Mother and Infant Predictors of Rapid Infant Weight Gain.

Objective. To examine characteristics of the infant and mother associated with rapid infant weight gain (RIWG). Methods. Electronic health records (N = 4626) of term infants born were reviewed. Multivariable logistic regression examined the presence of RIWG (vs not) using participant characteristics in the whole sample and in stratified groups. Results. The prevalence of RIWG was 18.7%. Predictors of RIWG were infant male sex, younger infant gestational age, firstborn (vs later born) status, maternal Black or Other (Asian, American Indian, etc), non-Hispanic race/ethnicity (vs White non-Hispanic), Medicaid (vs non-Medicaid insurance), and maternal cigarette smoking status (vs never smoker). The regression model explained between 7.0% and 11.4% of the variance in RIWG. There were few differences in predictors of RIWG in stratified samples. Conclusions. Early childhood obesity intervention efforts may target the modifiable risk factors for RIWG starting prenatally.

Comportamiento de la lactancia materna. Consultorio Médico de Familia No. 16. Policlínico "Manuel Piti Fajardo" / Behavior of the breastfeeding. Family Doctor´s Office Nr. 16. Policlínic "Manuel Piti Fajardo"

RESUMEN Introducción: que un niño reciba y se alimente con lactancia materna en las sociedades actuales, cada día es una tarea más compleja. Objetivo: caracterizar el comportamiento de la lactancia materna en el Consultorio Médico de Familia No 16. Policlínico "Manuel Piti Fajardo", municipio Cárdenas. Materiales y métodos: se realizó un estudio observacional, descriptivo, transversal. El universo lo constituyeron 68 madres de nacidos vivos pertenecientes a esa área de salud, en el período de enero 2011 -diciembre 2015. Las variables estudiadas fueron: edad, nivel escolar, ocupación, tiempo de lactancia, factores que incidieron en la suspensión de la lactancia materna, planificación familiar, conocimientos sobre lactancia materna. Los datos se obtuvieron de las historias clínicas familiares e individuales, del registro de nacimientos del Departamento de Estadística del Policlínico, del Análisis Integral de la Situación de Salud del Consultorio, la encuesta y la observación. Resultados: predominó en las madres de nacidos vivos el grupo de edad de 25 a 29 años, con el 41,7 %. El 77,9 % tenían nivel preuniversitario y el 47,0 % eran trabajadoras. El 47,5 % lactan entre 1-3 meses. Incidió en el abandono de la lactancia materna el no tener suficiente leche con un 44,1 %, el 50,0 % no planificaron el embarazo, y el 58,8 % no poseían los conocimientos adecuados. Conclusiones: un elevado porcentaje de las madres lactan hasta los 3 primeros meses de vida, la causa de abandono más frecuente de lactancia materna fue el no tener suficiente leche. Prevaleceieron los conocimientos no adecuados sobre la lactancia materna.

ABSTRACT Introduction: breastfeeding in current societies is a very complex task. Objective: to characterize breastfeeding in the Family Doctor´s Office Nr. 16 of the Policlinic ¨Manuel Pity Fajardo¨, municipality of Cardenas. Materials and methods: a cross-sectional, descriptive, observational study was carried out. The universe was composed by 68 mothers of born-alive children belonging to that health area in the period January 2011-December 2015. The studied variables were age, scholarship, job, breastfeeding time, factors causing breastfeeding delay, family planning, and knowledge on breastfeeding. Data were gathered from the individual and family records, from the births´ register of the Policlinic Statistics Department, from the Comprehensive Analysis of Health Situation, enquire and observation. Results: the 25-29-years-old age group predominated among mothers of born-alive children (41.7 %). 77.9 % had senior high school scholarship, and 47.0 % were workers. 47.5 % of them breastfeed 1-3 months. Not having enough breast milk (44.1 %), a non-planed pregnancy (50.0 %), and not having the adequate knowledge (58.8 %) influenced in breastfeeding delay. Conclusions: a high percent of mothers breastfeed just during the first three months of life; the most common cause of breastfeeding delay was not having enough breast milk. There it was a prevalence of non-adequate knowledge on maternal breastfeeding.

Modelo de asistencia integral del parto: concepto de integralidad basado en la calidad y seguridad / Comprehensive delivery care model: concept of comprehensiveness based on quality and safety

RESUMEN Introducción: A nivel internacional existe un interés por disminuir el uso excesivo de tecnologías durante el parto, inclinándose hacia el desarrollo de modelos de atención personalizados y respetuosos. Chile concentra una de las tasas de cesáreas más altas en la región, muchas de ellas sin justificación clínica. En este contexto, un proyecto FONDEF desarrolló y probó un modelo de asistencia integral del parto (MASIP), considerando la participación activa de la mujer y familia y menos intervenciones innecesarias. Objetivo: evaluar la efectividad de MASIP en comparación con el cuidado estándar del parto. Metodología: A través de un diseño experimental aleatorizado y controlado, se compararon los resultados de calidad y seguridad de MASIP con la modalidad habitual de asistencia del sistema público en Santiago de Chile, para la población de embarazadas de bajo riesgo. Resultados: MASIP resultó ser más efectiva que la asistencia tradicional en términos de calidad con los indicadores de bienestar materno, disminución de medidas de conducción y de atención de parto innecesarias. La frecuencia de cesárea disminuyó durante el período del estudio en ambos grupos, en comparación con un registro histórico de la misma población. En términos de seguridad, los indicadores mantuvieron el estándar alcanzado en las últimas décadas en ambas modalidades, pese a que el modelo integral se caracteriza por tener menos intervención. Conclusión: MASIP es un modelo seguro y de mejor calidad para mujeres de bajo riesgo del sistema público de Chile que el cuidado estándar. Intervenciones futuras para mejorar la experiencia de las mujeres y familias, deben incluir en su diseño los componentes de MASIP.

ABSTRACT Introduction: Worldwide there is a need to reduce the use of excessive technology during childbirth. Consequently, there is an interest to develop respectful and personalized models of care. Chile has one of the highest C-section rates in the region, many of which are not needed. A FONDEF project developed and tested a comprehensive health care model in childbirth (MASIP), considering active participation of women and families and less unneeded clinical interventions. Objective: to evaluate the effectiveness of MASIP in comparison with standard care. Methods: a randomized controlled experiment was conducted in one public hospital in Santiago Chile. Two arms were compared: MASIP vs. standard care. Low obstetric risk women were included. Variables of interest included quality and safety measures. Results: MASIP had better quality results, such as maternal wellbeing and less clinical interventions. During the study c-section was lower in both arms in comparison to a historical record of the same population. Safety outcomes were similar in both arms. Conclusion: MASIP is as safe as the standard care but it has better quality of care. Interventions to improve users' satisfaction and experience should consider the components of MASIP.

Analysis of socioeconomic gradients in the development of children aged 0-3 years in Fortaleza, Northeastern Brazil / Análisis de los gradientes socioeconómicos en el desarrollo de los niños de 0-3 años en Fortaleza, Noreste de Brasil

ABSTRACT OBJECTIVE To identify the socioeconomic gradients in the measures of development and well-being of children under three years of age in Fortaleza, Northeastern Brazil. METHODS We compiled information using a socioeconomic survey instrument, collecting anthropometric measurements, observing the home environment, and applying the Denver Test II to 2,755 children aged between zero and 28 months who are potential beneficiaries of the Cresça com Seu Filho program in Fortaleza. These children were randomly selected from a universe identified from the administrative record of the Cadastro Único of the Ministry of Social Development of Brazil. For the analysis, we reported descriptive statistics, Pearson correlations, and mean differences. RESULTS Rates of chronic malnutrition and overweight were 7.0%. The results of the Denver II test indicated that personal social (23%) and language (20%) are the domains in which children have the highest developmental delay, when compared with the international reference sample. Parental practices measured by two sub-scales of the Home Observation of the Environment Inventory were poor, with only 14.0% of families having two or more books in the home and 35.0% of the households reporting having spanked their child in the past three days. CONCLUSIONS We identified clear socioeconomic gradients in the anthropometric indicators, parenting practices, and the Denver Test II (especially in the language domain). Children from poorer households, as well as children of mothers with lower education levels, perform poorly on most measures.

RESUMEN OBJETIVO Identificar los gradientes socioeconómicos en medidas del desarrollo y bienestar en menores de tres años en Fortaleza, Nordeste de Brasil. MÉTODOS Se recolectó información a través de una encuesta socioeconómica, toma de medidas antropométricas, observación del ambiente en el hogar y aplicación del Test de Denver II de 2.755 niños de cero a 28 meses potenciales beneficiarios del programa Cresça com Seu Filho en Fortaleza. Estos niños fueron seleccionados aleatoriamente de un universo identificado a partir del registro administrativo del Catastro Único del Ministerio de Desarrollo Social de Brasil. Para el análisis se reportan estadísticas descriptivas, correlaciones de Pearson y diferencias de medias. RESULTADOS Las tasas de desnutrición crónica y el sobrepeso fueron iguales a 7,0%. Los resultados del Test de Denver II indicaron que las áreas en las que los niños presentan un mayor rezago en su desarrollo, cuando se compararon con la muestra de referencia internacional fueron personal-social (23,0%) y lenguaje (20,0%). Las prácticas parentales medidas por dos sub-escalas del Hom e Observation of the Enviroment fueron pobres, solo el 14,0% de las familias reportaron tener dos o más libros en el hogar y 35,0% de los hogares reportaron haberle pegado a su hijo en los últimos tres días. CONCLUSIONES Se identifican gradientes socioeconómicos claros en los indicadores antropométricos, las pautas de crianza y en la prueba Denver II (especialmente en el dominio de lenguaje). Los niños pertenecientes a los hogares más pobres, así como hijos de madres con menor nivel educativo, presentan un desempeño bajo en la mayoría de las medidas.

[Hypertrophic Pyloric Stenosis - Five-Year Retrospective Analysis].

Although the etiology of the disease has not yet been fully clarified in the 21st century, clinical significance of the disease is huge because it is frequent in the neonatal period compared with other diseases. Today, owing to advanced diagnostic possibilities, hypertrophic pyloric stenosis is easily distinguished from other differential diagnoses that are manifested by vomiting as the main symptom. At Department of Pediatric Surgery, Zagreb Children's Hospital, efforts have been invested to successfully manage this and a number of other conditions that affect newborns. We retrospectively analyzed data on 40 hospitalized children retrieved from the hospital information system for the 2010-2015 period and present them as a basis for the respective algorithms and future research. Reviewing a range of parameters, we have come to some concrete conclusions. On average, the disease started manifesting on 28th day after birth; 63% of the children developed metabolic alkalosis. Thickness of the muscle wall verified by ultrasound ranged from 3.1 mm to 7 mm. Surgery was performed seven days after hospitalization and correction of metabolic condition. The average duration of surgery was 48 minutes. The mean length of hospital stay was 11.64 days, of which 2 days in the intensive care unit. Complications occurred in two patients.

Intimate partner violence during pregnancy: maternal and neonatal outcomes.

The effects of intimate partner violence (IPV) on maternal and neonatal outcomes are multifaceted and largely preventable. During pregnancy, there are many opportunities within the current health care system for screening and early intervention during routine prenatal care or during episodic care in a hospital setting. This article describes the effects of IPV on maternal health (e.g., insufficient or inconsistent prenatal care, poor nutrition, inadequate weight gain, substance use, increased prevalence of depression), as well as adverse neonatal outcomes (e.g., low birth weight [LBW]), preterm birth [PTB], and small for gestational age [SGA]) and maternal and neonatal death. Discussion of the mechanisms of action are explored and include: maternal engagement in health behaviors that are considered "risky," including smoking and alcohol and substance use, and new evidence regarding the alteration of the hypothalamic-pituitary-adrenal axis and resulting changes in hormones that may affect LBW and SGA infants and PTB. Clinical recommendations include a commitment for routine screening of IPV in all pregnant women who present for care using validated screening instruments. In addition, the provision of readily accessible prenatal care and the development of a trusting patient-provider relationship are first steps in addressing the problem of IPV in pregnancy. Early trials of targeted interventions such as a nurse-led home visitation program and the Domestic Violence Enhanced Home Visitation Program show promising results. Brief psychobehavioral interventions are also being explored. The approach of universal screening, patient engagement in prenatal care, and targeted individualized interventions has the ability to reduce the adverse effects of IPV and highlight the importance of this complex social disorder as a top priority in maternal and neonatal health.

Uso de chupeta e aleitamento materno exclusivo / Use of pacifier and exclusive breastfeeding

Estudo quantitativo cujos objetivos foram comparar o tempo de Aleitamento Materno Exclusivo (AME) entre os grupos de idade de início do uso da chupeta e verificar a presença de associação entre o uso da chupeta e a interrupção precoce do AME. A amostra foi de 362 crianças cujas mães realizaram o pré-natal na atenção básica de saúde de Maringá, 2009. Utilizaram-se a análise ANOVA não paramétrica de Kruskal-Wallis, qui-quadrado e razão de chances. Mais da metade das crianças não fazia uso de chupeta; entre as que usavam, em 26,51% dos casos, ela foi introduzida no primeiro mês. Não foi encontrada diferença significativa entre o tempo de AME e as faixas de idade de início do uso da chupeta; no entanto, encontrou-se significância entre o grupo de crianças que não usaram chupeta com os demais grupos (p<0,05). Houve associação significativa entre o uso da chupeta e o desmame precoce (p<0,05; OR=3,2).

Development and validation of a vitamin D status prediction model in Danish pregnant women: a study of the Danish National Birth Cohort.

Vitamin D has been hypothesized to reduce risk of pregnancy complications such as preeclampsia, gestational diabetes mellitus, and preterm delivery. However, many of these outcomes are rare and require a large sample size to study, representing a challenge for cohorts with a limited number of preserved samples. The aims of this study were to (1) identify predictors of serum 25-hydroxy-vitamin D (25(OH)D) among pregnant women in a subsample (N = 1494) of the Danish National Birth Cohort (DNBC) and (2) develop and validate a score predicting 25(OH)D-status in order to explore associations between vitamin D and maternal and offspring health outcomes in the DNBC. In our study sample, 42.3% of the population had deficient levels of vitamin D (<50 nmol/L 25(OH)D) and average levels of 25(OH)D-status were 56.7(s.d. 24.6) nmol/L. A prediction model consisting of intake of vitamin D from diet and supplements, outdoor physical activity, tanning bed use, smoking, and month of blood draw explained 40.1% of the variance in 25(OH)D and mean measured 25(OH)D-level increased linearly by decile of predicted 25(OH)D-score. In total 32.2% of the women were placed in the same quintile by both measured and predicted 25(OH)D-values and 69.9% were placed in the same or adjacent quintile by both methods. Cohen's weighted kappa coefficient (Κ = 0.3) reflected fair agreement between measured 25(OH)D-levels and predicted 25(OH)D-score. These results are comparable to other settings in which vitamin D scores have shown similar associations with disease outcomes as measured 25(OH)D-levels. Our findings suggest that predicted 25(OH)D-scores may be a useful alternative to measured 25(OH)D for examining associations between vitamin D and disease outcomes in the DNBC cohort, but cannot substitute for measured 25(OH)D-levels for estimates of prevalence.

Amniotomy and cord prolapse.

Research shows that artificially rupturing the amniotic sac (amniotomy) can cause umbilical cord prolapse. Amniotomy became a routine part of obstetrical care with the introduction of active management, without evidence of benefit. In the 30 years since active management was introduced, the rate at which amniotomy causes umbilical cord prolapse has not been directly studied. Two controlled studies from Turkey from 2002 and 2006 are the only published studies that provide enough data to extract the rate at which cord prolapse follows amniotomy. They show that 1 cord prolapse results from every 300 amniotomies (0.3%). There is data suggesting amniotomy may also increase neonatal GBS infection, maternal pain and fetal blood loss if placental blood vessels are punctured.

Avaliação dos registros e opinião das mães sobre a caderneta de saúde da criança em unidades básicas de saúde, Pelotas, RS / Evaluation of the records and views of mothers on the child health notebook in basic health units of Pelotas, Rio Grande do Sul, Brazil

Introdução: A Caderneta de Saúde da Criança (CSC) é um instrumento importante para o acompanhamento da saúde, do crescimento e do desenvolvimento das crianças por ser o documento no qual são registrados os dados e os eventos mais relevantes para a saúde infantil. O objetivo do trabalho foi avaliar o preenchimento da CSC e conhecer a opinião das mães quanto às seções mais utilizadas, mais e menos apreciadas, em quatro unidades básicas de saúde da área urbana de Pelotas, RS, Brasil. Métodos: A população-alvo inclui todas as crianças nascidas em 2007 de quatro unidades básicas de saúde. A identificação das crianças foi feita pelos dados contidos nas fichas de puericultura. Os dados foram coletados entre janeiro e março de 2008, em visitas domiciliares. Foi utilizado um questionário pré-testado e a análise do preenchimento deu-se mediante a averiguação direta do registro em cada caderneta. Foram considerados preenchidos todos os itens que tinham no mínimo uma anotação. Resultados: Foram identificadas 167 crianças, e entrevistadas 92% das mães dessas crianças. Desse total, 80% conheciam a CSC e 71% a possuíam. As seções mais utilizadas da caderneta foram os gráficos e as relacionadas à imunização. As seções mais apreciadas foram o acompanhamento do desenvolvimento da criança e os gráficos, sendo o gráfico P/I (peso para idade) o que apresentou maior percentual de preenchimento. Conclusão: Apesar de muitas variáveis sobre saúde infantil estarem incluídas na CSC, poucas são utilizadas. As partes mais utilizadas e principalmente reconhecidas pelas mães referem-se à imunização, gráfico de crescimento e desenvolvimento (AU)

Introduction: The Child Health Notebook (CSC) is an important tool for monitoring the health, growth and development of children because it is the document in which the data and events most relevant to child health are recorded. The aim of this study is to assess the completeness of the information in the CSC and to obtain feedback from mothers about the most often used and the least/most appreciated sections of it in four basic health units in the urban area of Pelotas, south Brazil. Methods: The target population includes all children of four basic health units born in 2007. The identification of children was made by the data contained in childcare records. Data were collected on home visits between January and March 2008. We used a pre-tested questionnaire and analysis of the filling took place by direct inquiry of the record in each notebook. We considered fulfilled all the items that had at least one piece of information. Results: We identified 167 children and 92% of these children's mothers were interviewed. Of these, 80% knew the CSC and 71% owned one. The most often used sections of the book were the charts and the immunization-related ones. The most appreciated sections were those monitoring child development and the charts, with the weight for age chart having the highest percentage of completeness. Conclusion: Although many variables on child health are included in the CSC, few are actually used. The sections used the most and mainly recognized by mothers refer to immunization and growth and development charts (AU)

[Carrier-state of group B streptococcus in pregnant women--performance standards]. / Nosicielstwo paciorkowca grupy b u kobiet ciezarnych--standardy postepowania.

Group B Streptococcus (GBS) is a gram-negative bacteria, which is the most frequent cause of invasive neonatal infection. About 10-30% of pregnant woman are carriers of GBS. GBS infection is transmitted to neonates from colonized vagina. Children of those mothers have 25 times higher risk of early onset neonatal sepsis then of those not colonized. Colonization can be transient, intermittent or persistent that is why ano-vaginal swabs are taken between 35 to 37 gestation week. This is a primary way of defining a risk of neonatal GBS infection. Before the labor additional risk factors are determined. According to those two data a decision is made about intravenous administration of efficient antibiotic dose at least 4 hours before delivery. Selection ofintrapartum chemoprophylaxis depends on mothers drug allergies or given GBS strain resistance profile. GBS-positive mother's neonates should be under proper observation. When abnormal symptoms are present a full diagnostic evaluation should be made, including blood tests, lumbar puncture, chest X-Ray and cultures. Empirical antimicrobial treatment against E. coli and GBS should be administered. Current data concerning Group B Streptococcus infection epidemiology, standards of diagnosis, prophylaxis and treatment are quoted in the article.

Long term respiratory outcomes of very premature birth (<32 weeks).

Many very prematurely born infants develop bronchopulmonary dysplasia (BPD), remaining oxygen dependent for many months and requiring frequent rehospitalisations. Troublesome, recurrent respiratory symptoms requiring treatment and lung function abnormalities at follow-up are common. The most severely affected may remain symptomatic with evidence of airways obstruction even as adults. Data from adolescents and adults on the respiratory outcome of extreme prematurity, however, are usually from patients who have had 'classical' BPD with severe respiratory failure in the neonatal period. Nowadays, infants have 'new' BPD developing chronic oxygen dependence despite initially minimal or even no respiratory distress. Affected patients do suffer chronic respiratory morbidity and their lung function may deteriorate during the first year after birth. Infants who suffer respiratory syncytial virus lower respiratory tract infections are most likely to require rehospitalisation and suffer chronic respiratory morbidity, but this may reflect greater abnormal premorbid lung function.

Long term respiratory outcomes of late preterm-born infants.

In recent years, the rate of preterm births has risen in many industrialised countries with late preterm births forming a substantial proportion of the preterm births. Late preterm infants are delivered at the immature saccular stage of lung development when surfactant and antioxidant systems are still developing. It is now increasingly recognised that late preterm infants have increased respiratory morbidity in the neonatal period. In addition, late preterm infants are at an increased risk of lower respiratory tract infections in infancy from respiratory viruses such as respiratory syncytial virus. There is a paucity of data reporting lung function in infancy and childhood in late preterm born children. The available data suggest that children born late preterm may be at risk of decreased lung function in later life. However, further studies are required to assess the medium and long term respiratory consequences of late preterm birth.

Early obesity prevention: Polish contribution to European projects.

Poland faces the same problem of obesity epidemics as other European countries. Polish contribution to the EU research projects concerning overweight and obesity is a direct consequence of recognition of this problem and scientific activity of Polish researchers. At present time early prevention seems to be the only effective approach to decrease obesity and obesity-related chronic diseases in adulthood. Three studies described here consider early prevention of obesity - by decreasing protein intake in infancy (CHOP and EARNEST study) or by behavioural approach in preschoolers (TOYBOX). The Children's Memorial Health Institute is participating in all these projects as a recruiting centre of the subjects studied and as a central laboratory for the CHOP and EARNEST studies. The CHOP study proved in a randomized trial that high protein intake in infancy increases the risk of obesity. The results of the CHOP studies have already indicated the need for protein reduction in infant formulas. This was reduced to 1.8 g/100kcal in the 2006 EU Directive. The results from the TOYBOX project which was started in 2010 have not yet been published.

Evaluation of a newborn screen for predicting out-of-home placement.

A newborn screen designed to predict family risk was examined to: (a) determine whether all families with newborns were screened; (b) evaluate its predictive validity for identifying risk of out-of-home placement, as a proxy for maltreatment; (c) determine which items were most predictive of out-of-home placement. All infants born in Manitoba, Canada from 2000 to 2002 were followed until March 31, 2004 (N = 40,886) by linking four population-based data sets: (a) newborn screening data on biological, psychological, and social risks; (b) population registry data on demographics; (c) hospital discharge data on newborn birth records; (d) data on children entering out-of-home care. Of the study population, 18.4% were not screened and 3.0% were placed in out-of-home care at least once during the study period. Infants not screened were twice as likely to enter care compared to those screened (4.9% vs. 2.5%). Infants screening at risk were 15 times more likely to enter care than those screening "not at risk." Sensitivity and specificity of the screen were 77.6% and 83.3%, respectively. Screening efforts to identify vulnerable families missed a substantial portion of families needing support. The screening tool demonstrated moderate predictive validity for identifying children at risk of entering care in the first years of life.

Supporting breastfeeding in emergencies: protecting women's reproductive rights and maternal and infant health.

Women have the right to support that enables them to breastfeed. Supporting breastfeeding in emergencies is important because artificial feeding places mothers and children at risk. In emergencies, artificial feeding is dangerous to the infant, difficult and requires substantial resources. In contrast, breastfeeding guards infant health. It is also protective against postpartum haemorrhage, maternal depletion, maternal anaemia and closely spaced births and should therefore concern not only nutritionists, but also those involved in reproductive health. However, it is common for women's ability to breastfeed to be undermined in emergencies by the indiscriminate distribution of breast-milk substitutes and the absence of breastfeeding support. Controlling the distribution of breast-milk substitutes, providing supportive environments, and appropriate medical and practical assistance to breastfeeding women safeguards the health and well-being of mothers and babies. Greater collaboration between the nutrition and reproductive health sectors is required to promote best practice in protecting breastfeeding women and their children in emergencies.

Migration and health: a study of effects of early life experiences and current socio-economic situation on mortality of immigrants in Sweden.

OBJECTIVES: Previous research has demonstrated mortality differences between immigrants and natives living in Sweden. The aim of this study is to investigate the effects of early life conditions in the country of birth and current socio-economic conditions in adult life in Sweden on cardiovascular, cancer, all other cause and total mortality among immigrants and natives in Sweden. DESIGN: The cohort data concerning individual demographic characteristics and socio-economic conditions stems from the Swedish Longitudinal Immigrant Database (SLI), a register-based representative database, and consists of individuals from 11 countries of birth, born between 1921 and 1939, who were residents in Sweden between 1980 and 2001. The associations between current socio-economic conditions as well as infant mortality rates (IMR) and Gross Domestic Product (GDP) per capita in the year and country of birth, and total, cardiovascular, cancer and 'all other' mortality in 1980-2001 were calculated by survival analysis using Cox proportional hazards regression to calculate hazard rate ratios. RESULTS: The effects of current adult life socio-economic conditions in Sweden on mortality are both stronger and more straightforward than the effects of early life conditions in the sense that higher socio-economic status is significantly associated with lower mortality in all groups of diagnoses; however, we find associations between infant mortality rates (IMR) in the year and country of birth, and cancer mortality among men and women in the final model. CONCLUSIONS: Socioeconomic conditions in Sweden are more strongly associated with mortality than early life indicators IMR and GDP per capita in the year of birth in the country of origin. This finding has health policy and other policy implications.

Is direct access to obstetricians/gynecologists effective at improving maternal health behaviors?

OBJECTIVE: To examine the effects of state legislation mandating direct access to obstetricians and gynecologists (OB/GYNs) on maternal health behaviors and infant health outcomes. DATA SOURCES: 1992-2002 Natality Detail File; 1994-2002 Pregnancy Assessment and Monitoring Survey (PRAMS). STUDY DESIGN: Using variation in state policy over time, we use individual-level data from two sources to consider the effects of direct access legislation on prenatal care utilization, maternal health behaviors during pregnancy, and infant health outcomes. PRINCIPAL FINDINGS: Our results suggest that there is little evidence that direct access laws are effective at improving prenatal care access or conferring benefits to mothers and infants. These results are consistent across two data sets, a variety of specifications, and specific subgroups of women who are most likely to be affected by direct access legislation. CONCLUSION: We conclude that direct access to OB/GYNs is not related to improvements in maternal health behaviors or infant health outcomes. If policy makers are interested in reforms that improve maternal and infant health, we recommend a focus on alternative policies.