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1.
JAMA Netw Open ; 5(11): e2244077, 2022 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-36445707

RESUMO

Importance: In the US, more than 50 000 women experience severe maternal morbidity (SMM) each year, and the SMM rate more than doubled during the past 25 years. In response, professional organizations called for birthing facilities to routinely identify and review SMM events and identify prevention opportunities. Objective: To examine SMM levels, primary causes, and factors associated with the preventability of SMM using Maryland's SMM surveillance and review program. Design, Setting, and Participants: This cross-sectional study included pregnant and postpartum patients at 42 days or less after delivery who were hospitalized at 1 of 6 birthing hospitals in Maryland between August 1, 2020, and November 30, 2021. Hospital-based SMM surveillance was conducted through a detailed review of medical records. Exposures: Hospitalization during pregnancy or within 42 days post partum. Main Outcomes and Measures: The main outcomes were admission to an intensive care unit, having at least 4 U of red blood cells transfused, and/or having COVID-19 infection requiring inpatient hospital care. Results: A total of 192 SMM events were identified and reviewed. Patients with SMM had a mean [SD] age of 31 [6.49] years; 9 [4.7%] were Asian, 27 [14.1%] were Hispanic, 83 [43.2%] were non-Hispanic Black, and 68 [35.4%] were non-Hispanic White. Obstetric hemorrhage was the leading primary cause of SMM (83 [43.2%]), followed by COVID-19 infection (57 [29.7%]) and hypertensive disorders of pregnancy (17 [8.9%]). The SMM rate was highest among Hispanic patients (154.9 per 10 000 deliveries), primarily driven by COVID-19 infection. The rate of SMM among non-Hispanic Black patients was nearly 50% higher than for non-Hispanic White patients (119.9 vs 65.7 per 10 000 deliveries). The SMM outcome assessed could have been prevented in 61 events (31.8%). Clinician-level factors and interventions in the antepartum period were most frequently cited as potentially altering the SMM outcome. Practices that were performed well most often pertained to hospitals' readiness and adequate response to managing pregnancy complications. Recommendations for care improvement focused mainly on timely recognition and rapid response to such. Conclusions and Relevance: The findings of this cross-sectional study, which used hospital-based SMM surveillance and review beyond the mere exploration of administrative data, offers opportunities for identifying valuable quality improvement strategies to reduce SMM. Immediate strategies to reduce SMM in Maryland should target its most common causes and address factors associated with preventability identified at individual hospitals.


Assuntos
COVID-19 , Gravidez , Humanos , Feminino , Criança , Maryland/epidemiologia , COVID-19/epidemiologia , Estudos Transversais , População Negra , Etnicidade
2.
Child Care Health Dev ; 47(2): 184-190, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33125758

RESUMO

BACKGROUND: High rates of infant death associated with sleeping practices continue to persist in the United States. Infants spend a large portion of their day with child care and family child care learning home providers. Safe sleeping practices continue to be an area of need for care providers of young children. METHOD: The current study examines data drawn from a publicly available database of child care licensing reports in Georgia (n = 3,501), which contained data on child care centres and family child care learning homes. Information in the database included characteristics of the centres, year of data collection and the specific violations by child care provider type. RESULTS: Results indicated clear differences in the prevalence of violations between child care centres and family child care learning homes. Within the overall sample, 13.3% of centres and family child care learning homes were cited for safe sleeping practice violations with higher prevalence in licensed child care centres and unaccredited centres. Violations were consistent with those commonly found in child care environments and inconsistent with the American Academy of Pediatrics safe sleep recommendations. CONCLUSIONS: Data from the current study suggest a continued need for professional learning on safe sleep practices.


Assuntos
Morte Súbita do Lactente , Criança , Cuidado da Criança , Saúde da Criança , Pré-Escolar , Georgia , Humanos , Lactente , Sono , Estados Unidos
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