1
|
Feister J, Najera C, Rankin K, Collins JW. Lifetime Upward Economic Mobility and US-Born Latina Women's Preterm Birth Rates. Matern Child Health J 2024; 28:1086-1091. [PMID: 38308756 PMCID: PMC11058059 DOI: 10.1007/s10995-023-03890-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2023] [Indexed: 02/05/2024]
Abstract
OBJECTIVES To determine whether Latina women's upward economic mobility from early-life residence in impoverished urban neighborhoods is associated with preterm birth (< 37 weeks, PTB) . METHODS Multivariate logistic regression analyses were performed on the Illinois transgenerational birth-file with appended US census income information for Hispanic infants (born 1989-1991) and their mothers (born 1956-1976). RESULTS In Chicago, modestly impoverished-born Latina women (n = 1,674) who experienced upward economic mobility had a PTB rate of 8.5% versus 13.1% for those (n = 3,760) with a lifelong residence in modestly impoverished neighborhoods; the unadjusted and adjusted (controlling for age, marital status, adequacy of prenatal care, and cigarette smoking) RR equaled 0.65 (0.47, 0.90) and 0.66 (0.47, 0.93), respectively. Extremely impoverished-born Latina women (n = 2,507) who experienced upward economic mobility across their life-course had a PTB rate of 12.7% versus 15.9% for those (n = 3,849) who had a lifelong residence in extremely impoverished neighborhoods, the unadjusted and adjusted RR equaled 0.8 (0.63. 1.01) and 0.95 (0.75, 1.22), respectively. CONCLUSIONS FOR PRACTICE Latina women's upward economic mobility from early-life residence in modestly impoverished urban neighborhoods is associated with a decreased risk of PTB. A similar trend is absent among their peers with an early-life residence in extremely impoverished areas.
Collapse
Affiliation(s)
- John Feister
- Department of Pediatrics, University of Cincinnati College of Medicine, 3230 Eden Avenue, Cincinnati, OH, 45267, USA.
- Division of Neonatal and Pulmonary Biology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA.
| | - Clarissa Najera
- School of Public Health, Department of Epidemiology, University of Illinois, Chicago, USA
| | - Kristin Rankin
- School of Public Health, Department of Epidemiology, University of Illinois, Chicago, USA
| | - James W Collins
- Division of Neonatology, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave, Chicago, IL, 60611, USA
| |
Collapse
|
2
|
Feister J, Kan P, Lee HC, Sanders L. Readmission After Neonatal Intensive Care Unit Discharge: The Importance of Social Drivers of Health. J Pediatr 2024; 270:114014. [PMID: 38494087 DOI: 10.1016/j.jpeds.2024.114014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 02/23/2024] [Accepted: 03/12/2024] [Indexed: 03/19/2024]
Abstract
OBJECTIVE To determine associations between sociodemographic and medical factors and odds of readmission after discharge from the neonatal intensive care unit for infants with very low birth weight (<1500g). STUDY DESIGN Cohort study using linked data from the California Perinatal Quality Care Collaborative, California Vital Statistics, and the Child Opportunity Index (COI) 2.0. Infants with very low birth weight born from 2009 through 2018 in California were considered. Odds ratios of readmission within 30 days of discharge adjusting for infant medical factors, maternal sociodemographic factors, and birth hospital were calculated via multivariable logistic regression and fixed-effect logistic regression models. RESULTS A total of 42 411 infants met inclusion criteria. Also, 8.5% of all infants were readmitted within 30 days of discharge. In addition to traditional medical risk factors, two sociodemographic factors were significantly associated with increased odds of readmission in adjusted models: payor other than private insurance for delivery [aOR = 1.25 (95% CI 1.14-1.36)] and maternal education of less than high school degree [aOR = 1.19 (95% CI 1.06-1.33)]. Neighborhood Child Opportunity Index was not associated with odds of readmission. CONCLUSIONS Sociodemographic factors, including lack of private insurance and lower maternal educational attainment, are significantly and independently associated with increased odds of readmission after neonatal intensive care unit discharge, in addition to traditional medical risk factors. Socioeconomic deprivation and health literacy may contribute to risk of readmission. Targeted discharge interventions focused on addressing social drivers of health warrant exploration.
Collapse
Affiliation(s)
- John Feister
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH.
| | - Peiyi Kan
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA; California Perinatal Quality Care Collaborative, Palo Alto, CA
| | - Henry C Lee
- Department of Pediatrics, University of California San Diego, San Diego, CA
| | - Lee Sanders
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA; Department of Health Policy, Stanford University School of Medicine, Stanford, CA
| |
Collapse
|
3
|
Feister J, Razdan S, Sharp D, Punjabi S, Blecharczyk E, Escobar V, Gay PM, Scala M, Bonifacio S. Increasing in-person medical interpreter utilization in the NICU through a bundle of interventions. J Perinatol 2024:10.1038/s41372-024-01915-5. [PMID: 38424233 DOI: 10.1038/s41372-024-01915-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 02/05/2024] [Accepted: 02/16/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND In-person medical interpretation improves communication with patients who have preferred language other than English (PLOE). Multi-dimensional barriers to use of medical interpreters limit their use in the NICU. LOCAL PROBLEM Medical teams in our NICU were not consistently using in-person medical interpreters, leading to ineffective communication with families with PLOE. METHODS/INTERVENTIONS Interventions included staff educational sessions and grand rounds regarding equitable language access, distribution of interpreter request cards to families, and allocation of dedicated in-person interpreters for NICU rounds. Interpreter utilization was calculated by total requests per Spanish-speaking person day in the NICU. RESULTS Interpreter utilization increased five-fold during the intervention period (from 0.2 to 1.0 requests per Spanish-speaking person day). CONCLUSIONS We substantially increased our unit in-person interpreter utilization through a bundle of multifaceted interventions, many of which were low-cost. NICUs should regard dedicated medical interpreters as a critical part of the care team.
Collapse
Affiliation(s)
- John Feister
- Stanford University School of Medicine, Department of Pediatrics, Stanford, CA, USA.
- Lucile Packard Children's Hospital Stanford, Stanford, CA, USA.
- University of Cincinnati College of Medicine, Department of Pediatrics & Cincinnati Children's Hospital Medical Center Division of Neonatology, Cincinnati, OH, USA.
| | - Sheila Razdan
- Stanford University School of Medicine, Department of Pediatrics, Stanford, CA, USA
- Lucile Packard Children's Hospital Stanford, Stanford, CA, USA
| | - Danielle Sharp
- Stanford University School of Medicine, Department of Pediatrics, Stanford, CA, USA
- Lucile Packard Children's Hospital Stanford, Stanford, CA, USA
| | - Shamita Punjabi
- Stanford University School of Medicine, Department of Pediatrics, Stanford, CA, USA
- Lucile Packard Children's Hospital Stanford, Stanford, CA, USA
| | - Elizabeth Blecharczyk
- Stanford University School of Medicine, Department of Pediatrics, Stanford, CA, USA
- Lucile Packard Children's Hospital Stanford, Stanford, CA, USA
| | | | - Paw Mar Gay
- Stanford University School of Medicine, Department of Pediatrics, Stanford, CA, USA
| | - Melissa Scala
- Stanford University School of Medicine, Department of Pediatrics, Stanford, CA, USA
- Lucile Packard Children's Hospital Stanford, Stanford, CA, USA
| | - Sonia Bonifacio
- Stanford University School of Medicine, Department of Pediatrics, Stanford, CA, USA
- Lucile Packard Children's Hospital Stanford, Stanford, CA, USA
| |
Collapse
|
4
|
Marc-Aurele K, Branche T, Adams A, Feister J, Boyle K, Scala M. Recommendations for creating a collaborative NICU environment to support teamwork and trainee education. J Perinatol 2023; 43:1520-1525. [PMID: 37620402 DOI: 10.1038/s41372-023-01756-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 06/26/2023] [Accepted: 08/14/2023] [Indexed: 08/26/2023]
Abstract
In a 2022 survey, a majority of neonatology program directors reported regular conflict between neonatal-perinatal fellows and frontline providers (FLPs) (i.e., neonatal nurse practitioners (NNPs), neonatal physician assistants (PAs), and neonatal hospitalists). This paper reviews recommendations of a multidisciplinary workgroup for creating a more collaborative unit environment that supports teamwork and education. The self-study framework is a helpful tool to identify specific pressure points at individual institutions. Implementing clear guidelines for procedural distribution and role clarification are often critical interventions. FLPs and Pediatric Physician Trainees may benefit from conflict management coaching and communication training. At the same time, we recommend that respective leaders support a psychologically safe environment for team members to feel safe to solve problems on their own. Going forward, more work is important to optimize teamwork in the setting of anticipated staffing shortages, limitations to resident neonatology exposure, changes in training requirements, and ongoing development of the FLP role.
Collapse
Affiliation(s)
| | - Tonia Branche
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Aaron Adams
- Duke University School of Medicine, Durham, NC, USA
| | - John Feister
- Stanford University School of Medicine, Stanford, CA, USA
| | - Kristine Boyle
- Lucile Packard Children's Hospital Stanford, Stanford, CA, USA
| | - Melissa Scala
- Stanford University School of Medicine, Stanford, CA, USA.
| |
Collapse
|
5
|
Feister J, Kan P, Bonifacio SL, Profit J, Lee HC. Association of Primary Language with Very Low Birth Weight Outcomes in Hispanic Infants in California. J Pediatr 2023; 261:113527. [PMID: 37263521 DOI: 10.1016/j.jpeds.2023.113527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 05/23/2023] [Accepted: 05/24/2023] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To determine the association of Spanish as a primary language for a family with the health outcomes of Hispanic infants with very low birth weight (VLBW, <1500g). STUDY DESIGN Data from the California Perinatal Quality Care Collaborative (CPQCC) linked to hospital discharge records were analyzed. Hispanic infants with VLBW born between 2009 and 2018 with a primary language of English or Spanish were included. Outcomes selected were hypothesized to be sensitive to language barriers. Multivariable logistic regression models and mixed models estimated associations between language and outcomes. RESULTS Of 18 364 infants meeting inclusion criteria, 27% (n = 4976) were born to families with Spanish as a primary language. In unadjusted analyses, compared with infants of primarily English-speaking families, these infants had higher odds of hospital readmission within 1 year (OR 1.11 [95% CI 1.02-1.21]), higher odds to receive human milk at discharge (OR 1.32 [95% CI 1.23-1.42]), and lower odds of discharge home with oxygen (OR 0.83 [95% CI 0.73-0.94]). In multivariable analyses, odds of readmission and home oxygen remained significant when adjusting for infant but not maternal and hospital characteristics. Higher odds for receipt of any human milk at discharge were significant in all models. Remaining outcomes did not differ between groups. CONCLUSIONS Significant differences exist between Hispanic infants with VLBW of primarily Spanish-vs English-speaking families. Exploration of strategies to prevent readmissions of infants of families with Spanish as a primary language is warranted.
Collapse
Affiliation(s)
- John Feister
- Division of Neonatal & Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA.
| | - Peiyi Kan
- Division of Neonatal & Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA; California Perinatal Quality Care Collaborative, Palo Alto, CA
| | - Sonia L Bonifacio
- Division of Neonatal & Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
| | - Jochen Profit
- Division of Neonatal & Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA; California Perinatal Quality Care Collaborative, Palo Alto, CA
| | - Henry C Lee
- California Perinatal Quality Care Collaborative, Palo Alto, CA; Division of Neonatology, Department of Pediatrics, University of California San Diego, San Diego, CA
| |
Collapse
|
6
|
Tomatis Souverbielle C, Wang H, Feister J, Campbell J, Medoro A, Mejias A, Ramilo O, Pietropaolo D, Salamon D, Leber A, Erdem G. Year-Round, Routine Testing of Multiple Body Site Specimens for Human Parechovirus in Young Febrile Infants. J Pediatr 2021; 229:216-222.e2. [PMID: 33045237 PMCID: PMC7546655 DOI: 10.1016/j.jpeds.2020.10.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 08/12/2020] [Accepted: 10/02/2020] [Indexed: 01/05/2023]
Abstract
OBJECTIVES To test our hypothesis that routine year-round testing of specimens from multiple body sites and genotyping of detected virus would describe seasonal changes, increase diagnostic yield, and provide a better definition of clinical manifestations of human parechovirus (PeV-A) infections in young febrile infants. STUDY DESIGN PeV-A reverse-transcriptase polymerase chain reaction (RT-PCR) analysis was incorporated in routine evaluation of infants aged ≤60 days hospitalized at Nationwide Children's Hospital for fever and/or suspected sepsis-like syndrome beginning in July 2013. We reviewed electronic medical records of infants who tested positive for PeV-A between July 2013 and September 2016. Genotyping was performed with specific type 3 RT-PCR and sequencing. RESULTS Of 1475 infants evaluated, 130 (9%) tested positive for PeV-A in 1 or more sites: 100 (77%) in blood, 84 (65%) in a nonsterile site, and 53 (41%) in cerebrospinal fluid (CSF). Five infants (4%) were CSF-only positive, 31 (24%) were blood-only positive, and 20 (15%) were nonsterile site-only positive. PeV-A3 was the most common type (85%) and the only type detected in CSF. Although the majority (79%) of infections were diagnosed between July and December, PeV-A was detected year-round. The median age at detection was 29 days. Fever (96%), fussiness (75%), and lymphopenia (56%) were common. Among infants with PeV-A-positive CSF, 77% had no CSF pleocytosis. The median duration of hospitalization was 41 hours. Four infants had bacterial coinfections diagnosed within 24 hours of admission; 40 infants had viral coinfections. CONCLUSIONS Although most frequent in summer and fall, PeV-A infections were encountered in every calendar month within the 3-year period of study. More than one-half of patients had PeV-A detected at more than 1 body site. Coinfections were common. PeV-A3 was the most common type identified and the only type detected in the CSF.
Collapse
Affiliation(s)
| | - Huanyu Wang
- Department of Laboratory Medicine, Nationwide Children's Hospital, Columbus, OH
| | - John Feister
- Division of Infectious Diseases, Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH
| | - Jason Campbell
- Division of Infectious Diseases, Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH
| | - Alexandra Medoro
- Division of Infectious Diseases, Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH
| | - Asuncion Mejias
- Division of Infectious Diseases, Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH
| | - Octavio Ramilo
- Division of Infectious Diseases, Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH
| | - Domenico Pietropaolo
- Division of Infectious Diseases, Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH
| | - Douglas Salamon
- Department of Laboratory Medicine, Nationwide Children's Hospital, Columbus, OH
| | - Amy Leber
- Department of Laboratory Medicine, Nationwide Children's Hospital, Columbus, OH
| | - Guliz Erdem
- Division of Infectious Diseases, Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH
| |
Collapse
|
7
|
Tomatis Souverbielle C, Feister J, Leber A, Salamon D, Mejias A, Ramilo O, Erdem G. Multiple sites PCR testing for enteroviruses in young febrile infants. Lancet Infect Dis 2020; 19:239-240. [PMID: 30833055 DOI: 10.1016/s1473-3099(19)30042-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 01/25/2019] [Indexed: 10/27/2022]
Affiliation(s)
- Cristina Tomatis Souverbielle
- Division of Infectious Diseases, Nationwide Children's Hospital, Columbus, OH, USA; The Ohio State University, College of Medicine, Columbus, OH, USA.
| | - John Feister
- Division of Infectious Diseases, Nationwide Children's Hospital, Columbus, OH, USA; The Ohio State University, College of Medicine, Columbus, OH, USA
| | - Amy Leber
- Division of Laboratory Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Doug Salamon
- Division of Laboratory Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Asuncion Mejias
- Division of Infectious Diseases, Nationwide Children's Hospital, Columbus, OH, USA; The Ohio State University, College of Medicine, Columbus, OH, USA
| | - Octavio Ramilo
- Division of Infectious Diseases, Nationwide Children's Hospital, Columbus, OH, USA; The Ohio State University, College of Medicine, Columbus, OH, USA
| | - Guliz Erdem
- Division of Infectious Diseases, Nationwide Children's Hospital, Columbus, OH, USA; The Ohio State University, College of Medicine, Columbus, OH, USA
| |
Collapse
|
8
|
Feister J, Souverbielle CT, Medoro A, Campbell J, Ramilo O, Salamon D, Leber A, Erdem G. Comparison of Prevalence, Clinical and Laboratory Characteristics of Enterovirus (EV) and Human Parechovirus (HPeV) Infections in Infants Less Than Two Months of Age in Columbus, Ohio. Open Forum Infect Dis 2017. [DOI: 10.1093/ofid/ofx163.1856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|