ABSTRACT
Mortality, morbidity, and childhood developmental challenges can all result fromadverse birth outcomes. In regard to these outcomes, the United States exhibits significant racial and socioeconomic inequities, and effective interventions targeting lowincome pregnant people are necessary. A recommendation for expanding home visiting programs has been provided with the hope of improving newborn andmaternal outcomes, and substantial federal funding is granted to these programs via theMaternal, Infant, and Early Childhood Home Visiting program. The Nurse-Family Partnership program is a nurse home visiting service targeting nulliparous low-income families during pregnancy and early childhood. The state of South Carolina's preterm birth rate in 2016 was the sixth highest in the United States, which motivated the state to offer program services to Medicaid-eligible nulliparous women through aMedicaid waiver. This study's objective was to determine effects of intensive nurse home visiting programs on the composite outcome of small for gestational age, low birth weight, preterm birth, and perinatal mortality. This randomized clinical trial assigned participants in a 2:1 ratio to either a control group or an intervention group, which was offered access to the program. The control group was offered a list of community-based resources available to them, and all participants received usual care for South Carolina. Inclusion criteria were nulliparous pregnancy of less than 28 weeks' gestation, income-eligible for Medicaid during pregnancy, and residence in a program-served county. Self-referral, or referral through schools, clinicians, and Medicaid led patients to 1 of 9 program-implementing sites. The intervention, which consisted of a prenatal and early childhood home visiting program, was carried out by nurses conducting home visits with participants from pregnancy through the first 2 years of the child's life. The nurses used activities tailored to the clients' strengths, preferences, and risks via educational tools, motivational interviews, goal setting related to prenatal health, health assessments, maternal life course, and child health and development. Utilization of health care was encouraged when needed, coupled with referrals to health and social services. Ideal visits ranged from weekly 60- to 90-minute sessions for 4 weeks following enrollment and then every other week leading up to delivery. Nurse training encouraged flexible support of clients for more or fewer visits as necessary, with services provided in both Spanish and English, with other translation options. Enrollment for the study began on April 1, 2016, but concerns for the COVID-19 pandemic led to a recruitment halt on March 17, 2020. However, 95% of the target recruitment goal had already occurred, and the remaining home visits were conducted via telehealth. A total of 3319 patients were eligible and opted for enrollment. Upon time of enrollment, 18% of participants were younger than 19 years, with 54.8% of them between 19 and 24 years old. Self-reported race and ethnicity statistics were reported as 55.2% non-Hispanic Black, and 22.4% had not completed high school. Body mass index of greater than 30 kg/m2 was present in 34.5%, and smoking 3 months before pregnancy was reported in 25.8% of participants. Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.
ABSTRACT
Bacteriophages, or Phages for short, are viruses that specifically infect bacterial cells. Their name is derived from Greek for "bacteria eater" and it's an apt description: To reproduce, they must coopt the cellular machinery of a bacterium, sometimes destroying it in the process [1]. Phages thrive anywhere bacteria exist-on land, in water, and inside plants and animals. In fact, they are considered the most successful organisms on earth due to their abundance and genetic diversity. Scientists estimate there are a trillion phages for every grain of sand on earth. That's 10(31) phages [2].
ABSTRACT
The COVID-19 pandemic has resulted in the implementation of alternative models of education, with virtual learning in lieu of in-person schooling. School schedules significantly affect children's routines, including levels of activity, meals, and access to restrooms. The Dayton Children's Health Partners clinically integrated network has been working on a program to decrease costs associated with pediatric constipation in southwest Ohio, including emergency department (ED) utilization. We hypothesized that there would be a decrease in encounters due to constipation with the interruption of traditional in-person learning due to the coronavirus disease 2019 (COVID-19) pandemic. We have collected data on emergency department, primary care, and specialist outpatient encounters and hospital admissions for patients who have been diagnosed with constipation. We analyzed Dayton Children's Hospital (DCH) ED visits of school age children (5-18 years old) for constipation-related diagnosis codes and correlated the patients' street addresses and zip codes to state assigned school districts. Data were aggregated using Microsoft Power BI. We used the online quality improvement (QI) platform LifeQI to create control charts. Individual school district in-person/remote learning schedules were overlaid using local news reporting. We found that DCH ED visits for all causes decreased significantly beginning in March 2020, with the lowest point being in April/May 2020. Since that time, ED visits for all causes have gradually increased, although they have not yet returned to their pre-COVID-19 levels. Before COVID-19, DCH ED visits related to constipation were lower in the summer and rose when school began. Once there were school closures the percentage of DCH ED visits for constipation decreased and remained low even when school resumed in September, as many children were learning remotely. Many schools began in-person/hybrid learning in October or November 2020, and the percentage of constipation-related DCH ED visits began to rise around this time. School closure and re-opening affected the rate of DCH ED visits for constipation. Analysis of children from specific school districts demonstrated varying constipation ED visit rates related to in-person and remote learning.