A comparative state policy analysis of the adoption of birth defects surveillance legislation

Birth defects are the leading cause of infant mortality in the United States and are a major cause of lifetime disability. However, efforts to understand their causes have been hampered by a lack of population-specific data. During 1990–2004, 22 state legislatures responded to this need by proposing birth defects surveillance legislation (BDSL). The contrast between these states and those that did not pass BDSL provides an opportunity to better understand conditions associated with US public health policy diffusion. ^ This study identifies key state-specific determinants that predict: (1) the introduction of birth defects surveillance legislation (BDSL) onto states' formal legislative agenda, and (2) the successful adoption of these laws. Secondary aims were to interpret these findings in a theoretically sound framework and to incorporate evidence from three analytical approaches. ^ The study begins with a comparative case study of Texas and Oregon (states with divergent BDSL outcomes), including a review of historical documentation and content analysis of key informant interviews. After selecting and operationalizing explanatory variables suggested by the case study, Qualitative Comparative Analysis (QCA) was applied to publically available data to describe important patterns of variation among 37 states. Results from logistic regression were compared to determine whether the two methods produced consistent findings. ^ Themes emerging from the comparative case study included differing budgetary conditions and the significance of relationships within policy issue networks. However, the QCA and statistical analysis pointed to the importance of political parties and contrasting societal contexts. Notably, state policies that allow greater access to citizen-driven ballot initiatives were consistently associated with lower likelihood of introducing BDSL. ^ Methodologically, these results indicate that a case study approach, while important for eliciting valuable context-specific detail, may fail to detect the influence of overarching, systemic variables, such as party competition. However, QCA and statistical analyses were limited by a lack of existing data to operationalize policy issue networks, and thus may have downplayed the impact of personal interactions. ^ This study contributes to the field of health policy studies in three ways. First, it emphasizes the importance of collegial and consistent relationships among policy issue network members. Second, it calls attention to political party systems in predicting policy outcomes. Finally, a novel approach to interpreting state data in a theoretically significant manner (QCA) has been demonstrated.^

The association between parity and selected structural birth defects

BACKGROUND: Parity is a risk factor in neonatal morbidity and mortality. This dissertation examined the association between first births and selected birth defects. The first aim was to assess the risk of 66 birth defects among first births and third or greater births. The second aim was to determine if maternal race, maternal age, infant sex or infant birth weight modify the association between first births and selected birth defects. METHODS: The Texas Birth Defects Registry provided data for 1999-2009. For the first aim, odds ratios were calculated for each birth defect. For the second aim, analysis was restricted to the ten birth defects significantly associated with first births. Stratified analyses were conducted and interaction terms were added to logistic regression models to assess whether differences in the odds ratios for the effect of first birth were statistically significant across strata. RESULTS: Findings for the first aim showed that first births had significantly increased odds of having an infant with 24 of the 66 birth defects. Third or greater births had significantly increased odds of having four of the 66 birth defects. For the second aim, a number of significant effect modifiers were observed. For patent ductus arteriosis, obstructive urinary defects and gastroschisis, the effect of first births was significantly modified by black or U.S.-born Hispanic mothers. The effect of first birth was also significantly modified among mothers ≥30 years for mitral valve insufficiency, atrial septal defect and congenital hip dislocation. The effect of first births was significantly modified among infants with low birth weight for hypospadias, congenital hip dislocation and gastroschisis. CONCLUSIONS: First births were associated with an elevated risk of 24 categories of birth defects. For some of the birth defects studied, the effect of first birth is modified by maternal age, maternal race and low birth weight. Knowledge of the increased risk for birth defects among women having their first birth allows physicians and midwives to provide better patient care and spur further research into the etiology of associated birth defects. This knowledge may bring about interventions prior to conception in populations most likely to conceive.^

The effects of adequacy and content of prenatal care on birth outcomes in a high -risk Missouri population

The purpose of this observational study was investigation of the relationship between quantitative adequacy of prenatal care, specific prenatal care content and pregnancy outcome in a high risk Missouri population. A sample of 1484 women from three Missouri regions known to have high rates of low birth weight, infant mortality, and inadequate prenatal care rates participated in structured post-partum interviews. Approximately one-half of the sample had received adequate prenatal care and the other half inadequate prenatal care as determined by an index utilized by the Missouri Department of Health.^ Prenatal care content was assessed by reports of prenatal education in six different areas: Diet, smoking, alcohol, drug, preterm labor counseling, and advice on when to call the health provider if preterm labor was suspected by the woman. Low birth weight, in both term and preterm infants, were the two birth outcomes examined. A variety of maternal socio-demographic variables were also considered.^ The results of this study suggest that specific educational content, delivered during prenatal care, may have lessen the risk of giving birth to a preterm-low birth weight infant. Prenatal education for recognition of preterm labor, and advice on when to call the health provider if preterm labor was suspected were found to be associated with a decreased risk of preterm delivery. Specific educational content was not, however, associated with risk of term-low weight birth nor was quantitative adequacy of care associated with the risk of either term- or preterm-low birth weight.^ These findings reinforce a body of literature which stresses the importance of appropriate prenatal care in preventing preterm low birth weight. Additionally, the findings suggest interventions that may be specifically effective for prematurity prevention. ^

Administration of misoprostol by trained traditional birth attendants to prevent postpartum haemorrhage in homebirths in Pakistan: a randomised placebo-controlled trial

Gynuity

(Table 1) Spacing of diatom abundance index and opal index at ODP Site 175-1084

An important discovery during Ocean Drilling Program Leg 175, when investigating the record of upwelling off Namibia, was the finding of a distinct Late Pliocene diatom maximum spanning the lower half of the Matuyama reversed polarity chron (MDM, Matuyama Diatom Maximum) and centered around 2.6-2.0 Ma. This maximum was observed at all sites off southwestern Africa between 20°S and 30°S, and is most strongly represented in sediments of Site 1084, off Lüderitz, Namibia. The MDM is characterized by high biogenic opal content, high numbers of diatom valves, and a diatom flora rich in Southern Ocean representatives (with Thalassiothrix antarctica forming diatom mats) as well as coastal upwelling components. Before MDM time, diatoms are rare until ca. 3.6 Ma. After the MDM, in the Pleistocene, the composition of the diatom flora points to increased importance of coastal upwelling toward the present, but is accompanied by a general decrease in opal and diatom deposition. Here we present a simple conceptual model as a first step in formalizing a possible forcing mechanism responsible for the record of opal deposition in the upwelling system off Namibia. The model takes into account Southern Ocean oceanography, and a link with deepwater circulation and deepwater nutrient chemistry which, in turn, are coupled to the evolution of North Atlantic Deep Water (NADW). The model proposes that between the MDM and the Mid-Pleistocene climate revolution, opal deposition off Namibia is not directly tied to glacial-interglacial fluctuations (as seen in the global d18O record), but that, instead, a strong deepwater link exists with increased NADW production (as seen in the deepwater d13C record) accounting for higher supply of silicate to the thermocline waters that feed the upwelling process. The opal record of Site 1084 shows affinity to eccentricity on the 400-kyr scale but not for the 100-kyr scale. This points toward long-term geologic processes for delivery of silica to the ocean.

Effects of birth order and sibling sex composition on human capital investment in children in India

The paper explores the effects of birth order and sibling sex composition on human capital investment in children in India using the Indian Human Development Survey (IHDS). Endogeneity of fertility is addressed using instruments and controlling for household fixed effects. Family size effect is also distinguished from the sibling sex composition effect. Previous literature has often failed to take endogeneity into account and shows a negative birth order effect for girls in India. Once endogeneity of fertility is addressed, there is no evidence for a negative birth order effect or sibling sex composition effect for girls. Results show that boys are worse off in households that have a higher proportion of boys specifically when they have older brothers.

The British Influence in the Birth of Spanish Sport

Sports started to gain relevance in Spain around the end of the nineteenth century and the beginning of the twentieth century as a leisure and health option of the upper classes imported from Britain. Its early development was intertwined with the spread of other kinds of physical activities with much more tradition on the continent: gymnastics and physical education. First played by the ruling classes – aristocracy and high bourgeoisie – sports permeated towards petty bourgeoisie and middle classes in urban areas such as Madrid, Barcelona, San Sebastián and Santander. This pattern meant that the expansion of sports was unavoidably tied to the degree of industrialisation and cultural modernisation of the country. Since 1910, and mainly during the 1920s, sport grew in popularity as a spectacle and, toa much lesser degree, as a practice among the Spanish population.