Our multidisciplinary team examined published regulatory data to inform a 50-state database describing the environment for midwifery practice and interprofessional collaboration. Items (110) detailed ...differences across jurisdictions in scope of practice, autonomy, governance, and prescriptive authority; as well as restrictions that can affect patient safety, quality, and access to maternity providers across birth settings. A nationwide survey of state regulatory experts (n = 92) verified the 'on the ground' relevance, importance, and realities of local interpretation of these state laws. Using a modified Delphi process, we selected 50/110 key items to include in a weighted, composite Midwifery Integration Scoring (MISS) system. Higher scores indicate greater integration of midwives across all settings. We ranked states by MISS scores; and, using reliable indicators in the CDC-Vital Statistics Database, we calculated correlation coefficients between MISS scores and maternal-newborn outcomes by state, as well as state density of midwives and place of birth. We conducted hierarchical linear regression analysis to control for confounding effects of race.
MISS scores ranged from lowest at 17 (North Carolina) to highest at 61 (Washington), out of 100 points. Higher MISS scores were associated with significantly higher rates of spontaneous vaginal delivery, vaginal birth after cesarean, and breastfeeding, and significantly lower rates of cesarean, preterm birth, low birth weight infants, and neonatal death. MISS scores also correlated with density of midwives and access to care across birth settings. Significant differences in newborn outcomes accounted for by MISS scores persisted after controlling for proportion of African American births in each state.
The MISS scoring system assesses the level of integration of midwives and evaluates regional access to high quality maternity care. In the United States, higher MISS Scores were associated with significantly higher rates of physiologic birth, less obstetric interventions, and fewer adverse neonatal outcomes.
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Technological advances in military equipment, such as drones and sophisticated munitions, have intensified the dangers in urban battlefields.3 Moreover, the erosion of respect for International ...Humanitarian Law (IHL) by both state and non-state actors fosters a culture of impunity, aggravating the risks for aid workers.4 The breakdown of the deconfliction process, intended to shield humanitarians by sharing their movements with military forces, is alarmingly common, leading to deadly consequences.5 The repercussions of these attacks extend far beyond the loss of individual lives.6 Assaults on humanitarian workers severely hinder the delivery of crucial aid to populations teetering on the brink of disaster. ...the deconfliction mechanism must evolve from merely notifying military units to actively ensuring the safety of humanitarian operations. ...the international community must increase funding for humanitarian security measures, including training, protective gear, and technologies such as drone countermeasures.
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...recent events, from the devastating strike on the Al-Ahli Arab Hospital in Gaza1 to the dire situation at Al-Shifa, Gaza's largest hospital, in which thousands of patients and displaced ...individuals are struggling with restricted power and medical supplies, and hindered evacuations due to unsafe conditions2,3 during the ongoing conflict between Israel and Hamas, underscore the fact that this cornerstone of international humanitarian law is under assault. ...actions transcend military tactics; they signify a perilous mindset whereby life's sanctity and international legal tenets are considered dispensable. ...beyond immediate damage, these strikes erode community confidence in medical facilities, precipitating extensive relocations. Aside from one referral involving a strike during the Bosnian war, no other deliberate strike on a hospital has ever been prosecuted by an international court.10 The International Criminal Court (ICC), despite its mandate, has never issued an indictment for such a strike.
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The basic reproduction number (R
), also called the basic reproduction ratio or rate or the basic reproductive rate, is an epidemiologic metric used to describe the contagiousness or transmissibility ...of infectious agents. R
is affected by numerous biological, sociobehavioral, and environmental factors that govern pathogen transmission and, therefore, is usually estimated with various types of complex mathematical models, which make R
easily misrepresented, misinterpreted, and misapplied. R
is not a biological constant for a pathogen, a rate over time, or a measure of disease severity, and R
cannot be modified through vaccination campaigns. R
is rarely measured directly, and modeled R
values are dependent on model structures and assumptions. Some R
values reported in the scientific literature are likely obsolete. R
must be estimated, reported, and applied with great caution because this basic metric is far from simple.
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In the wake of the Supreme Court’s ruling on affirmative action, US medical and health professional schools must preserve and promote diversity in healthcare using alternative strategies, write Y ...Tony Yang and Sawali Sudarshan
The legal and ethical issues surrounding nurse ambassador programs of pharmaceutical companies are examined. Medical and nursing associations could implement stricter ethical guidelines regarding ...these programs as federal guidance remains limited.
Sage et al discuss the need to reduce COVID-19 misinformation while preserving free speech. Misinformation about risks, prevention, and treatment of COVID-19 has cost lives. Misinformation comes from ...many sources, with many motives for spreading and believing it. In caring capably and compassionately for patients, a substantial majority of health professionals and health care organizations have vigorously defended the standards of medical science and public health practice. However, a vocal minority and their sponsors or allies have exploited their medical credentials to the detriment of the public.
Travel restrictions violate international law Meier, Benjamin Mason; Habibi, Roojin; Yang, Y Tony
Science (American Association for the Advancement of Science),
03/2020, Volume:
367, Issue:
6485
Journal Article
With the US Food and Drug Administration’s (FDA’s) emergency use authorization of the Pfizer-BioNTech COVID-19 vaccine for adolescents aged 12-15 years on May 10, 2021, COVID-19 vaccination is now ...available to all adolescents aged 12-17 years.1 Moderna has also applied for emergency use authorization approval for this age group.1 The Centers for Disease Control and Prevention strongly recommends vaccination of the adolescent population, which comprises approximately 25 million people in the United States.2 Comprehensive protection is critical to adolescent and population health and is a big step toward a return to “normal life” for young people, including in-person school. Vaccine hesitancy—the reluctance or refusal to choose vaccination—identified by the World Health Organization as a top 10 global health threat, undermines these goals.3 According to a June 2021 Kaiser Family Foundation COVID-19 poll, 42% of parents with adolescents aged 12-17 years said they had either already vaccinated their children or planned to vaccinate their children, 18% said they would “wait a while to see how it is working,” 25% were definitely opposed, and 10% would choose vaccination only if required for school. Parental vaccine refusal has posed serious challenges to optimal coverage for childhood vaccines and led to outbreaks of measles and pertussis among unvaccinated children and surrounding communities.5 Similar challenges are likely if parents refuse COVID-19 vaccination for their children, particularly as the more transmissible Delta variant continues to spread and should booster shots be recommended in the future. In response to measles outbreaks, development of COVID-19 vaccines, and vaccine resistance, in December 2020 the District of Columbia enacted a first-of-its-kind law allowing adolescents aged <18 years to give first-person informed consent to vaccines recommended by the Advisory Committee on Immunization Practices and directed development of age-appropriate information sheets for use with health care providers.6 Recognizing the decisional rights of minors has 2 core components: adolescents’ ability to give informed consent and the legal right to decide. Health care providers can and should determine that many adolescents possess the maturity and capacity to give independent consent to COVID-19 vaccination. Both health care providers and adolescents need clear legal guidance for authorizing consent over parental objection. State policy makers should enact laws, or interpret extant law, to provide this guidance.
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