Effects of Recent Medicaid Expansions on Infant Mortality by Race and Ethnicity.

INTRODUCTION: The purpose of this study is to examine year-by-year effects of the 2014 Affordable Care Act Medicaid expansion on infant mortality by race and ethnicity over the first 6 years. METHODS: Publicly available 2011-2019 Multiple Cause of Death data were extracted in October and analyzed by November 2021. A difference-in-differences event-study design compared infant mortality changes in states that expanded in 2014 to nonexpansion states. RESULTS: In the main model, the 2014 Medicaid expansions were associated with a statistically significant decline in Black infants' mortality in 2018 and 2019 by 1.19 (95% CI= -2.27, -0.12) and 1.35 (95% CI= -2.45, -0.26) deaths per 1,000 live births, respectively. There was also a decline in mortality for Hispanic infants in 2015-2019, including by 0.8 (95% CI= -1.25, -0.36) and 1.28 (95% CI= -1.88, -0.68) deaths per 1,000 live births in 2015 and 2019, respectively. Overall, infant mortality declined by 0.37 (95% CI= -0.70, -0.05) deaths per 1,000 live births in 2019. CONCLUSIONS: The study adds evidence on the association of the Affordable Care Act Medicaid expansions with a decline in mortality of Black and Hispanic infants. The findings shed light on the importance of examining year-by-year effects over multiple years.

Academic outcomes of children with orofacial clefts: A review of the literature and recommendations for future research.

This paper summarizes the main findings of population-based studies of the academic outcomes of children with isolated orofacial clefts compared to peers, general samples, or siblings, published over the past decade. Most of the reviewed papers report that children with orofacial clefts, particularly children with cleft palate only or in some studies children with cleft lip and palate, may have on average lower achievement on certain outcomes like test scores when comparing to non-siblings. However, there are important differences across studies including designs, populations, outcome measures, and findings. The paper also offers recommendations for future research priorities including controlling for confounding, examining mechanisms and potential heterogeneity across family sociodemographic and contextual factors, and understanding outcomes in less developed settings.

Responding to health needs of women, children and adolescents within Syria during conflict: intervention coverage, challenges and adaptations.

BACKGROUND: Women and children suffer disproportionately in armed-conflicts. Since 2011, the protracted Syrian crisis has fragmented the pre-existing healthcare system. Despite the massive health needs of women and children, the delivery of key reproductive, maternal, newborn, child and adolescent health and nutrition (RMNCAH&N) interventions, and its underlying factors are not well-understood in Syria. Our objective was to document intervention coverage indicators and their implementation challenges inside Syria during conflict. METHODS: We conducted 1) a desk review to extract RMNCAH&N intervention coverage indicators inside Syria during the conflict; and 2) qualitative interviews with decision makers and health program implementers to explore reasons behind provision/non-provision of RMNCAH&N interventions, and the rationale informing decisions, priorities, collaborations and implementation. We attempt to validate findings by triangulating data from both sources. RESULTS: Key findings showed that humanitarian organisations operating in Syria adopted a complex multi-hub structure, and some resorted to remote management to improve accessibility to certain geographic areas. The emergency response prioritised trauma care and infectious disease control. Yet, with time, humanitarian organisations successfully advocated for prioritising maternal and child health and nutrition interventions given evident needs. The volatile security context had implications on populations' healthcare seeking behaviors, such as women reportedly preferring home births, or requesting Caesarean-sections to reduce insecurity risks. Additional findings were glaring data gaps and geographic variations in the availability of data on RMNCAH&N indicators. Adaptations of the humanitarian response included task-shifting to overcome shortage in skilled healthcare workers following their exodus, outreach activities to enhance access to RMNCAH&N services, and operating in 'underground' facilities to avoid risk of attacks. CONCLUSION: The case of Syria provides a unique perspective on creative ways of managing the humanitarian response and delivering RMNCAH&N interventions, mainly in the multi-hub structure and use of remote management, despite encountered challenges. The scarcity of RMNCAH&N data is a tremendous challenge for both researchers and implementing agencies, as it limits accountability and monitoring, thus hindering the evaluation of delivered interventions.

Using Mobile Health to Enhance Outcomes of Noncommunicable Diseases Care in Rural Settings and Refugee Camps: Randomized Controlled Trial.

BACKGROUND: Rural areas and refugee camps are characterized by poor access of patients to needed noncommunicable disease (NCD)-related health services, including diabetes and hypertension. Employing low-cost innovative eHealth interventions, such as mobile health (mHealth), may help improve NCDs prevention and control among disadvantaged populations. OBJECTIVE: The aim of this study was to assess the effect of employing low-cost mHealth tools on the accessibility to health services and improvement of health indicators of individuals with NCDs in rural areas and refugee camps in Lebanon. METHODS: This is a randomized controlled trial study in which centers were allocated randomly into control and intervention sites. The effect of an employed mHealth intervention is assessed through selected quality indicators examined in both control and intervention groups. Sixteen primary health care centers (eight controls, eight interventions) located in rural areas and Palestinian refugee camps across Lebanon were included in this study. Data on diabetic and hypertensive patients-1433 in the intervention group and 926 in the control group-was extracted from patient files in the pre and postintervention periods. The intervention entailed weekly short message service messages, including medical information, importance of compliance, and reminders of appointments or regular physician follow-up. Internationally established care indicators were utilized in this study. Descriptive analysis of baseline characteristics of participants, bivariate analysis, logistic and linear regression were conducted using SPSS (IBM Corp). RESULTS: Bivariate analysis of quality indicators indicated that the intervention group had a significant increase in blood pressure control (P=.03), as well as a significant decrease in the mean systolic blood pressure (P=.02), mean glycated hemoglobin (HbA1c; P<.01), and in the proportion of HbA1c poor control (P=.02). Separate regression models controlling for age, gender, and setting showed a 28% increase in the odds of blood pressure control (P=.05) and a 38% decrease in the odds of HbA1c poor control (P=.04) among the intervention group in the posttest period. Females were at lower odds of HbA1c poor control (P=.01), and age was statistically associated with annual HbA1c testing (P<.01). Regression models for mean systolic blood pressure, mean diastolic blood pressure, and mean HbA1c showed that a mean decrease in HbA1c of 0.87% (P<.01) pretest to posttest period was observed among the intervention group. Patients in rural areas belonging to the intervention group had a lower HbA1c score as compared with those in refugee camps (P<.01). CONCLUSIONS: This study underlines the importance of employing integrative approaches of diseases prevention and control in which existing NCD programs in underserved communities (ie, rural and refugee camps settings) are coupled with innovative, low-cost approaches such as mHealth to provide an effective and amplified effect of traditional NCD-targeted care that can be reflected by improved NCD-related health indicators among the population. TRIAL REGISTRATION: ClinicalTrials.gov NCT03580330; https://clinicaltrials.gov/ct2/show/NCT03580330 (Archived by WebCite at http://www.webcitation.org/70mhVEUwQ).

Perceptions and behaviors of patients and pharmacists towards generic drug substitution in Lebanon.

Background Patients, physicians and pharmacists are key stakeholders in the implementation of generic substitution policies. Objectives To explore Lebanese patients' perceptions and experience, and pharmacists' dispensing patterns towards the newly enacted unified health prescription policy promoting generic substitution. Setting Pharmacies in Beirut, the capital of Lebanon. Methods A cross-sectional design employing self-administered questionnaires to survey a total of 128 patients and 25 pharmacists. Chi square test and multiple logistic regression were performed. Main outcome Perceptions and behaviors of patients and pharmacists towards the unified health prescription and generic substitution. Results Fourty-eight percent of the patients knew the definition of generic drugs, among which 59.0% perceived that generic drugs have the same effectiveness as their branded alternatives and 59.0% perceiving that generic drugs could reduce Lebanon's medical bill as well. Sixty-one percent of the patients were aware of the unified health prescription. Only 13.6% of the pharmacists suggested to patients to replace prescribed brand drug by a generic when their prescriptions were not marked with non-substitution. Conclusions Progress has been made with regards to enhancing generic substitution in the Lebanese healthcare field. However, it remains important to educate patients about generic medicines and plan context-specific schemes that promote prescribing and dispensing of generic drugs among physicians and pharmacists.