194 DOI: 10.1001/jamanetworkopen.2023.10800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 03/02/2023] [Indexed: 04/29/2023] Open
Abstract
Importance There is some data to suggest that racial and ethnic minority infants with congenital diaphragmatic hernia (CDH) have poorer clinical outcomes. Objective To determine what patient- and institutional-level factors are associated with racial and ethnic differences in CDH mortality. Design, Setting, and Participants Multicenter cohort study of 49 US children's hospitals using the Pediatric Health Information System database from January 1, 2015, to December 31, 2020. Participants were patients with CDH admitted on day of life 0 who underwent surgical repair. Patient race and ethnicity were guardian-reported vs hospital assigned as Black, Hispanic (White or Black), or White. Data were analyzed from August 2021 to March 2022. Exposures Patient race and ethnicity: (1) White vs Black and (2) White vs Hispanic; and institutional-level diversity (as defined by the percentage of Black and Hispanic patients with CDH at each hospital): (1) 30% or less, (2) 31% to 40%, and (3) more than 40%. Main Outcomes and Measures The primary outcomes were in-hospital and 60-day mortality. The study hypothesized that hospitals managing a more racially and ethnically diverse population of patients with CDH would be associated with lower mortality among Black and Hispanic infants. Results Among 1565 infants, 188 (12%), 306 (20%), and 1071 (68%) were Black, Hispanic, and White, respectively. Compared with White infants, Black infants had significantly lower gestational ages (mean [SD], White: 37.6 [2] weeks vs Black: 36.6 [3] weeks; difference, 1 week; 95% CI for difference, 0.6-1.4; P < .001), lower birthweights (White: 3.0 [1.0] kg vs Black: 2.7 [1.0] kg; difference, 0.3 kg; 95% CI for difference, 0.2-0.4; P < .001), and higher extracorporeal life support use (White: 316 patients [30%] vs Black: 69 patients [37%]; χ21 = 3.9; P = .05). Black infants had higher 60-day (White: 99 patients [9%] vs Black: 29 patients [15%]; χ21 = 6.7; P = .01) and in-hospital (White: 133 patients [12%] vs Black: 40 patients [21%]; χ21 = 10.6; P = .001) mortality . There were no mortality differences in Hispanic patients compared with White patients. On regression analyses, institutional diversity of 31% to 40% in Black patients (hazard ratio [HR], 0.17; 95% CI, 0.04-0.78; P = .02) and diversity greater than 40% in Hispanic patients (HR, 0.37; 95% CI, 0.15-0.89; P = .03) were associated with lower mortality without altering outcomes in White patients. Conclusions and Relevance In this cohort study of 1565 who underwent surgical repair patients with CDH, Black infants had higher 60-day and in-hospital mortality after adjusting for disease severity. Hospitals treating a more racially and ethnically diverse patient population were associated with lower mortality in Black and Hispanic patients.
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Affiliation(s)
- Shelby R. Sferra
- Division of General Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Pooja S. Salvi
- Division of Pediatric Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Annalise B. Penikis
- Division of General Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jennine H. Weller
- Division of General Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Joseph K. Canner
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Matthew Guo
- Division of General Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Abigail J. Engwall-Gill
- Division of General Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Daniel S. Rhee
- Division of General Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Joseph M. Collaco
- Division of Pediatric Pulmonology, Department of Pediatrics, Johns Hopkins Children’s Center, Baltimore, Maryland
| | - Amaris M. Keiser
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Johns Hopkins Children’s Center, Baltimore, Maryland
| | - Daniel G. Solomon
- Division of Pediatric Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Shaun M. Kunisaki
- Division of General Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
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21
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Johnson TJ, Meier PP, Robinson DT, Suzuki S, Kadakia S, Garman AN, Patel AL. The Role of Work as a Social Determinant of Health in Mother's Own Milk Feeding Decisions for Preterm Infants: A State of the Science Review. CHILDREN (BASEL, SWITZERLAND) 2023; 10:416. [PMID: 36979974 PMCID: PMC10046918 DOI: 10.3390/children10030416] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 12/28/2022] [Accepted: 02/15/2023] [Indexed: 02/24/2023]
Abstract
In the United States, 10% of infants are born preterm (PT; <37 weeks gestational age) each year and are at higher risk of complications compared to full term infants. The burden of PT birth is borne disproportionately by Black versus non-Black families, with Black mothers significantly more likely to give birth to a PT infant. One proven strategy to improve short- and long-term health outcomes in PT infants is to feed mother's own milk (MOM; breast milk from the mother). However, mothers must make decisions about work and MOM provision following PT birth, and more time spent in paid work may reduce time spent in unpaid activities, including MOM provision. Non-Black PT infants are substantially more likely than Black PT infants to receive MOM during the birth hospitalization, and this disparity is likely to be influenced by the complex decisions mothers of PT infants make about allocating their time between paid and unpaid work. Work is a social determinant of health that provides a source of income and health insurance coverage, and at the same time, has been shown to create disparities through poorer job quality, lower earnings, and more precarious employment in racial and ethnic minority populations. However, little is known about the relationship between work and disparities in MOM provision by mothers of PT infants. This State of the Science review synthesizes the literature on paid and unpaid work and MOM provision, including: (1) the complex decisions that mothers of PT infants make about returning to work, (2) racial and ethnic disparities in paid and unpaid workloads of mothers, and (3) the relationship between components of job quality and duration of MOM provision. Important gaps in the literature and opportunities for future research are summarized, including the generalizability of findings to other countries.
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Affiliation(s)
- Tricia J. Johnson
- Department of Health Systems Management, Rush University, Chicago, IL 60612, USA
| | - Paula P. Meier
- College of Nursing, Rush University, Chicago, IL 60612, USA
- Department of Pediatrics, Rush University Medical Center, Chicago, IL 60612, USA
| | - Daniel T. Robinson
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Sumihiro Suzuki
- Department of Family and Preventive Medicine, Rush University Medical Center, Chicago, IL 60612, USA
| | - Suhagi Kadakia
- Department of Pediatrics, Rush University Medical Center, Chicago, IL 60612, USA
| | - Andrew N. Garman
- Department of Health Systems Management, Rush University, Chicago, IL 60612, USA
| | - Aloka L. Patel
- Department of Pediatrics, Rush University Medical Center, Chicago, IL 60612, USA
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22
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Anita WM, Ueda K, Uttajug A, Seposo XT, Takano H. Association between Long-Term Ambient PM2.5 Exposure and under-5 Mortality: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3270. [PMID: 36833969 PMCID: PMC9961703 DOI: 10.3390/ijerph20043270] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 02/04/2023] [Accepted: 02/08/2023] [Indexed: 06/18/2023]
Abstract
Studies have established a link between exposure to fine particles (PM2.5) and mortality in infants and children. However, few studies have explored the association between post-birth exposure to PM2.5 and under-5 mortality. We conducted a scoping review to identify relevant epidemiological evidence on the association between post-birth ambient PM2.5 exposure and under-5 mortality. We searched PubMed and Web of Science for articles published between 1970 and the end of January 2022 that explicitly linked ambient PM2.5 and under-5 mortality by considering the study area, study design, exposure window, and child age. Information was extracted on the study characteristics, exposure assessment and duration, outcomes, and effect estimates/findings. Ultimately, 13 studies on infant and child mortality were selected. Only four studies measured the effect of post-birth exposure to PM2.5 on under-5 mortality. Only one cohort study mentioned a positive association between post-birth ambient PM2.5 exposure and under-5 mortality. The results of this scoping review highlight the need for extensive research in this field, given that long-term exposure to ambient PM2.5 is a major global health risk and child mortality remains high in some countries.
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Affiliation(s)
- Wahida Musarrat Anita
- Graduate School of Global Environmental Studies (GSGES), Kyoto University, Kyoto 615-8540, Japan
| | - Kayo Ueda
- Graduate School of Global Environmental Studies (GSGES), Kyoto University, Kyoto 615-8540, Japan
- Department of Hygiene, Graduate School of Medicine, Hokkaido University, Hokkaido 060-8638, Japan
| | - Athicha Uttajug
- Department of Hygiene, Graduate School of Medicine, Hokkaido University, Hokkaido 060-8638, Japan
| | - Xerxes Tesoro Seposo
- Department of Hygiene, Graduate School of Medicine, Hokkaido University, Hokkaido 060-8638, Japan
| | - Hirohisa Takano
- Graduate School of Global Environmental Studies (GSGES), Kyoto University, Kyoto 615-8540, Japan
- Graduate School of Engineering, Kyoto University, Kyoto 615-8540, Japan
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23
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Listen to the Whispers before They Become Screams: Addressing Black Maternal Morbidity and Mortality in the United States. Healthcare (Basel) 2023; 11:healthcare11030438. [PMID: 36767014 PMCID: PMC9914526 DOI: 10.3390/healthcare11030438] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 01/09/2023] [Accepted: 01/31/2023] [Indexed: 02/09/2023] Open
Abstract
Black women in the United States (U.S.) disproportionately experience adverse pregnancy outcomes, including maternal mortality, compared to women of other racial and ethnic groups. Historical legacies of institutionalized racism and bias in medicine compound this problem. The disproportionate impact of COVID-19 on communities of color may further worsen existing racial disparities in maternal morbidity and mortality. This paper discusses structural and social determinants of racial disparities with a focus on the Black maternal mortality crisis in the United States. We explore how structural racism contributes to a greater risk of adverse obstetric outcomes among Black women in the U.S. We also propose public health, healthcare systems, and community-engaged approaches to decrease racial disparities in maternal morbidity and mortality.
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Jairam JA, Vigod SN, Siddiqi A, Guan J, Boblitz A, Wang X, O’Campo P, Ray JG. Severe Maternal Morbidity and Mortality Among Immigrant and Canadian-Born Women Residing Within Low-Income Neighborhoods in Ontario, Canada. JAMA Netw Open 2023; 6:e2256203. [PMID: 36795412 PMCID: PMC9936351 DOI: 10.1001/jamanetworkopen.2022.56203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
Abstract
IMPORTANCE Evidence indicates that immigrant women and women residing within low-income neighborhoods experience higher adversity during pregnancy. Little is known about the comparative risk of severe maternal morbidity or mortality (SMM-M) among immigrant vs nonimmigrant women living in low-income areas. OBJECTIVE To compare the risk of SMM-M between immigrant and nonimmigrant women residing exclusively within low-income neighborhoods in Ontario, Canada. DESIGN, SETTING, AND PARTICIPANTS This population-based cohort study used administrative data for Ontario, Canada, from April 1, 2002, to December 31, 2019. Included were all 414 337 hospital-based singleton live births and stillbirths occurring between 20 and 42 weeks' gestation, solely among women residing in an urban neighborhood of the lowest income quintile; all women were receiving universal health care insurance. Statistical analysis was performed from December 2021 to March 2022. EXPOSURES Nonrefugee immigrant status vs nonimmigrant status. MAIN OUTCOMES AND MEASURES The primary outcome, SMM-M, was a composite outcome of potentially life-threatening complications or mortality occurring within 42 days of the index birth hospitalization. A secondary outcome was SMM severity, approximated by the number of SMM indicators (0, 1, 2 or ≥3 indicators). Relative risks (RRs), absolute risk differences (ARDs), and odds ratios (ORs) were adjusted for maternal age and parity. RESULTS The cohort included 148 085 births to immigrant women (mean [SD] age at index birth, 30.6 [5.2] years) and 266 252 births to nonimmigrant women (mean [SD] age at index birth, 27.9 [5.9] years). Most immigrant women originated from South Asia (52 447 [35.4%]) and the East Asia and Pacific (35 280 [23.8%]) regions. The most frequent SMM indicators were postpartum hemorrhage with red blood cell transfusion, intensive care unit admission, and puerperal sepsis. The rate of SMM-M was lower among immigrant women (2459 of 148 085 [16.6 per 1000 births]) than nonimmigrant women (4563 of 266 252 [17.1 per 1000 births]), equivalent to an adjusted RR of 0.92 (95% CI, 0.88-0.97) and an adjusted ARD of -1.5 per 1000 births (95% CI, -2.3 to -0.7). Comparing immigrant vs nonimmigrant women, the adjusted OR of having 1 SMM indicator was 0.92 (95% CI, 0.87-0.98), the adjusted OR of having 2 indicators was 0.86 (95% CI, 0.76-0.98), and the adjusted OR of having 3 or more indicators was 1.02 (95% CI, 0.87-1.19). CONCLUSIONS AND RELEVANCE This study suggests that, among universally insured women residing in low-income urban areas, immigrant women have a slightly lower associated risk of SMM-M than their nonimmigrant counterparts. Efforts aimed at improving pregnancy care should focus on all women residing in low-income neighborhoods.
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Affiliation(s)
- Jennifer A. Jairam
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- MAP Centre for Urban Health Solutions, St Michael’s Hospital, Toronto, Ontario, Canada
| | - Simone N. Vigod
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Department of Psychiatry, Women’s College Hospital, Toronto, Ontario, Canada
| | - Arjumand Siddiqi
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill
| | | | | | | | - Patricia O’Campo
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- MAP Centre for Urban Health Solutions, St Michael’s Hospital, Toronto, Ontario, Canada
| | - Joel G. Ray
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Keenan Research Centre, St Michael’s Hospital, Toronto, Ontario, Canada
- Department of Obstetrics and Gynaecology, St Michael’s Hospital, Toronto, Ontario, Canada
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Patel I, Dev A. What is prenatal stress? A scoping review of how prenatal stress is defined and measured within the context of food insecurity, housing instability, and immigration in the United States. WOMEN'S HEALTH (LONDON, ENGLAND) 2023; 19:17455057231191091. [PMID: 37596926 PMCID: PMC10440065 DOI: 10.1177/17455057231191091] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 06/20/2023] [Accepted: 07/13/2023] [Indexed: 08/21/2023]
Abstract
BACKGROUND Stress during pregnancy can lead to significant adverse outcomes for maternal mental health. Early evaluation of prenatal stress can help identify treatment needs and appropriate interventions. Disparities in the social determinants of health can contribute to stress, but what constitutes stress during pregnancy within the social determinants of health framework is poorly understood. OBJECTIVE To scope how prenatal stress is defined and measured among pregnant people exposed to three prominent social stressors in the United States: insecurity pertaining to food, housing, and immigration. ELIGIBILITY CRITERIA We included all studies that focused on stress during pregnancy in the context of food insecurity, housing instability, and immigration, given their recent policy focus due to the COVID-19 pandemic and ongoing political discourse, in addition to their importance in American College of Obstetricians and Gynecologists (ACOG's) social determinants of health screening tool. SOURCES OF EVIDENCE We searched PubMed, Scopus, and Web of Science for articles published between January 2012 and January 2022. CHARTING METHODS Using a piloted charting tool, we extracted relevant study information from the selected articles and analyzed the content pertaining to stress. RESULTS An initial search identified 1,023 articles, of which 24 met our inclusion criteria. None of the studies defined prenatal stress, and only one used the Prenatal Distress Questionnaire, a prenatal stress-specific tool to measure it. The Perceived Stress Scale was the most common instrument used in seven studies. Fifteen studies measured over 25 alternative exposures that researchers theorized were associated with stress, and 4 of the 15 studies did not explain the association between the measure and stress. CONCLUSIONS Our findings demonstrate a fundamental inconsistency in how prenatal stress is defined and measured in the context of social determinants of health, limiting the comparison of results across studies and the potential development of effective interventions to promote better maternal mental health.
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Affiliation(s)
- Ishani Patel
- Chicago College of Osteopathic Medicine, Midwestern University, Downers Grove, IL, USA
| | - Alka Dev
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Hanover, IL, USA
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26
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Hiratsuka VY, Reid M, Chang J, Jiang L, Brega AG, Fyfe-Johnson AL, Huyser KR, Johnson-Jennings M, Conway C, Steiner JF, Rockell J, Dillard DA, Moore K, Manson SM, O'Connell J. Associations Between Rurality, pre-pregnancy Health Status, and Macrosomia in American Indian/Alaska Native Populations. Matern Child Health J 2022; 26:2454-2465. [PMID: 36346567 PMCID: PMC10468113 DOI: 10.1007/s10995-022-03536-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To examine the relationships between pre-pregnancy diabetes mellitus (DM), gestational diabetes mellitus (GDM), pre-pregnancy body mass index (BMI) and county-level social determinants of health, with infant macrosomia within a sample of American Indian/Alaska Native (AI/AN) women receiving Indian Health Service (IHS) care. METHODS The sample included women-infant dyads representing 1,136 singleton births from fiscal year 2011 (10/1/2019-9/30/2011). Data stemmed from the IHS Improving Health Care Delivery Data Project. Multivariate generalized linear mixed models were fitted to assess the association of macrosomia with pre-pregnancy health status and social determinants of health. RESULTS Nearly half of the women in the sample were under age 25 years (48.6%), and most had Medicaid health insurance coverage (76.7%). Of those with a pre-pregnancy BMI measure, 66.2% were overweight or obese. Although few women had pre-pregnancy DM (4.0%), GDM was present in 12.8% of women. Most women had a normal term delivery (85.4%). Overweight, obesity, pre-pregnancy DM, and county-level rurality were all significantly associated with higher odds of infant macrosomia.
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Affiliation(s)
- Vanessa Y Hiratsuka
- Research Department, Southcentral Foundation, 4501 Diplomacy Drive, 99508, Anchorage, AK, USA.
- Center for Human Development, University of Alaska Anchorage, 3211 Providence Drive, 99508, 99504, Anchorage, AK, USA.
| | - Margaret Reid
- Department of Health Systems, Management, and Policy, Colorado School of Public Health, University of Colorado Denver, Denver, USA
| | - Jenny Chang
- Department of Medicine, School of Medicine, University of California, 301 Medical Surge II, 92697-7550, Irvine, CA, USA
| | - Luohua Jiang
- Department of Epidemiology, University of California, Irvine, 3076 AIRB, 92697-7550, Irvine, CA, USA
| | - Angela G Brega
- School of Public Health, Centers for American Indian and Alaska Native Health, University of Colorado Anschutz Medical Campus, 13055 East 17th Avenue, 80045, Aurora, Colorado, CO, USA
| | - Amber L Fyfe-Johnson
- Institute for Research and Education to Advance Community Health (IREACH), Department of Medical Education and Clinical Sciences, Washington State University, 1100 Olive Way, Ste 1200, 98101, Seattle, WA, USA
| | - Kimberly R Huyser
- Department of Sociology, The University of British Columbia, Vancouver, USA
| | - Michelle Johnson-Jennings
- Canada Research Chair for Indigenous Community Engaged Research for Indigenous Community Engaged Research, LE Clinical Health Psychologist, University of Saskatchewan, University of Colorado- Associate Professor, University of Washington- Associate Professor, Washington, USA
| | - Cheryl Conway
- NE-BC; Quality Consultant, Charles George Veterans Medical Center, Asheville, NC, USA
| | - John F Steiner
- Institute for Health Research, Department of Medicine, Kaiser Permanente Colorado, University of Colorado Anschutz Medical Campus, Aurora, USA
| | - Jennifer Rockell
- Telligen, Inc. Greenwood Village, 7730 E. Belleview Ave Suite 300 Greenwood, 80111, Village, CO, USA
| | - Denise A Dillard
- Research Department, Southcentral Foundation, 4501 Diplomacy Drive, 99508, Anchorage, AK, USA
| | - Kelly Moore
- Centers for American Indian and Alaska Native Health, University of Colorado, Anschutz Medical Campus, Mail Stop F800, 13055 E. 17th Avenue, 80045, Aurora, CO, USA
| | - Spero M Manson
- Centers for American Indian and Alaska Native Health, University of Colorado, Anschutz Medical Campus, Mail Stop F800, 13055 E. 17th Avenue, 80045, Aurora, CO, USA
| | - Joan O'Connell
- Colorado School of Public Health, Centers for American Indian and Alaska Native Health, University of Colorado, Anschutz Medical Campus, Mail Stop F800, 13055 E. 17th Avenue, 80045, Aurora, CO, USA
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Onambele L, Ortega-Leon W, Guillen-Aguinaga S, Forjaz MJ, Yoseph A, Guillen-Aguinaga L, Alas-Brun R, Arnedo-Pena A, Aguinaga-Ontoso I, Guillen-Grima F. Maternal Mortality in Africa: Regional Trends (2000-2017). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13146. [PMID: 36293727 PMCID: PMC9602585 DOI: 10.3390/ijerph192013146] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 10/03/2022] [Accepted: 10/09/2022] [Indexed: 05/27/2023]
Abstract
BACKGROUND United Nations Sustainable Development Goals state that by 2030, the global maternal mortality rate (MMR) should be lower than 70 per 100,000 live births. MMR is still one of Africa's leading causes of death among women. The leading causes of maternal mortality in Africa are hemorrhage and eclampsia. This research aims to study regional trends in maternal mortality (MM) in Africa. METHODS We extracted data for maternal mortality rates per 100,000 births from the United Nations Children's Fund (UNICEF) databank from 2000 to 2017, 2017 being the last date available. Joinpoint regression was used to study the trends and estimate the annual percent change (APC). RESULTS Maternal mortality has decreased in Africa over the study period by an average APC of -3.0% (95% CI -2.9; -3,2%). All regions showed significant downward trends, with the greatest decreases in the South. Only the North African region is close to the United Nations' sustainable development goals for Maternal mortality. The remaining Sub-Saharan African regions are still far from achieving the goals. CONCLUSIONS Maternal mortality has decreased in Africa, especially in the South African region. The only region close to the United Nations' target is the North African region. The remaining Sub-Saharan African regions are still far from achieving the goals. The West African region needs more extraordinary efforts to achieve the goals of the United Nations. Policies should ensure that all pregnant women have antenatal visits and give birth in a health facility staffed by specialized personnel.
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Affiliation(s)
- Luc Onambele
- School of Health Sciences, Catholic University of Central Africa, Yaoundé 1110, Cameroon
| | - Wilfrido Ortega-Leon
- Epidemiology and Public Health Program, Department of Surgery, Medical and Social Sciences, University of Alcala de Henares, 28801 Madrid, Spain
| | - Sara Guillen-Aguinaga
- Department of Health Sciences, Public University of Navarra, 31008 Pamplona, Spain
- San Juan Health Center, Primary Health Care, Navarra Health Service, 31006 Pamplona, Spain
| | - Maria João Forjaz
- National Epidemiology Centre, Carlos III Health Institute, 28029 Madrid, Spain
- REDISSEC and REDIAPP, 28029 Madrid, Spain
| | - Amanuel Yoseph
- Department of Health Sciences, Public University of Navarra, 31008 Pamplona, Spain
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa P.O. Box 5, Ethiopia
| | | | - Rosa Alas-Brun
- Department of Health Sciences, Public University of Navarra, 31008 Pamplona, Spain
| | - Alberto Arnedo-Pena
- Department of Health Sciences, Public University of Navarra, 31008 Pamplona, Spain
- Epidemiology Division, Public Health Center, 12003 Castelló de la Plana, Spain
- Public Health and Epidemiology (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Ines Aguinaga-Ontoso
- Department of Health Sciences, Public University of Navarra, 31008 Pamplona, Spain
- Department of Preventive Medicine, Clínica Universidad de Navarra, 31008 Pamplona, Spain
- Facultad de Ciencias de la Salud, Universidad Pública de Navarra (UPNA), Avda. de Baranain sn, 31008 Pamplona, Spain
| | - Francisco Guillen-Grima
- Department of Health Sciences, Public University of Navarra, 31008 Pamplona, Spain
- Department of Preventive Medicine, Clínica Universidad de Navarra, 31008 Pamplona, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), 31008 Pamplona, Spain
- Center for Biomedical Research Network, Physiopathology of Obesity and CIBER-OBN, Instituto de Salud Carlos III, 28029 Madrid, Spain
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Basile Ibrahim B, Interrante JD, Fritz AH, Tuttle MS, Kozhimannil KB. Inequities in Availability of Evidence-Based Birth Supports to Improve Perinatal Health for Socially Vulnerable Rural Residents. CHILDREN (BASEL, SWITZERLAND) 2022; 9:1077. [PMID: 35884061 PMCID: PMC9324486 DOI: 10.3390/children9071077] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 07/13/2022] [Accepted: 07/16/2022] [Indexed: 11/17/2022]
Abstract
Rural residents in the United States (US) have disproportionately high rates of maternal and infant mortality. Rural residents who are Black, Indigenous, and People of Color (BIPOC) face multiple social risk factors and have some of the worst maternal and infant health outcomes in the U.S. The purpose of this study was to determine the rural availability of evidence-based supports and services that promote maternal and infant health. We developed and conducted a national survey of a sample of rural hospitals. We determined for each responding hospital the county-level scores on the 2018 CDC Social Vulnerability Index (SVI). The sample's (n = 93) median SVI score [IQR] was 0.55 [0.25-0.88]; for majority-BIPOC counties (n = 29) the median SVI score was 0.93 [0.88-0.98] compared with 0.38 [0.19-0.64] for majority-White counties (n = 64). Among counties where responding hospitals were located, 86.2% located in majority-BIPOC counties ranked in the most socially vulnerable quartile of counties nationally (SVI ≥ 0.75), compared with 14.1% of majority-White counties. In analyses adjusted for geography and hospital size, certified lactation support (aOR 0.36, 95% CI 0.13-0.97), midwifery care (aOR 0.35, 95% CI 0.12-0.99), doula support (aOR 0.30, 95% CI 0.11-0.84), postpartum support groups (aOR 0.25, 95% CI 0.09-0.68), and childbirth education classes (aOR 0.08, 95% CI 0.01-0.69) were significantly less available in the most vulnerable counties compared with less vulnerable counties. Residents in the most socially vulnerable rural counties, many of whom are BIPOC and thus at higher risk for poor birth outcomes, are significantly less likely to have access to evidence-based supports for maternal and infant health.
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Affiliation(s)
- Bridget Basile Ibrahim
- University of Minnesota Rural Health Research Center, Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN 55414, USA; (J.D.I.); (A.H.F.); (M.S.T.); (K.B.K.)
- School of Nursing, Yale University, Orange, CT 06477, USA
| | - Julia D. Interrante
- University of Minnesota Rural Health Research Center, Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN 55414, USA; (J.D.I.); (A.H.F.); (M.S.T.); (K.B.K.)
| | - Alyssa H. Fritz
- University of Minnesota Rural Health Research Center, Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN 55414, USA; (J.D.I.); (A.H.F.); (M.S.T.); (K.B.K.)
| | - Mariana S. Tuttle
- University of Minnesota Rural Health Research Center, Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN 55414, USA; (J.D.I.); (A.H.F.); (M.S.T.); (K.B.K.)
| | - Katy Backes Kozhimannil
- University of Minnesota Rural Health Research Center, Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN 55414, USA; (J.D.I.); (A.H.F.); (M.S.T.); (K.B.K.)
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Ilyes SG, Chiriac VD, Gluhovschi A, Mihaela V, Dahma G, Mocanu AG, Neamtu R, Silaghi C, Radu D, Bernad E, Craina M. The Influence of Maternal Factors on Neonatal Intensive Care Unit Admission and In-Hospital Mortality in Premature Newborns from Western Romania: A Population-Based Study. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58060709. [PMID: 35743972 PMCID: PMC9229487 DOI: 10.3390/medicina58060709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 05/21/2022] [Accepted: 05/24/2022] [Indexed: 11/16/2022]
Abstract
Background and Objectives: Neonatal mortality is a global public health issue, disproportionately affecting low- and middle-income nations. Although Romania is a high-income nation, according to the European Union’s most recent demographic data, it had the second-highest infant death rate in 2019. Although significant progress has been made in the last three decades in lowering newborn mortality, more initiatives to accelerate progress are required to meet the 2030 Sustainable Development Goals (SDG) objective. Therefore, we aimed to develop an observational study to determine the influence of maternal factors on in-hospital neonatal intensive care unit admission and mortality in premature infants born in western Romania. While newborn mortality has decreased globally, the pace of decline is far less than what is desired. Materials and Methods: A retrospective study comprising 328 premature patients and 422 full-term newborns, was developed at a tertiary obstetrics and gynecology clinic in western Romania, comprising the period of the last 24 months before the COVID-19 pandemic and the first 24 months of the pandemic. Results: The following variables were identified as statistically significant risk factors for neonatal intensive care unit admission: age > 35 years, OR = 1.59; twin births, OR = 1.14; low gestational age, OR = 1.66; preeclampsia, OR = 2.33; and peripartum infection, OR = 2.25. The same risk factors, with the exception of twin births, were significantly associated with in-hospital neonatal mortality. Except for a longer duration of maternal hospitalization and neonatal therapy with surfactant, steroids, and antibiotics, the COVID-19 pandemic did not cause significant differences in the evolution and outcomes of preterm newborns. Conclusions: The major maternal risk factors for NICU admission were advanced age, twin pregnancy, low gestational age, preeclampsia, and peripartum infection. Additionally, these characteristics contributed to a high likelihood of death, despite adequate access to medical care and advanced life support for the neonates. Understanding the causes of morbidity and death in neonates admitted to the neonatal intensive care unit enables better prioritization and planning of health services, resource reallocation, and care quality improvement.
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Affiliation(s)
- Stelian-Gabriel Ilyes
- Department of Obstetrics and Gynecology, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania; (S.-G.I.); (A.G.); (G.D.); (A.G.M.); (R.N.); (C.S.); (E.B.); (M.C.)
| | - Veronica Daniela Chiriac
- Department of Obstetrics and Gynecology, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania; (S.-G.I.); (A.G.); (G.D.); (A.G.M.); (R.N.); (C.S.); (E.B.); (M.C.)
- Correspondence: ; Tel.: +40-729-098-886
| | - Adrian Gluhovschi
- Department of Obstetrics and Gynecology, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania; (S.-G.I.); (A.G.); (G.D.); (A.G.M.); (R.N.); (C.S.); (E.B.); (M.C.)
| | - Valcovici Mihaela
- Department of Cardiology, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania;
| | - George Dahma
- Department of Obstetrics and Gynecology, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania; (S.-G.I.); (A.G.); (G.D.); (A.G.M.); (R.N.); (C.S.); (E.B.); (M.C.)
| | - Adelina Geanina Mocanu
- Department of Obstetrics and Gynecology, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania; (S.-G.I.); (A.G.); (G.D.); (A.G.M.); (R.N.); (C.S.); (E.B.); (M.C.)
| | - Radu Neamtu
- Department of Obstetrics and Gynecology, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania; (S.-G.I.); (A.G.); (G.D.); (A.G.M.); (R.N.); (C.S.); (E.B.); (M.C.)
| | - Carmen Silaghi
- Department of Obstetrics and Gynecology, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania; (S.-G.I.); (A.G.); (G.D.); (A.G.M.); (R.N.); (C.S.); (E.B.); (M.C.)
| | - Daniela Radu
- Department of General Surgery, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania;
| | - Elena Bernad
- Department of Obstetrics and Gynecology, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania; (S.-G.I.); (A.G.); (G.D.); (A.G.M.); (R.N.); (C.S.); (E.B.); (M.C.)
| | - Marius Craina
- Department of Obstetrics and Gynecology, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania; (S.-G.I.); (A.G.); (G.D.); (A.G.M.); (R.N.); (C.S.); (E.B.); (M.C.)
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