Assessing Racial and Ethnic Disparities in Timing of Pregnancy Related Deaths.

Existing research documents significant racial disparities in pregnancy-related deaths in the United States. Recently, the National Center for Health Statistics (NCHS) identified inconsistencies in maternal mortality data due to irregularities in previous data collection. Yet, corrections of the data still highlight stark differences across racial identity. Additionally, data indicates that while many people die during labor and delivery, a considerable percentage of people die up to a year postpartum. To assess disparities in the timing of pregnancy-related deaths using corrected data, we analyzed aggregated vital statistics data from 2015 to 2018 (n = 4,261). We present relative risk ratios from multinomial logistic regressions to examine the association between race and ethnicity and the timing of pregnancy-related deaths (pregnant at the time of death, 42 days post pregnancy, and 43 days to one-year post pregnancy). Results highlight significant differences in the distribution of timing of pregnancy-related deaths across nativity status and geographic region. Findings document a disproportionate percentage of pregnancy-related deaths among foreign-born people who give birth. Overall, results suggest extending our framing of postpartum care beyond a hospital stay.

Correction: The rural-urban divide in Tanzania: Residential context and socioeconomic inequalities in maternal health care utilization.

[This corrects the article DOI: 10.1371/journal.pone.0241746.].

Dependency Theory: An Evaluation of the Period-Based Changes in the Utilization of Maternal Health Care and Neonatal Mortality in Tanzania Between 1991 and 2016.

While efforts have been made to increase maternal health care (MHC) utilization and decrease neonatal mortality in Tanzania, much remains to be known about the effect of dependency (particularly on reproductive policy changes) on the use of MHC and neonatal health over time among varying socioeconomic groups. This study applied dependency theory to cross-sectional secondary data (collected by the Tanzania Demographic Health Surveys between 1991 and 2016) to investigate period-based changes in MHC and neonatal mortalities in Tanzania. Results from the data analysis found that while neonatal mortalities were decreasing in Tanzania (from 1991 to 2016), the odds of neonatal mortality were still greater in 2016. Also, a decline in the recommended skilled delivery assistance and 4 + antenatal care visits occurred in the data period. A significant increase in socioeconomic inequality around MHC use and neonatal mortality occurred during the study period as well. Policy recommendations to reduce these inequalities and move toward meeting Sustainability Development Goals for maternal and neonatal health in Tanzania are discussed.

Insights into the long-term effects of COVID-19 responses on transportation facilities.

The impacts of COVID-19 on transportation sector have received a substantial research attention, however, less is known about localized COVID-19 responses that provided safe space for mobility and other daily activities. We applied logistic regression and text mining approaches on the Shifting Streets COVID-19 Mobility Dataset to explore the long-term outcomes of the localized responses. We explored the purpose, affected space, function, and implementation approach. We found that responses instituted for economic recovery and public health are less likely to be long-term, while responses meant to improve safety or bicycle/pedestrian mobility are more likely to be long-term. Further, operational or regulatory responses are less likely to be long-term. Additionally, responses affecting curb space are more likely to be long-term than those affecting other right-of-way areas. Text-mining of responses' narratives revealed key patterns for both short-term and long-term outcomes. Study findings showcase the possible design and operations changes during post-COVID-19 era.

Exploring pre-crash gate violations behaviors of drivers at highway-rail grade crossings using a mixed multinomial logit model.

The highway-rail grade crossings (HRGCs) across the United States have been experiencing about 2500 crashes each year. Previous studies analyzed crash frequencies and fatalities; however, factors pertaining to drivers' gate violation behaviors are little known. Also, applied methodologies for gate violation behaviors analysis did not consider their heterogeneity across regions. This study uses 20-year of crash data (1999-2018) to evaluate pre-crash drivers' behaviors at HRGCs. A mixed multinomial logit model was developed to associate such behaviors with demographic factors, vehicle characteristics, temporal and environmental factors, as well as crossing-related factors. The study results indicated a high intra-class correlation coefficient which signifies the importance of including the random-effect parameter in the model. Further, the study found that male drivers are more likely to drive around the gate, while older drivers are more likely to stop and proceed before a train has passed. Furthermore, compared to trucks, all other vehicle types are more likely to drive around the gate. The influence of train speed, vehicle occupancy, visibility, among others, on drivers' pre-crash behaviors, is also presented. Understanding the impact of these factors on pre-crash behaviors may assist in improving the motorist's safety at the highway-rail grade crossings across the United States.

Exploring geographical distribution of transportation research themes related to COVID-19 using text network approach.

The COVID-19 outbreak has extremely impacted the globe due to travel restrictions and lockdowns. Geographically, COVID-19 has shown disproportional impacts; however, the research themes' distribution is yet to be explored. Thus, this study explored the geographical distribution of the research themes that relate to COVID-19 and the transportation sector. The study applied a text network approach on the bibliometric data of over 400 articles published between December 2019 and December 2020. It was found that the researches and the associated themes were geographically distributed based on the events that took place in the respective countries. Most of the articles were published by the authors from four countries, the USA, China, Japan, and the UK. The text network results revealed that the USA-based studies mainly focused on international travelers, monitoring, travel impacts of COVID-19, and social-distancing measures. The Japanese-based studies focused on the princess diamond cruise ship incident. On the other hand, Chinese authors published articles related to travel to Wuhan and China, passenger health, and public transportation. The UK-based studies had diverse topics of interest. Lastly, the remaining 62 countries' studies focused on returning travelers from China, public transportation, and the global spread of COVID-19. The findings are crucial to the transportation sector's researchers for various applications.

The rural-urban divide in Tanzania: Residential context and socioeconomic inequalities in maternal health care utilization.

BACKGROUND: Existing studies in Tanzania, based mostly on rural samples, have primarily focused on individual behaviors responsible for the lower utilization of maternal health care. Relatively less attention had been paid to inequalities in structural circumstances that contribute to reduced utilization of maternal health care. More importantly, scholarship concerning the impact of the rural-urban divide on socioeconomic disparities in the utilization of maternal health care is virtually nonexistent in Tanzania. METHODS: Drawing from the Demographic Health Survey (2015-2016) conducted in Tanzania, our study includes a total of 3,595 women aged between 15-49 years old, who had given birth in five years before the month of the interview and living in both rural and urban Tanzania. The maternal health care utilization was assessed by four variables (i.e., antenatal care, skilled delivery assistance, the before and after discharging postnatal care). The independent variables were wealth, education, residence, parity, occupation, age, and the head of the household's sex. We used bivariate statistics and logistic regression to examine the rural-urban differences in the influence of education and wealth on maternal health care utilization. RESULTS: Significantly lower use of maternal health care in rural than urban areas demonstrated a stark rural-urban divide in Tanzania. We documented socioeconomic inequalities in maternal health care utilization in the form of lower odds of the utilization of such services among women with lower levels of education and household wealth. The educational inequalities in the utilization of skilled delivery assistance (or = 0.37, 95% CI: 0.16, 0.86; p = 0.021) and (before discharge) postnatal care (or = 0.60, 95% CI: 0.38, 0.95; p = 0.030) were significantly wider in rural than urban areas. The differences in the odds of the utilization of skilled delivery assistance between women in poorer wealth quintile and women in richer household wealth quintile were also significantly wider in rural areas than in urban areas. However, the statistically significant rural-urban divides in the impacts of socioeconomic status on antenatal care and (after discharge) postnatal care were not observed. CONCLUSION: This study establishes the need for consideration of the rural-urban context in the formulation of policies to reduce disparities in maternal health care utilization in Tanzania.