Results of Universal Prenatal Screening for Hepatitis C Infection in a Remote American Indian Primary Care Population

BACKGROUND: Although chronic liver disease remains a major area of health disparity for American Indian (AI) people, the epidemiology of hepatitis C virus (HCV) infection among AI people is poorly documented. Because of suspected high local prevalence, two remote AI clinics in the Northern Plains implemented universal prenatal HCV screening in 2005. When this screening program reported an unexpectedly high prenatal anti-HCV (anti-HCV antibody) positivity rate, we conducted a case-control study to determine risks for infection and opportunities for community intervention. MAIN FINDINGS: The clinics screened a total of 205 pregnant women (median age, 22 years). Of these 205 women, a total of 13 (6.3%; 95% confidence interval, 3.4–10.6) had anti-HCV confirmed. Of the anti-HCV-positive women, 10 (76.9%) were aged 15–24 years. We included 10 cases and 40 anti-HCV-negative prenatal controls in a case-control study. On multivariate analysis, only injection-drug use (IDU) remained associated with HCV seropositivity. CONCLUSIONS: Universal prenatal screening revealed a high prevalence of anti-HCV at these remote AI clinics. This population has not been previously described at being at elevated risk for HCV infection. In order to reduce health disparities, young, rural AI populations seeking prenatal care need to be included in interventions to reduce HCV transmission

Kids Count Alaska 2008

We’re pleased to announce that Kids Count Alaska is part of a new site, the Kids Count Data Center (datacenter.kidscount.org). Developed by the KIDS COUNT national program, the site gives easy access to data on children and teenagers for every state and hundreds of cities and counties across the country. For Alaska, you can select indicators for each of the state’s seven regions and create your own maps, trend lines, and charts. There are also maps and graphs you can put on your Web site or blog. You can go directly to that national site, or you can link from our Web site (www.kidscount.alaska.edu). We hope you’ll find the new data and features helpful. This book and all previous data books are available on our Web site, and each data book is divided into sections for faster downloading. Also on our site is a link to the most recent national KIDS COUNT data book, as well as to other publications and reports. About This Year’s Book Alaska is celebrating 50 years as a state in 2009—and as part of the celebration, we decided to illustrate this year’s data book with historic photos of Alaska’s children before statehood. We also used information from the U.S. Census Bureau to take a broad look at how conditions have changed for Alaska’s children since statehood. In the Highlights at the end of this section (pages 7 to 10) you’ll find some comparisons of the social and economic wellbeing of children in Alaska in 1959 and today. What is Kids Count Alaska? Kids Count Alaska is part of a nationwide program, sponsored by the Annie E. Casey Foundation, to collect and publicize information about children’s health, safety, and economic status. We pull together information from many sources and present it all in one place. We hope this book gives Alaskans a broad picture of how the state’s children are doing and provides parents, policymakers, and others interested in the welfare of children with information they need to improve life for children and families. Our goals are: • Distributing information about the status of Alaska’s children • Creating an informed public, motivated to help children • Comparing the status of children in Alaska with children nationwide, and presenting additional Alaska indicators (including regional breakdowns) when possibleAnnie E. Casey FoundationIntroduction / Infancy / Economic Well-Being / Education / Children in Danger / Juvenile Justic

Practitioners' views about equity within prenatal services

The British National Health Service (NHS) is based on principles of equal access, treatment and outcomes. This article reviews health professionals' aims to provide equitable prenatal services and their views on whether women could be equal in their access to services, understanding during choice-making, and satisfaction about their care. Inequalities which compromise equity, conflicting meanings of equity, and the contribution of in-hospital ethics seminars to ethical health services are considered. Qualitative research, combining sociological and philosophical methods, investigated the experiences of health care staff attempting to provide equitable services and their practical and ethical problems. A total of 70 staff at a teaching hospital and a district general hospital took part in semi-structured interviews, followed by 11 innovative in-hospital ethics seminars based on themes derived from the interviews. The 56 seminar participants usually began with clear statements of their equitable aims, but, encouraged by the health care ethicist, they went on to discuss their many concerns about obstacles which complicated the achievement of these aims. The sociological-ethics seminars provided unique opportunities for multi-disciplinary discussion of these inequalities and their impact on equitable intentions in health care. Analysis of the contradictions revealed during the seminars is guided by sociological theories that seek to explain the persistence of inequalities in health, and how NHS policies appear to perpetuate and increase them, despite practitioners' stated intentions to promote equality

Risky drinking patterns are being continued into pregnancy: a prospective cohort study

Background: Risky patterns of alcohol use prior to pregnancy increase the risk of alcohol-exposed pregnancies and subsequent adverse outcomes. It is important to understand how consumption changes once women become pregnant. Objective: The aim of this study was to describe the characteristics of women that partake in risky drinking patterns before pregnancy and to examine how these patterns change once they become pregnant. Methods: A sample of 1577 women from the 1973–78 cohort of the Australian Longitudinal Study on Women’s Health were included if they first reported being pregnant in 2000, 2003, 2006, 2009 and reported risky drinking patterns prior to that pregnancy. Multinomial logistic regression was used to determine which risky drinking patterns were most likely to continue into pregnancy. Results: When reporting risky drinking patterns prior to pregnancy only 6% of women reported weekly drinking only, whereas 46% reported binge drinking only and 48% reported both. Women in both binge categories were more likely to have experienced financial stress, not been partnered, smoked, used drugs, been nulliparous, experienced a violent relationship, and were less educated. Most women (46%) continued these risky drinking patterns into pregnancy, with 40% reducing these behaviors, and 14% completely ceasing alcohol consumption. Once pregnant, women who binged only prior to pregnancy were more likely to continue (55%) rather than reduce drinking (29%). Of the combined drinking group 61% continued to binge and 47% continued weekly drinking. Compared with the combined drinking group, binge only drinkers prior to pregnancy were less likely to reduce rather than continue their drinking once pregnant (OR = 0.37, 95% CI = 0.29, 0.47). Conclusions: Over a third of women continued risky drinking into pregnancy, especially binge drinking, suggesting a need to address alcohol consumption prior to pregnancy. Alexis J. Hure, Peta M. Forder, Jennifer Powers, Frances J. Kay-Lambkin, Deborah J. Loxto

Fetal alcohol spectrum disorders: current issues in awareness, prevention and intervention

This paper reviews the research and current policy surrounding prenatal alcohol exposure and fetal alcohol spectrum disorders (FASD). Alcohol use during pregnancy is linked to a spectrum of adverse fetal outcomes. This spectrum of abnormalities is collectively termed fetal alcohol spectrum disorders and may include physical, cognitive and/or developmental symptoms. The aim of this paper is to inform practitioners and other professionals working in a range of fields about the implications of FASD for children and their families. Current research on interventions or programs to work with families affected by FASD is also explored. Key messages Prenatal alcohol exposure can cause a range of cognitive and physical abnormalities in embryos that can lead to impairments in a range of functions: sensory systems, language and communication, processing pace, learning and memory, abstract thinking, and executive functioning. Misunderstanding and labelling of those with FASD can lead to a poor self-concept, disrupted peer relationships, fractured educational and placement experiences and contact with youth justice services. The prevalence of FASD is likely to be underestimated by current measures. Certain populations, including children in out-of-home care and children in contact with youth justice services are thought to include an over-representation of individuals living with an undetected FASD. Tackling FASD requires focused and coordinated multidisciplinary and cross sector approaches. More information about the prevalence and nature of FASD will allow for improved service planning and implementation. Policy directions are needed that prioritise the screening and prevention of FASD in the community. Current and future professionals, including those in traditionally adult-focused services, need awareness and knowledge about the significance of FASD and prenatal alcohol exposure on children\u27s lives

The effectiveness of mHealth interventions for maternal, newborn and child health in low- and middle-income countries:Protocol for a systematic review and meta-analysis

Rates of maternal, newborn and child (MNCH) mortality and morbidity are vastly greater in low– than in high–income countries and represent a major source of global health inequity. A host of systemic, economic, geopolitical and sociocultural factors have been implicated. Mobile information and communication technologies hold potential to ameliorate several of these challenges by supporting coordinated and evidence–based care, facilitating community based health services and enabling citizens to access health information and support. mHealth has attracted considerable attention as a means of supporting maternal, newborn and child health in developing countries and research to assess the impacts of mHealth interventions is increasing. While a number of expert reviews have attempted to summarise this literature, there remains a need for a fully systematic review employing gold standard methods of evidence capture, critical appraisal and meta–analysis, in order to comprehensively map, quality assess and synthesise this body of knowledge

Kids Count Alaska 2009-2010

For information on children across America, visit the Kids Count Data Center (www.datacenter.kidscount.org). Developed by the national KIDS COUNT program, the site provides data on children and teenagers for every state and hundreds of cities and counties. For Alaska, you can select indicators for each of the state’s seven regions and create your own maps, trend lines, and charts. There are also maps and graphs you can put on your website or blog. You can go directly to that national site or link from our website (kidscount.alaska.edu). This book and all previous data books are available on our website, with each book divided into sections for faster downloading. Also on our site is a link to the most recent national KIDS COUNT data book, as well as other publications and reports.Annie E. Casey FoundationIntroduction / Infancy / Economic Well-Being / Education / Children in Danger / Juvenile Justic