Last data update: Jan 27, 2025. (Total: 48650 publications since 2009)
Records 1-14 (of 14 Records) |
Query Trace: St Pierre A[original query] |
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Identifying deaths during and after pregnancy: New approaches to a perennial challenge
Trost SL , Beauregard J , Petersen EE , Cox S , Chandra G , St Pierre A , Rodriguez M , Goodman D . Public Health Rep 2022 138 (4) 333549221110487 Maternal mortality is increasingly recognized as a public health crisis in the United States, with growing attention on the 3 major systems of national surveillance. National maternal mortality statistics are reported by the Centers for Disease Control and Prevention’s (CDC’s) National Vital Statistics System (NVSS)1 within the National Center for Health Statistics (NCHS) and the Pregnancy Mortality Surveillance System (PMSS)2 within the Division of Reproductive Health (DRH). Comprehensive surveillance data at the state and local level are also available from maternal mortality review committees (MMRCs) via the Maternal Mortality Review Information Application (MMRIA).3 Each surveillance system has inherent strengths and limitations, but all rely on valid, accurate, and timely case identification via vital statistics data. We outline recent innovations to improve identification and ensure robust and accurate surveillance of maternal mortality in the United States. |
Enhancing reviews and surveillance to eliminate maternal mortality
Callahan T , Zaharatos J , St Pierre A , Merkt PT , Goodman D . J Womens Health (Larchmt) 2021 30 (8) 1068-1073 Multisectoral investments over the past decade have accelerated the growth of Maternal Mortality Review Committee (MMRC) programs across the United States. The U.S. Centers for Disease Control and Prevention (CDC) launched the Enhancing Reviews and Surveillance to Eliminate Maternal Mortality (ERASE MM) Initiative in 2019. Under ERASE MM, CDC directly funds 24 U.S. jurisdictions supporting MMRCs in 25 states. With increased investment in programs nationally, the CDC has designed a performance management framework to identify areas for improvement or sustained achievement and standardize measurement of key process benchmarks across programs. This article presents a report on the baseline measures collected through this performance management approach and suggests key partnerships required to continue to accelerate progress toward the elimination of preventable maternal mortality in the United States. |
Why aren't we achieving high vaccination rates for rotavirus vaccine in the U.S.
Kempe A , O'Leary ST , Cortese MM , Crane LA , Cataldi JR , Brtnikova M , Beaty BL , Hurley LP , Gorman C , Tate JE , St Pierre JL , Lindley MC . Acad Pediatr 2021 22 (4) 542-550 BACKGROUND: Rotavirus vaccine (RV) coverage levels for U.S. infants are <80%. METHODS: We surveyed nationally representative networks of pediatricians by internet/mail from April-June, 2019. Multivariable regression assessed factors associated with difficulty administering the first RV dose (RV#1) by the maximum age. RESULTS: Response rate was 68% (303/448). 99% of providers reported strongly recommending RV. The most common barriers to RV delivery overall (definite/somewhat of a barrier) were: parental concerns about vaccine safety overall (27%), parents wanting to defer (25%), parents not thinking RV was necessary (12%) and parent concerns about RV safety (6%). The most commonly reported reasons for non-receipt of RV#1 by 4-5 months (often/always) were parental vaccine refusal (9%), hospitals not giving RV at discharge from nursery (7%), infants past the maximum age when discharged from NICU/nursery (6%), and infant not seen before maximum age for well care visit (3%) or seen but no vaccine given (4%). Among respondents 4% strongly agreed and 25% somewhat agreed that they sometimes have difficulty giving RV#1 before the maximum age. Higher percentage of State Child Health Insurance Program/Medicaid-insured children in the practice and reporting that recommendations for timing of RV doses are too complicated were associated with reporting difficulty delivering the RV#1 by the maximum age. CONCLUSIONS: U.S. pediatricians identified multiple, actionable issues that may contribute to suboptimal RV immunization rates including lack of vaccination prior to leaving nurseries after prolonged stays, infants not being seen for well care visits by the maximum age, missed opportunities at visits and parents refusing/deferring. |
Changing the conversation: Applying a health equity framework to maternal mortality reviews
Kramer MR , Strahan AE , Preslar J , Zaharatos J , St Pierre A , Grant J , Davis NL , Goodman D , Callaghan W . Am J Obstet Gynecol 2019 221 (6) 609 e1-609 e9 The risk of maternal death in the U.S. is higher than peer nations and rising, and varies dramatically by the race and place of residence of the woman. Critical efforts to reduce maternal mortality include patient risk stratification and system-level quality improvement efforts targeting specific aspects of clinical care. These efforts are important for addressing the causes of an individual's risk, but research to date suggests that individual risk factors alone do not adequately explain between-group disparities in pregnancy-related death by race, ethnicity, or geography. The holistic review and multidisciplinary makeup of maternal mortality review committees (MMRC) make them well positioned to fill knowledge gaps about the drivers of racial and geographic inequity in maternal death. However, committees may lack the conceptual framework, contextual data, and evidence base needed to identify community-based contributing factors to death, and when appropriate to make recommendations for future action. By incorporating a multileveled, theory-grounded framework for causes of health inequity, along with indicators of the 'community vital signs' - the social and community context in which women live, work, and seek healthcare - MMRCs may identify novel underlying factors at the community level that enhance understanding of racial and geographic inequity in maternal mortality. By considering evidence-informed community and regional resources and policies for addressing these factors, novel prevention recommendations, including recommendations that extend outside the realm of the formal health care system, may emerge. |
Survey of diagnostic testing for respiratory syncytial virus (RSV) in adults: Infectious disease physician practices and implications for burden estimates.
Allen KE , Beekmann SE , Polgreen P , Poser S , St Pierre J , Santibanez S , Gerber SI , Kim L . Diagn Microbiol Infect Dis 2017 92 (3) 206-209 ![]() ![]() Respiratory syncytial virus (RSV) often causes respiratory illness in adults. Over 40 RSV vaccine and monoclonal antibody products are currently in preclinical development or clinical trials. Because RSV diagnostic practices may impact disease burden estimates, we investigated infectious disease physicians' RSV diagnostic practices among their adult patients. |
Building U.S. capacity to review and prevent maternal deaths
Zaharatos J , St Pierre A , Cornell A , Pasalic E , Goodman D . J Womens Health (Larchmt) 2017 27 (1) 1-5 In the United States, the risk of death during and up to a year after pregnancy from pregnancy-related causes increased from approximately 10 deaths per 100,000 live births in the early 1990s to 17 deaths per 100,000 live births in 2013. While vital statistics-based surveillance systems are useful for monitoring trends and disparities, state and local maternal mortality review committees (MMRCs) are best positioned to both comprehensively assess deaths to women during pregnancy and the year after the end of pregnancy, and identify opportunities for prevention. Although the number of committees that exist has increased over the last several years, both newly formed and long-established committees struggle to achieve and sustain progress toward reviewing and preventing deaths. We describe the key elements of a MMRC; review a logic model that represents the general inputs, activities, and outcomes of a fully functional MMRC; and describe Building U.S. Capacity to Review and Prevent Maternal Deaths, a recent multisector initiative working to remove barriers to fully functional MMRCs. Increased standardization of review committee processes allows for better data to understand the multiple factors that contribute to maternal deaths and facilitates the collaboration that is necessary to eliminate preventable maternal deaths in the United States. |
Challenges and opportunities in identifying, reviewing, and preventing maternal deaths
St Pierre A , Zaharatos J , Goodman D , Callaghan WM . Obstet Gynecol 2017 131 (1) 138-142 Despite many efforts at the state, city, and national levels over the past 70 years, a nationwide consensus on how best to identify, review, and prevent maternal deaths remains challenging. We present a brief history of maternal death surveillance in the United States and compare the three systems of national surveillance that exist today: the National Vital Statistics System, the Pregnancy Mortality Surveillance System, and maternal mortality review committees. We discuss strategies to address the perennial challenges of shared terminology and accurate, comparable data among maternal mortality review committees. Finally, we propose that with the opportunity presented by a systematized shared data system that can accurately account for all maternal deaths, state and local-level maternal mortality review committees could become the gold standard for understanding the true burden of maternal mortality at the national level. |
Progress toward containment of poliovirus type 2 - worldwide, 2017
Previsani N , Singh H , St Pierre J , Boualam L , Fournier-Caruana J , Sutter RW , Zaffran M . MMWR Morb Mortal Wkly Rep 2017 66 (24) 649-652 The Global Polio Eradication Initiative (GPEI) continues to make progress toward the eradication target. Only one of the three serotypes, wild poliovirus (WPV) type 1 (WPV1), is still circulating, and the numbers of cases and countries with endemic transmission are at record lows. With the certification of wild poliovirus type 2 (WPV2) eradication in 2015 and the global replacement of trivalent oral poliovirus vaccine (tOPV) containing Sabin poliovirus types 1, 2, and 3 with bivalent OPV containing only Sabin poliovirus types 1 and 3 during April-May 2016, poliovirus type 2 (PV2) is now an eradicated pathogen. However, in eight countries (Cameroon, Chad, Democratic Republic of Congo, Mozambique, Niger, Nigeria, Pakistan, and Syria), monovalent type 2 OPV (mOPV2) was authorized for large-scale outbreak control after tOPV withdrawal (1). Poliovirus containment, an evolving area of work that affects every country, aims to ensure that all PV2 specimens are safely contained to minimize the risk for reintroducing the virus into communities. This report summarizes the current status of poliovirus containment and progress since the last report (2), and outlines remaining challenges. Within 30 countries, 86 facilities have been designated by the relevant national authorities (usually the Ministry of Health) to become poliovirus-essential facilities for the continued storage or handling of PV2 materials; each country is responsible for ensuring that these facilities meet all biorisk management requirements. |
Strategies, actions, and outcomes of pilot state programs in public health genomics, 2003-2008.
St Pierre J , Bach J , Duquette D , Oehlke K , Nystrom R , Silvey K , Zlot A , Giles R , Johnson J , Anders HM , Gwinn M , Bowen S , Khoury MJ . Prev Chronic Dis 2014 11 E97 ![]() State health departments in Michigan, Minnesota, Oregon, and Utah explored the use of genomic information, including family health history, in chronic disease prevention programs. To support these explorations, the Office of Public Health Genomics at the Centers for Disease Control and Prevention provided cooperative agreement funds from 2003 through 2008. The 4 states' chronic disease programs identified advocates, formed partnerships, and assessed public data; they integrated genomics into existing state plans for genetics and chronic disease prevention; they developed projects focused on prevention of asthma, cancer, cardiovascular disease, diabetes, and other chronic conditions; and they created educational curricula and materials for health workers, policymakers, and the public. Each state's program was different because of the need to adapt to existing culture, infrastructure, and resources, yet all were able to enhance their chronic disease prevention programs with the use of family health history, a low-tech "genomic tool." Additional states are drawing on the experience of these 4 states to develop their own approaches. |
Implementing screening for Lynch syndrome among patients with newly diagnosed colorectal cancer: summary of a public health/clinical collaborative meeting.
Bellcross CA , Bedrosian SR , Daniels E , Duquette D , Hampel H , Jasperson K , Joseph DA , Kaye C , Lubin I , Meyer LJ , Reyes M , Scheuner MT , Schully SD , Senter L , Stewart SL , St Pierre J , Westman J , Wise P , Yang VW , Khoury MJ . Genet Med 2011 14 (1) 152-62 ![]() Lynch syndrome is the most common cause of inherited colorectal cancer, accounting for approximately 3% of all colorectal cancer cases in the United States. In 2009, an evidence-based review process conducted by the independent Evaluation of Genomic Applications in Practice and Prevention Working Group resulted in a recommendation to offer genetic testing for Lynch syndrome to all individuals with newly diagnosed colorectal cancer, with the intent of reducing morbidity and mortality in family members. To explore issues surrounding implementation of this recommendation, the Centers for Disease Control and Prevention convened a multidisciplinary working group meeting in September 2010. This article reviews background information regarding screening for Lynch syndrome and summarizes existing clinical paradigms, potential implementation strategies, and conclusions, which emerged from the meeting. It was recognized that wide-spread implementation will present substantial challenges, and additional data from pilot studies will be needed. However, evidence of feasibility and population health benefits and the advantages of considering a public health approach were acknowledged. Lynch syndrome can potentially serve as a model to facilitate the development and implementation of population-level programs for evidencebased genomic medicine applications involving follow-up testing of at-risk relatives. Such endeavors will require multilevel and multidisciplinary approaches building on collaborative public health and clinical partnerships. |
Current priorities for public health practice in addressing the role of human genomics in improving population health.
Khoury MJ , Bowen MS , Burke W , Coates RJ , Dowling NF , Evans JP , Reyes M , St Pierre J . Am J Prev Med 2011 40 (4) 486-93 ![]() In spite of accelerating human genome discoveries in a wide variety of diseases of public health significance, the promise of personalized health care and disease prevention based on genomics has lagged behind. In a time of limited resources, public health agencies must continue to focus on implementing programs that can improve health and prevent disease now. Nevertheless, public health has an important and assertive leadership role in addressing the promise and pitfalls of human genomics for population health. Such efforts are needed not only to implement what is known in genomics to improve health but also to reduce potential harm and create the infrastructure needed to derive health benefits in the future. |
Knowledge gaps remain in the use of family health history in public health.
Valdez R , Coates RJ , St Pierre J , Grossniklaus D , Khoury MJ . Public Health Genomics 2010 14 (2) 94-5 ![]() The National Institutes of Health convened a State-ofthe-Science Conference to examine the evidence for the | role of family history when assessing and managing risk | for common chronic diseases in primary health care [1] . | A panel of health professionals was assembled for this | conference. They evaluated the strength of the science for | the following questions: | (1) What are the key elements of a family history in a | primary care setting for the purposes of risk assessment | for common diseases? | (2) What is the accuracy of the family history, and under what conditions does the accuracy vary? | (3) What is the direct evidence that getting a family | history will improve health outcomes for the patient or | family? | (4) What is the direct evidence that getting a family | history will result in adverse outcomes for the patient or | family? | (5) What are the factors that encourage or discourage | obtaining and using a family history? | (6) What are future research directions for assessing | the value of family history for common diseases in the | primary care setting? |
The genomic applications in practice and prevention network.
Khoury MJ , Feero WG , Reyes M , Citrin T , Freedman A , Leonard D , Burke W , Coates R , Croyle RT , Edwards K , Kardia S , McBride C , Manolio T , Randhawa G , Rasooly R , St Pierre J , Terry S . Genet Med 2009 11 (7) 488-94 ![]() The authors describe the rationale and initial development of a new collaborative initiative, the Genomic Applications in Practice and Prevention Network. The network convened by the Centers for Disease Control and Prevention and the National Institutes of Health includes multiple stakeholders from academia, government, health care, public health, industry and consumers. The premise of Genomic Applications in Practice and Prevention Network is that there is an unaddressed chasm between gene discoveries and demonstration of their clinical validity and utility. This chasm is due to the lack of readily accessible information about the utility of most genomic applications and the lack of necessary knowledge by consumers and providers to implement what is known. The mission of Genomic Applications in Practice and Prevention Network is to accelerate and streamline the effective integration of validated genomic knowledge into the practice of medicine and public health, by empowering and sponsoring research, evaluating research findings, and disseminating high quality information on candidate genomic applications in practice and prevention. Genomic Applications in Practice and Prevention Network will develop a process that links ongoing collection of information on candidate genomic applications to four crucial domains: (1) knowledge synthesis and dissemination for new and existing technologies, and the identification of knowledge gaps, (2) a robust evidence-based recommendation development process, (3) translation research to evaluate validity, utility and impact in the real world and how to disseminate and implement recommended genomic applications, and (4) programs to enhance practice, education, and surveillance. |
Health care provider and consumer awareness, perceptions, and use of direct-to-consumer personal genomic tests, United States, 2008.
Kolor K , Liu T , St Pierre J , Khoury MJ . Genet Med 2009 11 (8) 595 ![]() Recent perspectives have argued that genome-wide association studies (GWAS) have only identified a small fraction of the genetic component of most diseases, calling into question the current validity and utility of GWAS variants in predictive risk assessment1., 2., 3., 4. Nevertheless, personal genomic (PG) tests based on GWAS variants have been offered directly to consumers by several companies since 2007. There are currently no published studies on awareness, perceptions, and use of PG tests among health care providers (HPs) and general consumers. Such data are needed to inform educational and policy interventions. We used the 2008 DocStyles and HealthStyles national surveys to gain insights into HP and consumer awareness, perceptions, and use of direct-to-consumer PG tests. For both surveys, PG tests were defined as genetic tests marketed directly to consumers that scan a person's entire genetic makeup for potential health risks; specific company names were provided as examples to distinguish PG tests from other direct-to-consumer genetic tests. The 5399 HealthStyles respondents were 68% white, 12% black, 12% Hispanic, and 7% others; 12% were younger than 35 years, 50% were between 35 and 54 years, and 38% were 55 years or older. Of these respondents, 22% were aware of PG tests, 0.3% had used these tests, and two thirds of these users had shared the test results with a HP. In multivariate logistic regression analyses, significant predictors of consumer awareness of PG tests included older age, female gender, racial or ethnic group other than Black or Hispanic, higher education, and higher income. The 1880 DocStyles respondents were 510 family physicians, 490 internists, 250 pediatricians, 250 obstetrician/gynecologists, 250 dermatologists, and 130 registered dieticians. Of these respondents, 42% were aware of PG tests, with dermatologists and pediatricians most aware (50%) and obstetrician/gynecologists least aware (36%). Other significant predictors of awareness among HPs included older age and hospital or clinic practice setting, when compared with individual or group practice. Among those HPs aware of PG tests, 42% had at least one patient who asked questions in the past year about having such a test, and 15% had at least one patient who brought the results of a PG test to them for discussion in the past year. Among the latter group, which is composed primarily of internists and family physicians, 75% indicated that the PG test results changed some aspect of the patient's care, such as screening tests offered, medications or dosages prescribed, lifestyle changes recommended, frequency of follow-up appointments, or diagnoses made. When HPs aware of PG tests were asked about the likelihood that PG test results would influence their care of a patient if brought in that day, 52% responded somewhat or very likely, whereas 15% were uncertain. HPs who had encountered PG test results in their practice were more likely than other HPs to indicate that the test results were likely to influence patient case (73% vs. 48%; P < 0.0001). The majority of aware HPs had read or heard about PG tests in a media or Internet source (75%), with medical or scientific journals cited next (22%); 97% of aware HPs selected such journals as their most trusted source of information, highlighting the importance of the medical literature in educating physicians about the validity and utility of these tests. |
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