Journal of the Mississippi State Medical Association最新文献

Background: Maternal mortality and morbidity rates in the Southeastern states of the US are among the highest in the nation. Arkansas, Mississippi, and Louisiana are ranked first, second and fifth, respectively, in maternal mortality. This retrospective policy surveillance systematically documents legislation enacted to address maternal health disparities and ameliorate maternal health.

Methods: The Maternal and Child Health Legislative Database of the National Conference of State Legislators was searched for all legislation relating to maternal health in Arkansas, Louisiana, and Mississippi between 2018-2023. Two reviewers independently identified the laws passed by year and state and cross-checked to verify results. The legislative screening process is documented on a modified PRISMA flow diagram. Data extracted included the specific maternal health population targeted, the general health area addressed by the bill, and the directive of the bill.

Results: 126 pieces of legislation were identified using the database (41 AR, 12 MS, and 73 LA). There were no duplicates identified; 2 laws were identified outside of the database (1 AR, 1 MS). All 128 legislation titles and summaries were screened and laws pertaining to issues other than maternal health were excluded (28 AR, 9 MS, and 48 LA). 43 full text bills were retrieved and reviewed in their entirety to assess eligibility for inclusion. 40 pieces of legislation were included (11 AR, 4 MS, and 25 LA) in this policy surveillance.

Discussion: Louisiana enacted the most laws targeting and addressing maternal health, while Mississippi enacted the least. The legislation enacted addresses a broad range of health aspects, such as maternal mental health, incarcerated pregnant population reproductive health, and postpartum Medicaid coverage extension. Together with the task forces, committees, and study commissions created, the legislation enacted has the potential to address current inequities and improve maternal health outcomes in this vulnerable population by increasing access to and/or utilization of care, extending duration and/or type of evidence-based care available, and decreasing racial disparities in maternal health with the eventual goal of rooting out preventable morbidity and mortality.

Background: Familial clustering of ESRD has been noted in the families of 20-40% of African-Americans (AA) with ESRD but has been observed much less often in Caucasians (Cau). Because our impression indicated a higher frequency in Caucasians than reported in several recent studies we conducted a 2-year prospective evaluation of patients referred for renal transplantation to assess the frequency of familial clustering of ESRD in both Caucasians and African-Americans.

Methods: Detailed family histories were obtained in 350 ESRD patients referred for renal transplantation, 335 of whom could provide appropriate information regarding first- and second-degree family members (252AA and 83 Cau) who were maintained on out-patient dialysis at least one month or had received a renal transplant.

Results: Patient race and sex paralleled that of the current Mississippi ESRD population but mean age was 17 years younger in the transplant candidates (39.9 vs. 57.2 yrs). If polycystic kidney disease (PKD) is included in the analysis, 31.7% of AA and 30.1% of Cau had at least one other family member with ESRD. If PKD is eliminated then 30.9% of AA and 25% of Cau had at least one other family member with ESRD. In both races the frequency of a positive family history was greatest in index cases with chronic glomerulonephritis, and of those with renal biopsies (n = 59), patients with focal segmental glomerulosclerosis (FSGS) and systemic lupus erythematosus (SLE) had the strongest family histories of ESRD (40% and 36%, respectively). Cau and AA with FSGS had comparable familial clustering of ESRD (41% vs, 38%) but SLE was confined to AA.

Conclusions: In younger individuals with ESRD, familial clustering of end stage renal disease occurs with almost equal frequency in Caucasians and in African Americans. Screening of family members of index cases in both races might define a high-risk group of patients in whom prophylactic measures might be directed to thwart the progression [table: see text] of renal failure.