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Agulnik A, Nogovitsyna Y, Kizyma R, Yakimkova T, Vivtcharenko V, Bhakta N, Wise PH, Rodriguez-Galindo C, Kacharian A. Strategies to promote sustainable care for children with cancer in Ukraine. Lancet Oncol 2024; 25:285-288. [PMID: 38307103 DOI: 10.1016/s1470-2045(23)00577-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 10/23/2023] [Accepted: 11/06/2023] [Indexed: 02/04/2024]
Affiliation(s)
- Asya Agulnik
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN 38105, USA; Division of Critical Care, St Jude Children's Research Hospital, Memphis, TN 38105, USA.
| | | | - Roman Kizyma
- Western Ukrainian Specialized Children's Medical Center, Lviv, Ukraine; Clinical Center for Children's Healthcare, Lviv, Ukraine
| | - Taisiya Yakimkova
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN 38105, USA
| | | | - Nickhill Bhakta
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Paul H Wise
- Department of Pediatrics, Department of Health Policy, Stanford University School of Medicine, Stanford, CA, USA
| | - Carlos Rodriguez-Galindo
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN 38105, USA
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Salek M, Mueller A, Alanbousi I, Cepowska Z, Dutkiewicz M, Earl J, Evseev D, Kizyma R, Kliuchkivska K, Kolodrubiec J, Matczak K, Nogovitsyna Y, Oszer A, Pogorelyy M, Raciborska A, Rasul S, Sokolowski I, Sopilnyak A, Vinitsky A, Wlodarski MW, Wobst N, Yakimkova T, Rodriguez-Galindo C, Wise PH, Mlynarski W, Agulnik A. Development of a centralised triage centre for children with cancer and blood disorders in response to the humanitarian crisis in Ukraine. Lancet Oncol 2023; 24:1315-1318. [PMID: 38039989 DOI: 10.1016/s1470-2045(23)00456-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 09/04/2023] [Accepted: 09/08/2023] [Indexed: 12/03/2023]
Affiliation(s)
- Marta Salek
- St Jude Children's Research Hospital, Memphis, TN 38103, USA.
| | | | - Inna Alanbousi
- St Jude Children's Research Hospital, Memphis, TN 38103, USA
| | | | | | - Julian Earl
- St Jude Children's Research Hospital, Memphis, TN 38103, USA
| | - Dmitry Evseev
- St Jude Children's Research Hospital, Memphis, TN 38103, USA
| | - Roman Kizyma
- Western Ukrainian Specialized Children's Medical Centre, Lviv, Ukraine
| | | | | | | | | | | | | | | | | | | | | | - Anna Vinitsky
- St Jude Children's Research Hospital, Memphis, TN 38103, USA
| | | | | | | | | | - Paul H Wise
- Stanford University School of Medicine, Stanford, CA, USA
| | | | - Asya Agulnik
- St Jude Children's Research Hospital, Memphis, TN 38103, USA
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Pang EM, Saynina O, Schapira L, Wise PH, Boynton H, Smith M, Chamberlain LJ, Smith SM. Cancer center-based follow-up among pediatric and adolescent/young adult cancer survivors: the role of a community-based organization and the social determinants of health. J Cancer Surviv 2023:10.1007/s11764-023-01463-5. [PMID: 37792162 DOI: 10.1007/s11764-023-01463-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 09/08/2023] [Indexed: 10/05/2023]
Abstract
PURPOSE Adherence to survivorship care is suboptimal among pediatric and adolescent/young adult (AYA) cancer survivors. We evaluated predictors of cancer center-based follow-up among pediatric/AYA cancer survivors, with an emphasis on social determinants of health (SDOH). METHODS This retrospective cohort study used electronic health record data at an academic medical center to identify patients aged 0-29 years at last cancer treatment who completed treatment 2010-2019. Cancer center-based follow-up was defined by oncology or survivorship clinic visits through 12/31/2022. Multivariate logistic regression models (overall, ages 0-19 [pediatric], 20-29 [YA]) evaluated the association of demographics, clinical/treatment characteristics, and SDOH (insurance type, distance to cancer center, area deprivation index) with clinic attendance. Further modeling accounted for the service area of a community-based organization (CBO) that supports families of children with cancer. RESULTS A total of 2210 survivors were included (56% pediatric, 44% YA; 66% non-White). Cancer center-based follow-up decreased from 94% 1-year post-treatment to 35% at > 5-7 years. In adjusted analysis, AYAs had the lowest follow-up (5-7 years post-treatment: OR 0.25 [0.15-0.41] for age 25-29; OR 0.25 [0.16-0.41] for age 20-24; OR 0.32 [0.20-0.52] for age 15-19). Survivors residing within the CBO service area were twice as likely to follow-up (OR 2.10 [1.34-3.29]). CONCLUSIONS Among a diverse population, AYA survivors were vulnerable to loss to follow-up. Other SDOH were not consistently associated with follow-up. Support from a CBO may partly explain these findings. IMPLICATIONS FOR CANCER SURVIVORS CBOs may strengthen survivorship follow-up within medically underserved communities. More research is needed to understand community support in survivorship.
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Affiliation(s)
- Emily M Pang
- Stanford University School of Medicine, Stanford, CA, USA
| | - Olga Saynina
- Center for Policy, Outcomes, and Prevention, Stanford University School of Medicine, Stanford, CA, USA
| | - Lidia Schapira
- Department of Medicine, Division of Oncology, Stanford University School of Medicine, Palo Alto, CA, USA
- Stanford Cancer Institute, Stanford, CA, USA
| | - Paul H Wise
- Center for Policy, Outcomes, and Prevention, Stanford University School of Medicine, Stanford, CA, USA
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Heidi Boynton
- Jacob's Heart Children's Cancer Support Services, Watsonville, CA, USA
| | - Mary Smith
- Jacob's Heart Children's Cancer Support Services, Watsonville, CA, USA
| | - Lisa J Chamberlain
- Center for Policy, Outcomes, and Prevention, Stanford University School of Medicine, Stanford, CA, USA
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Stephanie M Smith
- Department of Pediatrics, Division of Pediatric Hematology, Oncology, Stem Cell Transplantation & Regenerative Medicine, Stanford University School of Medicine, 750 Welch Rd, Suite 200, Palo Alto, CA, 94304, USA.
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Espinosa CA, Khan W, Khanam R, Das S, Khalid J, Pervin J, Kasaro MP, Contrepois K, Chang AL, Phongpreecha T, Michael B, Ellenberger M, Mehmood U, Hotwani A, Nizar A, Kabir F, Wong RJ, Becker M, Berson E, Culos A, De Francesco D, Mataraso S, Ravindra N, Thuraiappah M, Xenochristou M, Stelzer IA, Marić I, Dutta A, Raqib R, Ahmed S, Rahman S, Hasan ASMT, Ali SM, Juma MH, Rahman M, Aktar S, Deb S, Price JT, Wise PH, Winn VD, Druzin ML, Gibbs RS, Darmstadt GL, Murray JC, Stringer JSA, Gaudilliere B, Snyder MP, Angst MS, Rahman A, Baqui AH, Jehan F, Nisar MI, Vwalika B, Sazawal S, Shaw GM, Stevenson DK, Aghaeepour N. Multiomic signals associated with maternal epidemiological factors contributing to preterm birth in low- and middle-income countries. Sci Adv 2023; 9:eade7692. [PMID: 37224249 DOI: 10.1126/sciadv.ade7692] [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] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 04/20/2023] [Indexed: 05/26/2023]
Abstract
Preterm birth (PTB) is the leading cause of death in children under five, yet comprehensive studies are hindered by its multiple complex etiologies. Epidemiological associations between PTB and maternal characteristics have been previously described. This work used multiomic profiling and multivariate modeling to investigate the biological signatures of these characteristics. Maternal covariates were collected during pregnancy from 13,841 pregnant women across five sites. Plasma samples from 231 participants were analyzed to generate proteomic, metabolomic, and lipidomic datasets. Machine learning models showed robust performance for the prediction of PTB (AUROC = 0.70), time-to-delivery (r = 0.65), maternal age (r = 0.59), gravidity (r = 0.56), and BMI (r = 0.81). Time-to-delivery biological correlates included fetal-associated proteins (e.g., ALPP, AFP, and PGF) and immune proteins (e.g., PD-L1, CCL28, and LIFR). Maternal age negatively correlated with collagen COL9A1, gravidity with endothelial NOS and inflammatory chemokine CXCL13, and BMI with leptin and structural protein FABP4. These results provide an integrated view of epidemiological factors associated with PTB and identify biological signatures of clinical covariates affecting this disease.
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Affiliation(s)
- Camilo A Espinosa
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
- Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, CA, USA
| | - Waqasuddin Khan
- Department of Pediatrics and Child Health, Faculty of Health Sciences, Medical College, The Aga Khan University, Karachi, Pakistan
| | - Rasheda Khanam
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sayan Das
- Centre for Public Health Kinetics, New Delhi, Delhi, India
| | - Javairia Khalid
- Department of Pediatrics and Child Health, Faculty of Health Sciences, Medical College, The Aga Khan University, Karachi, Pakistan
| | - Jesmin Pervin
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Margaret P Kasaro
- University of North Carolina Global Projects Zambia, Lusaka, Zambia
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Kévin Contrepois
- Department of Genetics, Stanford University School of Medicine, Stanford, CA, USA
| | - Alan L Chang
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
- Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, CA, USA
| | - Thanaphong Phongpreecha
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, CA, USA
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Basil Michael
- Department of Genetics, Stanford University School of Medicine, Stanford, CA, USA
| | - Mathew Ellenberger
- Department of Genetics, Stanford University School of Medicine, Stanford, CA, USA
| | - Usma Mehmood
- Department of Pediatrics and Child Health, Faculty of Health Sciences, Medical College, The Aga Khan University, Karachi, Pakistan
| | - Aneeta Hotwani
- Department of Pediatrics and Child Health, Faculty of Health Sciences, Medical College, The Aga Khan University, Karachi, Pakistan
| | - Ambreen Nizar
- Department of Pediatrics and Child Health, Faculty of Health Sciences, Medical College, The Aga Khan University, Karachi, Pakistan
| | - Furqan Kabir
- Department of Pediatrics and Child Health, Faculty of Health Sciences, Medical College, The Aga Khan University, Karachi, Pakistan
| | - Ronald J Wong
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Martin Becker
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
- Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, CA, USA
| | - Eloise Berson
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, CA, USA
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Anthony Culos
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
- Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, CA, USA
- Department of Computer Science, Columbia University, New York, NY, USA
| | - Davide De Francesco
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
- Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, CA, USA
| | - Samson Mataraso
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
- Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, CA, USA
| | - Neal Ravindra
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
- Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, CA, USA
| | - Melan Thuraiappah
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
- Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, CA, USA
| | - Maria Xenochristou
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
- Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, CA, USA
| | - Ina A Stelzer
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Ivana Marić
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Arup Dutta
- Centre for Public Health Kinetics, New Delhi, Delhi, India
| | - Rubhana Raqib
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | | | | | | | - Said M Ali
- Public Health Laboratory-Ivo de Carneri, Pemba, Zanzibar, Tanzania
| | - Mohamed H Juma
- Public Health Laboratory-Ivo de Carneri, Pemba, Zanzibar, Tanzania
| | - Monjur Rahman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Shaki Aktar
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Saikat Deb
- Centre for Public Health Kinetics, New Delhi, Delhi, India
- Public Health Laboratory-Ivo de Carneri, Pemba, Zanzibar, Tanzania
| | - Joan T Price
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
- Department of Obstetrics and Gynaecology, University of Zambia School of Medicine, Lusaka, Zambia
| | - Paul H Wise
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Virginia D Winn
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA
| | - Maurice L Druzin
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA
| | - Ronald S Gibbs
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA
| | - Gary L Darmstadt
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Jeffrey C Murray
- Department of Pediatrics, University of Iowa, Iowa City, IA, USA
| | - Jeffrey S A Stringer
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Brice Gaudilliere
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Michael P Snyder
- Department of Genetics, Stanford University School of Medicine, Stanford, CA, USA
| | - Martin S Angst
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Anisur Rahman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Abdullah H Baqui
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Fyezah Jehan
- Department of Pediatrics and Child Health, Faculty of Health Sciences, Medical College, The Aga Khan University, Karachi, Pakistan
| | - Muhammad Imran Nisar
- Department of Pediatrics and Child Health, Faculty of Health Sciences, Medical College, The Aga Khan University, Karachi, Pakistan
| | - Bellington Vwalika
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
- Department of Obstetrics and Gynaecology, University of Zambia School of Medicine, Lusaka, Zambia
| | - Sunil Sazawal
- Centre for Public Health Kinetics, New Delhi, Delhi, India
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Gary M Shaw
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - David K Stevenson
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Nima Aghaeepour
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
- Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, CA, USA
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Wise PH. Advocacy for Unaccompanied Migrant Children in US Detention. Pediatr Clin North Am 2023; 70:103-116. [PMID: 36402461 DOI: 10.1016/j.pcl.2022.09.006] [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] [Indexed: 11/18/2022]
Abstract
During 2021, nearly 150,000 unaccompanied children (UCs) were apprehended at the US-Mexican border. Most are leaving Guatemala, Honduras, and El Salvador, motivated by poverty, climate change, and violence. UCs are most often apprehended by the Border Patrol and then transferred to the Office of Refugee Resettlement (ORR), the Department of Health and Human Services. ORR is responsible for ensuring that the child is released to a parent or sponsor in the United States capable of providing an adequate home. Advocacy must not only address a complex system of legal and custodial care but also confront a troubled political environment.
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Affiliation(s)
- Paul H Wise
- Freeman Spogli Institute for International Studies, Stanford University, Encina Commons, Room 226, Stanford, CA 94305, USA.
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Padrez RC, Chamberlain LJ, Wise PH. A Lost Pandemic Generation: Only If We Do Not Act Now. JAMA Netw Open 2023; 6:e2249267. [PMID: 36622680 DOI: 10.1001/jamanetworkopen.2022.49267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Affiliation(s)
- Ryan C Padrez
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Lisa J Chamberlain
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Paul H Wise
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California
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7
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Agulnik A, Kizyma R, Salek M, Wlodarski MW, Pogorelyy M, Oszer A, Yakimkova T, Nogovitsyna Y, Dutkiewicz M, Dalle JH, Dirksen U, Eggert A, Fernández-Teijeiro A, Greiner J, Kraal K, Mueller A, Sramkova L, Zecca M, Wise PH, Mlynarski W. Global effort to evacuate Ukrainian children with cancer and blood disorders who have been affected by war. Lancet Haematol 2022; 9:e645-e647. [PMID: 36055331 DOI: 10.1016/s2352-3026(22)00259-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 08/04/2022] [Accepted: 08/05/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Asya Agulnik
- St Jude Children's Research Hospital, Memphis, TN, USA.
| | - Roman Kizyma
- Western Ukrainian Specialized Children's Medical Center, Lviv, Ukraine
| | - Marta Salek
- St Jude Children's Research Hospital, Memphis, TN, USA
| | | | | | | | | | | | | | | | | | | | | | - Jeanette Greiner
- Children's Hospital of Eastern Switzerland, St. Gallen, Switzerland
| | - Kathelijne Kraal
- Princess Maxima Centre for Pediatric Oncology, Utrecht, Netherlands
| | | | | | - Marco Zecca
- Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Paul H Wise
- Stanford University School of Medicine, Stanford, CA, USA
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Kumar WM, Gebregziabher BA, Mengesha RE, Wise PH. Humanitarian aid must be allowed to enter the besieged Tigray region of Ethiopia. Nat Med 2022; 28:1734-1735. [PMID: 35982308 DOI: 10.1038/s41591-022-01921-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Wasan M Kumar
- Stanford University School of Medicine, Stanford, CA, USA
| | | | - Reiye E Mengesha
- Department of Surgery, Ayder Comprehensive Specialized Hospital and College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Paul H Wise
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA.
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9
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Affiliation(s)
- Paul H Wise
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Lisa J Chamberlain
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California
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10
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Cahan EM, Maturi J, Bailey P, Fernandes S, Addala A, Kibrom S, Krissberg JR, Smith SM, Shah S, Wang E, Saynina O, Wise PH, Chamberlain LJ. The Impact of Telehealth Adoption During COVID-19 Pandemic on Patterns of Pediatric Subspecialty Care Utilization. Acad Pediatr 2022; 22:1375-1383. [PMID: 35318159 PMCID: PMC8933868 DOI: 10.1016/j.acap.2022.03.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 03/13/2022] [Accepted: 03/16/2022] [Indexed: 01/18/2023]
Abstract
OBJECTIVE The COVID-19 pandemic prompted health systems to rapidly adopt telehealth for clinical care. We examined the impact of demography, subspecialty characteristics, and broadband availability on the utilization of telehealth in pediatric populations before and after the early period of the COVID-19 pandemic. METHODS Outpatients scheduled for subspecialty visits at sites affiliated with a single quaternary academic medical center between March-June 2019 and March-June 2020 were included. The contribution of demographic, socioeconomic, and broadband availability to visit completion and telehealth utilization were examined in multivariable regression analyses. RESULTS Among visits scheduled in 2020 compared to 2019, in-person visits fell from 23,318 to 11,209, while telehealth visits increased from 150 to 7,675. Visits among established patients fell by 15% and new patients by 36% (P < .0001). Multivariable analysis revealed that completed visits were reduced for Hispanic patients and those with reduced broadband; high income, private non-HMO insurance, and those requesting an interpreter were more likely to complete visits. Those with visits scheduled in 2020, established patients, those with reduced broadband, and patients older than 1 year were more likely to complete TH appointments. Cardiology, oncology, and pulmonology patients were less likely to complete scheduled TH appointments. CONCLUSIONS Following COVID-19 onset, outpatient pediatric subspecialty visits shifted rapidly to telehealth. However, the impact of this shift on social disparities in outpatient utilization was mixed with variation among subspecialties. A growing reliance on telehealth will necessitate insights from other healthcare settings serving populations of diverse social and technological character.
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Affiliation(s)
- Eli M. Cahan
- Department of Pediatrics (EM Cahan, J Maturi, P Bailey, S Fernandes, A Addala, S Kibrom, JR Krissberg, SM Smith, S Shah, E Wang, PH Wise, and LJ Chamberlain), Stanford School of Medicine, Stanford, Calif,New York University School of Medicine (EM Cahan), New York, NY,Address correspondence to Eli M. Cahan, MS, Department of Pediatrics, Stanford School of Medicine, 770 Welch Road, #100, Stanford, CA 94305
| | - Jay Maturi
- Department of Pediatrics (EM Cahan, J Maturi, P Bailey, S Fernandes, A Addala, S Kibrom, JR Krissberg, SM Smith, S Shah, E Wang, PH Wise, and LJ Chamberlain), Stanford School of Medicine, Stanford, Calif
| | - Paige Bailey
- Department of Pediatrics (EM Cahan, J Maturi, P Bailey, S Fernandes, A Addala, S Kibrom, JR Krissberg, SM Smith, S Shah, E Wang, PH Wise, and LJ Chamberlain), Stanford School of Medicine, Stanford, Calif
| | - Susan Fernandes
- Department of Pediatrics (EM Cahan, J Maturi, P Bailey, S Fernandes, A Addala, S Kibrom, JR Krissberg, SM Smith, S Shah, E Wang, PH Wise, and LJ Chamberlain), Stanford School of Medicine, Stanford, Calif,Department of Medicine (S Fernandes), Stanford School of Medicine, Stanford, Calif
| | - Ananta Addala
- Department of Pediatrics (EM Cahan, J Maturi, P Bailey, S Fernandes, A Addala, S Kibrom, JR Krissberg, SM Smith, S Shah, E Wang, PH Wise, and LJ Chamberlain), Stanford School of Medicine, Stanford, Calif
| | - Sara Kibrom
- Department of Pediatrics (EM Cahan, J Maturi, P Bailey, S Fernandes, A Addala, S Kibrom, JR Krissberg, SM Smith, S Shah, E Wang, PH Wise, and LJ Chamberlain), Stanford School of Medicine, Stanford, Calif
| | - Jill R. Krissberg
- Department of Pediatrics (EM Cahan, J Maturi, P Bailey, S Fernandes, A Addala, S Kibrom, JR Krissberg, SM Smith, S Shah, E Wang, PH Wise, and LJ Chamberlain), Stanford School of Medicine, Stanford, Calif
| | - Stephanie M. Smith
- Department of Pediatrics (EM Cahan, J Maturi, P Bailey, S Fernandes, A Addala, S Kibrom, JR Krissberg, SM Smith, S Shah, E Wang, PH Wise, and LJ Chamberlain), Stanford School of Medicine, Stanford, Calif
| | - Sejal Shah
- Department of Pediatrics (EM Cahan, J Maturi, P Bailey, S Fernandes, A Addala, S Kibrom, JR Krissberg, SM Smith, S Shah, E Wang, PH Wise, and LJ Chamberlain), Stanford School of Medicine, Stanford, Calif
| | - Ewen Wang
- Department of Pediatrics (EM Cahan, J Maturi, P Bailey, S Fernandes, A Addala, S Kibrom, JR Krissberg, SM Smith, S Shah, E Wang, PH Wise, and LJ Chamberlain), Stanford School of Medicine, Stanford, Calif,Center for Policy, Outcomes, and Prevention (E Wang, O Saynina, PH Wise, and LJ Chamberlain), Stanford School of Medicine, Stanford, Calif,Department of Emergency Medicine (E Wang), Stanford School of Medicine, Stanford, Calif
| | - Olga Saynina
- Center for Policy, Outcomes, and Prevention (E Wang, O Saynina, PH Wise, and LJ Chamberlain), Stanford School of Medicine, Stanford, Calif
| | - Paul H. Wise
- Department of Pediatrics (EM Cahan, J Maturi, P Bailey, S Fernandes, A Addala, S Kibrom, JR Krissberg, SM Smith, S Shah, E Wang, PH Wise, and LJ Chamberlain), Stanford School of Medicine, Stanford, Calif,Center for Policy, Outcomes, and Prevention (E Wang, O Saynina, PH Wise, and LJ Chamberlain), Stanford School of Medicine, Stanford, Calif
| | - Lisa J. Chamberlain
- Department of Pediatrics (EM Cahan, J Maturi, P Bailey, S Fernandes, A Addala, S Kibrom, JR Krissberg, SM Smith, S Shah, E Wang, PH Wise, and LJ Chamberlain), Stanford School of Medicine, Stanford, Calif,Center for Policy, Outcomes, and Prevention (E Wang, O Saynina, PH Wise, and LJ Chamberlain), Stanford School of Medicine, Stanford, Calif
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11
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Martinez Garcia D, Amsalu R, Harkensee C, Janet S, Kadir A, Kampalath VN, Nejat S, Wise PH. Humanitarian paediatrics: A statement of purpose. PLOS Glob Public Health 2022; 2:e0001431. [PMID: 36962911 PMCID: PMC10021314 DOI: 10.1371/journal.pgph.0001431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Daniel Martinez Garcia
- Geneva University Paediatric Hospital, Geneva, Switzerland
- Médecins Sans Frontières, Toronto, Canada
| | - Ribka Amsalu
- California Preterm Birth Initiative, Department of Obstetrics, Gynaecology, & Reproductive Sciences, University of California San Francisco, San Francisco, San Francisco, California, United States of America
| | | | | | | | - Vinay N Kampalath
- Division of Emergency Medicine, Department of Paediatrics, Children's Hospital of Philadelphia and University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, United States of America
| | | | - Paul H Wise
- Stanford University School of Medicine, Stanford, California, United States of America
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12
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Braveman P, Dominguez TP, Burke W, Dolan SM, Stevenson DK, Jackson FM, Collins JW, Driscoll DA, Haley T, Acker J, Shaw GM, McCabe ERB, Hay WW, Thornburg K, Acevedo-Garcia D, Cordero JF, Wise PH, Legaz G, Rashied-Henry K, Frost J, Verbiest S, Waddell L. Explaining the Black-White Disparity in Preterm Birth: A Consensus Statement From a Multi-Disciplinary Scientific Work Group Convened by the March of Dimes. Front Reprod Health 2021; 3:684207. [PMID: 36303973 PMCID: PMC9580804 DOI: 10.3389/frph.2021.684207] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 07/06/2021] [Indexed: 11/30/2022] Open
Abstract
In 2017–2019, the March of Dimes convened a workgroup with biomedical, clinical, and epidemiologic expertise to review knowledge of the causes of the persistent Black-White disparity in preterm birth (PTB). Multiple databases were searched to identify hypothesized causes examined in peer-reviewed literature, 33 hypothesized causes were reviewed for whether they plausibly affect PTB and either occur more/less frequently and/or have a larger/smaller effect size among Black women vs. White women. While definitive proof is lacking for most potential causes, most are biologically plausible. No single downstream or midstream factor explains the disparity or its social patterning, however, many likely play limited roles, e.g., while genetic factors likely contribute to PTB, they explain at most a small fraction of the disparity. Research links most hypothesized midstream causes, including socioeconomic factors and stress, with the disparity through their influence on the hypothesized downstream factors. Socioeconomic factors alone cannot explain the disparity's social patterning. Chronic stress could affect PTB through neuroendocrine and immune mechanisms leading to inflammation and immune dysfunction, stress could alter a woman's microbiota, immune response to infection, chronic disease risks, and behaviors, and trigger epigenetic changes influencing PTB risk. As an upstream factor, racism in multiple forms has repeatedly been linked with the plausible midstream/downstream factors, including socioeconomic disadvantage, stress, and toxic exposures. Racism is the only factor identified that directly or indirectly could explain the racial disparities in the plausible midstream/downstream causes and the observed social patterning. Historical and contemporary systemic racism can explain the racial disparities in socioeconomic opportunities that differentially expose African Americans to lifelong financial stress and associated health-harming conditions. Segregation places Black women in stressful surroundings and exposes them to environmental hazards. Race-based discriminatory treatment is a pervasive stressor for Black women of all socioeconomic levels, considering both incidents and the constant vigilance needed to prepare oneself for potential incidents. Racism is a highly plausible, major upstream contributor to the Black-White disparity in PTB through multiple pathways and biological mechanisms. While much is unknown, existing knowledge and core values (equity, justice) support addressing racism in efforts to eliminate the racial disparity in PTB.
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Affiliation(s)
- Paula Braveman
- School of Medicine, University of California, San Francisco, San Francisco, CA, United States
- *Correspondence: Paula Braveman
| | - Tyan Parker Dominguez
- USC Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, United States
| | - Wylie Burke
- University of Washington School of Medicine, Seattle, WA, United States
| | - Siobhan M. Dolan
- Albert Einstein College of Medicine, New York, NY, United States
| | | | | | - James W. Collins
- Northwestern University School of Medicine, Chicago, IL, United States
| | - Deborah A. Driscoll
- University of Pennsylvania School of Medicine, Philadelphia, PA, United States
| | - Terinney Haley
- School of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Julia Acker
- School of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Gary M. Shaw
- Stanford University School of Medicine, Stanford, CA, United States
| | - Edward R. B. McCabe
- David Geffen School of Medicine at University of California, Los Angeles, CA, United States
| | | | - Kent Thornburg
- School of Medicine, Oregon State University, Portland, OR, United States
| | | | - José F. Cordero
- University of Georgia College of Public Health, Athens, GA, United States
| | - Paul H. Wise
- Stanford University School of Medicine, Stanford, CA, United States
| | - Gina Legaz
- March of Dimes, White Plains, NY, United States
| | | | | | - Sarah Verbiest
- University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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13
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Koch MR, Kanneh L, Wise PH, Kurina LM, Alhasan F, Garry RF, Schieffelin JS, Shaffer JG, Grant DS. Health seeking behavior after the 2013-16 Ebola epidemic: Lassa fever as a metric of persistent changes in Kenema District, Sierra Leone. PLoS Negl Trop Dis 2021; 15:e0009576. [PMID: 34260615 PMCID: PMC8312964 DOI: 10.1371/journal.pntd.0009576] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 07/26/2021] [Accepted: 06/19/2021] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND The West African Ebola epidemic of 2013-2016 killed nearly 4,000 Sierra Leoneans and devastated health infrastructure across West Africa. Changes in health seeking behavior (HSB) during the outbreak resulted in dramatic underreporting and substantial declines in hospital presentations to public health facilities, resulting in an estimated tens of thousands of additional maternal, infant, and adult deaths per year. Sierra Leone's Kenema District, a major Ebola hotspot, is also endemic for Lassa fever (LF), another often-fatal hemorrhagic disease. Here we assess the impact of the West African Ebola epidemic on health seeking behaviors with respect to presentations to the Kenema Government Hospital (KGH) Lassa Ward, which serves as the primary health care referral center for suspected Lassa fever cases in the Eastern Province of Sierra Leone. METHODOLOGY/PRINCIPAL FINDINGS Presentation frequencies for suspected Lassa fever presenting to KGH or one of its referral centers from 2011-2019 were analyzed to consider the potential impact of the West African Ebola epidemic on presentation patterns. There was a significant decline in suspected LF cases presenting to KGH following the epidemic, and a lower percentage of subjects were admitted to the KGH Lassa Ward following the epidemic. To assess general HSB, a questionnaire was developed and administered to 200 residents from 8 villages in Kenema District. Among 194 completed interviews, 151 (78%) of respondents stated they felt hospitals were safer post-epidemic with no significant differences noted among subjects according to religious background, age, gender, or education. However, 37 (19%) subjects reported decreased attendance at hospitals since the epidemic, which suggests that trust in the healthcare system has not fully rebounded. Cost was identified as a major deterrent to seeking healthcare. CONCLUSIONS/SIGNIFICANCE Analysis of patient demographic data suggests that fewer individuals sought care for Lassa fever and other febrile illnesses in Kenema District after the West African Ebola epidemic. Re-establishing trust in health care services will require efforts beyond rebuilding infrastructure and require concerted efforts to rebuild the trust of local residents who may be wary of seeking healthcare post epidemic.
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Affiliation(s)
- Mikaela R. Koch
- Program in Human Biology, Stanford University, Stanford, California, United States of America
- * E-mail: (MRK); (JGS); (DSG)
| | - Lansana Kanneh
- Pediatrics–Neonatal and Developmental Medicine, Stanford University, Stanford, California, United States of America
| | - Paul H. Wise
- Pediatrics–Neonatal and Developmental Medicine, Stanford University, Stanford, California, United States of America
| | - Lianne M. Kurina
- Program in Human Biology, Stanford University, Stanford, California, United States of America
| | - Foday Alhasan
- Viral Hemorrhagic Fever Program, Kenema Government Hospital, Kenema, Sierra Leone
| | - Robert F. Garry
- Tulane University, School of Medicine, Department of Microbiology and Immunology, New Orleans, Louisiana, United States of America
- Zalgen Labs, LCC, Germantown, MD, United States of America
| | - John S. Schieffelin
- Sections of Infectious Disease, Department of Pediatrics, School of Medicine, Tulane University, New Orleans, Louisiana, United States of America
| | - Jeffrey G. Shaffer
- Department of Biostatistics and Bioinformatics, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States of America
- * E-mail: (MRK); (JGS); (DSG)
| | - Donald S. Grant
- Viral Hemorrhagic Fever Program, Kenema Government Hospital, Kenema, Sierra Leone
- Ministry of Health and Sanitation, Freetown, Sierra Leone
- * E-mail: (MRK); (JGS); (DSG)
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14
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Nesamoney SN, Darmstadt GL, Wise PH. Gendered effects of COVID-19 on young girls in regions of conflict. Lancet 2021; 397:1880-1881. [PMID: 34022981 PMCID: PMC9751750 DOI: 10.1016/s0140-6736(21)00936-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 04/15/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Sophia N Nesamoney
- King Center on Global Development, Stanford University, Stanford, CA, USA
| | - Gary L Darmstadt
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA 94305, USA.
| | - Paul H Wise
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA 94305, USA
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15
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Nesamoney SN, Darmstadt GL, Wise PH. Addressing the impacts of COVID-19 on gender equality and global health security in regions of violent conflict. J Glob Health 2021; 11:03074. [PMID: 34055324 PMCID: PMC8141325 DOI: 10.7189/jogh.11.03074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
| | - Gary L Darmstadt
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Paul H Wise
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
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16
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Wise PH, Shiel A, Southard N, Bendavid E, Welsh J, Stedman S, Fazal T, Felbab-Brown V, Polatty D, Waldman RJ, Spiegel PB, Blanchet K, Dayoub R, Zakayo A, Barry M, Martinez Garcia D, Pagano H, Black R, Gaffey MF, Bhutta ZA. The political and security dimensions of the humanitarian health response to violent conflict. Lancet 2021; 397:511-521. [PMID: 33503458 DOI: 10.1016/s0140-6736(21)00130-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [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: 01/15/2020] [Revised: 10/01/2020] [Accepted: 10/02/2020] [Indexed: 11/22/2022]
Abstract
The nature of armed conflict throughout the world is intensely dynamic. Consequently, the protection of non-combatants and the provision of humanitarian services must continually adapt to this changing conflict environment. Complex political affiliations, the systematic use of explosive weapons and sexual violence, and the use of new communication technology, including social media, have created new challenges for humanitarian actors in negotiating access to affected populations and security for their own personnel. The nature of combatants has also evolved as armed, non-state actors might have varying motivations, use different forms of violence, and engage in a variety of criminal activities to generate requisite funds. New health threats, such as the COVID-19 pandemic, and new capabilities, such as modern trauma care, have also created new challenges and opportunities for humanitarian health provision. In response, humanitarian policies and practices must develop negotiation and safety capabilities, informed by political and security realities on the ground, and guidance from affected communities. More fundamentally, humanitarian policies will need to confront a changing geopolitical environment, in which traditional humanitarian norms and protections might encounter wavering support in the years to come.
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Affiliation(s)
- Paul H Wise
- Department of Pediatrics, Stanford University, CA, USA; Center for Innovation in Global Health, Stanford University, CA, USA; Stanford University School of Medicine, and The Freeman Spogli Institute for International Studies, Stanford University, CA, USA.
| | - Annie Shiel
- Stanford University School of Medicine, and The Freeman Spogli Institute for International Studies, Stanford University, CA, USA; Center for Civilians in Conflict, Washington DC, USA
| | - Nicole Southard
- Stanford University School of Medicine, and The Freeman Spogli Institute for International Studies, Stanford University, CA, USA
| | - Eran Bendavid
- Center for Innovation in Global Health, Stanford University, CA, USA; Department of Medicine, Stanford University, CA, USA; Stanford University School of Medicine, and The Freeman Spogli Institute for International Studies, Stanford University, CA, USA
| | - Jennifer Welsh
- Department of Political Science, McGill University, Montreal, QC, Canada
| | - Stephen Stedman
- Stanford University School of Medicine, and The Freeman Spogli Institute for International Studies, Stanford University, CA, USA
| | - Tanisha Fazal
- Department of Political Science, University of Minnesota, Minneapolis, MN, USA
| | - Vanda Felbab-Brown
- The Initiative on Nonstate Armed Actors, Foreign Policy Program, The Brookings Institution, Washington DC, USA
| | - David Polatty
- Civilian-Military Humanitarian Response Program, United States Naval War College, Newport, RI, USA
| | - Ronald J Waldman
- Milken Institute School of Public Health, George Washington University, Washington DC, USA
| | - Paul B Spiegel
- Center for Humanitarian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Karl Blanchet
- Geneva Centre for Education and Research in Humanitarian Action, University of Geneva, Geneva, Switzerland; Health and Humanitarian Crises Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Rita Dayoub
- Centre on Global Health Security, Chatham House, London, UK
| | | | - Michele Barry
- Center for Innovation in Global Health, Stanford University, CA, USA; Department of Medicine, Stanford University, CA, USA; Stanford University School of Medicine, and The Freeman Spogli Institute for International Studies, Stanford University, CA, USA
| | | | | | - Robert Black
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Michelle F Gaffey
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Centre of Excellence in Women and Child Health and Institute for Global Health and Development, The Aga Khan University, Karachi, Pakistan
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17
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Singh NS, Ataullahjan A, Ndiaye K, Das JK, Wise PH, Altare C, Ahmed Z, Sami S, Akik C, Tappis H, Mirzazada S, Garcés-Palacio IC, Ghattas H, Langer A, Waldman RJ, Spiegel P, Bhutta ZA, Blanchet K. Delivering health interventions to women, children, and adolescents in conflict settings: what have we learned from ten country case studies? Lancet 2021; 397:533-542. [PMID: 33503459 DOI: 10.1016/s0140-6736(21)00132-x] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [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: 12/20/2019] [Revised: 10/05/2020] [Accepted: 10/05/2020] [Indexed: 10/22/2022]
Abstract
Armed conflict disproportionately affects the morbidity, mortality, and wellbeing of women, newborns, children, and adolescents. Our study presents insights from a collection of ten country case studies aiming to assess the provision of sexual, reproductive, maternal, newborn, child, and adolescent health and nutrition interventions in ten conflict-affected settings in Afghanistan, Colombia, Democratic Republic of the Congo, Mali, Nigeria, Pakistan, Somalia, South Sudan, Syria, and Yemen. We found that despite large variations in contexts and decision making processes, antenatal care, basic emergency obstetric and newborn care, comprehensive emergency obstetric and newborn care, immunisation, treatment of common childhood illnesses, infant and young child feeding, and malnutrition treatment and screening were prioritised in these ten conflict settings. Many lifesaving women's and children's health (WCH) services, including the majority of reproductive, newborn, and adolescent health services, are not reported as being delivered in the ten conflict settings, and interventions to address stillbirths are absent. International donors remain the primary drivers of influencing the what, where, and how of implementing WCH interventions. Interpretation of WCH outcomes in conflict settings are particularly context-dependent given the myriad of complex factors that constitute conflict and their interactions. Moreover, the comprehensiveness and quality of data remain limited in conflict settings. The dynamic nature of modern conflict and the expanding role of non-state armed groups in large geographic areas pose new challenges to delivering WCH services. However, the humanitarian system is creative and pluralistic and has developed some novel solutions to bring lifesaving WCH services closer to populations using new modes of delivery. These solutions, when rigorously evaluated, can represent concrete response to current implementation challenges to modern armed conflicts.
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Affiliation(s)
- Neha S Singh
- Health in Humanitarian Crises Centre, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Khadidiatou Ndiaye
- Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Jai K Das
- Centre of Excellence in Women and Child Health and Institute of Global Health and Development, The Aga Khan University, Karachi, Pakistan
| | - Paul H Wise
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Chiara Altare
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Zahra Ahmed
- Somali Disaster Resilience Institute, Mogadishu, Somalia
| | - Samira Sami
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; CDC National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of HIV/AIDS Prevention, Atlanta, GA, USA
| | - Chaza Akik
- Center for Research on Population and Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Hannah Tappis
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | - Hala Ghattas
- Center for Research on Population and Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Ana Langer
- Women and Health Initiative, Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Ronald J Waldman
- Global Health Department, Milken Institute School of Public Health, George Washington University, Washington, DC, USA; Doctors of the World, New York, NY, USA
| | - Paul Spiegel
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada; Centre of Excellence in Women and Child Health and Institute of Global Health and Development, The Aga Khan University, Karachi, Pakistan
| | - Karl Blanchet
- Health in Humanitarian Crises Centre, London School of Hygiene & Tropical Medicine, London, UK; The Geneva Centre of Humanitarian Studies, University of Geneva, Graduate Institute, Geneva 1211, Switzerland.
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18
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Bendavid E, Boerma T, Akseer N, Langer A, Malembaka EB, Okiro EA, Wise PH, Heft-Neal S, Black RE, Bhutta ZA. The effects of armed conflict on the health of women and children. Lancet 2021; 397:522-532. [PMID: 33503456 PMCID: PMC7612212 DOI: 10.1016/s0140-6736(21)00131-8] [Citation(s) in RCA: 86] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 10/03/2020] [Accepted: 10/05/2020] [Indexed: 01/16/2023]
Abstract
Women and children bear substantial morbidity and mortality as a result of armed conflicts. This Series paper focuses on the direct (due to violence) and indirect health effects of armed conflict on women and children (including adolescents) worldwide. We estimate that nearly 36 million children and 16 million women were displaced in 2017, on the basis of international databases of refugees and internally displaced populations. From geospatial analyses we estimate that the number of non-displaced women and children living dangerously close to armed conflict (within 50 km) increased from 185 million women and 250 million children in 2000, to 265 million women and 368 million children in 2017. Women's and children's mortality risk from non-violent causes increases substantially in response to nearby conflict, with more intense and more chronic conflicts leading to greater mortality increases. More than 10 million deaths in children younger than 5 years can be attributed to conflict between 1995 and 2015 globally. Women of reproductive ages living near high intensity conflicts have three times higher mortality than do women in peaceful settings. Current research provides fragmentary evidence about how armed conflict indirectly affects the survival chances of women and children through malnutrition, physical injuries, infectious diseases, poor mental health, and poor sexual and reproductive health, but major systematic evidence is sparse, hampering the design and implementation of essential interventions for mitigating the harms of armed conflicts.
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Affiliation(s)
- Eran Bendavid
- Center for Population Health Sciences, Division of Primary Care and Population Health, Department of Medicine, Stanford University, CA, USA.
| | - Ties Boerma
- Center for Global Public Health, University of Manitoba, Winnipeg, MB, Canada
| | - Nadia Akseer
- Centre for Global Child Health, Hospital for Sick Children (SickKids), Toronto, ON, Canada; The Institute for International Programs, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Ana Langer
- Women and Health Initiative, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Espoir Bwenge Malembaka
- Ecole Régionale de Santé Publique, Faculté de Médecine, Université Catholique de Bukavu, Bukavu, DR Congo
| | - Emelda A Okiro
- Population Health Unit, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya; Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Paul H Wise
- Department of Pediatrics, Stanford University, CA, USA
| | - Sam Heft-Neal
- Center on Food Security and the Environment, Stanford University, CA, USA
| | - Robert E Black
- The Institute for International Programs, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, Hospital for Sick Children (SickKids), Toronto, ON, Canada; Centre of Excellence in Women and Child Health and Institute for Global Health and Development, The Aga Khan University, Karachi, Pakistan
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19
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Bhutta ZA, Gaffey MF, Spiegel PB, Waldman RJ, Wise PH, Blanchet K, Boerma T, Langer A, Black RE. Doing better for women and children in armed conflict settings. Lancet 2021; 397:448-450. [PMID: 33503454 DOI: 10.1016/s0140-6736(21)00127-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 10/02/2020] [Accepted: 10/02/2020] [Indexed: 11/22/2022]
Affiliation(s)
- Zulfiqar A Bhutta
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, ON, M5G 0A4, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Centre of Excellence in Women and Child Health and Institute for Global Health and Development, The Aga Khan University, Karachi, Pakistan; Milken Institute School of Public Health, George Washington University, Washington, DC, USA; Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Michelle F Gaffey
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, ON, M5G 0A4, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Paul B Spiegel
- Center for Humanitarian Health, Johns Hopkins University, Baltimore, MD, USA
| | - Ronald J Waldman
- Milken Institute School of Public Health, George Washington University, Washington, DC, USA; Doctors of the World USA, New York, NY, USA
| | - Paul H Wise
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Karl Blanchet
- The Geneva Centre of Humanitarian Studies, University of Geneva, The Graduate Institute, Geneva, Switzerland; Health in Humanitarian Crises Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Ties Boerma
- Centre for Global Public Health, University of Manitoba, Winnipeg, MB, Canada
| | - Ana Langer
- Women and Health Initiative, Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Robert E Black
- Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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20
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Main EK, Chang SC, Carpenter AM, Wise PH, Stevenson DK, Shaw GM, Gould JB. Singleton preterm birth rates for racial and ethnic groups during the coronavirus disease 2019 pandemic in California. Am J Obstet Gynecol 2021; 224:239-241. [PMID: 33203528 PMCID: PMC7582039 DOI: 10.1016/j.ajog.2020.10.033] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 10/21/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Elliott K Main
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford Medical School Office Bldg., 1265 Welch Rd., MS 5415, Stanford, CA 94305; California Maternal Quality Care Collaborative, Stanford, CA.
| | - Shen-Chih Chang
- California Maternal Quality Care Collaborative, Stanford, CA; Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
| | - Andrew M Carpenter
- California Maternal Quality Care Collaborative, Stanford, CA; Critical Juncture, LLC, Mill Valley, CA
| | - Paul H Wise
- Center for Health Policy and the Center for Primary Care and Outcomes Research, Stanford University, Stanford, CA
| | - David K Stevenson
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
| | - Gary M Shaw
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
| | - Jeffrey B Gould
- California Maternal Quality Care Collaborative, Stanford, CA; Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
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21
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Stevenson DK, Wong RJ, Aghaeepour N, Maric I, Angst MS, Contrepois K, Darmstadt GL, Druzin ML, Eisenberg ML, Gaudilliere B, Gibbs RS, Gotlib IH, Gould JB, Lee HC, Ling XB, Mayo JA, Moufarrej MN, Quaintance CC, Quake SR, Relman DA, Sirota M, Snyder MP, Sylvester KG, Hao S, Wise PH, Shaw GM, Katz M. Towards personalized medicine in maternal and child health: integrating biologic and social determinants. Pediatr Res 2021; 89:252-258. [PMID: 32454518 PMCID: PMC8061757 DOI: 10.1038/s41390-020-0981-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 05/13/2020] [Accepted: 05/14/2020] [Indexed: 12/16/2022]
Affiliation(s)
- David K Stevenson
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Ronald J Wong
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, 94305, USA.
| | - Nima Aghaeepour
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Ivana Maric
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Martin S Angst
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Kevin Contrepois
- Stanford Center for Genomics and Personalized Medicine, Department of Genetics, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Gary L Darmstadt
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Maurice L Druzin
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Michael L Eisenberg
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, 94305, USA
- Department of Urology, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Brice Gaudilliere
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Ronald S Gibbs
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Ian H Gotlib
- Department of Psychology, Stanford University School of Humanities and Science, Stanford, CA, 94305, USA
| | - Jeffrey B Gould
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Henry C Lee
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Xuefeng B Ling
- Department of Surgery, Stanford University School of Medicine, Stanford, CA, 94305, USA
- Clinical and Translational Research Program, Betty Irene Moore Children's Heart Center, Lucile Packard Children's Hospital, Palo Alto, CA, 94306, USA
| | - Jonathan A Mayo
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Mira N Moufarrej
- Departments of Bioengineering and Applied Physics, Stanford University, and Chan Zuckerberg Biohub, Stanford, CA, 94305, USA
| | - Cecele C Quaintance
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Stephen R Quake
- Departments of Bioengineering and Applied Physics, Stanford University, and Chan Zuckerberg Biohub, Stanford, CA, 94305, USA
| | - David A Relman
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, 94305, USA
- Infectious Diseases Section, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, 94306, USA
| | - Marina Sirota
- Bakar Computational Health Sciences Institute, University of California, San Francisco, San Francisco, CA, USA
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA, USA
| | - Michael P Snyder
- Stanford Center for Genomics and Personalized Medicine, Department of Genetics, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Karl G Sylvester
- Department of Surgery, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Shiying Hao
- Clinical and Translational Research Program, Betty Irene Moore Children's Heart Center, Lucile Packard Children's Hospital, Palo Alto, CA, 94306, USA
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Paul H Wise
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Gary M Shaw
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Michael Katz
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, 94305, USA
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22
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Jehan F, Sazawal S, Baqui AH, Nisar MI, Dhingra U, Khanam R, Ilyas M, Dutta A, Mitra DK, Mehmood U, Deb S, Mahmud A, Hotwani A, Ali SM, Rahman S, Nizar A, Ame SM, Moin MI, Muhammad S, Chauhan A, Begum N, Khan W, Das S, Ahmed S, Hasan T, Khalid J, Rizvi SJR, Juma MH, Chowdhury NH, Kabir F, Aftab F, Quaiyum A, Manu A, Yoshida S, Bahl R, Rahman A, Pervin J, Winston J, Musonda P, Stringer JSA, Litch JA, Ghaemi MS, Moufarrej MN, Contrepois K, Chen S, Stelzer IA, Stanley N, Chang AL, Hammad GB, Wong RJ, Liu C, Quaintance CC, Culos A, Espinosa C, Xenochristou M, Becker M, Fallahzadeh R, Ganio E, Tsai AS, Gaudilliere D, Tsai ES, Han X, Ando K, Tingle M, Marić I, Wise PH, Winn VD, Druzin ML, Gibbs RS, Darmstadt GL, Murray JC, Shaw GM, Stevenson DK, Snyder MP, Quake SR, Angst MS, Gaudilliere B, Aghaeepour N. Multiomics Characterization of Preterm Birth in Low- and Middle-Income Countries. JAMA Netw Open 2020; 3:e2029655. [PMID: 33337494 PMCID: PMC7749442 DOI: 10.1001/jamanetworkopen.2020.29655] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
IMPORTANCE Worldwide, preterm birth (PTB) is the single largest cause of deaths in the perinatal and neonatal period and is associated with increased morbidity in young children. The cause of PTB is multifactorial, and the development of generalizable biological models may enable early detection and guide therapeutic studies. OBJECTIVE To investigate the ability of transcriptomics and proteomics profiling of plasma and metabolomics analysis of urine to identify early biological measurements associated with PTB. DESIGN, SETTING, AND PARTICIPANTS This diagnostic/prognostic study analyzed plasma and urine samples collected from May 2014 to June 2017 from pregnant women in 5 biorepository cohorts in low- and middle-income countries (LMICs; ie, Matlab, Bangladesh; Lusaka, Zambia; Sylhet, Bangladesh; Karachi, Pakistan; and Pemba, Tanzania). These cohorts were established to study maternal and fetal outcomes and were supported by the Alliance for Maternal and Newborn Health Improvement and the Global Alliance to Prevent Prematurity and Stillbirth biorepositories. Data were analyzed from December 2018 to July 2019. EXPOSURES Blood and urine specimens that were collected early during pregnancy (median sampling time of 13.6 weeks of gestation, according to ultrasonography) were processed, stored, and shipped to the laboratories under uniform protocols. Plasma samples were assayed for targeted measurement of proteins and untargeted cell-free ribonucleic acid profiling; urine samples were assayed for metabolites. MAIN OUTCOMES AND MEASURES The PTB phenotype was defined as the delivery of a live infant before completing 37 weeks of gestation. RESULTS Of the 81 pregnant women included in this study, 39 had PTBs (48.1%) and 42 had term pregnancies (51.9%) (mean [SD] age of 24.8 [5.3] years). Univariate analysis demonstrated functional biological differences across the 5 cohorts. A cohort-adjusted machine learning algorithm was applied to each biological data set, and then a higher-level machine learning modeling combined the results into a final integrative model. The integrated model was more accurate, with an area under the receiver operating characteristic curve (AUROC) of 0.83 (95% CI, 0.72-0.91) compared with the models derived for each independent biological modality (transcriptomics AUROC, 0.73 [95% CI, 0.61-0.83]; metabolomics AUROC, 0.59 [95% CI, 0.47-0.72]; and proteomics AUROC, 0.75 [95% CI, 0.64-0.85]). Primary features associated with PTB included an inflammatory module as well as a metabolomic module measured in urine associated with the glutamine and glutamate metabolism and valine, leucine, and isoleucine biosynthesis pathways. CONCLUSIONS AND RELEVANCE This study found that, in LMICs and high PTB settings, major biological adaptations during term pregnancy follow a generalizable model and the predictive accuracy for PTB was augmented by combining various omics data sets, suggesting that PTB is a condition that manifests within multiple biological systems. These data sets, with machine learning partnerships, may be a key step in developing valuable predictive tests and intervention candidates for preventing PTB.
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Affiliation(s)
- Fyezah Jehan
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Sunil Sazawal
- Centre for Public Health Kinetics, New Delhi, Delhi, India
| | - Abdullah H. Baqui
- International Center for Maternal and Newborn Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Muhammad Imran Nisar
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Usha Dhingra
- Centre for Public Health Kinetics, New Delhi, Delhi, India
| | - Rasheda Khanam
- International Center for Maternal and Newborn Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Muhammad Ilyas
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Arup Dutta
- Centre for Public Health Kinetics, New Delhi, Delhi, India
| | - Dipak K. Mitra
- International Center for Maternal and Newborn Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Usma Mehmood
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Saikat Deb
- Centre for Public Health Kinetics, New Delhi, Delhi, India
- Public Health Laboratory-Ivo de Carneri, Pemba Island, Zanzibar
| | - Arif Mahmud
- International Center for Maternal and Newborn Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Aneeta Hotwani
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | | | - Sayedur Rahman
- International Center for Maternal and Newborn Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Ambreen Nizar
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | | | - Mamun Ibne Moin
- International Center for Maternal and Newborn Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Sajid Muhammad
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | | | - Nazma Begum
- International Center for Maternal and Newborn Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Waqasuddin Khan
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Sayan Das
- Centre for Public Health Kinetics, New Delhi, Delhi, India
| | - Salahuddin Ahmed
- International Center for Maternal and Newborn Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Tarik Hasan
- International Center for Maternal and Newborn Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Javairia Khalid
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Syed Jafar Raza Rizvi
- International Center for Maternal and Newborn Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Nabidul Haque Chowdhury
- International Center for Maternal and Newborn Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Furqan Kabir
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Fahad Aftab
- Centre for Public Health Kinetics, New Delhi, Delhi, India
| | - Abdul Quaiyum
- International Center for Maternal and Newborn Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Alexander Manu
- Maternal, Newborn, Child and Adolescent Health Research, World Health Organization, Geneva, Switzerland
| | - Sachiyo Yoshida
- Maternal, Newborn, Child and Adolescent Health Research, World Health Organization, Geneva, Switzerland
| | - Rajiv Bahl
- Maternal, Newborn, Child and Adolescent Health Research, World Health Organization, Geneva, Switzerland
| | - Anisur Rahman
- Matlab Health Research Centre, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Jesmin Pervin
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Jennifer Winston
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill
| | - Patrick Musonda
- School of Public Health, University of Zambia, Lusaka, Zambia
| | - Jeffrey S. A. Stringer
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill
| | - James A. Litch
- Global Alliance to Prevent Prematurity and Stillbirth, Seattle, Washington
| | - Mohammad Sajjad Ghaemi
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
- Digital Technologies Research Centre, National Research Council Canada, Toronto, Ontario, Canada
| | - Mira N. Moufarrej
- Department of Bioengineering, Stanford University, Stanford, California
| | - Kévin Contrepois
- Department of Genetics, Stanford University School of Medicine, Stanford, California
| | - Songjie Chen
- Department of Genetics, Stanford University School of Medicine, Stanford, California
| | - Ina A. Stelzer
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Natalie Stanley
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Alan L. Chang
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Ghaith Bany Hammad
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Ronald J. Wong
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Candace Liu
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | | | - Anthony Culos
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Camilo Espinosa
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Maria Xenochristou
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Martin Becker
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Ramin Fallahzadeh
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Edward Ganio
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Amy S. Tsai
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Dyani Gaudilliere
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Eileen S. Tsai
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Xiaoyuan Han
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Kazuo Ando
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Martha Tingle
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Ivana Marić
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Paul H. Wise
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Virginia D. Winn
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California
| | - Maurice L. Druzin
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California
| | - Ronald S. Gibbs
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California
| | - Gary L. Darmstadt
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | | | - Gary M. Shaw
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - David K. Stevenson
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Michael P. Snyder
- Department of Genetics, Stanford University School of Medicine, Stanford, California
| | - Stephen R. Quake
- Department of Bioengineering, Stanford University, Stanford, California
| | - Martin S. Angst
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Brice Gaudilliere
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Nima Aghaeepour
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
- Department of Biomedical Informatics, Stanford University School of Medicine, Stanford, California
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23
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Wren SM, Wild HB, Gurney J, Amirtharajah M, Brown ZW, Bulger EM, Burkle FM, Elster EA, Forrester JD, Garber K, Gosselin RA, Groen RS, Hsin G, Joshipura M, Kushner AL, Norton I, Osmers I, Pagano H, Razek T, Sáenz-Terrazas JM, Schussler L, Stewart BT, Traboulsi AAR, Trelles M, Troke J, VanFosson CA, Wise PH. A Consensus Framework for the Humanitarian Surgical Response to Armed Conflict in 21st Century Warfare. JAMA Surg 2020; 155:114-121. [PMID: 31722004 PMCID: PMC6865259 DOI: 10.1001/jamasurg.2019.4547] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Question What are consensus components of a framework for humanitarian surgical response in modern conflict zones? Findings This survey study using responses from 35 participants in the Stanford Humanitarian Surgical Response in Conflict Working Group suggests that humanitarian responses include both care of traumatic injury and emergency surgical needs of the population. Lessons from civilian and military trauma systems as well as humanitarian settings were translated into a tiered continuum of response from patient presentation through rehabilitation. Meaning Evidence suggests that modern trauma systems save lives but providing this standard of care in insecure conflict settings places new burdens on humanitarian systems; the framework presented herein integrates advances in surgical care to these environments. Importance Armed conflict in the 21st century poses new challenges to a humanitarian surgical response, including changing security requirements, access to patients, and communities in need, limited deployable surgical assets, resource constraints, and the requirement to address both traumatic injuries as well as emergency surgical needs of the population. At the same time, recent improvements in trauma care and systems have reduced injury-related mortality. This combination of new challenges and medical capabilities warrants reconsideration of long-standing humanitarian surgery protocols. Objective To describe a consensus framework for surgical care designed to respond to this emerging need. Design, Setting, and Participants An international group of 35 representatives from humanitarian agencies, US military, and academic trauma programs was invited to the Stanford Humanitarian Surgical Response in Conflict Working Group to engage in a structured process to review extant trauma protocols and make recommendations for revision. Main Outcomes and Measures The working group’s method adapted core elements of a modified Delphi process combined with consensus development conference from August 3 to August 5, 2018. Results Lessons from civilian and military trauma systems as well as recent battlefield experiences in humanitarian settings were integrated into a tiered continuum of response from point of injury through rehabilitation. The framework addresses the security and medical requirements as well as ethical and legal principles that guide humanitarian action. The consensus framework includes trained, lay first responders; far-forward resuscitation/stabilization centers; rapid damage control surgical access; and definitive care facilities. The system also includes nontrauma surgical care, injury prevention, quality improvement, data collection, and predeployment training requirements. Conclusions and Relevance Evidence suggests that modern trauma systems save lives. However, the requirements of providing this standard of care in insecure conflict settings places new burdens on humanitarian systems that must provide both emergency and trauma surgical care. This consensus framework integrates advances in trauma care and surgical systems in response to a changing security environment. It is possible to reduce disparities and improve the standard of care in these settings.
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Affiliation(s)
- Sherry M Wren
- Stanford University School of Medicine, Stanford, California
| | - Hannah B Wild
- Stanford University School of Medicine, Stanford, California
| | - Jennifer Gurney
- US Army Institute of Surgical Research/Joint Trauma System, San Antonio, Texas
| | | | - Zachary W Brown
- Department of Surgery, Uniformed Services University, Bethesda, Maryland
| | - Eileen M Bulger
- Department of Surgery, University of Washington, Seattle.,Committee on Trauma, American College of Surgeons, Chicago, Illinois
| | - Frederick M Burkle
- Harvard T. H. Chan School of Public Health, Harvard Humanitarian Initiative, Harvard University, Cambridge, Massachusetts
| | - Eric A Elster
- Department of Surgery, Uniformed Services University, Bethesda, Maryland
| | | | - Kent Garber
- Department of Surgery, University of California, Los Angeles
| | | | - Reinou S Groen
- Department of Obstetrics and Gynecology, Alaska Native Medical Center, Anchorage
| | - Gary Hsin
- Stanford University School of Medicine, Stanford, California
| | | | - Adam L Kushner
- Center for Humanitarian Health, Johns Hopkins Bloomberg School of Public health, Baltimore, Maryland
| | - Ian Norton
- Emergency Operations and Partnerships, Emergency Operations, World Health Organization, Geneva, Switzerland
| | - Inga Osmers
- Médecins Sans Frontières, Amsterdam, the Netherlands
| | | | - Tarek Razek
- Centre for Global Surgery, McGill University, Montreal, Quebec, Canada
| | | | | | | | | | | | - John Troke
- Samaritan's Purse, Boone, North Carolina
| | | | - Paul H Wise
- Stanford University School of Medicine, Stanford, California
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24
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Sadovsky Y, Mesiano S, Burton GJ, Lampl M, Murray JC, Freathy RM, Mahadevan-Jansen A, Moffett A, Price ND, Wise PH, Wildman DE, Snyderman R, Paneth N, Capra JA, Nobrega MA, Barak Y, Muglia LJ. Advancing human health in the decade ahead: pregnancy as a key window for discovery: A Burroughs Wellcome Fund Pregnancy Think Tank. Am J Obstet Gynecol 2020; 223:312-321. [PMID: 32565236 PMCID: PMC7303037 DOI: 10.1016/j.ajog.2020.06.031] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/07/2020] [Accepted: 06/10/2020] [Indexed: 12/16/2022]
Abstract
Recent revolutionary advances at the intersection of medicine, omics, data sciences, computing, epidemiology, and related technologies inspire us to ponder their impact on health. Their potential impact is particularly germane to the biology of pregnancy and perinatal medicine, where limited improvement in health outcomes for women and children has remained a global challenge. We assembled a group of experts to establish a Pregnancy Think Tank to discuss a broad spectrum of major gestational disorders and adverse pregnancy outcomes that affect maternal-infant lifelong health and should serve as targets for leveraging the many recent advances. This report reflects avenues for future effects that hold great potential in 3 major areas: developmental genomics, including the application of methodologies designed to bridge genotypes, physiology, and diseases, addressing vexing questions in early human development; gestational physiology, from immune tolerance to growth and the timing of parturition; and personalized and population medicine, focusing on amalgamating health record data and deep phenotypes to create broad knowledge that can be integrated into healthcare systems and drive discovery to address pregnancy-related disease and promote general health. We propose a series of questions reflecting development, systems biology, diseases, clinical approaches and tools, and population health, and a call for scientific action. Clearly, transdisciplinary science must advance and accelerate to address adverse pregnancy outcomes. Disciplines not traditionally involved in the reproductive sciences, such as computer science, engineering, mathematics, and pharmacology, should be engaged at the study design phase to optimize the information gathered and to identify and further evaluate potentially actionable therapeutic targets. Information sources should include noninvasive personalized sensors and monitors, alongside instructive "liquid biopsies" for noninvasive pregnancy assessment. Future research should also address the diversity of human cohorts in terms of geography, racial and ethnic distributions, and social and health disparities. Modern technologies, for both data-gathering and data-analyzing, make this possible at a scale that was previously unachievable. Finally, the psychosocial and economic environment in which pregnancy takes place must be considered to promote the health and wellness of communities worldwide.
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Affiliation(s)
- Yoel Sadovsky
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee-Womens Research Institute, University of Pittsburgh, Pittsburgh, PA
| | - Sam Mesiano
- Department of Reproductive Biology, Case Western Reserve University, and Department of Obstetrics and Gynecology, University Hospitals of Cleveland, Cleveland, OH
| | - Graham J Burton
- Centre for Trophoblast Research; University of Cambridge, Cambridge, United Kingdom
| | - Michelle Lampl
- Center for the Study of Human Health, Emory University, Atlanta, GA
| | | | | | - Anita Mahadevan-Jansen
- Vanderbilt Biophotonics Center and Department of Biomedical Engineering, Vanderbilt University, Nashville, TN
| | - Ashley Moffett
- Department of Pathology; Centre for Trophoblast Research
| | | | - Paul H Wise
- Department of Pediatrics, Stanford University School of Medicine, Stanford University, Stanford, CA
| | - Derek E Wildman
- Genomics Program, College of Public Health, University of South Florida, Tampa, FL
| | - Ralph Snyderman
- Duke Center for Personalized Health Care, Duke University Medical Center, Durham, NC
| | - Nigel Paneth
- Departments of Epidemiology and Biostatistics and of Pediatrics and Human Development, College of Human Medicine, Michigan State University, East Lansing, MI
| | | | | | - Yaacov Barak
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee-Womens Research Institute, University of Pittsburgh, Pittsburgh, PA
| | - Louis J Muglia
- Office of the President, Burroughs Wellcome Fund, Research Triangle Park, NC.
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25
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Abstract
Telehealth has improved delivery of health care worldwide by improving access to and the quality of health care and by improving the global shortage of health professionals through collaboration and training. Although many telehealth efforts have been reported in adult health care settings, it is important to examine telehealth efforts in the pediatric setting. Children who are most commonly ill and malnourished are often those of underserved populations of the developing world. This article examines current uses of pediatric telehealth in a global setting and discusses key approaches to how telehealth may become successfully integrated and scaled in those settings.
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Affiliation(s)
- Julianna C Hsing
- Department of Epidemiology and Population Health, Stanford University School of Medicine, 150 Governor's Lane, Stanford, CA 94305, USA; Center for Policy, Outcomes and Prevention, Stanford University School of Medicine, 117 Encina Commons, Stanford, CA 94305, USA.
| | - C Jason Wang
- Center for Policy, Outcomes and Prevention, Stanford University School of Medicine, 117 Encina Commons, Stanford, CA 94305, USA; Department of Pediatrics, Stanford University School of Medicine, 291 Campus Drive, Stanford, CA 94305, USA
| | - Paul H Wise
- Center for Policy, Outcomes and Prevention, Stanford University School of Medicine, 117 Encina Commons, Stanford, CA 94305, USA; Department of Pediatrics, Stanford University School of Medicine, 291 Campus Drive, Stanford, CA 94305, USA
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26
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Ataullahjan A, Gaffey MF, Sami S, Singh NS, Tappis H, Black RE, Blanchet K, Boerma T, Langer A, Spiegel PB, Waldman RJ, Wise PH, Bhutta ZA. Investigating the delivery of health and nutrition interventions for women and children in conflict settings: a collection of case studies from the BRANCH Consortium. Confl Health 2020; 14:29. [PMID: 32514294 PMCID: PMC7254714 DOI: 10.1186/s13031-020-00276-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 04/23/2020] [Indexed: 11/10/2022] Open
Abstract
Globally, the number of people affected by conflict is the highest in history, and continues to steadily increase. There is currently a pressing need to better understand how to deliver critical health interventions to women and children affected by conflict. The compendium of articles presented in this Conflict and Health Collection brings together a range of case studies recently undertaken by the BRANCH Consortium (Bridging Research & Action in Conflict Settings for the Health of Women and Children). These case studies describe how humanitarian actors navigate and negotiate the multiple obstacles and forces that challenge the delivery of health and nutrition interventions for women, children and adolescents in conflict-affected settings, and to ultimately provide some insight into how service delivery can be improved.
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Affiliation(s)
| | - Michelle F. Gaffey
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada
| | - Samira Sami
- Center for Humanitarian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Neha S. Singh
- Health in Humanitarian Crises Centre, London School of Hygiene and Tropical Medicine, London, UK
| | - Hannah Tappis
- Center for Humanitarian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Robert E. Black
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Karl Blanchet
- Health in Humanitarian Crises Centre, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Ana Langer
- Women and Health Initiative, Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, USA
| | - Paul B. Spiegel
- Center for Humanitarian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Ronald J. Waldman
- Milken Institute School of Public Health, George Washington University, Washington DC, USA
| | - Paul H. Wise
- The Center for Policy, Outcomes and Prevention, Stanford University, Palo Alto, CA USA
| | - Zulfiqar A. Bhutta
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada
- Center of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
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Garber K, Kushner AL, Wren SM, Wise PH, Spiegel PB. Applying trauma systems concepts to humanitarian battlefield care: a qualitative analysis of the Mosul trauma pathway. Confl Health 2020; 14:5. [PMID: 32042308 PMCID: PMC7001520 DOI: 10.1186/s13031-019-0249-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 12/29/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Trauma systems have been shown to save lives in military and civilian settings, but their use by humanitarians in conflict settings has been more limited. During the Battle of Mosul (October 2016-July 2017), trauma care for injured civilians was provided through a novel approach in which humanitarian actors were organized into a trauma pathway involving echelons of care, a key component of military trauma systems. A better understanding of this approach may help inform trauma care delivery in future humanitarian responses in conflicts. METHODOLOGY A qualitative study design was used to examine the Mosul civilian trauma response. From August-December 2017, in-depth semi-structured interviews were conducted with stakeholders (n = 54) representing nearly two dozen organizations that directly participated in or had first-hand knowledge of the response. Source document reviews were also conducted. Responses were analyzed in accordance with a published framework on civilian battlefield trauma systems, focusing on whether the response functioned as an integrated trauma system. Opportunities for improvement were identified. RESULTS The Mosul civilian trauma pathway was implemented as a chain of care for civilian casualties with three successive echelons (trauma stabilization points, field hospitals, and referral hospitals). Coordinated by the World Health Organization, it comprised a variety of actors, including non-governmental organizations, civilian institutions, and at least one private medical company. Stakeholders generally felt that this approach improved access to trauma care for civilians injured near the frontlines compared to what would have been available. Several trauma systems elements such as transportation, data collection, field coordination, and post-operative rehabilitative care might have been further developed to support a more integrated system. CONCLUSIONS The Mosul trauma pathway evolved to address critical gaps in trauma care during the Battle of Mosul. It adapted the concept of echelons of care from western military practice to push humanitarian actors closer to the frontlines and improve access to care for injured civilians. Although efforts were made to incorporate some of the integrative components (e.g. evidence-based pre-hospital care, transportation, and data collection) that have enabled recent achievements by military trauma systems, many of these proved difficult to implement in the Mosul context. Further discussion and research are needed to determine how trauma systems insights can be adapted in future humanitarian responses given resource, logistical, and security constraints, as well as to clarify the responsibilities of various actors.
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Affiliation(s)
- Kent Garber
- 0000 0000 9632 6718grid.19006.3eDepartment of Surgery, University of California, Los Angeles, CA USA ,0000 0001 2171 9311grid.21107.35Center for Humanitarian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Adam L. Kushner
- 0000 0001 2171 9311grid.21107.35Center for Humanitarian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA ,Surgeons OverSeas, New York, NY USA
| | - Sherry M. Wren
- 0000000419368956grid.168010.eDepartment of Surgery, Stanford University, Palo Alto, CA USA
| | - Paul H. Wise
- 0000000419368956grid.168010.eDepartment of Pediatrics, School of Medicine, Stanford University, Stanford, CA USA
| | - Paul B. Spiegel
- 0000 0001 2171 9311grid.21107.35Center for Humanitarian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
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Wagner Z, Heft-Neal S, Wise PH, Black RE, Burke M, Boerma T, Bhutta ZA, Bendavid E. Women and children living in areas of armed conflict in Africa: a geospatial analysis of mortality and orphanhood. Lancet Glob Health 2019; 7:e1622-e1631. [PMID: 31669039 PMCID: PMC7024993 DOI: 10.1016/s2214-109x(19)30407-3] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 09/05/2019] [Accepted: 09/11/2019] [Indexed: 01/22/2023]
Abstract
Background The population effects of armed conflict on non-combatant vulnerable populations are incompletely understood. We aimed to study the effects of conflict on mortality among women of childbearing age (15–49 years) and on orphanhood among children younger than 15 years in Africa. Methods We tested the extent to which mortality among women aged 15–49 years, and orphanhood among children younger than 15 years, increased in response to nearby armed conflict in Africa. Data on location, timing, and intensity of armed conflicts were obtained from the Uppsala Conflict Data Program, and data on the location, timing, and outcomes of women and children from Demographic and Health Surveys done in 35 African countries from 1990 to 2016. Mortality among women was obtained from sibling survival data. We used cluster-area fixed-effects regression models to compare survival of women during periods of nearby conflict (within 50 km) to survival of women in the same area during times without conflict. We used similar methods to examine the extent to which children living near armed conflicts are at increased risk of becoming orphans. We examined the effects of varying conflict intensity using number of direct battle deaths and duration of consecutive conflict exposure. Findings We analysed data on 1 629 352 women (19 286 387 person-years), of which 103 011 (6·3%) died (534·1 deaths per 100 000 women-years), and 2 354 041 children younger than 15 years, of which 204 276 (8·7%) had lost a parent. On average, conflict within 50 km increased women's mortality by 112 deaths per 100 000 person-years (95% CI 97–128; a 21% increase above baseline), and the probability that a child has lost at least one parent by 6·0% (95% CI 3–8). This effect was driven by high-intensity conflicts: exposure to the highest (tenth) decile conflict in terms of conflict-related deaths increased the probability of female mortality by 202% (187–218) and increased the likelihood of orphanhood by 42% compared with a conflict-free period. Among the conflict-attributed deaths, 10% were due to maternal mortality. Interpretation African women of childbearing age are at a substantially increased risk of death from nearby high-intensity armed conflicts. Children exposed to conflict are analogously at increased risk of becoming orphans. This work fills gaps in literature on the harmful effects of armed conflict on non-combatants and highlights the need for humanitarian interventions to protect vulnerable populations. Funding Bill & Melinda Gates Foundation to the BRANCH Consortium.
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Affiliation(s)
| | - Sam Heft-Neal
- Center on Food Security and the Environment, Stanford University, Stanford, CA, USA
| | - Paul H Wise
- The Center for Health Policy and the Center for Primary Care and Outcomes Research, Stanford University, Stanford, CA, USA; Department of Pediatrics, Stanford University, Stanford, CA, USA
| | - Robert E Black
- The Institute for International Programs, Bloomberg School of Public Health, John Hopkins University, Baltimore, MD, USA
| | - Marshall Burke
- Center on Food Security and the Environment, Stanford University, Stanford, CA, USA; Department of Earth System Science, Stanford University, Stanford, CA, USA
| | - Ties Boerma
- Center for Global Public Health, University of Manitoba, Winnipeg, MB, Canada
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, Hospital for Sick Children (SickKids), Toronto, ON, Canada; The Center of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Eran Bendavid
- The Center for Health Policy and the Center for Primary Care and Outcomes Research, Stanford University, Stanford, CA, USA; Center for Population Health Sciences, Division of Primary Care and Population Health, Department of Medicine, Stanford University, Stanford, CA, USA.
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Spiegel P, Ratnayake R, Hellman N, Ververs M, Ngwa M, Wise PH, Lantagne D. Responding to epidemics in large-scale humanitarian crises: a case study of the cholera response in Yemen, 2016-2018. BMJ Glob Health 2019; 4:e001709. [PMID: 31406596 PMCID: PMC6666825 DOI: 10.1136/bmjgh-2019-001709] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 06/06/2019] [Accepted: 06/08/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Large epidemics frequently emerge in conflict-affected states. We examined the cholera response during the humanitarian crisis in Yemen to inform control strategies. METHODS We conducted interviews with practitioners and advisors on preparedness; surveillance; laboratory; case management; malnutrition; water, sanitation and hygiene (WASH); vaccination; coordination and insecurity. We undertook a literature review of global and Yemen-specific cholera guidance, examined surveillance data from the first and second waves (28 September 2016-12 March 2018) and reviewed reports on airstrikes on water systems and health facilities (April 2015-December 2017). We used the Global Task Force on Cholera Control's framework to examine intervention strategies and thematic analysis to understand decision making. RESULTS Yemen is water scarce, and repeated airstrikes damaged water systems, risking widespread infection. Since a cholera preparedness and response plan was absent, on detection, the humanitarian cluster system rapidly developed response plans. The initial plans did not prioritise key actions including community-directed WASH to reduce transmission, epidemiological analysis and laboratory monitoring. Coordination was not harmonised across the crisis-focused clusters and epidemic-focused incident management system. The health strategy was crisis focused and was centralised on functional health facilities, underemphasising less accessible areas. As vaccination was not incorporated into preparedness, consensus on its use remained slow. At the second wave peak, key actions including data management, community-directed WASH and oral rehydration and vaccination were scaled-up. CONCLUSION Despite endemicity and conflict, Yemen was not prepared for the epidemic. To contain outbreaks, conflict-affected states, humanitarian agencies, and donors must emphasise preparedness planning and community-directed responses.
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Affiliation(s)
- Paul Spiegel
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Center for Humanitarian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ruwan Ratnayake
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Nora Hellman
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Center for Humanitarian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Mija Ververs
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Center for Humanitarian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Moise Ngwa
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Paul H Wise
- Department of Pediatrics, Stanford University School of Medicine, Stanford University, Stanford, California, USA
- Freeman Spogli Institute for International Studies, Stanford University, Stanford, California, USA
| | - Daniele Lantagne
- Department of Civil and Environmental Engineering, Tufts University, Medford, Massachusetts, USA
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Stevenson DK, Wong RJ, Aghaeepour N, Angst MS, Darmstadt GL, DiGiulio DB, Druzin ML, Gaudilliere B, Gibbs RS, B Gould J, Katz M, Li J, Moufarrej MN, Quaintance CC, Quake SR, Relman DA, Shaw GM, Snyder MP, Wang X, Wise PH. Understanding health disparities. J Perinatol 2019; 39:354-358. [PMID: 30560947 DOI: 10.1038/s41372-018-0298-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 09/10/2018] [Revised: 11/27/2018] [Accepted: 12/03/2018] [Indexed: 12/14/2022]
Abstract
Based upon our recent insights into the determinants of preterm birth, which is the leading cause of death in children under five years of age worldwide, we describe potential analytic frameworks that provides both a common understanding and, ultimately the basis for effective, ameliorative action. Our research on preterm birth serves as an example that the framing of any human health condition is a result of complex interactions between the genome and the exposome. New discoveries of the basic biology of pregnancy, such as the complex immunological and signaling processes that dictate the health and length of gestation, have revealed a complexity in the interactions (current and ancestral) between genetic and environmental forces. Understanding of these relationships may help reduce disparities in preterm birth and guide productive research endeavors and ultimately, effective clinical and public health interventions.
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Affiliation(s)
- David K Stevenson
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, 94305, USA.
| | - Ronald J Wong
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Nima Aghaeepour
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Martin S Angst
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Gary L Darmstadt
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Daniel B DiGiulio
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, 94305, USA.,Infectious Diseases Section, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, 94306, USA
| | - Maurice L Druzin
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Brice Gaudilliere
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Ronald S Gibbs
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Jeffrey B Gould
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Michael Katz
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Jingjing Li
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, 94305, USA.,Department of Genetics, Stanford Center for Genomics and Personalized Medicine, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Mira N Moufarrej
- Departments of Bioengineering and Applied Physics, Stanford University and Chan Zuckerberg Biohub, Stanford, CA, 94305, USA
| | - Cecele C Quaintance
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Stephen R Quake
- Departments of Bioengineering and Applied Physics, Stanford University and Chan Zuckerberg Biohub, Stanford, CA, 94305, USA
| | - David A Relman
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, 94305, USA.,Infectious Diseases Section, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, 94306, USA
| | - Gary M Shaw
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Michael P Snyder
- Department of Genetics, Stanford Center for Genomics and Personalized Medicine, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Xiaobin Wang
- Center on the Early Life Origins of Disease, Department of Population, Family and Reproductive Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, 21205, USA.,Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
| | - Paul H Wise
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, 94305, USA
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Anand S, Montez-Rath ME, Adasooriya D, Ratnatunga N, Kambham N, Wazil A, Wijetunge S, Badurdeen Z, Ratnayake C, Karunasena N, Schensul SL, Valhos P, Haider L, Bhalla V, Levin A, Wise PH, Chertow GM, Barry M, Fire AZ, Nanayakkara N. Prospective Biopsy-Based Study of CKD of Unknown Etiology in Sri Lanka. Clin J Am Soc Nephrol 2019; 14:224-232. [PMID: 30659059 PMCID: PMC6390926 DOI: 10.2215/cjn.07430618] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [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] [Received: 06/21/2018] [Accepted: 10/30/2018] [Indexed: 01/11/2023]
Abstract
BACKGROUND AND OBJECTIVES A kidney disease of unknown cause is common in Sri Lanka's lowland (dry) region. Detailed clinical characterizations of patients with biopsy-proven disease are limited, and there is no current consensus on criteria for a noninvasive diagnosis. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We designed a prospective study in a major Sri Lankan hospital servicing endemic areas to ascertain pathologic and clinical characteristics of and assess risk factors for primary tubulointerstitial kidney disease. We used logistic regression to determine whether common clinical characteristics could be used to predict the presence of primary tubulointerstitial kidney disease on kidney biopsy. RESULTS From 600 new patients presenting to a tertiary nephrology clinic over the course of 1 year, 87 underwent kidney biopsy, and 43 (49%) had a biopsy diagnosis of primary tubulointerstitial kidney disease. On detailed biopsy review, 13 (30%) had evidence of moderate to severe active kidney disease, and six (15%) had evidence of moderate to severe chronic tubulointerstitial kidney disease. Patients with tubulointerstitial kidney disease were exclusively born in endemic provinces; 91% spent a majority of their lifespan there. They were more likely men and farmers (risk ratio, 2.0; 95% confidence interval, 1.2 to 2.9), and they were more likely to have used tobacco (risk ratio, 1.7; 95% confidence interval, 1.0 to 2.3) and well water (risk ratio, 1.5; 95% confidence interval, 1.1 to 2.0). Three clinical characteristics-age, urine dipstick for protein, and serum albumin-could predict likelihood of tubulointerstitial kidney disease on biopsy (model sensitivity of 79% and specificity of 84%). Patients referred for kidney biopsy despite comorbid diabetes or hypertension did not experience lower odds of tubulointerstitial kidney disease. CONCLUSIONS A primary tubulointerstitial kidney disease occurs commonly in specific regions of Sri Lanka with characteristic environmental and lifestyle exposures.
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Affiliation(s)
| | | | - Dinuka Adasooriya
- Kandy Teaching Hospital, Kandy, Sri Lanka
- Center for Education Research and Training on Kidney Diseases, Faculty of Medicine and
| | | | | | | | | | - Zeid Badurdeen
- Center for Education Research and Training on Kidney Diseases, Faculty of Medicine and
| | | | | | | | - Penny Valhos
- Department of Marine Sciences, University of Connecticut, Groton, Connecticut; and
| | - Lalarukh Haider
- Division of Nephrology, University of Connecticut Health Center, Farmington, Connecticut
| | | | - Adeera Levin
- Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | - Michele Barry
- Medicine, Stanford University School of Medicine, Palo Alto, California
| | | | - Nishantha Nanayakkara
- Kandy Teaching Hospital, Kandy, Sri Lanka
- Center for Education Research and Training on Kidney Diseases, Faculty of Medicine and
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Affiliation(s)
- MyMy C Buu
- Department of Pediatrics, Division of Pediatric Pulmonary Medicine, Center for Excellence in Pulmonary Biology, Stanford University School of Medicine, Stanford, CA.
| | - Carlos E Milla
- Department of Pediatrics, Division of Pediatric Pulmonary Medicine, Center for Excellence in Pulmonary Biology, Stanford University School of Medicine, Stanford, CA
| | - Paul H Wise
- Department of Pediatrics, Division of General Pediatrics, Center for Policy, Outcomes and Prevention, Stanford University School of Medicine, Stanford, CA
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Abstract
A comprehensive patient information datafile of 320 topics has been developed, subserving the domains of medicine, surgery, gynaecology and paediatrics. The system was designed as loose-leaf sheets capable of being photocopied, as well as a computer-based datafile. In a four-practice study, 73% of consecutive general practice attenders could be issued with the relevant disorder or procedure information sheet. With a questionnaire return rate of 79%, 886 patients rated the three criteria of readability, understandability and usefulness of their leaflets as very or quite easy and very or quite useful in more than 94% of instances. This system could be a valuable adjunct to patient education in both general and hospital practice settings.
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Affiliation(s)
- P H Wise
- Charing Cross Hospital, London, England
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Abstract
Discourse about childhood chronic conditions has transitioned in the last decade from focusing primarily on broad groups of children with special health care needs to concentrating in large part on smaller groups of children with medical complexity (CMC). Although a variety of definitions have been applied, the term CMC has most commonly been defined as children and youth with serious chronic conditions, substantial functional limitations, increased health and other service needs, and increased health care costs. The increasing attention paid to CMC has occurred because these children are growing in impact, represent a disproportionate share of health system costs, and require policy and programmatic interventions that differ in many ways from broader groups of children with special health care needs. But will this change in focus lead to meaningful changes in outcomes for children with serious chronic diseases, or is the pediatric community simply adopting terminology with resonance in adult-focused health systems? In this article, we will explore the implications of the rapid emergence of pediatric complex care in child health services practice and research. As an emerging field, pediatric care systems should thoughtfully and rapidly develop evidence-based solutions to the new challenges of caring for CMC, including (1) clearer definitions of the target population, (2) a more appropriate incorporation of components of care that occur outside of hospitals, and (3) a more comprehensive outcomes measurement framework, including the recognition of potential limitations of cost containment as a target for improved care for CMC.
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Affiliation(s)
- Eyal Cohen
- Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada; .,Department of Pediatrics and Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
| | - Jay G Berry
- Complex Care Service, Division of General Pediatrics, Boston Children's Hospital and Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Lee Sanders
- Center for Policy, Outcomes and Prevention (CPOP) and.,Department of Pediatrics, School of Medicine, Stanford University, Stanford, California; and
| | - Edward L Schor
- Lucile Packard Foundation for Children's Health, Palo Alto, California
| | - Paul H Wise
- Center for Policy, Outcomes and Prevention (CPOP) and.,Department of Pediatrics, School of Medicine, Stanford University, Stanford, California; and
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35
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Alvarez EM, Keegan TH, Johnston EE, Haile R, Sanders L, Wise PH, Saynina O, Chamberlain LJ. The Patient Protection and Affordable Care Act dependent coverage expansion: Disparities in impact among young adult oncology patients. Cancer 2017; 124:110-117. [DOI: 10.1002/cncr.30978] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 07/10/2017] [Accepted: 08/02/2017] [Indexed: 11/09/2022]
Affiliation(s)
- Elysia M. Alvarez
- Division of Pediatric Hematology and Oncology; Stanford University School of Medicine; Palo Alto California
| | - Theresa H. Keegan
- Division of Hematology and Oncology; University of California at Davis School of Medicine; Sacramento California
| | - Emily E. Johnston
- Division of Pediatric Hematology and Oncology; Stanford University School of Medicine; Palo Alto California
| | - Robert Haile
- Division of Oncology; Stanford University School of Medicine; Palo Alto California
| | - Lee Sanders
- Division of General Pediatrics; Stanford University School of Medicine; Palo Alto California
| | - Paul H. Wise
- The Center for Policy, Outcomes and Prevention, Stanford University; Palo Alto California
| | - Olga Saynina
- The Center for Policy, Outcomes and Prevention, Stanford University; Palo Alto California
| | - Lisa J. Chamberlain
- Division of General Pediatrics; Stanford University School of Medicine; Palo Alto California
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36
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Cohen E, Horváth-Puhó E, Ray JG, Pedersen L, Adler N, Ording AG, Wise PH, Milstein A, Sørensen HT. Association Between the Birth of an Infant With Major Congenital Anomalies and Subsequent Risk of Mortality in Their Mothers. JAMA 2016; 316:2515-2524. [PMID: 27997654 DOI: 10.1001/jama.2016.18425] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [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] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Giving birth to a child with a major birth defect is a serious life event for a woman, yet little is known about the long-term health consequences for the mother. OBJECTIVE To assess whether birth of an infant born with a major congenital anomaly was associated with higher maternal risk of mortality. DESIGN, SETTING, AND PARTICIPANTS This population-based cohort study (n = 455 250 women) used individual-level linked Danish registry data for mothers who gave birth to an infant with a major congenital anomaly (41 508) between 1979 and 2010, with follow-up until December 31, 2014. A comparison cohort (413 742) was constructed by randomly sampling, for each mother with an affected infant, up to 10 mothers matched on maternal age, parity, and year of infant's birth. EXPOSURE Live birth of an infant with a major congenital anomaly as defined by the European Surveillance of Congenital Anomalies classification system. MAIN OUTCOMES AND MEASURES Primary outcome was all-cause mortality. Secondary outcomes included cause-specific mortality. Hazard ratios (HRs) were adjusted for marital status, immigration status, income quartile (since 1980), educational level (since 1981), diabetes mellitus, modified Charlson comorbidity index score, hypertension, depression, history of alcohol-related disease, previous spontaneous abortion, pregnancy complications, smoking (since 1991), and body mass index (since 2004). RESULTS Mothers in both groups were a mean (SD) age of 28.9 (5.1) years at delivery. After a median (IQR) follow-up of 21 (12-28) years, there were 1275 deaths (1.60 per 1000 person-years) among 41 508 mothers of a child with a major congenital anomaly vs 10 112 deaths (1.27 per 1000 person-years) among 413 742 mothers in the comparison cohort, corresponding to an absolute mortality rate difference of 0.33 per 1000 person-years (95% CI, 0.24-0.42), an unadjusted HR of 1.27 (95% CI, 1.20-1.35), and an adjusted HR of 1.22 (95% CI, 1.15-1.29). Mothers with affected infants were more likely to die of cardiovascular disease (rate difference, 0.05 per 1000 person-years [95% CI, 0.02-0.08]; adjusted HR, 1.26 [95% CI, 1.04-1.53]), respiratory disease (rate difference, 0.02 per 1000 person-years [95% CI, 0.00-0.04]; adjusted HR, 1.45 [95% CI, 1.01-2.08]), and other natural causes (rate difference, 0.11 per 1000 person-years [95% CI, 0.07-0.15]; adjusted HR, 1.50 [95% CI, 1.27-1.76]). CONCLUSIONS AND RELEVANCE In Denmark, having a child with a major congenital anomaly was associated with a small but statistically significantly increased mortality risk in the mother compared with women without an affected child. However, the clinical importance of this association is uncertain.
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Affiliation(s)
- Eyal Cohen
- Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada2Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark3Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada4Center for Primary Care and Outcomes Research, Stanford University, Stanford, California5Clinical Excellence Research Center, Stanford University School of Medicine, Stanford, California
| | | | - Joel G Ray
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada6St Michael's Hospital Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Lars Pedersen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Nancy Adler
- Center for Health and Community, University of California-San Francisco School of Medicine
| | - Anne Gulbech Ording
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Paul H Wise
- Center for Primary Care and Outcomes Research, Stanford University, Stanford, California
| | - Arnold Milstein
- Clinical Excellence Research Center, Stanford University School of Medicine, Stanford, California
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark8Division of Epidemiology, Department of Health Research and Policy, Stanford University, Stanford, California
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Nagata JM, Gippetti J, Wager S, Chavez A, Wise PH. Prevalence and Predictors of Malnutrition among Guatemalan Children at 2 Years of Age. PLoS One 2016; 11:e0164772. [PMID: 27806066 PMCID: PMC5091788 DOI: 10.1371/journal.pone.0164772] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 10/01/2016] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To identify the prevalence and predictors of malnutrition among 2-year old children in the Western Highlands of Guatemala. METHODS Prospective cohort of 852 Guatemalan children in San Lucas Toliman, Guatemala followed from birth to age 2 from May 2008 to December 2013. Socio-demographic, anthropometric, and health data of children was collected at 2 month intervals. RESULTS Among the 402 males and 450 females in the cohort, mean weight-for-age Z-score (WAZ) declined from -0.67 ± 1.01 at 1 year to -1.07 ± 0.87 at 2 years, while mean height-for-age Z-score (HAZ) declined from -1.88 ± 1.19 at 1 year to -2.37 ± 0.99 at 2 years. Using multiple linear regression modeling, number of children <5 years old, vomiting in the past week, fever in the past week, and WAZ at 1 year were significant predictors of WAZ at 2 years. Significant predictors of HAZ at 2 years included household size, number of children <5 years old, diarrhea in the past week, WAZ at 1 year, and HAZ at 1 year. Vomiting in the past week and WAZ at 1 year were significant predictors of weight-for-height z-score (WHZ) at 2 years. CONCLUSIONS Number of children <5 years old, symptoms such as vomiting or diarrhea in the previous week, and prior nutritional status were the most significant predictors of malnutrition in this cohort. Future research may focus on the application of models to develop predictive algorithms for mobile device technology, as well as the identification of other predictors of malnutrition that are not well characterized such as the interaction of environmental exposures with protein consumption and epigenetics.
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Affiliation(s)
- Jason M. Nagata
- Department of Pediatrics, Stanford University, Palo Alto, California, United States of America
- * E-mail:
| | - James Gippetti
- Center for Health Policy and the Center for Primary Care and Outcomes Research, Stanford University, Palo Alto, California, United States of America
| | - Stefan Wager
- Graduate School of Business, Stanford University, Palo Alto, California, United States of America
| | - Alejandro Chavez
- Center for Health Policy and the Center for Primary Care and Outcomes Research, Stanford University, Palo Alto, California, United States of America
| | - Paul H. Wise
- Department of Pediatrics, Stanford University, Palo Alto, California, United States of America
- Center for Health Policy and the Center for Primary Care and Outcomes Research, Stanford University, Palo Alto, California, United States of America
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Abstract
The epidemiology and social context of American childhood are rapidly changing. Adverse social, economic, and child-rearing conditions are loading children down with preventable illness, physical and behavioral disability, and dysfunction. This new epidemiology of childhood is swamping the capacity of the nation's health care system, schools, juvenile justice facilities, and child protective services to respond to the needs of those they serve. This low-performing system not only jeopardizes the health of children, it also jeopardizes the health of the adults they will become. In this article we review the science of life-course health development, a new field that provides a powerful explanatory framework for understanding how poor health and social adversity during childhood can affect lifelong health. We then present five ambitious policy recommendations to integrate educational, health, social, and economic initiatives designed to enhance health. Our bold but pragmatic goal is that by 2025, US children will have the highest levels of health among industrialized nations, instead of where US children currently rank-among the worst.
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Affiliation(s)
- Neal Halfon
- Neal Halfon is a professor of pediatrics at the Geffen School of Medicine; a professor of health policy and management at the Fielding School of Public Health; and a professor of public policy at the Luskin School of Public Affairs, all at the University of California, Los Angeles (UCLA), and is director of the UCLA Center for Healthier Children, Families, and Communities
| | - Paul H Wise
- Paul H. Wise is the Richard E. Behrman Professor in Child Health in the Department of Pediatrics, Stanford University School of Medicine, in California
| | - Christopher B Forrest
- Christopher B. Forrest is a professor of pediatrics at the Children's Hospital of Philadelphia and the University of Pennsylvania, in Philadelphia
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Amoils M, Chang KW, Saynina O, Wise PH, Honkanen A. Postoperative Complications in Pediatric Tonsillectomy and Adenoidectomy in Ambulatory vs Inpatient Settings. JAMA Otolaryngol Head Neck Surg 2016; 142:344-50. [PMID: 26915058 DOI: 10.1001/jamaoto.2015.3634] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE A large-scale review is needed to characterize the rates of airway, respiratory, and cardiovascular complications after pediatric tonsillectomy and adenoidectomy (T&A) for inpatient and ambulatory cohorts. OBJECTIVE To identify risk factors for postoperative complications stratified by age and operative facility type among children undergoing T&A. DESIGN, SETTING, AND PARTICIPANTS This retrospective review included 115,214 children undergoing T&A in hospitals, hospital-based facilities (HBF), and free-standing facilities (FSF) in California from January 1, 2005, to December 31, 2010. The analysis used the State of California Office of Statewide Health Planning and Development private inpatient data and Emergency Department and Ambulatory Surgery public data. Inpatient (n = 18,622) and ambulatory (n = 96,592) cohorts were identified by codes from the International Classification of Diseases, Ninth Revision, and Current Procedural Terminology. Data were collected from September 2011 to March 2012 and analyzed from March through May 2012. MAIN OUTCOMES AND MEASURES Rates of airway, respiratory, and cardiovascular complications. RESULTS A total of 18,622 inpatients (51% male; 49% female; mean age, 5.4 [range, 0-17] years) and 96,592 ambulatory patients (37% male; 35% female; 28%, masked; mean age, 7.6 [range, 0-17] years) underwent analysis. The ratio of ambulatory to inpatient procedures was 5:1. Inpatients demonstrated more comorbidities (≤8, compared with ≤4 for HBF and ≤3 for FSF patients) and, in general, their complication rates were 2 to 5 times higher (seen in 1% to 12% of patients) than those in HBFs (0.2% to 5%), and more than 10 times higher than those in the FSFs (0% to 0.38%), with rates varying markedly by age range and facility type. Tonsillectomy and adenoidectomy was associated with increased risk for all complication types in both settings, reaching an odds ratio of 8.5 (95% CI, 6.6-11.1) for respiratory complications in the ambulatory setting. Inpatients aged 0 to 9 years experienced higher rates of airway and respiratory complications, peaking at an odds ratio of 7.5 (95% CI, 3.1-18.2) for airway complications in the group aged 0 to 11 months. CONCLUSIONS AND RELEVANCE Large numbers of pediatric patients undergo T&A in ambulatory settings despite higher rates of complications in younger patients and patients with more comorbidities. Fortunately, a high percentage of these patients has been appropriately triaged to the inpatient setting. Further research is needed to elucidate the subgroups that warrant postoperative hospitalization.
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Affiliation(s)
- Misha Amoils
- Department of Otolaryngology, Stanford University, Stanford, California
| | - Kay W Chang
- Department of Otolaryngology, Stanford University, Stanford, California
| | - Olga Saynina
- Center for Health Policy and the Center for Primary Care and Outcomes Research, Stanford University, Stanford, California
| | - Paul H Wise
- Center for Health Policy and the Center for Primary Care and Outcomes Research, Stanford University, Stanford, California
| | - Anita Honkanen
- Department of Anesthesia, Stanford University, Stanford, California
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Abstract
Welfare reform in 1996 increased work requirements for welfare recipients. Poor mothers face multiple barriers to work, among them poor health and abuse. In a sample (N = 504) of low-income mothers of children with chronic illnesses, women who had experienced violence had significantly worse health, experienced increased hardship, and faced more barriers to employment than women who did not experience violence. Battered women's health outcomes were assessed in the context of welfare policies that emphasize work without making reasonable accommodations for health and other employment barriers, including violence.
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Wise PH. Child Poverty and the Promise of Human Capacity: Childhood as a Foundation for Healthy Aging. Acad Pediatr 2016; 16:S37-45. [PMID: 27044700 DOI: 10.1016/j.acap.2016.01.014] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [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: 10/16/2015] [Revised: 01/19/2016] [Accepted: 01/20/2016] [Indexed: 02/07/2023]
Abstract
The effect of child poverty and related early life experiences on adult health outcomes and patterns of aging has become a central focus of child health research and advocacy. In this article a critical review of this proliferating literature and its relevance to child health programs and policy are presented. This literature review focused on evidence of the influence of child poverty on the major contributors to adult morbidity and mortality in the United States, the mechanisms by which these associations operate, and the implications for reforming child health programs and policies. Strong and varied evidence base documents the effect of child poverty and related early life experiences and exposures on the major threats to adult health and healthy aging. Studies using a variety of methodologies, including longitudinal and cross-sectional strategies, have reported significant findings regarding cardiovascular disorders, obesity and diabetes, certain cancers, mental health conditions, osteoporosis and fractures, and possibly dementia. These relationships can operate through alterations in fetal and infant development, stress reactivity and inflammation, the development of adverse health behaviors, the conveyance of child chronic illness into adulthood, and inadequate access to effective interventions in childhood. Although the reviewed studies document meaningful relationships between child poverty and adult outcomes, they also reveal that poverty, experiences, and behaviors in adulthood make important contributions to adult health and aging. There is strong evidence that poverty in childhood contributes significantly to adult health. Changes in the content, financing, and advocacy of current child health programs will be required to address the childhood influences on adult health and disease. Policy reforms that reduce child poverty and mitigate its developmental effects must be integrated into broader initiatives and advocacy that also attend to the health and well-being of adults.
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Affiliation(s)
- Paul H Wise
- March of Dimes Center for Prematurity Research, the Division of Neonatology, Department of Pediatrics, School of Medicine, and the Centers for Health Policy/Primary Care and Outcomes Research, Stanford University, Calif.
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Affiliation(s)
- Paul H Wise
- Division of Neonatology, Department of Pediatrics, Stanford University School of Medicine, Stanford, California2Freeman Spogli Institute for International Studies, Stanford University, Stanford, California
| | - Gary L Darmstadt
- Division of Neonatology, Department of Pediatrics, Stanford University School of Medicine, Stanford, California2Freeman Spogli Institute for International Studies, Stanford University, Stanford, California
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Chamberlain LJ, Swenson SM, Wise PH. Pharmacy Expenditures for Children With Serious Chronic Illness--Reply. JAMA 2016; 315:706-7. [PMID: 26881379 DOI: 10.1001/jama.2015.16981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Lisa J Chamberlain
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
| | - Sonja M Swenson
- Center for Health Policy and Center for Primary Care and Outcomes Research, Stanford University, Stanford, California
| | - Paul H Wise
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
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Buu MC, Sanders LM, Mayo JA, Milla CE, Wise PH. Assessing Differences in Mortality Rates and Risk Factors Between Hispanic and Non-Hispanic Patients With Cystic Fibrosis in California. Chest 2016; 149:380-389. [PMID: 26086984 DOI: 10.1378/chest.14-2189] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Over the past 30 years, therapeutic advances have extended the median lifespan of patients with cystic fibrosis (CF). Hispanic patients are a vulnerable subpopulation with a high prevalence of risk factors for worse health outcomes. The consequences of these differences on health outcomes have not been well described. The objective of this study was to characterize the difference in health outcomes, including mortality rate, between Hispanic and non-Hispanic patients with CF. METHODS This study is a retrospective analysis of CF Foundation Patient Registry data of California residents with CF, diagnosed during or after 1991, from 1991 to 2010. Ethnicity was self-reported. The primary outcome was mortality. Hazard ratios were estimated from a Cox regression model, stratified by sex, and adjusted for socioeconomic status, clinical risk factors, and year of diagnosis. RESULTS Of 1,719 patients, 485 (28.2%) self-identified as Hispanic. Eighty-five deaths occurred, with an overall mortality rate of 4.9%. The unadjusted mortality rate was higher among Hispanic patients than among non-Hispanic patients (9.1% vs 3.3%, P < .0001). Compared with non-Hispanic patients, Hispanic patients had a lower survival rate 18 years after diagnosis (75.9% vs 91.5%, P < .0001). Adjusted for socioeconomic status and clinical risk factors, Hispanic patients had an increased rate of death compared with non-Hispanic patients (hazard ratio, 2.81; 95% CI, 1.70-4.63). CONCLUSIONS Hispanic patients with CF have a higher mortality rate than do non-Hispanic patients, even after adjusting for socioeconomic status and clinical severity. Further investigation into the mechanism for the measured difference in lung function will help inform interventions and improve the health of all patients with CF.
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Affiliation(s)
- MyMy C Buu
- Department of Pediatrics, Division of Pediatric Pulmonary Medicine, Center for Excellence in Pulmonary Biology, Stanford University School of Medicine, Stanford, CA.
| | - Lee M Sanders
- Department of Pediatrics, Division of General Pediatrics, Center for Policy, Outcomes and Prevention, Stanford University School of Medicine, Stanford, CA
| | - Jonathan A Mayo
- Department of Pediatrics, Division of General Pediatrics, Center for Policy, Outcomes and Prevention, Stanford University School of Medicine, Stanford, CA
| | - Carlos E Milla
- Department of Pediatrics, Division of Pediatric Pulmonary Medicine, Center for Excellence in Pulmonary Biology, Stanford University School of Medicine, Stanford, CA
| | - Paul H Wise
- Department of Pediatrics, Division of General Pediatrics, Center for Policy, Outcomes and Prevention, Stanford University School of Medicine, Stanford, CA
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Abstract
BACKGROUND Despite considerable improvements in reproductive and newborn health throughout the world, relatively poor outcomes persist in areas plagued by conflict or political instability. OBJECTIVES To assess the contribution of areas of conflict and instability to global patterns of stillbirths and newborn deaths and to identify opportunities for effective intervention in these areas. METHODS Analysis of the available data on stillbirths and neonatal mortality in association with conflict and governance indicators, and review of epidemiological and political literature pertaining to the provision of health and public services in areas of conflict and instability. RESULTS Of the 15 countries with the highest neonatal mortality rates in the world, 14 are characterized by chronic conflict or political instability. If India and China are excluded, countries experiencing chronic conflict or political instability account for approximately 42% of all neonatal deaths worldwide. Efforts to address adverse reproductive and newborn outcomes in these areas must adapt recommended intervention protocols to the special security and governance conditions associated with unstable political environment. CONCLUSION Despite troubling relative and absolute indicators, the special requirements of improving reproductive and neonatal outcomes in areas affected by conflict and political instability have not received adequate attention. New integrated political and technical strategies will be required. This should include moving beyond traditional approaches concerned with complex humanitarian emergencies. Rather, global efforts must be based on a deeper understanding of the specific governance requirements associated with protracted and widespread health requirements. A focus on women's roles, regional strategies which take advantage of relative stability and governance capacity in neighbouring states, virtual infrastructure, and assistance regimens directed specifically to unstable areas may prove useful.
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Abstract
Neonatal mortality is increasingly concentrated globally in situations of conflict and political instability. In 1991, countries with high levels of political instability accounted for approximately 10% of all neonatal deaths worldwide; in 2013, this figure had grown to 31%. This has generated a "grand divergence" between those countries showing progress in neonatal mortality reduction compared to those lagging behind. We present new analyses demonstrating associations of neonatal mortality with political instability (r = 0.55) and poor governance (r = 0.70). However, heterogeneity in these relationships suggests that progress is possible in addressing neonatal mortality even in the midst of political instability and poor governance. In order to address neonatal mortality more effectively in such situations, we must better understand how specific elements of "strategic governance"--the minimal conditions of political stability and governance required for health service implementation--can be leveraged for successful introduction of specific health services. Thus, a more strategic approach to policy and program implementation in situations of conflict and political instability could lead to major accelerations in neonatal mortality reduction globally. However, this will require new cross-disciplinary collaborations among public health professionals, political scientists, and country actors.
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Affiliation(s)
- Paul H Wise
- Department of Pediatrics, Stanford University School of Medicine, Stanford University, Stanford, CA; Freeman Spogli Institute for International Studies, Stanford University; March of Dimes Center for Prematurity Research, Stanford University, Stanford, CA.
| | - Gary L Darmstadt
- Department of Pediatrics, and March of Dimes Prematurity Research Center, Stanford University School of Medicine, Stanford, CA
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Affiliation(s)
- Sonja M Swenson
- Center for Primary Care and Outcomes Research, Stanford University, Stanford, California
| | - Lisa J Chamberlain
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
| | - Lee M Sanders
- Center for Primary Care and Outcomes Research, Stanford University, Stanford, California
| | - Vandana Sundaram
- Center for Primary Care and Outcomes Research, Stanford University, Stanford, California
| | - Paul H Wise
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
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Byrnes J, Mahoney R, Quaintance C, Gould JB, Carmichael S, Shaw GM, Showen A, Phibbs C, Stevenson DK, Wise PH. Spatial and temporal patterns in preterm birth in the United States. Pediatr Res 2015; 77:836-44. [PMID: 25760546 DOI: 10.1038/pr.2015.55] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [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: 08/13/2014] [Accepted: 11/26/2014] [Indexed: 01/05/2023]
Abstract
BACKGROUND Despite years of research, the etiologies of preterm birth remain unclear. In order to help generate new research hypotheses, this study explored spatial and temporal patterns of preterm birth in a large, total-population dataset. METHODS Data on 145 million US births in 3,000 counties from the Natality Files of the National Center for Health Statistics for 1971-2011 were examined. State trends in early (<34 wk) and late (34-36 wk) preterm birth rates were compared. K-means cluster analyses were conducted to identify gestational age distribution patterns for all US counties over time. RESULTS A weak association was observed between state trends in <34 wk birth rates and the initial absolute <34 wk birth rate. Significant associations were observed between trends in <34 wk and 34-36 wk birth rates and between white and African American <34 wk births. Periodicity was observed in county-level trends in <34 wk birth rates. Cluster analyses identified periods of significant heterogeneity and homogeneity in gestational age distributional trends for US counties. CONCLUSION The observed geographic and temporal patterns suggest periodicity and complex, shared influences among preterm birth rates in the United States. These patterns could provide insight into promising hypotheses for further research.
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Affiliation(s)
- John Byrnes
- Artificial Intelligence Center, SRI International, San Diego, California
| | | | - Cele Quaintance
- 1] Division of Neonatology, Department of Pediatrics, Stanford University School of Medicine, Stanford, California [2] March of Dimes Center for Prematurity Research at Stanford, Stanford University School of Medicine, Stanford, California
| | - Jeffrey B Gould
- 1] Division of Neonatology, Department of Pediatrics, Stanford University School of Medicine, Stanford, California [2] March of Dimes Center for Prematurity Research at Stanford, Stanford University School of Medicine, Stanford, California
| | - Suzan Carmichael
- 1] Division of Neonatology, Department of Pediatrics, Stanford University School of Medicine, Stanford, California [2] March of Dimes Center for Prematurity Research at Stanford, Stanford University School of Medicine, Stanford, California
| | - Gary M Shaw
- 1] Division of Neonatology, Department of Pediatrics, Stanford University School of Medicine, Stanford, California [2] March of Dimes Center for Prematurity Research at Stanford, Stanford University School of Medicine, Stanford, California
| | - Amy Showen
- David Geffen School of Medicine, University of California, Los Angeles, California
| | - Ciaran Phibbs
- 1] Division of Neonatology, Department of Pediatrics, Stanford University School of Medicine, Stanford, California [2] March of Dimes Center for Prematurity Research at Stanford, Stanford University School of Medicine, Stanford, California
| | - David K Stevenson
- 1] Division of Neonatology, Department of Pediatrics, Stanford University School of Medicine, Stanford, California [2] March of Dimes Center for Prematurity Research at Stanford, Stanford University School of Medicine, Stanford, California
| | - Paul H Wise
- 1] Division of Neonatology, Department of Pediatrics, Stanford University School of Medicine, Stanford, California [2] March of Dimes Center for Prematurity Research at Stanford, Stanford University School of Medicine, Stanford, California [3] Center for Policy, Outcomes and Prevention, Center for Health Policy/Center for Primary Care and Outcomes Research, Stanford University, Stanford, California
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Fernandes SM, Chamberlain LJ, Grady S, Saynina O, Opotowsky AR, Sanders L, Wise PH. Trends in utilization of specialty care centers in California for adults with congenital heart disease. Am J Cardiol 2015; 115:1298-304. [PMID: 25765587 DOI: 10.1016/j.amjcard.2015.02.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Revised: 02/03/2015] [Accepted: 02/03/2015] [Indexed: 02/04/2023]
Abstract
The American College of Cardiology and American Heart Association guidelines recommend that management of adult congenital heart disease (ACHD) be coordinated by specialty ACHD centers and that ACHD surgery for patients with moderate or complex congenital heart disease (CHD) be performed by surgeons with expertise and training in CHD. Given this, the aim of this study was to determine the proportion of ACHD surgery performed at specialty ACHD centers and to identify factors associated with ACHD surgery being performed outside of specialty centers. This retrospective population analysis used California's Office of Statewide Health Planning and Development's discharge database to analyze ACHD cardiac surgery (in patients 21 to 65 years of age) in California from 2000 to 2011. Designation as a "specialty ACHD center" was defined on the basis of a national ACHD directory. A total of 4,611 ACHD procedures were identified. The proportion of procedures in patients with moderate and complex CHD delivered at specialty centers increased from 46% to 71% from 2000 to 2011. In multivariate analysis among those discharges for ACHD surgery in patients with moderate or complex CHD, performance of surgery outside a specialty center was more likely to be associated with patients who were older, Hispanic, insured by health maintenance organizations, and living farther from a specialty center. In conclusion, although the proportion of ACHD surgery for moderate or complex CHD being performed at specialty ACHD centers has been increasing, 1 in 4 patients undergo surgery at nonspecialty centers. Increased awareness of ACHD care guidelines and of the patient characteristics associated with differential access to ACHD centers may help improve the delivery of appropriate care for all adults with CHD.
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Mudumbai SC, Honkanen A, Chan J, Schmitt S, Saynina O, Hackel A, Gregory G, Phibbs CS, Wise PH. Variations in inpatient pediatric anesthesia in California from 2000 to 2009: a caseload and geographic analysis. Paediatr Anaesth 2014; 24:1295-301. [PMID: 25203670 DOI: 10.1111/pan.12500] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [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] [Accepted: 07/04/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND Regional referral systems are considered important for children hospitalized for surgery, but there is little information on existing systems. OBJECTIVES To examine geographic variations in anesthetic caseloads in California for surgical inpatients ≤6 years and to evaluate the feasibility of regionalizing anesthetic care. METHODS We reviewed California's unmasked patient discharge database between 2000 and 2009 to determine surgical procedures, dates, and inpatient anesthetic caseloads. Hospitals were classified as urban or rural and were further stratified as low, intermediate, high, and very high volume. RESULTS We reviewed 257,541 anesthetic cases from 402 hospitals. Seventeen California Children's Services (CCS) hospitals conducted about two-thirds of all inpatient anesthetics; 385 non-CCS hospitals accounted for the rest. Urban hospitals comprised 82% of low- and intermediate-volume centers (n = 297) and 100% of the high- and very high-volume centers (n = 41). Ninety percent (n = 361) of hospitals performed <100 cases annually. Although potentially lower risk procedures such as appendectomies were the most frequent in urban low- and intermediate-volume hospitals, fairly complex neurosurgical and general surgeries were also performed. The median distance from urban lower-volume hospitals to the nearest high- or very high-volume center was 12 miles. Up to 98% (n = 40,316) of inpatient anesthetics at low- or intermediate-volume centers could have been transferred to higher-volume centers within 25 miles of smaller centers. CONCLUSIONS Many urban California hospitals maintained low annual inpatient anesthetic caseloads for children ≤6 years while conducting potentially more complex procedures. Further efforts are necessary to define the scope of pediatric anesthetic care at urban low- and intermediate-volume hospitals in California.
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Affiliation(s)
- Seshadri C Mudumbai
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA; Anesthesia and Perioperative Medicine Service, VA Palo Alto HCS, Palo Alto, CA, USA
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