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1.
J Womens Health (Larchmt) ; 28(8): 1031-1036, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31408424

RESUMO

Recent public health emergencies have highlighted the unique vulnerabilities of pregnant women and infants to emerging health threats and the critical role of public health surveillance. Surveillance systems can collect critical data to measure the impact of a disease or disaster and can be used to inform clinical guidance and prevention strategies. These systems can also be tailored to collect data on vulnerable populations, such as pregnant women and their infants. Novel surveillance systems to assess risks and outcomes of pregnant women and infants have been established during public health emergencies but typically cease data collection once the public health response has ended, limiting our ability to collect data to understand longer-term outcomes. State-based birth defects surveillance systems are not available in all states, and no national surveillance system linking pregnancy exposure data to longitudinal outcomes for infants and children exists. In this report, we describe ongoing surveillance efforts to monitor congenital syphilis, Zika virus infection during pregnancy, and neonatal abstinence syndrome. We describe the need and rationale for an ongoing integrated surveillance system to monitor pregnant women and their infants and to detect emerging threats. We also discuss how data collected through this type of system can better position federal, state, and local health departments to more rapidly and comprehensively respond to the next public health emergency.

3.
MMWR Morb Mortal Wkly Rep ; 66(45): 1248-1251, 2017 Nov 17.
Artigo em Inglês | MEDLINE | ID: mdl-29145353

RESUMO

Adherence to prescribed medications is associated with improved clinical outcomes for chronic disease management and reduced mortality from chronic conditions (1). Conversely, nonadherence is associated with higher rates of hospital admissions, suboptimal health outcomes, increased morbidity and mortality, and increased health care costs (2). In the United States, 3.8 billion prescriptions are written annually (3). Approximately one in five new prescriptions are never filled, and among those filled, approximately 50% are taken incorrectly, particularly with regard to timing, dosage, frequency, and duration (4). Whereas rates of nonadherence across the United States have remained relatively stable, direct health care costs associated with nonadherence have grown to approximately $100-$300 billion of U.S. health care dollars spent annually (5,6). Improving medication adherence is a public health priority and could reduce the economic and health burdens of many diseases and chronic conditions (7).


Assuntos
Doença Crônica/tratamento farmacológico , Adesão à Medicação/estatística & dados numéricos , Medicamentos sob Prescrição/uso terapêutico , Centers for Disease Control and Prevention, U.S. , Difusão de Inovações , Humanos , Resultado do Tratamento , Estados Unidos
4.
MMWR Morb Mortal Wkly Rep ; 66(29): 769-772, 2017 Jul 28.
Artigo em Inglês | MEDLINE | ID: mdl-28749927

RESUMO

Research suggests that many disparities in overall health and well-being are rooted in early childhood (1,2). Stressors in early childhood can disrupt neurologic, metabolic, and immunologic systems, leading to poorer developmental outcomes (1). However, consistent, responsive caregiving relationships and supportive community and health care environments promote an optimal trajectory (3,4). The first 8 years of a child's life build a foundation for future health and life success (5-7). Thus, the cumulative and lifelong impact of early experiences, both positive and negative, on a child's development can be profound. Although the health, social service, and education systems that serve young children and their families and communities provide opportunities to support responsive relationships and environments, efforts by these systems are often fragmented because of restrictions that limit the age groups they can serve and types of services they can provide. Integrating relationship-based prevention and intervention services for children early in life, when the brain is developing most rapidly, can optimize developmental trajectories (4,7). By promoting collaboration and data-driven intervention activities, public health can play a critical role in both the identification of at-risk children and the integration of systems that can support healthy development. These efforts can address disparities by reducing barriers that might prevent children from reaching their full potential.


Assuntos
Serviços de Saúde da Criança/organização & administração , Disparidades nos Níveis de Saúde , Centers for Disease Control and Prevention, U.S. , Criança , Pré-Escolar , Humanos , Estados Unidos
5.
MMWR Morb Mortal Wkly Rep ; 66(18): 479-481, 2017 May 12.
Artigo em Inglês | MEDLINE | ID: mdl-28493856

RESUMO

Worldwide, stroke is the second leading cause of death and a leading cause of serious long-term disability. In the United States, nearly 800,000 strokes occur each year; thus stroke is the fifth leading cause of death overall and the fourth leading cause of death among women (1). Major advances in stroke prevention through treatment of known risk factors has led to stroke being considered largely preventable. For example, in the United States, stroke mortality rates have declined 70% over the past 50 years, in large part because of important reductions in hypertension, tobacco smoking, and more recently, increased use of anticoagulation for atrial fibrillation (2,3). Although the reduction in stroke mortality is recognized as one of the 10 great public health achievements of the 20th century (4), gains can still be made. Approximately 80% of strokes could be prevented by screening for and addressing known risks with measures such as improving hypertension control, smoking cessation, diabetes prevention, cholesterol management, increasing use of anticoagulation for atrial fibrillation, and eliminating excessive alcohol consumption (5,6).


Assuntos
Prática de Saúde Pública , Acidente Vascular Cerebral/prevenção & controle , Acidente Vascular Cerebral/terapia , Centers for Disease Control and Prevention, U.S. , Governo Federal , Programas Governamentais , Humanos , Fatores de Risco , Resultado do Tratamento , Estados Unidos
6.
MMWR Morb Mortal Wkly Rep ; 65(48): 1374-1377, 2016 Dec 09.
Artigo em Inglês | MEDLINE | ID: mdl-27932782

RESUMO

Mathematical models incorporate various data sources and advanced computational techniques to portray real-world disease transmission and translate the basic science of infectious diseases into decision-support tools for public health. Unlike standard epidemiologic methods that rely on complete data, modeling is needed when there are gaps in data. By combining diverse data sources, models can fill gaps when critical decisions must be made using incomplete or limited information. They can be used to assess the effect and feasibility of different scenarios and provide insight into the emergence, spread, and control of disease. During the past decade, models have been used to predict the likelihood and magnitude of infectious disease outbreaks, inform emergency response activities in real time (1), and develop plans and preparedness strategies for future events, the latter of which proved invaluable during outbreaks such as severe acute respiratory syndrome and pandemic influenza (2-6). Ideally, modeling is a multistep process that involves communication between modelers and decision-makers, allowing them to gain a mutual understanding of the problem to be addressed, the type of estimates that can be reliably generated, and the limitations of the data. As models become more detailed and relevant to real-time threats, the importance of modeling in public health decision-making continues to grow.


Assuntos
Técnicas de Apoio para a Decisão , Modelos Teóricos , Saúde Pública , Centers for Disease Control and Prevention, U.S. , Doenças Transmissíveis/epidemiologia , Comunicação , Planejamento em Desastres/organização & administração , Surtos de Doenças/prevenção & controle , Emergências , Humanos , Estados Unidos/epidemiologia
7.
MMWR Morb Mortal Wkly Rep ; 65(32): 826-30, 2016 Aug 19.
Artigo em Inglês | MEDLINE | ID: mdl-27536925

RESUMO

Preterm birth (delivery before 37 weeks and 0/7 days of gestation) is a leading cause of infant morbidity and mortality in the United States. In 2013, 11.4% of the nearly 4 million U.S. live births were preterm; however, 36% of the 8,470 infant deaths were attributed to preterm birth (1). Infants born at earlier gestational ages, especially <32 0/7 weeks, have the highest mortality (Figure) and morbidity rates. Morbidity associated with preterm birth includes respiratory distress syndrome, necrotizing enterocolitis, and intraventricular hemorrhage; longer-term consequences include developmental delay and decreased school performance. Risk factors for preterm delivery include social, behavioral, clinical, and biologic characteristics (Box). Despite advances in medical care, racial and ethnic disparities associated with preterm birth persist. Reducing preterm birth, a national public health priority (2), can be accomplished by implementing and monitoring strategies that target modifiable risk factors and populations at highest risk, and by providing improved quality and access to preconception, prenatal, and interconception care through implementation of strategies with potentially high impact.


Assuntos
Nascimento Prematuro/prevenção & controle , Prática de Saúde Pública , Centers for Disease Control and Prevention, U.S. , Feminino , Humanos , Lactente , Mortalidade Infantil/tendências , Recém-Nascido , Gravidez , Complicações na Gravidez/prevenção & controle , Fatores de Risco , Estados Unidos/epidemiologia
8.
MMWR Morb Mortal Wkly Rep ; 64(35): 972-4, 2015 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-26356838

RESUMO

Recent public health emergencies including Hurricane Katrina (2005), the influenza H1N1 pandemic (2009), and the Ebola virus disease outbreak in West Africa (2014­2015) have demonstrated the importance of multiple-level emergency planning and response. An effective response requires integrating coordinated contributions from community-based health care providers, regional health care coalitions, state and local health departments, and federal agency initiatives. This is especially important when planning for the needs of children, who make up 23% of the U.S. population (1) and have unique needs that require unique planning strategies.


Assuntos
Planejamento em Desastres/organização & administração , Emergências , Saúde Pública , Centers for Disease Control and Prevention, U.S. , Criança , Humanos , Estados Unidos
9.
Reprod Toxicol ; 47: 15-20, 2014 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-24803403

RESUMO

Perfluorooctanoate (PFOA) is detectable in umbilical cord blood and amniotic fluid. Some toxicological findings suggest that perfluoroalkyl substances may be teratogenic. Using data from the C8 Health Project, a 2005-2006 survey in a Mid-Ohio Valley community exposed to PFOA through contaminated drinking water, we examined the association between estimated prenatal PFOA concentration and maternally reported birth defects (n=325) among 10,262 live singleton or multiple births from 1990 to 2006. Logistic regression models accounted for siblings using generalized estimating equations. There was generally no association between estimated PFOA concentration and birth defects, with the possible exception of brain defects, where the odds ratio adjusted for year of conception was 2.6 (95% confidence interval 1.3-5.1) for an increase in estimated PFOA exposure from the 25th to 75th percentile. This estimate, however, was based on 13 cases and may represent a chance finding. Further investigation of this potential association may be warranted.


Assuntos
Encéfalo/anormalidades , Caprilatos/sangue , Anormalidades Congênitas/epidemiologia , Exposição Ambiental/análise , Fluorcarbonetos/sangue , Poluentes Químicos da Água/sangue , Adolescente , Adulto , Feminino , Humanos , Recém-Nascido , Pessoa de Meia-Idade , Razão de Chances , Ohio/epidemiologia , Adulto Jovem
11.
Pharmacoepidemiol Drug Saf ; 22(9): 1013-8, 2013 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-23893932

RESUMO

PURPOSE: To determine which medications are most commonly used by women in the first trimester of pregnancy and identify the critical gaps in information about fetal risk for those medications. METHODS: Self-reported first-trimester medication use was assessed among women delivering liveborn infants without birth defects and serving as control mothers in two large case-control studies of major birth defects. The Teratology Information System (TERIS) expert Advisory Board ratings of quality and quantity of data available to assess fetal risk were reviewed to identify information gaps. RESULTS: Responses from 5381 mothers identified 54 different medication components used in the first trimester by at least 0.5% of pregnant women, including 31 prescription and 23 over-the-counter medications. The most commonly used prescription medication components reported were progestins from oral contraceptives, amoxicillin, progesterone, albuterol, promethazine, and estrogenic compounds. The most commonly used over-the-counter medication components reported were acetaminophen, ibuprofen, docusate, pseudoephedrine, aspirin, and naproxen. Among the 54 most commonly used medications, only two had "Good to Excellent" data available to assess teratogenic risk in humans, based on the TERIS review. CONCLUSIONS: For most medications commonly used in pregnancy, there are insufficient data available to characterize the fetal risk fully, limiting the opportunity for informed clinical decisions about the best management of acute and chronic disorders during pregnancy. Future research efforts should be directed at these critical knowledge gaps.


Assuntos
Revisão de Uso de Medicamentos/estatística & dados numéricos , Desenvolvimento Fetal/efeitos dos fármacos , Conhecimentos, Atitudes e Prática em Saúde , Exposição Materna/efeitos adversos , Medicamentos sem Prescrição/efeitos adversos , Medicamentos sob Prescrição/efeitos adversos , Sistemas de Notificação de Reações Adversas a Medicamentos , Prescrições de Medicamentos/estatística & dados numéricos , Revisão de Uso de Medicamentos/tendências , Feminino , Humanos , Exposição Materna/estatística & dados numéricos , Medicamentos sem Prescrição/administração & dosagem , Medicamentos sem Prescrição/uso terapêutico , Farmacoepidemiologia , Gravidez , Primeiro Trimestre da Gravidez , Medicamentos sob Prescrição/administração & dosagem , Medicamentos sob Prescrição/uso terapêutico , Risco , Inquéritos e Questionários , Estados Unidos
12.
Birth Defects Res A Clin Mol Teratol ; 91(12): 1019-27, 2011 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-22021073

RESUMO

BACKGROUND: National data on health care use among children with special needs are limited and do not address children with spina bifida (SB). One recent study examined health care costs during 2003 among privately insured individuals with SB. Our objective was to compare health care use and expenditures among publicly insured children with SB to children without a major birth defect and among children with SB with and without hydrocephalus. METHODS: Data from the North Carolina Birth Defects Monitoring Program and Medicaid were linked to identify continuously enrolled children with SB (case children) and children without a major birth defect (control children) born from 1995 to 2002. Medicaid expenditures per child for medical, inpatient, outpatient, dental, well-child care, developmental/behavioral services, and home health for those aged 0 to 4 years old were calculated for case and control children and for case children with and without hydrocephalus. RESULTS: Of 373 case children who survived infancy, 205 (55%) were enrolled in Medicaid. Expenditures were assessed for 144 case and 5674 control children aged 0 to 4 years old continuously enrolled in Medicaid. During infancy, mean expenditure was $33,135 per child with SB and $3900 per unaffected child. The biggest relative expenditures were for developmental/behavioral services (82 times higher for case than control child [$1401 vs. $17]) and home health services (20 times higher [$821 vs. $41]). Average expenditure for an infant with SB and hydrocephalus was 2.6 times higher than an infant with SB without hydrocephalus ($40,502 vs. $15,699). CONCLUSIONS: Expenditure comparisons by SB subtype are important for targeting health care resources.


Assuntos
Assistência à Saúde/economia , Gastos em Saúde/estatística & dados numéricos , Necessidades e Demandas de Serviços de Saúde/economia , Hidrocefalia/economia , Medicaid/economia , Disrafismo Espinal/economia , Criança , Pré-Escolar , Assistência à Saúde/estatística & dados numéricos , Feminino , Custos de Cuidados de Saúde/estatística & dados numéricos , Gastos em Saúde/tendências , Humanos , Hidrocefalia/complicações , Hidrocefalia/epidemiologia , Hidrocefalia/etnologia , Lactente , Recém-Nascido , Estudos Longitudinais , Masculino , Medicaid/estatística & dados numéricos , North Carolina/epidemiologia , Estudos Retrospectivos , Disrafismo Espinal/complicações , Disrafismo Espinal/epidemiologia , Disrafismo Espinal/etnologia , Estados Unidos , Adulto Jovem
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