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Introduction: Exclusive breastfeeding is recognized as the optimal source of nutrition for infants. Although exclusive breastfeeding rates have increased overall in the United States, substantial inequities exist in breastfeeding among individuals of different socioeconomic statuses, races, and ethnicities. The purpose of this study was to examine characteristics associated with exclusive breastfeeding intentions among pregnant women in Arkansas enrolled in a Healthy Start program. Methods: The current study included a cross-sectional design, with a sample of 242 pregnant women in Arkansas enrolled in a Healthy Start program. Results: The majority of the participants (56.6%) indicated their infant feeding intentions included a combination of breastfeeding and formula feeding. There were substantial differences in breastfeeding intentions among women of different races/ethnicities, with 18.5% of Marshallese women indicating they planned to exclusively breastfeed, compared to 42.1% of White women, 47.6% of Black women, and 31.8% of Hispanic women (p < 0.001). Women over the age of 18 and with higher educational attainment were more likely to intend on exclusively breastfeeding. Discussion: This is the first study to examine characteristics associated with exclusive breastfeeding intentions among pregnant women in Arkansas enrolled in a Healthy Start program. The study found that race/ethnicity and age were most strongly associated with breastfeeding intentions. These findings are critical to identifying populations for resource allocation and to developing culturally-tailored interventions to help women in Arkansas achieve their desired infant feeding methods. Significance: What is already known on this subject?: Exclusive breastfeeding is recognized as the optimal source of nutrition for infants, and it has been associated with decreased risk of obesity and cardiometabolic disease for both mother and infant. Although exclusive breastfeeding rates have increased overall in the United States, substantial inequities exist in breastfeeding among individuals of different socioeconomic statuses, races, and ethnicities. What this study adds?: This is the first study to examine characteristics associated with exclusive breastfeeding intentions among pregnant women in Arkansas enrolled in a Healthy Start program. The study found that race/ethnicity and age were most strongly associated with breastfeeding intentions. [ABSTRACT FROM AUTHOR]

The integration of multiple ancillary services into mental health treatment settings may improve outcomes, but there are no national studies addressing whether comprehensive services are distributed equitably. We investigated whether the availability of a wide range of service types differs based on the facility's racial/ethnic composition. We used the 2020 National Mental Health Services Survey to identify twelve services offered in outpatient mental health treatment facilities (N = 1,074 facilities). We used logistic regression to model each of the twelve services, predicted by the percentage of a facility's clientele that was White, Black, and Hispanic, adjusted for covariates. Facilities with the highest proportions of Black and Hispanic clientele demonstrated the lowest predicted probabilities of offering comprehensive and integrated services. Our findings offer context around upstream factors that may, in part, drive treatment disparities. We orient our findings around frameworks of structural racism and inequities in mental healthcare. [ABSTRACT FROM AUTHOR]

This study aimed to examine the demographic characteristics of pregnant women in a Healthy Start program who are presumed eligible for the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), but who have not yet applied for WIC benefits. We used a cross sectional evaluation of data collected from pregnant women (n=203) participating in a Healthy Start program. Data came from surveys administered at enrollment in the Healthy Start program from July 15th, 2019 until January 14th, 2022. The primary outcome was WIC application status, which was determined by whether the woman had applied or was receiving benefits at the time of enrollment. Covariates included race/ethnicity, marital status, insurance, education, income, age, employment, and having previous children/pregnancies. Fisher exact tests and logistic regression were used to examine associations. Approximately 65% of women had not yet applied for WIC benefits. Marshallese women (80.9%) and other NHPI women (80.0%) had the highest need for assistance. In adjusted analyses, White women (p = 0.040) and Hispanic women (p = 0.005) had lower rates of needing assistance applying for WIC than Marshallese women. There were higher rates of needing assistance in applying for women with private insurance or with no insurance and for those with higher incomes. Nearly two out of every three pregnant women who were eligible for WIC had not yet applied for benefits. The findings highlight the need for outreach for all populations that may be eligible, particularly among racial/ethnic minorities and those with higher incomes. [ABSTRACT FROM AUTHOR]

Background: Lung ultrasound is a well-established technique to assess extravascular lung water, a proxy for volume status, in the adult population. Despite its utility, the data are limited supporting the use of ultrasound to evaluate fluid volume status among pediatric patients. Our study uses a simplified ultrasound protocol to evaluate changes in extravascular lung water, represented by b-lines, among pediatric patients undergoing hemodialysis. Methods: This prospective single-center study included children from birth to 18 years of age. The number of b-lines per ml/kg of fluid removed was compared prior to, at the midpoint, and following termination of dialysis. An 8-zone protocol was utilized, and b-lines were correlated to hemoconcentration measured by the CRIT-LINE® hematocrit. Results: Six patients with a total of 26 hemodialysis sessions were included in this study. The b-line measurements post-dialysis were 2.27 (p < 0.001; 94%CI -3.31, -1.22) lower relative to pre-dialysis. The number of b-lines was reduced by 1.69 (p < 0.001; -2.58, -0.80) between pre-dialysis and at the midpoint of dialysis and by 0.58 (p = 0.001; -0.90, -0.24) between the midpoint of dialysis and post-dialysis. A 1 mL/kg fluid loss correlated to a decrease in the original b-lines by 0.079. An inverse relationship (r = -0.54; 95% CI: -0.72, -0.34; p < 0.001) was noted between the b-lines and the patients' hematocrit levels. Conclusions: A simplified 8-zone ultrasound protocol can assess fluid volume change in real time and correlates with hematocrit levels obtained throughout dialysis. This provides a valuable method for monitoring fluid status in volume overloaded patient populations. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to evaluate the association of mental health and substance use disorders on the risk of adverse infant outcomes overall and by race/ethnicity and payer.We used birth certificates (2017–2022; n = 125,071) linked with state-wide insurance claims (2016–2022; n = 7,583,488) to assess the risk of an adverse infant outcome (i.e., prematurity [< 37 weeks gestation] or low birthweight [< 2,500 g]) associated with “any mental health” or “any substance use” disorder overall, by race/ethnicity, and by payer using diagnoses during the 9 months of pregnancy. We additionally evaluated seven specific mental health conditions and four specific substance use disorders.The rate of having an adverse infant outcome was 13.4%. Approximately 21.5% of birthing individuals had a mental health condition, and 8.7% had a substance use disorder. We found increased adjusted risk of an adverse infant outcome associated with having a mental health condition overall (aRR: 1.28; 95%CI: 1.23–1.32) and for all racial/ethnic groups and payers. We additionally found increased risk associated with substance use disorder overall (aRR: 1.32; 95%CI: 1.25–1.40) and for White, Black, privately-covered, and Medicaid-covered individuals. There was increased risk associated with six of seven mental health and three of four substance use disorders.Given the risk of adverse infant outcomes associated with mental health and substance use disorders across racial/ethnic groups and payers, our findings highlight the critical importance of policies and clinical guidelines that support early identification and treatment of a broad spectrum of mental health and substance use disorders throughout the perinatal period.Methods: This study aimed to evaluate the association of mental health and substance use disorders on the risk of adverse infant outcomes overall and by race/ethnicity and payer.We used birth certificates (2017–2022; n = 125,071) linked with state-wide insurance claims (2016–2022; n = 7,583,488) to assess the risk of an adverse infant outcome (i.e., prematurity [< 37 weeks gestation] or low birthweight [< 2,500 g]) associated with “any mental health” or “any substance use” disorder overall, by race/ethnicity, and by payer using diagnoses during the 9 months of pregnancy. We additionally evaluated seven specific mental health conditions and four specific substance use disorders.The rate of having an adverse infant outcome was 13.4%. Approximately 21.5% of birthing individuals had a mental health condition, and 8.7% had a substance use disorder. We found increased adjusted risk of an adverse infant outcome associated with having a mental health condition overall (aRR: 1.28; 95%CI: 1.23–1.32) and for all racial/ethnic groups and payers. We additionally found increased risk associated with substance use disorder overall (aRR: 1.32; 95%CI: 1.25–1.40) and for White, Black, privately-covered, and Medicaid-covered individuals. There was increased risk associated with six of seven mental health and three of four substance use disorders.Given the risk of adverse infant outcomes associated with mental health and substance use disorders across racial/ethnic groups and payers, our findings highlight the critical importance of policies and clinical guidelines that support early identification and treatment of a broad spectrum of mental health and substance use disorders throughout the perinatal period.Results: This study aimed to evaluate the association of mental health and substance use disorders on the risk of adverse infant outcomes overall and by race/ethnicity and payer.We used birth certificates (2017–2022; n = 125,071) linked with state-wide insurance claims (2016–2022; n = 7,583,488) to assess the risk of an adverse infant outcome (i.e., prematurity [< 37 weeks gestation] or low birthweight [< 2,500 g]) associated with “any mental health” or “any substance use” disorder overall, by race/ethnicity, and by payer using diagnoses during the 9 months of pregnancy. We additionally evaluated seven specific mental health conditions and four specific substance use disorders.The rate of having an adverse infant outcome was 13.4%. Approximately 21.5% of birthing individuals had a mental health condition, and 8.7% had a substance use disorder. We found increased adjusted risk of an adverse infant outcome associated with having a mental health condition overall (aRR: 1.28; 95%CI: 1.23–1.32) and for all racial/ethnic groups and payers. We additionally found increased risk associated with substance use disorder overall (aRR: 1.32; 95%CI: 1.25–1.40) and for White, Black, privately-covered, and Medicaid-covered individuals. There was increased risk associated with six of seven mental health and three of four substance use disorders.Given the risk of adverse infant outcomes associated with mental health and substance use disorders across racial/ethnic groups and payers, our findings highlight the critical importance of policies and clinical guidelines that support early identification and treatment of a broad spectrum of mental health and substance use disorders throughout the perinatal period.Conclusions: This study aimed to evaluate the association of mental health and substance use disorders on the risk of adverse infant outcomes overall and by race/ethnicity and payer.We used birth certificates (2017–2022; n = 125,071) linked with state-wide insurance claims (2016–2022; n = 7,583,488) to assess the risk of an adverse infant outcome (i.e., prematurity [< 37 weeks gestation] or low birthweight [< 2,500 g]) associated with “any mental health” or “any substance use” disorder overall, by race/ethnicity, and by payer using diagnoses during the 9 months of pregnancy. We additionally evaluated seven specific mental health conditions and four specific substance use disorders.The rate of having an adverse infant outcome was 13.4%. Approximately 21.5% of birthing individuals had a mental health condition, and 8.7% had a substance use disorder. We found increased adjusted risk of an adverse infant outcome associated with having a mental health condition overall (aRR: 1.28; 95%CI: 1.23–1.32) and for all racial/ethnic groups and payers. We additionally found increased risk associated with substance use disorder overall (aRR: 1.32; 95%CI: 1.25–1.40) and for White, Black, privately-covered, and Medicaid-covered individuals. There was increased risk associated with six of seven mental health and three of four substance use disorders.Given the risk of adverse infant outcomes associated with mental health and substance use disorders across racial/ethnic groups and payers, our findings highlight the critical importance of policies and clinical guidelines that support early identification and treatment of a broad spectrum of mental health and substance use disorders throughout the perinatal period. [ABSTRACT FROM AUTHOR]

Background and Objective: Healthcare interventions that improve the health of children with autism spectrum disorder (ASD) have the potential to affect the health of caregivers. This study compares the three-level EuroQoL-5 Dimension (EQ-5D-3L) and the Short Form-6 Dimension (SF-6D) in their ability to value such spillover effects in caregivers.Methods: Clinical data collected from two Autism Treatment Network (ATN) sites was combined with survey data of caregivers of children diagnosed with ASD. Caregivers completed instruments by proxy describing child health and completed the EQ-5D-3L and SF-6D preference-weighted instruments to describe their own health.Results: There was a strong correlation between the health utility scores of the two preference-weighted instruments (ρ = 0.6172, p < 0.001) measuring caregiver health-related quality of life. There was a similar correlation between both the SF-6D and EQ-5D-3L scores with a previously validated care-related quality of life measure (Care-related Quality of Life instrument [CarerQol-7D]) (ρ = 0.569, p < 0.001 and ρ = 0.541, p < 0.001, respectively). The mean SF-6D scores for caregivers differed significantly in relation to four of the five child health or behavior measures whereas the EQ-5D-3L differed for only two of them.Conclusions: Health utility values of caregivers for children with ASD vary by the health characteristics of the child, suggesting significant potential for spillover effects. The comparison of the EQ-5D-3L and SF-6D demonstrated that both instruments can be used to estimate spillover effects of interventions to improve child health, but the SF-6D exhibited greater sensitivity to child health among children with ASD. [ABSTRACT FROM AUTHOR]