Cara J. Krulewitch

The safety of prenatal ultrasound exposure in human studies

Diagnostic ultrasound use in obstetrics has been growing rapidly to become an integral part of prenatal care today. The high proportion of exposure to prenatal ultrasound highlights the public health significance of routine ultrasound use. A majority of epidemiologic studies tends to support the safety of diagnostic ultrasound use during pregnancy. However, there have been some reports that there may be a relation between prenatal ultrasound exposure and adverse outcome. Some of the reported effects include growth restriction, delayed speech, dyslexia, and non-right-handedness associated with ultrasound exposure. Continued research is needed to evaluate the potential adverse effects of ultrasound exposure during pregnancy. These studies should measure the acoustic output, exposure time, number of exposures per subject, and the timing during the pregnancy when exposure(s) occurred, while controlling for potential confounding variables such as sociodemographic, medical, and obstetric risk factors. We recommend that a new consensus development conference be held to gather the needed data and provide guidelines for the future research needs, as well as respond to the rapid advances in this technology.

The Midwifery Workforce: ACNM 2012 and AMCB 2013 Core Data.

INTRODUCTION Core data are crucial for detailing an accurate profile of the midwifery workforce in the United States. The American College of Nurse-Midwives (ACNM) and the American Midwifery Certification Board, Inc. (AMCB), at the request and with support from the US Health Resources and Services Administration (HRSA), are engaged in a collaborative effort to develop a data collection strategy (the Midwifery MasterFile) that will reflect demographic and practice characteristics of certified nurse-midwives (CNMs) and certified midwives (CMs) in the United States. METHODS Two independent datasets, one collected by ACNM in 2012 and one by AMCB in 2013, were examined to determine key workforce information. ACNM data were collected from the online Core Data Survey sent to ACNM members. AMCB data were extracted from information submitted online by applicants seeking initial certification in 2013 and applicants seeking to recertify following 5 years of initial certification. RESULTS The ACNM 2012 survey was partially or fully completed by 36% (n = 2185) of ACNM members (N = 6072). AMCB respondents included 100% of new certificants (N = 539) and those applying for recertification in 2013 (n = 1323) of the total 11,682 certificants in the AMCB database. These two datasets demonstrate that midwives remain largely white, female, and older in age, with most engaged in clinical midwifery while employed primarily by hospitals and medical centers. Differences were reported between the ACNM membership and AMCB certification datasets in the numbers of midwives holding other certifications, working full-time, attending births, and providing newborn care. DISCUSSION The new collaboration among HRSA, ACNM, and AMCB, represented as the Midwifery MasterFile, provides the opportunity to clearly profile CNMs/CMs, distinct from advanced practice registered nurses, in government reports about the health care workforce. This information is central to identifying and marketing the role and contribution of CNMs/CMs in the provision of primary and reproductive health care services.

Alcohol use and pregnancy

The Minnesota Organization on Fetal Alcohol Syndrome (MOFAS) aims to eliminate disability caused by alcohol consumption during pregnancy and to improve the quality of life for those living with Fetal Alcohol Spectrum Disorders (FASD) throughout Minnesota. MOFAS works to achieve its mission by advancing public policy, educating citizens and policy makers, providing funding to community organizations, and offering resources to families such as screening and diagnosis, support groups, activities and classes.

Environmental Health And Pregnancy

Above all, we need to look at the entire life span. We can no longer divide life into segments such as fetal, neonatal, childhood adolescence, adulthood, and senescence. Rather, it is a dynamic continuum with the status at any one time being influenced by all that went before and, in turn, having an effect on all that follows (1).

The United States midwifery education, regulation, and association work group: what is it and what does it hope to accomplish?

During the triennium 2008 to 2011, the International Confederation of Midwives (ICM) developed a group of essential documents that described the Three Pillars of midwifery: education, regulation, and association. The pillars of midwifery were built upon the ICM Essential Competencies for Basic Midwifery and the ICM Definition of a Midwife.1,2 The core documents,3–5 which together comprise the global standards for midwifery education, practice, and regulation, are meant to strengthen midwifery worldwide and to provide high-quality evidence-based care for women, newborns, and families in order to decrease maternal and infant mortality and morbidity.3–5 In response to this global midwifery initiative, 7 US midwifery organizations convened the United States Midwifery Education, Regulation, and Association (US MERA) Steering Committee and a larger work group to develop a collaborative response to the ICM global vision, strengthen the midwifery profession in the United States, and expand delivery of high-quality care.6 These organizations include 3 professional associations as well as the 4 organizations responsible for education, certification, and regulation related to the 3 professional US midwifery credentials: the certified professional midwife (CPM), certified nurse-midwife (CNM), and certified midwife (CM). This article provides an overview of the history, current activities, and future directions of US MERA.

An Unexpected Adverse Drug Effect

Adverse drug-drug interactions can occur between active and/or inactive ingredients in different formulations. The occurrence of a disulfiram reaction that developed postpartum following a 7-day course of metronidazole is presented. The case is presented, followed by a discussion of the mechanism of action and treatment. Recommendations for prevention of adverse drug effects are reviewed.

The national strategy for suicide prevention.

The suffering of the suicidal is private and inexpressible, leaving family members, friends and colleagues to deal with an almost unfathomable kind of loss, as well as guilt. Suicide carries in its aftermath a level of confusion and devastation that is, for the most part beyond description. Kay Redfield Jamison (1)

Gaining ground, teen births in the United States 1940-2000.

The birth rate for United States teenagers has steadily declined over the past 60 years except for a brief spike in the late 1980s through 1991. The birth rate for 2000 was 11% lower than the rate in 1940. Although this represents 546000 less births compared to the expected number if the birth rate remained at the higher 1991 levels the United States teen birth rate is much higher than the rates for other developed countries. (excerpt)

The Global Hiv/Aids Epidemic

This table presents statistics on adults and children living with HIV/AIDS adults and children newly infected with HIV and percent of HIV-positive adults who are women for all regions of the world as of the end of 2000.

Women And Smoking (1)

Every ten seconds, somewhere in the world tobacco kills another victim. If current smoking trends continue, this toll will increase up to one tobacco-caused death every three seconds over the next thirty to forty years (2).