Obstetrician-Gynecologists’ Knowledge of Health Disparities and Barriers among American Indian/Alaska Native Women in Washington State

Background: Health disparities between American Indian/Alaska Native (AI/AN) women and other races/ethnicities have long been noted. Obstetricians-Gynecologists (Ob-Gyn) play a significant role in well-woman care and are often the first and most frequent point of medical contact for women, particularly among minority and low-income women. Objective: This study aimed to assess Ob-Gyns’ knowledge, beliefs, and practices related to health disparities among AI/AN women. Method: A self-administered questionnaire, consisting of questions about knowledge, beliefs, and practices of health disparities among AI/AN women, was mailed to 722 members of The American College of Obstetricians and Gynecologists (ACOG) practicing in the state of Washington in September 2013-February 2014. Results: The majority of respondents were knowledgeable about numerous health care disparities among non-pregnant AI/AN women, while slightly fewer were aware of disparities among pregnant AI/AN patients. Ob-Gyns reported low confidence in their training and knowledge of AI/AN culture and health disparities, but high confidence in their ability to treat AI/AN patients. Participants reported dissatisfaction with their AI/AN patients’ breastfeeding rates. Conclusion: Ob-Gyn knowledge of health disparities among AI/AN women is adequate. In spite of this, barriers to quality care are still present and increased identification and implementation of effective resources is needed

Lower respiratory tract disorder hospitalizations among children born via elective early-term delivery

<p><i>Objective</i>: We evaluated the hypothesis that elective early-term delivery increases the risk of childhood lower respiratory tract disorder hospitalization.</p> <p><i>Methods</i>: Children born via early-term elective inductions were compared to full- or late-term elective inductions in a retrospective cohort study using Washington State birth certificate and hospital discharge data. Outcomes were the odds of lower respiratory disorder hospitalization before age five and cause specific odds ratios for asthma, bronchiolitis, bronchitis, and pneumonia. In addition, a subgroup analysis excluding infants with perinatal complications was conducted.</p> <p><i>Results</i>: Electively induced early-term children were at significantly increased risk of hospitalization before age five for lower respiratory disorders compared to similar full- or late-term children (adjusted OR: 1.31, 95% CI: 1.11–1.55). Bronchiolitis was the only cause-specific outcome with a statistically significant increase in odds of hospitalization, though comparable increases were found for the less common diagnoses of asthma (adjusted OR: 1.39, 95% CI: 0.93–2.08) and pneumonia (adjusted OR: 1.27, 95% CI: 0.99–1.64). Excluding infants with perinatal complications did not alter the results.</p> <p><i>Conclusions</i>: There was an association between electively induced early-term delivery and hospitalization for lower respiratory tract disorders before age five. This reinforces policies discouraging elective early-term delivery.</p

Serious and Life-Threatening Pregnancy-Related Infections: Opportunities to Reduce the Global Burden

Serious and Life-Threatening Pregnancy-Related Infections: Opportunities to Reduce the Global Burde

Pyelonephritis/urosepsis.

<p>HICs, high-income countries.</p

Timing of four clinical syndromes and their pathogens, and potential opportunities for “bundled” diagnostic–therapeutic interventions.

<p>See <a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1001324#pmed-1001324-t002" target="_blank">Table 2</a> for further details of the interventions.</p

Literature review strategy.

<p>Relevant studies from the years 1980 to 2012 were identified by searching PubMed, Medline, Embase, and WHO publications. The search strategy used was “([infectious syndrome]) AND (Africa OR Asia OR India OR Thailand OR Bangladesh)”; the infectious syndromes included in our search were those that cause the most morbidity and mortality: puerperal sepsis (PPE, chorioamnionitis), septic abortion, pyelonephritis or urosepsis, and soft tissue infections (necrotizing fasciitis, group A streptococcal infection, and methicillin-resistant staphylococcal infection). All titles and abstracts were reviewed, and those including etiology, prevalence, or pregnancy were selected for further analysis.</p

Common syndromes associated with life-threatening maternal infections and the pathogens most frequently associated with these.

<p>Common syndromes associated with life-threatening maternal infections and the pathogens most frequently associated with these.</p

Interventions for reducing serious morbidities and mortalities from pregnancy-related infections.

<p>pPROM, preterm premature rupture of membranes; PROM, premature rupture of membranes.</p

Septic abortion.

<p>HICs, high-income countries.</p