Publications by authors named "Susan P Raine"

9 Publications

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Population-Based Estimation of the Preterm Birth Rate in Lilongwe, Malawi: Making Every Birth Count.

AJP Rep 2020 Jan 9;10(1):e78-e86. Epub 2020 Mar 9.

Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas.

 The objective of this study was to perform a population-based estimation of the preterm birth (PTB) rate in regions surrounding Lilongwe, Malawi.  We partnered with obstetrician specialists, community health workers, local midwives, and clinicians in a 50 km region surrounding Lilongwe, Malawi, to perform a population-based estimation of the PTB rate during the study period from December 1, 2012 to May 19, 2015.  Of the 14,792 births captured, 19.3% of births were preterm, including preterm early neonatal deaths. Additional PTB risk factors were similarly prevalent including domestic violence, HIV, malaria, anemia, and malnutrition.  When performing a population-based estimation of the rate of PTB, including women without antenatal care and women delivering at home, the 19.3% rate of PTB is among the highest recorded globally. This is accompanied by a high rate of risk factors and comorbid conditions.
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http://dx.doi.org/10.1055/s-0040-1708491DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7062552PMC
January 2020

Population-Based Estimation of Dental Caries and Periodontal Disease Rates of Gravid and Recently Postpartum Women in Lilongwe, Malawi.

AJP Rep 2019 Jul 20;9(3):e268-e274. Epub 2019 Aug 20.

Department of Obstetrics and Gynecology, Baylor College of Medicine, One Baylor Plaza, Houston, Texas.

 The objective of this study was to determine the rate of dental caries and periodontal disease among gravid and recently postpartum women at five delivery centers within and surrounding Lilongwe, Malawi.  We partnered with obstetric specialists, community health workers, and dentists to perform dental history interviews and dental examinations during the study period from December 2012 to May 2014. Dental examinations were performed according to World Health Organization standards to assess periodontal and oral health status.  Among the 387 gravid and recently postpartum women, the rate of dental caries was 69.3% and the rate of composite dental disease (caries and periodontal disease) was 76.7%. The majority (69.5%) of women examined had a decayed-missing-filled (DMF) index greater than or equal to one; the average DMF Index was 2.48. The majority of women had never seen a dentist (62.8%). However, most did perform oral hygiene, two or more times per day (90.2%); most women reported brushing with toothpaste (88.1%).  When assessing this population for dental caries and periodontal disease, the rate of dental disease was high. Therefore, this may be an ideal setting to test for impactful interventions aimed at reducing caries and periodontal disease.
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http://dx.doi.org/10.1055/s-0039-1695003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6702028PMC
July 2019

Competency-Based Objectives in Global Underserved Women's Health for Medical Trainees.

Obstet Gynecol 2017 10;130(4):836-842

Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland; the Department of Obstetrics, Gynecology and Reproductive Sciences, Larner College of Medicine at the University of Vermont, Burlington, Vermont; the Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, California; the Department of Obstetrics/Gynecology, Cooper Medical School of Rowan University, Camden, New Jersey; the Department of Obstetrics/Gynecology and Reproductive Biology, Case Western School of Medicine, Cleveland, Ohio; and the Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas.

The Association of Professors of Gynecology and Obstetrics Committee on Global Health developed an inclusive definition of global women's health and competency-based objectives that reflected work internationally, as well as with U.S. vulnerable and underserved populations, such as refugee and immigrant populations or those who would otherwise have compromised access to health care. The knowledge, skill, and attitude-based competencies required to fulfill each learning objective were mapped to the Accreditation Council for Graduate Medical Education Outcomes Project's educational domains and the Consortium of Universities for Global Health competency domains. The proposed global women's health definition and competency-based learning objective framework is a first step in ensuring quality standards for educating trainees to address global women's health needs. By proposing these objectives, we hope to guide future program development and spark a broader conversation that will improve health for vulnerable women and shape educational, ethical, and equitable global health experiences for medical trainees.
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http://dx.doi.org/10.1097/AOG.0000000000002197DOI Listing
October 2017

A survey of honor-related practices among US obstetricians and gynecologists.

Int J Gynaecol Obstet 2017 Nov 31;139(2):164-169. Epub 2017 Aug 31.

Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA.

Objective: To assess patterns of honor-related practices-including virginity testing, virginity restoration, and female genital mutilation (FGM)-among US obstetrician-gynecologists (OBGYNs).

Methods: Between June 1 and August 31, 2016, 1000 members of the American College of Obstetricians and Gynecologists were invited by email to complete an anonymous online survey. The survey comprised 42 questions evaluating the demographic and practice characteristics of the respondents.

Results: Overall, 288 of the 909 practicing US OBGYNs with functioning email addresses completed the survey (31.7% response rate). In the 12 months before the survey, 168 (58.3%) respondents had provided care to one or more patients who had previously undergone FGM. Care was also provided for patients who requested virginity testing or virginity restoration by 29 (10.1%) and 16 (5.6%) respondents, respectively. Ten (3.5%) respondents performed virginity testing on request, whereas 3 (1.0%) performed virginity restoration.

Conclusion: Some respondents performed honor-related practices, which indicated a need to educate all practicing US OBGYNs about their ethical and legal obligations in the care of such patients.
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http://dx.doi.org/10.1002/ijgo.12294DOI Listing
November 2017

Ethical issues in education: Medical trainees and the global health experience.

Authors:
Susan P Raine

Best Pract Res Clin Obstet Gynaecol 2017 Aug 15;43:115-124. Epub 2017 Mar 15.

Baylor College of Medicine, Houston, Texas, USA. Electronic address:

With interest in global health experiences (GHEs) by medical trainees remaining high, the number of global health programs offering educational experiences in resource limited settings has proliferated. Development and implementation of GHEs has outpaced the critical evaluation of ethical considerations inherent in these programs. Global health programs must adhere to the four principles of beneficence, nonmaleficence, respect of autonomy, and justice in crafting a GHE focused on maximizing the experience of the learners, host country, and patients. The four ethical principles provide a guideline for the development and implementation of highly ethical GHEs for medical trainees.
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http://dx.doi.org/10.1016/j.bpobgyn.2017.03.004DOI Listing
August 2017

Reply.

Am J Obstet Gynecol 2016 Jan 25;214(1):137-8. Epub 2015 Sep 25.

Department of Obstetrics and Gynecology, Weill Medical College of Cornell University/New York Presbyterian Hospital, New York, NY.

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http://dx.doi.org/10.1016/j.ajog.2015.09.070DOI Listing
January 2016

Health care justice and its implications for current policy of a mandatory waiting period for elective tubal sterilization.

Am J Obstet Gynecol 2015 Jun 29;212(6):736-9. Epub 2015 Apr 29.

Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX.

Tubal sterilization during the immediate postpartum period is 1 of the most common forms of contraception in the United States. This time of the procedure has the advantage of 1-time hospitalization, which results in ease and convenience for the woman. The US Collaborative Review of Sterilization Study indicates the high efficacy and effectiveness of postpartum tubal sterilization. Oral and written informed consent is the ethical and legal standard for the performance of elective tubal sterilization for permanent contraception for all patients, regardless of source of payment. Current health care policy and practice regarding elective tubal sterilization for Medicaid beneficiaries places a unique requirement on these patients and their obstetricians: a mandatory waiting period. This requirement originates in decades-old legislation, which we briefly describe. We then introduce the concept of health care justice in professional obstetric ethics and explain how it originates in the ethical concepts of medicine as a profession and of being a patient and its deontologic and consequentialist dimensions. We next identify the implications of health care justice for the current policy of a mandatory 30-day waiting period. We conclude that Medicaid policy allocates access to elective tubal sterilization differently, based on source of payment and gender, which violates health care justice in both its deontologic and consequentialist dimensions. Obstetricians should invoke health care justice in women's health care as the basis for advocacy for needed change in law and health policy, to eliminate health care injustice in women's access to elective tubal sterilization.
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http://dx.doi.org/10.1016/j.ajog.2015.03.049DOI Listing
June 2015

Gestational weight gain among Hispanic women.

Matern Child Health J 2014 Jan;18(1):153-160

Division of Obstetrics and Gynecology Houston, Department of Obstetrics and Gynecology, Texas Children's Pavilion for Women, Baylor College of Medicine, Room F1030.26, Houston, TX, 77030, USA.

To describe gestational weight gain among Hispanic women and to examine psychological, social, and cultural contexts affecting weight gain. A total of 282 Hispanic women were surveyed post-partum before leaving the hospital. Women were queried about their prepregnancy weight and weight gained during pregnancy. Adequacy of gestational weight gain was based on guidelines set by the Institute of Medicine in 2009. Independent risk factors for excessive or insufficient weight gain were examined by logistic regression. Most women were unmarried (59 %), with a mean age of 28.4 ± 6.6 years and an average weight gain of 27.9 ± 13.3 lbs. Approximately 45 % of women had gained too much, 32 % too little, and only 24 % had an adequate amount of weight gain. The mean birth weight was 7.3, 7.9, and 6.8 lbs among the adequate, excessive, and insufficient weight gain groups. Among women who exercised before pregnancy, two-thirds continued to do so during pregnancy; the mean gestational weight gain of those who continued was lower than those who stopped (26.8 vs. 31.4 lbs, p = 0.04). Independent risk factors for excessive weight gain were being unmarried, U.S. born, higher prepregnancy body mass index, and having indifferent or negative views about weight gain. Independent risk factors for insufficient weight gain were low levels of support and late initiation of prenatal care. Depression, stress, and a woman's or her partner's happiness regarding pregnancy were unrelated to weight gain. The results of this study can be used by prenatal programs to identify Hispanic women at risk for excessive or insufficient gestational weight gain.
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http://dx.doi.org/10.1007/s10995-013-1248-3DOI Listing
January 2014

Federal sterilization policy: unintended consequences.

Authors:
Susan P Raine

Virtual Mentor 2012 Feb 1;14(2):152-7. Epub 2012 Feb 1.

Department of Obstetrics and Gynecology and Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas, USA.

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http://dx.doi.org/10.1001/virtualmentor.2012.14.2.mhst1-1202DOI Listing
February 2012
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