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1.
MMWR Morb Mortal Wkly Rep ; 69(2): 25-29, 2020 Jan 17.
Artigo em Inglês | MEDLINE | ID: mdl-31945037

RESUMO

Birth defects are a leading cause of infant mortality in the United States, accounting for 20.6% of infant deaths in 2017 (1). Rates of infant mortality attributable to birth defects (IMBD) have generally declined since the 1970s (1-3). U.S. linked birth/infant death data from 2003-2017 were used to assess trends in IMBD. Overall, rates declined 10% during 2003-2017, but decreases varied by maternal and infant characteristics. During 2003-2017, IMBD rates decreased 4% for infants of Hispanic mothers, 11% for infants of non-Hispanic black (black) mothers, and 12% for infants of non-Hispanic white (white) mothers. In 2017, these rates were highest among infants of black mothers (13.3 per 10,000 live births) and were lowest among infants of white mothers (9.9). During 2003-2017, IMBD rates for infants who were born extremely preterm (20-27 completed gestational weeks), full term (39-40 weeks), and late term/postterm (41-44 weeks) declined 20%-29%; rates for moderate (32-33 weeks) and late preterm (34-36 weeks) infants increased 17%. Continued tracking of IMBD rates can help identify areas where efforts to reduce IMBD are needed, such as among infants born to black and Hispanic mothers and those born moderate and late preterm (32-36 weeks).


Assuntos
Anormalidades Congênitas/mortalidade , Mortalidade Infantil/tendências , Afro-Americanos/estatística & dados numéricos , Anormalidades Congênitas/etnologia , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Disparidades nos Níveis de Saúde , Hispano-Americanos/estatística & dados numéricos , Humanos , Lactente , Mortalidade Infantil/etnologia , Lactente Extremamente Prematuro , Recém-Nascido , Criança Pós-Termo , Recém-Nascido Prematuro , Masculino , Estados Unidos/epidemiologia
2.
J Epidemiol ; 29(7): 247-256, 2019 Jul 05.
Artigo em Inglês | MEDLINE | ID: mdl-30249945

RESUMO

BACKGROUND: The aims of the present report were to estimate the prevalence of congenital anomalies (CAs) among infants in Japan using data from the Japan Environment and Children's Study (JECS) and to evaluate the validity of CA classification within JECS. METHODS: Data on CAs were collected at delivery and at age 1 month from the medical records of 101,825 infants at 15 regional centers. The analyses focused on 61 CAs, selected on the basis of reported associations with environmental exposure. Prevalence per 10,000 pregnancies (including miscarriages, stillbirths, and live births) was stratified according to four reporting patterns (at delivery, at age 1 month, at either, and at both). To evaluate the accuracy of observed CA prevalence, the medical records of 179 cases from a single JECS regional center underwent independent, retrospective re-evaluation. RESULTS: The prevalence of major CAs in four reporting patterns (at delivery, at age 1 month, at either, and at both) was 2.4, 2.6, 3.5, and 1.4 for myelomeningocele/spina bifida; 4.3, 4.2, 5.3, and 3.2 for cleft palate; 18.1, 17.4, 19.5, and 15.1 for cleft lip with or without cleft palate; 73.4, 100.3, 120.8, and 52.8 for congenital heart disease; and 10.5, 14.1, 15.0, and 9.6 for Down's syndrome, respectively. In the subsample re-evaluation, CA diagnoses were confirmed for 92.7%, 93.3%, 90.5%, and 97.8% of cases in the four reporting patterns (at delivery, at age 1 month, at either, and at both), respectively. CONCLUSIONS: The present report generated reliable data concerning the prevalence of major CAs in JECS.


Assuntos
Anormalidades Congênitas/epidemiologia , Exposição Ambiental/efeitos adversos , Estudos de Coortes , Anormalidades Congênitas/etnologia , Feminino , Humanos , Recém-Nascido , Japão/epidemiologia , Masculino , Gravidez , Prevalência , Estudos Prospectivos , Fatores de Risco
3.
BMC Public Health ; 18(1): 1008, 2018 08 13.
Artigo em Inglês | MEDLINE | ID: mdl-30103721

RESUMO

BACKGROUND: The causes of birth defects (BDs) are complex and include genetic and environmental factors and/or their interactions. More research is needed to describe the epidemiology of BDs within specific regions of China. This study focused on differences in the prevalence of BDs based on ethnicity in a large city in Guangxi Province, China. METHODS: Surveillance data of infants born in 114 registered hospitals in Liuzhou between 2011 and 2015 were analyzed to determine the epidemiology of BDs across five major ethnic groups. We calculated the prevalence of BDs and relative risk of BDs by ethnicity. RESULTS: There were 260,722 perinatal infants of which 6581 had BDs, with the average prevalence of 25.24 per 1000 perinatal infants (PIs). Prevalence data showed an obvious uptrend over the past 5 years. Han had the highest prevalence of total BDs (28.98‰), followed by Zhuang (25.19‰), Yao (18.50‰), Miao (15.78‰) and Dong (14.24‰). Relative to the Han; Zhuang, Miao, Yao, and Dong had a lower risk of musculoskeletal and urogenital malformations; Miao and Yao had a lower risk of cardiovascular malformation; and Dong had a lower risk of cardiovascular and craniofacial malformation. Several maternal risk factors were found to be associated with BDs (e.g., maternal and gestational age, number of antenatal care visits). CONCLUSION: This study provided a comprehensive description of ethnic differences in the risk of BDs in Liuzhou City, China. Observed ethnic differences in the risk of BDs may be related to genetic susceptibilities, environment, cultural customs, or to potential combinations of these factors.


Assuntos
Grupo com Ancestrais do Continente Asiático/estatística & dados numéricos , Anormalidades Congênitas/epidemiologia , Grupos Étnicos/estatística & dados numéricos , Vigilância da População , Grupo com Ancestrais do Continente Asiático/etnologia , China/epidemiologia , Anormalidades Congênitas/etnologia , Feminino , Humanos , Recém-Nascido , Masculino , Gravidez , Prevalência
4.
Birth Defects Res ; 110(4): 352-363, 2018 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-29195034

RESUMO

BACKGROUND: Previous studies demonstrate that infant and childhood mortality differ among children with birth defects by maternal race/ethnicity, but limited mortality information is published for Hispanic ethnic subgroups. METHODS: We performed a retrospective cohort study using data for children with birth defects born to Hispanic mothers during 1999-2007 from 12 population-based state birth defects surveillance programs. Deaths were ascertained through multiple sources. Survival probabilities were estimated by the Kaplan-Meier method. Cox proportional hazards regression was used to examine the effect of clinical and demographic factors on mortality risk. RESULTS: Among 28,497 Hispanic infants and children with major birth defects, 1-year survival was highest for infants born to Cuban mothers at 94.6% (95% confidence intervals [CI] 92.7-96.0) and the lowest for Mexicans at 90.2% (95% CI 89.7-90.6; p < .0001). For children aged up to 8 years, survival remained highest for Cuban Americans at 94.1% (95% CI 91.8-95.7) and lowest for Mexican Americans at 89.2% (95% CI 88.7-89.7; p = .0002). In the multivariable analysis using non-Hispanic White as the reference group, only infants and children born to Mexican mothers were noted to have a higher risk of mortality for cardiovascular defects. CONCLUSIONS: This analysis provides a better understanding of survival and mortality for Hispanic infants and children with selected birth defects. The differences found in survival, particularly the highest survival rates for Cuban American children and lowest for Mexican American children with birth defects, underscores the importance of assessing Hispanic ethnic subgroups, as differences among subgroups appear to exist.


Assuntos
Mortalidade da Criança/etnologia , Anormalidades Congênitas/etnologia , Anormalidades Congênitas/mortalidade , Hispano-Americanos , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Estudos Retrospectivos , Fatores de Risco
5.
Aesthetic Plast Surg ; 42(3): 759-765, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29288423

RESUMO

BACKGROUND: Prominent ear is the most common external ear deformity. To comprehensively treat prominent ear deformity, adequate comprehension of its pathophysiology is crucial. In this article, we analyze cases of prominent ear and suggest a simple classification system and treatment algorithm according to pathophysiology. METHODS: We retrospectively reviewed a total of 205 Northeast Asian patients' clinical data who underwent an operation for prominent ear deformity. Follow-up assessments were conducted 3, 6, and 12 months after surgery. Prominent ear deformities were classified by diagnostic checkpoints. Class I (simple prominent ear) includes prominent ear that developed with the absence of the antihelix without conchal hypertrophy. Class II (mixed-type prominent ear) is defined as having not only a flat antihelix, but also conchal excess. Class III (conchal-type prominent ear) has an enlarged conchal bowl with a well-developed antihelix. RESULTS: Among the three types of prominent ear, class I was most frequent (162 patients, 81.6%). Class II was observed in 28 patients (13.6%) and class III in 10 patients (4.8%). We used the scaphomastoid suture method for correction of antihelical effacement, the anterior approach conchal resection for correction of conchal hypertrophy, and Bauer's squid incision for lobule prominence. The complication rate was 9.2% including early hematoma, hypersensitivity, and suture extrusion. Unfavorable results occurred in 4% including partial recurrence, overcorrection, and undercorrection. CONCLUSIONS: To reduce unfavorable results and avoid recurrence, we propose the use of a classification and treatment algorithm in preoperative evaluation of prominent ear. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .


Assuntos
Anormalidades Congênitas/classificação , Anormalidades Congênitas/cirurgia , Pavilhão Auricular/anormalidades , Pavilhão Auricular/cirurgia , Cirurgia Plástica/métodos , Adolescente , Adulto , Fatores Etários , Grupo com Ancestrais do Continente Asiático , Anormalidades Congênitas/etnologia , Bases de Dados Factuais , Estética , Feminino , Humanos , Hipertrofia/cirurgia , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Medição de Risco , Fatores Sexuais , Resultado do Tratamento , Adulto Jovem
6.
Semin Perinatol ; 41(6): 354-359, 2017 10.
Artigo em Inglês | MEDLINE | ID: mdl-28864275

RESUMO

In the United States, African-American infants have significantly higher mortality than white infants. Previous work has identified associations between individual socioeconomic factors and select community-level factors. In this review, the authors look beyond traditional risk factors for infant mortality and examine the social context of race in this country, in an effort to understand African-American women's long-standing birth outcome disadvantage. In the process, recent insights are highlighted concerning neighborhood-level factors such as crime, segregation, built environment, and institutional racism, other likely causes for the poor outcomes of African-American infants in this country compared with infants in most other industrialized nations.


Assuntos
Afro-Americanos/estatística & dados numéricos , Disparidades nos Níveis de Saúde , Mortalidade Infantil/etnologia , Nascimento Prematuro/etnologia , Acidentes/mortalidade , Causas de Morte , Anormalidades Congênitas/etnologia , Anormalidades Congênitas/mortalidade , Crime , Meio Ambiente , Humanos , Lactente , Recém-Nascido de Baixo Peso , Recém-Nascido , Racismo , Características de Residência , Segregação Social , Morte Súbita do Lactente/etnologia , Estados Unidos
7.
Int J Clin Pharm ; 39(4): 783-790, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28626851

RESUMO

Background Previous studies from western countries demonstrated the effectiveness of Teratology Information Service (TIS) counselling in reducing the teratogenic risk perception of pregnant women. Objective To assess whether TIS counselling would be effective in reducing the teratogenic risk perception of the Turkish pregnant women. Setting A TIS (Terafar) operating in a university hospital in Turkey. Methods A cross-sectional survey study. Pregnant women with non-teratogenic medication exposures were asked to assign scores on visual analogue scales (VAS) in response to the questions aiming to measure their teratogenic risk perception. The mean score before and after counselling were compared and the associations with maternal socio-demographic characteristics were analysed using SPSS (Version 20.0). Main outcome measures The differences in the mean scores of the perception regarding the baseline risk of pregnancy, own teratogenic risk and the likelihood of termination of pregnancy before and after counselling and their possible associations with maternal socio-demographic characteristics. Results 102 pregnant women participated in the study. The counselling significantly reduced the mean own teratogenic risk perception score and the mean score for the likelihood of termination of pregnancy whereas the mean baseline risk perception score was not significantly changed. Pregnancy week <8 and the exposed number of active ingredients <3 were significantly associated with the difference in the mean score for the likelihood of termination of pregnancy. Conclusions TIS counselling lowers the teratogenic risk perception of Turkish pregnant women and increases their likelihood to continue the pregnancy as it does in the western countries.


Assuntos
Aconselhamento/tendências , Medicina Baseada em Evidências/tendências , Pessoal de Saúde/tendências , Serviços de Informação/tendências , Efeitos Tardios da Exposição Pré-Natal/prevenção & controle , Teratogênios , Adulto , Ásia/etnologia , Anormalidades Congênitas/etnologia , Anormalidades Congênitas/prevenção & controle , Aconselhamento/métodos , Aconselhamento/normas , Estudos Transversais , Europa (Continente)/etnologia , Medicina Baseada em Evidências/métodos , Medicina Baseada em Evidências/normas , Feminino , Pessoal de Saúde/normas , Humanos , Serviços de Informação/normas , Gravidez , Efeitos Tardios da Exposição Pré-Natal/induzido quimicamente , Efeitos Tardios da Exposição Pré-Natal/etnologia , Teratologia , Turquia/etnologia
8.
MMWR Morb Mortal Wkly Rep ; 66(3): 84-87, 2017 Jan 27.
Artigo em Inglês | MEDLINE | ID: mdl-28125575

RESUMO

Birth defects are a leading cause of infant mortality in the United States (1), accounting for approximately 20% of infant deaths. The rate of infant mortality attributable to birth defects (IMBD) in the United States in 2014 was 11.9 per 10,000 live births (1). Rates of IMBD differ by race/ethnicity (2), age group at death (2), and gestational age at birth (3). Insurance type is associated with survival among infants with congenital heart defects (CHD) (4). In 2003, a checkbox indicating principal payment source for delivery was added to the U.S. standard birth certificate (5). To assess IMBD by payment source for delivery, CDC analyzed linked U.S. birth/infant death data for 2011-2013 from states that adopted the 2003 revision of the birth certificate. The results indicated that IMBD rates for preterm (<37 weeks of gestation) and term (≥37 weeks) infants whose deliveries were covered by Medicaid were higher during the neonatal (<28 days) and postneonatal (≥28 days to <1 year) periods compared with infants whose deliveries were covered by private insurance. Similar differences in postneonatal mortality were observed for the three most common categories of birth defects listed as a cause of death: central nervous system (CNS) defects, CHD, and chromosomal abnormalities. Strategies to ensure quality of care and access to care might reduce the difference between deliveries covered by Medicaid and those covered by private insurance.


Assuntos
Anormalidades Congênitas/mortalidade , Parto Obstétrico/economia , Mortalidade Infantil , Seguro Saúde/estatística & dados numéricos , Adulto , Anormalidades Congênitas/etnologia , Feminino , Idade Gestacional , Humanos , Lactente , Mortalidade Infantil/etnologia , Recém-Nascido , Medicaid/estatística & dados numéricos , Gravidez , Setor Privado/estatística & dados numéricos , Estados Unidos/epidemiologia , Adulto Jovem
9.
J Registry Manag ; 44(4): 146-156, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-30133431

RESUMO

INTRODUCTION: In Florida prior to 2004, the birth certificate only allowed parents to identify themselves as 1 race. The birth certificate was subsequently revised in 2004, allowing parents to identify with more than 1 race. This inconsistency in data collection methods can greatly impact the results of race-specific time trend analyses. Race-bridging techniques have been developed to reassign multiple race responses to single race categories. This investigation aimed to compare race-specific birth defect rates calculated in 2 ways: (1) the current method: treating those selecting multiple race categories as though they selected Other race, and (2) the bridged method: attempting to classify those selecting multiple categories into the category they would have selected if they could only pick 1 race. METHODS: Data from the Florida Office of Vital Statistics and the Florida Birth Defects Registry were used to examine rates of selected birth defects by race among births to non-Hispanic mothers from 2005 to 2014. Rates of selected birth defects were calculated and compared for the following race groups: white, black, American Indian/Alaska Native (AIAN), and Asian/Pacific Islander (API) using the following 6 bridging methods: (1) no bridging method, (2) largest group, whole allocation, (3) smallest group, whole allocation, (4) largest group other than white, (5) equal fractions, fractional allocation, and (6) reported fractions, fractional allocation. RESULTS: The differences in birth defect rates comparing the current method to the recalculated bridged-race population depends on the bridging method used. Using largest group, whole-allocation, the total population of white, black, and API races increased, whereas the total number of AIAN remained unaffected. Using the smallest group or largest group other than white, whole-allocation, the total population of black, API, and AIAN increased, resulting in decreased birth defect rates. Lastly, using equal fractions or reported fractions, fractional allocation we found an increase in the live birth count for each race and a corresponding decrease in birth defect rates. DISCUSSION: Race-bridging techniques may be useful when reviewing race-specific rates over time, or to account for the lack of comparability of race/ethnic classification in birth defect studies, particularly national studies combining data from different states. However, determining the best race-bridging technique warrants further investigation on larger populations and on other health outcomes.


Assuntos
Algoritmos , Anormalidades Congênitas/etnologia , Grupos de Populações Continentais/estatística & dados numéricos , Sistema de Registros/estatística & dados numéricos , Declaração de Nascimento , Feminino , Florida/epidemiologia , Humanos , Recém-Nascido , Masculino , Vigilância da População , Estatísticas Vitais
10.
Fertil Steril ; 106(3): 717-722.e2, 2016 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-27208695

RESUMO

OBJECTIVE: To assess the validity of outcome data reported to the Society for Assisted Reproductive Technology Clinic Outcome Reporting System (SART CORS) compared with data from vital records and the birth defects registry in Massachusetts. DESIGN: Longitudinal cohort. SETTING: Not applicable. PARTICIPANT(S): A total of 342,035 live births and fetal deaths from Massachusetts mothers giving birth in the state from July 1, 2004, to December 31, 2008; 9,092 births and fetal deaths were from mothers who had conceived with the use of assisted reproductive technology (ART) and whose cycle data had been reported to the SART CORS. INTERVENTION(S): Not applicable. MAIN OUTCOME MEASURE(S): Percentage agreement between maternal race and ethnicity, delivery outcome (live birth or fetal death), plurality (singleton, twin, or triplet+), delivery date, and singleton birth weight reported in the SART CORS versus vital records; sensitivity and specificity for birth defects among singletons as reported in the SART CORS versus the Massachusetts Birth Defects Monitoring Program (BDMP). RESULT(S): There was >95% agreement between the SART CORS and vital records for fields of maternal race/ethnicity, live birth/fetal death, and plurality; birth outcome date was within 1 day with 94.9% agreement and birth weight was within 100 g with 89.6% agreement. In contrast, sensitivity for report of any birth defect was 38.6%, with a range of 18.4%-50.0%, for specific birth defect categories. CONCLUSION(S): Although most SART CORS outcome fields are accurately reported, birth defect variables showed poor sensitivity compared with the gold standard data from the BDMP. We suggest that reporting of birth defects be discontinued.


Assuntos
Anormalidades Congênitas/epidemiologia , Confiabilidade dos Dados , Morte Fetal , Infertilidade/terapia , Resultado da Gravidez , Técnicas de Reprodução Assistida/efeitos adversos , Peso ao Nascer , Anormalidades Congênitas/diagnóstico , Anormalidades Congênitas/etnologia , Feminino , Fertilidade , Humanos , Infertilidade/diagnóstico , Infertilidade/fisiopatologia , Nascimento Vivo , Massachusetts/epidemiologia , Gravidez , Gravidez Múltipla , Sistema de Registros , Reprodutibilidade dos Testes , Técnicas de Reprodução Assistida/mortalidade , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
11.
Ethn Dis ; 26(2): 165-70, 2016 Apr 21.
Artigo em Inglês | MEDLINE | ID: mdl-27103766

RESUMO

BACKGROUND: US-born Mexican American women have greater rates of preterm birth and consequent overall infant mortality than their Mexico-born peers. However, the relation of Mexican American women's nativity to rates of congenital anomalies is poorly understood. Hispanic ethnicity and young maternal age are well-known risk factors for gastroschisis. OBJECTIVE: To determine the extent to which nativity of Mexican American women is associated with abdominal wall defects. METHODS: Stratified and multivariable logistic regression analyses were performed on the 2003-2004 National Center for Health Statistics linked live birth-infant death cohort. Only Mexican American infants were studied. Maternal variables examined included nativity, age, education, marital status, parity, and prenatal care usage. RESULTS: Infants with US-born Mexican American mothers (n=451,272) had an abdominal wall defect rate of 3.9/10,000 compared with 2.0/10,000 for those with Mexico-born mothers (n=786,878), RR=1.9 (1.5-2.4). Though a greater percentage of US-born (compared wtih Mexico-born) Mexican American mothers were teens, the nativity disparity was actually widest among women in their 20s. The adjusted (controlling for maternal age, education, marital status, parity, and prenatal care) odds ratio of abdominal wall defects among infants of US-born (compared with Mexico-born) Mexican American mothers was 1.6 (1.2-2.0). CONCLUSIONS: US-born Mexican American women have nearly a two-fold greater rate of delivering an infant with an abdominal wall defect than their Mexico-born counterparts. This phenomenon is only partially explained by traditional risk factors and highlights a detrimental impact of lifelong residence in the United States, or something closely related to it, on the pregnancy outcome of Mexican American women.


Assuntos
Parede Abdominal/anormalidades , Anormalidades Congênitas/etnologia , Americanos Mexicanos/estatística & dados numéricos , Adolescente , Adulto , Estudos de Coortes , Feminino , Hispano-Americanos , Humanos , Lactente , Mortalidade Infantil , Recém-Nascido , Idade Materna , México/etnologia , Mães , Razão de Chances , Paridade , Gravidez , Resultado da Gravidez/etnologia , Cuidado Pré-Natal , Fatores de Risco , Estados Unidos/epidemiologia
13.
Artigo em Inglês | MEDLINE | ID: mdl-26545588

RESUMO

The risk of giving birth to a stillborn child or a child with severe congenital anomaly is higher for women who have immigrated to Europe as compared to the majority population in the receiving country. The literature, however, reveals great differences between migrant groups, even within migrants from low-income countries, although there is no clear pattern regarding refugee or non-refugee status. This heterogeneity argues against a particular migration-related explanation. There are social disparities in stillbirth risk worldwide, and it has been suggested that the demonstrated ethnic disparity is a result of the socioeconomic disadvantage most migrants face. Consanguinity has been considered as another cause for the increased stillbirth risk and the high risk of congenital anomaly observed in many migrant groups. Utilization and quality of care during pregnancy and childbirth is the third major aspect. All three factors seem to contribute to stillbirth risk, and they should be considered in clinical practice and public health.


Assuntos
Anormalidades Congênitas/etnologia , Emigrantes e Imigrantes/estatística & dados numéricos , Disparidades nos Níveis de Saúde , Natimorto/etnologia , Anormalidades Congênitas/etiologia , Anormalidades Congênitas/prevenção & controle , Consanguinidade , Países Desenvolvidos , Países em Desenvolvimento , Europa (Continente)/epidemiologia , Feminino , Acesso aos Serviços de Saúde , Disparidades em Assistência à Saúde/etnologia , Humanos , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Gravidez , Fatores de Risco , Fatores Socioeconômicos
14.
Birth ; 42(4): 362-8, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26256095

RESUMO

BACKGROUND: Across Australia there are substantial disparities in uptake of antenatal testing for fetal anomalies, with very low uptake observed among Aboriginal women. The reasons behind these disparities are unclear, although poorer access to testing has been reported in some communities. We interviewed health care practitioners to explore the perceived barriers to providing fetal anomaly screening to Aboriginal women. METHODS: In 2009 and 2010, in-depth interviews were undertaken with 59 practitioners in five urban and remote sites across the Northern Territory (NT) of Australia. Data were analyzed thematically. Maximum variation sampling, independent review of findings by multiple analysts, and participant feedback were undertaken to strengthen the validity of findings. RESULTS: Participants included midwives (47%), Aboriginal health practitioners (AHP) (32%), general practitioners (12%), and obstetricians (9%); almost all (95%) were female. Participants consistently reported difficulties counseling women. Explaining the concept of "risk" (of abnormalities and the screening test result) was identified as particularly challenging, because of a perceived lack of an equivalent concept in Aboriginal languages. While AHPs could assist with overcoming language barriers, they are underutilized. Participants also identified impediments to organizing testing including difficulties establishing gestational age, late presentation for care, and a lack of standardized information and training. DISCUSSION: The availability of fetal anomaly testing is challenged by communication difficulties, including a focus on culturally specific biomedical concepts, and organizational barriers to arranging testing. Developing educational activities that address the technical aspects of screening and communication skills will assist in improving access. These activities must include AHPs.


Assuntos
Barreiras de Comunicação , Anormalidades Congênitas , Acesso aos Serviços de Saúde , Diagnóstico Pré-Natal , Adulto , Atitude do Pessoal de Saúde , Austrália/epidemiologia , Anormalidades Congênitas/diagnóstico , Anormalidades Congênitas/etnologia , Competência Cultural/organização & administração , Feminino , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Acesso aos Serviços de Saúde/normas , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Determinação de Necessidades de Cuidados de Saúde , Grupo com Ancestrais Oceânicos/psicologia , Grupo com Ancestrais Oceânicos/estatística & dados numéricos , Gravidez , Diagnóstico Pré-Natal/métodos , Diagnóstico Pré-Natal/psicologia , Diagnóstico Pré-Natal/estatística & dados numéricos
15.
Ethn Dis ; 25(2): 226-31, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26118153

RESUMO

BACKGROUND: Racial variability in certain prenatal risk factors, such as prenatal vitamin supplementation and termination of pregnancy for fetal anomaly, has altered the racial prevalence of congenital malformation (CM). Analysis of a single large representative population is required to analyze current racial differences in prevalence of CM in the United States. METHOD: This is a population-based cross-sectional study to analyze racial differences in prevalence of CM diagnoses. We reviewed all live births in the 2008 Nationwide Inpatient Sample (NIS) database and determined birth prevalence of 55 selected CM diagnoses in Caucasians. We then calculated the relative risk of these CM diagnoses in African American, Hispanics and Asians relative to Caucasians. RESULT: Overall CM prevalence was 29.2 per 1,000 in a cohort of 1,048,252 live births of which 51% were Caucasians. Compared to Caucasian, risk of overall CM was lower in African Americans (RR = .9, CI .8-9) and Hispanics (RR = .9, CI .8-.9). Risk of overall CM was similar in Caucasians and Asians. Relative to the Caucasians, African Americans had lower risk of cardiac, genitourinary, and craniofacial malformations but higher risk of musculoskeletal malformations. Hispanics had lower risk of genitourinary and gastrointestinal malformation. Asians had higher risk of craniofacial and musculoskeletal malformation. CONCLUSIONS: This is a comprehensive description of racial difference in risk of CM in the United States. Observed racial differences in risk of CM may be related to genetic susceptibilities, to cultural or social differences that could modify exposures, or to the many potential combinations between susceptibilities and exposures.


Assuntos
Anormalidades Congênitas/etnologia , Grupos Étnicos/estatística & dados numéricos , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Anormalidades Congênitas/genética , Anormalidades Congênitas/patologia , Estudos Transversais , Feminino , Humanos , Recém-Nascido , Masculino , Prevalência , Estados Unidos/epidemiologia
17.
J Pediatr ; 166(4): 819-26.e1-2, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25641238

RESUMO

OBJECTIVES: To examine racial/ethnic-specific survival of children with major birth defects in the US. STUDY DESIGN: We pooled data on live births delivered during 1999-2007 with any of 21 birth defects from 12 population-based birth defects surveillance programs. We used the Kaplan-Meier method to calculate cumulative survival probabilities and Cox proportional hazards models to estimate mortality risk. RESULTS: For most birth defects, there were small-to-moderate differences in neonatal (<28 days) survival among racial/ethnic groups. However, compared with children born to non-Hispanic white mothers, postneonatal infant (28 days to <1 year) mortality risk was significantly greater among children born to non-Hispanic black mothers for 13 of 21 defects (hazard ratios [HRs] 1.3-2.8) and among children born to Hispanic mothers for 10 of 21 defects (HRs 1.3-1.7). Compared with children born to non-Hispanic white mothers, a significantly increased childhood (≤ 8 years) mortality risk was found among children born to Asian/Pacific Islander mothers for encephalocele (HR 2.6), tetralogy of Fallot, and atrioventricular septal defect (HRs 1.6-1.8) and among children born to American Indian/Alaska Native mothers for encephalocele (HR 2.8), whereas a significantly decreased childhood mortality risk was found among children born to Asian/Pacific Islander mothers for cleft lip with or without cleft palate (HR 0.6). CONCLUSION: Children with birth defects born to non-Hispanic black and Hispanic mothers carry a greater risk of mortality well into childhood, especially children with congenital heart defect. Understanding survival differences among racial/ethnic groups provides important information for policy development and service planning.


Assuntos
Anormalidades Congênitas/etnologia , Grupos Étnicos , Vigilância da População , Medição de Risco/métodos , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Lactente , Recém-Nascido , Masculino , Prognóstico , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida/tendências , Estados Unidos/epidemiologia
18.
Birth Defects Res A Clin Mol Teratol ; 103(2): 105-10, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25721951

RESUMO

BACKGROUND: Approximately 6.3 million live births and fetal deaths occurred during the ascertainment period in the California Birth Defects Monitoring Program registry. American-Indian and non-Hispanic white women delivered 40,268 and 2,044,118 births, respectively. While much information has been published about non-Hispanic white infants, little is known regarding the risks of birth defects among infants born to American-Indian women. METHODS: This study used data from the California Birth Defects Monitoring Program to explore risks of selected birth defects in offspring of American-Indian relative to non-Hispanic white women in California. The study population included all live births and fetal deaths 20 weeks or greater from 1983 to 2010. Prevalence ratios and corresponding 95% confidence intervals (CI) were computed using Poisson regression for 51 groupings of birth defects. RESULTS: Prevalence ratios were estimated for 51 groupings of birth defects. Of the 51, nine had statistically precise results ranging from 0.78 to 1.85. The eight groups with elevated risks for American-Indian births were reduction deformities of brain, anomalies of anterior segments, specified anomalies of ear, ostium secundum type atrial septal defect, specified anomalies of heart, anomalies of the aorta, anomalies of great veins, and cleft lip with cleft palate. CONCLUSION: Our results suggest that American-Indian women having babies in California may be at higher risk for eight birth defect phenotypes compared with non-Hispanic whites. Further research is needed to determine whether these risks are observed among other populations of American-Indian women or when adjusted for potential covariates.


Assuntos
Anormalidades Congênitas/etnologia , Anormalidades Congênitas/epidemiologia , Mortalidade Fetal/etnologia , Nascimento Vivo/etnologia , California/epidemiologia , Anormalidades Congênitas/classificação , Anormalidades Congênitas/patologia , Grupo com Ancestrais do Continente Europeu , Feminino , Humanos , Índios Norte-Americanos , Lactente , Recém-Nascido , Masculino , Vigilância da População , Gravidez , Prevalência , Estudos Retrospectivos , Fatores de Risco
19.
Obstet Gynecol ; 125(1): 163-9, 2015 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-25560120

RESUMO

OBJECTIVE: To explore whether state restrictions on Medicaid funding for pregnancy termination of anomalous fetuses could be contributing to the black-white disparity in infant death resulting from congenital anomalies. METHODS: Data on deaths resulting from anomalies were obtained from U.S. vital statistics records (1983-2004) and the Nationwide Inpatient Sample (2003-2007). We conducted an ecological study using Poisson and logistic regression to explore the association between state Medicaid funding for pregnancy terminations of anomalous fetuses and infant death resulting from anomalies by calendar time, race, and individual Medicaid status. RESULTS: Since 1983, a gap in anomaly-related infant death has developed between states without compared with those with Medicaid funding for pregnancy termination (rate ratio in 2004 1.21, 95% confidence interval [CI] 1.18-1.24; crude risks: 146.8 compared with 121.7/100,000). Blacks were significantly more likely than whites to be on Medicaid (60.2% compared with 29.2%) and to live in a state without Medicaid funding for pregnancy termination (65.8% compared with 59.6%). The increased risk of anomaly-related death associated with lack of state Medicaid funding for pregnancy termination was most pronounced among black women on Medicaid (relative risk 1.94, 95% CI 1.52-2.36; crude risks: 245.5 compared with 129.3/100,000). CONCLUSION: States without Medicaid funding for pregnancy termination of anomalous fetuses have higher rates of infant death resulting from anomalies than those with funding, and this difference is most pronounced among black women on Medicaid. Restrictions on Medicaid funding for termination of anomalous fetuses potentially could be contributing to the black-white disparity in anomaly-related infant death. LEVEL OF EVIDENCE: II.


Assuntos
Aborto Eugênico/economia , Afro-Americanos/estatística & dados numéricos , Anormalidades Congênitas/mortalidade , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Disparidades nos Níveis de Saúde , Mortalidade Infantil/etnologia , Medicaid/economia , Anormalidades Congênitas/etnologia , Feminino , Humanos , Lactente , Mortalidade Infantil/tendências , Recém-Nascido , Gravidez , Características de Residência , Estados Unidos
20.
Reprod Health ; 12: 3, 2015 Jan 10.
Artigo em Inglês | MEDLINE | ID: mdl-25577202

RESUMO

BACKGROUND: Birth defects (BD) constitute an important public health issue as they are the main cause of infant death. Their prevalence in Europe for 2008-2012 was 25.6 per 1000 newborns. To date, there are no population-based studies for the Russian Federation. The aim of the present study is to estimate the prevalence of BD, its forms, and changes over time in the Russian Arctic city of Monchegorsk (Murmansk County) for the period 1973-2011. METHODS: The Murmansk County Birth Register and the Kola Birth Register were the primary sources of information, covering 30448 pregnancy outcomes in Monchegorsk (Murmansk County, Russia) during the study period. RESULTS: The total perinatal prevalence of BD was 36.1/1000 live births (LB) and stillborn (SB) (95% CI = 34.0-38.2). After exclusions of minor malformations according to the European Surveillance of Congenital Anomalies guidelines, it decreased to 26.5/1000 LB plus SB (95% CI = 24.6-28.3). The perinatal prevalence of BD that are obligatory to report in Russia was 7.3/1000 LB plus SB (95% CI = 6.4-8.3). There was a significant positive time-trend in total perinatal prevalence of birth defects across the study period (p < 0.001 for trend). Prevalence of all BD increased from 23.5/1000 to 46.3/1000 (LB plus SB), while that excluding minor defects rose from 17.7/1000 to 35.7/1000 (LB plus SB). The most prevalent group of defects was malformations of the musculoskeletal system, which represented 35.4% of all BD. The most prominent increase was observed for the urinary system, rising from 0.2/1000 to 19.1/1000 (LB plus SB). CONCLUSIONS: The observed perinatal prevalence of BD in Monchegorsk increased two-fold during the 38-year study period. Further investigations to identify the underlying bases for the observed progressive growth in BD are recommended.


Assuntos
Anormalidades Congênitas/epidemiologia , Transição Epidemiológica , Regiões Árticas/epidemiologia , Anormalidades Congênitas/diagnóstico , Anormalidades Congênitas/etnologia , Humanos , Recém-Nascido , Anormalidades Musculoesqueléticas/diagnóstico , Anormalidades Musculoesqueléticas/epidemiologia , Anormalidades Musculoesqueléticas/etnologia , Guias de Prática Clínica como Assunto , Prevalência , Sistema de Registros , Estudos Retrospectivos , Federação Russa/epidemiologia , Natimorto/epidemiologia , Natimorto/etnologia , Anormalidades Urogenitais/diagnóstico , Anormalidades Urogenitais/epidemiologia , Anormalidades Urogenitais/etnologia
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