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This paper sets out a short–cut method for allocating country level GDP estimates across regions. Comparing UK regional GDP estimates generated using the short–cut method against existing regional GDP figures suggests that it produces acceptable results. We make estimates of GDP for the four countries of the UK for each of the census years between 1861 and 1911. Irish GDP per worker and per caput grew faster than British. These indicators demonstrate weak convergence of the two regions. The bulk of the Irish performance may be explained by traditional forces such as TFP growth and capital accumulation. [ABSTRACT FROM AUTHOR]

Objectives: This study was undertaken to determine the prevalence of self-reported physical abuse among women seeking gynecologic and obstetric emergency care services.Study Design: A voluntary self-administered anonymous questionnaire was given to all women seeking treatment at the Gynecologic and Obstetric Emergency Clinic at Grady Memorial Hospital during the month of April 1991. The survey respondents were divided into 4 abuse categories.Results: Among the 452 respondents to the survey, 181 women (40.1%) gave a history of abuse. Among these, 93 women (51.3%) were currently in an abusive relationship, 45 women (24.9%) were currently in an abusive relationship and had a history of abuse, and 43 women (23.8%) had a history of abuse. The most common injuries described were fractures. Men were more likely not to have received counseling.Conclusions: The topic of domestic violence must be incorporated into the medical education curriculum and should be taught through a multidisciplinary approach. [ABSTRACT FROM AUTHOR]

Background: Black and brown birthing people experience persistent disparities in adverse maternal health outcomes, partially due to inadequate perinatal care. The goal of this study is to design and evaluate a patient-centered intervention for obstetric patients with one or more cardiometabolic risk factors for severe maternal morbidity [gestational diabetes, diabetes mellitus, hypertensive disorders of pregnancy (chronic hypertension, preeclampsia, eclampsia, or gestational hypertension), or preconception obesity (BMI > 30)] to promote postpartum visit attendance., Methods: To address identified unmet needs for postpartum support and barriers to postpartum care, we developed 20 thematic postpartum planning modules, each with corresponding patient educational materials, community resources, care coordination protocols, and clinician support tools (decision aids, electronic medical record prompts and fields). During prenatal care encounters, a research coordinator delivers the educational content (in English or Spanish), facilitates the participant's planning and shared decision-making, provides the participant with resources, and documents decisions in the electronic medical record. We will randomize 320 eligible patients with a 1:1 ratio to the intervention or standard prenatal care and evaluate the impact on postpartum visit attendance at 4-12 weeks and secondary outcomes (postpartum mental health, perceived future maternal and cardiometabolic risk, contraceptive use, primary care use, readmission, and patient satisfaction with care)., Discussion: Through engagement with patients and community stakeholders, we developed a guideline-based, locally tailored intervention to address drivers of engagement with postpartum care for high-risk obstetric patients. If demonstrated to be effective, the educational materials and electronic medical record based-tool can be adapted to other settings., Trial Registration: This trial was registered on ClinicalTrials.gov (NCT05430815) on June 23, 2022., Competing Interests: Declaration of competing interest This study is funded by the National Institute of Minority Health and Health Disparities (R01MD016031) and registered under clinicaltrials.gov (NCT05430815). It received ethical approval from the Emory University Institutional Review Board (00001427). All participating individuals completed informed consent prior to participation in the study. The NIMHD has no role in the conduct, analysis, or interpretation of results. We have no competing interests to declare., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objectives: To understand perinatal risks associated with social needs in pregnancy Methods. Multivariable log-binomial regression analyses adjusting for age, parity, and insurance were used to evaluate the relationship between any social need (e.g., housing, transportation, food, and intimate partner violence) and adverse perinatal outcomes (stillbirth, prematurity, maternal morbidity) in a cohort of English and Spanish-speaking patients who obtained prenatal care and birthed at our institution during a one-year period., Results: Of 2,435 patients, 1,608 (66%) completed social needs screening at least once during prenatal care. The cohort was predominantly non-Hispanic Black (1,294, 80%) and publicly insured (1,395, 87%). Having one or more social need was associated with three-fold increased risk of stillbirth (aRR 3.35, 95%CI 1.31,8.6) and 14% reduction in postpartum care attendance (aRR 0.86, 95%CI 0.78-0.95) and was highest in individuals reporting transportation needs., Conclusions: Social needs during pregnancy were associated with increased risk of stillbirth.

Objective: To evaluate the association between sickle cell disease (SCD) and severe maternal morbidity (SMM) in a contemporary cohort of deliveries by non-Hispanic Black people., Methods: We retrospectively examined SMM by using electronic health record data on deliveries by non-Hispanic Black patients between 2011 and 2020 at a single tertiary, public institution. Sickle cell disease was identified during the delivery admission by using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) and International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes. The primary outcome, SMM at delivery hospitalization, was ascertained using ICD-9-CM and ICD-10-CM codes and excluded sickle cell crisis as an indicator of SMM. We also constructed a secondary measure of SMM that excluded deliveries in which blood transfusion was the only indication of SMM. Poisson regression models were used to estimate risk ratios (RRs) and 95% CIs for the associations between SCD and SMM (overall and for individual indicators). Multivariable models adjusted for age, parity, insurance type, chronic conditions (chronic hypertension, diabetes mellitus, obesity), and multiple gestation., Results: Among 17,493 deliveries by non-Hispanic Black patients during the study period, 132 (0.8%) had a diagnosis of SCD. Of those patients, 87 (65.9%, 95% CI 57.2-73.9) with SCD and 2,035 (11.7%), 95% CI 11.2-12.2) without SCD had SMM. Sickle cell disease was associated with increased risk of SMM (87 vs 2,035, adjusted risk ratio [aRR] 5.4, 95% CI 4.6-6.3) and nontransfusion SMM (51 vs 1,057, aRR 6.0, 95% CI 4.6-8.0). Effect estimates were highest for cardiac arrest (3 vs 14, RR 28.2, 95% CI 3.8-209.3), air and thrombotic embolism (14 vs 72, RR 25.6, 95% CI 12.0-54.6), and puerperal cerebrovascular disorders (10 vs 53, RR 24.8, 95% CI 10.2-60.5)., Conclusion: Sickle cell disease was associated with a more than fivefold increased risk of SMM during the delivery hospitalization. Our data suggest cardiovascular morbidity as the driving major risk. The identification and monitoring of cardiovascular pathology in patients with SCD before and during pregnancy may reduce SMM., Competing Interests: Financial Disclosure The authors did not report any potential conflicts of interest., (Copyright © 2022 by the American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.)

Objective: To understand perceived quality of obstetric care following changes to the structure of care in a safety-net institution during the COVID-19 pandemic., Methods: We conducted a mixed-methods study including a web-based survey (n = 67) and in-depth interviews (n = 16) between October 2020 and January 2021. We present a descriptive analysis of quantitative results and key qualitative themes on reactions to changes and drivers of perceived quality., Results: Reported quality was high for in-person and phone visits (median subscale responses: 5/5). Respondents were willing to include phone visits in care for a future pregnancy (77.8% (49)) but preferred in-person visits (84.1% (53)). In interviews, provider communication was the key driver of quality. Respondents found changes to care to be inconvenient but acceptable., Conclusions: To improve satisfaction with changes to care, health systems should ensure that relationship building remains a priority and offer patients information about the reason behind changes., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: There are no conflicts of interest to declare., (Copyright © 2022 National Medical Association. Published by Elsevier Inc. All rights reserved.)

Background: Despite recommendations, maternal influenza vaccine acceptance has stagnated around 50%. Materials and Methods: A prospective cohort study was conducted of pregnant women seen in the clinic from September 2018 to April 2019. Primary outcomes included influenza vaccine uptake and reasons for vaccine refusal, categorized based on the Health Belief Model. We compared characteristics between three vaccination groups (never refused, refused and vaccinated, and refused and not vaccinated) by using chi-square and one-way analysis of variance. We used multivariate logistic regression to calculate adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for associations between patient characteristics and vaccine acceptance. Mixed-effects logistic regression models were used to explore the impact of provider-patient race concordance on influenza vaccine uptake. Results: Among 1666 women, 902 (54.1%) were vaccinated. Of these, 183 (20.3%) initially refused. Those who refused and were never vaccinated were more likely to be non-Hispanic black (aOR: 1.64, 95% CI: 1.05-2.56) and less likely to be Hispanic (aOR: 0.44, 95% CI: 0.24-0.81). Overall, perceived barriers were the most common reason for refusal (52.4%). Women who refused consistently were more likely to cite reasons related to perceived benefits (38.5% vs. 7.6%). Those who eventually accepted were more likely to cite cue to action (22.4% vs. 12.6%). Women who were race discordant with their provider were more likely to be vaccinated compared with those who were race concordant (57.9% vs. 52.9%, aOR: 1.16, 95% CI: 1.07-1.27). Conclusions: Women who refuse influenza vaccination in pregnancy may later choose to be vaccinated. Continued promotion of vaccination throughout pregnancy is crucial for vaccine uptake.

To assess the use of Rh immunoglobulin (RhIG) after ectopic pregnancy, we reviewed the charts of 305 patients treated from 1975 through 1978 at a large metropolitan hospital. We compared these patients with 389 who had had spontaneous abortions and been treated at the same hospital in 1975. The rate of ascertainment of Rh type was significantly higher for the group with ectopic pregnancy than for the group with spontaneous abortion (98.4% versus 95.1%; p less than 0.05). Nevertheless, presumable fertile RhIG candidates after ectopic pregnancy were 3.3 times more likely not to receive RhIG than candidates after spontaneous abortion (64.3% versus 19.4%;; p less than 0.01). Patients with ectopic pregnancy are an important part of the "RhIG utilization gap"; the mechanism for providing prophylaxis for patients needs to be improved.