RESUMEN
BACKGROUND: The risk of recurrent adverse birth outcomes has been reported worldwide, but there are limited estimates of these risks by social subgroups such as race and ethnicity in the United States. We assessed racial and ethnic disparities in the risk of recurrent adverse birth outcomes, including preterm birth, low birthweight, fetal growth restriction, small for gestational age, stillbirth, and neonatal mortality in the U.S. METHODS: We searched MEDLINE, CINAHL Complete, Web of Science, and Scopus from the date of inception to April 5, 2022. We identified 3,540 articles for a title and abstract review, of which 80 were selected for full-text review. Studies were included if they focused on the recurrence of any of the six outcomes listed in the objectives. Study quality was assessed using the NIH Study Quality Assessment Tool. Heterogeneity across studies was too large for meta-analysis, but race and ethnicity-stratified estimates and tests for homogeneity results were reported. RESULTS: Six studies on recurrent preterm birth and small for gestational age were included. Pooled comparisons showed a higher risk of recurrent preterm birth and small for gestational age for all women. Stratified race comparisons showed a higher but heterogeneous risk of recurrence of preterm birth across Black and White women. Relative risks of recurrent preterm birth ranged from 2.02 [1.94, 2.11] to 2.86 [2.40, 3.39] for Black women and from 3.23 [3.07, 3.39] to 3.92 [3.35, 4.59] for White women. The evidence was weak for race and ethnicity stratification for Hispanic and Asian women for both outcomes. CONCLUSIONS: Disparities exist in the recurrence of preterm birth, and race/ethnicity-concordant comparisons suggest race is an effect modifier for recurrent preterm birth for Black and White women. Due to the small number of studies, no conclusions could be made for small for gestational age or Hispanic and Asian groups. The results pose new research areas to better understand race-based differences in recurrent adverse birth outcomes.
RESUMEN
Medical social workers are essential members of healthcare teams, especially during a pandemic. Their scope of practice includes conducting psychological assessments, coordinating social services, connecting patients to resources that address social determinants of health, discharge planning, and patient advocacy. Social workers' experiences of psychological distress were unique even before the COVID-19 pandemic; their work demands a high amount of emotional investment as they frequently witness others' pain and suffering and navigate various daily challenges and crises. This study explores psychological distress experienced by medical social workers and the coping strategies used by these professionals during the pandemic prior to the COVID-19 vaccine rollout. Faced with conflicting information from state and federal agencies, social workers dealt with resource shortages, took on additional roles and responsibilities, and contended with regular value conflicts and ethical dilemmas. Our findings indicate that medical social workers are not sufficiently protected or prioritized in their workplaces and that infrastructure to support social workers' emotional wellbeing is lacking. Distinct themes that emerged from the data under the umbrella of psychological distress include feeling unprotected, overburdened, and undervalued. We discuss a need for targeted policy and sustainability-oriented solutions to improve coping and resilience, mitigate psychological distress, and prevent burnout among medical social workers.