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The United States (US) is experiencing a maternal health crisis, with high rates of maternal morbidity and mortality. The US has the highest rates of pregnancy-related mortality among industrialized nations. Maternal mortality has more than quadrupled over the last decades. Rural areas and minoritized populations are disproportionately affected. Increased pregnancy-care workforce with greater participation from family medicine, greater collaborative care, and adequate postpartum care could prevent many maternal deaths. However, more than 40% of birthing people in the US receive no postpartum care. No singular solutions can address the complex contributors to the current situation, and efforts to address the crisis must address workforce shortages and improve care during and after pregnancy. This essay explores the role family medicine (FM) can play in addressing the crisis. We discuss pregnancy care training in FM residencies as well as the threats posed by financial and medico-legal climates to the maternal health workforce. We explore how collaborative care models and comprehensive postpartum care may impact the maternal health workforce. Efforts and resources devoted to high impact solutions for which FM has considerable autonomy, including collaborative and postpartum care, are likely to have greatest impact. [ABSTRACT FROM AUTHOR]

Under neoliberal social provision, debt has become a primary tool for US households to pursue economic mobility and manage risk. Borrowing supports financial and non‐financial investments that, in theory, should lead to lifetime income and asset gains from which debt can be repaid. Many scholars argue, however, that reliance on credit as a welfare tool significantly increases inequality, particularly along racial lines. In this paper, I examine this process of debt‐financed asset accumulation by analyzing racial disparities in the relationship between household debt and assets. Using Survey of Consumer Finances data, I examine disparities in assets held at given debt levels across Black and White households. Results indicate that at equal debt levels, Black households' assets are between 30% and 80% lower than those of comparable White households. This suggests that White households benefit considerably more from social policies that center borrowing as a mechanism of social provision. This likely contributes to the persistence of the racial wealth gap. Racial disparities in access to credit, to homeownership, and to non‐market financial transfers like inheritances partly explain White households' higher returns, but racial gaps remain even when accounting for these factors. [ABSTRACT FROM AUTHOR]

Background and aims: Patient navigation (PN) may benefit pregnant individuals with opioid use disorder (OUD) by improving treatment adherence. We examined participant enrollment, session delivery and assessment feasibility for a PN intervention among pregnant participants and compared PN preliminary effectiveness for OUD treatment engagement with participants in usual care (UC). Design: This study was a pilot single‐blinded multi‐site randomized trial. Setting: Two academic medical centers in Pennsylvania (n = 57) and Utah (n = 45), United States participated. Participants: One hundred and two pregnant adult participants unestablished (fewer than 6 weeks) on medication for OUD (MOUD) were randomized to PN (n = 53) or UC (n = 49). Intervention: PN was composed of 10 prenatal sessions (delivered after baseline but before the prenatal assessments) and four postnatal sessions (delivered before the 2‐ and 6‐month postpartum assessments) focused upon OUD treatment and physical/mental health needs. UC involved brief case management. Measurements Feasibility assessments included consent, session delivery and assessment rates. Mixed‐effect models for intent‐to‐treat (ITT) and per protocol (PP, received six or more sessions) populations were estimated to compare outcomes of MOUD use, secondary outcomes of substance use disorder (SUD) treatment attendance and non‐prescribed opioid use, and exploratory outcome of overdose at baseline, predelivery and 2 and 6 months postpartum. Findings We consented 87% (106 of 122) of the proposed target, delivered ~60% of sessions delivered and completed ≥ 75% assessments. PN ITT and PP had better MOUD adherence, SUD treatment attendance, non‐prescribed opioid use and overdose outcomes than UC. Notable changes included good evidence for greater percentage change in days for PN PP MOUD use from baseline to 2 months postpartum [PN = 28.0 versus UC = −10.9, 95% confidence interval (CI) = 9.7, 62.1] and some evidence for baseline to 6 months postpartum (PN = 45.4 versus UC = 23.4, 95% CI = −0.7, 48.2). PN PP percentage change in days for SUD treatment attendance also showed good evidence for improvements from baseline to prenatal assessment (PN = 7.4 versus UC = −21.3, 95% CI = 3.3, 53.5). PN compared to UC participants reported fewer overdoses at 2 months (PN = 11.9%/UC = 16.1%) and at 6 months postpartum (PN = 3.8%/UC = 6.2%). Conclusions: Patient navigation appears to be associated with improvements in opioid use disorder treatment engagement and overdoses during pregnancy. This pilot trial shows the feasibility of the intervention and a future large‐scale trial. [ABSTRACT FROM AUTHOR]

This study investigated the status of communication ethics pedagogy at colleges and universities in the United States, Canada, and Puerto Rico. Data were collected from 193 institutions that responded to an online survey. Results showed an increase in communication ethics courses compared with 19 years ago, with 51% now offering a required or optional course in communication ethics. The most common reason for not offering a stand-alone course was that ethical concerns were included in other classes. Respondents noted a decrease in focus on classical ethical theory and an increase in attention to applied ethics and moral reasoning skills. These findings merit a disciplinary discussion of the perceived tension between the classical philosophical foundations of communication ethics and ethics in practice.

In the study described in this article, fourth-grade teachers and students of different abilities and language backgrounds were interviewed before, during, and after participating in an Internet pen pal program. Results reveal that the program's authentic tasks and texts facilitated communication and enabled students to learn about a different culture. Enthusiasm generated by the program was evidenced in student writing. This program motivated students to write. It facilitated problem solving and supported critical thinking in written-language acquisition.

The article discusses research which examined the health-related social needs of older adults enrolled in the Medicare Advantage health insurance plan in the U.S. Topics explored include the prevalence of social needs cited such as food insecurity, poor housing quality, and social isolation, the logistic regression models developed based on individual social needs, and the link between these needs and the characteristics of Medicare Advantage respondents.

While studies show a consistent negative relationship between the level of corruption and range indicators of national-level economic performance, including sovereign credit ratings, we know less about the relationship between corruption and subnational credit ratings. This study suggests that federal transfers allow states with higher levels of corruption to retain good credit ratings, despite the negative economic implications of corruption more broadly, which also allows them to continue to borrow at low costs. Using data on corruption conviction in US states and credit ratings between 2001 and 2015, we show that corruption does not directly reduce credit ratings on average. We find, however, heterogeneous effects, in that there is a negative effect of corruption on credit ratings only in states that have a comparatively low level of fiscal dependence on federal transfers. This suggest that while less dependent states are punished by international assessors when seen as more corrupt, corruption does not affect the ratings of states with higher levels of fiscal dependence on federal revenue. [ABSTRACT FROM AUTHOR]

The purpose of this cross-sectional, descriptive, pilot study was to examine the correlations in sleep between caregivers (≥18 years) and young (6–12 years) children with type 1 diabetes. Sleep was measured in both parent and child over 7 days using actigraphy and a sleep diary. Parents completed questionnaires on sleep, stress, depressive symptoms, and demographics. Children completed pediatric anxiety and fatigue questionnaires, and A1C (Hemoglobin A1c) was documented at clinic. Descriptive statistics and Pearson correlations were used to analyze data. Parents (N = 18, mean age: 39.3 ± 5.4 years, 100% Caucasian, 83% mothers) and children (N = 18, mean age: 9.6 ± 2.4 years, diagnosed for mean 3.0 ± 2.4 years, 66% female, mean A1C: 7.5 ± 0.8%) were recruited. Strong to moderate correlations were found for several measures including sleep measures based on actigraphy: mean sleep duration (hours; 7.6 ± 0.7 for parents and 8.8 ± 0.8 for children; r =.638, p =.004), mean sleep efficiency (r =.823, p <.001), and mean daily wake after sleep onset (minutes; r =.530, p =.024). [ABSTRACT FROM AUTHOR]

Background: American Indian/Alaska Native (AI/AN) adolescents are at higher risk for gestational diabetes (GDM), type 2 diabetes, and pregnancy complications than the general population. Objective: To inform cultural adaptation of a validated evidence‐based intervention (VEBI) originally designed to deliver preconception counseling and diabetes education to non‐AI/AN teens with diabetes. Design Qualitative data were collected using focus group and individual interview methods with health care professionals and experts (n = 16) in AI/AN health, GDM, adolescent health, and/or mother‐daughter communication. A semistructured discussion guide elicited responses about provision of care for AI/AN girls at risk for GDM, experience with successful programs for AI/AN teens, comfort of mother/daughter dyads in talking about diabetes and reproductive health and reactions to video clips and booklet selections from the VEBI. All interviews were recorded and transcribed verbatim, and data analysis included inductive coding and identification of emergent themes. Results: Providers felt teens and their moms would be comfortable talking about the VEBI topics and that teens who did not feel comfortable talking to their mom would likely rely on another adult female. Participants suggested including: AI/AN images/motifs, education with a community focus, and avoiding directive language. Concerns included: socioeconomic issues that affect AI/AN people such as: food and housing insecurity, abuse, and historical trauma. Conclusions: Perspectives from these participants have been used to guide the development of a culturally tailored GDM risk reduction program for AI/AN girls. This program will be available to health care providers who serve the AI/AN population. [ABSTRACT FROM AUTHOR]

Purpose: To explore the personal experiences, challenges, and practices of parish nurses in their communities. Method/Design: The overall study used a mixed methods concurrent embedded design to describe parish nurses' experiences with diabetes education and preconception counseling in their practice. Also included were descriptions of generalized practices. Therefore, this current report will focus on these broader experiences. Focus group data were collected using face-to-face, teleconference, and video conferencing formats with 48 nurses who consider themselves to be parish nurses and analyzed with content analysis. Findings: Four qualitative themes were identified in the data: (1) Gaining Entry Through Trust, (2) Enhanced Focus on Spiritual Caring, (3) Accomplishing Much Despite Challenges, and (4) Practice Making a Difference. Parish nurses are uniquely situated to provide holistic care for the mind, body, and spirit of their patients. Despite the many positive aspects, parish nurses experience unique challenges, such as funding their practice and working independently. Conclusions: The parish nurses can play a vital role in providing holistic care to patients in a faith-based community. Future work is needed to address the challenges of parish nurses such as access to continuing education programs related to health topics of concern to their community members. [ABSTRACT FROM AUTHOR]

Rainfall intensity‐duration‐frequency (IDF) curves are commonly used for the design of water resources infrastructure. Numerous studies reported non‐stationarity in meteorological time series. Neglecting to incorporate non‐stationarities in hydrological models may lead to inaccurate results. The present work focuses on the development of a general methodology that copes with non‐stationarities that may exist in rainfall, by making the parameters of the IDF relationship dependent on the covariates of time and climate oscillations. In the recent literature, non‐stationary models are generally fit on data series of specific durations. In the approach proposed here, a single model with a separate functional relation with the return period and the rainfall duration is instead defined. This model has the advantage of being simpler and extending the effective sample size. Its parameters are estimated with the maximum composite likelihood method. Two sites in Ontario, Canada and one site in California, USA, exhibiting non‐stationary behaviours are used as case studies to illustrate the proposed method. For these case studies, the time and the climate indices Atlantic Multi‐decadal Oscillation (AMO) and Western Hemisphere Warm Pool (WHWP) for the stations in Canada, and the time and the climate indices Southern Oscillation Index (SOI) and Pacific Decadal Oscillation (PDO) for the stations in United States are used as covariates. The Gumbel and the generalized extreme value distributions are used as the time‐dependent functions in the numerator of the general IDF relationship. Results show that the non‐stationary framework for IDF modelling provides a better fit to the data than its stationary counterpart according to the Akaike information criterion. Results indicate also that the proposed generalized approach is more robust than the common approach especially for stations with short rainfall records (e.g., R2 of 0.98 compared to 0.69 for duration of 30 min and a sample size of 27 years). Neglecting to incorporate climate variability and change in the estimation of hydro‐meteorological variables has adverse impacts on the quality of the estimates. We developed a general methodology for non‐stationary rainfall intensity‐duration‐frequency (IDF) curves where parameters are dependent upon the temporal trend and climate indices. The figure illustrates non‐stationary IDF curves for a fixed duration of 10 min that are dependent upon the climate index AMO and the year. [ABSTRACT FROM AUTHOR]

The article discusess efforts taken by the U.S. Food and Drug Administration (FDA) in redefining term healthy related to its regulations governing food-labeling claims in the U.S. Topics dicussed include enactment of Federal Food, Drug and Cosmetic Act and Nutrition Labeling and Education Act for addressing health related issues; and analysis of constitutional boundaries of commercial speech for defining innovation within the food industry.

The Israeli-Palestinian conflict has been in existence since 1948, when Israel declared statehood in the land formally occupied by Palestinians. Since then, tension has resulted on both sides as they fight for control of the West Bank and Gaza Strip, the occupied territories in this region. This hostility appears to result from a lack of nationalism for Israeli-Palestinians and inequality rooted in education, social class, and politics, to name a few. Furthermore, it appears that al-Qaeda, a multinational terrorist group responsible for the September 11 attacks in the United States (U.S.), has entered the region. If so, this could be problematic for the U.S. due to the group's anti-American sentiments and extreme ideology. Because it seems unlikely a solution will occur anytime soon, it would be in the U.S.'s best interests to develop strategies that would minimize this conflict and demonstrate that the nation does not solely support Israel. Efforts to fight prejudice and restore nationalism are some of the efforts the U.S. could make. [ABSTRACT FROM AUTHOR]

Background: Postoperative wound infections are a widespread and costly problem, especially in colorectal surgery. Despite their prevalence, there are few data regarding appropriate management and prevention strategies.Materials and Methods: In order to assess current attitudes and practices about this subject, and as a guide to designing a randomized trial to gather evidence in order to support data-driven protocol development, an e-mail survey was sent to the membership of the American Society of Colorectal Surgeons to assess current attitudes and practices pertaining to prevention and management of wound infections.Results: Most respondents estimated that the wound infection rate in their own patients was much lower than commonly reported in the literature. Use of evidence-based perioperative strategies for reducing wound infection, such as the use of a wound protector, hyperoxygenation, and implementation of the Surgical Care Improvement Project guidelines, were far from universal. Management strategies varied widely, without apparent rational basis.Conclusion: Based on the practices and beliefs in the surgical community, it is our hope that a multi-institutional study can be carried out to objectify best practices in both the effective and cost-effective management of this common condition and to reduce the wide variation in the treatment of surgical site infections. [ABSTRACT FROM AUTHOR]

OBJECTIVE -- To evaluate the impact of a preconception counseling program tailored for teens with type 1 diabetes on cognitive, psychosocial, and behavioral outcomes and to assess its cost-effectiveness. RESEARCH DESIGN AND METHODS -- A total of 88 teens with type 1 diabetes from two sites were randomized into the READY-Girls (Reproductive-health Education and Awareness of Diabetes in Youth for Girls) intervention (IG) (n = 43) or standard care (SC) (n = 45) groups. During three diabetes clinic visits, IG subjects viewed a two-part CD-ROM, read a book, and met with a nurse. Program effectiveness was measured by knowledge, attitudes, intentions, and behaviors regarding diabetes, pregnancy, sexuality, and preconception counseling. Assessments occurred at baseline, before and after viewing program materials, and at 9 months. Economic analyses included an assessment of resource utilization, direct medical costs, and a break-even cost analysis. RESULTS -- Age range was 13.2-19.7 years (mean ± SD 16.7 ± 1.7 years); 6% (n = 5) were African American, and 24% (n = 21) were sexually active. Compared with baseline and SC subjects, IG subjects demonstrated a significant group-by-time interaction for benefit and knowledge of preconception counseling and reproductive health: increasing immediately after the first visit (P < 0.001) and being sustained for 9 months (P < 0.05 benefits; P < 0.001 knowledge). For IG subjects, preconception counseling barriers decreased over time (P < 0.001), and intention and initiation of preconception counseling and reproductive health discussions increased (P < 0.001). Costs of adverse reproductive outcomes are high. Direct medical costs of READY-Girls were low. CONCLUSIONS-- READY-Girls was beneficial and effects were sustained for at least 9 months. This low-cost self-instructional program can potentially empower young women with type 1 diabetes to make well-informed reproductive health choices, adding little time burden or cost to their diabetes management. [ABSTRACT FROM AUTHOR]

Many in the media have depicted conflicts between the Western and Muslim worlds as a 'Clash of Civilizations' (CoC), and this has revived many of the questions surrounding the value of Samuel Huntington's CoC theory. Previous empirical tests have analysed his theory using low-level conflict at the interstate level or violent conflict at the subnational level. The former have demonstrated little or no empirical support for his theory, while the results in the latter group are mixed. This analysis adds to previous empirical studies in a number of ways. One, the empirical models test CoC exclusively in the post-Cold War era. Two, along with examining the civilizational determinants of military interstate disputes, as prior studies have done, I include models that focus exclusively on interstate wars, because Huntington frequently points out that a CoC between states will lead to violent political conflict. Finally, this study directly tests Huntington's civilizational 'fault lines' and Islamic 'bloody border' hypotheses. I include an extension and find that intra-civilizational conflict is relatively rare in the post-Cold War era. Contrary to earlier analyses, the data show strong empirical support for CoC, particularly when focusing on violent international conflict in the post-Cold War era, and the results are robust when testing the hypotheses with alternative data on international crises. [ABSTRACT FROM AUTHOR]

In this article, we review the laparoscopic experience of general surgery and colorectal residency training programs in the United States during the past 5 and 12 years, respectively. The purpose of this study was to determine whether an adequate experience was being provided, and at what level of training, to safely and effectively perform advanced laparoscopy. General Surgery Operative Reports from the training years 2000 to 2004 were obtained from the Accreditation Council for Graduate Medical Education. Similarly, colorectal operative performance logs from the training years 1994 to 2005 were obtained from the American Board of Colon and Rectal Surgery. From 2000 to 2004, basic and advanced laparoscopic cases (as designated by the Accreditation Council for Graduate Medical Education) have increased from 10.1 to 12.2 percent and 2.1 to 3.7 percent, respectively. Within this period, the number of laparoscopic colon cases/resident/career has increased from 1.8 to 4.6. The percentage of cases performed laparoscopically increased from 3.9 to 22.5 percent from 1993–1994 to 2004–2005 training years. From 1993 to 2001, the average number of laparoscopic cases/resident increased from 6.3 to 16.1. In 2004, the average number of cases/resident increased to 45.3. Of this number, 30 were colon, 9.4 were rectal, and the remaining 5.9 were miscellaneous colorectal procedures. Learning curves for laparoscopic colectomy are reported in the range of 20 to 60 cases. Based on the most recent data reviewed, colon and rectal resident experience is trending toward this threshold. Recent general surgery graduates may be lacking the appropriate volume to reach proficiency in laparoscopic colorectal surgery. [ABSTRACT FROM AUTHOR]

PURPOSE: The purpose of this study was to examine the diabetes nurse educator's role, practice, and training in preconception counseling (PC) when caring for adolescents with diabetes. METHODS: A descriptive, correlational research design, using a cross-sectional survey technique, was used. Subjects were 2003 registered nurse members of the American Association of Diabetes Educators. A survey instrument was developed by the investigator and placed on the World Wide Web. RESULTS: Although most of the diabetes nurse educators were aware of PC, most reported not having received any training in PC and would benefit from this education. Thirty percent of the respondents did not routinely provide PC to their adult female clients, and 40% did not provide this to adolescents. CONCLUSIONS: Results of this study suggest that the diabetes nurse educators in this sample would benefit from receiving instruction about PC. The diabetes nurse educators should be trained to provide PC to all female clients with diabetes of childbearing age starting at puberty. [ABSTRACT FROM AUTHOR]

Providing culturally sensitive health care to diverse groups would be enhanced by better understanding of their experiences with the health care system and perceptions of health and illness. Haitians comprise an immigrant group that has increased dramatically in the United States over the past three decades. The purposes of this study were to identify the health seeking behaviors of Haitian parents for their schoolaged children and the barriers they experienced in obtaining health care services. Sixty-two Haitian parents and guardians were interviewed. Findings highlighted a lack of health insurance coverage, frequent use of private providers, general satisfaction with health care services, and strong parental values regarding preventive health care behaviors. Parents also reported the combined use of traditional remedies and biomedical treatments during their child's illness episodes. Implications for practice and future research with Haitian parents and children are identified. Keywords: Haitian Families; School Aged-Children. [ABSTRACT FROM AUTHOR]

Parental coping patterns can influence health outcomes of a child with a chronic illness. As part of a longitudinal study of 8- to 13-year-old children with newly diagnosed diabetes, we examined the relation between maternal health-related coping strategies and rehospitalizations and psychopathology in the child with diabetes. Forty-two pairs of children and their mothers were evaluated separately by means of a comprehensive assessment battery including a semistructured psychiatric interview, self-rated questionnaires, and overall diabetes course and management. Although results of this study suggest that mothers' coping patterns have no detectable impact on short-term health outcomes of children with diabetes, mothers considered maintaining family integration and understanding the medical situation as very helpful coping strategies. Suggestions for research using a longer follow-up period and implications for health care providers are discussed. [ABSTRACT FROM AUTHOR]

Discusses the impact of physical environment to science students. Guidelines and strategies for science teachers to make themselves more aware of what their classroom tell students; Classroom objects and physical arrangements as silent contributors to teachers' instructional programs.

Presents a study on the estimation of the overall uncertainty of passive monitors to determine the exposure of employees to methylene chloride in pharmaceutical production facilities in the United States. Collection of samples; Reference method used; Sample analysis; Results and discussion.

The article discusses the problems encountered in teaching science among elementary and secondary students in the U.S. An emphasis on an ideal teaching environment with all the necessary means to promote science learning was focused by science educators. They explained that learning science required not only their effort to teach science students but also the will and motivation among the students in the subject. In response to the demand of science education among elementary students, it should be noted that science was not only demanding among elementary but also in higher level education and that different levels has its nature of science instructions and individual difficulties.

The article presents a study on the effects of social and cultural research on science education in the U.S. In considering these two factors, there is still the need to further develop the social contexts designed mainly for science education. This enabled other scientist to continue in the development of contexts research. It is expected however, that several changes on the scientific discipline will follow after the development of the research including the changes on the conceptual frameworks, procedures and instruments used.

Background: This study examined contraceptive initiation patterns in the 12 months following childbirth among women with opioid use disorder (OUD), women with non-opioid substance use disorders (SUDs), and women without SUDs.Methods: We conducted a retrospective cohort study using claims data from South Carolina Medicaid-enrolled women aged 15-44 who had singleton live birth between January 2005 and December 2016. Study outcomes were initiation of most or moderately effective (MME) contraceptive methods. Using multivariable and propensity score-weighted logistic regression, we analyzed the relationship between OUD and contraceptive initiation within 12 months after delivery.Results: We identified 71,283 live birth deliveries during the study period. In multivariable analysis, women with non-opioid SUDs and women without SUDs compared to women with OUD were more likely to initiate a MME method vs a least effective method or no method by 3 months (non-opioid SUDs: odds ratio [OR] = 1.32, 95 % confidence interval [CI] = 1.14-1.52; no SUDs: OR = 1.55, 95 % CI = 1.36-1.77) and 12 months (non-opioid SUD: OR = 1.23, 95 % CI = 1.06-1.42; no SUD: OR = 1.46, 95 % CI = 1.27-1.66) after delivery. With regards to the timing of initiation, women with non-opioid SUDs and women without SUDs were more likely than women with OUD to initiate a MME method vs a least effective method or no method after the immediate postpartum period through 3 months following delivery (non-opioid SUDs: OR = 1.41, 95 % CI = 1.18-1.68; no SUDs: OR = 1.87, 95 % CI = 1.59-2.21). We detected the similar patterns in analyses that used propensity score weighting.Conclusion: OUD was associated with decreased likelihood of initiating a MME contraceptive method within 12 months after delivery. [ABSTRACT FROM AUTHOR]

The article discusses issues concerning ethics of predictive genetic screening for type 1 diabetes (T1D). The status of newborn genetic screening for T1D is beginning to be offered at a statewide level in the U.S. The primary purpose of newborn genetic screening is the identification of high-risk infants. Currently, more than 90% of parents consent. Babies at high risk are recruited into natural history studies. American Diabetes Association Position Statement indicates that genetic screening for T1D outside the context of research is not warranted. Concerns for ethics of newborn genetic screening for a nonpreventable disorder such as T1D include the psychosocial risks of predictive testing, the false assurance for children not considered to be at high risk and proper informed consent.

Comments on studies about the preconception counselling of diabetic women in the United States. Reduction of the risk of malformed infants; Prevention of pregnancy complications; Assessment of the psychosocial factors associated with family planning behavior.