Intrapartum Antibiotic Chemoprophylaxis Policies for the Prevention of Group B Streptococcal Disease Worldwide: Systematic Review.

Background: Intrapartum antibiotic chemoprophylaxis (IAP) prevents most early-onset group B streptococcal (GBS) disease. However, there is no description of how IAP is used around the world. This article is the sixth in a series estimating the burden of GBS disease. Here we aimed to review GBS screening policies and IAP implementation worldwide. Methods: We identified data through (1) systematic literature reviews (PubMed/Medline, Embase, Literature in the Health Sciences in Latin America and the Caribbean [LILACS], World Health Organization library database [WHOLIS], and Scopus) and unpublished data from professional societies and (2) an online survey and searches of policies from medical societies and professionals. We included data on whether an IAP policy was in use, and if so whether it was based on microbiological or clinical risk factors and how these were applied, as well as the estimated coverage (percentage of women receiving IAP where indicated). Results: We received policy information from 95 of 195 (49%) countries. Of these, 60 of 95 (63%) had an IAP policy; 35 of 60 (58%) used microbiological screening, 25 of 60 (42%) used clinical risk factors. Two of 15 (13%) low-income, 4 of 16 (25%) lower-middle-income, 14 of 20 (70%) upper-middle-income, and 40 of 44 (91%) high-income countries had any IAP policy. The remaining 35 of 95 (37%) had no national policy (25/33 from low-income and lower-middle-income countries). Coverage varied considerably; for microbiological screening, median coverage was 80% (range, 20%-95%); for clinical risk factor-based screening, coverage was 29% (range, 10%-50%). Although there were differences in the microbiological screening methods employed, the individual clinical risk factors used were similar. Conclusions: There is considerable heterogeneity in IAP screening policies and coverage worldwide. Alternative global strategies, such as maternal vaccination, are needed to enhance the scope of global prevention of GBS disease

Unconscious bias in the suppressive policing of Black and Latino men and boys: neuroscience, Borderlands theory, and the policymaking quest for just policing

his article applies neuroscience and Borderlands theory to reveal how unconscious bias currently stabilizes suppressive policing practices in America despite new efforts at reform. Illustrative cases are offered from Oakland and Santa Barbara, California, with a focus on civil gang injunctions (CGIs) and youth gang suppression. Theoretical analysis of these cases reveals how the unconscious biases of validity illusions and framing effects operate despite the best intentions of law enforcement personnel. Such unconscious or implicit biases create contradictions between the stated beliefs and actions of law enforcement. In turn, these unintended self-contradictions then work to the detriment of Latino and Black boys. The analysis here also extends to how unconscious biases and unintended self-contradictions can influence municipal policymaking in favor of suppressive police tactics such as CGIs, thereby displacing evidence-based policies that are proven to be far more effective. The article concludes with brief discussion of some of the means by which the unconscious biases – effects to which everyone is involuntarily prone – can be disrupted