Addressing Racial Disparities in Maternal and Infant Health Outcomes Through an Anti-Racism Curriculum.

OBJECTIVE: The purpose of this project was for current and future health care professionals to acknowledge and address implicit biases through education and engagement in workshops surrounding the topic of racism in medicine. PROJECT SUMMARY: Current anti-racism curricula exist in various spaces, including schools, businesses, and health care. However, these curricula often target different audiences, lack interactive components, and do not always incorporate community voices into the work. Therefore, a series of novel workshops was created for students, residents, and faculty to address biases and policies that perpetuate inequity. Over the course of the 2021-2022 academic year, 74 participants engaged in three workshops addressing racial disparities in maternal and child health. The first workshop focused on allowing participants to develop a common language about race and racism, provided background and historical context, and started to encourage awareness and acceptance of responsibility for engaging in anti-racist behavior. The second workshop incorporated voices from the community to understand how those affected by the disparity feel that it can best be addressed and to explore what effective allyship means. The third workshop explored the effect of microaggressions and allowed participants to review common problematic responses to being made aware of our own biases as well as to practice responding authentically and openly. This workshop series has been expanded into a second year, with new topics based on participant feedback. OUTCOME: Although many participants had previously engaged in anti-racism training, there was still a lack of knowledge regarding both historical context and current factors contributing to disparities. The goal of this workshop series was to provide a forum for participants who may not otherwise have an accessible opportunity for engagement to better understand the relevance of current disparities to their practice. Through this curriculum, participants accomplished several goals, including: 1) increasing awareness about the prevalence of racial and ethnic disparities and the effect of these on health outcomes; 2) exploring implicit biases, the culture of medicine, and the difference between intention and effect; 3) understanding the role that practitioner bias plays in health outcomes; and 4) understanding culturally derived mistrust of the health care system. RELEVANCE TO WOMENS HEALTH: As health care professionals, we need to address our own implicit biases and acknowledge the collective failures as a health care system before we can build an equitable health care space. Anti-racism workshops can contribute to the elimination of systemic racism and health disparities by engaging health care professionals at various points in their personal journeys toward becoming anti-racist. This allows individuals and institutions to begin the conversations needed to address system-level policies and practices that perpetuate inequity.

Negative Perceptions and Long-Acting Reversible Contraceptive Choice in Adolescents and Young Adults: A Cross-Sectional Study.

OBJECTIVE: Long-acting reversible contraceptives (LARCs) have high rates of safety, satisfaction, and continuation in adolescents and young adults (AYAs). Despite this, utilization of these methods by AYAs is low. The purpose of this study was to evaluate the negative personal perceptions or beliefs about birth control and LARCs and their association with contraceptive use in AYAs. METHODS: We surveyed young people (14-24 years old) seeking care at a Title X-supported adolescent reproductive and sexual health clinic to assess negative perceptions of birth control methods, with an emphasis on LARCs. We used appropriate bivariate statistics to compare those endorsing 3 or fewer negative perceptions with those who had more than 3 and logistic regression to identify predictors of contraceptive choice. RESULTS: We recruited 345 participants; 337 (97.7%) completed the survey. Among respondents, the median age was 20 (range 14-24) years, and 7.04% of participants had ever been pregnant. The most commonly held negative perceptions were fear of device migration or breakage causing adverse health effects and concern about effect on future fertility. The number of negative perceptions endorsed did not differ significantly by age. However, a greater number of negative perceptions and younger age were clinical predictors of LARC nonuse. CONCLUSION: AYAs have negative perceptions about LARCs that are often inaccurate and may limit contraceptive acceptability and perceived options. Engaged and respectful dialogue with AYAs about their concerns and fears is essential to provide accurate and patient-centered contraceptive counseling and to ensure that young people can make informed contraceptive choices.

Effects of 3D-Printed Models and 3D Printed Pictures on Maternal- and Paternal-Fetal Attachment, Anxiety, and Depression.

OBJECTIVE: To compare the effect of a 3D-printed model versus 3D printed pictures on maternal- and paternal-fetal attachment, pregnancy-related anxiety, and depression in parents in the third trimester. DESIGN: Randomized controlled trial. SETTING: University- and clinic-affiliated hospital system. PARTICIPANTS: Between August 2020 and July 2021, we screened 419 women for eligibility. A total of 184 participants (n = 95 women and n = 89 men) were included in the intention-to-treat analysis, of whom 47 women and 44 men received the 3D-printed model, whereas 48 women and 45 men received the 3D printed picture. METHODS: Participants completed a set of questionnaires before they received third trimester 3D ultrasonography and a second set of questionnaires approximately 14 days after the study ultrasonography. The primary outcome was the global Maternal and Paternal Antenatal Attachment scale scores. Secondary outcomes included the Maternal and Paternal Antenatal Attachment subscale scores, global Generalized Anxiety Disorder-7 scores, global Patient Health Questionnaire-9 scores, and global Pregnancy-Related Anxiety Questionnaire-Revised (second version) scores. We used multilevel models to estimate the effect of the intervention. RESULTS: We found a statistically significant increase in mean attachment scores after the 3D printed picture and 3D-printed model intervention of 0.26, 95% confidence interval (CI) [0.22, 0.31], p < .001. Additionally, we found statistically significant improvement in depression (mean change = -1.08, 95% CI [-1.54, -0.62], p < .001), generalized anxiety (mean change = -1.38, 95% CI [-1.87, -0.89], p < .001), and pregnancy-related anxiety (mean change = -2.92, 95% CI [-4.11, -1.72], p < .001) scores. We found no statistically significant between-group differences related to maternal or paternal attachment, anxiety, depression, or pregnancy-related anxiety. CONCLUSIONS: Our findings support the use of 3D printed pictures and 3D-printed models to improve prenatal attachment, anxiety, depression, and pregnancy-related anxiety.

Differential diagnosis of an osseous cranial tumor from Hellenistic Mugla, Turkey.

OBJECTIVE: This project evaluates a cranial lesion from a Hellenistic-era individual excavated by the Mugla Archaeological Museum in Gülagzi, Turkey. MATERIALS: An osseous tumor measuring 3.02 × 3.54 × 2.98 cm originating from the occipital bone of a probable young adult male. METHODS: The tumor was examined using gross morphological inspection, plain radiography (x-ray), and computed tomography (CT) imaging to identify potential differential diagnoses for the osseous cranial tumor. RESULTS: The lesion in question displays features highly consistent with both osteoid osteoma and osteoblastoma. The tumor had a non-sclerotic, sharply demarcated border, a radiolucent nidus measuring less than 2 centimeters in diameter, and homogeneous sclerotic bone surrounding the nidus. CONCLUSIONS: Differential diagnosis determined the osseous tumor to be a benign neoplasm, and in this case the features of the tumor are highly consistent with a diagnosis of either osteoblastoma or osteoid osteoma. SIGNIFICANCE: The identification of novel neoplastic cases in paleopathology represents an important contribution to ongoing discussions regarding the temporality and regional variability of neoplastic conditions in the past. Additionally, a rigorous diagnostic study augmented by x-ray, CT scans, and 3D modeling provides data that can be utilized in future paleopathological studies. LIMITATIONS: Diagnostic interpretation would be aided by histological examination of the tumor, which was impossible in this case. Histological examination would provide a definitive diagnosis. SUGGESTIONS FOR FURTHER RESEARCH: Given the high incidence of benign tumors in the clinical literature but a paucity of reports in the paleopathological record, further research is indicated to better understand the implications of benign neoplasms in antiquity.

Community perspectives on the racial disparity in perinatal outcomes.

OBJECTIVE: The United States' infant and maternal mortality rates are significantly higher among non-Hispanic Black women and infants than women and infants of other races, independent of educational attainment or socioeconomic status. The purpose of this research was to understand conditions that lead to these disparities and propose practices for addressing them through community perspectives. METHOD: Researchers conducted six focus groups with African American women who had been pregnant previously (n = 27) and performed inductive thematic analysis looking at the interaction between race and health. RESULTS: Major themes included barriers to quality healthcare and support. Women perceived that healthcare professionals provided substandard care based on implicit biases and felt that asking questions of providers led to loss of autonomy.Conclusions and relevance: The perceived quality of a woman's perinatal experience is affected by women's relationships with their healthcare providers, their social support, and their sense of autonomy in decision-making. To improve the relationships between African American women and their providers, participants expressed that racism and implicit bias must be recognized and addressed. While this should be addressed in individual interactions, this study also suggests the role of policy change and system-level modifications that should be considered to effectively decrease the racial disparity in perinatal outcomes.

Understanding barriers to uptake of 17 alpha-hydroxyprogesterone caproate (17-OHP) in women with history of preterm birth.

Background: Premature birth is responsible for approximately 38% of infant deaths as well as a host of complications, including abnormal lung development, infection, and long-term disabilities. For women with a history of spontaneous preterm birth in a singleton pregnancy, use of 17 alpha-hydroxyprogesterone caproate (17-OHP) can reduce the risk of a recurrent preterm birth by up to 42%. However, less than half of eligible women currently receive 17-OHP.Objectives: The purpose of this study was to understand the barriers to access and acceptability of 17-OHP use from the patient perspective.Study design: A qualitative study was conducted of women with a history of a prior spontaneous, singleton preterm birth who were eligible for 17-OHP during a subsequent singleton pregnancy. Researchers recruited 118 eligible women during the Spring and Summer of 2018 from a safety-net hospital in Denver, CO, USA, a hospital that provides healthcare for individuals regardless of their insurance status or ability to pay. Responses from 35 participants were analyzed, looking at themes surrounding knowledge of and counseling received regarding 17-OHP, hesitations, and barriers toward receiving the treatment.Results: Among respondents (34.0% response rate), the mean age was 31.5 years and mean gestational age at delivery was 32.1 weeks. Major themes from interviews included reasons that encouraged women to use 17-OHP, such as the desire to do anything for the health of their baby and reasons that women felt discouraged from using 17-OHP, including unknown complications and lack of information. Other barriers to this treatment method included the time commitment, specifically the length of clinic appointments and concerns about the safety of the 17-OHP injection.Conclusions: One of the strongest reasons for women choosing to use 17-OHP was a desire to do anything possible to support their babies. Somewhat surprisingly, there was not a significant relationship with the participants between gestational age of prior preterm deliveries and subsequent use of 17-OHP. There were two important reasons women cited most frequently for choosing not to use 17-OHP. One was feeling that they lacked information or knowledge about 17-OHP to make an informed decision, which is crucial because the study also showed that all eligible women are not being appropriately counseled on the option of 17-OHP. In terms of time commitment, it was the length of individual appointments, rather than frequency that was a barrier to receiving weekly injections.