Delaware journal of public health最新文献

Objective: This study describes the ten-year evolution of Delaware's Maternal Mortality Review (MMR) and key findings over two five-year periods of review: 2015-2019 and 2020-2024.

Methods: This retrospective study describes the causes of death, key characteristics and priority recommendations documented in pregnancy associated deaths reviewed by the MMR Committee between 2015 and 2024. A pregnancy associated death is defined as the death of a Delaware resident while pregnant, or up to one year after the end of pregnancy, from any cause.

Results: In the ten-year time period from 2015 to 2024, 75 cases were fully reviewed by the Delaware MMR Committee. Due to better case identification processes with the addition of vital statistics linkage in 2017, 58% more cases were identified and brought before the Committee in 2020-2024 compared to 2015-2019. Thirty-four percent and 20% of cases were determined to be pregnancy related in 2015-2019 and 2020-2024, respectively. A pregnancy related case is one in which the person's death is causally linked in some way to her being pregnant. Most pregnancy related cases occurred in the early postpartum period, within 42 days of delivery. In contrast, most pregnancy associated but not related cases occurred in the late postpartum period, months after delivery. Overdose was the single most common cause of death reviewed by the MMR Committee, most often representing the intersection of mental health conditions and substance use disorder.

Conclusion: Recommendations put forth by the MMR Committee focus on implementing evidence-based standards and coordinated care across physical health, behavioral health and social domains.

Policy implications: MMR is a key public health program that provides the most in-depth, comprehensive source of information on the drivers of maternal mortality in the state and its associated risk factors.

Objectives: To estimate the prevalence and distribution of social needs among obstetric triage patients at ChristianaCare; examine associations with patient characteristics and insurance status; and identify implementation and policy implications for integrating social determinants of health (SDOH) screening into obstetric care in Delaware.

Methods: We conducted cross-sectional SDOH screening among patients aged ≥18 years presenting to the obstetric triage unit at Christiana Hospital (November 2019-February 2020). An 11-item tool covering 10 social-need domains was administered; 326 (82%) patients participated, and 317 unique patients were analyzed. Descriptive statistics estimated social-need prevalence. Age-adjusted logistic regression assessed associations of race/ethnicity and insurance (Medicaid/self-pay vs other) with each domain and with cumulative needs. Screeners completed brief debriefs on feasibility and workflow.

Results: Participants had a mean age of 30.2 years; 49.5% were White, 38.4% Black, and 10.7% Hispanic/Latine; 39.1% had Medicaid or were self-pay. Overall, 46.1% reported ≥1 social need and 7.0% reported ≥4 needs. Financial strain, food insecurity, and housing and transportation challenges were among the most frequently endorsed domains. Black and Hispanic/Latine patients and those with Medicaid or self-pay coverage experienced significantly higher odds of multiple social-need domains and ≥4 needs (all p<0.05). Screening was feasible and acceptable but required attention to privacy, timing, and referral pathways.

Conclusions: Nearly half of obstetric triage patients reported unmet social needs, with marked inequities by race/ethnicity and insurance. Triage-based SDOH screening is feasible and can connect patients to social, legal, and community supports. Public Health and Policy Implications: Integrating SDOH and food insecurity screening into obstetric triage, linking patients to social, legal, and Food is Medicine supports, and advancing upstream policies on wages, housing, and racism may narrow racial and socioeconomic gaps in maternal and infant outcomes and advance reproductive justice in Delaware.

Maternal and infant health outcomes in the United States remain concerning despite advances in medicine, with persistent disparities in underserved communities. This article highlights the role of health education as a preventive strategy to improve outcomes for mothers and babies. By providing expectant and new parents with knowledge on prenatal care, nutrition, breastfeeding, infant safety, and postpartum wellness, health education programs empower families to make informed decisions and adopt healthier practices. Drawing on professional experience in maternal and infant nutrition and health education, the article introduces Healthy from the Bump, a tailored program designed to provide culturally relevant, accessible, and practical education for parents and their support partners. While immediate results may be difficult to measure, health education's long-term benefits include reducing risks, fostering healthier habits, and strengthening caregiver confidence. Investing in maternal and infant health education is an essential step toward closing health gaps and building healthier generations from the very start.

Mistrust among Black women toward the medical system is evident across many eras of reproductive history, and the generational mistreatment of their reproductive health continues to harm their mental well-being and family health in the 21st century. Even with the advancement of modern medicine, Black women and babies are dying at a higher rate than other ethnic groups. Medicine has long been used to stereotype Black women's physical and emotional resilience, sexuality, and capacity for motherhood. The interplay of race, socioeconomic power, and institutional knowledge has worked to preserve an inequitable and oppressive framework governing Black women's reproductive rights. This article reviews literature on the history of reproduction as it relates to Black women, as well as studies examining culturally sensitive approaches aimed at improving provider-patient interactions and reducing maternal and infant mortality. The results indicate that historical constructions of race and the persistence of racial stereotypes continue to shape the practices of today's medical professionals. By understanding how these stereotypes developed and how they intersect with race and socioeconomic status, we can foster new frameworks that improve outcomes for Black women and their families.

Regular physical activity and structured exercise during pregnancy and postpartum are strongly associated with improved maternal and infant health outcomes; however, confusion persists among clinicians, fitness professionals, and patients regarding the safety, intensity, and appropriate modes of exercise across the perinatal period. The objective of this paper is to synthesize current evidence on aerobic training, resistance training, flexibility and mobility work, and high-intensity training (HIT) to provide clear, practical, and mode-specific recommendations that support safe, enjoyable, and effective movement during pregnancy and postpartum.

Background: Educating school children about vaccination as a part of health promotion intervention is one of the strategies to improve vaccination acceptance. The aim of this scoping review is to describe the range of school-based education interventions related to vaccination and particularly about efforts to include such education in school curricula.

Methods: This systematic scoping review was conducted based on the methodological framework proposed by Arskey and O'Malley. Searches were performed in four databases from Nov 1, 2004 to Nov 30, 2024. Databases were systematically searched for published articles on school education on vaccination. Two independent authors screened the articles followed by data extraction using MS-Excel tool.

Results: Out of total identified 18,706 articles, only six articles met the inclusion criteria. All studies were focused on developed countries and most were experimental studies. Interventions were delivered by teachers or researchers and reported general improvements in vaccine knowledge as well as of vaccine-specific interventions. This review documented the outcomes on a curriculum based on immunity and vaccine related concept in school education. The review also highlights the ad hoc approach of health promotion during the vaccine specific knowledge dissemination in school.

Conclusion: Formalizing health education could be a long-term strategy for better public health outcomes which face numerous challenges due to vaccine hesitancy or denial. Structured school curriculum on vaccination is warranted to sustain the knowledge on vaccination and its effect on community.