Black/white disparities in infant mortality rates in the U.S.: A quality of care perspective

The infant mortality rate for non-Hispanic Black infants in the U.S. is 13.63 deaths per 1,000 live births while the IMR for non-Hispanic White persons in the U.S. is 5.76 deaths per 1,000 live births. Black women are 2 times as likely as White women to deliver preterm infants and Black women are 2 times as likely as White women to deliver low birth weight infants (weighing less than 2,500 grams at birth). Differential underlying risk factors among mothers of different racial/ethnic groups for delivering pre-term and low birth weight infants have been historically accepted as the cause of racial disparities in IMRs. However, differential underlying risk status may not be the only major causative factor. Differential or unequal access to and provision of care is widely speculated to be a leading contributing factor to the wide racial disparity in infant mortality.2 This paper conducts a systematic review of existing literature investigating racial disparities in obstetrical care provided by healthcare practitioners to evaluate whether inequities in healthcare services provided to pregnant mothers and their neonates exist. The search terms "racial disparities obstetrical care," "racial differences quality of prenatal care," and "infant mortality racial disparities" were entered into the EBSCO Medline, Ovid Medline, PubMed, and Academic Search Complete databases, and articles between years 1990–2011 were selected for abstract review. The only articles included were those that used statistical methods to assess whether racial inequalities were present in the obstetrical services provided to pregnant women. My literature search returned 5 articles. Four of the five studies yielded significant racial differences in obstetrical care. However, the one study that used a large, nationally representative valid sample did not represent significant differences. Thus, this review provides initial evidence for racial disparities in obstetrical care, but concludes that more studies are needed in this area. Not all of the studies reviewed were consistent in the use and measurement of services, and not all studies were significant. The policy and public health implications of possible racial disparities in obstetrical care include the need to develop standard of care protocols for ALL obstetrical patients across the United States to minimize and/or eliminate the inequities and differences in obstetrical services provided.^

Regression with autocorrelated data: A study of time trend of global infant mortality rate

The infant mortality rate (IMR) is considered to be one of the most important indices of a country's well-being. Countries around the world and other health organizations like the World Health Organization are dedicating their resources, knowledge and energy to reduce the infant mortality rates. The well-known Millennium Development Goal 4 (MDG 4), whose aim is to archive a two thirds reduction of the under-five mortality rate between 1990 and 2015, is an example of the commitment. ^ In this study our goal is to model the trends of IMR between the 1950s to 2010s for selected countries. We would like to know how the IMR is changing overtime and how it differs across countries. ^ IMR data collected over time forms a time series. The repeated observations of IMR time series are not statistically independent. So in modeling the trend of IMR, it is necessary to account for these correlations. We proposed to use the generalized least squares method in general linear models setting to deal with the variance-covariance structure in our model. In order to estimate the variance-covariance matrix, we referred to the time-series models, especially the autoregressive and moving average models. Furthermore, we will compared results from general linear model with correlation structure to that from ordinary least squares method without taking into account the correlation structure to check how significantly the estimates change.^

Mistreatment and self-neglect in community dwelling older adults: Studies of construct validity, measurement invariance and latent classes

Mistreatment and self-neglect significantly increase the risk of dying in older adults. It is estimated that 1 to 2 million older adults experience elder mistreatment and self-neglect every year in the United States. Currently, there are no elder mistreatment and self-neglect assessment tools with construct validity and measurement invariance testing and no studies have sought to identify underlying latent classes of elder self-neglect that may have differential mortality rates. Using data from 11,280 adults with Texas APS substantiated elder mistreatment and self-neglect 3 studies were conducted to: (1) test the construct validity and (2) the measurement invariance across gender and ethnicity of the Texas Adult Protective Services (APS) Client Assessment and Risk Evaluation (CARE) tool and (3) identify latent classes associated with elder self-neglect. Study 1 confirmed the construct validity of the CARE tool following adjustments to the initial hypothesized CARE tool. This resulted in the deletion of 14 assessment items and a final assessment with 5 original factors and 43 items. Cross-validation for this model was achieved. Study 2 provided empirical evidence for factor loading and item-threshold invariance of the CARE tool across gender and between African-Americans and Caucasians. The financial status domain of the CARE tool did not function properly for Hispanics and thus, had to be deleted. Subsequent analyses showed factor loading and item-threshold invariance across all 3 ethnic groups with the exception of some residual errors. Study 3 identified 4-latent classes associated with elder self-neglect behaviors which included individuals with evidence of problems in the areas of (1) their environment, (2) physical and medical status, (3) multiple domains and (4) finances. Overall, these studies provide evidence supporting the use of APS CARE tool for providing unbiased and valid investigations of mistreatment and neglect in older adults with different demographic characteristics. Furthermore, the findings support the underlying notion that elder self-neglect may not only occur along a continuum, but that differential types may exist. All of which, have very important potential implications for social and health services distributed to vulnerable mistreated and neglected older adults.^

Indigent care and infant mortality in Texas

Infant Mortality has been made a point of emphasis by the Department of Health and Human Services in the Healthy People 2000, 2010, and 2020 priorities. This study used the Behavioral Model for Vulnerable Populations to consider a number of factors which impact infant mortality in the indigent populations in the State of Texas. The primary focus of this study was the enabling factor of community resources, specifically the program used by each county to provide care to their indigent population. The Legislature of the State of Texas requires that each state have a program set up within a Hospital District, Public Hospital or develop a County Indigent Health Care Program (CIHCP) in order to provide the basic health care needs of their most vulnerable residents. We sought to determine whether the development of a CICHP without an appointed hospital to provide the care would have an adverse effect on residents seeking care and increase infant mortality. A Poisson Regression Analysis was used to analyze incidence rate ratios adjusting for race/ethnicity and wealth/poverty variables. Our study showed that counties using a CIHCP had significantly lower infant mortality rates when compared to counties using a hospital district and were statistically equivalent to counties using a public hospital program or a combination of service programs. This relationship was maintained when adjusted incidence rate ratios were calculated. This may give evidence that counties struggling to fund a public hospital or hospital district may be able to find a more cost-effective alternative in the CIHCP without adversely affecting the health status of their residents. More cost-benefit analysis and controlling analysis must be done to further characterize this relationship. ^

Questões sobre Classes, Dominação e Conflitos Sociais na Alta Idade Média

Except for a History that is mobilized, nowadays, much more by the supposedly continuities than the changes, the periods of major transitions continue to demand interpretative effort from specialists. It is long the list of those who have been dedicated to the transitional problem between the Antiquity and the Middle Ages, focused on a period of poor and unequally distributed sources, trying to shed light and establish various interpretative means for this phenomenon. Albeit having overcome some of the catastrophic perspectives hindering the pioneer analyses within this context, the current approaches have also eliminated the recognition of both the contradictory manifestations and the social struggles acting as central and fundamental engines of the social transformations within the discussed context. When supported by an adequate theoretical background, documents from the period lead us to a process resulting from contradictions and a scenario of actions and reactions that eventually materialized the conflicts and moved History forward. The transition from the Antiquity to the Middle Ages was encompassed by diverse social antagonist manifestations, which allows us to consider that the arena of disputes were, therefore, that of the society itself.

Questões sobre Classes, Dominação e Conflitos Sociais na Alta Idade Média

Except for a History that is mobilized, nowadays, much more by the supposedly continuities than the changes, the periods of major transitions continue to demand interpretative effort from specialists. It is long the list of those who have been dedicated to the transitional problem between the Antiquity and the Middle Ages, focused on a period of poor and unequally distributed sources, trying to shed light and establish various interpretative means for this phenomenon. Albeit having overcome some of the catastrophic perspectives hindering the pioneer analyses within this context, the current approaches have also eliminated the recognition of both the contradictory manifestations and the social struggles acting as central and fundamental engines of the social transformations within the discussed context. When supported by an adequate theoretical background, documents from the period lead us to a process resulting from contradictions and a scenario of actions and reactions that eventually materialized the conflicts and moved History forward. The transition from the Antiquity to the Middle Ages was encompassed by diverse social antagonist manifestations, which allows us to consider that the arena of disputes were, therefore, that of the society itself.

Questões sobre Classes, Dominação e Conflitos Sociais na Alta Idade Média

Except for a History that is mobilized, nowadays, much more by the supposedly continuities than the changes, the periods of major transitions continue to demand interpretative effort from specialists. It is long the list of those who have been dedicated to the transitional problem between the Antiquity and the Middle Ages, focused on a period of poor and unequally distributed sources, trying to shed light and establish various interpretative means for this phenomenon. Albeit having overcome some of the catastrophic perspectives hindering the pioneer analyses within this context, the current approaches have also eliminated the recognition of both the contradictory manifestations and the social struggles acting as central and fundamental engines of the social transformations within the discussed context. When supported by an adequate theoretical background, documents from the period lead us to a process resulting from contradictions and a scenario of actions and reactions that eventually materialized the conflicts and moved History forward. The transition from the Antiquity to the Middle Ages was encompassed by diverse social antagonist manifestations, which allows us to consider that the arena of disputes were, therefore, that of the society itself.