ABSTRACT
Policy Points The White House Blueprint for Addressing the Maternal Health Crisis report released in June 2022 highlighted the need to enhance equitable access to maternity care. Nationwide hospital maternity unit closures have worsened the maternal health crisis in underserved communities, leaving many birthing people with few options and with long travel times to reach essential care. Ensuring equitable access to maternity care requires addressing travel burdens to care and inadequate digital access. Our findings reveal socioeconomically disadvantaged communities in the United States face dual barriers to maternity care access, as communities located farthest away from care facilities had the least digital access. CONTEXT: With the increases in nationwide hospital maternity unit closures, there is a greater need for telehealth services for the supervision, evaluation, and management of prenatal and postpartum care. However, challenges in digital access persist. We examined associations between driving time to hospital maternity units and digital access to understand whether augmenting digital access and telehealth services might help mitigate travel burdens to maternity care. METHODS: This cross-sectional study used 2020 American Hospital Association Annual Survey data for hospital maternity unit locations and 2020 American Community Survey five-year ZIP Code Tabulation Area (ZCTA)-level estimates of household digital access to telecommunication technology and broadband. We calculated driving times of the fastest route from population-weighted ZCTA centroids to the nearest hospital maternity unit. Rural-urban stratified generalized median regression models were conducted to examine differences in ZCTA-level proportions of household lacking digital access equipment (any digital device, smartphones, tablet), and lacking broadband subscriptions by spatial accessibility to maternity units. FINDINGS: In 2020, 2,905 (16.6%) urban and 3,394 (39.5%) rural ZCTAs in the United States were located >30 minutes from the nearest hospital maternity units. Regardless of rurality, these communities farther away from a maternity unit had disproportionally lower broadband and device accessibility. Although urban communities have greater digital access to technology and broadband subscriptions compared to rural communities, disparities in the percentage of households with access to digital devices were more pronounced within urban areas, particularly between those with and without close proximity to a hospital maternity unit. Communities where nearest hospital maternity units were >30 minutes away had higher poverty and uninsurance rates than those with <15-minute access. CONCLUSIONS: Socioeconomically disadvantaged communities face significant barriers to maternity care access, both with substantial travel burdens and inadequate digital access. To optimize maternity care access, ongoing efforts (e.g., Affordable Connectivity Program introduced in the 2021 Infrastructure Act), should bridge the gaps in digital access and target communities with substantial travel burdens to care and limited digital access.
Subject(s)
Health Services Accessibility , Maternal Health Services , Humans , Female , Pregnancy , United States , Cross-Sectional Studies , Hospitals , PovertyABSTRACT
An adult sand snake specimen was collected during a herpetofaunal survey conducted in the Turpan Basin in northwest China. Phylogenetic analyses revealed that this specimen, along with other snake sloughs and skins collected from different localities in the Turpan Basin formed a clade that is sister to Psammophis lineolatus. This taxon exhibited substantial divergence from its congeners (P. lineolatus and P. condanarus) with uncorrelated p-distances ranging from 11.9 ± 0.9% to 15.8 ± 1.6% for the ND4 gene and from 10.2 ± 0.8% to 13.8 ± 1.1% for the Cytb gene. Given the genetic differences along with morphological differences, we describe the specimen from the Turpan Basin as Psammophis turpanensis sp. nov. We provide detailed morphological descriptions, and compare this specimen with five Asian sand snakes and the Afro-Asian Sand Snake, P. schokari. In addition, we provide brief comments on the biogeography of Psammophis in China.
Subject(s)
Snakes/classification , Animals , China , Genes, Mitochondrial , PhylogenyABSTRACT
A new species of the primarily Australasian genus Eupines King, 1866, E. crinita Li, Nomura Yin, sp. nov., is described from China and Japan, which is also the first record of the genus from the former country. Moreover, a new distributional record of E. sphaerica (Motschulsky, 1851) from China is provided.
Subject(s)
Coleoptera/classification , Animals , China , JapanABSTRACT
The adult female, adult male and all immature stages (except the male prepupa and pupa) of a new species of Fiorinia (Hemiptera: Coccomorpha: Diaspididae), F. yongxingensis Liu, Cai Feng sp. n., collected from Hainan Province, China, are described and illustrated. A key is provided to identify the Fiorinia species known to occur in Hainan Province, China. The new species may become a significant pest on coconut palms.
