1 00:00:05,520 --> 00:00:08,720 THANK YOU FOR JOINING US TODAY. 2 00:00:08,720 --> 00:00:11,720 I KNOW THERE ARE MANY COMPETING 3 00:00:11,720 --> 00:00:15,120 OBLIGATIONS AS WE APPROACH THE 4 00:00:15,120 --> 00:00:16,880 THANKSGIVING HOLIDAY. 5 00:00:16,880 --> 00:00:21,400 AS YOU KNOW THIS IS OUR SECOND 6 00:00:21,400 --> 00:00:23,160 MEETING OF THE NICHD STILLBIRTH 7 00:00:23,160 --> 00:00:25,160 WORK GROUP THE ADVISORY GROUP OF 8 00:00:25,160 --> 00:00:27,960 OUR COUNCIL. 9 00:00:27,960 --> 00:00:30,560 BEFORE WE BEGIN I'D JUST LIKE TO 10 00:00:30,560 --> 00:00:32,600 THANK EVERYONE WHO WAS SO 11 00:00:32,600 --> 00:00:34,840 ENGAGED IN OUR FIRST MEETING. 12 00:00:34,840 --> 00:00:39,880 WHAT YOU SAID WAS VERY IMPORTANT 13 00:00:39,880 --> 00:00:43,360 TO US AND WE HAVE TAKEN YOUR 14 00:00:43,360 --> 00:00:44,600 COMMENTS INTO CONSIDERATION AND 15 00:00:44,600 --> 00:00:46,120 THAT HAS REALLY INFLUENCED HOW 16 00:00:46,120 --> 00:00:47,440 WE HAVE ORGANIZED THE REMAINING 17 00:00:47,440 --> 00:00:54,760 MEETINGS. 18 00:00:54,760 --> 00:00:56,960 I WANTED TO LET YOU KNOW WE ARE 19 00:00:56,960 --> 00:00:58,600 APPRECIATIVE OF PARTICULARLY THE 20 00:00:58,600 --> 00:01:00,440 ENGAGEMENT OF THE PEOPLE WHO 21 00:01:00,440 --> 00:01:03,240 HAVE HAD LIVED EXPERIENCE OF 22 00:01:03,240 --> 00:01:06,840 HAVING DELIVERED STILLBORN 23 00:01:06,840 --> 00:01:08,520 BABIES AND WE ARE COMMITTED TO 24 00:01:08,520 --> 00:01:12,280 JOINING YOU IN DEVELOPING A 25 00:01:12,280 --> 00:01:13,760 RESEARCH AGENDA TO PREVENT THIS 26 00:01:13,760 --> 00:01:14,440 FROM HAPPENING IN THE FUTURE. 27 00:01:14,440 --> 00:01:17,280 WITH THAT, I'M GOING TO TURN THE 28 00:01:17,280 --> 00:01:19,120 VIRTUAL MICROPHONE OVER TO 29 00:01:19,120 --> 00:01:23,640 DR. JANE FOR THE INTRODUCTIONS. 30 00:01:23,640 --> 00:01:28,200 >>HI THERE, GOOD MORNING 31 00:01:28,200 --> 00:01:30,120 EVERYONE. 32 00:01:30,120 --> 00:01:32,320 HELLO, DR. BIANCHI. 33 00:01:32,320 --> 00:01:39,200 I ECHO THE FEELINGS THAT THE 34 00:01:39,200 --> 00:01:44,000 ENGAGEMENT FROM THE GROUP HAS 35 00:01:44,000 --> 00:01:46,080 BEEN ENORMOUS AND I'M GRATEFUL 36 00:01:46,080 --> 00:01:51,480 TO ALL OF YOU FOR PARTICIPATING 37 00:01:51,480 --> 00:02:02,160 IN THIS VERY IMPORTANT EXERCISE. 38 00:02:02,160 --> 00:02:04,600 STILLBIRTH IS IS AN IMPORTANT 39 00:02:04,600 --> 00:02:06,240 AREA TO FOCUS ON AND THE NUMBER 40 00:02:06,240 --> 00:02:08,480 OF STILLBIRTH HAPPEN EVERY YEAR 41 00:02:08,480 --> 00:02:11,080 I GOT AN E-MAIL FROM ONE OF YOU 42 00:02:11,080 --> 00:02:13,960 LAST NIGHT ABOUT HOW STILLBIRTHS 43 00:02:13,960 --> 00:02:17,240 FAR EXCEED THE NUMBER OF SIDES 44 00:02:17,240 --> 00:02:20,160 DEATH EACH YEAR AND WE NEED FOR 45 00:02:20,160 --> 00:02:24,520 US TO CONTINUE TO FOCUS ON 46 00:02:24,520 --> 00:02:25,880 FINDING THE CAUSES OF STILL 47 00:02:25,880 --> 00:02:36,400 BIRTH AND FOCUS ON PREVENTION. 48 00:02:37,040 --> 00:02:41,000 WITH MY CO-CHAIR I WANT TO THANK 49 00:02:41,000 --> 00:02:44,160 YOU TO THE THE FIRST OF OUR 50 00:02:44,160 --> 00:02:45,840 SESSIONS ON EXPERTS ON 51 00:02:45,840 --> 00:02:47,360 STILLBIRTH. 52 00:02:47,360 --> 00:02:55,000 WE ORGANIZED TODAY'S AGENDA INTO 53 00:02:55,000 --> 00:02:55,320 AGENDAS. 54 00:02:55,320 --> 00:02:57,320 ONE ON BARRIERS TO COLLECTING 55 00:02:57,320 --> 00:02:58,560 DATA ON STILLBIRTHS. 56 00:02:58,560 --> 00:03:00,680 THE SECOND SESSION WILL FOCUS ON 57 00:03:00,680 --> 00:03:02,600 COMMUNITIES AT HIGHER RISK FOR 58 00:03:02,600 --> 00:03:06,880 STILLBIRTHS. 59 00:03:06,880 --> 00:03:10,320 IN SESSION 1 WE'LL HAVE SEVERAL 60 00:03:10,320 --> 00:03:10,800 SPEAKERS. 61 00:03:10,800 --> 00:03:13,400 WE'LL GET STARTED WITH AN 62 00:03:13,400 --> 00:03:16,160 OVERVIEW OF THE DATA CHALLENGES 63 00:03:16,160 --> 00:03:21,840 THAT WE FACE IN STILLBIRTHS AND 64 00:03:21,840 --> 00:03:22,960 THEN WE'LL HAVE A DISCUSSION 65 00:03:22,960 --> 00:03:27,360 ABOUT THE POTENTIAL FOR A 66 00:03:27,360 --> 00:03:29,440 U.S. STILLBIRTH REGISTRY. 67 00:03:29,440 --> 00:03:31,320 SIMILAR TO WHAT THE BIRTH 68 00:03:31,320 --> 00:03:36,440 DEFECTS REGISTRY DOES AT THE CDC 69 00:03:36,440 --> 00:03:39,600 AND THEN WE'LL TALK ABOUT THE 70 00:03:39,600 --> 00:03:42,760 ALL OF US STILLBIRTH 71 00:03:42,760 --> 00:03:44,600 SURVEILLANCE PROGRAM AND THE 72 00:03:44,600 --> 00:03:46,080 BARRIERS THEY'VE BEEN FACING IN 73 00:03:46,080 --> 00:03:51,640 COLLECTING DATA AND FOLLOWED BY 74 00:03:51,640 --> 00:03:54,040 CONCERNS IN COLLECTING 75 00:03:54,040 --> 00:03:55,400 STILLBIRTH DATA AND WILL HAVE 76 00:03:55,400 --> 00:03:58,040 HALF AN HOUR, AMPLE TIME FOR 77 00:03:58,040 --> 00:03:58,320 DISCUSSION. 78 00:03:58,320 --> 00:04:03,760 WE'LL THEN HAVE A BREAK FOLLOWED 79 00:04:03,760 --> 00:04:09,240 BY SECOND SESSION AND I'LL TALK 80 00:04:09,240 --> 00:04:13,200 ABOUT THAT WHEN WE GET THERE. 81 00:04:13,200 --> 00:04:14,920 I WANTED TO SEE IF THERE'S 82 00:04:14,920 --> 00:04:15,600 COMMENTS BEFORE WE GET STARTED 83 00:04:15,600 --> 00:04:22,520 WITH THE FIRST SESSION. 84 00:04:22,520 --> 00:04:24,520 >>NO, THANK YOU. 85 00:04:24,520 --> 00:04:26,320 WE'RE EXCITE ABOUT THE PANEL OF 86 00:04:26,320 --> 00:04:28,080 SPEAKERS AND EXCITED ABOUT THE 87 00:04:28,080 --> 00:04:28,800 ROBUST DISCUSSION ABOUT 88 00:04:28,800 --> 00:04:30,520 IMPORTANT ISSUES. 89 00:04:30,520 --> 00:04:30,800 THANK YOU. 90 00:04:30,800 --> 00:04:35,080 >>GREAT. 91 00:04:35,080 --> 00:04:37,280 >>THANK YOU. 92 00:04:37,280 --> 00:04:43,120 DR. DUDLEY, ARE YOU READY TO 93 00:04:43,120 --> 00:04:44,640 KICK US OFF. 94 00:04:44,640 --> 00:04:48,560 NO BETTER PERSON TO GIVE US THE 95 00:04:48,560 --> 00:04:49,840 BACKGROUND AROUND DATA 96 00:04:49,840 --> 00:04:50,160 CHALLENGES. 97 00:04:50,160 --> 00:04:56,320 THE WORK DR. DUDLEY HAS DONE 98 00:04:56,320 --> 00:05:02,600 OVER THE YEARS IN THIS AREA AND 99 00:05:02,600 --> 00:05:03,480 I LOOK FORWARD TO THE DISCUSSION 100 00:05:03,480 --> 00:05:04,600 THAT FOLLOWS. 101 00:05:04,600 --> 00:05:07,320 DR. DUDLEY, PLEASE GO AHEAD. 102 00:05:07,320 --> 00:05:10,280 >>THANK YOU, GOOD MORNING, 103 00:05:10,280 --> 00:05:10,880 EVERYBODY. 104 00:05:10,880 --> 00:05:12,880 NOT 100% SURE WHAT YOU'RE 105 00:05:12,880 --> 00:05:14,320 WANTING TO GET OUT OF MY 10 106 00:05:14,320 --> 00:05:16,160 MINUTES OF FAME BUT WE'LL KICK 107 00:05:16,160 --> 00:05:17,840 IT OFF AND GET THINGS GOING IF 108 00:05:17,840 --> 00:05:19,920 SOMEONE CAN PULL UP MY SLIDES OR 109 00:05:19,920 --> 00:05:30,240 WHATEVER YOU WANT. 110 00:05:51,880 --> 00:05:53,880 SADLY I HAVE NO DISCLOSURES TO 111 00:05:53,880 --> 00:05:54,120 REPORT. 112 00:05:54,120 --> 00:05:58,320 I'M JUST OUT THERE DOING WORK. 113 00:05:58,320 --> 00:06:00,400 I THOUGHT WE'D GET BASIC FIRST 114 00:06:00,400 --> 00:06:02,840 AND TO BE HONEST WITH YOU I'VE 115 00:06:02,840 --> 00:06:05,440 NEVER LOOKED AT THE DEATH 116 00:06:05,440 --> 00:06:08,320 CERTIFICATE FORM IN ANY GREAT 117 00:06:08,320 --> 00:06:10,480 DETAIL SO THE FIRST FEW SLIDES 118 00:06:10,480 --> 00:06:12,880 ARE JUST TO REVIEW WHAT A DEATH 119 00:06:12,880 --> 00:06:14,400 CERTIFICATE LOOKS LIKE AND THIS 120 00:06:14,400 --> 00:06:24,960 IS PAPER ONE OFF THE CDC WEBSITE 121 00:06:28,120 --> 00:06:29,200 THE FIRST PART IS DEMOGRAPHIC 122 00:06:29,200 --> 00:06:33,800 DATA AND DISPOSITION OF THE 123 00:06:33,800 --> 00:06:37,640 REMAINS THE FATHER IS THE CAUSE 124 00:06:37,640 --> 00:06:39,640 CONDITIONS CONTRIBUTING TO FETAL 125 00:06:39,640 --> 00:06:39,840 DEATH. 126 00:06:39,840 --> 00:06:42,120 YOU CAN SEE THERE'S INITIATING 127 00:06:42,120 --> 00:06:45,040 CAUSE CONDITION, OTHER SIG CAUSE 128 00:06:45,040 --> 00:06:46,680 CONDITIONS AND CHECK BOXES AND 129 00:06:46,680 --> 00:06:48,600 FILL-IN BLANKS FOR THIS AND IF 130 00:06:48,600 --> 00:06:50,320 YOU LOOK, THERE ARE THINGS LIKE 131 00:06:50,320 --> 00:06:55,320 FETAL ANOMALY, FETAL INFECTION 132 00:06:55,320 --> 00:06:59,160 AND THE LIKE. 133 00:06:59,160 --> 00:07:04,800 THE TOP OF THE SECOND PAGE IS 134 00:07:04,800 --> 00:07:06,600 INFORMATION ON THE MOTHER. 135 00:07:06,600 --> 00:07:11,360 THE EDUCATION, RACE, ETHNICITY, 136 00:07:11,360 --> 00:07:13,240 MARITAL STATUS, DETAILS ABOUT 137 00:07:13,240 --> 00:07:13,880 PRENATAL CARE. 138 00:07:13,880 --> 00:07:16,880 IT'S QUITE A DETAILED FORM. 139 00:07:16,880 --> 00:07:18,680 THEN YOU GET DOWN TO THE RISK 140 00:07:18,680 --> 00:07:19,920 FACTORS FOR PREGNANCY AND YOU 141 00:07:19,920 --> 00:07:23,400 CAN LOOK AT ALL THE RISK FACTORS 142 00:07:23,400 --> 00:07:26,320 THAT ARE LISTED INCLUDING METHOD 143 00:07:26,320 --> 00:07:30,360 OF DELIVERY, INFECTIONS DURING 144 00:07:30,360 --> 00:07:33,320 DELIVERY, COMORBIDITIES AND 145 00:07:33,320 --> 00:07:33,960 FETUS. 146 00:07:33,960 --> 00:07:40,600 THE FORM HAS QUITE A BIT OF 147 00:07:40,600 --> 00:07:41,000 DETAIL. 148 00:07:41,000 --> 00:07:48,520 WHAT I DID A HIGHLY BIASSED 149 00:07:48,520 --> 00:07:49,880 LIMITED SURVEY OF WHERE I CAN 150 00:07:49,880 --> 00:07:52,120 FIND OUT HOW PEOPLE FILLED OUT 151 00:07:52,120 --> 00:07:52,640 THE FORM. 152 00:07:52,640 --> 00:07:56,720 THE FIRST FOUR SITES ARE IN 153 00:07:56,720 --> 00:07:57,800 VIRGINIA AND THE RESIDENT 154 00:07:57,800 --> 00:08:00,720 COMPLETES THE WORK SHEET AND IT 155 00:08:00,720 --> 00:08:08,480 GOES TO THE DEAN IN DECEDENT 156 00:08:08,480 --> 00:08:10,160 AFFAIRS AND GOES BACK TO THE 157 00:08:10,160 --> 00:08:18,720 RESIDENT FOR ATTESTATION AND THE 158 00:08:18,720 --> 00:08:20,640 DIENER FILLS OUT THE DEATH 159 00:08:20,640 --> 00:08:28,800 REGISTRATION IN VIRGINIA. 160 00:08:28,800 --> 00:08:30,160 AND THE BIRTH REGISTRAR 161 00:08:30,160 --> 00:08:32,320 COMPLETES THE EDRS AND THEN GOES 162 00:08:32,320 --> 00:08:38,520 BACK TO THE RESIDENT FOR 163 00:08:38,520 --> 00:08:39,840 ATTESTATION THE THIRD IS 164 00:08:39,840 --> 00:08:41,520 DEFINING WOMEN WHO HAVE FETAL 165 00:08:41,520 --> 00:08:41,720 DEATH. 166 00:08:41,720 --> 00:08:43,080 THEY HAVE A SYSTEM THEY CREATED 167 00:08:43,080 --> 00:08:44,920 TO HELP THEM WITH THAT. 168 00:08:44,920 --> 00:08:46,520 THEY COMPLETE THE FORMS AND HAVE 169 00:08:46,520 --> 00:08:48,920 THE RESIDENT SIGN IN THE EDRS. 170 00:08:48,920 --> 00:08:53,040 THE DATA IS OFTEN INCOMPLETE DUE 171 00:08:53,040 --> 00:08:55,040 TO DISCHARGES. 172 00:08:55,040 --> 00:08:56,560 OFTEN THE PATIENTS DON'T TAKE 173 00:08:56,560 --> 00:08:58,600 TIME AND IT TAKES TIME FOR THE 174 00:08:58,600 --> 00:09:00,000 REGISTRARS TO FIND THEM. 175 00:09:00,000 --> 00:09:02,480 THE FIRST THREE SITES WERE 176 00:09:02,480 --> 00:09:03,720 UNIVERSITY HOSPITALS WITH 177 00:09:03,720 --> 00:09:04,000 RESIDENCY. 178 00:09:04,000 --> 00:09:05,720 THE FOURTH SITE WAS A COMMUNITY 179 00:09:05,720 --> 00:09:07,720 HOSPITAL AND AT THIS SITE THE 180 00:09:07,720 --> 00:09:09,800 PHYSICIAN WHO DELIVERS THE BABY 181 00:09:09,800 --> 00:09:12,760 COMPLETES A PAPER FORM, GIVES IT 182 00:09:12,760 --> 00:09:15,360 TO THE UNIT CLERK WHO FORWARDS 183 00:09:15,360 --> 00:09:17,000 IT TO THE BIRTH REGISTRAR TO THE 184 00:09:17,000 --> 00:09:25,880 ED ARE -- EDRS AND GOES TO THE 185 00:09:25,880 --> 00:09:26,360 STATE. 186 00:09:26,360 --> 00:09:29,360 IN THE FIFTH SITE THE BABY'S 187 00:09:29,360 --> 00:09:31,840 BODY GOES TO THE HOSPITAL MORGUE 188 00:09:31,840 --> 00:09:34,120 AND IN INTERNAL MESSAGE GOES TO 189 00:09:34,120 --> 00:09:36,120 THE DELIVERING RESIDENT WITH AN 190 00:09:36,120 --> 00:09:39,960 ONLINE FORM WITH A LINK TO THE 191 00:09:39,960 --> 00:09:41,320 ELECTRONIC SYSTEM IN THIS STATE 192 00:09:41,320 --> 00:09:44,640 THE RESIDENT COMPLETES THE FORM 193 00:09:44,640 --> 00:09:51,200 AND THEN RECEIVE AS A 194 00:09:51,200 --> 00:09:52,480 CONFIRMATORY E-MAIL AND 195 00:09:52,480 --> 00:09:54,200 RESIDENTS HAVE A CHEAT SHEET TO 196 00:09:54,200 --> 00:09:55,680 HELP THEM FILL OUT THE FORMS. 197 00:09:55,680 --> 00:09:57,680 YOU CAN SEE THERE ARE EACH 198 00:09:57,680 --> 00:09:59,000 HOSPITAL THAT CALLED HAS 199 00:09:59,000 --> 00:10:00,240 DEVELOPED THEIR OWN INTERNAL 200 00:10:00,240 --> 00:10:05,080 SYSTEM TO TRY TO COMPLETE THESE 201 00:10:05,080 --> 00:10:07,320 FORMS WHICH CAN BE QUITE 202 00:10:07,320 --> 00:10:08,600 CUMBERSOME YOU CAN IMAGINE. 203 00:10:08,600 --> 00:10:11,200 THE OTHER THING TO KEEP IN MIND 204 00:10:11,200 --> 00:10:12,720 IS PRACTICALLY AT LEAST IN 205 00:10:12,720 --> 00:10:15,320 RESIDENCY PROGRAMS OFTEN WOMEN 206 00:10:15,320 --> 00:10:17,320 WHO SUFFER STILLBIRTH ARE 207 00:10:17,320 --> 00:10:19,560 DELIVERED BY FIRST-YEAR, 208 00:10:19,560 --> 00:10:21,520 SECOND-YEAR RESIDENTS. 209 00:10:21,520 --> 00:10:23,240 HAVE YOU YOUNG JUNIOR PEOPLE 210 00:10:23,240 --> 00:10:25,000 FILLING OUT THE FORMS. 211 00:10:25,000 --> 00:10:26,400 THEY DON'T NECESSARY GO TO THE 212 00:10:26,400 --> 00:10:26,720 ATTEND. 213 00:10:26,720 --> 00:10:28,760 LIKE I SAID I'VE NEVER SEEN THE 214 00:10:28,760 --> 00:10:31,360 FORM UNTIL I LOOKED AT IT 215 00:10:31,360 --> 00:10:33,640 ONLINE. 216 00:10:33,640 --> 00:10:35,640 SO SOME FUN FACTS I LEARNED 217 00:10:35,640 --> 00:10:38,200 THROUGH ALL THIS, VIRGINIA 218 00:10:38,200 --> 00:10:40,960 DEPARTMENT OF HEALTH HAS A NICE 219 00:10:40,960 --> 00:10:44,080 20-PAGE GUIDE BOOK ON HOW TO 220 00:10:44,080 --> 00:10:47,280 HELP COMPLETE THIS EDRS AND I 221 00:10:47,280 --> 00:10:50,080 PAGED THROUGH IT BUT I GUARANTEE 222 00:10:50,080 --> 00:10:52,160 A PRIVATE PHYSICIAN WILL NOT 223 00:10:52,160 --> 00:10:54,960 TAKE THE TIME AND IT'S 224 00:10:54,960 --> 00:11:01,880 STRAIGHTFORWARD BUT CUMBERSOME 225 00:11:01,880 --> 00:11:05,720 THEY HAVE AN ONLINE VIDEO TO 226 00:11:05,720 --> 00:11:08,240 VIEW HOW TO COMPLETE THE 227 00:11:08,240 --> 00:11:08,960 CERTIFI 228 00:11:08,960 --> 00:11:09,280 CERTIFICATES. 229 00:11:09,280 --> 00:11:11,360 IN VIRGINIA ALL FETAL DEATHS, 230 00:11:11,360 --> 00:11:13,600 ALL PREGNANCY LOSSES ARE 231 00:11:13,600 --> 00:11:16,360 SUPPOSED TO BE ENTERED SO IT 232 00:11:16,360 --> 00:11:18,200 DOESN'T MATTER GESTATIONAL AGE. 233 00:11:18,200 --> 00:11:19,920 IF THE EVENT OCCURS OUTSIDE 234 00:11:19,920 --> 00:11:22,200 LABOR AND DELIVERY, FEW PEOPLE 235 00:11:22,200 --> 00:11:23,760 KNOW ANYTHING ABOUT THESE FORMS. 236 00:11:23,760 --> 00:11:25,560 FOR EXAMPLE, EMERGENCY ROOM 237 00:11:25,560 --> 00:11:26,440 DOCTORS DON'T KNOW ANYTHING 238 00:11:26,440 --> 00:11:27,080 ABOUT IT. 239 00:11:27,080 --> 00:11:32,280 SO THERE'S GOING TO BE SOME 240 00:11:32,280 --> 00:11:34,640 INCOMPLETE DATA. 241 00:11:34,640 --> 00:11:36,680 AS YOU CAN SEE, LOOKING AT THE 242 00:11:36,680 --> 00:11:38,480 BIRTH CERTIFICATE FORM, 243 00:11:38,480 --> 00:11:40,920 ASSIGNING A CAUSE OF DEATH FROM 244 00:11:40,920 --> 00:11:42,640 THAT COULD BE A BIT OF A 245 00:11:42,640 --> 00:11:44,640 CHALLENGE AND I'M GOING TO TALK 246 00:11:44,640 --> 00:11:48,520 BRIEFLY ABOUT WHAT WE DID IN THE 247 00:11:48,520 --> 00:11:50,080 STILLBIRTH COLLABORATIVE 248 00:11:50,080 --> 00:11:51,920 RESEARCH NETWORK BACK 10, 15 249 00:11:51,920 --> 00:11:53,880 YEARS AGO BECAUSE WHEN WE WERE 250 00:11:53,880 --> 00:11:55,720 COLLECTING OUR DATA AND HAD 251 00:11:55,720 --> 00:12:00,640 COLLECTED OUR COHORT, WE WERE 252 00:12:00,640 --> 00:12:03,200 INTERESTED IN TRYING TO DEVELOP 253 00:12:03,200 --> 00:12:07,360 A SYSTEM TO IDENTIFY CAUSE OF 254 00:12:07,360 --> 00:12:17,480 DEATH. 255 00:12:19,320 --> 00:12:22,440 WE HAD A WORKSHOP AND BROUGHT IN 256 00:12:22,440 --> 00:12:23,920 EXPERTS FROM ALL OVER THE WORLD. 257 00:12:23,920 --> 00:12:27,560 AT THE TIME THERE WERE 35 258 00:12:27,560 --> 00:12:29,160 DIFFERENT WAYS OR CLASSIFICATION 259 00:12:29,160 --> 00:12:31,960 SYSTEMS TO IDENTIFY A CAUSE OF 260 00:12:31,960 --> 00:12:32,360 FETAL DEATH. 261 00:12:32,360 --> 00:12:34,680 THE MAIN THING WE LEARNED IS 262 00:12:34,680 --> 00:12:36,680 THAT EACH OF THE SYSTEMS WAS 263 00:12:36,680 --> 00:12:38,320 CREATED BASED ON THEIR SPECIFIC 264 00:12:38,320 --> 00:12:40,720 DATA SET AND WHAT THEY HAD 265 00:12:40,720 --> 00:12:41,760 COLLECTED AND HAD A SPECIFIC 266 00:12:41,760 --> 00:12:43,960 PURPOSE IN MIND. 267 00:12:43,960 --> 00:12:46,440 THE PURPOSE SEEMED TO BE 268 00:12:46,440 --> 00:12:47,920 DIRECTED TOWARDS A RESPONSE TO 269 00:12:47,920 --> 00:12:50,240 SOME NEED IN THAT COMMUNITY OR 270 00:12:50,240 --> 00:12:51,840 THAT COHORT. 271 00:12:51,840 --> 00:12:54,120 SO WE WANTED TO -- AND NONE OF 272 00:12:54,120 --> 00:12:56,000 THEM WERE REALLY SUFFICIENT OR 273 00:12:56,000 --> 00:12:57,720 WHAT WE HAD COLLECTED OR WERE 274 00:12:57,720 --> 00:12:59,320 COLLECTING IN OUR COHORT. 275 00:12:59,320 --> 00:13:02,600 AND SO IN RESPONSE TO THAT, WE 276 00:13:02,600 --> 00:13:06,600 CREATED OUR OWN SYSTEM WHICH IS 277 00:13:06,600 --> 00:13:09,480 CALLED INCODE WHICH WE PUBLISHED 278 00:13:09,480 --> 00:13:11,840 IN GREEN JOURNAL BACK IN 2010. 279 00:13:11,840 --> 00:13:14,480 THIS IS A FAIRLY UNBIASSED, 280 00:13:14,480 --> 00:13:18,800 EVIDENCE-BASED SYSTEM WHERE WE 281 00:13:18,800 --> 00:13:21,000 IDENTIFIED WHAT WERE KNOWN 282 00:13:21,000 --> 00:13:23,080 CAUSES OF BIRTHS -- SUPPOSED TO 283 00:13:23,080 --> 00:13:26,640 BE KNOWN CAUSES OF STILLBIRTH 284 00:13:26,640 --> 00:13:34,080 AND CLASSIFIED THESE. 285 00:13:34,080 --> 00:13:37,480 THIS IS CALLED INITIAL CAUSES OF 286 00:13:37,480 --> 00:13:41,440 FETAL DEATH EVALUATION WITH THE 287 00:13:41,440 --> 00:13:43,200 THOUGHT WHEN THERE'S MORE 288 00:13:43,200 --> 00:13:44,000 INFORMATION AVAILABLE THERE'S 289 00:13:44,000 --> 00:13:45,720 MORE CAUSES FOR WHAT THE FETAL 290 00:13:45,720 --> 00:13:46,320 DEATH WAS. 291 00:13:46,320 --> 00:13:51,000 WE CREATED BASICALLY AN 292 00:13:51,000 --> 00:13:54,440 EIGHT-PAGE FORM WITH A BRIEF 293 00:13:54,440 --> 00:13:55,440 SECOND FOR HYPERTENSIVE 294 00:13:55,440 --> 00:13:57,160 DISORDERS OF PREGNANCY. 295 00:13:57,160 --> 00:13:59,000 WE CREATED A SYSTEM WHERE YOU 296 00:13:59,000 --> 00:14:00,960 CAN HAVE A DISEASE THAT'S 297 00:14:00,960 --> 00:14:02,080 PRESENT, FOR EXAMPLE, JUST 298 00:14:02,080 --> 00:14:05,240 HYPERTENSION ALONE, PROBABLE 299 00:14:05,240 --> 00:14:08,760 CAUSE AND POSSIBLE CAUSE OF 300 00:14:08,760 --> 00:14:11,880 STILLBIRTH AND PROBABLE CAUSE OF 301 00:14:11,880 --> 00:14:13,000 STILLBIRTH AND HYPERTENSIVE 302 00:14:13,000 --> 00:14:23,560 DISEASE WITH AT LEAST TWO OF THE 303 00:14:24,920 --> 00:14:26,480 FOLLOWING. 304 00:14:26,480 --> 00:14:29,240 THE POINT WAS TO GO THROUGH EACH 305 00:14:29,240 --> 00:14:30,880 SET OF STILLBIRTH AND COMPLETE 306 00:14:30,880 --> 00:14:34,200 THE EIGHT-PAGE FORM AND IDENTIFY 307 00:14:34,200 --> 00:14:38,800 A CAUSE OF PROBABLE OR POSSIBLE 308 00:14:38,800 --> 00:14:43,040 CAUSE OF DEATH. 309 00:14:43,040 --> 00:14:47,920 AND INCODE ARE MATERNAL MEDICAL 310 00:14:47,920 --> 00:14:51,680 CONDITIONS, COMPLICATIONS, FETAL 311 00:14:51,680 --> 00:14:55,880 GENETIC ABNORMALITIES, 312 00:14:55,880 --> 00:15:01,040 PATHOLOGIC ABNORMALITIES. 313 00:15:01,040 --> 00:15:06,080 SO IF YOU GO THROUGH BACK TO THE 314 00:15:06,080 --> 00:15:06,760 BIRTH CERTIFICATE FORM YOU'LL 315 00:15:06,760 --> 00:15:11,320 FIND QUITE A BIT OF WHAT IS IN 316 00:15:11,320 --> 00:15:14,240 INCODE AND THINGS MENTIONED ARE 317 00:15:14,240 --> 00:15:16,400 ACCOUNTED FOR IN INCODE. 318 00:15:16,400 --> 00:15:18,880 NOW, THE THING ABOUT OUR 319 00:15:18,880 --> 00:15:20,600 ANALYSIS, WE HAD 500 STILLBIRTHS 320 00:15:20,600 --> 00:15:25,000 AND EACH OF THE STILLBIRTHS 321 00:15:25,000 --> 00:15:27,440 REVIEWED BY TWO INVESTIGATORS 322 00:15:27,440 --> 00:15:29,240 WHO THEN DISCUSSED THEM AT 323 00:15:29,240 --> 00:15:31,040 LENGTH WITH EACH OTHER TO 324 00:15:31,040 --> 00:15:35,840 IDENTIFY WHAT WE THOUGHT WAS A 325 00:15:35,840 --> 00:15:37,760 POSSIBLE CAUSE OF DEATH. 326 00:15:37,760 --> 00:15:40,280 IT WAS QUITE A LABORIOUS TASK 327 00:15:40,280 --> 00:15:43,320 AND EVEN THEN UPWARDS WITH OF 328 00:15:43,320 --> 00:15:47,600 20% TO 25% OF THE STILLBIRTHS WE 329 00:15:47,600 --> 00:15:48,880 COULD NOT IDENTIFY POSSIBLE 330 00:15:48,880 --> 00:15:49,320 CAUSES OF DEATH. 331 00:15:49,320 --> 00:15:52,160 COMPARE THAT TO WHAT YOU DO FOR 332 00:15:52,160 --> 00:15:55,360 FETAL DEATH CERTIFICATE WHERE 333 00:15:55,360 --> 00:16:00,200 YOU MAY HAVE A JUNIOR RESIDENT 334 00:16:00,200 --> 00:16:03,360 OBSTETRICIAN HAS TO FILL OUT A 335 00:16:03,360 --> 00:16:07,160 FORM THAT HAS 40 VALUES YOU CAN 336 00:16:07,160 --> 00:16:12,600 SEE HOW THE DATA MAY BE A LITTLE 337 00:16:12,600 --> 00:16:14,840 BIT NOT AS THOROUGH OR AS 338 00:16:14,840 --> 00:16:16,480 COMPLETE AS ONE MIGHT HOPE. 339 00:16:16,480 --> 00:16:19,200 THIS MAY SHAKE OUT IN THE LONG 340 00:16:19,200 --> 00:16:21,560 TERM WITH LARGE NUMBERS BUT 341 00:16:21,560 --> 00:16:23,360 STILL IT IS A CHALLENGE TRYING 342 00:16:23,360 --> 00:16:25,720 TO UNDERSTAND EXACTLY WHAT 343 00:16:25,720 --> 00:16:26,640 HAPPENED IN SPECIFIC STILL 344 00:16:26,640 --> 00:16:27,040 BIRTH. 345 00:16:27,040 --> 00:16:28,880 THE OTHER THING TO KEEP IN MIND 346 00:16:28,880 --> 00:16:32,200 AT LEAST IN VIRGINIA, THERE'S A 347 00:16:32,200 --> 00:16:33,560 SEVEN-DAY DEADLINE THAT WE'RE 348 00:16:33,560 --> 00:16:34,960 SUPPOSED TO HAVE THE FORMS 349 00:16:34,960 --> 00:16:38,640 COMPLETE WITHIN SEVEN DAYS OF 350 00:16:38,640 --> 00:16:41,000 STILLBIRTH AND SO NOT ALL THE 351 00:16:41,000 --> 00:16:41,840 INFORMATION IS AVAILABLE. 352 00:16:41,840 --> 00:16:52,320 THE PLACENTAL PATHOLOGY AND 353 00:16:55,440 --> 00:16:58,560 AUTOPSY AND WHEN IT COMES TO THE 354 00:16:58,560 --> 00:17:00,160 TIME OF THE STILLBIRTH IS WHEN 355 00:17:00,160 --> 00:17:01,960 THE PATIENT DELIVERS AND THE 356 00:17:01,960 --> 00:17:04,520 EXACT TIMING OF WHEN THE STILL 357 00:17:04,520 --> 00:17:05,720 BIRTH OCCURRED MAY BE DIFFERENT 358 00:17:05,720 --> 00:17:07,680 AS IT MAY BE DAYS TO WEEKS AFTER 359 00:17:07,680 --> 00:17:10,720 THE BABY HAS DIED BEFORE THE 360 00:17:10,720 --> 00:17:13,960 STILLBIRTH WAS DETECTED AND 361 00:17:13,960 --> 00:17:15,360 DEBBIE CONWAY ON THE PANEL, LED 362 00:17:15,360 --> 00:17:17,680 OUR EFFORTS TO COME UP WITH A 363 00:17:17,680 --> 00:17:22,240 SYSTEM TO ACTUALLY IDENTIFY THE 364 00:17:22,240 --> 00:17:27,320 DATE OF WHEN THE FETUS PASSED. 365 00:17:27,320 --> 00:17:30,560 THOSE ARE TWO EXCLUSIVE EVENTS 366 00:17:30,560 --> 00:17:33,160 AND IT'S MATHEMATIC AND I'M NOT 367 00:17:33,160 --> 00:17:36,440 EXACT ON THE WAY WE ARRIVE AT IT 368 00:17:36,440 --> 00:17:40,040 IF DR. CONWAY WANTS TO GO OVER 369 00:17:40,040 --> 00:17:41,120 THAT WE CAN DO THAT. 370 00:17:41,120 --> 00:17:44,160 IN CONCLUSION, THE FETAL DEATH 371 00:17:44,160 --> 00:17:46,840 CERTIFICATE IS A BIT CUMBERSOME 372 00:17:46,840 --> 00:17:47,240 TO COMPLETE. 373 00:17:47,240 --> 00:17:48,920 I DON'T KNOW HOW I'D DO AT IT, 374 00:17:48,920 --> 00:17:51,080 TO BE HON EST. 375 00:17:51,080 --> 00:17:56,640 THE LACK OF MANAGEMENT OF FETAL 376 00:17:56,640 --> 00:17:58,240 BIRTH CERTIFICATE. 377 00:17:58,240 --> 00:18:00,720 EVERY SYSTEM HAS COME UP WITH 378 00:18:00,720 --> 00:18:02,920 THEIR OWN WAY OF COMPLETING THE 379 00:18:02,920 --> 00:18:03,360 FORMS. 380 00:18:03,360 --> 00:18:05,360 DETERMINING THE CAUSE OF FETAL 381 00:18:05,360 --> 00:18:10,520 DEATH CAN BE DIFFICULT EVEN FOR 382 00:18:10,520 --> 00:18:13,600 EXPERTS AND IT STRUCK ME THAT WE 383 00:18:13,600 --> 00:18:14,960 COULD EASILY WE DEVELOPED INCODE 384 00:18:14,960 --> 00:18:17,800 BACK IN THE TIME WHEN THERE WAS 385 00:18:17,800 --> 00:18:21,600 NOT A LOT OF COMPUTER-BASED 386 00:18:21,600 --> 00:18:23,360 ALGORITHMS IT WOULD BE EASY FOR 387 00:18:23,360 --> 00:18:26,640 SOMEONE WHO KNOWS WHAT THEY'RE 388 00:18:26,640 --> 00:18:29,560 DOING COMPUTER I'D THAT OR THE 389 00:18:29,560 --> 00:18:31,880 CAUSE OF DEATH OR EVALUATION YOU 390 00:18:31,880 --> 00:18:33,760 WANT TO USE AND POTENTIALLY LINK 391 00:18:33,760 --> 00:18:36,120 IT THE EMRs. 392 00:18:36,120 --> 00:18:37,560 I'M SURE THEY'RE GOING TO BE 393 00:18:37,560 --> 00:18:41,240 LEGAL AND OTHER HURDLES TO TRY 394 00:18:41,240 --> 00:18:43,720 TO DO THAT BUT WHERE THERE'S A 395 00:18:43,720 --> 00:18:45,080 WILL THERE'S A WAY AND IT WOULD 396 00:18:45,080 --> 00:18:48,120 MAKE IT SO BASICALLY YOU CAN 397 00:18:48,120 --> 00:18:49,200 EXTRACT THE CLINICAL DATA FROM 398 00:18:49,200 --> 00:18:50,680 THE MEDICAL RECORD AND IT 399 00:18:50,680 --> 00:18:52,880 DEPENDS ON HOW ACCURATE THE 400 00:18:52,880 --> 00:18:54,840 MEDICAL RECORD IS AND CUTS OUT 401 00:18:54,840 --> 00:18:56,720 THE MIDDLEMEN AND THEN IT COULD 402 00:18:56,720 --> 00:19:02,120 BE UPDATEABLE AS MORE 403 00:19:02,120 --> 00:19:03,280 INFORMATION BECAME AVAILABLE AS 404 00:19:03,280 --> 00:19:07,120 THE CAUSE OF DEATH EVOLVES OVER 405 00:19:07,120 --> 00:19:09,440 TIME UNTIL SOMEONE SAYS YOU 406 00:19:09,440 --> 00:19:10,240 FINISHED THE EVALUATION. 407 00:19:10,240 --> 00:19:15,360 AND I THINK THAT CONCLUDES MY 408 00:19:15,360 --> 00:19:16,640 SLIDES AND MY COMMENTS. 409 00:19:16,640 --> 00:19:20,680 I JUST THINK THIS IS SOMETHING 410 00:19:20,680 --> 00:19:25,160 RIPE FOR ELECTRONIC MECHANISM 411 00:19:25,160 --> 00:19:29,440 WOULD CUT OUT -- WOULD MAKE THE 412 00:19:29,440 --> 00:19:35,360 DATA MUCH MORE APPLICABLE. 413 00:19:35,360 --> 00:19:44,960 >>THANK YOU. 414 00:19:44,960 --> 00:19:46,680 DR. DUDLEY IS THE DIVISION CHIEF 415 00:19:46,680 --> 00:19:51,480 OF MATERNAL FETAL MEDICINE IN 416 00:19:51,480 --> 00:19:54,360 THE DEPARTMENT OF OG GYN 417 00:19:54,360 --> 00:19:55,880 DEPARTMENT OF VIRGINIA AND HAS A 418 00:19:55,880 --> 00:20:03,280 LONG TRACK RECORD OF THIS FIELD. 419 00:20:03,280 --> 00:20:04,680 WE'LL SAVE QUESTIONS TOWARDS THE 420 00:20:04,680 --> 00:20:06,080 END OF THE PANEL DISCUSSION. 421 00:20:06,080 --> 00:20:12,360 I ALSO WANTED TO MENTION TO THIS 422 00:20:12,360 --> 00:20:20,640 GROUP THAT THE NICHD WOUL LIKE 423 00:20:20,640 --> 00:20:23,480 YOU ALL TO KNOW -- WOULD LIKE 424 00:20:23,480 --> 00:20:27,080 YOU ALL TO KNOW THERE BE A 425 00:20:27,080 --> 00:20:29,680 PUBLIC LISTENING SESSION COMING 426 00:20:29,680 --> 00:20:31,640 UP AND REGISTRATION INFORMATION 427 00:20:31,640 --> 00:20:37,960 WILL BE COMING YOUR WAY PRETTY 428 00:20:37,960 --> 00:20:38,360 SOON. 429 00:20:38,360 --> 00:20:44,280 THERE'S ALSO AN RFI SEEKING 430 00:20:44,280 --> 00:20:45,960 INFORMATION THAT WOULD BE 431 00:20:45,960 --> 00:20:47,760 HELPFUL IN DEVELOPING A STRONG 432 00:20:47,760 --> 00:20:49,920 STRATEGY AROUND STILLBIRTHS 433 00:20:49,920 --> 00:20:50,200 RESEARCH. 434 00:20:50,200 --> 00:20:53,280 I'M GOING PULL IT UP FOR A 435 00:20:53,280 --> 00:20:55,360 MINUTE SO EVERYONE IS FAMILIAR 436 00:20:55,360 --> 00:21:00,080 AND CAN TRACK ALONG WITH WHAT 437 00:21:00,080 --> 00:21:02,400 NICHD'S ENVISIONING WITH THE 438 00:21:02,400 --> 00:21:03,600 PRESENTATIONS YOU ARE LISTENING 439 00:21:03,600 --> 00:21:03,840 TO. 440 00:21:03,840 --> 00:21:07,360 SO LET ME SEE IF I CAN PULL THIS 441 00:21:07,360 --> 00:21:17,520 UP HERE. 442 00:21:23,120 --> 00:21:26,120 LET ME READ OUT A BRIEF OVERVIEW 443 00:21:26,120 --> 00:21:29,080 OF THE RFI. 444 00:21:29,080 --> 00:21:35,360 THE RFI WHICH IS NOTHD22054 IS 445 00:21:35,360 --> 00:21:36,800 THE NOTICE NUMBER. 446 00:21:36,800 --> 00:21:38,720 IT'S ENTITLED DEVELOPING 447 00:21:38,720 --> 00:21:42,240 STRATEGIES TO STRENGTHEN 448 00:21:42,240 --> 00:21:43,280 RESEARCH ON STILLBIRTH 449 00:21:43,280 --> 00:21:43,880 PREVENTION. 450 00:21:43,880 --> 00:21:48,400 IT WAS RELEASED ON NOVEMBER 10. 451 00:21:48,400 --> 00:21:52,280 RESPONSES ARE DUE IN BY JANUARY 452 00:21:52,280 --> 00:21:55,320 6 OF 2023. 453 00:21:55,320 --> 00:21:58,960 AND I THINK IT'S REALLY 454 00:21:58,960 --> 00:22:02,000 IMPORTANT THAT EVERYONE 455 00:22:02,000 --> 00:22:03,040 PARTICIPATES IN GIVING FEEDBACK 456 00:22:03,040 --> 00:22:08,000 TO THE NICHD SO THE RESEARCH 457 00:22:08,000 --> 00:22:08,520 AGENDA CAN BE PROPERLY 458 00:22:08,520 --> 00:22:15,240 ORGANIZED. 459 00:22:15,240 --> 00:22:18,520 THE FOUR AREAS WE'RE CURRENTLY 460 00:22:18,520 --> 00:22:20,480 FOCUSSING IN ARE ON VALUES TO 461 00:22:20,480 --> 00:22:22,360 COLLECTING DATA ON STILLBIRTHS 462 00:22:22,360 --> 00:22:23,280 THROUGHOUT THE UNITED STATES. 463 00:22:23,280 --> 00:22:25,320 WE'RE LOOKING AT COMMUNITIES AT 464 00:22:25,320 --> 00:22:27,720 HIGH RISK FOR STILLBIRTH AND 465 00:22:27,720 --> 00:22:29,000 LOOKING AT THE PSYCHOLOGICAL 466 00:22:29,000 --> 00:22:30,120 IMPACT AND TREATMENT FOR MOTHERS 467 00:22:30,120 --> 00:22:34,160 FOLLOWING STILLBIRTH AND FINALLY 468 00:22:34,160 --> 00:22:35,240 WE'RE LOOKING AT KNOWN RISK 469 00:22:35,240 --> 00:22:38,880 FACTORS FOR STILLBIRTHS. 470 00:22:38,880 --> 00:22:43,960 SO THANK YOU, DR. DUDLEY FOR THE 471 00:22:43,960 --> 00:22:44,280 INTRODUCTION. 472 00:22:44,280 --> 00:22:53,240 NEXT ON OUR AGENDA WE HAVE A 473 00:22:53,240 --> 00:22:55,360 DISCUSSION ON PREVENTION OR HE 474 00:22:55,360 --> 00:22:56,640 PRESENTATION WILL FOCUS ON 475 00:22:56,640 --> 00:23:00,720 U.S. STILLBIRTHS REGISTRY. 476 00:23:00,720 --> 00:23:07,360 IT'S SIMILARITY WITH DEFECTS 477 00:23:07,360 --> 00:23:10,080 REGISTRY SHE IS FROM THE CDC. 478 00:23:10,080 --> 00:23:10,920 IT'S ALL YOURS. 479 00:23:10,920 --> 00:23:12,000 >>THANK YOU. 480 00:23:12,000 --> 00:23:18,840 >>GOOD MORNING, AS DR. JAIN 481 00:23:18,840 --> 00:23:22,440 SAID I'M DR. REEFHUIS. 482 00:23:22,440 --> 00:23:24,240 I WATCHED THE RECORDING OF THE 483 00:23:24,240 --> 00:23:25,720 FIRST MEETING I'M SORRY I MISSED 484 00:23:25,720 --> 00:23:28,760 AND HOPE TO ANSWER QUESTIONS 485 00:23:28,760 --> 00:23:30,840 RAISED AROUND WHAT CDC IS DOING 486 00:23:30,840 --> 00:23:31,480 AROUND FETAL DEATH SURVEILLANCE 487 00:23:31,480 --> 00:23:35,960 AND RESEARCH. 488 00:23:35,960 --> 00:23:39,960 BEFORE I WANT TO MAKE A NOTE ON 489 00:23:39,960 --> 00:23:41,320 TERMINOLOGY. 490 00:23:41,320 --> 00:23:42,440 CDC USES STILLBIRTH AND STILL 491 00:23:42,440 --> 00:23:47,200 DEATH TO REFER TO THE LOSS OF A 492 00:23:47,200 --> 00:23:50,840 BABY AT OR AFTER 20 WEEKS OF 493 00:23:50,840 --> 00:23:51,080 PREGNANCY. 494 00:23:51,080 --> 00:23:54,160 YOU HEARD FROM ANY COLLEGIATE 495 00:23:54,160 --> 00:23:54,600 THE LAST MEETING. 496 00:23:54,600 --> 00:23:56,640 THERE'S SEVERAL GROUPS AT CDC 497 00:23:56,640 --> 00:23:58,840 THAT LOOK AT FETAL DEATHS 498 00:23:58,840 --> 00:24:01,080 INCLUDING NCHI AND THE DIVISION 499 00:24:01,080 --> 00:24:02,880 OF REPRODUCTIVE HEALTH AND I 500 00:24:02,880 --> 00:24:03,840 KNOW COLLEAGUES ARE ATTENDING 501 00:24:03,840 --> 00:24:04,240 TODAY. 502 00:24:04,240 --> 00:24:06,080 I'LL FOCUS ON THE WORK THE 503 00:24:06,080 --> 00:24:08,640 DIVISION OF BIRTH DEFECTS AND 504 00:24:08,640 --> 00:24:14,280 INFANT DISORDERS. 505 00:24:14,280 --> 00:24:16,200 SO WHAT IS THE BRANCH TALKING 506 00:24:16,200 --> 00:24:18,040 ABOUT FETAL DEATHS? 507 00:24:18,040 --> 00:24:22,320 AS MENTIONED LAST TIME IN 2020, 508 00:24:22,320 --> 00:24:23,960 31.6% OF THE FETAL DEATHS HAD AN 509 00:24:23,960 --> 00:24:26,000 UNKNOWN CAUSE OF DEATH BUT OF 510 00:24:26,000 --> 00:24:29,040 THOSE WHERE THE CAUSE IS KNOWN, 511 00:24:29,040 --> 00:24:32,840 15.5% WERE CAUSED BY BIRTH 512 00:24:32,840 --> 00:24:34,160 DEFECTS SO THERE'S SUBSTANTIAL 513 00:24:34,160 --> 00:24:34,600 OVERLAP. 514 00:24:34,600 --> 00:24:37,320 THE FETAL DEATH RISK AMONG SOME 515 00:24:37,320 --> 00:24:39,760 SPECIFIC BIRTH DEFECTS. 516 00:24:39,760 --> 00:24:42,320 FOR SOME WE KNOW THE RISK WAS 517 00:24:42,320 --> 00:24:47,680 HIGH BUT EVEN FOR BIRTH DEFECTS 518 00:24:47,680 --> 00:24:54,200 NOT AFFECTING ORGAN WE SEE AN 519 00:24:54,200 --> 00:24:54,560 ELEVATED RISK. 520 00:24:54,560 --> 00:24:55,800 THERE'S EFFICIENCIES TO BE 521 00:24:55,800 --> 00:24:58,240 REACHED BY COMBINING WORK ON 522 00:24:58,240 --> 00:25:00,640 THESE TWO TOPICS AND AS SOMEONE 523 00:25:00,640 --> 00:25:01,440 WHO WORKED WITH SURVEILLANCE 524 00:25:01,440 --> 00:25:03,360 SYSTEMS FOR MY ENTIRE CAREER, 525 00:25:03,360 --> 00:25:05,760 THE FOUNDATION FOR THAT WORK 526 00:25:05,760 --> 00:25:06,640 SHOULD BE SURVEILLANCE. 527 00:25:06,640 --> 00:25:08,880 AS MANY KNOW, MUCH OF OUR 528 00:25:08,880 --> 00:25:10,360 CURRENT SURVEILLANCE RELIES ON 529 00:25:10,360 --> 00:25:13,640 FETAL DEATH CERTIFICATES AS 530 00:25:13,640 --> 00:25:15,840 DR. GREGORY EXPLAINED HAS THE 531 00:25:15,840 --> 00:25:17,160 ADVANTAGE OF HAVING A BROAD 532 00:25:17,160 --> 00:25:18,640 REACH ACROSS THE UNITED STATES. 533 00:25:18,640 --> 00:25:23,320 THIS IS A FORM OF PASSIVE CASE 534 00:25:23,320 --> 00:25:24,600 FINDING WHERE'S THE SYSTEM 535 00:25:24,600 --> 00:25:25,840 RECEIVES REPORTS FROM HOSPITALS 536 00:25:25,840 --> 00:25:27,360 AND OTHER SERVICES BUT THERE'S 537 00:25:27,360 --> 00:25:29,080 NO FOLLOW-UP TO CONFIRM THE 538 00:25:29,080 --> 00:25:29,360 DATA. 539 00:25:29,360 --> 00:25:32,640 TO USE BIRTH DEFECT AS A 540 00:25:32,640 --> 00:25:32,960 COMPARATOR. 541 00:25:32,960 --> 00:25:34,640 THERE SURVEILLANCE METHODS VARY 542 00:25:34,640 --> 00:25:36,800 BY STATE AND SOME RELY ON 543 00:25:36,800 --> 00:25:38,280 PASSIVE CASE FINDING AND THERE'S 544 00:25:38,280 --> 00:25:40,080 AN INFRASTRUCTURE IN PLACE FOR 545 00:25:40,080 --> 00:25:42,120 OTHER METHODS. 546 00:25:42,120 --> 00:25:43,160 AN ACTIVE SURVEILLANCE SYSTEMS 547 00:25:43,160 --> 00:25:45,240 STAFF MEMBERS CONTINUALLY REVIEW 548 00:25:45,240 --> 00:25:48,000 MEDICAL RECORDS FROM USUALLY 549 00:25:48,000 --> 00:25:49,200 MULTIPLE HEALTH CARE FACILITIES 550 00:25:49,200 --> 00:25:52,720 IN A GIVEN GEOGRAPHIC AREA THAT 551 00:25:52,720 --> 00:25:54,600 DIAGNOSE AND CARE FOR CHILDREN 552 00:25:54,600 --> 00:25:56,360 WITH BIRTH DEFECTS. 553 00:25:56,360 --> 00:26:00,240 FOR EACH CASE IDENTIFIED THEY 554 00:26:00,240 --> 00:26:01,600 COLLECT INFORMATION ON MOTHER 555 00:26:01,600 --> 00:26:02,000 AND BABY. 556 00:26:02,000 --> 00:26:05,400 THIS CAN BE TIME AND RESOURCE 557 00:26:05,400 --> 00:26:07,040 INTENSIVE BUT RESULTS IN THE 558 00:26:07,040 --> 00:26:07,720 MOST COMPLETE COLLECTION OF 559 00:26:07,720 --> 00:26:09,680 BIRTH DEFECTS DATA. 560 00:26:09,680 --> 00:26:11,640 THERE ARE ALSO STATES WITH 561 00:26:11,640 --> 00:26:13,040 PASSIVE CASE FINDING WITH 562 00:26:13,040 --> 00:26:13,360 CONFIRMATION. 563 00:26:13,360 --> 00:26:17,520 THE SYSTEMS DO NOT RELY ON 564 00:26:17,520 --> 00:26:18,320 COMMITTED STAFF TO FIND 565 00:26:18,320 --> 00:26:20,200 INFORMATION ABOUT PREGNANCIES 566 00:26:20,200 --> 00:26:21,680 IMPACTED BY BIRTH DEFECTS BUT 567 00:26:21,680 --> 00:26:26,080 RELY ON AGREEMENTS TO USE A SET 568 00:26:26,080 --> 00:26:28,600 OF CASE DEFINITION OFTEN ICD 569 00:26:28,600 --> 00:26:31,000 CODES FROM HOSPITALS AND OTHER 570 00:26:31,000 --> 00:26:31,800 AVAILABLE HEALTH CARE SERVICE. 571 00:26:31,800 --> 00:26:34,800 THE INFORMATION IS REVIEWED AND 572 00:26:34,800 --> 00:26:37,320 VARIED MOTHER ODDS ARE USED TO 573 00:26:37,320 --> 00:26:38,600 VERIFY THE DIAGNOSES OF THE 574 00:26:38,600 --> 00:26:40,040 BABIES REPORTED TO HAVE BIRTH 575 00:26:40,040 --> 00:26:40,440 DEFECTS. 576 00:26:40,440 --> 00:26:43,360 ALL THE METHODS ARE POPULATION 577 00:26:43,360 --> 00:26:44,920 BASED OPPOSED TO CLINIC BASED. 578 00:26:44,920 --> 00:26:45,920 THIS IS CRUCIAL TO DEVELOP A 579 00:26:45,920 --> 00:26:47,840 CLEAR UNDERSTANDING HOW THE 580 00:26:47,840 --> 00:26:49,960 ENTIRE POPULATION IS IMPACTED 581 00:26:49,960 --> 00:26:56,680 AND SNFK TO ALLOW US TO ASSESS 582 00:26:56,680 --> 00:26:57,120 HEALTH INEQUITIES. 583 00:26:57,120 --> 00:27:00,960 OUR DIVISION IS ABLE TO SUPPORT 584 00:27:00,960 --> 00:27:02,560 BIRTH DEFECT SURVEILLANCE ACROSS 585 00:27:02,560 --> 00:27:05,360 THE COUNTRY WITH 10 586 00:27:05,360 --> 00:27:06,320 POPULATION-BASED SURVEILLANCE 587 00:27:06,320 --> 00:27:08,640 PROGRAMS AND SEVEN SITES 588 00:27:08,640 --> 00:27:10,640 PARTICIPATING TO EVALUATE 589 00:27:10,640 --> 00:27:11,800 PREGNANCY EXPOSURES WHICH I'LL 590 00:27:11,800 --> 00:27:18,080 DISCUSS IN MORE DETAIL LATER. 591 00:27:18,080 --> 00:27:20,360 IN 2005, OUR DIVISION STARTED 592 00:27:20,360 --> 00:27:25,560 WORK TO EXPLORE THE FEASIBILITY 593 00:27:25,560 --> 00:27:29,120 OF FETAL BIRTH SURVEILLANCE AND 594 00:27:29,120 --> 00:27:34,760 TWO SYSTEMS IN IOWA AND 595 00:27:34,760 --> 00:27:35,280 METROPOLITAN IOWA WERE 596 00:27:35,280 --> 00:27:38,600 ESTABLISHED TO USE AS A 597 00:27:38,600 --> 00:27:39,560 FOUNDATION FOR RESEARCH AND FOR 598 00:27:39,560 --> 00:27:49,800 FETAL DEATHS. 599 00:27:52,680 --> 00:28:00,480 WE LEARNED FETAL DEATH RECORDS 600 00:28:00,480 --> 00:28:03,960 CONTRIBUTE TO DATA AND SEVERAL 601 00:28:03,960 --> 00:28:05,600 WOUND UP NOT INCLUDED WITH THE 602 00:28:05,600 --> 00:28:06,760 MOST COMMON REASON BEING IN THE 603 00:28:06,760 --> 00:28:09,240 MEDICAL RECORD THE PREGNANCY WAS 604 00:28:09,240 --> 00:28:10,760 REPORTED TO BE LESS THAN 20 605 00:28:10,760 --> 00:28:12,800 WEEKS GESTATION. 606 00:28:12,800 --> 00:28:14,400 THESE FINDINGS PROVIDE IMPORTANT 607 00:28:14,400 --> 00:28:17,240 INFORMATION AND GUIDANCE FOR 608 00:28:17,240 --> 00:28:19,360 FUTURE WORK ON FETAL DEATH 609 00:28:19,360 --> 00:28:21,000 SURVEILLANCE. 610 00:28:21,000 --> 00:28:24,520 WE USED WHAT WE LEARNED IN THE 611 00:28:24,520 --> 00:28:26,400 PROJECT TO EXPAND OUR BIRTH 612 00:28:26,400 --> 00:28:27,960 DEFECT RESEARCH TO INCLUDE FETAL 613 00:28:27,960 --> 00:28:28,200 DEATHS. 614 00:28:28,200 --> 00:28:30,080 THE BIRTH DEFECT STUDY TO 615 00:28:30,080 --> 00:28:31,920 EVALUATE PREGNANCY EXPOSURES IS 616 00:28:31,920 --> 00:28:34,280 A LARGE CASE CONTROLLED STUDY 617 00:28:34,280 --> 00:28:35,320 THAT STARTED TO COLLECT 618 00:28:35,320 --> 00:28:37,840 INFORMATION ON BIRTH DEFECTS IN 619 00:28:37,840 --> 00:28:38,080 2013. 620 00:28:38,080 --> 00:28:43,240 IN 2015 WE STARTED INCLUDING 621 00:28:43,240 --> 00:28:44,760 FETAL DEATHS AS WELL. 622 00:28:44,760 --> 00:28:47,200 TWO OF THE SEVEN SITES, ARKANSAS 623 00:28:47,200 --> 00:28:48,800 AND MASSACHUSETTS WERE FUNDED TO 624 00:28:48,800 --> 00:28:50,680 CONDUCT ACTIVE FETAL DEATH 625 00:28:50,680 --> 00:28:53,880 SURVEILLANCE MEANING THEY 626 00:28:53,880 --> 00:28:54,760 IDENTIFY FETAL DEATHS THROUGH 627 00:28:54,760 --> 00:28:58,480 HOSPITAL RECORDS AND REVIEWED 628 00:28:58,480 --> 00:28:59,280 THE MEDICAL RECORD AND THEY'RE 629 00:28:59,280 --> 00:29:00,440 IN THE PROCESS OF REVIEWING ALL 630 00:29:00,440 --> 00:29:02,680 THE CASE TO CLASSIFY THE CAUSE 631 00:29:02,680 --> 00:29:08,720 OF DEATH. 632 00:29:08,720 --> 00:29:17,640 AND BD STEPS IS A CASE CONTROL 633 00:29:17,640 --> 00:29:18,000 STUDY. 634 00:29:18,000 --> 00:29:20,200 THE INTERVIEW COVERS A WIDE 635 00:29:20,200 --> 00:29:21,680 RANGE OF POSSIBLE RISK FACTORS 636 00:29:21,680 --> 00:29:25,440 INCLUDING ILLNESS, STRESS, AND 637 00:29:25,440 --> 00:29:26,480 INFORMATION ABOUT FETAL 638 00:29:26,480 --> 00:29:26,760 MOVEMENT. 639 00:29:26,760 --> 00:29:31,640 THE TWO SITES HAVE CONDUCTED 503 640 00:29:31,640 --> 00:29:33,600 INTERVIEWS WITH WOMEN WHO 641 00:29:33,600 --> 00:29:34,760 EXPERIENCED FETAL DEATH AND MOST 642 00:29:34,760 --> 00:29:38,400 DIDN'T HAVE A BIRTH DEFECT AND 643 00:29:38,400 --> 00:29:42,600 375 INTERVIEWS IN THE CONTROL. 644 00:29:42,600 --> 00:29:44,960 WHILE WE'RE WAITING FOR THE DATA 645 00:29:44,960 --> 00:29:47,240 TO BE CLEANED FOR ANALYSIS WE 646 00:29:47,240 --> 00:29:49,200 PUBLISHED OTHER PROJECTS I'LL 647 00:29:49,200 --> 00:29:50,800 DESCRIBE IN THE NEXT FEW SLIDES. 648 00:29:50,800 --> 00:29:54,400 WE USED THREE DATA SOURCES 649 00:29:54,400 --> 00:29:56,160 AVAILABLE, THE NATIONAL VITAL 650 00:29:56,160 --> 00:29:58,320 STATISTICS DATA THE LARGEST 651 00:29:58,320 --> 00:29:59,280 FETAL DEATH DATA WE HAVE IN THE 652 00:29:59,280 --> 00:30:00,520 POPULATION AND DATA FROM THE 653 00:30:00,520 --> 00:30:07,360 NATIONAL BIRTH DEFECTS 654 00:30:07,360 --> 00:30:08,320 PREVENTION STUDY COLLECTING 655 00:30:08,320 --> 00:30:10,280 INFORMATION ON FETAL DEATHS BUT 656 00:30:10,280 --> 00:30:13,160 ONLY FOR CASES WITH BIRTH 657 00:30:13,160 --> 00:30:19,000 DEFECTS IN 10 STATES AND THE 658 00:30:19,000 --> 00:30:21,400 METROPOLITAN STUDY I DISCUSSED 659 00:30:21,400 --> 00:30:21,680 EARLIER. 660 00:30:21,680 --> 00:30:25,600 IN EARLY 2020, WE COLLABORATED 661 00:30:25,600 --> 00:30:27,360 WITH COLLEAGUES AND PUBLISHED A 662 00:30:27,360 --> 00:30:32,040 REPORT BASED ON VITAL STATISTIC 663 00:30:32,040 --> 00:30:34,560 DATA AND IT SHOWED 1 IN EVERY 664 00:30:34,560 --> 00:30:36,920 166 PREGNANCIES ENDED IN A FETAL 665 00:30:36,920 --> 00:30:39,240 DEATH AND A THIRD DID NOT HAVE A 666 00:30:39,240 --> 00:30:41,960 CAUSE SPECIFIED ON THE RECORD. 667 00:30:41,960 --> 00:30:45,360 WE ALSO DESCRIBED DIFFERENCES BY 668 00:30:45,360 --> 00:30:51,920 RACE, ETHNICITY. 669 00:30:51,920 --> 00:30:53,680 ON THE LEFT YOU SEE FETAL DEATH 670 00:30:53,680 --> 00:30:54,200 RATE BY STATE. 671 00:30:54,200 --> 00:30:56,040 THE DARKER THE BLUE, THE HIGHER 672 00:30:56,040 --> 00:30:58,120 THE RATE OF FETAL DEATH. 673 00:30:58,120 --> 00:31:00,600 IN THE TOP LEFT YOU SEE THE OVER 674 00:31:00,600 --> 00:31:02,760 ALL RATE FOR ALL ETHNICITIES 675 00:31:02,760 --> 00:31:04,240 COMBINED WITH HIGHER RATES IN 676 00:31:04,240 --> 00:31:04,760 THE SOUTHEAST. 677 00:31:04,760 --> 00:31:07,360 YOU CAN SEE IN THE OTHER THREE 678 00:31:07,360 --> 00:31:09,800 MAPS, ONCE YOU STRATIFY BY RACE, 679 00:31:09,800 --> 00:31:12,080 ETHNICITY THE FETAL DEATH RATES 680 00:31:12,080 --> 00:31:14,400 ARE RELATIVELY CONSISTENT AND 681 00:31:14,400 --> 00:31:16,000 HIGHEST FOR NON-HISPANIC BLACK 682 00:31:16,000 --> 00:31:16,200 WOMEN. 683 00:31:16,200 --> 00:31:17,960 THE GRAPH ON THE RIGHT SHOWS THE 684 00:31:17,960 --> 00:31:20,800 DISTRIBUTION OF RACE ETHNICITY 685 00:31:20,800 --> 00:31:22,440 WITHIN EACH ASSIGNED CAUSE OF 686 00:31:22,440 --> 00:31:23,000 DEATH. 687 00:31:23,000 --> 00:31:25,040 THOUGH THE DISTRIBUTION IS 688 00:31:25,040 --> 00:31:26,680 PRETTY EVEN WITH BIRTH EFFECTS 689 00:31:26,680 --> 00:31:28,880 YOU CAN SEE THE HIGHER RATES FOR 690 00:31:28,880 --> 00:31:29,960 NON-HISPANIC BLACK WOMEN FOR ALL 691 00:31:29,960 --> 00:31:35,600 OTHER CAUSES OR MOST OF THEM. 692 00:31:35,600 --> 00:31:38,480 I ALSO WANTED TO SHARE TWO 693 00:31:38,480 --> 00:31:39,760 RECENT PAPERS LED BY SOME 694 00:31:39,760 --> 00:31:41,000 COLLABORATORS FROM MASSACHUSETTS 695 00:31:41,000 --> 00:31:45,760 USING DATA. 696 00:31:45,760 --> 00:31:49,880 THE FIRST DESCRIBED FETAL DEATH 697 00:31:49,880 --> 00:31:54,920 RISK AND A SECOND LOOKED AT 698 00:31:54,920 --> 00:31:56,120 PREGNANCIES AFFECTED BY BIRTH 699 00:31:56,120 --> 00:32:01,560 DEFECTS AND VASO MEDICATIONS 700 00:32:01,560 --> 00:32:03,200 CAUSE EFFECT AND RESEARCHERS 701 00:32:03,200 --> 00:32:04,160 ACKNOWLEDGE MORE RESEARCH IS 702 00:32:04,160 --> 00:32:06,680 NEEDED SINCE IT COULD BE RELATED 703 00:32:06,680 --> 00:32:07,840 TO THE UNDERLYING HYPERTENSION 704 00:32:07,840 --> 00:32:09,800 INSTEAD OF MEDICATION. 705 00:32:09,800 --> 00:32:12,240 AND DATA FROM BD STEPS COULD BE 706 00:32:12,240 --> 00:32:13,000 USED TO FURTHER EXPLORE THE 707 00:32:13,000 --> 00:32:14,240 ASSOCIATION BUT WE STARTED TO 708 00:32:14,240 --> 00:32:15,400 LOOK AT THE RISK FACTORS WITH 709 00:32:15,400 --> 00:32:21,480 THE DATA AVAILABLE TO US. 710 00:32:21,480 --> 00:32:25,000 AND LASTLY, I WANTED TO MENTION 711 00:32:25,000 --> 00:32:26,680 A RECENT PUBLICATION THAT 712 00:32:26,680 --> 00:32:29,560 SUMMARIZES THE FETAL DEATH DATA 713 00:32:29,560 --> 00:32:30,880 VIA THE ENHANCED UNIVERSAL 714 00:32:30,880 --> 00:32:32,640 PROJECT. 715 00:32:32,640 --> 00:32:37,800 DATA WAS COLLECTED ON 2,211 716 00:32:37,800 --> 00:32:41,280 FETAL DEATHS AND AS SEEN HERE 717 00:32:41,280 --> 00:32:42,280 COMBINING ACTIVE SURVEILLANCE 718 00:32:42,280 --> 00:32:45,440 DATA WITH FETAL DEATH 719 00:32:45,440 --> 00:32:49,000 CERTIFICATE DATA APPEARS TO 720 00:32:49,000 --> 00:32:50,880 SUPPORT MORE ACCURATE DEATH 721 00:32:50,880 --> 00:32:51,240 ASCERTAINMENT. 722 00:32:51,240 --> 00:32:53,360 THERE'S MORE WORK TO BE DONE 723 00:32:53,360 --> 00:32:54,400 WHICH IS WHY WE'RE. 724 00:32:54,400 --> 00:32:55,920 WE HAVE SEVERAL ACTIVITIES 725 00:32:55,920 --> 00:32:57,840 PLANNED AROUND FETAL DEATHS. 726 00:32:57,840 --> 00:32:59,920 SOME OF OUR IMMEDIATE WORK 727 00:32:59,920 --> 00:33:01,680 INCLUDES BEGINNING ANALYSIS OF 728 00:33:01,680 --> 00:33:03,400 BD STEPS FETAL DEATH DATA AND 729 00:33:03,400 --> 00:33:05,000 CLASSIFICATION OF CAUSES IS 730 00:33:05,000 --> 00:33:06,680 UNDERWAY AND THE INTERVIEW DATA 731 00:33:06,680 --> 00:33:07,920 ARE BEING CLEANED AND GETTING 732 00:33:07,920 --> 00:33:08,680 READY FOR ANALYSIS. 733 00:33:08,680 --> 00:33:10,040 I HOPE THIS MEETING CAN GIVE US 734 00:33:10,040 --> 00:33:11,960 SOME DIRECTION AS TO WHICH 735 00:33:11,960 --> 00:33:12,640 TOPICS TO PRIORITIZE ONCE THE 736 00:33:12,640 --> 00:33:16,560 DATA ARE READY. 737 00:33:16,560 --> 00:33:21,600 WE HAVE ALSO FORECASTED A NOTICE 738 00:33:21,600 --> 00:33:24,000 OF FUNDING AND WE WILL CONTINUE 739 00:33:24,000 --> 00:33:25,280 TO COLLECT INFORMATION TO ASSESS 740 00:33:25,280 --> 00:33:27,000 POSSIBLE RISK FACTORS. 741 00:33:27,000 --> 00:33:29,280 AND FINALLY, WE'RE FORECASTING A 742 00:33:29,280 --> 00:33:31,360 NOTICE OF FUNDING OPPORTUNITIES 743 00:33:31,360 --> 00:33:34,520 FOR PREGNANCY INFANT LINKED 744 00:33:34,520 --> 00:33:35,520 SURVEILLANCE INCLUDING SEVERAL 745 00:33:35,520 --> 00:33:42,520 OUTCOMES INCLUDING FETAL DEATHS. 746 00:33:42,520 --> 00:33:44,400 AGAIN, THANK YOU FOR THE 747 00:33:44,400 --> 00:33:45,520 OPPORTUNITY TO SHARE WHAT WE'RE 748 00:33:45,520 --> 00:33:46,960 WORKING ON AT THE CDC AND I'M 749 00:33:46,960 --> 00:33:57,440 HAPPY TO ANSWER ANY QUESTIONS. 750 00:33:59,080 --> 00:34:01,880 >>THANK YOU, SO MUCH. 751 00:34:01,880 --> 00:34:03,600 I CAN'T IMAGINE ANY BETTER 752 00:34:03,600 --> 00:34:08,680 PERSON TO HAVE COVERED THIS 753 00:34:08,680 --> 00:34:12,480 ASPECT OF STILLBIRTH DATA 754 00:34:12,480 --> 00:34:13,400 GATHERING AT THE RESEARCH BRANCH 755 00:34:13,400 --> 00:34:14,600 AT THE CDC. 756 00:34:14,600 --> 00:34:18,120 I'M LOOKING FORWARD TO THE 757 00:34:18,120 --> 00:34:18,720 DISCUSSION SESSION. 758 00:34:18,720 --> 00:34:20,640 I'M SURE THERE'LL BE LOTS OF 759 00:34:20,640 --> 00:34:30,760 QUESTIONS FOR YOU. 760 00:34:30,760 --> 00:34:35,600 OUR NEXT SPEAKER IS THE 761 00:34:35,600 --> 00:34:37,840 EXECUTIVE OFFICER FOR THE CENTER 762 00:34:37,840 --> 00:34:40,840 FOR INHERITED DISORDERS STATE 763 00:34:40,840 --> 00:34:43,320 GENETICS COORDINATOR FOR THE 764 00:34:43,320 --> 00:34:47,920 IOWA DEPARTMENT OF PUBLIC 765 00:34:47,920 --> 00:34:50,560 HEALTH. 766 00:34:50,560 --> 00:34:52,320 I'M THRILLED, KIMBERLY, YOU WERE 767 00:34:52,320 --> 00:34:53,200 ABLE TO PARTICIPATE IN THIS 768 00:34:53,200 --> 00:34:53,600 DISCUSSION TODAY. 769 00:34:53,600 --> 00:34:56,920 OVER TO YOU. 770 00:34:56,920 --> 00:34:59,720 >>THANK YOU, DR., JAIN. 771 00:34:59,720 --> 00:35:00,440 AND THANK YOU FOR THE 772 00:35:00,440 --> 00:35:02,320 OPPORTUNITY TO SHARE IOWA'S 773 00:35:02,320 --> 00:35:08,680 EXPERIENCE FROM THE FIELD AND 774 00:35:08,680 --> 00:35:09,680 THE PREVIOUS SPEAKER SET ME UP 775 00:35:09,680 --> 00:35:10,520 FOR THIS AS WELL. 776 00:35:10,520 --> 00:35:12,720 I HAVE NO DISCLOSURES TO REPORT 777 00:35:12,720 --> 00:35:15,320 AND FOR THIS PRESENTATION I USE 778 00:35:15,320 --> 00:35:17,320 THE TERM STILLBIRTH AND FETAL 779 00:35:17,320 --> 00:35:20,960 DEATH INTERCHANGEABLY. 780 00:35:20,960 --> 00:35:23,360 I'M GOING DESCRIBE TWO PARALLEL 781 00:35:23,360 --> 00:35:25,400 PROJECTS IOWA USED TO BUILD THE 782 00:35:25,400 --> 00:35:26,640 INFRASTRUCTURE FOR STILLBIRTH 783 00:35:26,640 --> 00:35:31,920 SURVEILLANCE. 784 00:35:31,920 --> 00:35:35,360 IN 2004 A BILL WAS SIGNED BY THE 785 00:35:35,360 --> 00:35:38,280 GOVERNOR AND THIS HOUSE FILE 786 00:35:38,280 --> 00:35:40,560 2362 CAME FROM LEGISLATION 787 00:35:40,560 --> 00:35:42,960 INTRODUCED BY 788 00:35:42,960 --> 00:35:48,520 THEN-REPRESENTATIVE JANET 789 00:35:48,520 --> 00:35:53,840 PETERSON WHO HAD THE HEARD 790 00:35:53,840 --> 00:35:56,840 BREAKING EXPERIENCE AND BEGAN TO 791 00:35:56,840 --> 00:35:59,240 LOOK AT WAYS TO UNDERSTAND THE 792 00:35:59,240 --> 00:36:02,800 OCCURRENCE OF STILLBIRTHS AND 793 00:36:02,800 --> 00:36:04,560 INTRODUCE HOUSE FILE 2362. 794 00:36:04,560 --> 00:36:06,600 THE INTENT WAS HAVE THE IOWA 795 00:36:06,600 --> 00:36:07,520 DEPARTMENT OF PUBLIC HEALTH 796 00:36:07,520 --> 00:36:10,440 STUDY AND DEVELOP PREVENTION 797 00:36:10,440 --> 00:36:11,960 STRATEGIES TO REDUCE STILLBIRTHS 798 00:36:11,960 --> 00:36:14,360 AND OTHER INHERITED OR 799 00:36:14,360 --> 00:36:15,600 CONGENITAL DISORDERS WHICH CAN 800 00:36:15,600 --> 00:36:17,480 CAUSE DEATH AND DISABILITY IN 801 00:36:17,480 --> 00:36:17,720 NEWBORNS. 802 00:36:17,720 --> 00:36:19,720 THE AIM WAS TO ENABLE THE 803 00:36:19,720 --> 00:36:22,600 DEPARTMENT TO ESTABLISH A 804 00:36:22,600 --> 00:36:24,360 STILLBIRTH PROTOCOL WORK GROUND 805 00:36:24,360 --> 00:36:25,600 FOR THE GUIDELINES AND 806 00:36:25,600 --> 00:36:26,760 EVALUATIONS OF CAUSES AND 807 00:36:26,760 --> 00:36:33,920 PREVENTION OF STILLBIRTHS. 808 00:36:33,920 --> 00:36:35,200 AND LOOK AT SURVEILLANCE TOOLS 809 00:36:35,200 --> 00:36:40,640 AND PROCESSES FROM THAT. 810 00:36:40,640 --> 00:36:43,880 SO WE START BY BUILDING A SYSTEM 811 00:36:43,880 --> 00:36:47,160 FOR STILL BIRTH SURVEILLANCE. 812 00:36:47,160 --> 00:36:51,040 WE CONVENED AN EXPERT WORK 813 00:36:51,040 --> 00:36:51,320 GROUP. 814 00:36:51,320 --> 00:36:52,320 THE LIST OF THE WORK GROUP IS 815 00:36:52,320 --> 00:36:57,280 DESCRIBED HERE. 816 00:36:57,280 --> 00:37:00,560 THE AIM WAS TO BUILD AN 817 00:37:00,560 --> 00:37:01,760 EVALUATION TOOL AND PROVIDE 818 00:37:01,760 --> 00:37:03,680 GUIDANCE AND THE EVALUATION OF 819 00:37:03,680 --> 00:37:05,440 STILLBIRTH OCCURRENCE. 820 00:37:05,440 --> 00:37:07,920 IN ADDITION WE ALSO ENGAGED WITH 821 00:37:07,920 --> 00:37:10,200 OTHER IOWA DEPARTMENT OF PUBLIC 822 00:37:10,200 --> 00:37:13,400 HEALTH STAFF AND OUR MEDIA 823 00:37:13,400 --> 00:37:16,560 RELATIONS AREA AND OUR STATE 824 00:37:16,560 --> 00:37:17,560 CHILD DEATH REVIEW TEAM AND 825 00:37:17,560 --> 00:37:20,280 STAFF IN GENETICS PROGRAMS AS 826 00:37:20,280 --> 00:37:23,880 WELL. 827 00:37:23,880 --> 00:37:26,680 IN DEVELOPING THE SYSTEM WE 828 00:37:26,680 --> 00:37:30,320 WANTED TO DESIGN A STILLBIRTH 829 00:37:30,320 --> 00:37:30,960 EVALUATION PROTOCOL WITH AN 830 00:37:30,960 --> 00:37:33,520 EVALUATION FORM AND THIS WAS 831 00:37:33,520 --> 00:37:36,760 BASED ON WISCONSIN'S PROGRAM THE 832 00:37:36,760 --> 00:37:38,480 WISCONSIN STILLBIRTH 833 00:37:38,480 --> 00:37:39,720 SURVEILLANCE PROGRAM FORMS AND 834 00:37:39,720 --> 00:37:41,400 YOU CAN FIND LINKS TO THOSE AT 835 00:37:41,400 --> 00:37:42,960 THE BOTTOM OF THE PAGE. 836 00:37:42,960 --> 00:37:44,320 WE HELD WORK GROUP MEETINGS. 837 00:37:44,320 --> 00:37:46,960 WE WE VIEWED THE PROCESS FOR 838 00:37:46,960 --> 00:37:48,120 EVALUATION OF STILLBIRTH. 839 00:37:48,120 --> 00:37:50,520 THE GOALS WERE REVIEWED, WE 840 00:37:50,520 --> 00:37:52,320 DISCUSSED THE EVALUATION TOOL, 841 00:37:52,320 --> 00:37:53,120 THE DISSEMINATION OF THE TOOL 842 00:37:53,120 --> 00:37:54,840 AND A MANUAL THAT WENT ALONG 843 00:37:54,840 --> 00:37:56,320 WITH THAT AND WE EDITED THE TOOL 844 00:37:56,320 --> 00:38:06,200 AS WE WENT ALONG. 845 00:38:06,200 --> 00:38:09,880 WE DESIGN THE STILLBIRTH 846 00:38:09,880 --> 00:38:10,440 EVALUATION PROTOCOL WITH 847 00:38:10,440 --> 00:38:13,520 DIFFERENT SECTIONS AND THIS 848 00:38:13,520 --> 00:38:15,320 EXPANDS UPON WHAT YOU WOULD FIND 849 00:38:15,320 --> 00:38:17,800 IN THE FETAL DEATH CERTIFICATE. 850 00:38:17,800 --> 00:38:22,960 THE SECTIONS INCLUDE MORE 851 00:38:22,960 --> 00:38:27,520 DETAILED HISTORY AND HISTORY AND 852 00:38:27,520 --> 00:38:30,200 A PATIENT INTERVIEW. 853 00:38:30,200 --> 00:38:32,120 THERE'S A SECTION FOR NARRATIVE 854 00:38:32,120 --> 00:38:34,320 FOR THE PATIENT OR MOTHER TO 855 00:38:34,320 --> 00:38:36,920 DESCRIBE HER EXPERIENCE WITH THE 856 00:38:36,920 --> 00:38:37,200 STILLBIRTH. 857 00:38:37,200 --> 00:38:39,960 WE ALSO ASKED THEM TO RECORD ON 858 00:38:39,960 --> 00:38:42,480 GROSS FETAL, UMBILICAL AND 859 00:38:42,480 --> 00:38:47,360 PLACENTAL CORD EXAMINES AND 860 00:38:47,360 --> 00:38:50,680 PROVIDED RECOMMENDED PATHOLOGY 861 00:38:50,680 --> 00:38:53,840 AND POSTMOREM EVALUATION AND 862 00:38:53,840 --> 00:38:54,880 RECOMMENDED WAYS TO FOLLOW UP 863 00:38:54,880 --> 00:38:57,800 WITH THE FAMILY AND MADE SURE WE 864 00:38:57,800 --> 00:39:00,520 WE PROVIDED CULTURALLY SPECIFIC 865 00:39:00,520 --> 00:39:01,480 GRIEF SUPPORT INFORMATION. 866 00:39:01,480 --> 00:39:04,960 THE HOSPITALS THAT FILL THIS OUT 867 00:39:04,960 --> 00:39:09,040 ESPECIALLY THE SMALLER HOSPITALS 868 00:39:09,040 --> 00:39:10,520 DON'T HAVE STILLBIRTHS OCCURRING 869 00:39:10,520 --> 00:39:12,320 VERY OFTEN IN THE FACILITIES SO 870 00:39:12,320 --> 00:39:13,560 EVERY TIME IT DOES HAPPEN 871 00:39:13,560 --> 00:39:15,560 THEY'RE RELEARNING WHAT TO DO 872 00:39:15,560 --> 00:39:17,000 AND HOW BEST TO SUPPORT THIS 873 00:39:17,000 --> 00:39:17,720 FAMILY. 874 00:39:17,720 --> 00:39:20,200 IN ADDITION TO BUILDING A TOOL 875 00:39:20,200 --> 00:39:22,280 THEY WOULD FILL OUT AND SPIT 876 00:39:22,280 --> 00:39:25,440 WITH THE INFORMATION WE WANT 877 00:39:25,440 --> 00:39:26,640 WANTED TO GIVE A DOCUMENT THEY 878 00:39:26,640 --> 00:39:28,400 COULD USE TO GUIDE THEM THROUGH 879 00:39:28,400 --> 00:39:29,160 THE SUPPORT OF THE FAMILY AND 880 00:39:29,160 --> 00:39:39,520 THE SITUATION AS WELL. 881 00:39:42,920 --> 00:39:45,240 WE DISSEMINATED THE TOOL AND 882 00:39:45,240 --> 00:39:47,160 PROVIDED INFORMATION ON THE USE 883 00:39:47,160 --> 00:39:50,080 OF THE TOOL DURING SITE VISITS. 884 00:39:50,080 --> 00:39:56,880 OUR CARE TEAM IS COMPRISED OF A 885 00:39:56,880 --> 00:40:00,040 NEONATOLOGIST AND FETAL MEDICINE 886 00:40:00,040 --> 00:40:03,200 SPECIALIST AND NICU NURSE AND 887 00:40:03,200 --> 00:40:04,720 VISIT ALL THE BIRTHING HOSPITALS 888 00:40:04,720 --> 00:40:08,880 IN IOWA ON A REGULAR AND PROVIDE 889 00:40:08,880 --> 00:40:12,920 INFORMATION AND PROVIDE A 890 00:40:12,920 --> 00:40:21,880 RECORDS REVIEW OF THEIR OUTLYING 891 00:40:21,880 --> 00:40:24,880 INCIDENTS AND I SENT THE 892 00:40:24,880 --> 00:40:25,520 PROTOCOL TO ALL THE BIRTHING 893 00:40:25,520 --> 00:40:27,080 HOSPITALS IN THE STATE AND 894 00:40:27,080 --> 00:40:28,440 PROVIDED IN-PERSON EDUCATION TO 895 00:40:28,440 --> 00:40:29,880 THE LARGEST BIRTHING HOSPITALS 896 00:40:29,880 --> 00:40:32,640 TO THEIR NURSING AND MEDICAL 897 00:40:32,640 --> 00:40:35,120 STAFF AND THE COPY OF THE FORMS 898 00:40:35,120 --> 00:40:38,680 ARE AVAILABLE ON THE WEBSITE AT 899 00:40:38,680 --> 00:40:46,640 THE LINK HERE. 900 00:40:46,640 --> 00:40:47,920 I DID RECEIVE ASSISTANCE FROM 901 00:40:47,920 --> 00:40:50,680 THE MEDICAL STAFF AT THE 902 00:40:50,680 --> 00:40:54,160 HOSPITALS WHEN I MET WITH THEM. 903 00:40:54,160 --> 00:40:56,240 THEY SAW IT AS ONE OTHER FORM TO 904 00:40:56,240 --> 00:40:57,600 FILL OUT. 905 00:40:57,600 --> 00:41:01,520 ONE PHYSICIAN SAID WHO'S GOING 906 00:41:01,520 --> 00:41:02,720 TO PAY US FOR FILLING OUT THE 907 00:41:02,720 --> 00:41:03,960 FORM. 908 00:41:03,960 --> 00:41:05,920 THERE WAS RESISTANCE OF GOING 909 00:41:05,920 --> 00:41:07,240 BEYOND WHAT THEY WERE REQUIRED 910 00:41:07,240 --> 00:41:09,240 TO DO BY LAW, IF YOU WILL. 911 00:41:09,240 --> 00:41:12,200 THE SURVEILLANCE PORTION OF THE 912 00:41:12,200 --> 00:41:13,080 SCHMIDT EVALUATION PROTOCOL FORM 913 00:41:13,080 --> 00:41:15,360 ARE SENT TO THE IOWA REGISTRY 914 00:41:15,360 --> 00:41:17,120 FOR CONGENITAL AND INHERITED 915 00:41:17,120 --> 00:41:18,440 DISORDERS TO ME AS AN ADDITIONAL 916 00:41:18,440 --> 00:41:20,040 CASE FINDING TOOL AND THE 917 00:41:20,040 --> 00:41:22,480 INFORMATION FROM THAT IS 918 00:41:22,480 --> 00:41:24,600 COLLECTED AND ABSTRACTED AND 919 00:41:24,600 --> 00:41:26,440 SURVEILLANCE HAPPENS AS WITH THE 920 00:41:26,440 --> 00:41:28,600 OTHER BIRTH DEFECTS PROGRAM THAT 921 00:41:28,600 --> 00:41:31,360 OUR IOWA REG STRE FOR CONGENITAL 922 00:41:31,360 --> 00:41:33,320 AND INHERITED DISORDERS UNDER 923 00:41:33,320 --> 00:41:33,960 TAKES. 924 00:41:33,960 --> 00:41:37,200 THE FETAL DEATH CERTIFICATE IS 925 00:41:37,200 --> 00:41:38,240 STILL THE LEGAL RECORD OF 926 00:41:38,240 --> 00:41:41,640 STILLBIRTH IN IOWA THE 927 00:41:41,640 --> 00:41:43,360 EVALUATION TOOL'S ANCILLARY TO 928 00:41:43,360 --> 00:41:48,760 THAT PROCESS. 929 00:41:48,760 --> 00:41:51,560 WHERE WE ARE NOW WITH USE OF THE 930 00:41:51,560 --> 00:41:54,880 FETAL DEATH EVALUATION FORM IT'S 931 00:41:54,880 --> 00:41:55,120 VOLUNTARY. 932 00:41:55,120 --> 00:41:57,720 NOT EVERY BIRTHING FACILITY IS 933 00:41:57,720 --> 00:41:59,960 FILLING IT OUT AND SUBMITTING 934 00:41:59,960 --> 00:42:00,160 IT. 935 00:42:00,160 --> 00:42:01,960 HALF THE HOSPITALS ARE SENDING 936 00:42:01,960 --> 00:42:06,200 THE FORM IN AND THERE ARE OFTEN 937 00:42:06,200 --> 00:42:07,440 VARIOUS STAGES OF COMPLETION AND 938 00:42:07,440 --> 00:42:11,080 NOT ALL STAGES ARE COMPLETION, 939 00:42:11,080 --> 00:42:13,040 THE ENTIRE FORM ISN'T DONE AND 940 00:42:13,040 --> 00:42:14,960 GET JUST ONE SIDE OF THE FORM IF 941 00:42:14,960 --> 00:42:17,640 THE FORM IS DOUBLE SIDED BUT WE 942 00:42:17,640 --> 00:42:20,000 ARE ABLE TO GET SOME VALUABLE 943 00:42:20,000 --> 00:42:21,080 INFORMATION FROM THOSE FORMS. 944 00:42:21,080 --> 00:42:23,240 I PUT THAT INFORMATION ON THE 945 00:42:23,240 --> 00:42:24,240 SPREAD SHEET WHICH IS SPREAD 946 00:42:24,240 --> 00:42:26,320 WITH OUR BIRTH DEFECTS REGISTRY 947 00:42:26,320 --> 00:42:28,520 AND THE EVALUATION FORM HAS BEEN 948 00:42:28,520 --> 00:42:31,600 ABLE TO BE MODIFIED SINCE IT'S 949 00:42:31,600 --> 00:42:31,880 INCEPTION. 950 00:42:31,880 --> 00:42:33,080 AS RESEARCH PROGRESSES AND WE'RE 951 00:42:33,080 --> 00:42:34,440 FINDING OUT MORE THINGS, WE DO 952 00:42:34,440 --> 00:42:36,000 HAVE THE ABILITY TO AMEND THE 953 00:42:36,000 --> 00:42:38,120 FORM DEPENDING ON OUR CURRENT 954 00:42:38,120 --> 00:42:40,000 DATA NEEDS WHICH IS DEFINITELY 955 00:42:40,000 --> 00:42:41,800 NOT LIKE THE FETAL DEATH 956 00:42:41,800 --> 00:42:42,080 CERTIFICATE. 957 00:42:42,080 --> 00:42:45,480 SOME OF THE THINGS THAT WE HAVE 958 00:42:45,480 --> 00:42:47,080 ADDED INCLUDE WE ASKED 959 00:42:47,080 --> 00:42:48,360 INFORMATION ABOUT THE BLOOD 960 00:42:48,360 --> 00:42:49,640 PRESSURE RANGE, SLEEPING 961 00:42:49,640 --> 00:42:51,360 POSITION, INDICATED IF THE 962 00:42:51,360 --> 00:42:52,400 MOTHER RECEIVED INFORMATION 963 00:42:52,400 --> 00:42:53,840 ABOUT MONITORING FETAL MOVEMENT 964 00:42:53,840 --> 00:42:56,800 AND RECENTLY WE'VE ASKED THEM 965 00:42:56,800 --> 00:43:01,600 ABOUT THE MOTHERS COVID STATUS. 966 00:43:01,600 --> 00:43:03,760 AND EDUCATION CONTINUING ON THIS 967 00:43:03,760 --> 00:43:05,000 WITH HEALTH CARE AND PROVIDERS 968 00:43:05,000 --> 00:43:08,680 AND POLICY MAKERS ABOUT USING 969 00:43:08,680 --> 00:43:09,040 THE FORM. 970 00:43:09,040 --> 00:43:10,240 AND SOME INFORMATION IS SHARED 971 00:43:10,240 --> 00:43:13,440 WITH THE STATEWIDE PERINATAL 972 00:43:13,440 --> 00:43:16,680 CARE TEAM FOR EXAMPLE I HAD ONE 973 00:43:16,680 --> 00:43:18,840 SITUATION WHERE A PARENT ON THE 974 00:43:18,840 --> 00:43:22,760 PARENT NARRATIVE FORM THEY 975 00:43:22,760 --> 00:43:24,240 INDICATED THAT THEY WERE 976 00:43:24,240 --> 00:43:25,000 EXPERIENCING DECREASED FETAL 977 00:43:25,000 --> 00:43:29,480 MOVEMENT AND CONTACTED THE HELP 978 00:43:29,480 --> 00:43:31,200 LINE OR 24-HOUR NURSE CALL IN 979 00:43:31,200 --> 00:43:32,320 LINE AT THE HOSPITAL AND WAS 980 00:43:32,320 --> 00:43:34,720 TOLD TO GET REST, DRINK ORANGE 981 00:43:34,720 --> 00:43:35,920 JUICE AND GET REST AND COME BACK 982 00:43:35,920 --> 00:43:37,840 IN THE MORNING AND OF COURSE 983 00:43:37,840 --> 00:43:42,480 WHEN THEY DID, THAT INFANT HAD 984 00:43:42,480 --> 00:43:44,360 DIED. 985 00:43:44,360 --> 00:43:47,360 SO WE'RE ABLE TO PROVIDE 986 00:43:47,360 --> 00:43:48,440 INFORMATION DEPENDING ON THE 987 00:43:48,440 --> 00:43:50,680 INFORMATION WE GET FROM THE 988 00:43:50,680 --> 00:43:56,560 EVALUATION FORMS. 989 00:43:56,560 --> 00:43:58,320 THE BUDGET WE HAVE FOR THE 990 00:43:58,320 --> 00:44:00,680 INITIAL PROJECT WAS $26,000 FROM 991 00:44:00,680 --> 00:44:03,840 THE STATE TOBACCO SETTLEMENT AND 992 00:44:03,840 --> 00:44:04,400 FUNDED OUR MEETING AND 993 00:44:04,400 --> 00:44:10,560 CONFERENCE CALLS, ETCETERA. 994 00:44:10,560 --> 00:44:12,080 WE WERE ABLE TO RECEIVE SOME 995 00:44:12,080 --> 00:44:14,800 FUNDING THROUGH A COOPERATIVE 996 00:44:14,800 --> 00:44:18,960 AGREEMENT FROM CDC FORESYSTEM 997 00:44:18,960 --> 00:44:20,400 DEVELOPMENT AND THAT LEADS ME TO 998 00:44:20,400 --> 00:44:21,840 DISCUSS THE NEXT PART OF THE 999 00:44:21,840 --> 00:44:22,720 PROJECT THE IOWA STILL BIRTH 1000 00:44:22,720 --> 00:44:33,080 SURVEILLANCE PROJECT. 1001 00:44:34,280 --> 00:44:35,760 IOWA RECEIVED A COOPERATIVE 1002 00:44:35,760 --> 00:44:37,600 AGREEMENT FROM THE CENTERS FOR 1003 00:44:37,600 --> 00:44:38,680 DISEASE CONTROL AND PREVENTION 1004 00:44:38,680 --> 00:44:42,240 TO ESTABLISH THE IOWA STILLBIRTH 1005 00:44:42,240 --> 00:44:43,320 SURVEILLANCE PROJECT AND THE 1006 00:44:43,320 --> 00:44:44,320 DEPARTMENT RECEIVED CONTINUATION 1007 00:44:44,320 --> 00:44:46,400 AWARDS WITH THE PROJECT ENDING 1008 00:44:46,400 --> 00:44:48,480 ULTIMATELY IN SEPTEMBER OF 2015. 1009 00:44:48,480 --> 00:44:51,160 AND THE AIMS OF THE STILLBIRTH 1010 00:44:51,160 --> 00:44:52,280 SURVEILLANCE PROJECT WERE TO 1011 00:44:52,280 --> 00:44:54,600 EVALUATE THE FEASIBILITY OF 1012 00:44:54,600 --> 00:44:56,080 EXPANDING OUR SURVEILLANCE 1013 00:44:56,080 --> 00:44:58,040 PROGRAM TO INCLUDE STILLBIRTH 1014 00:44:58,040 --> 00:44:58,440 SURVEILLANCE. 1015 00:44:58,440 --> 00:45:00,960 SO WE WANTED TO EXAMINE THE 1016 00:45:00,960 --> 00:45:03,760 FEASIBILITY OF EXPANDING OUR 1017 00:45:03,760 --> 00:45:04,440 POPULATION-BASED SURVEILLANCE 1018 00:45:04,440 --> 00:45:06,840 PROGRAM TO INCORPORATE DATA FROM 1019 00:45:06,840 --> 00:45:08,000 EXISTING RECORDS OR FETAL 1020 00:45:08,000 --> 00:45:08,280 DEATHS. 1021 00:45:08,280 --> 00:45:13,200 WE WANTED TO MONITOR AND REPORT 1022 00:45:13,200 --> 00:45:16,720 ON FETAL DEATHS AND SERVE AS A 1023 00:45:16,720 --> 00:45:19,320 REGISTRY FOR ET YO LOGICAL 1024 00:45:19,320 --> 00:45:22,440 STUDIES AND SERVE AS A RESOURCE 1025 00:45:22,440 --> 00:45:24,200 FOR EVALUATION OF STILLBIRTH 1026 00:45:24,200 --> 00:45:25,840 PREVENTION PROGRAMS THAT AIM TO 1027 00:45:25,840 --> 00:45:27,280 REDUCE THE OCCURRENCE OF FETAL 1028 00:45:27,280 --> 00:45:27,520 DEATHS. 1029 00:45:27,520 --> 00:45:28,920 I HAVE TO SAY WE NEED TO NOTE 1030 00:45:28,920 --> 00:45:32,680 THE INTENT WAS NOT TO CONDUCT 1031 00:45:32,680 --> 00:45:34,520 ONGOING STILL BIRTH SURVEILLANCE 1032 00:45:34,520 --> 00:45:38,840 AND ANALYSIS BUT SOMEONE THE 1033 00:45:38,840 --> 00:45:40,960 FEASIBILITY TO INCLUDE FETAL 1034 00:45:40,960 --> 00:45:43,320 DEATHS THAT COULD IN TURN INFORM 1035 00:45:43,320 --> 00:45:43,760 RESEARCH. 1036 00:45:43,760 --> 00:45:44,920 DEV DEV 1037 00:45:58,200 --> 00:46:05,240 OUR REGISTRY FOR CONGENITAL 1038 00:46:05,240 --> 00:46:11,800 DISORDERS AND IRCID HAD AN 1039 00:46:11,800 --> 00:46:14,240 ACTIVE PROCESS AND WOULD EXAMINE 1040 00:46:14,240 --> 00:46:18,120 HOSPITAL AND PROVIDER RECORDS 1041 00:46:18,120 --> 00:46:19,120 AND PROTOCOL FORMS AND 1042 00:46:19,120 --> 00:46:22,120 INFORMATION FROM OUR STATEWIDE 1043 00:46:22,120 --> 00:46:23,640 PERINATAL CARE TEAM REPORTS AND 1044 00:46:23,640 --> 00:46:24,960 IN THE BEGINNING WE WERE LOOKING 1045 00:46:24,960 --> 00:46:27,920 AT OBITUARIES IN OUR LOCAL PAPER 1046 00:46:27,920 --> 00:46:31,360 OR ONLINE TO IDENTIFY POTENTIAL 1047 00:46:31,360 --> 00:46:32,400 CASES FOR ABSTRACTION. 1048 00:46:32,400 --> 00:46:33,960 AND OUR REGISTRY GOES OUT AND 1049 00:46:33,960 --> 00:46:37,120 LOOKS FOR CASES RATHER THAN 1050 00:46:37,120 --> 00:46:39,360 RELYING ON FACILITY-PROVIDED 1051 00:46:39,360 --> 00:46:41,040 REPORTING AND PULLING DATA FROM 1052 00:46:41,040 --> 00:46:41,440 SECONDARY SOURCES. 1053 00:46:41,440 --> 00:46:44,360 THE CASES ARE REVIEWED AND 1054 00:46:44,360 --> 00:46:45,680 ABSTRACTED AND ENTERED IN THE 1055 00:46:45,680 --> 00:46:49,040 DATA SYSTEM AND EXAMINED BY THE 1056 00:46:49,040 --> 00:46:49,600 DATA REGISTRY MANAGER AND 1057 00:46:49,600 --> 00:46:52,120 CLINICIAN AND PATHOLOGIST AND 1058 00:46:52,120 --> 00:46:53,960 FOR QUALITY CONTROL AND THE DATA 1059 00:46:53,960 --> 00:46:56,680 ANALYSES ARE CONDUCTED BY THE 1060 00:46:56,680 --> 00:46:59,000 REGISTRY EPIDEMIOLOGIST. 1061 00:46:59,000 --> 00:47:02,480 WE HAD A PERINATOLOGIST AND 1062 00:47:02,480 --> 00:47:05,000 PATHOLOGIST TO REVIEW EACH CASE 1063 00:47:05,000 --> 00:47:08,200 TO VERIFY ITS ELIGIBILITY TO BE 1064 00:47:08,200 --> 00:47:12,240 INCLUDED AS A STILLBIRTH CASE. 1065 00:47:12,240 --> 00:47:15,360 SOME OF THE OUTPUTS FROM THIS 1066 00:47:15,360 --> 00:47:17,960 PROJECT INITIALLY WE IDENTIFIED 1067 00:47:17,960 --> 00:47:19,360 AND ABSTRACTED ABOUT 1600 CASES 1068 00:47:19,360 --> 00:47:21,880 OF FETAL DEATH IN IOWA OCCURRING 1069 00:47:21,880 --> 00:47:24,880 FROM 2005 TO 2013. 1070 00:47:24,880 --> 00:47:27,960 AND THEN IN 2011 THE REGISTRY 1071 00:47:27,960 --> 00:47:29,440 FORMED A CONSORTIUM WITH 1072 00:47:29,440 --> 00:47:31,320 STATEWIDE COVERAGE IN IOWA AND 1073 00:47:31,320 --> 00:47:33,400 HAWAI'I AND A FIVE-COUNTY 1074 00:47:33,400 --> 00:47:35,000 METROPOLITAN AREA OF COLORADO 1075 00:47:35,000 --> 00:47:36,560 AND THE 12 WESTERN COUNTIES OF 1076 00:47:36,560 --> 00:47:36,960 NEW YORK STATE. 1077 00:47:36,960 --> 00:47:39,120 THIS ALLOWED FOR THE INCLUSION 1078 00:47:39,120 --> 00:47:42,280 OF CASES WHICH ENHANCED THE 1079 00:47:42,280 --> 00:47:45,520 RACIAL AND ETHNIC DIVERSITY AND 1080 00:47:45,520 --> 00:47:50,040 ALLOWED FOR REPLICATION OF THE 1081 00:47:50,040 --> 00:47:51,160 FEASIBILITY TO INCLUDE 1082 00:47:51,160 --> 00:47:51,840 STILLBIRTH SURVEILLANCE AND WE 1083 00:47:51,840 --> 00:47:54,000 HAVE MANUSCRIPTS AVAILABLE IF 1084 00:47:54,000 --> 00:47:55,840 YOU'D LIKE I CAN SHARE LATER. 1085 00:47:55,840 --> 00:47:59,120 AND IT ADDRESSED ALL OF OUR 1086 00:47:59,120 --> 00:48:02,680 PROJECT AND WAS ABLE TO ADDRESS 1087 00:48:02,680 --> 00:48:04,720 ALL THE STILLBIRTH SURVEILLANCE 1088 00:48:04,720 --> 00:48:06,520 AIMS ON THE FEASIBILITY OF 1089 00:48:06,520 --> 00:48:07,360 EXPANDING OUR SURVEILLANCE TO 1090 00:48:07,360 --> 00:48:13,040 INCLUDE STILLBIRTHS. 1091 00:48:13,040 --> 00:48:15,600 I'LL HIGHLIGHT A COUPLE STUDIES 1092 00:48:15,600 --> 00:48:17,240 THAT CONSIDER SOME CONTESTS WE 1093 00:48:17,240 --> 00:48:21,240 WERE PRESENTED WITH IS THE IOWA 1094 00:48:21,240 --> 00:48:23,440 STILLBIRTH PROJECT REGARDING 1095 00:48:23,440 --> 00:48:26,600 COLLECTION OF THE DATA AND SOME 1096 00:48:26,600 --> 00:48:27,080 CHALLENGES EXPERIENCED. 1097 00:48:27,080 --> 00:48:33,640 SO WE HAD A STUDY THAT EXAMINE 1098 00:48:33,640 --> 00:48:35,360 FETAL DEATH CERTIFICATES AND 1099 00:48:35,360 --> 00:48:39,920 NEARLY ONE-QUARTER OF THE 1100 00:48:39,920 --> 00:48:41,200 STILLBIRTHS THAT RESOURCED FETAL 1101 00:48:41,200 --> 00:48:45,000 DEATH SER CATS DID NOT MEET THE 1102 00:48:45,000 --> 00:48:46,000 REPORTING CRITERIA. 1103 00:48:46,000 --> 00:48:48,400 AND RECORD ABSTRACTION VERIFIED 1104 00:48:48,400 --> 00:48:51,160 192 AS REPORTABLE STILLBIRTH FOR 1105 00:48:51,160 --> 00:48:51,360 THOSE. 1106 00:48:51,360 --> 00:48:54,240 NOT EVERY CASE THAT RECEIVED A 1107 00:48:54,240 --> 00:48:56,480 FETAL DEATH CERTIFICATE MET THE 1108 00:48:56,480 --> 00:48:58,200 CRITERIA FOR BEING A FETAL 1109 00:48:58,200 --> 00:48:58,600 DEATH. 1110 00:48:58,600 --> 00:49:07,080 OF THE STILLBIRTHS NOT MEETING 1111 00:49:07,080 --> 00:49:11,120 THOSE 80% WERE NOT REPORTABLE 1112 00:49:11,120 --> 00:49:11,760 DUE TO INACCURATE INFORMATION 1113 00:49:11,760 --> 00:49:15,920 AND IT WAS LARGELY DUE TO MEET 1114 00:49:15,920 --> 00:49:18,600 THE STILLBIRTH CRITERIA AND 1115 00:49:18,600 --> 00:49:20,640 GESTATIONAL AGE 20 WEEKS OR 1116 00:49:20,640 --> 00:49:22,160 BIRTH WEIGHT 350 GRAMS OR MORE 1117 00:49:22,160 --> 00:49:27,560 AND DESPITE ACCURATELY REPORTED 1118 00:49:27,560 --> 00:49:29,720 GESTATIONAL AGE AND BIRTH 1119 00:49:29,720 --> 00:49:30,240 WEIGHT. 1120 00:49:30,240 --> 00:49:32,600 AND AS DR. DUDLEY MENTIONED THE 1121 00:49:32,600 --> 00:49:35,080 TRAINING AND EDUCATION OF HOW TO 1122 00:49:35,080 --> 00:49:36,320 COMPLETE THE FETAL DEATH 1123 00:49:36,320 --> 00:49:39,600 CERTIFICATE IS DEFINITELY 1124 00:49:39,600 --> 00:49:42,680 LACKING AND SHOULD BE AN ONGOING 1125 00:49:42,680 --> 00:49:42,920 PROCESS. 1126 00:49:42,920 --> 00:49:45,640 WE LOOKED AT A COMPARISON OF 1127 00:49:45,640 --> 00:49:48,360 CASE ASCERTAINMENT SOURCES AND 1128 00:49:48,360 --> 00:49:50,160 EVALUATED DATA SOURCES INCLUDING 1129 00:49:50,160 --> 00:49:51,360 FETAL DEATH RECORDS WHICH 1130 00:49:51,360 --> 00:49:56,400 ENUMERATED EACH REPORTABLE 1131 00:49:56,400 --> 00:49:57,040 STILLBIRTH DELIVERED FROM 2005 1132 00:49:57,040 --> 00:50:05,440 TO 2013 AND RECORDS IDENTIFYING 1133 00:50:05,440 --> 00:50:11,360 1,434 OF 1,754 REPORTABLE STIL 1134 00:50:11,360 --> 00:50:17,200 BIRTHS AND THE MEDICAL RECORDS 1135 00:50:17,200 --> 00:50:22,560 HAD AN ADDITIONAL 207 1136 00:50:22,560 --> 00:50:26,280 STILLBIRTHS AND SOME WERE FOR 1137 00:50:26,280 --> 00:50:37,000 REPORT BE STILLBIRTHS AND 351 1138 00:50:37,000 --> 00:50:39,760 STILLBIRTHS WERE NOT REPORTED 1139 00:50:39,760 --> 00:50:41,160 AND WE FOUND ABSTRACTION THAT 1140 00:50:41,160 --> 00:50:43,800 MET OUR DEFINITION FOR 1141 00:50:43,800 --> 00:50:48,640 STILLBIRTH BUT WERE NOT ISSUED A 1142 00:50:48,640 --> 00:50:49,320 FETAL DEATH CERTIFICATE. 1143 00:50:49,320 --> 00:50:53,520 THIS IS A LIST OF SOME OF THE -- 1144 00:50:53,520 --> 00:50:55,360 I ASKED THE BIRTH DEFECTS 1145 00:50:55,360 --> 00:50:56,200 REGISTRY STAFF TO GIVE ME 1146 00:50:56,200 --> 00:50:59,200 INFORMATION ABOUT SOME OF THE 1147 00:50:59,200 --> 00:51:01,840 BARRIERS THEY MET WHEN OBTAINING 1148 00:51:01,840 --> 00:51:03,760 QUALITY COMPREHENSIVE DATA AND 1149 00:51:03,760 --> 00:51:07,800 THIS IS THE LIST THEY CAME UP 1150 00:51:07,800 --> 00:51:08,440 WITH. 1151 00:51:08,440 --> 00:51:10,240 THEY NOTED A LACK OF AUTOPSY 1152 00:51:10,240 --> 00:51:10,480 RESULTS. 1153 00:51:10,480 --> 00:51:12,840 THE LACK OF GENETIC TESTING 1154 00:51:12,840 --> 00:51:15,720 RELATED TO THE ABOVE ON THE LACK 1155 00:51:15,720 --> 00:51:18,720 OF AUTOPSIES AND IN LIEU OF 1156 00:51:18,720 --> 00:51:20,680 AUTOPSIES, THERE'S A LACK OF 1157 00:51:20,680 --> 00:51:24,640 PHOTOS OF THE FETUS TO EXAMINE 1158 00:51:24,640 --> 00:51:27,600 AND DO AN EXAMINE ON THE BABY 1159 00:51:27,600 --> 00:51:29,960 AND POOR DATA ON DELIVERY 1160 00:51:29,960 --> 00:51:32,360 WEIGHT, GESTATIONAL AGE, 1161 00:51:32,360 --> 00:51:32,600 ETCETERA. 1162 00:51:32,600 --> 00:51:33,760 LACK OF INFORMATION ON THE EXACT 1163 00:51:33,760 --> 00:51:37,200 DAY OF FETAL DEATH OR PREGNANCY 1164 00:51:37,200 --> 00:51:38,400 DATING AND THEN VARIABLE 1165 00:51:38,400 --> 00:51:41,520 INFORMATION ON THE PRENATAL 1166 00:51:41,520 --> 00:51:41,840 HISTORY. 1167 00:51:41,840 --> 00:51:43,920 WITHOUT GOING DIRECTLY TO THE 1168 00:51:43,920 --> 00:51:45,800 PRENATAL PROVIDERS. 1169 00:51:45,800 --> 00:51:49,080 THEY WOULD HAVE TO GO DEEPER IN 1170 00:51:49,080 --> 00:51:56,040 THE CLIENT'S MEDICAL TO RECORD 1171 00:51:56,040 --> 00:51:57,280 INFORMATION AND THERE'S RISK 1172 00:51:57,280 --> 00:52:00,200 FACTORS AND THERE'S A LACK OF 1173 00:52:00,200 --> 00:52:02,680 TRAINING AND PROVIDERS AND 1174 00:52:02,680 --> 00:52:04,600 FUNERAL HOME DIRECT IN 1175 00:52:04,600 --> 00:52:06,120 COMPLETING THE DEATH 1176 00:52:06,120 --> 00:52:06,840 CERTIFICATES. 1177 00:52:06,840 --> 00:52:10,200 OUR MAIN CHALLENGE REMAINS THAT 1178 00:52:10,200 --> 00:52:12,360 STILLBIRTH SURVEILLANCE HAS THE 1179 00:52:12,360 --> 00:52:13,440 LIMITED AVAILABILITY OF 1180 00:52:13,440 --> 00:52:14,880 POPULATION-BASED DATA. 1181 00:52:14,880 --> 00:52:17,240 AND TO REVIEW THE EXAMINE OF 1182 00:52:17,240 --> 00:52:19,840 FETAL DEATH CERTIFICATES WE 1183 00:52:19,840 --> 00:52:23,600 FOUND THEY WERE OFTEN FILLED OUT 1184 00:52:23,600 --> 00:52:24,880 INCORRECTLY IN COMPLETELY OR FOR 1185 00:52:24,880 --> 00:52:29,760 CASES THAT DID NOT MEET THE 1186 00:52:29,760 --> 00:52:32,000 STATE CRITERIA FOR FETAL DEATH 1187 00:52:32,000 --> 00:52:42,560 REPORTING AND USING AS USING THE 1188 00:52:43,960 --> 00:52:45,480 DATA IN THE FETAL DEATH 1189 00:52:45,480 --> 00:52:56,200 REPORTING IN ADDITION TO THIS 1190 00:52:56,200 --> 00:52:59,200 QUOTE HE SAYS IF WE FIRST KNOW 1191 00:52:59,200 --> 00:53:02,360 WHERE WE ARE AND WITHER WE ARE 1192 00:53:02,360 --> 00:53:03,360 TENDING WE CAN BETTER JUDGE WHAT 1193 00:53:03,360 --> 00:53:11,360 TO DO AND HOW TO DO IT AND WE 1194 00:53:11,360 --> 00:53:17,200 FIRST MUST KNOW WHERE WE ARE AND 1195 00:53:17,200 --> 00:53:18,560 WITHER WE ARE TENDING. 1196 00:53:18,560 --> 00:53:20,240 THAT'S ALL I HAVE AND I'M HAPPY 1197 00:53:20,240 --> 00:53:20,880 TO ANSWER QUESTIONS LATER. 1198 00:53:20,880 --> 00:53:31,080 THANK YOU. 1199 00:53:36,120 --> 00:53:38,840 >>THANK YOU, SO MUCH, KIMBERLY. 1200 00:53:38,840 --> 00:53:40,920 THIS WAS A GREAT PRESENTATION. 1201 00:53:40,920 --> 00:53:44,880 AGAIN, AS I MENTIONED, THERE'LL 1202 00:53:44,880 --> 00:53:46,960 BE PLENTY OF DISCUSSION TIME 1203 00:53:46,960 --> 00:53:49,800 FOLLOWING YOUR PRESENTATIONS AND 1204 00:53:49,800 --> 00:53:52,040 I'M SURE THERE'LL BE QUESTIONS 1205 00:53:52,040 --> 00:53:58,040 FOR YOU RELATED TO CASE 1206 00:53:58,040 --> 00:53:59,080 ASCERTAINMENT AND REALLY 1207 00:53:59,080 --> 00:54:00,880 FIGURING OUT THET BEST WAY TO 1208 00:54:00,880 --> 00:54:02,480 BRING IN -- FIGURING OUT THE 1209 00:54:02,480 --> 00:54:07,080 BEST WAY TO BRING IN RELIABLE 1210 00:54:07,080 --> 00:54:07,360 INFORMATION. 1211 00:54:07,360 --> 00:54:11,120 SO CONTINUING WITH THE THEME, 1212 00:54:11,120 --> 00:54:13,560 OUR NEXT SPEAKER IS PROFESSOR IS 1213 00:54:13,560 --> 00:54:16,640 THE ROBERT A. LEFFLER PROFESSOR 1214 00:54:16,640 --> 00:54:17,720 OF LAW AND ASSOCIATE DEAN FOR 1215 00:54:17,720 --> 00:54:19,680 RESEARCH AND FACULTY DEVELOPMENT 1216 00:54:19,680 --> 00:54:24,200 AT THE UNIVERSITY OF ARKANSAS 1217 00:54:24,200 --> 00:54:25,000 SCHOOL OF LAW. 1218 00:54:25,000 --> 00:54:33,280 SHE WILL TALK TO US ABOUT THE 1219 00:54:33,280 --> 00:54:39,160 LEGAL ISSUES REGULLATED OR OR L 1220 00:54:39,160 --> 00:54:40,400 WITH STILLBIRTH DATA COLLECTION. 1221 00:54:40,400 --> 00:54:44,680 THIS IS AN INTERESTING AREA, 1222 00:54:44,680 --> 00:54:45,120 JILL. 1223 00:54:45,120 --> 00:54:48,360 WE OFTEN IN THE HEALTH CARE WE 1224 00:54:48,360 --> 00:54:49,880 TEND TO STRAIGHTAWAY JUMP INTO 1225 00:54:49,880 --> 00:54:51,760 HOW DO WE DO THINGS. 1226 00:54:51,760 --> 00:54:56,480 WE DON'T FOCUS ON WHY ARE WE 1227 00:54:56,480 --> 00:54:59,000 DOING THIS AND WHAT DO WE REALLY 1228 00:54:59,000 --> 00:55:02,680 NEED BACK TO KIMBERLY'S POINT 1229 00:55:02,680 --> 00:55:06,480 THERE. 1230 00:55:06,480 --> 00:55:07,520 ABOUT WHERE WE ARE AND WHERE ARE 1231 00:55:07,520 --> 00:55:09,000 WE HEADED FROM HERE. 1232 00:55:09,000 --> 00:55:10,400 THANK YOU FOR JOINING US TODAY, 1233 00:55:10,400 --> 00:55:10,840 JILL. 1234 00:55:10,840 --> 00:55:11,480 WE LOOK FORWARD TO JUR 1235 00:55:11,480 --> 00:55:13,800 PRESENTATION. 1236 00:55:13,800 --> 00:55:15,320 -- YOUR PRESENTATION. 1237 00:55:15,320 --> 00:55:18,120 >>THANK YOU, SO MUCH, DR. JAIN 1238 00:55:18,120 --> 00:55:19,760 AND THANK YOU SO MUCH TO THE 1239 00:55:19,760 --> 00:55:20,680 NATIONAL INSTITUTE OF CHILD 1240 00:55:20,680 --> 00:55:23,880 HEALTH AND HUMAN DEVELOPMENT. 1241 00:55:23,880 --> 00:55:26,200 I'M GRATEFUL THIS WORKING GROUP 1242 00:55:26,200 --> 00:55:27,440 EVEN EXISTS AND I REALLY 1243 00:55:27,440 --> 00:55:28,040 APPRECIATE THE OPPORTUNITY TO 1244 00:55:28,040 --> 00:55:35,840 PRESENT HERE TODAY. 1245 00:55:35,840 --> 00:55:37,600 I'M JILL LENS A LAW PROFESSOR 1246 00:55:37,600 --> 00:55:39,480 NOW AT THE ARKANSAS SCHOOL OF 1247 00:55:39,480 --> 00:55:43,320 LAW AND ALSO A STILLBIRTH MOM 1248 00:55:43,320 --> 00:55:47,320 ABOUT FIVE AND A HALF YEARS AGO 1249 00:55:47,320 --> 00:55:50,600 MY KIDDO WAS STILLBORN AND WAS 1250 00:55:50,600 --> 00:55:52,160 37 WEEKS IN PREGNANCY. 1251 00:55:52,160 --> 00:55:54,800 WHEN I GOT BACK TO WORK I PUT 1252 00:55:54,800 --> 00:55:55,840 THE PIECES TOGETHER THAT I COULD 1253 00:55:55,840 --> 00:55:58,160 DO THIS PROFESSIONALLY AND 1254 00:55:58,160 --> 00:55:59,440 WANTED TO FIGURE OUT HOW LAWS 1255 00:55:59,440 --> 00:56:02,680 AFFECT STILLBIRTH AND HOW THEY 1256 00:56:02,680 --> 00:56:04,400 MAY BE AFFECTING OUR STILLBIRTH 1257 00:56:04,400 --> 00:56:06,640 RATES AND THE EXPERIENCE OF 1258 00:56:06,640 --> 00:56:07,640 STILLBIRTH AND OTHER RESEARCH I 1259 00:56:07,640 --> 00:56:08,840 MAY BRING UP HERE OR THERE 1260 00:56:08,840 --> 00:56:09,640 WITHIN THE PRESENTATION. 1261 00:56:09,640 --> 00:56:12,320 THE MAIN FOCUS OF WHAT I WANT TO 1262 00:56:12,320 --> 00:56:14,160 TALK ABOUT TODAY IS ABOUT HOW 1263 00:56:14,160 --> 00:56:16,440 LAWS AFFECT OUR DATA COLLECTION. 1264 00:56:16,440 --> 00:56:22,240 AND BEFORE I GET TOO INTO THIS, 1265 00:56:22,240 --> 00:56:27,720 I DO WANT TO THANK A FEW 1266 00:56:27,720 --> 00:56:30,040 EPIDEMIOLOGISTS THAT COULD TALK 1267 00:56:30,040 --> 00:56:32,160 TO ME AND I KNEW I HAD ONE 1268 00:56:32,160 --> 00:56:37,800 PERFECT MY KIDDO BUT I JUST SAW 1269 00:56:37,800 --> 00:56:40,680 DOMINIQUE'S NAME IN A SLIDE A 1270 00:56:40,680 --> 00:56:48,080 LITTLE BIT AGO, DOMINIQUE HENKE 1271 00:56:48,080 --> 00:56:49,880 WAS HELPFUL AND DR. WENDY 1272 00:56:49,880 --> 00:56:52,720 NIMHARD AT THE UNIVERSITY OF 1273 00:56:52,720 --> 00:56:53,920 ARKANSAS MEDICAL SCHOOL WAS VERY 1274 00:56:53,920 --> 00:56:56,000 HELPFUL AND ALSO I DON'T KNOW IF 1275 00:56:56,000 --> 00:56:57,920 KIM REMEMBERS BUT I WAS CALLING 1276 00:56:57,920 --> 00:56:59,440 KIM I DON'T REMEMBER HOW MANY 1277 00:56:59,440 --> 00:57:00,520 SUMMERS AGO AND GOT A LITTLE BIT 1278 00:57:00,520 --> 00:57:06,400 INSIGHT FROM HER ALSO. 1279 00:57:06,400 --> 00:57:09,520 I WANTED TO START WITH AUTOPSIES 1280 00:57:09,520 --> 00:57:11,040 WHICH I KNOW WAS TALKED ABOUT IN 1281 00:57:11,040 --> 00:57:15,680 THE LAST MEETING. 1282 00:57:15,680 --> 00:57:19,200 WE DON'T HAVE MANY AUTOPSIES IN 1283 00:57:19,200 --> 00:57:20,280 THIS COUNTRY. 1284 00:57:20,280 --> 00:57:23,160 THIS WAS TWO YEARS FROM 2014 AND 1285 00:57:23,160 --> 00:57:23,560 2015. 1286 00:57:23,560 --> 00:57:28,520 WE ONLY HAD ONE-FIFTH ABOUT OF 1287 00:57:28,520 --> 00:57:39,080 STILLBIRTHS HAD A FETAL AUTOPSY. 1288 00:57:40,000 --> 00:57:42,960 THERE ARE DISPARITIES WHEN THEY 1289 00:57:42,960 --> 00:57:44,200 HAPPEN AND THERE'S ETHNIC AND 1290 00:57:44,200 --> 00:57:47,120 RACIAL DISPARITIES AND SOCIO 1291 00:57:47,120 --> 00:57:48,680 ECONOMIC DISPARITIES. 1292 00:57:48,680 --> 00:57:52,000 AUTOPSY WAS MORE LIKELY WITH 1293 00:57:52,000 --> 00:57:53,240 INCREASED MATERNAL EDUCATION NOT 1294 00:57:53,240 --> 00:57:56,680 ONLY DO WE NOT HAVE ENOUGH 1295 00:57:56,680 --> 00:57:57,480 AUTOPSIES BUT THE ONCE HAVE WILL 1296 00:57:57,480 --> 00:58:07,440 NOT BE REPRESENTATIVE. 1297 00:58:07,440 --> 00:58:08,760 WHY DON'T WE HAVE MORE AUTOPSIES 1298 00:58:08,760 --> 00:58:12,920 IS A QUESTION I WAS RESEARCHING? 1299 00:58:12,920 --> 00:58:14,280 OBVIOUSLY, IT'S A DISTRESSING 1300 00:58:14,280 --> 00:58:15,360 AND SHOCKING TIME. 1301 00:58:15,360 --> 00:58:17,080 YOU'RE HOLDING YOUR BABY AND 1302 00:58:17,080 --> 00:58:21,720 ALSO TRYING TO MAKE DECISIONS 1303 00:58:21,720 --> 00:58:24,040 WHETHER OR NOT TO HAVE AN 1304 00:58:24,040 --> 00:58:28,640 AUTOPSY AND IT'S ALSO DIFFICULT 1305 00:58:28,640 --> 00:58:30,080 BECAUSE IT'S A DIFFICULT 1306 00:58:30,080 --> 00:58:31,160 SITUATION AND DIFFICULT FOR 1307 00:58:31,160 --> 00:58:32,480 DOCTORS TO TALK ABOUT ALSO. 1308 00:58:32,480 --> 00:58:35,480 THESE ARE DOCTORS WHO ARE USED 1309 00:58:35,480 --> 00:58:37,520 TO HELPING BIRTH LIVE BABIES AND 1310 00:58:37,520 --> 00:58:43,280 THESE ARE DOCTORS USED TO HAPPY 1311 00:58:43,280 --> 00:58:51,360 TIMES AND THIS IS NOT A HAPPY 1312 00:58:51,360 --> 00:59:00,840 TIME AND MAYBE DON'T ALWAYS USE 1313 00:59:00,840 --> 00:59:01,960 CERTAIN LANGUAGE AND THE AUTOPSY 1314 00:59:01,960 --> 00:59:04,520 MAY NOT REVEAL A CAUSE BUT THAT 1315 00:59:04,520 --> 00:59:07,120 SAID WITH HEY, THEY'RE GOING TO 1316 00:59:07,120 --> 00:59:09,720 CUT YOU'RE BABY UP CAN BE 1317 00:59:09,720 --> 00:59:14,840 DISCOURAGING AND THERE'S AN EASY 1318 00:59:14,840 --> 00:59:16,640 WAY TO SAY THE SAME THING SAYING 1319 00:59:16,640 --> 00:59:19,360 THIS IS THE BEST WAY TO FIND OUT 1320 00:59:19,360 --> 00:59:19,880 THE CAUSE. 1321 00:59:19,880 --> 00:59:22,440 AND DOCTORS ARE WORRIED ABOUT 1322 00:59:22,440 --> 00:59:22,720 LIABILITY. 1323 00:59:22,720 --> 00:59:23,880 PERHAPS THEY'RE WORRIED ABOUT 1324 00:59:23,880 --> 00:59:25,960 THE RESULTS OF THAT AUTOPSY 1325 00:59:25,960 --> 00:59:27,320 SHOWING IT WAS SOMETHING RELATED 1326 00:59:27,320 --> 00:59:30,720 TO MEDICAL CARE THAT CAUSED THE 1327 00:59:30,720 --> 00:59:31,960 STILLBIRTHS AND ANOTHER REASON 1328 00:59:31,960 --> 00:59:33,720 AUTOPSIES DON'T HAPPEN IS 1329 00:59:33,720 --> 00:59:34,840 SOMETIMES DOCTORS ARE OVER 1330 00:59:34,840 --> 00:59:38,520 CONFIDENT ABOUT THE CAUSE AND 1331 00:59:38,520 --> 00:59:39,840 THAT'S SOMETHING THAT HAPPENED 1332 00:59:39,840 --> 00:59:42,800 WITH MY KIDDO THE DOCTOR WAS 1333 00:59:42,800 --> 00:59:47,760 CONVINCED I HAD A PLACENTAL 1334 00:59:47,760 --> 00:59:48,800 ISSUE AND I FELT GUILT SINCE 1335 00:59:48,800 --> 00:59:52,240 THEN I DID NOT DO EVERYTHING 1336 00:59:52,240 --> 00:59:55,960 POSSIBLE TO FIND OUT WHY MY SON 1337 00:59:55,960 --> 00:59:57,400 DIED BUT AT THE SAME TIME IT 1338 00:59:57,400 --> 00:59:58,560 WOULD HAVE BEEN DIFFICULT TO 1339 00:59:58,560 --> 01:00:00,040 AGREE TO THAT THAT DAY. 1340 01:00:00,040 --> 01:00:01,280 THE THOUGHT OF THAT HAPPENING TO 1341 01:00:01,280 --> 01:00:05,640 HIM WAS VERY DIFFICULT. 1342 01:00:05,640 --> 01:00:10,000 AT THE SAME TIME I WASN'T TOLD, 1343 01:00:10,000 --> 01:00:13,880 THIS WILL HELP CONTRIBUTE TO 1344 01:00:13,880 --> 01:00:14,960 RESEARCH TOO THOUGH AND 1345 01:00:14,960 --> 01:00:17,000 SOMETHING LIKE THAT MAY ARE ALSO 1346 01:00:17,000 --> 01:00:17,920 SWAYED MY DECISION A LITTLE BIT. 1347 01:00:17,920 --> 01:00:19,640 COST WAS NOT A FACTOR IN OUR 1348 01:00:19,640 --> 01:00:20,160 DECISION. 1349 01:00:20,160 --> 01:00:23,240 WE WOULD HAVE FIGURED THAT OUT 1350 01:00:23,240 --> 01:00:26,680 BUT I'M PRIVILEGED IN MANY WAYS 1351 01:00:26,680 --> 01:00:30,240 AND COST IS A BIG PROBLEM WITH 1352 01:00:30,240 --> 01:00:34,640 FETAL AUTOPSIES. 1353 01:00:34,640 --> 01:00:36,320 THERE'S NO GUARANTEE OF 1354 01:00:36,320 --> 01:00:37,000 INSURANCE COVERAGE AND THERE'S 1355 01:00:37,000 --> 01:00:38,680 DIFFICULTY TRYING TO FIGURE OUT 1356 01:00:38,680 --> 01:00:40,560 IF INSURANCE COVERS THIS. 1357 01:00:40,560 --> 01:00:42,000 MEDICAID DOES NOT COVER THE COST 1358 01:00:42,000 --> 01:00:44,800 OF THE FETAL AUTOPSY AND I KNOW 1359 01:00:44,800 --> 01:00:47,800 EVERYONE ON THE PANEL THOSE THIS 1360 01:00:47,800 --> 01:00:49,720 BUT MEDICAID COVERS HALF OF 1361 01:00:49,720 --> 01:00:51,240 PREGNANCIES IN OUR COUNTRY AND I 1362 01:00:51,240 --> 01:00:53,680 THINK HIGHER IN MY STATE CLOSER 1363 01:00:53,680 --> 01:00:56,240 TO TWO-THIRDS IN ARKANSAS 1364 01:00:56,240 --> 01:00:57,640 MEDICAID COVERS THESE 1365 01:00:57,640 --> 01:00:58,760 PREGNANCIES. 1366 01:00:58,760 --> 01:01:00,360 MEDICAID IS NOT COVERING AN 1367 01:01:00,360 --> 01:01:00,600 AUTOPSY. 1368 01:01:00,600 --> 01:01:03,920 AND AUTOPSIES ARE EXPENSIVE AND 1369 01:01:03,920 --> 01:01:09,000 STILLBIRTH IS SURPRISINGLY 1370 01:01:09,000 --> 01:01:10,160 EXPENSIVE AND AUTOPSIES CAN 1371 01:01:10,160 --> 01:01:11,600 EASILY FALL TO A LOW PRIORITY. 1372 01:01:11,600 --> 01:01:13,080 WE ALSO NEED TO BE CONCERNED 1373 01:01:13,080 --> 01:01:18,440 ABOUT THE QUALITY OF AUTOPSIES 1374 01:01:18,440 --> 01:01:21,040 THAT ARE COMPLETED WE DON'T HAVE 1375 01:01:21,040 --> 01:01:24,440 ENOUGH PERINATAL PATHOLOGISTS IN 1376 01:01:24,440 --> 01:01:25,760 THE COUNTRY. 1377 01:01:25,760 --> 01:01:29,760 LITTLE KIDS ARE NOT JUST LITTLE 1378 01:01:29,760 --> 01:01:31,360 ADULTS AND STILLBORN BABY NOT 1379 01:01:31,360 --> 01:01:33,120 LITTLE ADULTS AND HAVE TO BE 1380 01:01:33,120 --> 01:01:33,720 CONCERN ABOUT THE QUALITY OF 1381 01:01:33,720 --> 01:01:37,480 AUTOPSIES WE DO HAVE. 1382 01:01:37,480 --> 01:01:39,160 I WILL TALK ABOUT AUTOPSIES A 1383 01:01:39,160 --> 01:01:43,160 LITTLE BIT MORE AT THE END BUT 1384 01:01:43,160 --> 01:01:44,760 WANT SHIFT TO FETAL DEATH 1385 01:01:44,760 --> 01:01:46,920 CERTIFICATES AND WE ALL KNOW 1386 01:01:46,920 --> 01:01:50,200 THESE THINGS HAVE INACCURATE 1387 01:01:50,200 --> 01:01:51,240 INFORMATION AND HAVE INCOMPLETE 1388 01:01:51,240 --> 01:01:51,880 INFORMATION. 1389 01:01:51,880 --> 01:01:54,120 I NEVER SAT THROUGH THE TRAINING 1390 01:01:54,120 --> 01:01:55,960 TO COMPLETE A FETAL DEATH 1391 01:01:55,960 --> 01:01:56,680 CERTIFICATE. 1392 01:01:56,680 --> 01:01:59,120 I DO NOT KNOW WHAT THAT'S LIKE. 1393 01:01:59,120 --> 01:02:00,680 I DO WANT TO SUGGEST I THINK 1394 01:02:00,680 --> 01:02:01,480 PART OF THE PROBLEM BEHIND THIS 1395 01:02:01,480 --> 01:02:04,560 IS LACK OF AWARENESS OF 1396 01:02:04,560 --> 01:02:06,800 STILLBIRTH AND A COMPLETE LACK 1397 01:02:06,800 --> 01:02:08,720 OF AWARENESS OF HOW IMPORTANT 1398 01:02:08,720 --> 01:02:10,600 FETAL DEATH CERTIFICATES ARE IN 1399 01:02:10,600 --> 01:02:11,360 OUR ABILITY TO RESEARCH 1400 01:02:11,360 --> 01:02:15,520 STILLBIRTHS. 1401 01:02:15,520 --> 01:02:17,240 I DO WANT TO START WITH A 1402 01:02:17,240 --> 01:02:20,960 HISTORY LESSON BECAUSE I THINK 1403 01:02:20,960 --> 01:02:21,720 IT'S VERY INTERESTING. 1404 01:02:21,720 --> 01:02:24,360 WE GATHERED DATA ON STILLBIRTH 1405 01:02:24,360 --> 01:02:28,240 SINCE THE EARLY 1900s AND I MEAN 1406 01:02:28,240 --> 01:02:29,880 LIKE 1905. 1407 01:02:29,880 --> 01:02:31,920 THIS IS ALWAYS BEEN STATE-BASED 1408 01:02:31,920 --> 01:02:34,640 ALL VITAL STATISTICS ARE 1409 01:02:34,640 --> 01:02:35,160 STATE-BASED. 1410 01:02:35,160 --> 01:02:38,960 THE FEDERAL -- THE CONGRESS HAS 1411 01:02:38,960 --> 01:02:41,120 NO FEDERAL AUTHORITY TO MANDATE 1412 01:02:41,120 --> 01:02:46,200 ANY SORT OF VITAL STATISTICS 1413 01:02:46,200 --> 01:02:48,920 ABSENT AMENDING A CONSTITUTION. 1414 01:02:48,920 --> 01:02:51,240 IT'S STILL STATE-BASED. 1415 01:02:51,240 --> 01:02:55,360 BACK IN 1905, STATES HAD LAWS 1416 01:02:55,360 --> 01:02:57,720 ABOUT REGISTERING STILLBIRTHS 1417 01:02:57,720 --> 01:03:01,520 BUT THE WAY IT WAS DONE WAS WITH 1418 01:03:01,520 --> 01:03:03,520 A BIRTH AND DEATH CERTIFICATE. 1419 01:03:03,520 --> 01:03:04,880 INTERESTINGLY THERE WAS JUST A 1420 01:03:04,880 --> 01:03:06,160 QUESTION ON THE BIRTH 1421 01:03:06,160 --> 01:03:08,400 CERTIFICATE, WAS THE BABY 1422 01:03:08,400 --> 01:03:08,800 STILLBORN. 1423 01:03:08,800 --> 01:03:13,040 THIS CONTINUED FOR A WHILE. 1424 01:03:13,040 --> 01:03:18,400 ALSO, I ASKED MY MOM HER 1946 1425 01:03:18,400 --> 01:03:19,720 BIRTH CERTIFICATE AND I OUTED 1426 01:03:19,720 --> 01:03:22,240 HER AGE BUT FOR A GOOD REASON, 1427 01:03:22,240 --> 01:03:23,640 EVEN HER BIRTH CERTIFICATE HAD A 1428 01:03:23,640 --> 01:03:26,560 BOX TO CHECK IF THE BABY WAS 1429 01:03:26,560 --> 01:03:26,840 STILLBORN. 1430 01:03:26,840 --> 01:03:30,080 THIS PRACTICE WAS AROUND FOR 1431 01:03:30,080 --> 01:03:31,320 QUITE SOME TIME. 1432 01:03:31,320 --> 01:03:34,400 I MENTIONED THIS IS 1433 01:03:34,400 --> 01:03:35,200 DECENTRAL 1434 01:03:35,200 --> 01:03:35,520 DECENTRALIZED. 1435 01:03:35,520 --> 01:03:38,720 STATES ALL DO THEIR OWN THING AS 1436 01:03:38,720 --> 01:03:40,960 FAR AS ISSUING VITAL STATISTICS. 1437 01:03:40,960 --> 01:03:42,320 WE TRY TO HELP. 1438 01:03:42,320 --> 01:03:44,520 UNIFORMITY IS A GOOD THING. 1439 01:03:44,520 --> 01:03:46,800 SO SOMETHING LIKE THE MODEL 1440 01:03:46,800 --> 01:03:48,760 VITAL STATISTIC LAW EXISTS. 1441 01:03:48,760 --> 01:03:50,720 THERE'S A MODEL LAW THAT FEDERAL 1442 01:03:50,720 --> 01:03:52,600 AGENCIES PRODUCE AND WE HOPE 1443 01:03:52,600 --> 01:03:53,800 STATES WILL FOLLOW THAT. 1444 01:03:53,800 --> 01:03:58,840 I BRING THAT UP IMPORTANTLY 1445 01:03:58,840 --> 01:04:00,840 BECAUSE THE 1907 MODEL VITAL 1446 01:04:00,840 --> 01:04:02,440 STATISTICS LAW WAS THE SAME AS 1447 01:04:02,440 --> 01:04:07,840 THIS PENNSYLVANIA LAW ABOUT 1448 01:04:07,840 --> 01:04:12,680 USING THE STILLBIRTH WITH THE 1449 01:04:12,680 --> 01:04:13,120 BIRTH CERTIFICATE. 1450 01:04:13,120 --> 01:04:20,760 BACK TO MODERN DAY, STATES 1451 01:04:20,760 --> 01:04:22,880 CONTROL THE ISSUANCE OF FETAL 1452 01:04:22,880 --> 01:04:25,680 DEATH CERTIFICATES AND NOT EVERY 1453 01:04:25,680 --> 01:04:29,880 STATE USES THE SAME DEFINITION. 1454 01:04:29,880 --> 01:04:32,160 SOME STATES DO FETAL WEIGHT OVER 1455 01:04:32,160 --> 01:04:34,880 350 GRAMS OR WEIGHT UNKNOWN 20 1456 01:04:34,880 --> 01:04:35,120 WEEKS. 1457 01:04:35,120 --> 01:04:37,320 SOME STATES DO 20 WEEKS AND SOME 1458 01:04:37,320 --> 01:04:40,920 DO 20 WEEKS OR IF THAT'S UNKNOWN 1459 01:04:40,920 --> 01:04:41,920 THEN 350 GRAMS. 1460 01:04:41,920 --> 01:04:47,400 THERE HAVE BEEN SOME OUTLIERS. 1461 01:04:47,400 --> 01:04:48,920 SOUTH DAKOTA I CAN'T GET TO THE 1462 01:04:48,920 --> 01:04:50,760 BOTTOM OF THIS ONE. 1463 01:04:50,760 --> 01:04:55,360 EVEN THE REPORT ON THE 2020 1464 01:04:55,360 --> 01:04:58,800 STILLBIRTH DATA HAD AN ASTERISK 1465 01:04:58,800 --> 01:05:00,400 NEXT TO SOUTH DAKOTA IT ONLY 1466 01:05:00,400 --> 01:05:03,320 REPORTS STILL BIRTHS OVER 500 1467 01:05:03,320 --> 01:05:04,240 GRAMS WHICH USED TO BE SOUTH 1468 01:05:04,240 --> 01:05:06,000 DAKOTA'S LAW BUT THEY CHANGED 1469 01:05:06,000 --> 01:05:07,840 THAT LAW IN 2007 AND THEY NOW 1470 01:05:07,840 --> 01:05:13,520 USE THE 20-WEEK STANDARD. 1471 01:05:13,520 --> 01:05:21,360 SO I DON'T KNOW IF WE ARE ONLY 1472 01:05:21,360 --> 01:05:23,160 REPORTING 20 GRAMS BUT 1473 01:05:23,160 --> 01:05:25,560 SOMETHING'S AMISS THERE. 1474 01:05:25,560 --> 01:05:28,600 ALSO, WE HAD SOME RECENT 1475 01:05:28,600 --> 01:05:30,120 OUTLIERS ONLY WITHIN THE LAST 10 1476 01:05:30,120 --> 01:05:32,400 YEARS THAT OUR OUTLIER 1477 01:05:32,400 --> 01:05:34,520 DEFINITIONS HAVE CHANGED. 1478 01:05:34,520 --> 01:05:37,000 IT WAS 2012 THAT TENNESSEE 1479 01:05:37,000 --> 01:05:39,040 FINALLY GOT RID OF ITS -- IT 1480 01:05:39,040 --> 01:05:41,680 USED TO HAVE 500 GRAMS OR 22 1481 01:05:41,680 --> 01:05:42,080 WEEKS. 1482 01:05:42,080 --> 01:05:44,520 SO THAT'S WHAT TENNESSEE WAS 1483 01:05:44,520 --> 01:05:47,120 USING UP TO 2012. 1484 01:05:47,120 --> 01:05:49,640 NEW MEXICO WAS USING 500 GRAMS 1485 01:05:49,640 --> 01:05:50,720 UNTIL 2014. 1486 01:05:50,720 --> 01:05:52,320 EVEN IF WE FEEL COMFORTABLE 1487 01:05:52,320 --> 01:05:54,880 WHERE STATES ARE NOW, IT'S 1488 01:05:54,880 --> 01:05:59,480 RELATIVELY RECENT. 1489 01:05:59,480 --> 01:06:03,800 I WILL SAY PEOPLE MAY LOOK AT 1490 01:06:03,800 --> 01:06:07,400 THIS AND SAY THE DEFINITION 1491 01:06:07,400 --> 01:06:09,280 CLOSE ENOUGH AND THEY ARE 1492 01:06:09,280 --> 01:06:09,640 RELATIVE CLOSE. 1493 01:06:09,640 --> 01:06:11,600 I DON'T KNOW IF WE SETTLED FOR 1494 01:06:11,600 --> 01:06:13,280 CLOSE ENOUGH IN OTHER CONTEXT 1495 01:06:13,280 --> 01:06:15,880 THOUGH AND ONE THING I DO NOT 1496 01:06:15,880 --> 01:06:19,720 UNDERSTAND IS THAT THE 1992 1497 01:06:19,720 --> 01:06:23,760 MODEL VITAL STATISTICS ACT HAS 1498 01:06:23,760 --> 01:06:25,880 THE 350 OR WEIGHT UNKNOWN 20 1499 01:06:25,880 --> 01:06:28,680 WEEKS AND THAT CHANGED BEFORE 1500 01:06:28,680 --> 01:06:31,280 1992 IT WAS USING THE 20 WEEKS 1501 01:06:31,280 --> 01:06:33,840 OR WEEKS UNKNOWN, 350 GRAMS AND 1502 01:06:33,840 --> 01:06:35,800 I CANNOT FIND ANY DOCUMENTATION 1503 01:06:35,800 --> 01:06:39,400 ABOUT WHY THAT WAS CHANGED. 1504 01:06:39,400 --> 01:06:41,600 I DON'T UNDERSTAND WHY OUR MODEL 1505 01:06:41,600 --> 01:06:45,040 ACT WOULD NOT USE THE MEDICAL 1506 01:06:45,040 --> 01:06:47,360 DEFINITION OF STILLBIRTH AT 20 1507 01:06:47,360 --> 01:06:52,680 WEEKS. 1508 01:06:52,680 --> 01:06:55,480 THESE ARE PICTURES OF MY KIDDO'S 1509 01:06:55,480 --> 01:06:57,920 FETAL DEATH CERTIFICATE. 1510 01:06:57,920 --> 01:06:59,480 WE SAW A BLANK VERSION FROM 1511 01:06:59,480 --> 01:07:00,760 DR. DUDLEY EARLIER THIS MORNING. 1512 01:07:00,760 --> 01:07:03,160 THIS IS THE INITIATING CAUSE AND 1513 01:07:03,160 --> 01:07:08,760 THE SIGNIFICANT CAUSE SECTIONS 1514 01:07:08,760 --> 01:07:13,440 OF CALEB'S DEATH CERTIFICATE, MY 1515 01:07:13,440 --> 01:07:15,480 SON'S NAME IS CALEB, AND THOUGHT 1516 01:07:15,480 --> 01:07:19,960 I HAD A PLACENTAL OBSTRUCTION 1517 01:07:19,960 --> 01:07:22,880 AND I LEARNED FROM A SPECIALIST 1518 01:07:22,880 --> 01:07:24,800 SINCE I DIDN'T HAVE ONE BUT WHAT 1519 01:07:24,800 --> 01:07:30,280 I ALSO WANTED TO MENTION IS 1520 01:07:30,280 --> 01:07:33,720 Y'ALL CAN SEE AS FAR AS OTHER 1521 01:07:33,720 --> 01:07:34,600 OBSTETRICAL COMPLICATIONS LISTED 1522 01:07:34,600 --> 01:07:38,560 AS A CAUSE OR SIGNIFICANT CAUSE 1523 01:07:38,560 --> 01:07:40,200 CONTRIBUTING TO CALEB'S DEATH 1524 01:07:40,200 --> 01:07:41,960 WAS MY GESTATIONAL DIABETES. 1525 01:07:41,960 --> 01:07:44,240 I WANTED TO PAUSE FOR A SECOND 1526 01:07:44,240 --> 01:07:47,240 TO EXPRESS HOW UPSET I WAS WHEN 1527 01:07:47,240 --> 01:07:50,760 I OPENED THIS MAIL AND GOT THE 1528 01:07:50,760 --> 01:07:53,120 FETAL DEATH CERTIFICATE AND SAW 1529 01:07:53,120 --> 01:07:54,200 GESTATIONAL DIABETES LISTED AS A 1530 01:07:54,200 --> 01:07:56,440 CAUSE OR SIGNIFICANT CAUSE OF 1531 01:07:56,440 --> 01:07:57,760 CALEB'S DEATH. 1532 01:07:57,760 --> 01:08:02,720 OBVIOUSLY, THIS WAS SOMETHING I 1533 01:08:02,720 --> 01:08:04,960 HAD AND SOMETHING I HAD CONTROL 1534 01:08:04,960 --> 01:08:06,160 OVER TO SOME EXTENT. 1535 01:08:06,160 --> 01:08:12,280 SO TO SEE THAT AS LISTED AS A 1536 01:08:12,280 --> 01:08:14,760 CAUSE OF HIS DEATH WAS VERY 1537 01:08:14,760 --> 01:08:16,040 DIFFICULT FOR ME. 1538 01:08:16,040 --> 01:08:21,520 ALSO WHAT WAS ALSO EXTREMELY 1539 01:08:21,520 --> 01:08:23,640 DIFFICULT FOR ME WAS IF THIS 1540 01:08:23,640 --> 01:08:25,600 ILLNESS, DISEASE, THE ILLNESS I 1541 01:08:25,600 --> 01:08:27,680 HAD WAS A BIG ENOUGH DEAL TO BE 1542 01:08:27,680 --> 01:08:34,400 LISTED AS A CAUSE, WHY WASN'T I 1543 01:08:34,400 --> 01:08:36,440 HOLD AHEAD OF TIME? 1544 01:08:36,440 --> 01:08:39,320 WHY WASN'T I TOLD WHEN I WAS 1545 01:08:39,320 --> 01:08:41,960 DIAGNOSED WITH GESTATIONAL 1546 01:08:41,960 --> 01:08:44,720 DIABETES THIS CAN BE AN ISSUE 1547 01:08:44,720 --> 01:08:45,280 CONTRIBUTING TO STILLBIRTHS? 1548 01:08:45,280 --> 01:08:47,360 I MEAN, THE OPPOSITE WAS TRUE, 1549 01:08:47,360 --> 01:08:50,040 LIKE I DO BELIEVE MY DOCTOR 1550 01:08:50,040 --> 01:08:51,840 MENTIONED THAT MAYBE HE WOULD 1551 01:08:51,840 --> 01:08:53,760 HAVE TO COME OUT EARLY WHICH IS 1552 01:08:53,760 --> 01:08:55,360 NOT ANYTHING WE WORRY ABOUT 1553 01:08:55,360 --> 01:08:57,760 THESE DAYS WITH HOW FAR MEDICINE 1554 01:08:57,760 --> 01:08:58,720 HAS ADVANCED. 1555 01:08:58,720 --> 01:09:00,480 OTHERWISE IT WAS LIKE A NO BIG 1556 01:09:00,480 --> 01:09:02,360 DEAL AND CONTROL IT WITH YOUR 1557 01:09:02,360 --> 01:09:04,400 DIET AND I DID CONTROL IT WITH 1558 01:09:04,400 --> 01:09:06,600 MY DIET. 1559 01:09:06,600 --> 01:09:08,440 BUT IT'S A DISCONNECT. 1560 01:09:08,440 --> 01:09:11,000 LIKE IF THIS WAS A BIG ENOUGH 1561 01:09:11,000 --> 01:09:13,880 DEAL TO APPEAR ON HIS FETAL 1562 01:09:13,880 --> 01:09:16,400 DEATH CERTIFICATE I SHOULD HAVE 1563 01:09:16,400 --> 01:09:19,360 BEEN TOLD THAT GESTATIONAL 1564 01:09:19,360 --> 01:09:24,200 DIABETES WAS A BIG DEAL AND I 1565 01:09:24,200 --> 01:09:25,120 THINK THIS IS CONSISTENT WITH 1566 01:09:25,120 --> 01:09:26,880 THE THEME OTHERS HAVE SHARED 1567 01:09:26,880 --> 01:09:31,080 WITH THE THIS WORKING GROUP. 1568 01:09:31,080 --> 01:09:33,200 THERE'S A LACK OF KNOWLEDGE OF 1569 01:09:33,200 --> 01:09:34,280 STILLBIRTH AND IT BEING A 1570 01:09:34,280 --> 01:09:35,680 POSSIBILITY UNTIL IT HAPPENS TO 1571 01:09:35,680 --> 01:09:40,000 YOU. 1572 01:09:40,000 --> 01:09:46,920 AS ALLOW -- AS A LAWYER WE TALK 1573 01:09:46,920 --> 01:09:47,880 ABOUT THE DISPARITY BETWEEN 1574 01:09:47,880 --> 01:09:50,360 PATIENT AND DOCTORS AND TALK 1575 01:09:50,360 --> 01:09:52,280 ABOUT LAWS THAT HELP EVEN THAT 1576 01:09:52,280 --> 01:09:52,560 DISPARITY. 1577 01:09:52,560 --> 01:09:55,160 I THINK ESPECIALLY IN PREGNANCY 1578 01:09:55,160 --> 01:09:58,240 CARE, I THINK THAT DISPARITY IS 1579 01:09:58,240 --> 01:09:58,760 QUITE STARK YET. 1580 01:09:58,760 --> 01:10:00,080 AND ONE THINGS I WANT TO MENTION 1581 01:10:00,080 --> 01:10:03,240 ON THIS LEVEL, THERE'S GREAT 1582 01:10:03,240 --> 01:10:04,440 SCHOLARSHIP OUT THERE ABOUT IS 1583 01:10:04,440 --> 01:10:06,840 BEING CALLED OBSTETRIC VIOLENCE 1584 01:10:06,840 --> 01:10:10,640 AND THE IDEA THAT COERCING 1585 01:10:10,640 --> 01:10:13,720 PEOPLE INTO LIKE C-SECTIONS THEY 1586 01:10:13,720 --> 01:10:17,000 DON'T WANT AND THE STORIES TOLD 1587 01:10:17,000 --> 01:10:19,080 THERE IS THE DOCTOR WAS TRYING 1588 01:10:19,080 --> 01:10:20,960 TO PRESSURE ME INTO IT AND 1589 01:10:20,960 --> 01:10:23,360 PLAYED THE DEAD BABY CARD. 1590 01:10:23,360 --> 01:10:26,320 THE ONLY TIME STILLBIRTHS COMES 1591 01:10:26,320 --> 01:10:28,400 UP IS WHEN WE ARE TRYING TO 1592 01:10:28,400 --> 01:10:30,680 SCARE PEOPLE INTO PROCEDURES, 1593 01:10:30,680 --> 01:10:31,840 WHICH I HAVE A VERY DIFFERENT 1594 01:10:31,840 --> 01:10:33,600 TAKE ON THAT AND IF THERE'S SOME 1595 01:10:33,600 --> 01:10:35,360 CHANCE OF STILLBIRTH YOU NEED TO 1596 01:10:35,360 --> 01:10:38,040 BE LISTENING TO YOUR DOCTOR BUT 1597 01:10:38,040 --> 01:10:40,280 THE LACK OF AWARENESS AND LACK 1598 01:10:40,280 --> 01:10:44,560 OF DISCUSSION ABOUT STILLBIRTH 1599 01:10:44,560 --> 01:10:46,000 MAKES PEOPLE IMMEDIATELY THINK I 1600 01:10:46,000 --> 01:10:52,800 DON'T NEED TO WORRY ABOUT THAT. 1601 01:10:52,800 --> 01:10:55,360 COMING BACK TO CALEB'S FETAL 1602 01:10:55,360 --> 01:10:57,360 DEATH CERTIFICATE AND IT SAYS 1603 01:10:57,360 --> 01:11:01,120 PLACENTAL OBSTRUCTION AND I'M 1604 01:11:01,120 --> 01:11:02,680 SINCE LEARNED FROM A SPECIALIST 1605 01:11:02,680 --> 01:11:06,600 THAT PROBABLY DIDN'T HAPPEN SO 1606 01:11:06,600 --> 01:11:08,200 HIS FETAL DEATH IS INACCURATE. 1607 01:11:08,200 --> 01:11:10,280 SO I WANTED TO SHARE THIS WITH 1608 01:11:10,280 --> 01:11:13,040 YOU AND WE SAW THIS FROM 1609 01:11:13,040 --> 01:11:15,160 DR. DUDLEY AND WE ALSO DISCUSSED 1610 01:11:15,160 --> 01:11:18,080 IT THAT THESE FETAL DEATH 1611 01:11:18,080 --> 01:11:19,320 CERTIFICATES ARE FILLED OUT 1612 01:11:19,320 --> 01:11:24,120 BEFORE AUTOPSY ARE PERFORMED AND 1613 01:11:24,120 --> 01:11:29,960 BEFORE PLACENTAS ARE EXAMINED 1614 01:11:29,960 --> 01:11:31,920 AND THIS THERE'S THE QUESTION 1615 01:11:31,920 --> 01:11:34,800 WAS THE AUTOPSY RESULTS USED IN 1616 01:11:34,800 --> 01:11:36,520 DETERMINING THE CAUSE OF FETAL 1617 01:11:36,520 --> 01:11:37,720 DEATH. 1618 01:11:37,720 --> 01:11:39,360 THE FETAL DEATH CERTIFICATE 1619 01:11:39,360 --> 01:11:41,280 CONTEMPLATES THAT TIMING. 1620 01:11:41,280 --> 01:11:43,520 THAT'S ALSO TRUE FOR DEATH 1621 01:11:43,520 --> 01:11:45,160 CERTIFICATES FOR DEATHS OF 1622 01:11:45,160 --> 01:11:45,960 LIVING PEOPLE. 1623 01:11:45,960 --> 01:11:48,080 THERE'S A QUESTION ON THAT 1624 01:11:48,080 --> 01:11:49,640 STANDARD DEATH CERTIFICATE ALSO 1625 01:11:49,640 --> 01:11:51,280 WHETHER AN AUTOPSY WAS PERFORMED 1626 01:11:51,280 --> 01:11:52,840 AND WHETHER THE FINDINGS WERE 1627 01:11:52,840 --> 01:11:53,200 AVAILABLE. 1628 01:11:53,200 --> 01:11:55,800 THERE IS AN ADDITIONAL LANGUAGE 1629 01:11:55,800 --> 01:11:56,920 ON THE STANDARD DEATH 1630 01:11:56,920 --> 01:11:58,000 CERTIFICATE AND YOU CAN SEE THAT 1631 01:11:58,000 --> 01:12:00,680 ON THE BOTTOM OF MY SLIDE IF 1632 01:12:00,680 --> 01:12:05,760 THERE'S ADDITIONAL MEDICAL 1633 01:12:05,760 --> 01:12:07,360 INFORMATION THAT BECOMES 1634 01:12:07,360 --> 01:12:09,200 AVAILABLE WE NEED TO IMMEDIATELY 1635 01:12:09,200 --> 01:12:10,840 REPORT THAT SO GET IT AMENDED. 1636 01:12:10,840 --> 01:12:13,440 THAT LANGUAGE IS NOT ON THE 1637 01:12:13,440 --> 01:12:15,400 FETAL STANDARD DEATH CERTIFICATE 1638 01:12:15,400 --> 01:12:19,080 UNLESS THERE'S A PAGE OF IT I 1639 01:12:19,080 --> 01:12:22,760 CAN'T FIND BUT I'M CURIOUS WHY 1640 01:12:22,760 --> 01:12:24,360 THE URGENCY EXISTS FOR THE 1641 01:12:24,360 --> 01:12:26,000 STANDARD DEATH CERTIFICATE AND 1642 01:12:26,000 --> 01:12:31,200 NOT THE FETAL DEATH CERTIFICATE. 1643 01:12:31,200 --> 01:12:35,000 IF WE DO LEARN MEDICAL 1644 01:12:35,000 --> 01:12:38,480 INFORMATION LATER WE CAN AMEND A 1645 01:12:38,480 --> 01:12:40,320 FETAL DEATH CERTIFICATE BUT 1646 01:12:40,320 --> 01:12:41,280 THERE'S A PROCESS. 1647 01:12:41,280 --> 01:12:43,000 THERE'S A PROCESS AND ANY 1648 01:12:43,000 --> 01:12:46,040 CHANGES TO ME MEDICAL DATA OF 1649 01:12:46,040 --> 01:12:47,920 THE PART OF THE FETAL DEATH 1650 01:12:47,920 --> 01:12:49,160 CERTIFICATE HAS TO COME FROM THE 1651 01:12:49,160 --> 01:12:54,120 DOCTOR WHO PROVIDED THE MEDICAL 1652 01:12:54,120 --> 01:12:57,400 INFORMATION ON THE FETAL DEATH 1653 01:12:57,400 --> 01:12:58,520 CERTIFICATE. 1654 01:12:58,520 --> 01:13:02,760 THAT COULD BE THE DOCTOR THAT 1655 01:13:02,760 --> 01:13:05,320 TRIED TO TALK OUT OU FROM THE 1656 01:13:05,320 --> 01:13:07,520 AUTOPSY WITH OR YOU CUT OFF THE 1657 01:13:07,520 --> 01:13:09,520 RELATIONSHIP WITH OR COULD STILL 1658 01:13:09,520 --> 01:13:11,160 BE THE DOCTOR YOU STILL HAVE A 1659 01:13:11,160 --> 01:13:14,520 GREAT RELATIONSHIP WITH BUT THE 1660 01:13:14,520 --> 01:13:16,960 CHANGING THE FETAL DEATH 1661 01:13:16,960 --> 01:13:18,200 CERTIFICATE IS NOT ON TOP HIS 1662 01:13:18,200 --> 01:13:18,600 PRIORITY LIST. 1663 01:13:18,600 --> 01:13:21,600 HE HAS OTHER PATIENTS. 1664 01:13:21,600 --> 01:13:27,160 ULTIMATELY, I GUESS THE QUESTION 1665 01:13:27,160 --> 01:13:29,280 IS, WHAT'S THE POINT? 1666 01:13:29,280 --> 01:13:33,960 I'VE SHOWED YOU MY KIDDO'S FETAL 1667 01:13:33,960 --> 01:13:36,760 DEATH CERTIFICATE ACCORDING TO A 1668 01:13:36,760 --> 01:13:39,920 SPECIALIST IS INACCURATE BUT I 1669 01:13:39,920 --> 01:13:41,200 DON'T SEE WORTHWHILE REASON TO 1670 01:13:41,200 --> 01:13:41,960 GO THROUGH THE PROCESS OF 1671 01:13:41,960 --> 01:13:50,600 AMENDING IT. 1672 01:13:50,600 --> 01:13:53,320 AND I CARE VERY MUCH ABOUT WHY 1673 01:13:53,320 --> 01:13:57,320 HE DIED BUT I DON'T SEE A 1674 01:13:57,320 --> 01:13:58,000 WORTHWHILE REASON OF GOING 1675 01:13:58,000 --> 01:14:03,040 THROUGH THE PROCESS OF HAVING 1676 01:14:03,040 --> 01:14:11,200 HIS DEATH CERTIFICATE AMENDED IS 1677 01:14:11,200 --> 01:14:14,760 WORTHWHILE AND IT'S CONCERNING 1678 01:14:14,760 --> 01:14:17,000 FOR OUR SYSTEM AS A WHOLE. 1679 01:14:17,000 --> 01:14:20,720 KIM PIPER BROUGHT UP IN IOWA 1680 01:14:20,720 --> 01:14:21,440 THEY'RE GATHERING COVID 1681 01:14:21,440 --> 01:14:23,200 INFORMATION WITH RESPECT TO 1682 01:14:23,200 --> 01:14:24,640 STILLBIRTHS AND THAT'S SOMETHING 1683 01:14:24,640 --> 01:14:27,240 I WANT TO TALK ABOUT HERE TOO IN 1684 01:14:27,240 --> 01:14:27,960 MY TIME. 1685 01:14:27,960 --> 01:14:29,640 COVID INFECTIONS DURING 1686 01:14:29,640 --> 01:14:33,120 PREGNANCY AND STILLBIRTHS AND 1687 01:14:33,120 --> 01:14:37,200 VACCINATION STATUS OR 1688 01:14:37,200 --> 01:14:37,560 UNVACCINATED. 1689 01:14:37,560 --> 01:14:41,160 THE CDC REALIZED VERY EARLY ON 1690 01:14:41,160 --> 01:14:43,320 THAT WE NEEDED DATA ABOUT 1691 01:14:43,320 --> 01:14:48,400 POSSIBLE AFFECTS IN PREGNANCY IF 1692 01:14:48,400 --> 01:14:53,760 A PREGNANT PERSON WERE TO HAVE A 1693 01:14:53,760 --> 01:15:01,240 COVID INFECTION AND ACT ED VER 1694 01:15:01,240 --> 01:15:03,040 EARLY AND SAID WE NEED THE 1695 01:15:03,040 --> 01:15:05,040 INFORMATION AND DATA. 1696 01:15:05,040 --> 01:15:08,560 THE EMPHASIS AND NOT ONLY 1697 01:15:08,560 --> 01:15:10,560 EMPHASIS BUT THE ONLY WORK WAS 1698 01:15:10,560 --> 01:15:16,040 DONE WITH RESPECT TO LIVE BIRTH 1699 01:15:16,040 --> 01:15:17,120 CERTIFICATES. 1700 01:15:17,120 --> 01:15:24,200 THIS IS STUFF -- THREES EXAMPLES 1701 01:15:24,200 --> 01:15:26,880 FROM THE CDC AND SUGGESTIONS 1702 01:15:26,880 --> 01:15:28,080 THEY ASKED -- RECOMMENDATIONS 1703 01:15:28,080 --> 01:15:32,800 THEY MADE TO STATES TO CHANGE 1704 01:15:32,800 --> 01:15:37,120 LIVE BIRTH CERTIFICATES. 1705 01:15:37,120 --> 01:15:41,480 ONE OF THESE ONE IS PLEASE AS 1706 01:15:41,480 --> 01:15:42,720 INFECTION PRESENT OR TREATED 1707 01:15:42,720 --> 01:15:45,800 DURING PREGNANCY CAN YOU AT 1708 01:15:45,800 --> 01:15:47,960 LEAST WRITE COVID, BETTER YET 1709 01:15:47,960 --> 01:15:50,680 CAN WE LIST COVID AS A POSSIBLE 1710 01:15:50,680 --> 01:15:51,640 INFECTION AND BETTER THAN THAT 1711 01:15:51,640 --> 01:15:54,720 CAN WE HAVE INFORMATION WITH 1712 01:15:54,720 --> 01:15:57,320 COVID TO WHICH TRIMESTER THAT 1713 01:15:57,320 --> 01:16:02,800 COVID INFECTION HAPPENED. 1714 01:16:02,800 --> 01:16:04,000 AGAIN, THIS WAS ONLY ON LIVE 1715 01:16:04,000 --> 01:16:09,080 BIRTH CERTIFICATES. 1716 01:16:09,080 --> 01:16:14,480 THERE IS A SPOT ON A FETAL DEATH 1717 01:16:14,480 --> 01:16:17,280 CERTIFICATE ASKED FOR TREATMENTS 1718 01:16:17,280 --> 01:16:20,800 DURING PREGNANCY AND A SPOT FOR 1719 01:16:20,800 --> 01:16:23,520 OTHER WE COULD EASILY WRITTEN 1720 01:16:23,520 --> 01:16:27,640 COVID IN BUT IN WELL-INTENTIONED 1721 01:16:27,640 --> 01:16:30,560 EFFORTS TO SIMPLIFY THE FETAL 1722 01:16:30,560 --> 01:16:32,760 DEATH CERTIFICATE WE STOPPED 1723 01:16:32,760 --> 01:16:33,680 NATIONALLY COLLECTING CERTAIN 1724 01:16:33,680 --> 01:16:35,280 INFO AND THAT INCLUDES 1725 01:16:35,280 --> 01:16:37,080 INFORMATION ABOUT MATERNAL 1726 01:16:37,080 --> 01:16:41,240 INFECTIONS DURING PREGNANCY. 1727 01:16:41,240 --> 01:16:44,440 SO EVEN IF WE HAD INFORMATION ON 1728 01:16:44,440 --> 01:16:48,480 THE FETAL DEATH ISSUE 1729 01:16:48,480 --> 01:16:51,960 CERTIFICATE FOR COVID DURING 1730 01:16:51,960 --> 01:16:52,680 PREGNANCY WE'RE NOT COLLECTING 1731 01:16:52,680 --> 01:16:57,800 THAT ANYMORE AND IT WAS A 1732 01:16:57,800 --> 01:16:58,920 WELL-INTENTIONED EFFORT TO MAKE 1733 01:16:58,920 --> 01:17:01,760 THE DEATH CERTIFICATE EASIER TO 1734 01:17:01,760 --> 01:17:03,960 FILL OUT BUT WE'RE NOT 1735 01:17:03,960 --> 01:17:04,480 COLLECTING THE DATA. 1736 01:17:04,480 --> 01:17:08,280 THIS HAMPERED OUR ABILITY TO 1737 01:17:08,280 --> 01:17:09,320 GATHER DATA ON COVID INFECTION 1738 01:17:09,320 --> 01:17:10,640 AND STILLBIRTHS. 1739 01:17:10,640 --> 01:17:14,040 THE STUDIES THE CDC HAS DONE 1740 01:17:14,040 --> 01:17:16,680 ABOUT HOW AN UNVACCINATED 1741 01:17:16,680 --> 01:17:21,240 INFECTION INCREASES THE RISK OF 1742 01:17:21,240 --> 01:17:22,840 STILLBIRTH, THEY AREN'T -- FETAL 1743 01:17:22,840 --> 01:17:24,680 DEATH CERTIFICATE IS ONE SOURCE 1744 01:17:24,680 --> 01:17:34,960 AND THE OTHER IS HOSPITALS. 1745 01:17:34,960 --> 01:17:38,640 AND THE EMERGING THREATS 1746 01:17:38,640 --> 01:17:40,520 DATABASE WAS COMPARING STATE 1747 01:17:40,520 --> 01:17:43,320 COVID DATABASES WITH STATE 1748 01:17:43,320 --> 01:17:48,240 STILLBIRTH DATA THEN HOME TESTS 1749 01:17:48,240 --> 01:17:51,040 HAVE -- YOU ALL KNOW. 1750 01:17:51,040 --> 01:17:55,360 IT'S ENTIRELY STILL POSSIBLE 1751 01:17:55,360 --> 01:17:57,880 THAT YOUR O.B. MAY BE ASKING YOU 1752 01:17:57,880 --> 01:17:59,680 IF YOU HAD COVID AND THAT 1753 01:17:59,680 --> 01:18:01,400 INFORMATION WOULD BE IN THE 1754 01:18:01,400 --> 01:18:02,960 PREGNANT PERSON'S MEDICAL FILE 1755 01:18:02,960 --> 01:18:04,640 AND MAYBE COULD EVEN SHOW UP IN 1756 01:18:04,640 --> 01:18:09,920 THE OTHER PART OF THE FETAL 1757 01:18:09,920 --> 01:18:14,640 DEATH CERTIFICATE I'LL BE 1758 01:18:14,640 --> 01:18:17,640 HONEST, WHEN I MADE THE 1759 01:18:17,640 --> 01:18:19,200 DISCOVERY I WAS LIKE IS THIS 1760 01:18:19,200 --> 01:18:21,240 RIGHT WE'RE NOT DOING THIS FOR 1761 01:18:21,240 --> 01:18:22,800 STILLBIRTHS AND E-MAILS 1762 01:18:22,800 --> 01:18:24,080 DR. MARTIN AT THE CDC AND TO 1763 01:18:24,080 --> 01:18:30,080 MAKE SURE I WAS RIGHT ABOUT THIS 1764 01:18:30,080 --> 01:18:31,280 AND WE MOVED TO GATHER MORE DATA 1765 01:18:31,280 --> 01:18:33,160 ABOUT COVID INFECTIONS AND LIVE 1766 01:18:33,160 --> 01:18:33,440 BIRTHS. 1767 01:18:33,440 --> 01:18:37,120 WE WANTED TO FOCUS IN ON IS IT 1768 01:18:37,120 --> 01:18:39,240 CAUSING LOW BIRTH WEIGHT OR 1769 01:18:39,240 --> 01:18:40,360 PREMATURE BIRTHS. 1770 01:18:40,360 --> 01:18:43,080 WE NEVER DID IT WITH RESPECT TO 1771 01:18:43,080 --> 01:18:43,360 STILLBIRTHS. 1772 01:18:43,360 --> 01:18:45,840 WE WORRIED ABOUT COVID INFECTION 1773 01:18:45,840 --> 01:18:47,360 INFORMATION WITH RESPECT TO 1774 01:18:47,360 --> 01:18:51,800 STI 1775 01:18:51,800 --> 01:18:52,120 STILLBIRTHS. 1776 01:18:52,120 --> 01:18:54,760 TO ME IT SPEAKS TO A QUESTION OF 1777 01:18:54,760 --> 01:18:56,440 HOW COVID IS SUCH AN 1778 01:18:56,440 --> 01:19:00,640 AFTERTHOUGHT AND OF COURSE, YES, 1779 01:19:00,640 --> 01:19:02,120 HINDSIGHT'S 20/20. 1780 01:19:02,120 --> 01:19:08,760 IF WE CAN GO BACK AND FIX ALL 1781 01:19:08,760 --> 01:19:11,000 THIS BUT THANK GOODNESS BUT 1782 01:19:11,000 --> 01:19:13,960 APRIL 2020 WAS A DIFFICULT TIME 1783 01:19:13,960 --> 01:19:14,760 AND STILLBIRTH WAS AN 1784 01:19:14,760 --> 01:19:19,400 AFTERTHOUGHT. 1785 01:19:19,400 --> 01:19:21,680 I THINK ALL THE SLIDE SAYS IS 1786 01:19:21,680 --> 01:19:22,200 POSSIBLE IMPROVEMENTS. 1787 01:19:22,200 --> 01:19:26,800 THINGS I WANTED TO SHARE. 1788 01:19:26,800 --> 01:19:29,560 NEXT SLIDE. 1789 01:19:29,560 --> 01:19:32,640 WE'VE TALKED ABOUT SID DEATHS IN 1790 01:19:32,640 --> 01:19:35,000 THESE PRESENTATIONS. 1791 01:19:35,000 --> 01:19:37,080 A LOT OF STATES PAY FOR 1792 01:19:37,080 --> 01:19:43,440 AUTOPSIES AFTER A SUSPECTED SID 1793 01:19:43,440 --> 01:19:45,960 DEATH AND A LOT OF STATES 1794 01:19:45,960 --> 01:19:48,280 DECLARED IT A PUBLIC EMERGENCY 1795 01:19:48,280 --> 01:19:50,520 WE NEED TO DO WE CAN ABOUT AND 1796 01:19:50,520 --> 01:19:54,240 THAT INCLUDES AUTOPSY AND THAT 1797 01:19:54,240 --> 01:19:55,680 INCLUDES STATE-PAID FOR 1798 01:19:55,680 --> 01:19:55,960 AUTOPSIES. 1799 01:19:55,960 --> 01:19:58,280 WE'RE NOT DOING THIS FOR STILL 1800 01:19:58,280 --> 01:19:58,480 BIRTH. 1801 01:19:58,480 --> 01:20:02,800 WE'RE NOT EVEN DOING THIS FOR 1802 01:20:02,800 --> 01:20:07,560 TERM STILLBIRTHS. 1803 01:20:07,560 --> 01:20:08,400 RATHER THAN FOCUS ON THE 1804 01:20:08,400 --> 01:20:09,560 FRUSTRATION I'D LIKE TO FOCUS ON 1805 01:20:09,560 --> 01:20:11,520 THE FACT WE HAVE A BLUEPRINT. 1806 01:20:11,520 --> 01:20:13,640 WE HAVE A BLUEPRINT OUT THERE 1807 01:20:13,640 --> 01:20:15,760 ALREADY AS TO HOW WE COULD 1808 01:20:15,760 --> 01:20:19,120 INCREASE THE NUMBER OF AUTOPSIES 1809 01:20:19,120 --> 01:20:21,240 THAT HAPPEN FOR STILL BIRTHS. 1810 01:20:21,240 --> 01:20:23,160 IT WOULD BE MORE EXPENSIVE 1811 01:20:23,160 --> 01:20:27,160 BECAUSE WE HAVE MORE STILLBIRTHS 1812 01:20:27,160 --> 01:20:29,800 BUT WE HAVE A BLUEPRINT FOR 1813 01:20:29,800 --> 01:20:31,360 FIGURING OUT HOW YOU DO MORE 1814 01:20:31,360 --> 01:20:33,040 AUTOPSIES. 1815 01:20:33,040 --> 01:20:36,680 WE'VE HEARD ABOUT REGISTRIES. 1816 01:20:36,680 --> 01:20:44,400 AND ARKANSAS HAS ONE TOO. 1817 01:20:44,400 --> 01:20:46,840 ARKANSAS CREATED A REPRODUCTIVE 1818 01:20:46,840 --> 01:20:48,720 HEALTH MONITORING SYSTEM AND IT 1819 01:20:48,720 --> 01:20:50,120 SPECIFICALLY ALSO GATHERED DATA 1820 01:20:50,120 --> 01:20:54,960 ON STILLBIRTHS. 1821 01:20:54,960 --> 01:20:59,280 SO THIS WASN'T JUST PIGGYBACKING 1822 01:20:59,280 --> 01:21:02,720 OFF THE STILLBIRTH REGISTRY. 1823 01:21:02,720 --> 01:21:05,200 I DO WANT TO TAKE A STEP TO 1824 01:21:05,200 --> 01:21:08,880 MENTION THAT ARKANSAS IS NOT 1825 01:21:08,880 --> 01:21:12,040 DOING WELL WITH ITS STILLBIRTH 1826 01:21:12,040 --> 01:21:14,080 RATE BUT WE DO HAVE A PRETTY 1827 01:21:14,080 --> 01:21:14,800 GOOD SYSTEM FOR GATHERING DATA 1828 01:21:14,800 --> 01:21:19,600 HERE. 1829 01:21:19,600 --> 01:21:20,920 THE LAST THING I WANT TO LEAVE 1830 01:21:20,920 --> 01:21:25,600 YOU WITH AND THIS IS SOMETHING I 1831 01:21:25,600 --> 01:21:26,960 RUN INTO MY RESEARCH ALL THE 1832 01:21:26,960 --> 01:21:27,320 TIME. 1833 01:21:27,320 --> 01:21:29,000 I WANT TO EMPHASIZE THAT GOING 1834 01:21:29,000 --> 01:21:29,800 FORWARD WHEN WE TALK ABOUT 1835 01:21:29,800 --> 01:21:32,760 ADDITIONAL RESEARCH, WE NEED TO 1836 01:21:32,760 --> 01:21:36,360 FOCUS ON RESEARCH AS PREVENTION 1837 01:21:36,360 --> 01:21:42,600 AND THE PURPOSE IS TO PREVENT 1838 01:21:42,600 --> 01:21:53,280 AND NOT TO -- AND BABIES ARE 1839 01:22:21,760 --> 01:22:29,520 STILL BEING STILLBORN. 1840 01:22:29,520 --> 01:22:33,360 AND I THINK BOTH SIDES IN THE 1841 01:22:33,360 --> 01:22:35,360 ABORTION DEBATE ASSUME EITHER A 1842 01:22:35,360 --> 01:22:39,920 PREGNANCY ENDS IN ABORTION OR 1843 01:22:39,920 --> 01:22:42,320 LIVING BABY AND THE 1844 01:22:42,320 --> 01:22:43,360 ANTI-ABORTION SIDE WANTS TO 1845 01:22:43,360 --> 01:22:45,000 EMPHASIZE THE BABE YES SHOULD BE 1846 01:22:45,000 --> 01:22:49,800 BORN AND WILL BE BORN AND THE 1847 01:22:49,800 --> 01:22:51,440 ABORTION RIGHT SIDE WANTS TO SAY 1848 01:22:51,440 --> 01:22:53,160 IF ABORTION IS NOT AVAILABLE 1849 01:22:53,160 --> 01:22:58,760 EVERYONE WOULD BE FORCED INTO 1850 01:22:58,760 --> 01:22:59,280 PARENTHOOD. 1851 01:22:59,280 --> 01:23:09,800 PREGNANCY LOSS DOESN'T HAPPEN. 1852 01:23:17,040 --> 01:23:25,280 AND THE FRAMING LEADS TO US 1853 01:23:25,280 --> 01:23:27,760 BLAME THE PREGNANT PERSON WHEN A 1854 01:23:27,760 --> 01:23:28,680 BABY IS STILL BORN. 1855 01:23:28,680 --> 01:23:30,840 WE HAD WOMEN ARRESTED FOR 1856 01:23:30,840 --> 01:23:35,920 CAUSING THEIR CHILD'S STILLBIRTH 1857 01:23:35,920 --> 01:23:38,800 AND THOSE WOMEN ARE ALMOST 1858 01:23:38,800 --> 01:23:43,280 ALWAYS MARGINALIZED. 1859 01:23:43,280 --> 01:23:50,000 AND IT WAS POOR WHITE WOMEN WHO 1860 01:23:50,000 --> 01:23:56,360 WERE ARRESTED AND PROSECUTED AND 1861 01:23:56,360 --> 01:24:04,440 IT'S DRUG USE AND I ALWAYS PAUSE 1862 01:24:04,440 --> 01:24:12,360 BECAUSE I'M AMAZED AND THE 1863 01:24:12,360 --> 01:24:13,240 MEDICAL DISCUSSION IS IT'S 1864 01:24:13,240 --> 01:24:15,360 DIFFICULT TO FIGURE OUT THE 1865 01:24:15,360 --> 01:24:18,160 CAUSE OF STILLBIRTH AND WE HAVE 1866 01:24:18,160 --> 01:24:20,320 PEOPLE IN JAIL FOR CAUSING THEIR 1867 01:24:20,320 --> 01:24:22,280 KIDDO'S STILL BIRTH AND THE JURY 1868 01:24:22,280 --> 01:24:25,000 DETERMINE THE CONDUCT CAUSED THE 1869 01:24:25,000 --> 01:24:26,800 STILLBIRTH BEYOND A REASONABLE 1870 01:24:26,800 --> 01:24:36,480 DOUBT. 1871 01:24:36,480 --> 01:24:41,560 AND HER BABY WAS BORN WITH THE 1872 01:24:41,560 --> 01:24:44,600 CORD WRAPPED AROUND THE BABY'S 1873 01:24:44,600 --> 01:24:46,120 NECK AND USUALLY THE REPORT IS 1874 01:24:46,120 --> 01:24:47,640 WELL, IT HAPPENS. 1875 01:24:47,640 --> 01:24:50,200 BUT THEY TESTED HER BLOOD AND 1876 01:24:50,200 --> 01:24:54,760 THEY FOUND COCAINE IN THE BLOOD 1877 01:24:54,760 --> 01:25:00,480 AND THE STATE MEDICAL EXAMINER 1878 01:25:00,480 --> 01:25:03,760 WHO WASN'T EVEN CERTIFIED CON 1879 01:25:03,760 --> 01:25:05,240 INCLUDED COCAINE WAS THE CAUSE 1880 01:25:05,240 --> 01:25:07,440 AND THE JURY FOUND BEYOND THE 1881 01:25:07,440 --> 01:25:08,960 REASONABLE DOUBT THE COCAINE 1882 01:25:08,960 --> 01:25:11,280 CAUSED THE BABY'S STILLBIRTH. 1883 01:25:11,280 --> 01:25:17,040 WE NEED TO KEEP THE STORIES IN 1884 01:25:17,040 --> 01:25:27,600 MIND AND PREGNANCY STILL BIRTH 1885 01:25:29,760 --> 01:25:34,120 ALMOST CRIME SCENES. 1886 01:25:34,120 --> 01:25:36,480 AND THAT DOESN'T PREVENT AN 1887 01:25:36,480 --> 01:25:38,520 ARREST AND THE ADDITIONAL TRAUMA 1888 01:25:38,520 --> 01:25:41,680 THAT CAN COME FROM AN ARREST AND 1889 01:25:41,680 --> 01:25:44,400 I'M REALLY CONCERNED ABOUT THE 1890 01:25:44,400 --> 01:25:47,360 QUALITY OF MEDICAL CARE THAT 1891 01:25:47,360 --> 01:25:48,600 PEOPLE OVERSEE WHEN THEY'RE 1892 01:25:48,600 --> 01:25:48,880 SUSPECTED. 1893 01:25:48,880 --> 01:25:52,440 I'M CONCERNED ABOUT THE QUALITY 1894 01:25:52,440 --> 01:25:54,840 OF MEDICAL AREA EVERYONE 1895 01:25:54,840 --> 01:26:03,400 EXPERIENCES THEIR BABY IS IT 1896 01:26:03,400 --> 01:26:09,560 STILLBORN WHEN WOMEN ARE 1897 01:26:09,560 --> 01:26:11,320 SUSPECTED HOW WILL THEY BE 1898 01:26:11,320 --> 01:26:11,560 TREATED. 1899 01:26:11,560 --> 01:26:16,480 TWO WOMEN IN CALIFORNIA SPENT 1900 01:26:16,480 --> 01:26:27,000 TIME IN PRISON AND ANOTHER WOMAN 1901 01:26:32,960 --> 01:26:35,360 FELL ASLEEP DURING A DIFFICULT 1902 01:26:35,360 --> 01:26:36,960 LABOR AND THEY TOOK THE BABY 1903 01:26:36,960 --> 01:26:40,720 AWAY SO I'M CONCERNED ABOUT 1904 01:26:40,720 --> 01:26:46,400 TREATMENT AND ADDING THE 1905 01:26:46,400 --> 01:26:47,360 TRAUMATIZATION FROM BEING 1906 01:26:47,360 --> 01:26:49,320 INVESTIGATED FROM THE POLICE AND 1907 01:26:49,320 --> 01:26:51,200 THESE ARE ALSO MARGINALIZED 1908 01:26:51,200 --> 01:26:52,440 PERSONS WHO WILL NOT HAVE EASY 1909 01:26:52,440 --> 01:26:54,880 ACCESS TO MENTAL HEALTH CARE. 1910 01:26:54,880 --> 01:26:56,840 THAT'S A BIT OF A SOAPBOX BUT I 1911 01:26:56,840 --> 01:26:57,520 JUST WANT US TO KEEP THIS IN 1912 01:26:57,520 --> 01:27:02,000 MIND. 1913 01:27:02,000 --> 01:27:07,840 RESEARCH IS ABOUT PREVENTING NOT 1914 01:27:07,840 --> 01:27:13,840 BLAMING. 1915 01:27:13,840 --> 01:27:18,800 I COULDN'T RESIST SHARING A 1916 01:27:18,800 --> 01:27:21,600 PICTURE OF MY KIDDO WHEN HE WAS 1917 01:27:21,600 --> 01:27:25,720 BORN AND WE COUNT WHAT MATTERS 1918 01:27:25,720 --> 01:27:27,040 AND THE FACT THAT WE'RE NOT 1919 01:27:27,040 --> 01:27:30,520 DOING THE BEST JOB OF COUNTING 1920 01:27:30,520 --> 01:27:32,120 STILLBIRTHS TO ME COMMUNICATES 1921 01:27:32,120 --> 01:27:35,360 WE -- STILL BIRTHS DON'T 1922 01:27:35,360 --> 01:27:38,760 MATTER -- THEY DON'T MATTER AND 1923 01:27:38,760 --> 01:27:39,360 AGAIN, THANK YOU AGAIN FOR THE 1924 01:27:39,360 --> 01:27:39,680 OPPORTUNITY. 1925 01:27:39,680 --> 01:27:39,760 1926 01:27:46,240 --> 01:27:48,440 >>THANK YOU, PROFESSOR LENS. 1927 01:27:48,440 --> 01:27:58,800 THIS IS A POWERFUL PRESENTATION. 1928 01:27:58,800 --> 01:28:01,320 YOUR BACKGROUND AS A MOM WITH 1929 01:28:01,320 --> 01:28:04,040 STILLBIRTH AND YOUR EXPERTISE IN 1930 01:28:04,040 --> 01:28:07,520 THE LEGAL PROFESSIONAL AND RICH 1931 01:28:07,520 --> 01:28:08,760 CONVERSATION AROUND ALMOST A 1932 01:28:08,760 --> 01:28:12,080 STATE OF DISARRAY THAT SURROUNDS 1933 01:28:12,080 --> 01:28:12,360 STILLBIRTHS. 1934 01:28:12,360 --> 01:28:14,080 WE HAVE PLENTY OF TIME FOR 1935 01:28:14,080 --> 01:28:14,400 DISCUSSION. 1936 01:28:14,400 --> 01:28:19,200 BEFORE I HAND IT OVER TO 1937 01:28:19,200 --> 01:28:23,040 DR. LONGO, I WANTS TO SEE IF 1938 01:28:23,040 --> 01:28:24,520 DR. BIANCHI HAD COMMENTS TO 1939 01:28:24,520 --> 01:28:24,720 MAKE. 1940 01:28:24,720 --> 01:28:25,960 >>THANK YOU, LUCKY. 1941 01:28:25,960 --> 01:28:27,320 I WANT TO THANK THE SPEAKERS FOR 1942 01:28:27,320 --> 01:28:28,600 THEIR PRESENTATIONS. 1943 01:28:28,600 --> 01:28:31,200 I ALSO WANTED TO CLARIFY THERE 1944 01:28:31,200 --> 01:28:33,600 SEEMS TO BE SOME 1945 01:28:33,600 --> 01:28:36,120 MISUNDERSTANDING ON TWITTER THAT 1946 01:28:36,120 --> 01:28:38,120 WE ARE NOT INCLUDING THE VOICES 1947 01:28:38,120 --> 01:28:39,520 OF PEOPLE WITH LIVED EXPERIENCE 1948 01:28:39,520 --> 01:28:44,560 OF STILL BIRTH. 1949 01:28:44,560 --> 01:28:47,360 WELL, YOU JUST HEARD JILL LENS 1950 01:28:47,360 --> 01:28:49,040 DESCRIBING HER EXPERIENCE. 1951 01:28:49,040 --> 01:28:53,400 WE ESTABLISHED JANUARY 5 SESSION 1952 01:28:53,400 --> 01:28:56,840 IS PURELY FOCUSSED ON HEARING 1953 01:28:56,840 --> 01:29:00,000 THE VOICES OF PEOPLE 1954 01:29:00,000 --> 01:29:01,320 EXPERIENCING STILLBIRTH. 1955 01:29:01,320 --> 01:29:03,040 MAYBE THAT WASN'T CLEAR AT THE 1956 01:29:03,040 --> 01:29:04,480 BEGINNING OF THE WE'RE GOING 1957 01:29:04,480 --> 01:29:09,480 DEDICATE THAT SESSION TO HEARING 1958 01:29:09,480 --> 01:29:10,760 FROM YOU BUT IN ORGANIZING THE 1959 01:29:10,760 --> 01:29:13,800 SESSIONS TODAY AND THE ONE ON 1960 01:29:13,800 --> 01:29:16,240 DECEMBER 9, WE NEEDED TO 1961 01:29:16,240 --> 01:29:17,400 ORGANIZE EACH OF THE SESSIONS TO 1962 01:29:17,400 --> 01:29:20,360 RESPOND TO THE MANDATE FROM 1963 01:29:20,360 --> 01:29:23,160 CONGRESS AND SO YOU'VE HEARD 1964 01:29:23,160 --> 01:29:26,800 ABOUT THE FOUR TOPICS WE'RE 1965 01:29:26,800 --> 01:29:29,240 ADDRESSING AND TODAY'S MORNING 1966 01:29:29,240 --> 01:29:31,200 SESSION IS ON CURRENT BARRIERS 1967 01:29:31,200 --> 01:29:32,680 TO COLLECTING DATA ON 1968 01:29:32,680 --> 01:29:33,080 STILLBIRTHS. 1969 01:29:33,080 --> 01:29:35,360 WE ARE REQUIRED BY CONGRESS TO 1970 01:29:35,360 --> 01:29:45,520 ADDRESS. 1971 01:29:46,600 --> 01:29:52,480 I I REALIZE FORMS DON'T REFLECT 1972 01:29:52,480 --> 01:29:54,840 THE EMOTIONS BUT THEY ARE DATA 1973 01:29:54,840 --> 01:30:00,600 TO GIVE US INFORMATION ON HOW TO 1974 01:30:00,600 --> 01:30:09,360 PROPOSE A RESEARCH AGENDA AND 1975 01:30:09,360 --> 01:30:11,200 WHERE POSSIBLE WE HAVE EXPERT 1976 01:30:11,200 --> 01:30:16,440 SPEAKERS WHO THEY THEMSELVES 1977 01:30:16,440 --> 01:30:18,040 EXPERIENCE STILLBIRTH. 1978 01:30:18,040 --> 01:30:20,400 KEEP THAT IN MIND AS WITH YOU 1979 01:30:20,400 --> 01:30:20,920 WRITE ON TWITTER. 1980 01:30:20,920 --> 01:30:22,680 WE'RE LISTENING TO YOU AND 1981 01:30:22,680 --> 01:30:23,600 INCORPORATING WHAT YOU SAID INTO 1982 01:30:23,600 --> 01:30:25,480 THE AGENDA BUT PLEASE GIVE US A 1983 01:30:25,480 --> 01:30:30,560 LITTLE BIT OF TIME TO GO THROUGH 1984 01:30:30,560 --> 01:30:32,800 THE AGENDA AND AGAIN WE WELCOME 1985 01:30:32,800 --> 01:30:34,800 YOUR VOICES IN WRITING TODAY IN 1986 01:30:34,800 --> 01:30:36,920 THE LIVE FEED BUT WE'RE 1987 01:30:36,920 --> 01:30:37,600 DEDICATING AN ADDITIONAL SESSION 1988 01:30:37,600 --> 01:30:40,400 WE DIDN'T ORIGNALLY HAVE 1989 01:30:40,400 --> 01:30:41,760 SCHEDULED IN JANUARY SO WE CAN 1990 01:30:41,760 --> 01:30:52,160 HEAR FROM YOU DIRECTLY. 1991 01:30:54,600 --> 01:30:55,440 >>THANK YOU. 1992 01:30:55,440 --> 01:31:01,440 I WANTED TO THANKS ALL THE 1993 01:31:01,440 --> 01:31:01,720 SPEAKERS. 1994 01:31:01,720 --> 01:31:11,160 THIS WAS WONDERFUL. 1995 01:31:11,160 --> 01:31:12,280 WE'RE TRYING TO ANSWER QUESTIONS 1996 01:31:12,280 --> 01:31:18,680 TO MOVE FORWARD TO ADD THE RIGHT 1997 01:31:18,680 --> 01:31:19,680 QUESTION FOR US. 1998 01:31:19,680 --> 01:31:23,000 I ALSO WANT TO REMIND AGAIN WE 1999 01:31:23,000 --> 01:31:24,920 HAVE THE REQUEST OF INFORMATION 2000 01:31:24,920 --> 01:31:31,360 ON POSTED ON THE NICHD WHICH HAS 2001 01:31:31,360 --> 01:31:34,440 YOUR INPUT REGARDING THE 2002 01:31:34,440 --> 01:31:35,360 INVESTMENT OF STRATEGIES TO 2003 01:31:35,360 --> 01:31:39,280 INCLUDE THE IMPACT OF NIH IN THE 2004 01:31:39,280 --> 01:31:41,720 RESEARCH OF STILLBIRTHS. 2005 01:31:41,720 --> 01:31:44,280 USE THAT TOOL ALSO TO REACH OUT 2006 01:31:44,280 --> 01:31:46,840 TO US TO INCORPORATE YOUR 2007 01:31:46,840 --> 01:31:49,080 FEEDBACK AND AS DR. BIANCHI SAID 2008 01:31:49,080 --> 01:31:51,600 USE THE RESEARCH FOR THE MEETING 2009 01:31:51,600 --> 01:31:55,240 AND MEETING WITH THE PUBLIC ON 2010 01:31:55,240 --> 01:32:00,760 JANUARY 5, 3-5. 2011 01:32:00,760 --> 01:32:02,800 AND NOW WE'RE GOING TRANSITION 2012 01:32:02,800 --> 01:32:07,360 TO THE MEETING DISCUSSION ON THE 2013 01:32:07,360 --> 01:32:18,000 FIRST PART WITH OUR SPEAKERS. 2014 01:32:21,320 --> 01:32:23,880 NOW SEVERAL QUESTIONS CAME WERE 2015 01:32:23,880 --> 01:32:27,280 ABOUT THE PLACENTAL AND FETAL 2016 01:32:27,280 --> 01:32:27,520 AUTOPSY. 2017 01:32:27,520 --> 01:32:30,640 WE CAN ADD DISCUSSION AROUND 2018 01:32:30,640 --> 01:32:32,840 THAT BUT I ALSO WANT TO LET YOU 2019 01:32:32,840 --> 01:32:38,200 KNOW WE HAVE SPEAKERS TO ADDRESS 2020 01:32:38,200 --> 01:32:43,120 THE COMPONENT ON THE TO THE 2021 01:32:43,120 --> 01:32:47,360 MEETING AND KNOW IT'S AN 2022 01:32:47,360 --> 01:32:50,760 IMPORTANT PART OF THE DATA 2023 01:32:50,760 --> 01:32:53,120 COLLECTION. 2024 01:32:53,120 --> 01:32:56,840 AND WE CAN UTILIZE THE STILL 2025 01:32:56,840 --> 01:33:02,000 BIRTH DEFECT REGISTRY TO CREATE 2026 01:33:02,000 --> 01:33:03,520 THE SURVEILLANCE. 2027 01:33:03,520 --> 01:33:04,120 PLEASE, IT'S OPEN TO THE TASK 2028 01:33:04,120 --> 01:33:14,320 FORCE NOW. 2029 01:33:17,240 --> 01:33:19,080 >>I HAVE A FOR PROFESSOR LENS 2030 01:33:19,080 --> 01:33:20,080 TO BEGIN WITH. 2031 01:33:20,080 --> 01:33:24,720 JILL, I ASSUME IF YOU KNEW WHAT 2032 01:33:24,720 --> 01:33:27,840 YOU KNOW NOW YOU WOULD HAVE 2033 01:33:27,840 --> 01:33:38,360 OPTED FOR AN AUTOPSY FOR CALEB. 2034 01:33:42,160 --> 01:33:48,760 WHAT ELSE WOULD YOU HAVE DONE 2035 01:33:48,760 --> 01:33:51,960 WITH A REARVIEW MIRROR. 2036 01:33:51,960 --> 01:33:55,360 WHAT WOULD HAVE YOU DONE 2037 01:33:55,360 --> 01:33:56,360 DIFFERENTLY. 2038 01:33:56,360 --> 01:33:58,000 >>AND THANK YOU FOR SAYING 2039 01:33:58,000 --> 01:33:59,040 CALEB'S NAME, BY THE WAY, I GET 2040 01:33:59,040 --> 01:34:01,960 A KICK OUT OF THAT. 2041 01:34:01,960 --> 01:34:04,360 I WOULD HAVE DONE MEDICALLY, 2042 01:34:04,360 --> 01:34:05,680 I'LL BE HONEST THE AUTOPSY 2043 01:34:05,680 --> 01:34:06,720 QUESTION STILL DIFFICULT FOR ME. 2044 01:34:06,720 --> 01:34:07,360 I DON'T KNOW WHAT I WOULD HAVE 2045 01:34:07,360 --> 01:34:17,480 DONE. 2046 01:34:19,120 --> 01:34:24,560 I WAS VERY FORTUNATE THOUGH TO 2047 01:34:24,560 --> 01:34:27,240 GET INVOLVED IN THE STILLBIRTH 2048 01:34:27,240 --> 01:34:29,600 COMMUNITY AND IT WAS PROBABLY 2049 01:34:29,600 --> 01:34:31,800 THREE YEARS LATER I WAS ABLE TO 2050 01:34:31,800 --> 01:34:35,600 LEARN FROM HIM THAT IT WASN'T A 2051 01:34:35,600 --> 01:34:43,320 PLACENTAL ISSUE AND I LIVED WITH 2052 01:34:43,320 --> 01:34:50,560 THE IDEA OF BEING AN ABRUPTION 2053 01:34:50,560 --> 01:34:52,560 MOM AND THAT WAS DIFFICULT FOR 2054 01:34:52,560 --> 01:34:52,960 ME. 2055 01:34:52,960 --> 01:34:57,560 AGAIN, I'M SO PRIVILEGED TO EVEN 2056 01:34:57,560 --> 01:34:59,280 HAVE FOUND THE ADDITIONAL 2057 01:34:59,280 --> 01:35:03,440 INFORMATION BECAUSE IT'S ONE 2058 01:35:03,440 --> 01:35:06,640 THING THAT'S DIFFICULT. 2059 01:35:06,640 --> 01:35:10,360 FINDING OUT WHETHER OUR KIDS 2060 01:35:10,360 --> 01:35:11,960 DIED SHOULD DEPEND ON WHETHER 2061 01:35:11,960 --> 01:35:22,280 YOU CAN AFFORD IT. 2062 01:35:25,640 --> 01:35:26,680 IN THE UNITED STATES WHERE WE 2063 01:35:26,680 --> 01:35:29,040 ARE CAPABLE OF PROVIDING OUR 2064 01:35:29,040 --> 01:35:32,120 PATIENTS WITH THE MOST SCENESED 2065 01:35:32,120 --> 01:35:32,800 HEALTH CARE BECAUSE HEALTH CARE 2066 01:35:32,800 --> 01:35:36,680 LAWS ARE MANAGED AT THE STATE 2067 01:35:36,680 --> 01:35:39,360 LEVEL, THERE'S SUCH LACK OF 2068 01:35:39,360 --> 01:35:43,360 STANDARDIZATION AND AN 2069 01:35:43,360 --> 01:35:48,800 OPPORTUNITY TO STANDARDIZE BASIC 2070 01:35:48,800 --> 01:35:56,080 ELEMENTS OF DATA COLLECTION AND 2071 01:35:56,080 --> 01:35:59,040 REPORTING SO HOW DO WE DEAL 2072 01:35:59,040 --> 01:36:00,480 WHERE THE SUPREME COURT IS 2073 01:36:00,480 --> 01:36:02,240 PUSHING DOWN THOUGH THE STATE 2074 01:36:02,240 --> 01:36:02,840 LEVEL MORE AND MORE AUTHORITY 2075 01:36:02,840 --> 01:36:10,840 AND RESPONSIBILITY? 2076 01:36:10,840 --> 01:36:16,160 >>I THINK UNFORTUNATELY THE 2077 01:36:16,160 --> 01:36:26,440 ANSWER IS MONEY. 2078 01:36:30,920 --> 01:36:32,840 EVEN THE MODEL STATISTICS ACT 2079 01:36:32,840 --> 01:36:35,360 DOESN'T USE THE STANDARD 20 2080 01:36:35,360 --> 01:36:37,840 WEEKS I DON'T UNDERSTAND AND WE 2081 01:36:37,840 --> 01:36:43,360 COULD GIVE THEM MONEY TO 2082 01:36:43,360 --> 01:36:48,880 ENCOURAGE THEM AS FAR AS DOING 2083 01:36:48,880 --> 01:36:49,520 STILLBIRTH RESEARCH BUT WHERE 2084 01:36:49,520 --> 01:36:55,760 DOES THAT MONEY COME FROM IS A 2085 01:36:55,760 --> 01:36:56,040 QUESTION. 2086 01:36:56,040 --> 01:37:01,320 >>ONE QUESTION FOR MS. KIM 2087 01:37:01,320 --> 01:37:06,560 PIPER, AS I LISTEN TO THE 2088 01:37:06,560 --> 01:37:08,080 PRESENTATION AROUND ISSP, TWO 2089 01:37:08,080 --> 01:37:10,320 QUESTIONS FOR KIM. 2090 01:37:10,320 --> 01:37:15,880 FIRST, IT APPEARS TO ME EIGHT OF 2091 01:37:15,880 --> 01:37:20,200 THIS IS STILL MANUALLY DONE AND 2092 01:37:20,200 --> 01:37:20,840 CUMBERSOME GIVEN HOW MANY TIMES 2093 01:37:20,840 --> 01:37:22,400 DATA IS TRANSFERRED FROM ONE 2094 01:37:22,400 --> 01:37:25,280 FORM TO THE NEXT FORM ULTIMATELY 2095 01:37:25,280 --> 01:37:30,720 TO PERHAPS A DATABASE WHICH 2096 01:37:30,720 --> 01:37:33,720 LEADS TO POOR CASE ASCERTAINMENT 2097 01:37:33,720 --> 01:37:34,760 ALSO. 2098 01:37:34,760 --> 01:37:36,080 COULD YOU COMMENT HOW EFFICIENT 2099 01:37:36,080 --> 01:37:38,680 THAT ENTIRE PROCESS IS OR HOW WE 2100 01:37:38,680 --> 01:37:40,400 COULD BE MADE BETTER, KIM, IF 2101 01:37:40,400 --> 01:37:46,360 YOU HAD PLENTY OF THESE SOURCES? 2102 01:37:46,360 --> 01:37:52,240 >>YEAH, PLENTY OF RESOURCES 2103 01:37:52,240 --> 01:37:54,280 WOULD BE EXCELLENT BUT THE TWO 2104 01:37:54,280 --> 01:37:55,880 SEPARATE PROCESSES WITH THE 2105 01:37:55,880 --> 01:37:57,240 FETAL DEATH EVALUATION FORM 2106 01:37:57,240 --> 01:38:01,200 WHICH IS VOLUNTARY THE HOSPITALS 2107 01:38:01,200 --> 01:38:03,520 FILL OUT, THAT IS A VERY 2108 01:38:03,520 --> 01:38:05,040 INFORMAL ASSESSMENT TOOL WE USE 2109 01:38:05,040 --> 01:38:09,640 TO SEE WHAT'S GOING ON WITH THE 2110 01:38:09,640 --> 01:38:10,840 FETAL DEATHS AND THE 2111 01:38:10,840 --> 01:38:12,360 CIRCUMSTANCES AROUND FETAL DEATH 2112 01:38:12,360 --> 01:38:14,840 AND THOSE ARE THE FORMS THAT 2113 01:38:14,840 --> 01:38:19,000 USUALLY THE NURSING STAFF FILL 2114 01:38:19,000 --> 01:38:21,000 OUT AND SUBMIT TO ME AND I'LL 2115 01:38:21,000 --> 01:38:22,120 FORWARD THE INFORMATION OR 2116 01:38:22,120 --> 01:38:23,440 SPREAD SHEET INFORMATION ON TO 2117 01:38:23,440 --> 01:38:30,840 OUR REGISTRY WHO ALSO DOES 2118 01:38:30,840 --> 01:38:34,680 THE -- USES THE INFORMATION ON 2119 01:38:34,680 --> 01:38:37,400 FETAL DEATH CERTIFICATES FOR 2120 01:38:37,400 --> 01:38:42,320 THEIR ASCERTAINMENT IT'S A FORM 2121 01:38:42,320 --> 01:38:44,880 TO USE A CASE OF STILLBIRTH 2122 01:38:44,880 --> 01:38:50,000 SUBMITTED BY THE HOSPITAL BUT 2123 01:38:50,000 --> 01:38:51,040 THE OFFICIAL PROCESS IS THROUGH 2124 01:38:51,040 --> 01:38:53,840 THE BIRTH DEFECTS REGISTRY AND 2125 01:38:53,840 --> 01:38:56,640 THE ACTIVE SURVEILLANCE METHODS 2126 01:38:56,640 --> 01:38:59,360 AND THEY'RE USING THE FIELD 2127 01:38:59,360 --> 01:39:01,360 DEATH CERTIFICATES AND REVIEWING 2128 01:39:01,360 --> 01:39:04,360 MEDICAL RECORDS FOR CASES OF 2129 01:39:04,360 --> 01:39:04,880 FETAL DEATH. 2130 01:39:04,880 --> 01:39:06,440 THAT PROCESS IS ELECTRONIC AND 2131 01:39:06,440 --> 01:39:08,400 THERE'S NO HAND-OFFS WITH THAT 2132 01:39:08,400 --> 01:39:10,640 SYSTEM SO THAT'S OUR OFFICIAL 2133 01:39:10,640 --> 01:39:13,120 PROCESS RIGHT NOW WITH THE FETAL 2134 01:39:13,120 --> 01:39:15,360 DEATH EVALUATION FORMS KIND OF 2135 01:39:15,360 --> 01:39:19,360 BEING AN ANCILLARY PROJECT RIGHT 2136 01:39:19,360 --> 01:39:24,760 NOW. 2137 01:39:24,760 --> 01:39:28,880 >>THANK YOU. 2138 01:39:28,880 --> 01:39:39,080 OVER TO YOU. 2139 01:39:51,840 --> 01:39:55,120 >>THANK YOU TO ALL THE 2140 01:39:55,120 --> 01:39:55,640 SPEAKERS. 2141 01:39:55,640 --> 01:39:57,160 FANTASTIC TALKS AFTER HEARING 2142 01:39:57,160 --> 01:39:59,720 ABOUT THE WONDERFUL STUDIES DONE 2143 01:39:59,720 --> 01:40:10,280 THAT HAVE USED A PROTOCOL WHERE 2144 01:40:11,080 --> 01:40:13,360 FAMILIES HAVE BEEN INTERVIEWED 2145 01:40:13,360 --> 01:40:15,200 AND STUDIES PRESENTED IN IOWA, 2146 01:40:15,200 --> 01:40:21,520 THE CDC FUNDED STUDY, STILLBIRTH 2147 01:40:21,520 --> 01:40:23,200 COLLATERAL RESEARCH NETWORK AND 2148 01:40:23,200 --> 01:40:26,880 WHERE THERE'S SPECIFIC PROTOCOL 2149 01:40:26,880 --> 01:40:29,200 WHERE AN ATTEMPT AT WISCONSIN 2150 01:40:29,200 --> 01:40:33,200 WHERE THE SPECIFIC STILLBIRTH 2151 01:40:33,200 --> 01:40:34,560 PROTOCOL AND MUCH INFORMATION IS 2152 01:40:34,560 --> 01:40:34,800 POSSIBLE. 2153 01:40:34,800 --> 01:40:37,560 THE IDEA AND I GUESS STARTING 2154 01:40:37,560 --> 01:40:43,800 WITH THE CDC, DOING SOME SORT OF 2155 01:40:43,800 --> 01:40:54,320 INDIVIDUAL META-ANALYSIS TAKING 2156 01:40:55,200 --> 01:40:56,440 THE DATA AND MATERNAL INTERVIEWS 2157 01:40:56,440 --> 01:40:59,120 AND SEE IF WE CAN COMBINE THE 2158 01:40:59,120 --> 01:41:02,880 INFORMATION ON U.S.-BASED 2159 01:41:02,880 --> 01:41:13,080 PREGNANCIES. 2160 01:41:13,840 --> 01:41:14,600 >>THANK YOU. 2161 01:41:14,600 --> 01:41:15,360 TRYING TO PULL TOGETHER 2162 01:41:15,360 --> 01:41:25,920 DIFFERENT DATA WE HAVE TO TRY TO 2163 01:41:30,520 --> 01:41:31,560 QUESTIONS OUT THERE ARE A GOOD 2164 01:41:31,560 --> 01:41:34,160 STEP FORWARD AND THE CHALLENGES 2165 01:41:34,160 --> 01:41:38,960 IS THE SAMPLES WE HAVE AVAILABLE 2166 01:41:38,960 --> 01:41:42,440 ARE NOT GOING TO BE 2167 01:41:42,440 --> 01:41:44,040 REPRESENTATIVE OF THE ENTIRE 2168 01:41:44,040 --> 01:41:49,800 POPULATION AND BY INCREASING THE 2169 01:41:49,800 --> 01:42:00,280 UPTAKE AND AVAILABILITY IS 2170 01:42:02,880 --> 01:42:04,240 IMPORTANT AND WE ARE CONTINUING 2171 01:42:04,240 --> 01:42:10,240 AND IT WOULD BE GREAT TO HAVE 2172 01:42:10,240 --> 01:42:11,200 ADDITIONAL SITES THAT WE CAN 2173 01:42:11,200 --> 01:42:15,040 EACH AND OUT DO INTERVIEWS FOR 2174 01:42:15,040 --> 01:42:17,040 THE PARENTS OF STILLBIRTHS. 2175 01:42:17,040 --> 01:42:20,840 THAT'S SOMETHING WE'RE ALWAYS 2176 01:42:20,840 --> 01:42:25,480 INTERESTED IN IN EXPANDING AND 2177 01:42:25,480 --> 01:42:26,840 DOING MORE ON SO THAT'S 2178 01:42:26,840 --> 01:42:28,360 SOMETHING WE WORK TOWARDS. 2179 01:42:28,360 --> 01:42:34,320 >>JUST TO FOLLOW-UP, I THINK WE 2180 01:42:34,320 --> 01:42:38,400 HEAR LOUD AND CLEAR THAT PARENTS 2181 01:42:38,400 --> 01:42:42,200 WANT TO HELP US FIND ANSWERS AND 2182 01:42:42,200 --> 01:42:44,880 WE HAVE THEM PART OF THE STUDIES 2183 01:42:44,880 --> 01:42:46,680 AND ASK THEM IF THEY'RE WILLING 2184 01:42:46,680 --> 01:42:49,040 TO BE INTERVIEWED AND GIVE A 2185 01:42:49,040 --> 01:42:49,600 BLOOD SAMPLE. 2186 01:42:49,600 --> 01:42:50,880 HEARING THE WONDERFUL WORK DONE 2187 01:42:50,880 --> 01:42:56,200 AT THE CDC AND IOWA AND 2188 01:42:56,200 --> 01:42:57,720 WISCONSIN'S DONE WONDERFUL WORK 2189 01:42:57,720 --> 01:42:59,920 AND UTAH'S DOING WONDERFUL WORK 2190 01:42:59,920 --> 01:43:01,160 WITH THE FAMILIES WE'VE 2191 01:43:01,160 --> 01:43:02,840 IDENTIFIED NOW TO SEE IF WE CAN 2192 01:43:02,840 --> 01:43:05,080 DO A DEEPER DIVE WITH ALL THE 2193 01:43:05,080 --> 01:43:06,760 INFORMATION WE HAVE AVAILABLE 2194 01:43:06,760 --> 01:43:08,920 BECAUSE THE FETAL DEATH 2195 01:43:08,920 --> 01:43:10,880 CERTIFICATE THERE'S SO MUCH THAT 2196 01:43:10,880 --> 01:43:13,480 NEEDS TO BE DONE AND JILL, THANK 2197 01:43:13,480 --> 01:43:14,760 YOU FOR YOUR TALK. 2198 01:43:14,760 --> 01:43:18,800 IT'S EXTREMELY INSPIRING AND 2199 01:43:18,800 --> 01:43:21,880 MOTIVATING AND IN TERMS OF THE 2200 01:43:21,880 --> 01:43:23,320 STILL BIRTH COLLABORATIVE 2201 01:43:23,320 --> 01:43:26,160 RESEARCH NETWORK, DR. DUDLEY 2202 01:43:26,160 --> 01:43:28,480 PRESENTED THE CLASSIFICATION, 2203 01:43:28,480 --> 01:43:29,600 GESTATIONAL DIABETES WOULD NOT 2204 01:43:29,600 --> 01:43:30,400 BE CONSIDERED A CAUSE. 2205 01:43:30,400 --> 01:43:34,040 JUST WANTED TO SAY THAT. 2206 01:43:34,040 --> 01:43:35,320 THANK YOU FOR TALKING ABOUT YOUR 2207 01:43:35,320 --> 01:43:45,560 EXPERIENCE. 2208 01:43:49,680 --> 01:43:50,800 >>GOOD MORNING. 2209 01:43:50,800 --> 01:43:52,680 THIS IS GOOD TIMING BECAUSE I 2210 01:43:52,680 --> 01:43:57,240 WANTED TO PIGGY BACK ON WHAT 2211 01:43:57,240 --> 01:44:03,400 DR. REDDY WAS SAYING I TALK WITH 2212 01:44:03,400 --> 01:44:05,480 THE UTAH'S STILLBIRTHS PROGRAM 2213 01:44:05,480 --> 01:44:16,040 WHICH IS KIND OF LIKE A LOOK AT 2214 01:44:22,000 --> 01:44:23,120 THE SOCIAL DETERMINATES OF 2215 01:44:23,120 --> 01:44:25,760 HEALTH AND IT'S AN INTERVIEW 2216 01:44:25,760 --> 01:44:28,960 WITH THE PARENT THAT HAS 2217 01:44:28,960 --> 01:44:29,720 EXPERIENCED A FETAL DEATH. 2218 01:44:29,720 --> 01:44:31,480 AND I DON'T NEED TO ASK MY 2219 01:44:31,480 --> 01:44:34,720 QUESTION ANYMORE BECAUSE I WAS 2220 01:44:34,720 --> 01:44:38,440 CURIOUS IN IOWA TO FIND OUT HOW 2221 01:44:38,440 --> 01:44:39,640 SOON AFTER THE PATERNAL 2222 01:44:39,640 --> 01:44:41,760 INTERVIEW WAS CONDUCTED BECAUSE 2223 01:44:41,760 --> 01:44:44,200 I DO ALSO AGREE WITH YOU OF THE 2224 01:44:44,200 --> 01:44:49,360 IMPORTANCE OF GETTING THE 2225 01:44:49,360 --> 01:44:53,760 PARENTS' VOICE INVOLVED I LIKE 2226 01:44:53,760 --> 01:44:55,040 THE ACTIVE SURVEILLANCE WITH CDC 2227 01:44:55,040 --> 01:44:56,480 AND THE DIFFERENT SITES AND 2228 01:44:56,480 --> 01:44:57,480 LOOKING AT THE DIFFERENCE 2229 01:44:57,480 --> 01:44:59,920 PRESENTATIONS FROM IOWA IS 2230 01:44:59,920 --> 01:45:04,880 COMPELLING AND I'M ALSO CURIOUS 2231 01:45:04,880 --> 01:45:13,440 TO SEE AND LOOKING AT THE SOCIAL 2232 01:45:13,440 --> 01:45:14,880 SIDE AND OTHER INFORMATION THAT 2233 01:45:14,880 --> 01:45:17,240 MAY NOT BE FOUND ON THE 2234 01:45:17,240 --> 01:45:17,520 CERTIFICATE. 2235 01:45:17,520 --> 01:45:27,800 OVER, THANK YOU. 2236 01:45:32,640 --> 01:45:35,920 >>THE MATERNAL PART IS MY 2237 01:45:35,920 --> 01:45:37,640 FAVORITE PART OF A FETAL DEATH 2238 01:45:37,640 --> 01:45:38,160 INFORMATION FORM. 2239 01:45:38,160 --> 01:45:41,160 THE INFORMATION THE PARENTS CAN 2240 01:45:41,160 --> 01:45:43,880 PROVIDE TO ILLUMINATE THEIR 2241 01:45:43,880 --> 01:45:44,880 PERCEPTION OF THE CIRCUMSTANCES 2242 01:45:44,880 --> 01:45:47,640 AROUND WHAT HAS HAPPENED IS VERY 2243 01:45:47,640 --> 01:45:50,920 BENEFICIAL. 2244 01:45:50,920 --> 01:45:53,640 THOSE FORMS ARE USUALLY FILLED 2245 01:45:53,640 --> 01:45:56,320 OUT BY THE NURSING STAFF. 2246 01:45:56,320 --> 01:45:58,360 SOMETIMES THE MEDICAL PROVIDERS 2247 01:45:58,360 --> 01:46:00,160 WILL FILL THEM OUT AND SEND THEM 2248 01:46:00,160 --> 01:46:01,800 IN BUT OFTEN IT'S THE NURSING 2249 01:46:01,800 --> 01:46:02,920 STAFF AND THEY TEND TO HAVE 2250 01:46:02,920 --> 01:46:03,720 CLOSER RELATIONSHIP WITH THE 2251 01:46:03,720 --> 01:46:05,520 FAMILIES AT THAT POINT. 2252 01:46:05,520 --> 01:46:10,400 AND THEY FILL THE FORM OUT AND 2253 01:46:10,400 --> 01:46:13,920 SUBMIT IT WITHIN A DAY OR TWO OF 2254 01:46:13,920 --> 01:46:16,520 THE CONCEPT OF THE STILLBIRTH. 2255 01:46:16,520 --> 01:46:25,720 >>THANK YOU. 2256 01:46:25,720 --> 01:46:28,440 A COUPLE POINTS AND A QUESTION. 2257 01:46:28,440 --> 01:46:30,920 ONE THING IS ABOUT CONSENTING 2258 01:46:30,920 --> 01:46:33,320 WOMEN FOR AUTOPSIES. 2259 01:46:33,320 --> 01:46:35,080 IN OUR EXPERIENCE WITH SCREEN, 2260 01:46:35,080 --> 01:46:37,560 MY VIEW OF THIS IS THAT 2261 01:46:37,560 --> 01:46:38,880 CONSENTING FOR AUTOPSY IS A 2262 01:46:38,880 --> 01:46:40,000 PROFESSION NOT AN EVENT. 2263 01:46:40,000 --> 01:46:41,920 MOST PEOPLE JUST DO A ONE-OFF, 2264 01:46:41,920 --> 01:46:44,480 HEY, YOU WANT TO SIGN THIS FORM 2265 01:46:44,480 --> 01:46:46,680 ABOUT AN AUTOPSY AND THAT'S JUST 2266 01:46:46,680 --> 01:46:47,760 NOT EFFICIENT. 2267 01:46:47,760 --> 01:46:49,800 YOU HAVE TO BROACH THE TOPIC AND 2268 01:46:49,800 --> 01:46:51,280 WORK WITH THE PATIENT AND 2269 01:46:51,280 --> 01:46:52,760 SOMETIMES REQUIRES MULTIPLE 2270 01:46:52,760 --> 01:46:57,280 VISITS TO OBTAIN CONSENT AND AT 2271 01:46:57,280 --> 01:46:58,920 LEAST IN THE STILLBIRTH 2272 01:46:58,920 --> 01:47:01,040 COLLABORATIVE RESEARCH NETWORK 2273 01:47:01,040 --> 01:47:02,440 WE WERE ABLE TO OBTAIN CONSENT 2274 01:47:02,440 --> 01:47:04,960 WITH 50% TO 60% OF OUR PATIENTS 2275 01:47:04,960 --> 01:47:08,760 WHICH WAS OUR TARGET, IT WAS OUR 2276 01:47:08,760 --> 01:47:08,960 GOAL. 2277 01:47:08,960 --> 01:47:10,160 SECOND, THERE'S A PREVAILING 2278 01:47:10,160 --> 01:47:11,920 OPINION AND I STILL ENCOUNTER 2279 01:47:11,920 --> 01:47:13,640 OFTEN THAT WOMEN AND FAMILIES 2280 01:47:13,640 --> 01:47:18,200 WHO SUFFER STILLBIRTH DON'T WANT 2281 01:47:18,200 --> 01:47:20,400 TALK ABOUT WHAT'S HAPPENED TO 2282 01:47:20,400 --> 01:47:20,880 THEM. 2283 01:47:20,880 --> 01:47:25,640 THAT'S ENTIRELY WRONG. 2284 01:47:25,640 --> 01:47:27,360 OUR EXPERIENCE WAS THESE 2285 01:47:27,360 --> 01:47:31,320 PATIENTS DESPERATELY WANT TO 2286 01:47:31,320 --> 01:47:33,120 TALK ABOUT THIS AND TRYING TO 2287 01:47:33,120 --> 01:47:34,840 PROCESS ALL THE EMOTIONS AND 2288 01:47:34,840 --> 01:47:35,640 TALKING THROUGH THE IS THE WAY 2289 01:47:35,640 --> 01:47:37,360 THEY DO THIS AND IT'S CRITICALLY 2290 01:47:37,360 --> 01:47:38,520 IMPORTANT FOR THEM TOOK ABOUT 2291 01:47:38,520 --> 01:47:41,600 THIS ESPECIALLY WITH HEALTH CARE 2292 01:47:41,600 --> 01:47:43,360 PROVIDERS WHO ARE SYMPATHETIC TO 2293 01:47:43,360 --> 01:47:44,800 WHAT HAPPENED TO THEM. 2294 01:47:44,800 --> 01:47:47,200 MY QUESTION TO KIM PIPER THOUGH 2295 01:47:47,200 --> 01:47:49,400 IS HOW MUCH BURSTING FACILITIES 2296 01:47:49,400 --> 01:47:53,320 DO YOU HAVE IN IOWA -- 2297 01:47:53,320 --> 01:47:54,560 BIRTHINGBIRTH 2298 01:47:54,560 --> 01:47:55,720 BIRTHINGBIRTH IING 2299 01:47:55,720 --> 01:47:57,120 FIRST HALVES DO YOU HAVE IN 2300 01:47:57,120 --> 01:47:57,560 IOWA? 2301 01:47:57,560 --> 01:47:58,600 >>ABOUT 60. 2302 01:47:58,600 --> 01:48:00,440 >>WHAT ARE THE AVERAGE DELIVERY 2303 01:48:00,440 --> 01:48:00,760 VOLUMES? 2304 01:48:00,760 --> 01:48:04,960 >>WELL, OBVIOUSLY THERE'S A 2305 01:48:04,960 --> 01:48:05,160 RANGE. 2306 01:48:05,160 --> 01:48:10,080 IOWA HAS ABOUT 6,000 BIRTHS A 2307 01:48:10,080 --> 01:48:10,640 YEAR SO -- 2308 01:48:10,640 --> 01:48:14,040 >>I DID MY RESIDENCY AT IOWA. 2309 01:48:14,040 --> 01:48:16,880 IT'S KIND OF LIKE A LAWYER -- 2310 01:48:16,880 --> 01:48:19,600 YOU ONLY ASK THE QUESTION YOU 2311 01:48:19,600 --> 01:48:21,760 KNOW THE ANSWER TO. 2312 01:48:21,760 --> 01:48:24,400 THE THING IS LIKE A LOT OF THESE 2313 01:48:24,400 --> 01:48:28,080 FACILITIES ARE GOING TO BE 300, 2314 01:48:28,080 --> 01:48:30,400 400 WOMEN A YEAR AND HAVE ONE 2315 01:48:30,400 --> 01:48:30,680 STILLBIRTH. 2316 01:48:30,680 --> 01:48:32,720 I CAN SEE HOW THAT WOULD BE A 2317 01:48:32,720 --> 01:48:33,000 CHALLENGE. 2318 01:48:33,000 --> 01:48:35,080 IN OTHER STATES, FOR EXAMPLE, AT 2319 01:48:35,080 --> 01:48:38,120 LEAST HERE IN VIRGINIA WE HAVE 2320 01:48:38,120 --> 01:48:40,520 55 DELIVERING FACILITIES SPREAD 2321 01:48:40,520 --> 01:48:43,960 ACROSS A HUGE GEOGRAPHIC REGION. 2322 01:48:43,960 --> 01:48:45,560 YOU DON'T REALIZE HOW LONG 2323 01:48:45,560 --> 01:48:46,720 VIRGINIA IS UNTIL YOU LIVE HERE. 2324 01:48:46,720 --> 01:48:48,760 IT'S A LONG STATE. 2325 01:48:48,760 --> 01:48:50,760 YOU THINK ABOUT TEXAS AND 2326 01:48:50,760 --> 01:48:52,400 THERE'S ABOUT 240 DELIVERY 2327 01:48:52,400 --> 01:48:55,360 FACILITIES OR CALIFORNIA WHERE 2328 01:48:55,360 --> 01:48:57,600 THERE'S ABOUT 240 OR 260. 2329 01:48:57,600 --> 01:48:59,760 TRYING TO REPLICATE THAT AND 2330 01:48:59,760 --> 01:49:01,840 SCALE IT UP WOULD BE A 2331 01:49:01,840 --> 01:49:04,440 CHALLENGE, I THINK. 2332 01:49:04,440 --> 01:49:05,480 DO YOU HAVE THOUGHTS ABOUT THAT 2333 01:49:05,480 --> 01:49:07,360 HOW YOU CAN SCALE THIS UP TO A 2334 01:49:07,360 --> 01:49:11,320 LARGER STATE. 2335 01:49:11,320 --> 01:49:12,120 ARE YOU ASKING ME? 2336 01:49:12,120 --> 01:49:15,760 >>YEAH, I'M ASKING YOU. 2337 01:49:15,760 --> 01:49:21,200 YOU'VE BEEN DOING THE WORK. 2338 01:49:21,200 --> 01:49:26,640 >>THE KICKER IS IT'S VOLUNTARY 2339 01:49:26,640 --> 01:49:28,200 THOUGH WE HAVE 60 BIRTHING 2340 01:49:28,200 --> 01:49:30,280 FACILITIES NOT ALL SUBMIT THE 2341 01:49:30,280 --> 01:49:30,600 INFORMATION. 2342 01:49:30,600 --> 01:49:32,600 I DON'T NECESSARILY HAVE A 2343 01:49:32,600 --> 01:49:34,680 CARROT OR A HAMMER TO ENCOURAGE 2344 01:49:34,680 --> 01:49:38,080 THEM TO DO THAT OTHER THAN THE 2345 01:49:38,080 --> 01:49:42,920 VALUE AND THE INFORMATION THAT 2346 01:49:42,920 --> 01:49:44,040 THEY'RE ABLE TO PROVIDE TO 2347 01:49:44,040 --> 01:49:45,000 INFORM POTENTIAL STILLBIRTH 2348 01:49:45,000 --> 01:49:46,280 PREVENTION EFFORTS. 2349 01:49:46,280 --> 01:49:53,000 SO SCALING IT UP DEFINITELY YOU 2350 01:49:53,000 --> 01:49:58,920 WOULD LOSE THE RELATIONSHIP THAT 2351 01:49:58,920 --> 01:50:01,640 YOU WOULD HAVE WITH WITH THE 2352 01:50:01,640 --> 01:50:03,440 FACILITIES BEING IN A SMALLER 2353 01:50:03,440 --> 01:50:03,640 STATE. 2354 01:50:03,640 --> 01:50:06,040 BUT I THINK RAMPING UP, I DON'T 2355 01:50:06,040 --> 01:50:07,360 THINK THAT WOULD TAKE A WHOLE 2356 01:50:07,360 --> 01:50:08,440 LOT TO DO THAT. 2357 01:50:08,440 --> 01:50:10,080 BUT THE THING WOULD JUST BE 2358 01:50:10,080 --> 01:50:16,240 HAVING THEM SEE THE VALUE AND 2359 01:50:16,240 --> 01:50:17,960 PROVIDING THIS ADDITIONAL 2360 01:50:17,960 --> 01:50:19,480 INFORMATION. 2361 01:50:19,480 --> 01:50:28,960 >>THANK YOU. 2362 01:50:28,960 --> 01:50:29,640 >>THANKS. 2363 01:50:29,640 --> 01:50:31,320 FIRST, THANKS TO ALL THE GREAT 2364 01:50:31,320 --> 01:50:32,000 SPEAKERS THIS MORNING. 2365 01:50:32,000 --> 01:50:38,880 IT WAS FUN AND A LOT OF REALLY 2366 01:50:38,880 --> 01:50:46,600 INNOVATIVE APPROACHES AND A HAVE 2367 01:50:46,600 --> 01:50:47,920 A COMMENT MORE THAN A QUESTION. 2368 01:50:47,920 --> 01:50:53,120 I WANTED TO FRAME THE COMMENTS 2369 01:50:53,120 --> 01:50:56,840 IN A WAY TO POINT THE WAY 2370 01:50:56,840 --> 01:50:57,720 FORWARD AS FAR AS WHERE RESEARCH 2371 01:50:57,720 --> 01:50:57,920 GOES. 2372 01:50:57,920 --> 01:50:59,400 THERE'S DIFFERENT COMPONENTS TO 2373 01:50:59,400 --> 01:51:04,440 THIS THING. 2374 01:51:04,440 --> 01:51:06,400 AND ONE MAJOR COMPONENT IS 2375 01:51:06,400 --> 01:51:09,360 LOGISTICAL AND ONE IS ECONOMIC. 2376 01:51:09,360 --> 01:51:12,640 AND THEN A MAJOR COMPONENT IS 2377 01:51:12,640 --> 01:51:14,440 RESEARCH AND I THINK AS AN 2378 01:51:14,440 --> 01:51:16,960 UNDERSTAND IT, THE NIH'S ROLE IS 2379 01:51:16,960 --> 01:51:18,880 GOING TO BE MORE RESEARCH. 2380 01:51:18,880 --> 01:51:22,960 SO HOW CAN WE FRAME THIS AS 2381 01:51:22,960 --> 01:51:23,880 RESEARCH? 2382 01:51:23,880 --> 01:51:27,320 I THINK SEVERAL THINGS WERE WELL 2383 01:51:27,320 --> 01:51:27,640 HIGHLIGHTED. 2384 01:51:27,640 --> 01:51:30,280 THE QUALITY OF THE FETAL DEATH 2385 01:51:30,280 --> 01:51:31,720 CERTIFICATES IS NOT REAL GOOD. 2386 01:51:31,720 --> 01:51:33,680 IT'S NOT BECAUSE PEOPLE DON'T 2387 01:51:33,680 --> 01:51:33,880 CARE. 2388 01:51:33,880 --> 01:51:42,160 IT'S BECAUSE OF RESOURCES. 2389 01:51:42,160 --> 01:51:46,400 AND ONE IS INACCURATE DATA 2390 01:51:46,400 --> 01:51:48,440 BECAUSE SO MUCH THE EVALUATION 2391 01:51:48,440 --> 01:51:49,760 OF THE STILLBIRTH HAPPENS AFTER 2392 01:51:49,760 --> 01:51:53,440 THE FORM IS FILLED OUT AND 2393 01:51:53,440 --> 01:51:54,560 THERE'S WAY TO ACCESS ELECTRONIC 2394 01:51:54,560 --> 01:51:55,840 HEALTH RECORD AND IMPROVE THE 2395 01:51:55,840 --> 01:51:57,200 QUALITY OF THE DATA BUT THE 2396 01:51:57,200 --> 01:51:59,680 SECOND PIECE -- AND I THINK 2397 01:51:59,680 --> 01:52:00,480 EVERYONE WORKING IN THE FIELD 2398 01:52:00,480 --> 01:52:03,520 FOR A WHILE REALIZES THIS IS 2399 01:52:03,520 --> 01:52:05,680 EVEN IF YOU GET THE ACCURATE 2400 01:52:05,680 --> 01:52:08,920 DATA, DETERMINING A CAUSE OF 2401 01:52:08,920 --> 01:52:11,360 STILLBIRTH IS DIFFICULT. 2402 01:52:11,360 --> 01:52:15,200 OFTEN IT REQUIRES SEVERAL 2403 01:52:15,200 --> 01:52:16,520 EXPERTS DISCUSSING ALL THE 2404 01:52:16,520 --> 01:52:18,440 INFORMATION AND PUTTING IT IN 2405 01:52:18,440 --> 01:52:20,200 CONTEXT AND IDEALLY INTERVIEWING 2406 01:52:20,200 --> 01:52:23,520 FAMILIES AND THEN MAKING A 2407 01:52:23,520 --> 01:52:24,720 SOMEWHAT SUBJECTIVE 2408 01:52:24,720 --> 01:52:26,920 DETERMINATION OF THE CAUSE OF 2409 01:52:26,920 --> 01:52:29,320 STILLBIRTH AND IT'S USUALLY 2410 01:52:29,320 --> 01:52:32,920 REFERRED TO AS AUDITS AND WE'RE 2411 01:52:32,920 --> 01:52:37,240 SEEING THAT IN IOWA AND IN 2412 01:52:37,240 --> 01:52:37,920 CAPTURING SOCIAL DETERMINATES IT 2413 01:52:37,920 --> 01:52:39,360 REQUIRES AN INTERVIEW AND AS THE 2414 01:52:39,360 --> 01:52:40,720 VERY EXPENSIVE TO DO THOSE KINDS 2415 01:52:40,720 --> 01:52:41,720 OF THINGS. 2416 01:52:41,720 --> 01:52:44,120 THE SECOND PIECE IS WE'RE NOT 2417 01:52:44,120 --> 01:52:46,120 DOING ADEQUATE EVALUATIONS. 2418 01:52:46,120 --> 01:52:49,080 ONLY ABOUT 20% OF FOLKS HAVE 2419 01:52:49,080 --> 01:52:53,320 AUTOPSIES AND A LOT OF FOLKS 2420 01:52:53,320 --> 01:52:55,040 DON'T HAVE OTHER COMPONENTS OF 2421 01:52:55,040 --> 01:52:55,960 THE STILLBIRTH EVALUATION. 2422 01:52:55,960 --> 01:52:58,400 SO WE NEED A BETTER EVALUATION 2423 01:52:58,400 --> 01:52:59,560 AND MORE COMPREHENSIVE 2424 01:52:59,560 --> 01:53:01,120 EVALUATION OF EACH CASE AND THEN 2425 01:53:01,120 --> 01:53:03,600 WE NEED TO TRACK THOSE DATA. 2426 01:53:03,600 --> 01:53:07,400 AND I THINK ALL THOSE THINGS 2427 01:53:07,400 --> 01:53:10,720 WERE MADE UNEQUIVOCALLY CLEAR BY 2428 01:53:10,720 --> 01:53:11,760 OUR EXCELLENT SPEAKERS. 2429 01:53:11,760 --> 01:53:13,360 THE PROBLEM IS THAT IT'S SO 2430 01:53:13,360 --> 01:53:14,880 EXPENSIVE TO JUST GO AHEAD AND 2431 01:53:14,880 --> 01:53:15,480 DO THAT ON EVERY CASE IN THE 2432 01:53:15,480 --> 01:53:20,920 UNITED STATES. 2433 01:53:20,920 --> 01:53:23,440 SO IN ORDER FOR US TO JUSTIFY 2434 01:53:23,440 --> 01:53:26,520 THE EXPENSE FOR THE HEALTH CARE 2435 01:53:26,520 --> 01:53:28,240 SYSTEM AND FOR EACH STATE HEALTH 2436 01:53:28,240 --> 01:53:31,320 DEPARTMENT AND THE CDC, I THINK 2437 01:53:31,320 --> 01:53:34,120 WE NEED TO DETERMINE THROUGH 2438 01:53:34,120 --> 01:53:36,080 RESEARCH WHICH APPROACHES ARE 2439 01:53:36,080 --> 01:53:37,440 MOST VALUABLE AND WHICH 2440 01:53:37,440 --> 01:53:39,640 APPROACHES ARE BEST FOR FAMILIES 2441 01:53:39,640 --> 01:53:41,200 AND WHICH APPROACHES ARE MOST 2442 01:53:41,200 --> 01:53:45,880 COST EFFECTIVE. 2443 01:53:45,880 --> 01:53:51,360 THE KINDS OF RESEARCH THAT MIGHT 2444 01:53:51,360 --> 01:54:00,080 BE IMPORTANT WOULD BE ONE AND 2445 01:54:00,080 --> 01:54:02,560 THE MOST IMPORTANT WAYS TO 2446 01:54:02,560 --> 01:54:04,160 COUNSEL FAMILIES AND TO HELP 2447 01:54:04,160 --> 01:54:07,200 THEM DECIDE THEY WANT TO DO 2448 01:54:07,200 --> 01:54:09,000 AUTOPSIES AND THEN WORKING WITH 2449 01:54:09,000 --> 01:54:12,280 EACH STATE TO DO IMPLEMENTATION 2450 01:54:12,280 --> 01:54:22,320 SCIENCE. 2451 01:54:22,320 --> 01:54:24,760 HOW DO YOU GET THE MOST ACCURATE 2452 01:54:24,760 --> 01:54:26,960 DATA AND CONDUCT AUDITS WITH 2453 01:54:26,960 --> 01:54:28,720 FAMILIES TO CAPTURE SOCIAL 2454 01:54:28,720 --> 01:54:29,320 DETERMINATES AND CAPTURE THE 2455 01:54:29,320 --> 01:54:32,400 CAUSES. 2456 01:54:32,400 --> 01:54:34,440 IT WOULD BE GREAT FOR ALL THE 2457 01:54:34,440 --> 01:54:35,920 PEOPLE INVOLVED HERE TO TOUCH 2458 01:54:35,920 --> 01:54:38,000 BASE WITH EACH OTHER AND SEE HOW 2459 01:54:38,000 --> 01:54:41,520 WE CAN DO RESEARCH TO DETERMINE 2460 01:54:41,520 --> 01:54:48,400 THE BEST WAY TO IMPROVE 2461 01:54:48,400 --> 01:54:49,080 STILLBIRTH EVALUATION AND THE 2462 01:54:49,080 --> 01:54:53,960 BEST WAY TO IMPROVE ACCURACY AND 2463 01:54:53,960 --> 01:54:57,200 IT WOULD BE EASIER TO PUSH 2464 01:54:57,200 --> 01:54:58,600 LEGISLATION THROUGH TO FUND 2465 01:54:58,600 --> 01:54:59,920 STATE HEALTH DEPARTMENTS TO THEN 2466 01:54:59,920 --> 01:55:00,720 IMPLEMENT THOSE THINGS. 2467 01:55:00,720 --> 01:55:02,440 I WANTED TO AT LEAST TRY TO 2468 01:55:02,440 --> 01:55:04,920 FRAME THE DISCUSSION IN TERMS OF 2469 01:55:04,920 --> 01:55:06,280 WHAT ARE THE BEST RESEARCH IDEAS 2470 01:55:06,280 --> 01:55:08,920 THAT CAN COME OUT OF THIS AND 2471 01:55:08,920 --> 01:55:12,920 COULD PEOPLE INVOLVED IN THIS 2472 01:55:12,920 --> 01:55:14,400 GROUP AS WELL AS OTHERS PARTNER 2473 01:55:14,400 --> 01:55:19,320 TO TRY TO CONDUCT THAT RESEARCH. 2474 01:55:19,320 --> 01:55:27,320 THANKS. 2475 01:55:27,320 --> 01:55:28,960 >>THAT'S A WONDERFUL POINT ALL 2476 01:55:28,960 --> 01:55:33,520 OF YOU HAVE BROUGHT UP. 2477 01:55:33,520 --> 01:55:34,320 AND I THINK WE'RE CLEAR IT'S IN 2478 01:55:34,320 --> 01:55:41,320 THE COLLECTION OF THE DATA AND 2479 01:55:41,320 --> 01:55:44,080 CAN WE STANDARDIZE TOOLS. 2480 01:55:44,080 --> 01:55:47,280 I'M NOT SURE IF I'M MISSING 2481 01:55:47,280 --> 01:55:49,920 ANYONE FOR QUESTION OR 2482 01:55:49,920 --> 01:55:50,680 DISCUSSION AND ANSWERING SOME OF 2483 01:55:50,680 --> 01:55:57,520 THE COMMENT I BROUGHT UP? 2484 01:55:57,520 --> 01:56:03,840 LIKE MS. NOBLE PIPER, I MAY HAVE 2485 01:56:03,840 --> 01:56:09,520 MISSED THE BUDGET YOU WERE 2486 01:56:09,520 --> 01:56:12,800 SAYING -- I WAS CURIOUS WHAT IT 2487 01:56:12,800 --> 01:56:15,880 TOOK TO GET THERE IN TIME LINE 2488 01:56:15,880 --> 01:56:21,480 AND MECHANISMS AND GIVING AN 2489 01:56:21,480 --> 01:56:23,320 IDEA OF THE ORGANIZATION 2490 01:56:23,320 --> 01:56:27,240 INFRASTRUCTURE AND THE TIME AND 2491 01:56:27,240 --> 01:56:32,680 BUDGET JUST TO SEE BACK TO THE 2492 01:56:32,680 --> 01:56:34,840 OTHER QUESTION THE FEASIBILITY 2493 01:56:34,840 --> 01:56:36,200 OF SCALING UP. 2494 01:56:36,200 --> 01:56:38,480 >>WE HAD A WHOPPING $26,000 FOR 2495 01:56:38,480 --> 01:56:39,400 THE EVALUATION FORMS TO START 2496 01:56:39,400 --> 01:56:42,520 THAT AND THAT PAID FOR THE WORK 2497 01:56:42,520 --> 01:56:45,520 GROUP, CONVENING THE WORK GROUP 2498 01:56:45,520 --> 01:56:47,280 OF EXPERTS AND THE ORIGINAL 2499 01:56:47,280 --> 01:56:51,200 DRAFTING AND EDITING OF THE 2500 01:56:51,200 --> 01:56:52,840 FETAL DEATH EVALUATION PROTOCOL 2501 01:56:52,840 --> 01:56:53,160 ON THE FORM. 2502 01:56:53,160 --> 01:57:00,520 SINCE THEN IT HAS BEEN -- I JUST 2503 01:57:00,520 --> 01:57:02,240 DO IT. 2504 01:57:02,240 --> 01:57:04,080 THERE'S NO SPECIFIC FUNDING OR 2505 01:57:04,080 --> 01:57:05,280 OTHER RESOURCES PROVIDED TO DO 2506 01:57:05,280 --> 01:57:05,800 THAT. 2507 01:57:05,800 --> 01:57:09,760 SO DEFINITELY, IF WE HAVE MORE 2508 01:57:09,760 --> 01:57:11,640 RESOURCES WE COULD DO A LOT MORE 2509 01:57:11,640 --> 01:57:14,400 WITH THAT PROJECT AS FAR AS 2510 01:57:14,400 --> 01:57:17,400 EXPANDING IT AND GETTING THE 2511 01:57:17,400 --> 01:57:18,840 BIRTHING FACILITIES TO SUBMIT 2512 01:57:18,840 --> 01:57:20,000 THESE FORMS AND SEE THE 2513 01:57:20,000 --> 01:57:21,600 IMPORTANCE OF THAT AND 2514 01:57:21,600 --> 01:57:22,560 DISSEMINATING SOME OF THE 2515 01:57:22,560 --> 01:57:24,280 INFORMATION THAT WE'RE GLEAN 2516 01:57:24,280 --> 01:57:28,440 FROM THE FORMS AS WELL. 2517 01:57:28,440 --> 01:57:30,680 AS FAR AS THE BIRTH DEFECTS 2518 01:57:30,680 --> 01:57:32,120 REGISTRY WE HAVE THE COOPERATIVE 2519 01:57:32,120 --> 01:57:33,720 AGREEMENT WITH CDC TO DO THAT 2520 01:57:33,720 --> 01:57:38,960 AND THAT'S ABOUT $300,000 A 2521 01:57:38,960 --> 01:57:44,880 YEAR. 2522 01:57:44,880 --> 01:57:50,920 >>THANK YOU SO MUCH. 2523 01:57:50,920 --> 01:57:58,680 DR. JAIN OR DR. REDDY. 2524 01:57:58,680 --> 01:58:02,520 >>I WANT TO BRING BACK 2525 01:58:02,520 --> 01:58:03,520 DR. BIANCHI FOR A MOMENT BECAUSE 2526 01:58:03,520 --> 01:58:05,320 IT'S IMPORTANT TO CLARIFY THE 2527 01:58:05,320 --> 01:58:07,520 NICHD AND NIH IN GENERAL IS 2528 01:58:07,520 --> 01:58:14,600 CHARGED WITH RESEARCH, LOOKING 2529 01:58:14,600 --> 01:58:18,640 INTO THE WHY. 2530 01:58:18,640 --> 01:58:23,320 THE WHAT AND HOW IS REALLY THE 2531 01:58:23,320 --> 01:58:26,920 DOMAIN OF THE HUMAN HEALTH 2532 01:58:26,920 --> 01:58:30,920 SERVICES, PUBLIC HEALTH 2533 01:58:30,920 --> 01:58:32,600 AUTHORITIES AND CMS AND OTHER 2534 01:58:32,600 --> 01:58:34,240 AREAS WHERE HEALTH CARE IS 2535 01:58:34,240 --> 01:58:35,360 MANAGED AND DISTRIBUTED. 2536 01:58:35,360 --> 01:58:38,800 DIANA, AS I LOOK AT THE COMMENTS 2537 01:58:38,800 --> 01:58:42,960 POSTED BY PEOPLE OBVIOUSLY ARE 2538 01:58:42,960 --> 01:58:45,880 VERY EMOTIONALLY TO THIS CAUSE, 2539 01:58:45,880 --> 01:58:47,640 WE'LL NEED TO MAKE SURE WE FRAME 2540 01:58:47,640 --> 01:58:52,400 OUR PRIORITIES IN A WAY WE STAY 2541 01:58:52,400 --> 01:58:54,320 FOCUSSED ON OUR RESEARCH 2542 01:58:54,320 --> 01:58:58,200 PRIORITIES THAT WILL HOPEFULLY 2543 01:58:58,200 --> 01:58:59,320 LEAD TO PROGRESS IN THE FIELD 2544 01:58:59,320 --> 01:59:03,600 BUT ULTIMATELY THERE'S A BIGGER 2545 01:59:03,600 --> 01:59:06,160 COMPONENT TO STILLBIRTH 2546 01:59:06,160 --> 01:59:08,280 PREVENTION AND MANAGEMENT AND 2547 01:59:08,280 --> 01:59:11,280 EVERYTHING THAT KIM AND JILL AND 2548 01:59:11,280 --> 01:59:13,640 OTHERS SPOKE TO ABOUT WHICH 2549 01:59:13,640 --> 01:59:14,920 NEEDS TO BE MANAGED IN THE 2550 01:59:14,920 --> 01:59:17,480 PUBLIC HEALTH DOMAIN. 2551 01:59:17,480 --> 01:59:18,720 >>THANK YOU, LUCKY. 2552 01:59:18,720 --> 01:59:22,320 I AGREE WITH YOU. 2553 01:59:22,320 --> 01:59:24,640 THIS IS NOT OBVIOUSLY 2554 01:59:24,640 --> 01:59:30,680 EXCLUSIVELY A RESEARCH PROBLEM. 2555 01:59:30,680 --> 01:59:35,000 WE'VE HEARD ABOUT PROBLEMS WITH 2556 01:59:35,000 --> 01:59:36,080 MEDICAID COVERING OF AN AUTOPSY 2557 01:59:36,080 --> 01:59:38,080 THAT THE NOT IN NIH'S PURVIEW. 2558 01:59:38,080 --> 01:59:40,080 I THINK WE'LL TALK ABOUT THOSE 2559 01:59:40,080 --> 01:59:41,560 WHEN IT COMES TIME TO WRITING 2560 01:59:41,560 --> 01:59:43,880 THE REPORT, THE FOCUS OF OUR 2561 01:59:43,880 --> 01:59:50,440 REPORT WILL NEED TO BE ON 2562 01:59:50,440 --> 01:59:51,960 ESTABLISHING A RESEARCH AGENDA 2563 01:59:51,960 --> 01:59:53,760 FOR PREVENTION. 2564 01:59:53,760 --> 01:59:54,960 AS PART OF THE REPORT I'M SURE 2565 01:59:54,960 --> 01:59:56,640 WE CAN MENTION THE NEED FOR 2566 01:59:56,640 --> 01:59:58,320 OTHER FEDERAL AGENCIES TO BE 2567 01:59:58,320 --> 01:59:58,720 INVOLVED. 2568 01:59:58,720 --> 02:00:03,800 YOU'VE HEARD FROM THE CDC, 2569 02:00:03,800 --> 02:00:12,400 DR. REEFHUIS GAVE AN EXCELLENT 2570 02:00:12,400 --> 02:00:13,960 PRESENTATION AND THEY CAN 2571 02:00:13,960 --> 02:00:15,360 PARTNER WITH US ON HOW TO MOVE 2572 02:00:15,360 --> 02:00:20,720 FORWARD WE CAN'T SOLVE ALL THE 2573 02:00:20,720 --> 02:00:24,160 PROBLEMS WE'RE LISTENING AND 2574 02:00:24,160 --> 02:00:26,120 MANY THINGS TO DO WITH CARE COME 2575 02:00:26,120 --> 02:00:27,920 UNDER THE PURVIEW OF OTHER 2576 02:00:27,920 --> 02:00:31,360 AGENCIES AND WE HAVE DEALING 2577 02:00:31,360 --> 02:00:33,520 WITH SIMILAR ISSUES WITH 2578 02:00:33,520 --> 02:00:37,160 MATERNAL MORTALITY AND SEVERE 2579 02:00:37,160 --> 02:00:38,800 MORBIDITY WHERE NIH HAS A 2580 02:00:38,800 --> 02:00:44,840 RESEARCH AGENDA BUT WE ALSO 2581 02:00:44,840 --> 02:00:48,880 PARTNER TO ADDRESS THE ISSUE OF 2582 02:00:48,880 --> 02:00:50,080 HOW TO DECREASE MATERNAL 2583 02:00:50,080 --> 02:00:51,280 MORTALITY IN THE COUNTRY. 2584 02:00:51,280 --> 02:00:52,760 AGAIN, I SAID IT LAST TIME AND 2585 02:00:52,760 --> 02:00:56,320 I'LL SAY IT AGAIN, OUR FOCUS IS 2586 02:00:56,320 --> 02:00:57,760 ON RESEARCH WHICH IS DIRECTLY 2587 02:00:57,760 --> 02:00:59,280 LINKED TO PREVENTION AND THAT'S 2588 02:00:59,280 --> 02:01:02,920 WHAT WE NEED TO FOCUS ON. 2589 02:01:02,920 --> 02:01:04,160 THAT'S OUR DELIVERABLE. 2590 02:01:04,160 --> 02:01:06,320 NOW, DID I HAVE A QUESTION FOR 2591 02:01:06,320 --> 02:01:09,400 BOTH OF YOU, SO PEOPLE ARE 2592 02:01:09,400 --> 02:01:11,920 WRITING IN TO THE SUPPOSEDLY THE 2593 02:01:11,920 --> 02:01:13,840 LIVE DISCUSSION AND SENDING 2594 02:01:13,840 --> 02:01:14,960 E-MAILS TO THE BEZEL GROUP. 2595 02:01:14,960 --> 02:01:18,600 IS ANYONE LOOKING AT THOSE? 2596 02:01:18,600 --> 02:01:19,560 CAN WE ASK SOME OF THOSE 2597 02:01:19,560 --> 02:01:29,280 QUESTIONS? 2598 02:01:29,280 --> 02:01:31,080 >>WE'RE LOOKING AT THOSE. 2599 02:01:31,080 --> 02:01:34,160 SOME ARE ABOUT THE PLACENTA 2600 02:01:34,160 --> 02:01:38,760 PATHOLOGY AND WE CAN OPEN THAT 2601 02:01:38,760 --> 02:01:41,800 UP NEXT SESSION AND SOME WERE 2602 02:01:41,800 --> 02:01:51,240 JUST ABOUT WHAT YOU SAID AND WE 2603 02:01:51,240 --> 02:01:53,480 WERE EXPLAINING THE RESTRICTION 2604 02:01:53,480 --> 02:01:56,920 OF THE TIME AND ONE WERE SENDING 2605 02:01:56,920 --> 02:01:59,840 IN AN E-MAIL SHARING WITH US THE 2606 02:01:59,840 --> 02:02:05,480 WORK FROM AUSTRALIA ON THE 2607 02:02:05,480 --> 02:02:06,360 STILLBIRTH CENTER FOR RESEARCH 2608 02:02:06,360 --> 02:02:09,000 EXCELLENCE WHICH I DON'T KNOW IF 2609 02:02:09,000 --> 02:02:11,840 ANYONE MAY BE ON THE TASK FORCE 2610 02:02:11,840 --> 02:02:13,040 IS FAMILIAR I HEARD ABOUT BUT I 2611 02:02:13,040 --> 02:02:19,360 DON'T KNOW THE DETAIL. 2612 02:02:19,360 --> 02:02:22,600 AND THIS I BELIEVE IS ON THE 2613 02:02:22,600 --> 02:02:26,200 DATA COLLECTION AND WE WERE 2614 02:02:26,200 --> 02:02:31,320 APPRECIATING WITH DR. LENS WITH 2615 02:02:31,320 --> 02:02:36,720 US TODAY AND WE HAVE MORE JUST 2616 02:02:36,720 --> 02:02:38,560 TO LET YOU KNOW EVERYONE IS 2617 02:02:38,560 --> 02:02:38,800 LISTENING. 2618 02:02:38,800 --> 02:02:42,240 WE HAVE MORE THAN ARE GOING TO 2619 02:02:42,240 --> 02:02:46,640 BE IN THE NEXT SECTION SPEAKER 2620 02:02:46,640 --> 02:02:47,600 THAT I EXPERIENCE. 2621 02:02:47,600 --> 02:02:51,360 I HAVE TRIED TO INCORPORATE AS 2622 02:02:51,360 --> 02:02:54,840 MUCH AS WE CAN. 2623 02:02:54,840 --> 02:02:57,480 YEAH, I DON'T HAVE ANOTHER 2624 02:02:57,480 --> 02:03:01,480 QUESTION BUT I SEE DR. HAHN ON 2625 02:03:01,480 --> 02:03:02,120 CAMERA MAYBE SHE HAS SOMETHING 2626 02:03:02,120 --> 02:03:06,480 SHE WANTS TO SHARE. 2627 02:03:06,480 --> 02:03:10,000 >>I WANTED TO THANK DR. BIANCHI 2628 02:03:10,000 --> 02:03:13,840 FOR THOSE COMMENTS AND NOTE THAT 2629 02:03:13,840 --> 02:03:17,800 BECAUSE YOU DO HAVE THE PARTNERS 2630 02:03:17,800 --> 02:03:20,960 AS PART OF THE TASK FORCE THAT 2631 02:03:20,960 --> 02:03:21,880 THE REPORT COULD INCLUDE 2632 02:03:21,880 --> 02:03:22,560 RECOMMENDATIONS TO AGENCIES IF 2633 02:03:22,560 --> 02:03:33,080 YOU FEEL THOSE ARE APPROPRIATE. 2634 02:03:34,520 --> 02:03:38,400 >>I ALSO WANT TO THANK YOU FOR 2635 02:03:38,400 --> 02:03:40,120 THE ARTICLE WHICH I READ AND 2636 02:03:40,120 --> 02:03:43,800 PART OF WHY YOU WERE INVITED 2637 02:03:43,800 --> 02:03:44,000 TODAY. 2638 02:03:44,000 --> 02:03:47,040 YOU THOUGHT YOU PRESENTED NOT 2639 02:03:47,040 --> 02:03:49,200 ONLY THE PERSONAL EXPERIENCE BUT 2640 02:03:49,200 --> 02:03:51,120 FROM THE LENS OF THE LEGAL 2641 02:03:51,120 --> 02:03:51,400 PERSPECTIVE. 2642 02:03:51,400 --> 02:03:57,840 THANK YOU FOR SENDING THAT. 2643 02:03:57,840 --> 02:04:02,320 >>MONICA, IF I CAN PROPOSE, I 2644 02:04:02,320 --> 02:04:04,360 KNOW WE HAVE A LONG DAY AND WE 2645 02:04:04,360 --> 02:04:06,520 DIDN'T FACTOR IN A LUNCH BREAK 2646 02:04:06,520 --> 02:04:08,680 WE ONLY HAD A 10 MINUTE BREAK. 2647 02:04:08,680 --> 02:04:11,480 I MAY ASK WE BREAK OVER HERE AND 2648 02:04:11,480 --> 02:04:12,440 GIVE EVERYONE ENOUGH TIME TO 2649 02:04:12,440 --> 02:04:15,920 GRAB A BITE TO EAT AND THEN 2650 02:04:15,920 --> 02:04:17,720 REASSEMBLE AT 12:30. 2651 02:04:17,720 --> 02:04:21,920 I DO WANT TO JUST SUMMARIZE THIS 2652 02:04:21,920 --> 02:04:24,600 MORNING'S SESSION BY BRINGING 2653 02:04:24,600 --> 02:04:27,360 BACK PETER WHEN HE SAID WHAT WE 2654 02:04:27,360 --> 02:04:29,480 CAN'T MEASURE PROPERLY, WE CAN'T 2655 02:04:29,480 --> 02:04:29,760 IMPROVE. 2656 02:04:29,760 --> 02:04:36,520 AND SO I THINK THE STARTING 2657 02:04:36,520 --> 02:04:40,160 POINT IN ANY QUEST TO TACKLE 2658 02:04:40,160 --> 02:04:41,600 STILLBIRTH AS A MAJOR PUBLIC 2659 02:04:41,600 --> 02:04:46,200 HEALTH PROBLEM HAS TO BE 2660 02:04:46,200 --> 02:04:49,280 ACCURATE MEASUREMENT CASE, 2661 02:04:49,280 --> 02:04:50,960 ASCERTAINMENT AND FIGURING OUT 2662 02:04:50,960 --> 02:04:55,160 WHAT LED TO THE FETAL DEMISE. 2663 02:04:55,160 --> 02:04:57,920 IT'S AN EXCRUCIATINGLY PAINFUL 2664 02:04:57,920 --> 02:04:58,200 EXPERIENCE. 2665 02:04:58,200 --> 02:05:05,840 I REMEMBER MY OLDER BROTHER, HIS 2666 02:05:05,840 --> 02:05:08,640 WIFE HAD A STILLBIRTH WHEN I WAS 2667 02:05:08,640 --> 02:05:10,800 IN MEDICAL SCHOOL AND IT SHAPED 2668 02:05:10,800 --> 02:05:16,280 MY ENTIRE CAREER BEYOND THAT 2669 02:05:16,280 --> 02:05:20,520 BECAUSE TO THE FAMILY WENT 2670 02:05:20,520 --> 02:05:22,320 THROUGH A LONG PERIOD OF 2671 02:05:22,320 --> 02:05:24,720 GRIEVING WITH THAT LOSS AND FELT 2672 02:05:24,720 --> 02:05:26,880 SO HELPLESS AROUND THAT TIME AND 2673 02:05:26,880 --> 02:05:30,720 HOW I CHOSE A CAREER AROUND 2674 02:05:30,720 --> 02:05:31,200 NEON 2675 02:05:31,200 --> 02:05:31,520 NEONATOLOGY. 2676 02:05:31,520 --> 02:05:32,640 THANK YOU FOR THE SPEAKERS IN 2677 02:05:32,640 --> 02:05:34,000 THE SESSION. 2678 02:05:34,000 --> 02:05:36,840 AMAZING TALKS AND WE'LL REGROUP 2679 02:05:36,840 --> 02:05:37,520 AT 12:30. 2680 02:05:37,520 --> 02:05:48,440 THANK YOU. 2681 02:05:48,440 --> 02:05:50,440 >>THE SECOND SESSION PROMISES 2682 02:05:50,440 --> 02:05:54,800 TO BE AS IMPORTANT AND AS ENGAGE 2683 02:05:54,800 --> 02:05:55,840 AS THE FIRST SESSION. 2684 02:05:55,840 --> 02:06:00,520 IN THIS WE'RE FOCUSSING ON WHAT 2685 02:06:00,520 --> 02:06:05,760 MAKES SOME COMMUNITIES OR GROUPS 2686 02:06:05,760 --> 02:06:12,960 ADD HIGH RISK FOR STILLBIRTHS. 2687 02:06:12,960 --> 02:06:13,400 MON 2688 02:06:13,400 --> 02:06:14,280 MONICA, WOULD I LIKE TO GET US 2689 02:06:14,280 --> 02:06:16,440 STARTED WITH THE SESSION. 2690 02:06:16,440 --> 02:06:18,280 >>SURE. 2691 02:06:18,280 --> 02:06:19,760 WELCOME BACK AGAIN, EVERYONE. 2692 02:06:19,760 --> 02:06:25,480 LIKE DR. JAIN SAID IT'S GOING TO 2693 02:06:25,480 --> 02:06:28,440 BE ABOUT COMMUNITY RISK OF 2694 02:06:28,440 --> 02:06:31,160 STILLBIRTH WE HAVE DR. DONNA 2695 02:06:31,160 --> 02:06:32,840 HOYERT WHO WILL GIVE AN OVERVIEW 2696 02:06:32,840 --> 02:06:35,640 ON THE CAUSE OF FETAL DEATH AND 2697 02:06:35,640 --> 02:06:35,920 DISPARITIES. 2698 02:06:35,920 --> 02:06:46,320 THANK YOU, DR. HOYERT. 2699 02:06:50,800 --> 02:06:52,600 >>I WAS ASKED TO TALK ABOUT 2700 02:06:52,600 --> 02:06:55,640 RACE AND ETHNIC DISPARITIES IN 2701 02:06:55,640 --> 02:06:56,720 STILLBIRTH BEFORE YOU HEAR FROM 2702 02:06:56,720 --> 02:06:58,840 THE OTHER SPEAKERS IN THE 2703 02:06:58,840 --> 02:07:02,680 SESSION. 2704 02:07:02,680 --> 02:07:06,320 AND MY INFORMATION IS BASED ON 2705 02:07:06,320 --> 02:07:09,200 THE NATIONAL VITAL STATISTICS 2706 02:07:09,200 --> 02:07:13,360 SYSTEM AND OVERLAPS ON WHAT 2707 02:07:13,360 --> 02:07:16,800 ELIZABETH GREGORY TALKED ABOUT 2708 02:07:16,800 --> 02:07:18,840 IN THE LAST MEETING AND MY 2709 02:07:18,840 --> 02:07:20,600 CONTINUING ROLE IS MORE FOCUSSED 2710 02:07:20,600 --> 02:07:22,800 ON CAUSE OF DEATH AND THE FETAL 2711 02:07:22,800 --> 02:07:32,600 DEATH DATA. 2712 02:07:32,600 --> 02:07:34,720 THIS IS ON DATA COLLECTED 2713 02:07:34,720 --> 02:07:39,240 THROUGH A DECENTRALIZED 2714 02:07:39,240 --> 02:07:40,920 STRUCTURE AND WHILE STATE LAW 2715 02:07:40,920 --> 02:07:46,280 REGULATION PREEMINENT THERE'S 2716 02:07:46,280 --> 02:07:48,520 LEVELS THAT TOUCH VITAL 2717 02:07:48,520 --> 02:07:48,800 STATISTICS. 2718 02:07:48,800 --> 02:07:52,040 THE INTERNATIONAL STANDARDS 2719 02:07:52,040 --> 02:07:54,760 EMBODIED IN THE INTERNATIONAL 2720 02:07:54,760 --> 02:07:56,600 CLASSIFICATION OF DISEASES HAVE 2721 02:07:56,600 --> 02:07:57,920 WIDE RANGING INFLUENCE ON WHAT 2722 02:07:57,920 --> 02:08:00,760 WE COLLECT, HOW WE COLLECT THAT 2723 02:08:00,760 --> 02:08:02,520 INFORMATION AND HOW WE PROCESS 2724 02:08:02,520 --> 02:08:05,880 IT AND HOW WE CLASSIFY CAUSE OF 2725 02:08:05,880 --> 02:08:06,160 DEATH. 2726 02:08:06,160 --> 02:08:08,040 THESE ARE ALSO THE SAME SOURCE 2727 02:08:08,040 --> 02:08:11,840 FOR THE STANDARDS THAT DEFINE 2728 02:08:11,840 --> 02:08:14,840 WHAT IS DONE FOR THE OTHER 3.4 2729 02:08:14,840 --> 02:08:15,440 MILLION ANNUAL DEATHS IN THE 2730 02:08:15,440 --> 02:08:25,520 U.S. 2731 02:08:30,240 --> 02:08:32,120 AND FETAL DEATH INFORMATION WAS 2732 02:08:32,120 --> 02:08:33,760 FIRST COLLECTED IN 1918 AND HAS 2733 02:08:33,760 --> 02:08:35,480 BEEN COLLECTED ANNUALLY SINCE 2734 02:08:35,480 --> 02:08:43,400 1921. 2735 02:08:43,400 --> 02:08:46,720 IF YOU DON'T ALREADY KNOW WHY WE 2736 02:08:46,720 --> 02:08:49,120 USE THE TERM FETAL DEATH IN THE 2737 02:08:49,120 --> 02:08:52,000 BIO STATISTICS SYSTEM WE USE THE 2738 02:08:52,000 --> 02:08:54,080 UMBRELLA TERM FETAL DEATH 2739 02:08:54,080 --> 02:08:55,960 FOLLOWING A LONGSTANDING W.H.O. 2740 02:08:55,960 --> 02:08:56,320 RECOMMENDATION. 2741 02:08:56,320 --> 02:09:00,600 THE POINT WAS TO TRY TO AVOID 2742 02:09:00,600 --> 02:09:02,840 CONFUSION ARRIVING FROM VARYING 2743 02:09:02,840 --> 02:09:06,480 USAGES OF A VARIETY OF TERMS 2744 02:09:06,480 --> 02:09:10,840 INCLUDING STILLBIRTHS, 2745 02:09:10,840 --> 02:09:11,360 SPONTANEOUS ABORTION AND 2746 02:09:11,360 --> 02:09:13,680 MISCARRIAGE AND OTHERS. 2747 02:09:13,680 --> 02:09:15,920 YOU'VE ALREADY SEEN THIS IN 2748 02:09:15,920 --> 02:09:16,840 ELIZABETH'S PRESENTATION BUT 2749 02:09:16,840 --> 02:09:19,240 AGAIN A PRESENTATION OF A 2750 02:09:19,240 --> 02:09:22,840 DEFINITION AND REPORTING 2751 02:09:22,840 --> 02:09:24,160 REQUIREMENT DETERMINES WHICH 2752 02:09:24,160 --> 02:09:25,200 FETAL DEATHS ARE INCLUDED IN THE 2753 02:09:25,200 --> 02:09:27,000 VITAL STATISTICS SYSTEM. 2754 02:09:27,000 --> 02:09:28,800 IN THE UNITED STATES, THIS IS 2755 02:09:28,800 --> 02:09:32,400 THE RECOMMENDED DEFINITION THAT 2756 02:09:32,400 --> 02:09:34,600 ENCOMPASSES AN INTRAUTERINE 2757 02:09:34,600 --> 02:09:36,160 DEATH WITH DEATH OCCURRING AT 2758 02:09:36,160 --> 02:09:38,120 ANY POINT WITHIN THE PREGNANCY 2759 02:09:38,120 --> 02:09:39,880 BUT THE REPORTING REQUIREMENT 2760 02:09:39,880 --> 02:09:43,800 ONLY REQUIRES THE SUBSET OF ALL 2761 02:09:43,800 --> 02:09:45,160 THESE EVENTS BE REPORTED. 2762 02:09:45,160 --> 02:09:48,480 SINCE IT IS A DECENTRALIZED 2763 02:09:48,480 --> 02:09:49,800 SYSTEM, EACH STATE HAS 2764 02:09:49,800 --> 02:09:51,400 RECOMMENDATION FETAL DEATHS. 2765 02:09:51,400 --> 02:09:53,080 THE DEFINITION IS CONSISTENT 2766 02:09:53,080 --> 02:09:57,880 WHILE REPORTING REQUIREMENTS ARE 2767 02:09:57,880 --> 02:10:00,280 MORE VARIABLE ACROSS BUT 2768 02:10:00,280 --> 02:10:02,440 NEVERTHELESS MOST STATES REQUIRE 2769 02:10:02,440 --> 02:10:04,800 REPORTING OF FETAL DEATH WITH A 2770 02:10:04,800 --> 02:10:09,160 GESTATION OF 20 WEEKS OR MORE. 2771 02:10:09,160 --> 02:10:13,080 THE NEXT SLIDE SHOWS WHEN A 2772 02:10:13,080 --> 02:10:14,240 PREGNANCY ENDS WITH FETAL DEATH 2773 02:10:14,240 --> 02:10:16,360 STATE RESOLUTIONS SPECIFIES IF 2774 02:10:16,360 --> 02:10:19,320 THE FETAL DEATH NEEDS TO BE 2775 02:10:19,320 --> 02:10:20,120 RECORDED ON A FETAL DEATH 2776 02:10:20,120 --> 02:10:20,360 REPORT. 2777 02:10:20,360 --> 02:10:22,480 IF IT DOES, WE HAVE GUIDANCE ON 2778 02:10:22,480 --> 02:10:24,520 WHO AND WHAT DOCUMENTATION 2779 02:10:24,520 --> 02:10:26,760 SHOULD BE THE BETTER SOURCE OF 2780 02:10:26,760 --> 02:10:27,080 INFORMATION. 2781 02:10:27,080 --> 02:10:30,120 FOR A VARIETY OF DETAILS AND 2782 02:10:30,120 --> 02:10:31,200 CHARACTERISTICS ABOUT THE 2783 02:10:31,200 --> 02:10:32,160 MOTHER, PREGNANCY AND DELIVERY 2784 02:10:32,160 --> 02:10:42,400 AND THE FETUS. 2785 02:10:46,880 --> 02:10:53,240 AUS -- CAUSE OF DEATH IS MUCH 2786 02:10:53,240 --> 02:10:54,720 MORE RECENT PUBLICATION RELEASED 2787 02:10:54,720 --> 02:10:55,680 AND BY PROCESSING CAUSE 2788 02:10:55,680 --> 02:10:57,080 INFORMATION I MEAN ALL 2789 02:10:57,080 --> 02:10:59,200 CONDITIONS ARE ASSIGNED A CODE 2790 02:10:59,200 --> 02:11:01,000 AND ASSOCIATED TITLE FROM THE 2791 02:11:01,000 --> 02:11:03,200 10th REVISION OF THE W.H.O.'S 2792 02:11:03,200 --> 02:11:06,320 INTERNATIONAL CLASSIFICATION OF 2793 02:11:06,320 --> 02:11:08,320 DISEASES AS MOST APPLICABLE TO 2794 02:11:08,320 --> 02:11:09,560 THE LITERAL TEXT. 2795 02:11:09,560 --> 02:11:13,360 ONE CONDITION FROM THE MANY THAT 2796 02:11:13,360 --> 02:11:16,800 MIGHT BE RECORDED IS DESIGNATED 2797 02:11:16,800 --> 02:11:19,680 THE INITIATING CONDITION AND WE 2798 02:11:19,680 --> 02:11:21,040 USE MODIFICATION RULES FOR 2799 02:11:21,040 --> 02:11:27,240 SELECTING THE INITIATING CAUSE. 2800 02:11:27,240 --> 02:11:31,880 AND THERE ARE ABOUT 8,000 2801 02:11:31,880 --> 02:11:32,720 CATEGORIES IN THE CLASSIFICATION 2802 02:11:32,720 --> 02:11:35,040 IT'S ORGANIZE IN MULTIPLE LEVELS 2803 02:11:35,040 --> 02:11:37,720 OF DETAIL WITH PERINATAL 2804 02:11:37,720 --> 02:11:40,000 CONDITION AND CONGENITAL 2805 02:11:40,000 --> 02:11:41,720 MALFORMATION CHAPTERS BEING MOST 2806 02:11:41,720 --> 02:11:45,600 RELEVANT FOR FETAL DEATHS. 2807 02:11:45,600 --> 02:11:47,800 ICD CODES CAN BE REARRANGED IN 2808 02:11:47,800 --> 02:11:49,360 GROUPS IN DIFFERENT WAYS BUT WE 2809 02:11:49,360 --> 02:11:51,640 PRIMARILY USE A STANDARD 2810 02:11:51,640 --> 02:11:54,800 TABULATION LIST AND FOCUS ON THE 2811 02:11:54,800 --> 02:11:58,840 MOST FREQUENTLY REPORTED CAUSES 2812 02:11:58,840 --> 02:12:01,680 FROM THAT LIST. 2813 02:12:01,680 --> 02:12:04,480 USING THAT GROUPING OF CAUSE, 2814 02:12:04,480 --> 02:12:07,240 NEARLY 90% OF FETAL DEATHS ARE 2815 02:12:07,240 --> 02:12:08,320 REPORTED INVITAL STATISTICS DATA 2816 02:12:08,320 --> 02:12:11,560 AS DUE TO ONE OF FIVE CAUSES. 2817 02:12:11,560 --> 02:12:15,200 THIS SLIDE SHOWS THE MOST 2818 02:12:15,200 --> 02:12:16,960 COMMONLY REPORTED CAUSES FOR 42 2819 02:12:16,960 --> 02:12:19,800 AREAS FOR 2018 TO 2020. 2820 02:12:19,800 --> 02:12:22,680 UNSPECIFIED CAUSE AT 31% IS MOST 2821 02:12:22,680 --> 02:12:25,560 COMMON FOLLOWED BY PLACENTAL 2822 02:12:25,560 --> 02:12:27,960 CORD AND MEMBRANE COMPLICATIONS 2823 02:12:27,960 --> 02:12:30,440 WITH 25%, MATERNAL COMPLICATIONS 2824 02:12:30,440 --> 02:12:39,000 WITH 13%, CONGENITAL 2825 02:12:39,000 --> 02:12:40,720 MALFORMATIONS UNRELATED TO 2826 02:12:40,720 --> 02:12:44,320 PREGNANCY AT 11%. 2827 02:12:44,320 --> 02:12:46,040 IF YOU INSERT THE VARIOUS CAUSES 2828 02:12:46,040 --> 02:12:48,160 BY CHARACTERISTIC THE CAUSES 2829 02:12:48,160 --> 02:12:51,280 REMAIN REPEATEDLY. 2830 02:12:51,280 --> 02:12:53,440 BIRTH WEIGHT AND GESTATIONAL 2831 02:12:53,440 --> 02:12:55,240 AGES ARE CHARACTERISTICS WHICH 2832 02:12:55,240 --> 02:12:58,320 THE CAUSES ARE SUPPLANT OTHERS 2833 02:12:58,320 --> 02:12:59,920 SPECIFICALLY DIABETES AND OTHER 2834 02:12:59,920 --> 02:13:02,840 COMPLICATIONS OF LABOR AND 2835 02:13:02,840 --> 02:13:04,440 DELIVERY AND SOME OF THE HIGHER 2836 02:13:04,440 --> 02:13:10,200 BIRTH WEIGHT AND LONGER 2837 02:13:10,200 --> 02:13:15,600 GESTATIONAL AGE CATEGORIES. 2838 02:13:15,600 --> 02:13:17,840 THERE'S INVESTIGATION TO 2839 02:13:17,840 --> 02:13:18,600 DETERMINE WHAT HAPPENED WITH 2840 02:13:18,600 --> 02:13:21,560 FETAL DEATHS BUT ITEMS 2841 02:13:21,560 --> 02:13:22,840 THEMSELVES HAVE COMPLETED AND 2842 02:13:22,840 --> 02:13:23,920 PLANNED CATEGORIES. 2843 02:13:23,920 --> 02:13:28,400 THIS SLIDE I'M ASSUMING PLAN IS 2844 02:13:28,400 --> 02:13:32,080 REALIZED AND COMBINE THE VALUES. 2845 02:13:32,080 --> 02:13:35,240 DOING THIS INDICATES PLACENTAL 2846 02:13:35,240 --> 02:13:37,760 EXAMINES ARE FAIRLY COMMON AT 2847 02:13:37,760 --> 02:13:39,240 NEARLY 70% WITH AUTOPSY LESS 2848 02:13:39,240 --> 02:13:49,600 COMMON AT AROUND 20%. 2849 02:13:56,920 --> 02:13:58,800 THESE THREE ORIGIN GROUPS ARE IN 2850 02:13:58,800 --> 02:14:08,440 OUR DATA. 2851 02:14:08,440 --> 02:14:10,840 AND RACE IS ONE OF A NUMBER OF 2852 02:14:10,840 --> 02:14:15,200 CHARACTERISTICS THAT HAVE LONG 2853 02:14:15,200 --> 02:14:16,000 BEEN AVAILABLE AND ASSESSED 2854 02:14:16,000 --> 02:14:17,760 FETAL DEATH DATA AND THE VARIOUS 2855 02:14:17,760 --> 02:14:19,240 OTHER LINES ON THE SLIDE 2856 02:14:19,240 --> 02:14:29,600 INDICATE RACE GROUPS. 2857 02:14:30,120 --> 02:14:35,000 AND WE HAVE A LITTLE MORE DETAIL 2858 02:14:35,000 --> 02:14:37,000 AND THESE ARE PERIODIC BREAKS AS 2859 02:14:37,000 --> 02:14:38,000 WE CHANGE. 2860 02:14:38,000 --> 02:14:39,840 I'M NOT BEING CAREFUL IN SHOWING 2861 02:14:39,840 --> 02:14:43,080 THE CHANGES IN THE LABELS OVER 2862 02:14:43,080 --> 02:14:43,720 TIME IN THE SLIDE BUT THE 2863 02:14:43,720 --> 02:14:46,840 CURRENT LABELS FOR THE LARGEST 2864 02:14:46,840 --> 02:14:48,680 GROUPS ARE SINGLE RACE 2865 02:14:48,680 --> 02:14:52,960 NON-HISPANIC WHITE AND 2866 02:14:52,960 --> 02:14:54,240 NON-HISPANIC BLACK AND HISPANIC 2867 02:14:54,240 --> 02:14:56,360 BLACK POPULATIONS. 2868 02:14:56,360 --> 02:14:58,840 THERE'S SUBSTANTIAL AND 2869 02:14:58,840 --> 02:14:59,760 PERSISTENT HIGHER FOR THE BLACK 2870 02:14:59,760 --> 02:15:03,200 POPULATION COMPARED TO THE WHITE 2871 02:15:03,200 --> 02:15:13,440 POPULATION. 2872 02:15:22,720 --> 02:15:25,520 THIS IS A SMALL CHARACTERISTIC 2873 02:15:25,520 --> 02:15:26,720 AND WHAT IT LOOKS LIKE BY 2874 02:15:26,720 --> 02:15:27,680 HISPANIC AND ORIGIN GROUPS. 2875 02:15:27,680 --> 02:15:30,120 I START WITH AN EXAMPLE OF 2876 02:15:30,120 --> 02:15:34,360 GEOGRAPHY WHICH IS WHERE MY 2877 02:15:34,360 --> 02:15:35,680 THOUGHTS WOULD FIRST TURN AT THE 2878 02:15:35,680 --> 02:15:39,200 MENTION OF ENVIRONMENTAL 2879 02:15:39,200 --> 02:15:49,440 INFLUENCES. 2880 02:15:49,840 --> 02:15:53,520 AND WE LOOKED AT ARKANSAS, 2881 02:15:53,520 --> 02:15:54,720 ALABAMA, MISSISSIPPI AND NEW 2882 02:15:54,720 --> 02:15:57,400 MEXICO, TEXAS, CONNECTICUT, 2883 02:15:57,400 --> 02:16:01,320 MASSACHUSETTS AND IOWA. 2884 02:16:01,320 --> 02:16:03,200 THE NUMBER OF EVENTS BECOMES AN 2885 02:16:03,200 --> 02:16:07,200 ISSUE IF YOU START LOOKING AT 2886 02:16:07,200 --> 02:16:08,360 ADDITIONAL CHARACTERISTIC AND WE 2887 02:16:08,360 --> 02:16:09,000 OFTEN COMBINE YEARS OF DATA TO 2888 02:16:09,000 --> 02:16:13,400 DO SO. 2889 02:16:13,400 --> 02:16:16,240 THREE YEARS IS NOT ENOUGH SO WE 2890 02:16:16,240 --> 02:16:17,560 SAW THE MAP FOR ANOTHER GROUP OF 2891 02:16:17,560 --> 02:16:28,000 THREE YEARS EARLIER TODAY. 2892 02:16:53,280 --> 02:16:55,480 THE PERCENTAGE IN REPORTING 2893 02:16:55,480 --> 02:16:57,280 UNSPECIFIED CAUSE OF DEATH 2894 02:16:57,280 --> 02:16:59,200 STICKS OUT THE MOST AND IT'S 2895 02:16:59,200 --> 02:17:00,960 SUBSTANTIALLY MORE FOR THE 2896 02:17:00,960 --> 02:17:02,920 STATES WITH HIGHER FETAL 2897 02:17:02,920 --> 02:17:04,560 MORTALITY RATES. 2898 02:17:04,560 --> 02:17:06,120 THE PERCENTAGE IS ABOUT 38% FOR 2899 02:17:06,120 --> 02:17:09,120 THE HIGH FETAL MORTALITY RATE 2900 02:17:09,120 --> 02:17:11,800 STATES VERSUS 24% FOR THE LOW 2901 02:17:11,800 --> 02:17:20,600 FETAL MORTALITY RATE STATES. 2902 02:17:20,600 --> 02:17:23,200 I ALREADY KNOW FETAL MORTALITY 2903 02:17:23,200 --> 02:17:25,000 RATES VARY AND THIS SHOWS MORE 2904 02:17:25,000 --> 02:17:27,240 CATEGORIES THAN SHOWN A FEW 2905 02:17:27,240 --> 02:17:30,160 SLIDES BACK. 2906 02:17:30,160 --> 02:17:34,840 IN 2020 FETAL MORTALITY RATES 2907 02:17:34,840 --> 02:17:38,600 WERE HIGHEST FOR NON-HISPANIC 2908 02:17:38,600 --> 02:17:41,320 AND PACIFIC ISLANDER AND 2909 02:17:41,320 --> 02:17:42,960 NON-HISPANIC BLACK WOMEN 2910 02:17:42,960 --> 02:17:47,200 FOLLOWED BY NON-HISPANIC 2911 02:17:47,200 --> 02:17:51,200 AMERICAN INDIAN OR ALASKAN 2912 02:17:51,200 --> 02:17:51,640 NATIVE. 2913 02:17:51,640 --> 02:17:53,800 LOOKING AT THE SAME CAUSES WERE 2914 02:17:53,800 --> 02:17:55,240 AMONG THE FIVE MOST COMMON 2915 02:17:55,240 --> 02:17:58,840 ACROSS RACE AND HISPANIC ORIGIN 2916 02:17:58,840 --> 02:18:01,000 GROUPS. 2917 02:18:01,000 --> 02:18:02,920 WITH RESPECT TO PERCENT 2918 02:18:02,920 --> 02:18:07,000 DISTRIBUTION THE PERCENT WITH 2919 02:18:07,000 --> 02:18:08,600 CONGENITAL MALL FORMATIONS 2920 02:18:08,600 --> 02:18:09,480 DIFFERED THE MOST BETWEEN GROUPS 2921 02:18:09,480 --> 02:18:13,720 WITH AN ACCOUNTING FOR 6.1% OF 2922 02:18:13,720 --> 02:18:17,320 DEATHS FOR NON-HISPANIC BLACK, 2923 02:18:17,320 --> 02:18:19,960 11.7% FOR HISPANIC AND 12.2% FOR 2924 02:18:19,960 --> 02:18:27,440 NON-HISPANIC WHITE POPULATIONS. 2925 02:18:27,440 --> 02:18:30,120 IF WE CALCULATED FETAL MORTALITY 2926 02:18:30,120 --> 02:18:32,040 PERCENT BY CAUSE RATHER THAN 2927 02:18:32,040 --> 02:18:32,760 DISTRIBUTION, THE LARGER 2928 02:18:32,760 --> 02:18:34,520 DIFFERENCES ARE BETWEEN THE 2929 02:18:34,520 --> 02:18:37,200 NON-HISPANIC WHITE AND 2930 02:18:37,200 --> 02:18:38,680 NON-HISPANIC BLACK POPULATIONS. 2931 02:18:38,680 --> 02:18:40,560 LIKE THE OVER ALL DIFFERENCE 2932 02:18:40,560 --> 02:18:41,520 BETWEEN NON-HISPANIC WHITE AND 2933 02:18:41,520 --> 02:18:43,800 BLACK THE RATES FOR THE 2934 02:18:43,800 --> 02:18:44,880 NON-HISPANIC BLACK POPULATION 2935 02:18:44,880 --> 02:18:47,760 WOULD BE ABOUT DOUBLE THAT FOR 2936 02:18:47,760 --> 02:18:52,560 THE WHITE POPULATION AND FOR 2937 02:18:52,560 --> 02:18:54,120 UNSPECIFIED CAUSE AND 2938 02:18:54,120 --> 02:18:56,360 COMBINATIONS OF PLACENTA CORD 2939 02:18:56,360 --> 02:18:58,880 AND MEMBRANES WITH TRIPLE FOR 2940 02:18:58,880 --> 02:19:01,560 MATERNAL COMPLICATIONS AND 2941 02:19:01,560 --> 02:19:03,400 MATERNAL CONDITIONS UNRELATED TO 2942 02:19:03,400 --> 02:19:05,680 PREGNANCY AND DIFFERENT WITH 2943 02:19:05,680 --> 02:19:07,000 SIMILAR RATES FOR CONGENITAL 2944 02:19:07,000 --> 02:19:07,520 MALFORMATIONS FOR THE TWO 2945 02:19:07,520 --> 02:19:14,200 GROUPS. 2946 02:19:14,200 --> 02:19:18,880 AS YOU KNOW THE HISPANIC ORE MIN 2947 02:19:18,880 --> 02:19:23,600 POPULATION IS COMPRISED OF MANY 2948 02:19:23,600 --> 02:19:24,000 SUBGROUPS. 2949 02:19:24,000 --> 02:19:26,040 AMONG HISPANIC ORIGIN SUBGROUPS 2950 02:19:26,040 --> 02:19:31,200 IN 2020 RATES RANGE FROM 4.41 2951 02:19:31,200 --> 02:19:33,800 FOR DOMINICAN WOMEN AND OTHER IN 2952 02:19:33,800 --> 02:19:34,840 KNOWN HISPANIC WOMEN. 2953 02:19:34,840 --> 02:19:37,000 HOWEVER, DIFFERENCES AMONG THESE 2954 02:19:37,000 --> 02:19:39,240 GROUPS WERE GENERALLY NOT 2955 02:19:39,240 --> 02:19:49,440 SIGNIFICANT. 2956 02:19:51,760 --> 02:19:53,840 FETAL MORTALITY RATES WERE 2957 02:19:53,840 --> 02:19:57,360 LOWEST FOR WOMEN AGE 25 TO 29 2958 02:19:57,360 --> 02:19:59,160 AND 30-34. 2959 02:19:59,160 --> 02:20:00,600 IF ONE LOOKS AT THIS BY RACE AND 2960 02:20:00,600 --> 02:20:02,280 HISPANIC ORIGIN THE NUMBER OF 2961 02:20:02,280 --> 02:20:06,400 EVENTS WAS TOO SMALL FOR A 2962 02:20:06,400 --> 02:20:09,960 SINGLE YEAR AND TO CALCULATE 2963 02:20:09,960 --> 02:20:12,240 RELIABLE RATES FOR FEMALES UNDER 2964 02:20:12,240 --> 02:20:16,360 AGE 15 FOR ALL THREE IN HISPANIC 2965 02:20:16,360 --> 02:20:17,040 ORIGIN GROUPS. 2966 02:20:17,040 --> 02:20:19,000 AGE SPECIFIC RATES FOR 2967 02:20:19,000 --> 02:20:20,160 NON-HISPANIC BLACK WOMEN WERE 2968 02:20:20,160 --> 02:20:21,280 HIGHER THAN THOSE FOR 2969 02:20:21,280 --> 02:20:22,280 NON-HISPANIC WHITE WOMEN FOR 2970 02:20:22,280 --> 02:20:25,560 THOSE AGED 15 AND OVER. 2971 02:20:25,560 --> 02:20:28,880 RATES FOR NON-HISPANIC BLACK 2972 02:20:28,880 --> 02:20:31,240 WOMEN WERE HIGHER THAN THOSE AGE 2973 02:20:31,240 --> 02:20:33,400 15 TO 44. 2974 02:20:33,400 --> 02:20:35,480 THE RATE AT AGE 45 AND OVER WERE 2975 02:20:35,480 --> 02:20:40,360 NOT SIGNIFICANTLY DIFFERENT. 2976 02:20:40,360 --> 02:20:43,560 THE RATES FOR NON-HISPANIC WHITE 2977 02:20:43,560 --> 02:20:45,440 CROSSED NEITHER IS CONSISTENTLY 2978 02:20:45,440 --> 02:20:55,840 GREATER THAN THE OTHER. 2979 02:21:03,040 --> 02:21:05,400 THE RATE FOR THE NON-HISPANIC 2980 02:21:05,400 --> 02:21:08,240 BLACK POPULATION WAS GREATER 2981 02:21:08,240 --> 02:21:11,160 THAN THE NON-HISPANIC BLACK AND 2982 02:21:11,160 --> 02:21:14,240 WHILE THE POPULATIONS AND THE 2983 02:21:14,240 --> 02:21:15,280 GREATER WAS GREATER FOR THE 2984 02:21:15,280 --> 02:21:16,200 HISPANIC WHITE THAN NON-HISPANIC 2985 02:21:16,200 --> 02:21:23,120 WHITE POPULATION. 2986 02:21:23,120 --> 02:21:26,040 THE FETAL MORTALITY DECLINED TO 2987 02:21:26,040 --> 02:21:28,800 A LOW AT 39 TO 41 AND 41 WEEKS 2988 02:21:28,800 --> 02:21:30,080 AND INCREASED AT 42 WEEKS OF 2989 02:21:30,080 --> 02:21:32,920 GESTATION OR MORE. 2990 02:21:32,920 --> 02:21:35,200 THE PATTERN WAS SIMILAR FOR THE 2991 02:21:35,200 --> 02:21:37,040 THREE LARGEST RACE IN HISPANIC 2992 02:21:37,040 --> 02:21:37,360 ORIGIN GROUPS. 2993 02:21:37,360 --> 02:21:40,160 THE LINES FOR THE DIFFERENT 2994 02:21:40,160 --> 02:21:42,760 GROUPS ARE CROSSING SOME IN THE 2995 02:21:42,760 --> 02:21:43,840 NON-HISPANIC BLACK POPULATION 2996 02:21:43,840 --> 02:21:49,440 DOES NOT CYST LY -- CONSISTENTY 2997 02:21:49,440 --> 02:21:51,800 HAVE HIGHER RATES ACROSS THE 2998 02:21:51,800 --> 02:21:53,440 GESTATIONAL AGES. 2999 02:21:53,440 --> 02:21:54,600 I SWITCHED TO LOG SCALE WITH THE 3000 02:21:54,600 --> 02:21:58,880 NEXT SLIDE. 3001 02:21:58,880 --> 02:22:01,480 THE FETAL MORTALITY RATE IS 3002 02:22:01,480 --> 02:22:04,120 HIGHER FOR FETUSES WEIGHING LESS 3003 02:22:04,120 --> 02:22:06,440 THAN 500 GRAMS AND INCREASED TO 3004 02:22:06,440 --> 02:22:11,120 A LOW FOR FETUSES WEIGHING 300 3005 02:22:11,120 --> 02:22:18,520 TO 3,999 GRAMS AND INCREASED 3006 02:22:18,520 --> 02:22:19,600 SLIGHTLY FOR FETUSES WEIGHING 3007 02:22:19,600 --> 02:22:21,000 4,000 GRAMS MORE AND THE PATTERN 3008 02:22:21,000 --> 02:22:23,800 WAS SIMILAR FOR THE THREE 3009 02:22:23,800 --> 02:22:24,800 LARGEST RACE IN HISPANIC ORIGIN 3010 02:22:24,800 --> 02:22:28,360 GROUPS BUT SEE THE LINES ARE 3011 02:22:28,360 --> 02:22:31,840 CROSSING AT POINTS. 3012 02:22:31,840 --> 02:22:33,760 HERE'S ANOTHER INSTANCES WHERE 3013 02:22:33,760 --> 02:22:35,880 THE RATES ARE NOT CONSISTENTLY 3014 02:22:35,880 --> 02:22:36,600 MUCH HIGHER. 3015 02:22:36,600 --> 02:22:39,880 DIFFERENCES IN RATES BETWEEN THE 3016 02:22:39,880 --> 02:22:42,520 NON-HISPANIC WHITE AND HISPANIC 3017 02:22:42,520 --> 02:22:44,680 POPULATION ARE NOT SUBSTANTIALLY 3018 02:22:44,680 --> 02:22:44,920 DIFFERENT. 3019 02:22:44,920 --> 02:22:46,440 THE 4,000 GRAMS OR MORE CATEGOY 3020 02:22:46,440 --> 02:22:50,640 IS ONE THAT HAS A NOTABLY 3021 02:22:50,640 --> 02:22:51,240 DIFFERENT REPORTED CAUSE OF 3022 02:22:51,240 --> 02:22:53,480 DEATH DISTRIBUTION. 3023 02:22:53,480 --> 02:22:55,200 AT THAT DELIVERY WEIGHT, 3024 02:22:55,200 --> 02:22:58,240 DIABETES IS THE MOST FREQUENTLY 3025 02:22:58,240 --> 02:23:00,800 MENTIONED CAUSE OF DEATH CLOSELY 3026 02:23:00,800 --> 02:23:02,440 FOLLOWED BY UNSPECIFIED CAUSE 3027 02:23:02,440 --> 02:23:04,480 BOTH AROUND 30%. 3028 02:23:04,480 --> 02:23:07,240 THERE'S VARIATION BY RACE AND 3029 02:23:07,240 --> 02:23:10,480 HISPANIC ORIGIN FOR THE WHITE 3030 02:23:10,480 --> 02:23:12,520 POPULATION UNSPECIFIED REMAINS 3031 02:23:12,520 --> 02:23:14,720 MOST COMMON AND COMBINATIONS OF 3032 02:23:14,720 --> 02:23:16,720 PLACENTA CORD AND MEMBRANES AT 3033 02:23:16,720 --> 02:23:24,960 25% AND DIABETES AT 22%. 3034 02:23:24,960 --> 02:23:29,240 FOR THE BLACK POPULATION, 38% 3035 02:23:29,240 --> 02:23:31,960 DIABETES AND 21% UNSPECIFIED AND 3036 02:23:31,960 --> 02:23:33,720 CORD AND MEMBRANE 12%. 3037 02:23:33,720 --> 02:23:35,840 FOR THE HISPANIC POPULATION, 43% 3038 02:23:35,840 --> 02:23:40,840 ARE ATTRIBUTED TO DIABETES, .4% 3039 02:23:40,840 --> 02:23:42,680 UNSPECIFIED CAUSE AND 3040 02:23:42,680 --> 02:23:44,240 COMPLICATIONS OF PLACENTA CORD 3041 02:23:44,240 --> 02:23:54,560 AND MEMBRANES, 14%. 3042 02:23:58,840 --> 02:24:04,560 THE FETAL MORTALITY RATE WAS 3043 02:24:04,560 --> 02:24:05,960 GREATER FOR THE SMOKING GROUP 3044 02:24:05,960 --> 02:24:07,880 AND GREATER FOR THE NON-HISPANIC 3045 02:24:07,880 --> 02:24:08,920 BLACK POPULATION THAN OTHER 3046 02:24:08,920 --> 02:24:10,640 GROUPS AND THE RATES WERE 3047 02:24:10,640 --> 02:24:12,840 GREATER FOR THE HISPANIC 3048 02:24:12,840 --> 02:24:13,480 POPULATION THAN THE NON-HISPANIC 3049 02:24:13,480 --> 02:24:22,160 WHITE POPULATION. 3050 02:24:22,160 --> 02:24:25,480 DATA FROM THE NATIONAL VITAL 3051 02:24:25,480 --> 02:24:26,320 STATISTICS SYSTEM FETAL DEATH 3052 02:24:26,320 --> 02:24:28,520 DATA SHOWED FETAL MORTALITY 3053 02:24:28,520 --> 02:24:30,560 RATES VARY BY MANY 3054 02:24:30,560 --> 02:24:31,200 CHARACTERISTICS. 3055 02:24:31,200 --> 02:24:33,320 OVER ALL THE FETAL MORTALITY 3056 02:24:33,320 --> 02:24:34,640 RATE FOR NON-HISPANIC WHITE 3057 02:24:34,640 --> 02:24:35,720 POPULATIONS ARE SIMILAR WHILE 3058 02:24:35,720 --> 02:24:39,240 THE RATES FOR THE NON-HISPANIC 3059 02:24:39,240 --> 02:24:42,480 BLACK POPULATIONS IS MORE THAN 3060 02:24:42,480 --> 02:24:45,520 DOUBLE THOSE FOR THE 3061 02:24:45,520 --> 02:24:47,200 NON-HISPANIC WHITE AND LOOKING 3062 02:24:47,200 --> 02:24:50,440 AT RATES BY OTHER VARIABLES OR 3063 02:24:50,440 --> 02:24:51,920 CHARACTERISTICS, DIFFERENCES ARE 3064 02:24:51,920 --> 02:24:53,280 OBSERVED BETWEEN THE 3065 02:24:53,280 --> 02:24:54,720 NON-HISPANIC BLACK AND WHITE 3066 02:24:54,720 --> 02:24:58,360 POPULATIONS ACROSS MANY OF THESE 3067 02:24:58,360 --> 02:25:02,360 OTHER CHARACTERISTICS. 3068 02:25:02,360 --> 02:25:04,880 SAYS TOBACCO USE AND OTHERS NOT 3069 02:25:04,880 --> 02:25:06,200 SHOWN TODAY. 3070 02:25:06,200 --> 02:25:10,200 HOWEVER THIS IS NOT ALWAYS THE 3071 02:25:10,200 --> 02:25:10,400 CASE. 3072 02:25:10,400 --> 02:25:12,440 AND RATES FOR THE NON-HISPANIC 3073 02:25:12,440 --> 02:25:13,840 BLACK POPULATION ARE NOT 3074 02:25:13,840 --> 02:25:15,240 CONSISTENTLY GREATER THAN THAT 3075 02:25:15,240 --> 02:25:19,120 FOR THE NON-HISPANIC WHITE 3076 02:25:19,120 --> 02:25:20,480 POPULATION ACROSS GESTATIONAL 3077 02:25:20,480 --> 02:25:21,880 AGE AND BIRTH WEIGHT CATEGORIES. 3078 02:25:21,880 --> 02:25:24,880 WITH FEW CAUSES OF DEATH RAISED 3079 02:25:24,880 --> 02:25:26,360 IN THIS PRESENTATION, THE 3080 02:25:26,360 --> 02:25:28,920 DIFFERENTIAL IS MORE ELEVATED 3081 02:25:28,920 --> 02:25:31,160 FOR MATERNAL COMPLICATIONS AND 3082 02:25:31,160 --> 02:25:33,960 CONDITIONS UNRELATED TO 3083 02:25:33,960 --> 02:25:35,920 PREGNANCY BUT ABSENT FOR COULD 3084 02:25:35,920 --> 02:25:37,360 BE GENTLE MALFORMATION. 3085 02:25:37,360 --> 02:25:39,840 AND THAT CONCLUDES MY 3086 02:25:39,840 --> 02:25:40,880 PRESENTATION. 3087 02:25:40,880 --> 02:25:48,240 THANK YOU FOR YOUR ATTENTION. 3088 02:25:48,240 --> 02:25:50,800 >>WONDERFUL, PRESENTATION, 3089 02:25:50,800 --> 02:25:52,880 DR. HOGUE FOR THE DIFFERENCES IN 3090 02:25:52,880 --> 02:25:55,160 THE DISPARITIES WE'RE SEEING AND 3091 02:25:55,160 --> 02:25:56,240 THE CAUSE OF FETAL DEATH. 3092 02:25:56,240 --> 02:26:02,520 THANK YOU FOR ACCEPTING. 3093 02:26:02,520 --> 02:26:07,160 NOW TO TRANSITION DEEPER INTO 3094 02:26:07,160 --> 02:26:08,480 DISPARITIES WE HAVE DR. HOGUE 3095 02:26:08,480 --> 02:26:16,840 PROFESSOR OF EPIDEMIOLOGY OF 3096 02:26:16,840 --> 02:26:18,680 MATERNAL AND STUDY AND LOOKING 3097 02:26:18,680 --> 02:26:20,800 AT RACIAL AND ETHNIC DISPARITIES 3098 02:26:20,800 --> 02:26:21,800 IN BIRTH. 3099 02:26:21,800 --> 02:26:26,160 >>THANK YOU, DR. LONGO. 3100 02:26:26,160 --> 02:26:27,240 GOOD AFTERNOON. 3101 02:26:27,240 --> 02:26:28,480 I WOULD LIKE TO THANK 3102 02:26:28,480 --> 02:26:29,440 DR. BIANCHI AND THE WORKING 3103 02:26:29,440 --> 02:26:32,040 GROUP FOR YOUR INVITATION TO 3104 02:26:32,040 --> 02:26:33,880 SPEAK TODAY. 3105 02:26:33,880 --> 02:26:36,680 MY ONLY DISCLOSURE IS THIS 3106 02:26:36,680 --> 02:26:41,360 INVITATION APPEARED IN MY E-MAIL 3107 02:26:41,360 --> 02:26:42,800 WHEN I WAS IN NEW ZEALAND ON 3108 02:26:42,800 --> 02:26:45,560 VACATION AND I ARRIVED BACK HOME 3109 02:26:45,560 --> 02:26:47,200 SATURDAY NIGHT SO I HAVE HAD 3110 02:26:47,200 --> 02:26:50,600 LITTLE TIME TO PREPARE THIS 3111 02:26:50,600 --> 02:26:51,560 PRESENTATION. 3112 02:26:51,560 --> 02:26:57,080 AND I HOPE DURING THE Q&A PERIOD 3113 02:26:57,080 --> 02:26:58,760 YOU ASK FOR FURTHER 3114 02:26:58,760 --> 02:27:00,280 CLARIFICATION OR EXPANSION FOR 3115 02:27:00,280 --> 02:27:02,440 ANYTHING THAT MAY NOT HAVE BEEN 3116 02:27:02,440 --> 02:27:04,680 CLEAR AS WE HAVE GONE THROUGH 3117 02:27:04,680 --> 02:27:05,280 THIS RATHER HASTY PRESENTATION 3118 02:27:05,280 --> 02:27:10,320 PREPARATION. 3119 02:27:10,320 --> 02:27:15,720 I WAS ASKED TO COMMENT ON RACIAL 3120 02:27:15,720 --> 02:27:16,760 DISPARITIES IN STILLBIRTH. 3121 02:27:16,760 --> 02:27:18,240 I'LL LIMIT MY COMMENT TO ONE 3122 02:27:18,240 --> 02:27:20,760 TYPE OF COMMUNITY AT HIGHER RISK 3123 02:27:20,760 --> 02:27:22,200 NAMELY AFRICAN AMERICAN WOMEN. 3124 02:27:22,200 --> 02:27:26,040 THIS IS FOR TWO REASONS. 3125 02:27:26,040 --> 02:27:26,960 FIRST, AFRICAN AMERICAN WOMEN AS 3126 02:27:26,960 --> 02:27:30,640 YOU HAVE HEARD HAVE A DECIDED 3127 02:27:30,640 --> 02:27:32,280 HIGHER RATE OF STILLBIRTH THAN 3128 02:27:32,280 --> 02:27:34,880 WHITE WOMEN AND THE STILLBIRTH 3129 02:27:34,880 --> 02:27:37,880 RATE FOR OTHERS REPORTED BY RACE 3130 02:27:37,880 --> 02:27:43,120 OR ETHNICITY IS SIMILAR OF THAT 3131 02:27:43,120 --> 02:27:46,360 BLACK WOMEN AND MORE IS RAIN FOR 3132 02:27:46,360 --> 02:27:47,480 RACIAL DISPARITY FOR AFRICAN 3133 02:27:47,480 --> 02:27:49,440 AMERICAN WOMEN THAN FOR OTHER 3134 02:27:49,440 --> 02:27:49,720 GROUPS. 3135 02:27:49,720 --> 02:27:51,800 IT'S IMPORTANT TO UNDERSTAND 3136 02:27:51,800 --> 02:27:58,840 RACE IS NOT A RISK FACTOR BUT 3137 02:27:58,840 --> 02:28:02,720 INDICATOR OF PERINATAL PROBLEMS 3138 02:28:02,720 --> 02:28:03,480 INCLUDING STILLBIRTH. 3139 02:28:03,480 --> 02:28:04,720 IN THE UNITED STATES, 3140 02:28:04,720 --> 02:28:06,680 INDIVIDUALS IN A COMMUNITY 3141 02:28:06,680 --> 02:28:07,840 BROADLY DEFINED BY THE TERM 3142 02:28:07,840 --> 02:28:09,280 AFRICAN AMERICAN ARE ABOUT TWICE 3143 02:28:09,280 --> 02:28:12,000 AS LIKELY THAN INDIVIDUALS IN 3144 02:28:12,000 --> 02:28:13,360 ANOTHER COMMUNITY DEFINED BY 3145 02:28:13,360 --> 02:28:17,000 WHITE, COLOR OR ANCESTRY TO 3146 02:28:17,000 --> 02:28:17,760 EXPERIENCE STILLBIRTH. 3147 02:28:17,760 --> 02:28:22,880 THE REASONS FOR THIS ARE THE 3148 02:28:22,880 --> 02:28:24,520 RISK FACTORS THAT AFRICAN 3149 02:28:24,520 --> 02:28:26,560 AMERICANS EXPERIENCE MORE 3150 02:28:26,560 --> 02:28:27,200 FREQUENTLY THAN WHITE COMMUNITY 3151 02:28:27,200 --> 02:28:32,240 MEMBERS EXPERIENCE. 3152 02:28:32,240 --> 02:28:35,640 THE PURPOSES OF RESEARCH AND 3153 02:28:35,640 --> 02:28:37,160 SURVEILLANCE ONE CAN 3154 02:28:37,160 --> 02:28:39,640 CHARACTERIZE RISK FACTORS FOR 3155 02:28:39,640 --> 02:28:42,280 EXCESS STILLBIRTH RISK AMONG 3156 02:28:42,280 --> 02:28:43,640 AFRICAN AMERICANS AS SOCIAL 3157 02:28:43,640 --> 02:28:47,800 SYSTEMIC, GENETIC, MEDICAL OR 3158 02:28:47,800 --> 02:28:48,960 INDIVIDUAL INTERPERSONAL. 3159 02:28:48,960 --> 02:28:52,200 SOCIAL SYSTEMIC RISKS INCLUDE 3160 02:28:52,200 --> 02:28:55,000 INSTITUTIONALIZED AND HISTORICAL 3161 02:28:55,000 --> 02:28:56,120 RACISM THAT PLACE MANY AFRICAN 3162 02:28:56,120 --> 02:28:58,880 AMERICAN WOMEN IN REDLINED 3163 02:28:58,880 --> 02:29:00,640 NEIGHBORHOODS WITH POOR ACCESS 3164 02:29:00,640 --> 02:29:02,200 TO HEALTH NUTRITION, HEALTH 3165 02:29:02,200 --> 02:29:04,720 SERVICES AND LIMITED ACCESS TO 3166 02:29:04,720 --> 02:29:07,920 WORK THAT PAYS LIVABLE WAGES. 3167 02:29:07,920 --> 02:29:10,840 WOMEN WHO ACHIEVE A HIGH LEVEL 3168 02:29:10,840 --> 02:29:13,440 OF EDUCATION AND WELL PAYING 3169 02:29:13,440 --> 02:29:15,560 JOBS ARE OFTEN FACED WITH 3170 02:29:15,560 --> 02:29:18,760 INSTITUTIONALIZED RACISM WITHIN 3171 02:29:18,760 --> 02:29:20,960 THEIR WORK AND NEIGHBORHOOD 3172 02:29:20,960 --> 02:29:21,720 SETTINGS. 3173 02:29:21,720 --> 02:29:24,400 FOOD DESERTS AND OTHER 3174 02:29:24,400 --> 02:29:26,400 ENVIRONMENTS THAT INCREASE THE 3175 02:29:26,400 --> 02:29:28,960 RISK OF OBESITY BEGINNING IN 3176 02:29:28,960 --> 02:29:29,200 CHILDHOOD. 3177 02:29:29,200 --> 02:29:31,480 OBESITY IS DIFFICULT TO 3178 02:29:31,480 --> 02:29:32,600 INTERVENE AFTER ONE BECOMES 3179 02:29:32,600 --> 02:29:34,840 OBESE AND IT'S AN ANYONE RISK 3180 02:29:34,840 --> 02:29:39,040 FACTOR FOR STILLBIRTH. 3181 02:29:39,040 --> 02:29:39,840 PREGNANT AFRICAN AMERICAN WOMEN 3182 02:29:39,840 --> 02:29:44,680 ARE ABOUT 50% MORE LIKELY THAN 3183 02:29:44,680 --> 02:29:46,880 WHITE WOMEN TO BE OBESE. 3184 02:29:46,880 --> 02:29:55,320 AMEALIOR -- AMELIORATION 3185 02:29:55,320 --> 02:29:58,120 EFFORTS CAN BE EVALUATED THROUGH 3186 02:29:58,120 --> 02:29:59,880 QUASI-EXPERIMENTAL RESEARCH. 3187 02:29:59,880 --> 02:30:02,520 AS AN EXAMPLE OF SUCH A SYSTEMIC 3188 02:30:02,520 --> 02:30:06,000 INTERVENTION THAT REDUCES RACIAL 3189 02:30:06,000 --> 02:30:09,200 DISPARITIES, THE NIH SPONSORED A 3190 02:30:09,200 --> 02:30:11,520 QUASI-EXPERIMENTAL STUDY OF 3191 02:30:11,520 --> 02:30:12,920 CHANGES IN ELEMENTARY STUDENT'S 3192 02:30:12,920 --> 02:30:15,480 HEALTH WITH THE INTRODUCTION OF 3193 02:30:15,480 --> 02:30:16,840 SCHOOL-BASED HEALTH CENTERS 3194 02:30:16,840 --> 02:30:18,880 PLACED IN PUBLIC SCHOOLS WHICH 3195 02:30:18,880 --> 02:30:20,320 HAVE A LARGE PERCENTAGE OF 3196 02:30:20,320 --> 02:30:22,480 STUDENTS WITH LIMITED FINANCIAL 3197 02:30:22,480 --> 02:30:22,760 RESOURCES. 3198 02:30:22,760 --> 02:30:27,240 THIS STUDY DEMONSTRATED INCLUDES 3199 02:30:27,240 --> 02:30:28,520 THE HEALTH SERVICES FOR STUDENTS 3200 02:30:28,520 --> 02:30:34,160 ENROLLED IN MEDICAID. 3201 02:30:34,160 --> 02:30:36,800 RECENT STUDIES FOUND THAT 3202 02:30:36,800 --> 02:30:37,440 AFRICAN AMERICAN WOMEN ALSO FACE 3203 02:30:37,440 --> 02:30:38,960 MEDICAL CARE SYSTEMS THAT IGNORE 3204 02:30:38,960 --> 02:30:42,080 THEIR VOICE AND MAKE RACIST 3205 02:30:42,080 --> 02:30:43,480 ASSUMPTIONS THAT LEAD TO LOWER 3206 02:30:43,480 --> 02:30:45,200 QUALITY HEALTH CARE AND 3207 02:30:45,200 --> 02:30:47,240 ULTIMATELY TO GREATER RISK OF 3208 02:30:47,240 --> 02:30:51,360 SEVERE MATERNAL MORBIDITY AND 3209 02:30:51,360 --> 02:30:54,680 POOR PREGNANCY OUTCOMES. 3210 02:30:54,680 --> 02:30:58,880 A RECENT ANALYSIS OF WOMEN 3211 02:30:58,880 --> 02:30:59,440 DELIVERING STILLBIRTH IN 3212 02:30:59,440 --> 02:31:03,240 CALIFORNIA FOUND 10.6% OF 3213 02:31:03,240 --> 02:31:04,320 AFRICAN AMERICAN MOTHERS 3214 02:31:04,320 --> 02:31:06,040 SUFFERED SEVERE MATERNAL 3215 02:31:06,040 --> 02:31:08,760 MORBIDITY COMPARED TO 5.2% OF 3216 02:31:08,760 --> 02:31:15,000 WHITE OR HISPANIC MOTHERS. 3217 02:31:15,000 --> 02:31:16,600 PROGRESS TOWARDS ACHIEVING 3218 02:31:16,600 --> 02:31:18,560 EQUITY CAN BE MEASURED THROUGH 3219 02:31:18,560 --> 02:31:22,200 SURVEILLANCE OF END RESULTS 3220 02:31:22,200 --> 02:31:24,040 INCLUDING REDUCED MATERNAL 3221 02:31:24,040 --> 02:31:27,240 OBESITY, SEVERE MORBIDITY AND 3222 02:31:27,240 --> 02:31:31,200 ADVERSE PREGNANCY OUTCOMES AND 3223 02:31:31,200 --> 02:31:34,880 PRO 3224 02:31:34,880 --> 02:31:43,200 PRO 3225 02:31:43,200 --> 02:31:44,520 PROXY. 3226 02:31:44,520 --> 02:31:50,480 CERTIFICATES BECAME LINKED AND 3227 02:31:50,480 --> 02:31:51,720 WAS ASSOCIATED TO INFANT 3228 02:31:51,720 --> 02:31:52,800 MORTALITY TO COMMUNITIES OF 3229 02:31:52,800 --> 02:31:55,480 COLOR AND THE BENEFIT OF 3230 02:31:55,480 --> 02:31:57,560 MOTHER'S HIGHER EDUCATIONAL 3231 02:31:57,560 --> 02:31:58,600 ATTAINMENT WAS LESS THAN FOR 3232 02:31:58,600 --> 02:32:00,080 AFRICAN AMERICAN THAN FOR WHITE 3233 02:32:00,080 --> 02:32:03,520 WOMEN IN LARGE PART BECAUSE WELL 3234 02:32:03,520 --> 02:32:04,200 EDUCATED AFRICAN AMERICAN WOMEN 3235 02:32:04,200 --> 02:32:07,240 WERE FAR MORE LIKELY TO DELIVER 3236 02:32:07,240 --> 02:32:10,880 PERI VIABLE INFANTS AT EXTREMELY 3237 02:32:10,880 --> 02:32:12,560 LOW GESTATIONAL AGES. 3238 02:32:12,560 --> 02:32:14,480 SUBSEQUENT RESEARCH HAS REVEALED 3239 02:32:14,480 --> 02:32:17,200 THE STRESS OF RACISM ON AFRICAN 3240 02:32:17,200 --> 02:32:19,160 AMERICAN WOMEN'S HEALTH AS WELL 3241 02:32:19,160 --> 02:32:21,600 AS LOWER QUALITY MATERNAL CARE 3242 02:32:21,600 --> 02:32:26,760 ARE THE LIKELY REASONS FOR THIS 3243 02:32:26,760 --> 02:32:27,520 ONGOING DISPARITIES IN VERY 3244 02:32:27,520 --> 02:32:31,120 PRETERM BIRTH AND INFANT 3245 02:32:31,120 --> 02:32:31,560 MORTALITY. 3246 02:32:31,560 --> 02:32:36,320 AND JUST TO MAKE A COMMENT ABOUT 3247 02:32:36,320 --> 02:32:40,720 DR. HOYERT'S WONDERFUL 3248 02:32:40,720 --> 02:32:42,680 PRESENTATION, IT'S TRUE THAT THE 3249 02:32:42,680 --> 02:32:45,800 FETAL MORTALITY RATE FOR VERY 3250 02:32:45,800 --> 02:32:47,880 PRETERM BIRTHS IS SIMILAR ACROSS 3251 02:32:47,880 --> 02:32:49,680 RACES. 3252 02:32:49,680 --> 02:32:50,680 WHAT MAKES THE DIFFERENCE IS 3253 02:32:50,680 --> 02:32:51,560 AFRICAN AMERICAN WOMEN ARE THREE 3254 02:32:51,560 --> 02:32:55,200 TO FOUR TIMES AS LIKELY TO 3255 02:32:55,200 --> 02:32:58,880 DELIVER BABIES AT THOSE VERY LOW 3256 02:32:58,880 --> 02:33:02,880 GESTATIONAL AGES. 3257 02:33:02,880 --> 02:33:04,320 SYSTEMIC PROGRESS IN MEDICAL 3258 02:33:04,320 --> 02:33:08,760 CARE SUCH AS REDUCTION IN 3259 02:33:08,760 --> 02:33:11,160 UNNECESSARY INFECTION CAN ALSO 3260 02:33:11,160 --> 02:33:12,960 BE TRACKED THROUGH VITAL RECORD 3261 02:33:12,960 --> 02:33:13,320 SURVEILLANCE. 3262 02:33:13,320 --> 02:33:23,640 EXCUSE ME A MINUTE. 3263 02:33:25,080 --> 02:33:28,320 SYSTEM PROGRESS IN MEDICAL CARE 3264 02:33:28,320 --> 02:33:33,560 SUCH AS REDUCTION IN UNNECESSARY 3265 02:33:33,560 --> 02:33:38,040 C SECTION CAN BE TRACKED BUT 3266 02:33:38,040 --> 02:33:39,560 HOWEVER, THIS MECHANISM IS NOT 3267 02:33:39,560 --> 02:33:40,760 IN PLACE FOR STILLBIRTHS. 3268 02:33:40,760 --> 02:33:43,120 THE DATA IS COLLECTED FROM LIVE 3269 02:33:43,120 --> 02:33:47,080 BIRTHS BUT NOT FOR STILLBIRTHS. 3270 02:33:47,080 --> 02:33:52,520 THIS CAN BE DEVELOPED THROUGH 3271 02:33:52,520 --> 02:33:55,720 ADEQUATE EXPANSION OF RECORDS OF 3272 02:33:55,720 --> 02:33:58,360 THE GESTATION IS AS COMPLETE AND 3273 02:33:58,360 --> 02:33:59,320 ACCURATE AS THE INFORMATION NOW 3274 02:33:59,320 --> 02:34:06,880 AVAILABLE FOR LIVE BIRTHS. 3275 02:34:06,880 --> 02:34:10,240 SOME MEASURES ARE ON THE FETAL 3276 02:34:10,240 --> 02:34:11,200 DEATH CERTIFICATE AND SOME ARE 3277 02:34:11,200 --> 02:34:16,880 REMOVED BECAUSE OF LIMITED 3278 02:34:16,880 --> 02:34:17,280 RESOURCES. 3279 02:34:17,280 --> 02:34:18,800 AS ANOTHER DIVERSION FROM 3280 02:34:18,800 --> 02:34:21,200 PREPARED COMMENTS IN RESPONSE TO 3281 02:34:21,200 --> 02:34:22,640 THE DISCUSSION ABOUT THE QUALITY 3282 02:34:22,640 --> 02:34:25,640 OF FETAL DEATH CERTIFICATES THE 3283 02:34:25,640 --> 02:34:26,720 NATIONAL CENTER FOR HEALTH 3284 02:34:26,720 --> 02:34:29,880 STATISTICS HAS LONG BEEN STYMIED 3285 02:34:29,880 --> 02:34:30,800 AND REDUCED IN RESOURCES 3286 02:34:30,800 --> 02:34:34,600 AVAILABLE TO STATES TO IMPROVE 3287 02:34:34,600 --> 02:34:36,400 THEIR VITAL RECORD SYSTEMS. 3288 02:34:36,400 --> 02:34:38,320 STATES AS YOU KNOW ARE 3289 02:34:38,320 --> 02:34:40,880 RESPONSIBLE FOR VITAL RECORDS 3290 02:34:40,880 --> 02:34:43,240 AND REPORT TO THE NATION ONLY ON 3291 02:34:43,240 --> 02:34:46,720 REQUEST. 3292 02:34:46,720 --> 02:34:50,000 THE NATION CAN REQUEST QUALITY 3293 02:34:50,000 --> 02:34:51,200 BY INCREASING THE FINANCIAL 3294 02:34:51,200 --> 02:34:55,920 SUPPORT TO STATES WHO ARE ALSO 3295 02:34:55,920 --> 02:34:57,480 STRAPPED IN QUALITY OF THEIR 3296 02:34:57,480 --> 02:34:58,040 VITAL RECORDS COLLECTION. 3297 02:34:58,040 --> 02:35:03,120 SO THIS IS A MATTER OF FUNDS AND 3298 02:35:03,120 --> 02:35:04,920 FUNDS FOR ONGOING SURVEILLANCE 3299 02:35:04,920 --> 02:35:09,600 ARE VERY IMPORTANT. 3300 02:35:09,600 --> 02:35:12,960 IN THE LONG RUN, I BELIEVE IT 3301 02:35:12,960 --> 02:35:14,920 WOULD BE A HIGHLY HOST COST 3302 02:35:14,920 --> 02:35:16,320 EFFECTIVE WAY IN ACHIEVING 3303 02:35:16,320 --> 02:35:16,960 SYSTEMIC ACTIVITY AND THE NEED 3304 02:35:16,960 --> 02:35:22,680 IS GROWING. 3305 02:35:22,680 --> 02:35:27,080 MORE DELIVERIES ARE NOW LIVE 3306 02:35:27,080 --> 02:35:30,000 BORN. 3307 02:35:30,000 --> 02:35:32,160 IN GEORGIA, DIFFERENT REPORTS GO 3308 02:35:32,160 --> 02:35:35,200 IN THE VITAL RECORDS SYSTEM. 3309 02:35:35,200 --> 02:35:37,960 THAT MEANS PERI VIABLE BABIES 3310 02:35:37,960 --> 02:35:39,680 THAT DIE SOON AFTER BIRTH MAY BE 3311 02:35:39,680 --> 02:35:41,960 MISSED ENTIRELY BECAUSE OF THE 3312 02:35:41,960 --> 02:35:43,200 UNDERSTANDING OF WHO SHOULD 3313 02:35:43,200 --> 02:35:44,880 REPORT THEM. 3314 02:35:44,880 --> 02:35:45,960 BY REQUIRING THE SAME 3315 02:35:45,960 --> 02:35:47,880 INFORMATION FOR ALL DELIVERIES 3316 02:35:47,880 --> 02:35:52,120 AT 20 WEEKS GESTATION AND ABOVE, 3317 02:35:52,120 --> 02:35:54,880 THERE'S VITAL STATUS AT DELIVERY 3318 02:35:54,880 --> 02:35:55,840 AND PROBLEMS SUCH AS THESE COULD 3319 02:35:55,840 --> 02:36:06,080 BE MINIMIZED. 3320 02:36:07,120 --> 02:36:09,320 AND WITH RISK FACTORS FOR STILL 3321 02:36:09,320 --> 02:36:12,240 BIRTH AND KNOWN TO OCCUR MORE 3322 02:36:12,240 --> 02:36:12,760 FREQUENTLY AMONG AFRICAN 3323 02:36:12,760 --> 02:36:15,200 AMERICAN WOMEN SOME ARE GENETIC, 3324 02:36:15,200 --> 02:36:19,120 OTHER CAUSES ARE YET TO BE FULLY 3325 02:36:19,120 --> 02:36:20,360 UNDERSTOOD. 3326 02:36:20,360 --> 02:36:21,360 BETTER UNDERSTANDING WILL 3327 02:36:21,360 --> 02:36:22,880 REQUIRE A BETTER UNDERSTANDING 3328 02:36:22,880 --> 02:36:25,280 OF THE UNDERLYING CAUSES OF THE 3329 02:36:25,280 --> 02:36:30,400 CAUSES OF DEATH AND FOR THAT 3330 02:36:30,400 --> 02:36:32,880 STUDIES ARE VERY VALUABLE AS HAS 3331 02:36:32,880 --> 02:36:34,200 BEEN DEMONSTRATED THROUGH THE 3332 02:36:34,200 --> 02:36:44,120 COLLABORATIVE RESEARCH. 3333 02:36:44,120 --> 02:36:46,880 WE ARE REVIEWED THE RACIAL AND 3334 02:36:46,880 --> 02:36:49,560 ETHNIC DISPARITIES IN STILLBIRTH 3335 02:36:49,560 --> 02:36:55,240 KNOWN IN 2011 AND HERE I HAVE 3336 02:36:55,240 --> 02:36:57,360 LISTED HIGHER RISK FOR AFRICAN 3337 02:36:57,360 --> 02:37:02,440 AMERICAN WOMEN FOR SYSTEMIC 3338 02:37:02,440 --> 02:37:10,920 LUPUS AND TWIN GESTATION AND 3339 02:37:10,920 --> 02:37:13,280 SPONTANEOUS PRE TERM BIRTH. 3340 02:37:13,280 --> 02:37:16,480 AND LEAGUES USED THE FETUSES AT 3341 02:37:16,480 --> 02:37:19,160 RISK APPROACH WHICH IS SLIGHTLY 3342 02:37:19,160 --> 02:37:21,200 DIFFERENT THAN THE ODDS RATIO'S 3343 02:37:21,200 --> 02:37:25,320 APPROACH PER GESTATIONAL AGE TO 3344 02:37:25,320 --> 02:37:26,840 ESTIMATE THE RISK OF STILLBIRTH 3345 02:37:26,840 --> 02:37:30,960 AT SPECIFIC GESTATIONAL AGES AND 3346 02:37:30,960 --> 02:37:31,560 FOUND AFRICAN AMERICAN PERI 3347 02:37:31,560 --> 02:37:33,760 VIABLE DELIVERIES AND PRETERM 3348 02:37:33,760 --> 02:37:36,640 BIRTHS WERE AT HIGHER HAZARD OF 3349 02:37:36,640 --> 02:37:38,080 STILLBIRTH THAN WHITES WITH 3350 02:37:38,080 --> 02:37:39,080 HAZARD DECLINING AS FETAL AGE 3351 02:37:39,080 --> 02:37:44,720 DECREASED. 3352 02:37:44,720 --> 02:37:48,040 IN THE PAPER HAZARD RATIO WAS 3353 02:37:48,040 --> 02:37:51,040 LOWEST AT 1.57 FOR FETUSES 3354 02:37:51,040 --> 02:37:53,960 DELIVERING AT 39 TO 40 WEEKS AND 3355 02:37:53,960 --> 02:37:55,200 INCREASED WITH POST TERM 3356 02:37:55,200 --> 02:38:01,240 DELIVERIES AT 2.2 AFTER 41 3357 02:38:01,240 --> 02:38:02,840 WEEKS. 3358 02:38:02,840 --> 02:38:05,120 6 IN THE FIRST TASK FORCE WE 3359 02:38:05,120 --> 02:38:06,600 NOTED STILLBIRTH IS NOT A 3360 02:38:06,600 --> 02:38:13,920 DISEASE BUT RATHER A CONDITION. 3361 02:38:13,920 --> 02:38:15,080 SIMILAR PRE TERM DELIVERY IS NOT 3362 02:38:15,080 --> 02:38:18,000 A DISEASE BUT A CONDITION. 3363 02:38:18,000 --> 02:38:19,560 PRETERM DELIVERY AND STILLBIRTH 3364 02:38:19,560 --> 02:38:22,880 ARE HIGHLY CORRELATED AT 3365 02:38:22,880 --> 02:38:25,080 GESTATIONAL AGES BELOW 24 WEEKS 3366 02:38:25,080 --> 02:38:27,920 WHEN FEW FETUSES ARE LIVE BORN. 3367 02:38:27,920 --> 02:38:31,200 IN FACT IN THE STILLBIRTH 3368 02:38:31,200 --> 02:38:33,240 COLLABORATIVE NETWORK STUDY 3369 02:38:33,240 --> 02:38:36,120 STILLBIRTHS AT 20-24 WEEKS WERE 3370 02:38:36,120 --> 02:38:38,760 CONSIDERED TO BE CAUSED BY 3371 02:38:38,760 --> 02:38:41,520 OBSTETRIC COMPLICATIONS AND NOT 3372 02:38:41,520 --> 02:38:42,000 PREVENTIBLE. 3373 02:38:42,000 --> 02:38:45,320 AS NOTED THE COMMONALITY OF 3374 02:38:45,320 --> 02:38:48,280 INDIVIDUAL AND INTERPERSONAL 3375 02:38:48,280 --> 02:38:49,760 RISK FACTORS FOR PRE TERM BIRTH 3376 02:38:49,760 --> 02:38:52,120 AND THE MAJORITY OF EXCESS STILL 3377 02:38:52,120 --> 02:38:54,240 BIRTHS AMONG AFRICAN AMERICAN 3378 02:38:54,240 --> 02:38:55,200 PREGNANCY A STRONG ARGUMENT FOR 3379 02:38:55,200 --> 02:38:57,440 CONSIDERING THE EXTENT OF THOSE 3380 02:38:57,440 --> 02:39:04,880 RISK FACTORS AND THOSE 3381 02:39:04,880 --> 02:39:10,000 AMELIORATION AND THE FACTORS 3382 02:39:10,000 --> 02:39:10,880 AMONG AFRICAN AMERICAN PREGNANCY 3383 02:39:10,880 --> 02:39:16,800 SIMILAR. 3384 02:39:16,800 --> 02:39:17,840 FORTUNATELY, THERE'S AN EXISTING 3385 02:39:17,840 --> 02:39:19,240 MECHANISM THAT CAN BE USED FOR 3386 02:39:19,240 --> 02:39:20,360 RESEARCH FOR THE FACTORS. 3387 02:39:20,360 --> 02:39:27,200 THAT IS THE PREGNANCY RISK 3388 02:39:27,200 --> 02:39:30,560 ASSESSMENT MONITORING SYSTEM 3389 02:39:30,560 --> 02:39:34,360 WHICH ALREADY PROVIDED DATA ON 3390 02:39:34,360 --> 02:39:35,120 RESEARCH IN BIRTHS IN AFRICAN 3391 02:39:35,120 --> 02:39:36,480 AMERICAN DELIVERIES. 3392 02:39:36,480 --> 02:39:39,400 IT'S A CDC SPONSORED STATE-BASED 3393 02:39:39,400 --> 02:39:40,640 SURVEILLANCE PROGRAM THAT 3394 02:39:40,640 --> 02:39:42,600 SAMPLES WOMEN WHO HAVE RECENTLY 3395 02:39:42,600 --> 02:39:44,440 GIVEN BIRTH AND APPROACHES THEM 3396 02:39:44,440 --> 02:39:48,360 TO ASK ABOUT THEIR PRENATAL AND 3397 02:39:48,360 --> 02:39:49,440 POSTPARTUM CARE EXPERIENCES AS 3398 02:39:49,440 --> 02:39:52,880 WELL AS TO INQUIRE ABOUT OTHER 3399 02:39:52,880 --> 02:39:56,160 RISK FACTORS NOT ON THE 3400 02:39:56,160 --> 02:39:56,480 CERTIFICATE. 3401 02:39:56,480 --> 02:39:59,400 TODAY THERE'S MORE THAN 700 3402 02:39:59,400 --> 02:40:01,720 PUBLICATIONS FROM THE ONGOING 3403 02:40:01,720 --> 02:40:02,880 SYSTEM INCLUDING EXAMINATIONS OF 3404 02:40:02,880 --> 02:40:07,200 RACIAL DISPARITIES IN PRENATAL 3405 02:40:07,200 --> 02:40:08,920 CARE AND RISK FACTORS. 3406 02:40:08,920 --> 02:40:10,480 SPECIAL TOPICS ARE INCLUDED AT 3407 02:40:10,480 --> 02:40:12,680 TIMES FOR ALL STATES AND ALSO 3408 02:40:12,680 --> 02:40:15,240 STATES HAVE THE OPPORTUNITIES TO 3409 02:40:15,240 --> 02:40:17,000 ASK ADDITIONAL QUESTIONS. 3410 02:40:17,000 --> 02:40:20,920 A FEW YEARS AGO, CDC FUNDED TO 3411 02:40:20,920 --> 02:40:24,600 DO A SMALL PILOT STUDY OF WOMEN 3412 02:40:24,600 --> 02:40:28,880 IDENTIFIED THROUGH FETAL DEATH 3413 02:40:28,880 --> 02:40:30,120 CERTIFICATES TO EXPLORE WHETHER 3414 02:40:30,120 --> 02:40:33,120 THEY'D BE WILLING TO ANSWER THE 3415 02:40:33,120 --> 02:40:33,440 QUESTIONNAIRE. 3416 02:40:33,440 --> 02:40:36,360 THE ENCOURAGING FINDINGS LED TO 3417 02:40:36,360 --> 02:40:42,560 A MORE EXTENSIVE STUDY IN HUE 3418 02:40:42,560 --> 02:40:43,320 UTAH. 3419 02:40:43,320 --> 02:40:49,120 THE PLUS SIGN INCLUDES FETAL 3420 02:40:49,120 --> 02:40:55,240 DEATHS IN THE FINDING. 3421 02:40:55,240 --> 02:40:58,520 IF PRAMS WAS CONTINUED THIS WAY 3422 02:40:58,520 --> 02:41:03,200 IT WOULD PROVIDE VALUABLE 3423 02:41:03,200 --> 02:41:06,120 INFORMATION SURVEILLANCE AS WELL 3424 02:41:06,120 --> 02:41:08,520 AS RESEARCH USING LINKED 3425 02:41:08,520 --> 02:41:09,040 RECORDS. 3426 02:41:09,040 --> 02:41:11,760 I DID A QUICK SEARCH IN PUB MED 3427 02:41:11,760 --> 02:41:14,200 AND FOUND SOME STUDIES IN 3428 02:41:14,200 --> 02:41:15,480 PRETERM BIRTH AND SEVEN 3429 02:41:15,480 --> 02:41:18,280 ADDITIONAL RACIAL BIAS OR 3430 02:41:18,280 --> 02:41:19,200 DISCRIMINATION IN PRAMS. 3431 02:41:19,200 --> 02:41:20,560 AS AN EXAMPLE OF WHAT CAN BE 3432 02:41:20,560 --> 02:41:23,000 LEARNED, CONSIDER THE STUDY BY 3433 02:41:23,000 --> 02:41:26,200 KIM AND COLLEAGUES PUBLISHED IN 3434 02:41:26,200 --> 02:41:28,880 2020 IN THE ANNALS OF BEHAVIOR 3435 02:41:28,880 --> 02:41:31,200 AND MEDICINE THEY FOUND CHRONIC 3436 02:41:31,200 --> 02:41:36,160 STRESS AND RACISM MAY DEVELOP 3437 02:41:36,160 --> 02:41:37,600 ACCELERATED PRE TERM BIRTH RISK 3438 02:41:37,600 --> 02:41:38,760 AMONG MINORITY WOMEN AND 3439 02:41:38,760 --> 02:41:39,720 RECOMMENDED FUTURE RESEARCH THAT 3440 02:41:39,720 --> 02:41:43,200 WOULD INCLUDE MORE OBJECTIVE AND 3441 02:41:43,200 --> 02:41:44,560 ACCURATE CHRONIC STRESS MEASURES 3442 02:41:44,560 --> 02:41:49,120 TO ASCERTAIN THE COMPLEX 3443 02:41:49,120 --> 02:41:50,440 RELATIONSHIPS AMONG CHRONIC 3444 02:41:50,440 --> 02:41:53,080 STRESS AND RACIAL DISCRIMINATION 3445 02:41:53,080 --> 02:41:55,240 AND THE AGE WITH DIFFERENTIALS 3446 02:41:55,240 --> 02:41:56,440 IN PRE TERM BIRTH. 3447 02:41:56,440 --> 02:41:58,800 I WOULD ASKED MORE NUANCED 3448 02:41:58,800 --> 02:42:00,680 MEASURES OF RACIAL 3449 02:42:00,680 --> 02:42:03,680 DISCRIMINATION SUCH AS IF I CAN 3450 02:42:03,680 --> 02:42:07,320 TOP THIS, THE JACKSON MEASURE OF 3451 02:42:07,320 --> 02:42:08,480 GENDERED RACISM WOULD BE USEFUL 3452 02:42:08,480 --> 02:42:10,000 AND THAT'S THE DOUBLE PLUS. 3453 02:42:10,000 --> 02:42:15,800 PLEASE ALSO NOTE ON THIS SLIDE 3454 02:42:15,800 --> 02:42:19,000 THERE IS KNOWN RISK FACTORSES 3455 02:42:19,000 --> 02:42:21,440 ARE INCLUDED AND THESE INCLUDE 3456 02:42:21,440 --> 02:42:25,840 OBJECTIVE MEASURES SUCH AS THE 3457 02:42:25,840 --> 02:42:27,560 SOURCE OF FUNDING FOR MEDICAL 3458 02:42:27,560 --> 02:42:30,560 CARE, MEDICARE OR PRIVATE AND 3459 02:42:30,560 --> 02:42:32,440 ANALYSES HAVE SHOWN 3460 02:42:32,440 --> 02:42:33,800 LOW-RESOURCED WOMEN DO BETTER IN 3461 02:42:33,800 --> 02:42:36,960 PREGNANCY OUTCOMES IF THEY'RE IN 3462 02:42:36,960 --> 02:42:39,400 MEDICAID RATHER THAN PRIVATE 3463 02:42:39,400 --> 02:42:40,600 INSURANCE AND THAT MAY BE 3464 02:42:40,600 --> 02:42:48,560 RELATED TO THE KIND OF CARE T 3465 02:42:48,560 --> 02:42:51,080 RECEIVED IN PRIVATE CARE AND 3466 02:42:51,080 --> 02:42:55,160 RECALL ADVICE ABOUT CONTROLLING 3467 02:42:55,160 --> 02:42:57,000 WEIGHT, MARIJUANA USE AND 3468 02:42:57,000 --> 02:42:57,560 SMOKING. 3469 02:42:57,560 --> 02:43:00,120 I ADDED FETAL MONITORING WHICH 3470 02:43:00,120 --> 02:43:01,920 IS OF INTEREST TO THOSE WHO 3471 02:43:01,920 --> 02:43:03,960 EXPERIENCED STILLBIRTH AND 3472 02:43:03,960 --> 02:43:08,960 THERE'S A QUESTION WHETHER HER 3473 02:43:08,960 --> 02:43:10,600 PRENEATAL CARE PROVIDER ADVISED 3474 02:43:10,600 --> 02:43:13,520 HER TO COUNT KICK COUNTS. 3475 02:43:13,520 --> 02:43:15,240 HYPERTENSIVE DISORDERS OF 3476 02:43:15,240 --> 02:43:19,040 PREGNANCY ARE NOTED ON THE 3477 02:43:19,040 --> 02:43:20,360 CERTIFICATE AND USING THIS 3478 02:43:20,360 --> 02:43:21,720 INFORMATION AND STRESSFUL LIFE 3479 02:43:21,720 --> 02:43:26,520 EVENTS ERS FOUND PRETERM BIRTH 3480 02:43:26,520 --> 02:43:28,880 WAS EXPERIENCED WITH JOB LOSS, 3481 02:43:28,880 --> 02:43:31,200 PAY REDUCTION AND DIFFICULTY 3482 02:43:31,200 --> 02:43:32,000 PAYING BILLS AND STRESS. 3483 02:43:32,000 --> 02:43:34,880 AND IT INCLUDED QUESTIONS ABOUT 3484 02:43:34,880 --> 02:43:38,000 HEALTH CONDITIONS INCLUDING 3485 02:43:38,000 --> 02:43:38,440 GESTATIONAL DIABETES. 3486 02:43:38,440 --> 02:43:41,560 THIS INFORMATION IS ALSO 3487 02:43:41,560 --> 02:43:42,480 COLLECTED ON THE BIRTH 3488 02:43:42,480 --> 02:43:42,880 CERTIFICATE. 3489 02:43:42,880 --> 02:43:44,320 INVESTIGATIONS OF THE TWO 3490 02:43:44,320 --> 02:43:45,880 SOURCES HAVE BEEN INCLUDED AT 3491 02:43:45,880 --> 02:43:50,360 THE MOST ACCURATE VARIABLE AND 3492 02:43:50,360 --> 02:43:52,320 LOOK AT GESTATIONAL DIABETES AND 3493 02:43:52,320 --> 02:43:52,920 AFTER LEAF ONE OF THE TWO 3494 02:43:52,920 --> 02:44:00,640 SOURCES. 3495 02:44:00,640 --> 02:44:02,400 USING THE MEASURE THEY USED DATA 3496 02:44:02,400 --> 02:44:07,240 TO INVESTIGATE THE ASSOCIATION 3497 02:44:07,240 --> 02:44:09,680 OF GESTATIONAL DIABETES WITH A 3498 02:44:09,680 --> 02:44:10,880 REPORT OF RACIAL DISCRIMINATION 3499 02:44:10,880 --> 02:44:13,000 AMONG WOMEN IN NEW YORK CITY. 3500 02:44:13,000 --> 02:44:15,760 THEY REPORTED THAT RACIAL 3501 02:44:15,760 --> 02:44:17,480 DISCRIMINATION WAS ASSOCIATED 3502 02:44:17,480 --> 02:44:19,200 WITH A 24% INCREASE IN 3503 02:44:19,200 --> 02:44:20,440 GESTATIONAL DIABETES AFTER 3504 02:44:20,440 --> 02:44:22,920 ADJUSTING FOR ALL OTHER 3505 02:44:22,920 --> 02:44:29,200 COVARIANTS. 3506 02:44:29,200 --> 02:44:33,160 WHILE CLINICAL METHODS TO AVOID 3507 02:44:33,160 --> 02:44:35,200 EXTREME CLINICAL DELIVERY HAVE 3508 02:44:35,200 --> 02:44:37,800 BEEN FOUND AND MOUNTING EVIDENCE 3509 02:44:37,800 --> 02:44:44,840 OF RACIALLY DISCRIMINATE 3510 02:44:44,840 --> 02:44:46,000 PRACTICES MAY ARE REDUCE 3511 02:44:46,000 --> 02:44:46,880 BARRIERS FOR WOMEN AND AT THE 3512 02:44:46,880 --> 02:44:48,360 SAME TIME RESEARCH IS NEEDED 3513 02:44:48,360 --> 02:44:50,280 INTO EFFECTIVE METHODS TO 3514 02:44:50,280 --> 02:44:52,080 SUPPORT THE EMOTIONAL HEALTH OF 3515 02:44:52,080 --> 02:44:54,080 THESE WOMEN WHO ARE AT INCREASED 3516 02:44:54,080 --> 02:44:58,400 RISK OF DEPRESSION ASSOCIATED 3517 02:44:58,400 --> 02:45:01,800 WIN LIFE EVENTS AND ENGENDERED 3518 02:45:01,800 --> 02:45:02,040 RACISM. 3519 02:45:02,040 --> 02:45:05,240 NIH IS CURRENTLY SPONSORING 3520 02:45:05,240 --> 02:45:09,720 RESEARCH ON MINDFULNESS METHODS 3521 02:45:09,720 --> 02:45:12,520 AND LOOKING AT COGNITIVE 3522 02:45:12,520 --> 02:45:15,240 BEHAVIORAL THERAPY FOR 3523 02:45:15,240 --> 02:45:15,880 DEPRESSION PREVENTION AMONG HIGH 3524 02:45:15,880 --> 02:45:17,120 HISPANIC PREGNANT WOMEN IN UTAH. 3525 02:45:17,120 --> 02:45:20,640 I'M NOT AWARE OF ANY SUCH 3526 02:45:20,640 --> 02:45:22,880 CURRENT PROJECT FOCUS ON AFRICAN 3527 02:45:22,880 --> 02:45:27,240 AMERICAN WOMEN. 3528 02:45:27,240 --> 02:45:34,080 AT THE FIRST TASK FORCE MEETING 3529 02:45:34,080 --> 02:45:35,680 THERE RESEARCH MENTIONED IN 3530 02:45:35,680 --> 02:45:40,720 AUSTRALIA AND THE UNITED 3531 02:45:40,720 --> 02:45:40,960 KINGDOM. 3532 02:45:40,960 --> 02:45:42,600 AND CONDUCT CLINICAL HEALTH 3533 02:45:42,600 --> 02:45:43,720 SERVICES RESEARCH MAY BE AN 3534 02:45:43,720 --> 02:45:44,400 OPTION TO CONSIDER. 3535 02:45:44,400 --> 02:45:50,040 IF SUCH A STURDY IS UNDERTAKEN T 3536 02:45:50,040 --> 02:45:56,800 CAN BE TAKEN WITH A SAMPLE OF 3537 02:45:56,800 --> 02:45:58,880 THOSE EXPERIENCING DEATH AND 3538 02:45:58,880 --> 02:46:00,600 ASKING ABOUT THOSE AND WOMEN 3539 02:46:00,600 --> 02:46:03,760 WITH LIVE BIRTH WOULD ALSO BE 3540 02:46:03,760 --> 02:46:06,360 ASKED AND THE RISK REDUCTION 3541 02:46:06,360 --> 02:46:10,720 THEREFORE COULD BE ESTIMATED. 3542 02:46:10,720 --> 02:46:13,600 THE OUTCOME MEASURE COULD BE 3543 02:46:13,600 --> 02:46:16,000 EMOTIONAL STATUS AT THE TIME OF 3544 02:46:16,000 --> 02:46:16,800 THE POSTPARTUM INTERVIEW. 3545 02:46:16,800 --> 02:46:19,280 THIS TYPE OF STUDY IS ANALOGOUS 3546 02:46:19,280 --> 02:46:26,200 TO ONE CONDUCTED TO EVALUATE 3547 02:46:26,200 --> 02:46:35,600 BREAST FEEDING PRACTICES. 3548 02:46:35,600 --> 02:46:37,560 BREAST FEEDING WAS HIGHER FOR 3549 02:46:37,560 --> 02:46:40,280 THE WOMEN WHO HAD DELIVERED IN 3550 02:46:40,280 --> 02:46:41,080 BABY-FRIENDLY HOSPITALS BUT MANY 3551 02:46:41,080 --> 02:46:41,760 COMPONENTS OF THE BUNDLE WERE 3552 02:46:41,760 --> 02:46:44,920 MISSING. 3553 02:46:44,920 --> 02:46:48,520 THEY RECOMMENDED THE HOSPITALS 3554 02:46:48,520 --> 02:46:49,520 BE MONITORED AS GREATER 3555 02:46:49,520 --> 02:46:51,680 COMPLIANCE WITH A LARGER IMPACT 3556 02:46:51,680 --> 02:46:53,240 ON BREAST FEEDING RATES AND 3557 02:46:53,240 --> 02:46:57,480 POTENTIALLY REDUCE SOCIO 3558 02:46:57,480 --> 02:46:58,920 ECONOMIC DISPARITIES IN BREAST 3559 02:46:58,920 --> 02:47:03,600 FEEDING. 3560 02:47:03,600 --> 02:47:07,240 WITH TO TREATMENT AND MOTHERS, 3561 02:47:07,240 --> 02:47:11,360 THERE'S BEEN A GROUP OF FORMER 3562 02:47:11,360 --> 02:47:13,080 STILLBIRTH COLLABORATIVE 3563 02:47:13,080 --> 02:47:14,040 INVESTIGATORS IN ANALYZING SWIM 3564 02:47:14,040 --> 02:47:16,920 FROM THE STUDY WHO AGREED TO BE 3565 02:47:16,920 --> 02:47:18,960 FOLLOWED AND LATER INTERVIEWED 3566 02:47:18,960 --> 02:47:19,760 BY SCREENING STAFF. 3567 02:47:19,760 --> 02:47:23,560 WE'VE PREVIOUSLY REPORTED ON THE 3568 02:47:23,560 --> 02:47:24,560 SYMPTOMS THAT WERE PRESENT AT 3569 02:47:24,560 --> 02:47:26,720 THE TIME OF FOLLOW-UP WHICH WAS 3570 02:47:26,720 --> 02:47:29,040 FROM SIX MONTHS TO 36 MONTHS 3571 02:47:29,040 --> 02:47:30,440 AFTER THEIR LOSS. 3572 02:47:30,440 --> 02:47:34,880 MORE RECENTLY, WE EXPLORED THE 3573 02:47:34,880 --> 02:47:36,280 DISTRIBUTION OF SELF-IDENTIFIED 3574 02:47:36,280 --> 02:47:38,080 STRESS IN THE COHORT OF WOMEN 3575 02:47:38,080 --> 02:47:40,440 WHO EXPERIENCED A PERINATAL LOSS 3576 02:47:40,440 --> 02:47:42,640 COMPARED WITH THE COHORT OF 3577 02:47:42,640 --> 02:47:44,200 WOMEN WITH A SURVIVING LIVE 3578 02:47:44,200 --> 02:47:44,440 BIRTH. 3579 02:47:44,440 --> 02:47:46,920 ABOUT TWO-THIRDS OF WOMEN WHO 3580 02:47:46,920 --> 02:47:47,480 EXPERIENCED A STILLBIRTH 3581 02:47:47,480 --> 02:47:50,520 INDICATE THE LOSS WAS THEIR MOST 3582 02:47:50,520 --> 02:48:00,120 STRESSFUL LIFE EVENT. 3583 02:48:00,120 --> 02:48:01,680 RECORDING MALTREATMENT WAS 3584 02:48:01,680 --> 02:48:04,880 ASSOCIATED WITH LOWER RISK AS 3585 02:48:04,880 --> 02:48:07,240 IDENTIFYING THE MOST STRESSFUL 3586 02:48:07,240 --> 02:48:17,520 LIFE EVENT AFTER ADJUSTING FOR 3587 02:48:17,800 --> 02:48:19,840 COVARIATES AND THIS IS IN EFFORT 3588 02:48:19,840 --> 02:48:21,720 TO HELP WOMEN COPE WITH THE 3589 02:48:21,720 --> 02:48:21,960 STRESS. 3590 02:48:21,960 --> 02:48:27,480 OUR CURRENT WORK IS FOCUSSED ON 3591 02:48:27,480 --> 02:48:30,200 COPING STRATEGIES FOR WOMEN 3592 02:48:30,200 --> 02:48:32,280 EXPERIENCING STILLBIRTH OR 3593 02:48:32,280 --> 02:48:33,840 PERINATAL LOSS. 3594 02:48:33,840 --> 02:48:37,200 1 IN 6 WOMEN RECEIVED KNOW 3595 02:48:37,200 --> 02:48:38,560 SUPPORT AND AMONG THOSE WHO WERE 3596 02:48:38,560 --> 02:48:40,880 SUPPORTED, WE FOUND A DIVERSITY 3597 02:48:40,880 --> 02:48:44,320 OF COPING MECHANISMS WITH A 3598 02:48:44,320 --> 02:48:45,600 BROAD DIVERSITY OF EXPERIENCE 3599 02:48:45,600 --> 02:48:50,560 POTENTIALLY BASED ON THE 3600 02:48:50,560 --> 02:48:55,200 RESOURCES AVAILABLE TO THEM AS 3601 02:48:55,200 --> 02:48:56,400 WELL AS CULTURAL EXPERIENCES AND 3602 02:48:56,400 --> 02:48:58,920 AS APPROACHES DEVELOP, TAKING 3603 02:48:58,920 --> 02:49:00,160 THIS DIVERSITY INTO ACCOUNT WILL 3604 02:49:00,160 --> 02:49:03,200 BE HELPFUL PARTICULARLY FOR 3605 02:49:03,200 --> 02:49:06,080 AFRICAN AMERICAN WOMEN WHO ALONG 3606 02:49:06,080 --> 02:49:08,760 WITH HISPANIC RESPONDENTS WERE 3607 02:49:08,760 --> 02:49:10,920 MORE LIKELY TO RECOMMEND PRAYER 3608 02:49:10,920 --> 02:49:11,440 OR OTHER SPIRITUAL COPING 3609 02:49:11,440 --> 02:49:21,600 METHODS. 3610 02:49:23,600 --> 02:49:33,520 STILLBIRTH RISK IS ABOUT TWICE 3611 02:49:33,520 --> 02:49:34,200 THE RISK OF STILLBIRTH IN THE 3612 02:49:34,200 --> 02:49:36,800 FIRST PREGNANCY. 3613 02:49:36,800 --> 02:49:37,840 AMONG AFRICAN AMERICAN WOMEN, 3614 02:49:37,840 --> 02:49:40,080 STILLBIRTH RECURRENCE IS MORE 3615 02:49:40,080 --> 02:49:41,120 LIKELY THAN AMONG WHILE THE 3616 02:49:41,120 --> 02:49:41,400 WOMEN. 3617 02:49:41,400 --> 02:49:43,560 IN THE SCREEN STUDY, WE FOUND 3618 02:49:43,560 --> 02:49:46,200 ABOUT ONE-FIFTH OF THE 3619 02:49:46,200 --> 02:49:47,240 ASSOCIATION OF THIS REOCCURRENCE 3620 02:49:47,240 --> 02:49:50,480 RISK MAY BE ATTRIBUTABLE TO A 3621 02:49:50,480 --> 02:49:52,240 SHORT INTERPREGNANCY INTERVAL OF 3622 02:49:52,240 --> 02:49:53,720 SIX MONTHS OR LESS BETWEEN THE 3623 02:49:53,720 --> 02:49:55,080 LOSS AND THE CONCEPTION OF THE 3624 02:49:55,080 --> 02:49:57,640 NEXT PREGNANCY. 3625 02:49:57,640 --> 02:50:00,000 THE EVIDENCE FOR INCREASED RISK 3626 02:50:00,000 --> 02:50:01,960 OF ADVERSE PREGNANCY OUTCOMES 3627 02:50:01,960 --> 02:50:05,120 WITH A SHORT INTERVAL IS 3628 02:50:05,120 --> 02:50:05,880 EXTENS 3629 02:50:05,880 --> 02:50:06,160 EXTENSIVE. 3630 02:50:06,160 --> 02:50:07,800 DESPITE THIS IN A NATIONAL 3631 02:50:07,800 --> 02:50:10,000 SURVEY OF OBSTETRICIANS, 3632 02:50:10,000 --> 02:50:12,040 TWO-THIRDS ENDORSED A WAITING 3633 02:50:12,040 --> 02:50:13,840 TIME IN THE HIGH-RISK PERIOD OF 3634 02:50:13,840 --> 02:50:15,760 LESS THAN SIX MONTHS FOR PARENTS 3635 02:50:15,760 --> 02:50:19,720 WHO HAD EXPERIENCED A 3636 02:50:19,720 --> 02:50:20,040 STILLBIRTH. 3637 02:50:20,040 --> 02:50:23,880 MORE RESEARCH IS NEEDED FOR 3638 02:50:23,880 --> 02:50:24,880 EFFECTIVE CLINICAL EDUCATION. 3639 02:50:24,880 --> 02:50:26,720 WITH RESPECT TO THE FINAL ISSUE 3640 02:50:26,720 --> 02:50:29,160 ON THE SLIDE, I MENTIONED 3641 02:50:29,160 --> 02:50:30,640 ONGOING RESEARCH INTO 3642 02:50:30,640 --> 02:50:31,320 MINDFULNESS-BASED THERAPIES. 3643 02:50:31,320 --> 02:50:33,520 THIS COULD BE ONE APPROACH TO 3644 02:50:33,520 --> 02:50:38,600 RESEARCH FOR WOMEN WHO 3645 02:50:38,600 --> 02:50:39,120 EXPERIENCED STILLBIRTH. 3646 02:50:39,120 --> 02:50:45,000 THIS IS THEN OF MY FORMAL AL 3647 02:50:45,000 --> 02:50:48,040 REMARKS AND LOOK FORWARD TO THE 3648 02:50:48,040 --> 02:50:49,720 DISCUSSION AT THEN OF THIS 3649 02:50:49,720 --> 02:50:50,040 SESSION. 3650 02:50:50,040 --> 02:50:56,200 >>THANK YOU, DR. HOGUE FOR THE 3651 02:50:56,200 --> 02:51:00,160 PRESENTATION AND ANSWERING 3652 02:51:00,160 --> 02:51:01,440 RESEARCH QUESTIONS BASED ON OUR 3653 02:51:01,440 --> 02:51:02,000 FIRST MEETING. 3654 02:51:02,000 --> 02:51:04,120 I APPRECIATE THAT. 3655 02:51:04,120 --> 02:51:08,960 NOW WE'LL GO TO DR. MICHELLE 3656 02:51:08,960 --> 02:51:10,920 DEBBINK ASSIST PROFESSOR OF 3657 02:51:10,920 --> 02:51:12,400 GYNECOLOGY AND MATERNAL FETAL 3658 02:51:12,400 --> 02:51:14,000 MEDICINE AT THE UNIVERSITY OF 3659 02:51:14,000 --> 02:51:15,200 UTAH. 3660 02:51:15,200 --> 02:51:18,440 SHE'S GOING TO TALK ABOUT 3661 02:51:18,440 --> 02:51:20,320 EPIDEMIOLOGY AND DATA TO 3662 02:51:20,320 --> 02:51:22,160 UNDERSTAND RACIAL AND ETHNIC 3663 02:51:22,160 --> 02:51:22,920 INEQUALITIES IN STILLBIRTH. 3664 02:51:22,920 --> 02:51:26,040 THANK YOU. 3665 02:51:26,040 --> 02:51:27,240 >>THANK YOU FOR THE 3666 02:51:27,240 --> 02:51:27,560 INTRODUCTION. 3667 02:51:27,560 --> 02:51:28,920 THANK YOU ALL FOR HAVING ME 3668 02:51:28,920 --> 02:51:29,880 TODAY. 3669 02:51:29,880 --> 02:51:32,200 I'M REALLY HONORED AND 3670 02:51:32,200 --> 02:51:32,840 PRIVILEGED TO BE ABLE TO SHARE 3671 02:51:32,840 --> 02:51:36,360 SOME OF DATA WITH YOU ALL. 3672 02:51:36,360 --> 02:51:38,400 I HOPE THAT THEY PROVIDE SOME 3673 02:51:38,400 --> 02:51:39,240 ADDITIONAL RICHNESS TO THE 3674 02:51:39,240 --> 02:51:42,560 CONVERSATION TO COME. 3675 02:51:42,560 --> 02:51:44,800 AS DR. LONGO SAID I'LL BE 3676 02:51:44,800 --> 02:51:48,160 SPEAKING ABOUT A MIXED METHODS 3677 02:51:48,160 --> 02:51:57,680 APPROACH, EPIDEMIOLOGIC AND 3678 02:51:57,680 --> 02:52:00,240 QUANTITATIVE DATA IN LOOKING AT 3679 02:52:00,240 --> 02:52:01,080 MARGINALIZED COMMUNITIES IN 3680 02:52:01,080 --> 02:52:01,280 UTAH. 3681 02:52:01,280 --> 02:52:03,720 I HAVE NO CONFLICTS OF INTEREST 3682 02:52:03,720 --> 02:52:05,480 TO DISCLOSE WITH THE 3683 02:52:05,480 --> 02:52:07,240 PRESENTATION BUT I CURRENTLY 3684 02:52:07,240 --> 02:52:09,280 RECEIVE SALARY SUPPORT FROM THE 3685 02:52:09,280 --> 02:52:14,760 MARCH OF DIMES AS PART OF THE 3686 02:52:14,760 --> 02:52:22,240 REPRODUCTION DEVELOPMENTALIST 3687 02:52:22,240 --> 02:52:23,800 PROGRAM AND PART OF THE U-CARES 3688 02:52:23,800 --> 02:52:24,000 GRANT. 3689 02:52:24,000 --> 02:52:26,360 THE OBJECTIVES KNOWING THE 3690 02:52:26,360 --> 02:52:28,280 AUDIENCE IS BROAD TO TALK A 3691 02:52:28,280 --> 02:52:30,960 LITTLE BIT ABOUT STRUCTURAL 3692 02:52:30,960 --> 02:52:33,960 MODELS OF HEALTH INEQUITY TO 3693 02:52:33,960 --> 02:52:37,640 IDENTIFY INEQUITY IN STILLBIRTH 3694 02:52:37,640 --> 02:52:39,480 AND PREGNANCY LOSS AND TO 3695 02:52:39,480 --> 02:52:42,040 CONNECT WITH STORIES OF MOTHERS 3696 02:52:42,040 --> 02:52:45,360 AND ATTEMPT TO INTEGRATE THE 3697 02:52:45,360 --> 02:52:46,160 EPIDEMIOLOGIC AND QUALITATIVE 3698 02:52:46,160 --> 02:52:49,160 DATA TO BEGIN TO UNDERSTAND THE 3699 02:52:49,160 --> 02:52:51,200 SCOPE OF ADDRESSING STILLBIRTH 3700 02:52:51,200 --> 02:52:55,000 AND PREGNANCY LOSS IN UTAH. 3701 02:52:55,000 --> 02:53:01,360 SOME MAY BE FAMILIAR WITH THE 3702 02:53:01,360 --> 02:53:03,240 PUBLIC HEALTH PARABLE AND THE 3703 02:53:03,240 --> 02:53:04,240 IDEA OF THE PUBLIC HEALTH 3704 02:53:04,240 --> 02:53:05,840 PARABLE IS TAKING CARE OF PEOPLE 3705 02:53:05,840 --> 02:53:10,240 AND UNDERSTANDING RISK FOR 3706 02:53:10,240 --> 02:53:14,280 ADVERSE HEALTH OUTCOMES OCCURS 3707 02:53:14,280 --> 02:53:16,920 ALONG A SPECTRUM OF A RIVER WITH 3708 02:53:16,920 --> 02:53:21,560 A WATER FALL AT THE END 3709 02:53:21,560 --> 02:53:21,920 METAPHORICALLY. 3710 02:53:21,920 --> 02:53:24,040 ON ONE END OF THIS RIVER WHERE 3711 02:53:24,040 --> 02:53:27,160 THE WHITE ARROW IS YOU HAVE 3712 02:53:27,160 --> 02:53:28,400 INDIVIDUALS WHO ARE ON THE FRONT 3713 02:53:28,400 --> 02:53:29,840 LINES TAKING CARE OF PATIENTS 3714 02:53:29,840 --> 02:53:40,400 WHO ARE IMPACTED BY WE LOOK AT 3715 02:53:47,200 --> 02:53:50,680 INDIVIDUAL WHO'S ARE STANDING AT 3716 02:53:50,680 --> 02:53:52,120 EDGE OF THE WATER FALL AND 3717 02:53:52,120 --> 02:53:53,840 TRYING TO PUT TOGETHER KAYAKS 3718 02:53:53,840 --> 02:53:55,960 AND LIFE VESTS AND WAYS TO 3719 02:53:55,960 --> 02:53:56,760 HELPFUL PEOPLE OUT OF THE RIVER 3720 02:53:56,760 --> 02:54:00,560 BEFORE THEY GO OVER THE WATER 3721 02:54:00,560 --> 02:54:02,040 FALL AND EXPERIENCE THE ADVERSE 3722 02:54:02,040 --> 02:54:04,640 HEALTH OUTCOME WE'RE TRYING TO 3723 02:54:04,640 --> 02:54:05,160 PREV 3724 02:54:05,160 --> 02:54:09,040 PREVENT. 3725 02:54:09,040 --> 02:54:16,240 THINKING HOW DO WE AND WORK WITH 3726 02:54:16,240 --> 02:54:19,280 MOTHERS WHO MAY BE AT RISK OF 3727 02:54:19,280 --> 02:54:20,600 PREGNANCY LOSS AND TRYING TO 3728 02:54:20,600 --> 02:54:23,320 PREVENT THEM FROM GOING OVER THE 3729 02:54:23,320 --> 02:54:28,440 WATER FALL AND LOOKING AT 3730 02:54:28,440 --> 02:54:29,560 INDIVIDUALS AND SURVEIL PEOPLE 3731 02:54:29,560 --> 02:54:31,200 WE FEEL ARE AT HIGH RISK FOR 3732 02:54:31,200 --> 02:54:41,640 GOING OVER THE WATER FALL. 3733 02:54:42,280 --> 02:54:44,640 AND WE KNOW PEOPLE ENDS UP AT 3734 02:54:44,640 --> 02:54:46,640 THE WATER FULL AT 3735 02:54:46,640 --> 02:54:47,480 DISPROPORTIONATE RATES AND 3736 02:54:47,480 --> 02:54:49,360 PREGNANT PEOPLE FROM 3737 02:54:49,360 --> 02:54:51,920 HISTORICALLY AND STRUCTURALLY 3738 02:54:51,920 --> 02:54:52,920 MARGINALIZED ETHNIC BACKGROUNDS 3739 02:54:52,920 --> 02:54:56,560 END UP AT THE PRECIPICE OF 3740 02:54:56,560 --> 02:54:58,600 ADVERSE OUTCOMES WITH AN 3741 02:54:58,600 --> 02:55:01,960 INCREASED FREQUENCY COMPARED TO 3742 02:55:01,960 --> 02:55:03,760 FOLKS FROM MORE PRIVILEGED 3743 02:55:03,760 --> 02:55:04,520 BACKGROUNDS. 3744 02:55:04,520 --> 02:55:07,720 THE QUESTIONS WE MAY ASK 3745 02:55:07,720 --> 02:55:12,800 OURSELVES UP STREAM OR UP RIVER 3746 02:55:12,800 --> 02:55:14,840 IS HOW ARE PEOPLE ENDING UP IN 3747 02:55:14,840 --> 02:55:16,920 THE RIVER AND AT THE PRECIPICE 3748 02:55:16,920 --> 02:55:18,360 OF THE WATER FALL? 3749 02:55:18,360 --> 02:55:21,120 IN OTHER WORDS, WHAT PUTS 3750 02:55:21,120 --> 02:55:27,520 PEOPLE AT RISK OF RISK. 3751 02:55:27,520 --> 02:55:28,920 THAT'S WHEN WE START TO ASK 3752 02:55:28,920 --> 02:55:36,120 BIGGER STRUCTURAL QUESTIONS. 3753 02:55:36,120 --> 02:55:40,720 THINKING OF MODELS OF STRUCTURAL 3754 02:55:40,720 --> 02:55:42,960 CAUSE OF HEALTH INEQUITY THIS 3755 02:55:42,960 --> 02:55:44,840 TAKES INTO ACCOUNT THE LIFE 3756 02:55:44,840 --> 02:55:47,600 COURSE OF PREGNANT AND 3757 02:55:47,600 --> 02:55:49,840 POSTPARTUM PEOPLE AND DEVELOPED 3758 02:55:49,840 --> 02:55:51,240 TO DISCUSS MATERNAL MORBIDITY 3759 02:55:51,240 --> 02:55:55,240 AND MORTALITY AND APPLICABLE TO 3760 02:55:55,240 --> 02:55:58,120 ADVERSE PREGNANCY OUTCOMES. 3761 02:55:58,120 --> 02:56:00,520 THE MODEL WORKS IN THIS WAY THE 3762 02:56:00,520 --> 02:56:06,120 SMALL BLUE DOT IN THE CENTER IS 3763 02:56:06,120 --> 02:56:08,040 A SINGLE PERSON CAPABLE OF 3764 02:56:08,040 --> 02:56:10,000 PREGNANCY AND GOING THROUGH 3765 02:56:10,000 --> 02:56:12,360 THEIR LIFE WHICH IS THE LIGHT 3766 02:56:12,360 --> 02:56:16,920 GREEN ORBIT THERE AND GOING 3767 02:56:16,920 --> 02:56:19,800 THROUGH THEIR LIFE THE 3768 02:56:19,800 --> 02:56:22,840 PREREPRODUCTIVE LIFE CYCLE AND 3769 02:56:22,840 --> 02:56:26,560 THROUGH THE POSTPARTUM PERIOD 3770 02:56:26,560 --> 02:56:27,240 AND YOU'LL NOTICE AS YOU COME 3771 02:56:27,240 --> 02:56:29,120 AROUND THE ORBIT OF THIS 3772 02:56:29,120 --> 02:56:32,680 PERSON'S LIFE WE HAVE THIS PINK 3773 02:56:32,680 --> 02:56:37,840 BOX HERE AND THE PINK BOX 3774 02:56:37,840 --> 02:56:42,280 CONTAINS HEALTH CONDITIONS, 3775 02:56:42,280 --> 02:56:45,640 THINGS WE THINK ABOUT WHEN 3776 02:56:45,640 --> 02:56:47,800 SOMEONE WALKS THROUGH THE DOORS 3777 02:56:47,800 --> 02:56:49,360 OF A CLINIC AND HOSPITAL AND HAS 3778 02:56:49,360 --> 02:56:52,880 WHAT WE ASCERTAIN TO BE HIGHER 3779 02:56:52,880 --> 02:56:55,280 RISK FOR PREGNANCY LOSS OR A 3780 02:56:55,280 --> 02:56:58,920 STILLBIRTH AND FOR THE VAST 3781 02:56:58,920 --> 02:57:00,440 MAJORITY OF THE TIME FOLKS IN 3782 02:57:00,440 --> 02:57:01,680 CLINICAL SPACES FOCUS ON WHAT'S 3783 02:57:01,680 --> 02:57:03,680 IN THAT PINK BOX AND HOW DO WE 3784 02:57:03,680 --> 02:57:06,040 TRY TO REDUCE THE LIKELIHOOD 3785 02:57:06,040 --> 02:57:08,040 SOMEONE FALLS OVER THE WATER 3786 02:57:08,040 --> 02:57:09,520 FALL AND EXPERIENCES A 3787 02:57:09,520 --> 02:57:15,320 STILLBIRTH OR PREGNANCY LOSS. 3788 02:57:15,320 --> 02:57:22,400 I ARGUE IF WE TAKE THE UPSTREAM 3789 02:57:22,400 --> 02:57:23,400 ATTENTION YOU'LL SEE NOT ONLY IS 3790 02:57:23,400 --> 02:57:25,520 IT SHOWING THE SINGLE DOT OF AN 3791 02:57:25,520 --> 02:57:30,760 INDIVIDUAL IN THE ORBIT OF THEIR 3792 02:57:30,760 --> 02:57:33,440 LIFE BUT THE CONCENTRIC CIRCLES 3793 02:57:33,440 --> 02:57:40,840 OF INFLUENCE ON THEIR LIFE. 3794 02:57:40,840 --> 02:57:43,920 AND IT GOES TO THE FACTORS THAT 3795 02:57:43,920 --> 02:57:45,600 CAN CREATE THE RISK OF RISK. 3796 02:57:45,600 --> 02:57:46,800 THE WAYS PEOPLE GET THROWN INTO 3797 02:57:46,800 --> 02:57:51,960 THE RIVER IN THE FIRST PLACE. 3798 02:57:51,960 --> 02:57:53,640 YOU'LL SEE THE RINGS OF 3799 02:57:53,640 --> 02:57:55,120 INFLUENCE MAY GO FROM HEALTH 3800 02:57:55,120 --> 02:57:59,040 STATUS, FAMILY AND INTERPERSONAL 3801 02:57:59,040 --> 02:58:00,400 RELATIONSHIPS, PERSONAL 3802 02:58:00,400 --> 02:58:01,840 CHARACTERISTICS AND BELIEVES ALL 3803 02:58:01,840 --> 02:58:04,680 THE WAY TO OUT TO PREEXISTING 3804 02:58:04,680 --> 02:58:07,320 SOCIO ECONOMIC STATUS, ACCESS TO 3805 02:58:07,320 --> 02:58:08,320 CERTAIN HEALTH SYSTEMS AND QUAT 3806 02:58:08,320 --> 02:58:10,680 OF CARE AND LAWS AND POLICIES. 3807 02:58:10,680 --> 02:58:15,560 AND I WOULD ARGUE THERE'S ONE 3808 02:58:15,560 --> 02:58:21,480 LEVEL ABOVE THESE IN THE PURPLE 3809 02:58:21,480 --> 02:58:24,440 BOX AND THEY ARE THE STRUCTURAL 3810 02:58:24,440 --> 02:58:26,560 SYSTEMS THAT DIFFERENTIALLY 3811 02:58:26,560 --> 02:58:27,280 DISTRIBUTE ACCESS TO THE THINGS 3812 02:58:27,280 --> 02:58:29,360 IN THE PURPLE BOX AND THOSE ARE 3813 02:58:29,360 --> 02:58:34,640 THINGS LIKE STRUCTURAL RACISM, 3814 02:58:34,640 --> 02:58:37,520 STRUCTURAL REPRESSION AND 3815 02:58:37,520 --> 02:58:39,160 STRUCTURAL DISTRIBUTION OF 3816 02:58:39,160 --> 02:58:41,280 ACCESS BY SOCIO ECONOMIC STATUS. 3817 02:58:41,280 --> 02:58:47,960 SO EVEN ACCESS TO THE LARGER 3818 02:58:47,960 --> 02:58:49,160 FACTORS IN THE PURPLE BOX ARE 3819 02:58:49,160 --> 02:58:51,800 SHAPED BY STRUCTURAL FACTORS 3820 02:58:51,800 --> 02:58:57,480 SUCH AS STRUCTURAL RACISM AND 3821 02:58:57,480 --> 02:58:58,680 INSTITUTIONAL RACISM. 3822 02:58:58,680 --> 02:59:02,400 WHEN WE THINK OF INEQUITIES IN 3823 02:59:02,400 --> 02:59:02,960 STILLBIRTH IN PARTICULAR 3824 02:59:02,960 --> 02:59:06,200 DR. HOGUE AND SILVER PUBLISHED 3825 02:59:06,200 --> 02:59:10,960 THIS FRAMEWORK IN 2011. 3826 02:59:10,960 --> 02:59:14,080 I WANT TO FOCUS ON THE LEST SIDE 3827 02:59:14,080 --> 02:59:17,280 OF THE FIGURE BECAUSE THAT'S THE 3828 02:59:17,280 --> 02:59:19,160 UPSTREAM STRUCTURAL FACTOR. 3829 02:59:19,160 --> 02:59:20,280 THIS IS THE LEVEL OF THE PURPLE 3830 02:59:20,280 --> 02:59:22,600 BOX AND ABOVE THAT I WAS TALKING 3831 02:59:22,600 --> 02:59:27,200 ABOUT ON THE PREVIOUS SLIDE 3832 02:59:27,200 --> 02:59:29,440 WHICH IS INDIVIDUALS WHO OTHERS 3833 02:59:29,440 --> 02:59:33,560 PERCEIVE TO HAVE AN ETHNIC 3834 02:59:33,560 --> 02:59:36,440 IDENTIFY MAY EXPERIENCE 3835 02:59:36,440 --> 02:59:38,480 INTERPERSONAL RACISM AND 3836 02:59:38,480 --> 02:59:42,920 INSTITUTIONALIZED RACISM AND THE 3837 02:59:42,920 --> 02:59:45,640 INTERPERSONAL EXPERIENCES CAN 3838 02:59:45,640 --> 02:59:56,040 DIFFERENTLY DISTRIBUTE 3839 03:00:01,480 --> 03:00:04,280 OPPORTUNITIES AND FOR WEALTH 3840 03:00:04,280 --> 03:00:06,760 ACCUMULATION AND THAT PLAYS INTO 3841 03:00:06,760 --> 03:00:11,200 THE RISK FOR STILLBIRTH DOWN 3842 03:00:11,200 --> 03:00:12,680 STREAM. 3843 03:00:12,680 --> 03:00:13,920 TO BETTER UNDERSTAND WHAT'S 3844 03:00:13,920 --> 03:00:18,560 HAPPENING IN A CONCRETE WAY, 3845 03:00:18,560 --> 03:00:21,680 WE'RE ARE GOING TO DIVE IN THE 3846 03:00:21,680 --> 03:00:22,480 EPIDEMIOLOGIC DATA. 3847 03:00:22,480 --> 03:00:25,960 THE DATA COMES FROM UTAH'S VITAL 3848 03:00:25,960 --> 03:00:30,240 RECORDS DATA FROM 2013 TO 2019 3849 03:00:30,240 --> 03:00:35,600 USING FETAL DEATH AND BIRTH 3850 03:00:35,600 --> 03:00:39,200 CERTIFICATES ONWARD AND IT 3851 03:00:39,200 --> 03:00:41,080 PROVIDES MORE RELIABLE RACE AND 3852 03:00:41,080 --> 03:00:45,680 ETHNICITY DATA AND PRIOR TO 2013 3853 03:00:45,680 --> 03:00:55,240 THE DATA'S SOMEWHAT UNLIABLE AND 3854 03:00:55,240 --> 03:00:57,680 WE MODELLED OUR GROUPS ON NIH 3855 03:00:57,680 --> 03:00:57,960 CATEGORIES. 3856 03:00:57,960 --> 03:01:02,000 I THINK THERE'S IMPORTANT 3857 03:01:02,000 --> 03:01:04,120 CAVEATS WITH NIH CATEGORIES IN 3858 03:01:04,120 --> 03:01:07,200 TERMS OF MULTI-RACIAL 3859 03:01:07,200 --> 03:01:08,160 INDIVIDUALS AND AMERICAN INDIAN 3860 03:01:08,160 --> 03:01:10,400 AND ALASKAN NATIVE INDIVIDUALS 3861 03:01:10,400 --> 03:01:11,040 PARTICULARLY IN THE SOUTHWEST 3862 03:01:11,040 --> 03:01:17,320 AND INTERMOUNTAIN WEST. 3863 03:01:17,320 --> 03:01:19,800 FOR THOSE WHO IDENTIFY AS 3864 03:01:19,800 --> 03:01:21,000 MULTIRACIAL THERE'S A SEPARATE 3865 03:01:21,000 --> 03:01:23,400 BUCKET AND THE EXPERIENCE IN 3866 03:01:23,400 --> 03:01:24,440 TERMS OF THE WAYS PEOPLE PRESENT 3867 03:01:24,440 --> 03:01:27,880 IN THE WORLD AND THEIR CULTURAL 3868 03:01:27,880 --> 03:01:29,080 BACKGROUNDS AND THEIR EXPERIENCE 3869 03:01:29,080 --> 03:01:31,240 OF STRUCTURAL AND INTERPERSONAL 3870 03:01:31,240 --> 03:01:35,760 RACISM MAY BE VERY DIFFERENT 3871 03:01:35,760 --> 03:01:40,720 FROM OTHERS WITHIN THAT SAME 3872 03:01:40,720 --> 03:01:41,160 MULTI-RACIAL CATEGORY. 3873 03:01:41,160 --> 03:01:42,280 IF YOU HAVE SOMEONE WHO FOR 3874 03:01:42,280 --> 03:01:48,160 INSTANCE IDENTIFIES AS BIRACIAL 3875 03:01:48,160 --> 03:01:50,200 AND BLACK AND WHITE BACKGROUND 3876 03:01:50,200 --> 03:01:54,520 OR PACIFIC ISLANDER AND ALSO 3877 03:01:54,520 --> 03:01:55,680 WHITE THEIR EXPERIENCE WITHIN 3878 03:01:55,680 --> 03:01:58,000 THAT CATEGORY MAY NOT BE THE 3879 03:01:58,000 --> 03:01:59,600 SAME AS SOMEONE WHO IDENTIFIES 3880 03:01:59,600 --> 03:02:02,920 AS WHITE AND JAPANESE OR OTHER 3881 03:02:02,920 --> 03:02:08,520 WAYS AND THAT CATEGORY IS 3882 03:02:08,520 --> 03:02:11,040 HETEROGENEOUS AND SOME WHO HAVE 3883 03:02:11,040 --> 03:02:15,200 EXPERIENCE WHO MIRROR AN 3884 03:02:15,200 --> 03:02:16,840 EXPERIENCE THAT'S MULTI-RACIAL 3885 03:02:16,840 --> 03:02:27,400 BUT IMPOSSIBLE TO TEASE OUT WITH 3886 03:02:28,600 --> 03:02:35,200 THIS DATA AND THE MOST OCCURRING 3887 03:02:35,200 --> 03:02:37,280 IDENTITY IS HISPANIC IDENTITY 3888 03:02:37,280 --> 03:02:41,960 AND BECAUSE OF THE CATEGORIES, 3889 03:02:41,960 --> 03:02:45,280 THAT LATINO, LATINA IS PRIVILEGE 3890 03:02:45,280 --> 03:02:47,200 OVER ALASKAN NATIVE IDENTITY SO 3891 03:02:47,200 --> 03:02:49,560 THERE'S SOME CROSSOVER THERE 3892 03:02:49,560 --> 03:02:51,320 THAT MAY BE LOST. 3893 03:02:51,320 --> 03:02:55,240 THE DATA I'LL SHOW ARE BASIC 3894 03:02:55,240 --> 03:02:59,200 DESCRIPTIVE ANALYSIS AND 3895 03:02:59,200 --> 03:03:01,120 LOGISTIC REGRESSIONS. 3896 03:03:01,120 --> 03:03:04,040 WHAT YOU SEE IS STILLBIRTH RATES 3897 03:03:04,040 --> 03:03:06,360 PER 1,000 BIRTHS FROM 2013 TO 3898 03:03:06,360 --> 03:03:10,760 2019 IN UTAH. 3899 03:03:10,760 --> 03:03:14,080 THE GREEN AND YELLOW LINES ARE 3900 03:03:14,080 --> 03:03:15,560 LINES FOR WHITE INDIVIDUALS AND 3901 03:03:15,560 --> 03:03:20,720 THE DARKER GREEN LINE AROUND SIX 3902 03:03:20,720 --> 03:03:24,840 STILLBIRTHS PER 1,000 AND THEN 3903 03:03:24,840 --> 03:03:29,240 YOU CAN SEE HISPANIC AND LATINA 3904 03:03:29,240 --> 03:03:31,400 AND THE LIGHTER GREEN AND GOLD 3905 03:03:31,400 --> 03:03:33,920 LINES LARGELY TRACK TOGETHER. 3906 03:03:33,920 --> 03:03:35,920 THE DARK PURPLE LINE AT THE TOP 3907 03:03:35,920 --> 03:03:38,400 WHICH IS ABOUT 50% SOMEWHERE 3908 03:03:38,400 --> 03:03:41,280 BETWEEN 50% HIGHER AND TWO TIMES 3909 03:03:41,280 --> 03:03:42,800 HIGHER THAN THE STILLBIRTH RATE 3910 03:03:42,800 --> 03:03:46,080 FOR OTHER GROUPS IN UTAH IS THE 3911 03:03:46,080 --> 03:03:47,800 RATE EXPERIENCED BY NATIVE 3912 03:03:47,800 --> 03:03:50,640 HAWAIIAN AND PACIFIC ISLANDER 3913 03:03:50,640 --> 03:03:56,360 AND THE DARK GREEN LINE IS THE 3914 03:03:56,360 --> 03:03:57,040 INDIVIDUALS IDENTIFIED AS BLACK 3915 03:03:57,040 --> 03:04:00,960 IN UTAH AND THAT'S ABOUT 50% 3916 03:04:00,960 --> 03:04:02,200 GREATER AND OCCASIONALLY TWO 3917 03:04:02,200 --> 03:04:04,680 TIMES AS HIGH AS THE RATES 3918 03:04:04,680 --> 03:04:07,400 EXPERIENCED BY WHITE INDIVIDUALS 3919 03:04:07,400 --> 03:04:09,840 OR THE TOTAL STILLBIRTH RATE IN 3920 03:04:09,840 --> 03:04:10,040 UTAH. 3921 03:04:10,040 --> 03:04:11,840 FINALLY, I WANTED TO DRAW 3922 03:04:11,840 --> 03:04:14,040 ATTENTION TO THE BRIGHT BLUE 3923 03:04:14,040 --> 03:04:17,400 LINE WHICH IS THE STILLBIRTH 3924 03:04:17,400 --> 03:04:20,240 RATE FOR AMERICAN INDIAN ALASKAN 3925 03:04:20,240 --> 03:04:21,640 NATIVE INDIVIDUALS AND THERE ARE 3926 03:04:21,640 --> 03:04:24,720 TWO THINGS TO DRAW ATTENTION TO. 3927 03:04:24,720 --> 03:04:27,800 ONE IS THE RATE FLUCTUATES 3928 03:04:27,800 --> 03:04:29,360 BROADLY ACROSS TIME AND PART IS 3929 03:04:29,360 --> 03:04:31,520 DUE TO NOISE IN THE DATA. 3930 03:04:31,520 --> 03:04:36,560 THE NUMBER OF INDIVIDUALS GIVING 3931 03:04:36,560 --> 03:04:41,320 BIRTH WHO IDENTIFY AMERICAN 3932 03:04:41,320 --> 03:04:42,440 INDIAN AND ALASKAN NATIVE AND 3933 03:04:42,440 --> 03:04:45,800 THEY CAN BE ALTERED BY ONE OR 3934 03:04:45,800 --> 03:04:46,560 TWO ADDITIONAL STILLBIRTHS IN 3935 03:04:46,560 --> 03:04:50,680 ANY GIVEN YEAR AND ALSO BECAUSE 3936 03:04:50,680 --> 03:04:52,640 OF VARIOUS DATA DIFFICULTIES 3937 03:04:52,640 --> 03:04:55,200 BETWEEN COLLABORATIONS BETWEEN 3938 03:04:55,200 --> 03:05:00,280 THE STATE OF UTAH AND SOVEREIGN 3939 03:05:00,280 --> 03:05:01,400 NATIONS WITHIN UTAH THERE ARE 3940 03:05:01,400 --> 03:05:02,960 DIFFICULTIES WITH MAKING SURE 3941 03:05:02,960 --> 03:05:05,360 THE DATA ASCERTAINMENT IS 3942 03:05:05,360 --> 03:05:15,240 COMPLETE. 3943 03:05:15,240 --> 03:05:19,040 WHAT WE HAVE HERE IS TRANSLATING 3944 03:05:19,040 --> 03:05:23,240 THESE LINES TO SOME NUMBERS AND 3945 03:05:23,240 --> 03:05:32,840 THE DATA INCLUDE 355,310 LIVE 3946 03:05:32,840 --> 03:05:35,200 AND STILLBIRTHS INCLUDED AND 3947 03:05:35,200 --> 03:05:39,200 AMONG NATIVE HAWAIIAN AND 3948 03:05:39,200 --> 03:05:44,800 PACIFIC ISLANDER THERE WAS AN 3949 03:05:44,800 --> 03:05:47,960 11.6 PER 1,000 STILLBIRTHS AND 3950 03:05:47,960 --> 03:05:49,760 AMONG BLACK AND AFRICAN AMERICAN 3951 03:05:49,760 --> 03:05:58,200 THERE WAS A TOTAL OF 39 AND FOR 3952 03:05:58,200 --> 03:06:01,360 LATINAS 5.39 PER 1,000 AND THE 3953 03:06:01,360 --> 03:06:04,040 AVERAGE WAS 5.2 FOR ALASKAN 3954 03:06:04,040 --> 03:06:05,920 NATIVE AND ONLY 16 STILLBIRTHS 3955 03:06:05,920 --> 03:06:07,200 OVER THE COURSE OF THAT TIME 3956 03:06:07,200 --> 03:06:09,240 PERIOD THAT CONTRIBUTES TO THAT 3957 03:06:09,240 --> 03:06:17,800 FLUCTUATION OF DATA OVER TIME. 3958 03:06:17,800 --> 03:06:21,040 THESE NUMBERS TRANSLATE TO ODDS 3959 03:06:21,040 --> 03:06:22,760 RATIOS FOR PACIFIC ISLANDER 3960 03:06:22,760 --> 03:06:25,920 INDIVIDUALS, 1.7 TIMES THE ODDS 3961 03:06:25,920 --> 03:06:28,120 FOR AFRICAN AMERICAN INDIVIDUALS 3962 03:06:28,120 --> 03:06:31,240 AND SIMILAR ODDS FOR HISPANIC 3963 03:06:31,240 --> 03:06:33,520 AND LATINA OR AMERICAN INDIAN OR 3964 03:06:33,520 --> 03:06:34,600 ALASKAN NATIVE INDIVIDUALS 3965 03:06:34,600 --> 03:06:35,520 WITHIN UTAH DURING THIS TIME 3966 03:06:35,520 --> 03:06:40,320 FRAME. 3967 03:06:40,320 --> 03:06:42,960 WHEN WE'RE THINKING OF DRAWING 3968 03:06:42,960 --> 03:06:46,160 ATTENTION TO THE EXPERIENCES OF 3969 03:06:46,160 --> 03:06:51,800 NATIVE HAWAIIAN AND PACIFIC 3970 03:06:51,800 --> 03:06:55,120 ISLANDER INDIVIDUALS YOU MAY SAY 3971 03:06:55,120 --> 03:06:58,120 WHY SIT IMPORTANT TO DRAW 3972 03:06:58,120 --> 03:07:00,040 ATTENTION AND THIS SAY 3973 03:07:00,040 --> 03:07:01,360 POPULATION RELATIVELY UNDER 3974 03:07:01,360 --> 03:07:02,200 STUDIED BUT IMPORTANTLY IS 3975 03:07:02,200 --> 03:07:03,240 GROWING RAPIDLY WITHIN THE 3976 03:07:03,240 --> 03:07:08,920 UNITED STATES. 3977 03:07:08,920 --> 03:07:12,400 UTAH HAS THE HIGHEST PER CAPITA 3978 03:07:12,400 --> 03:07:14,600 POPULATION OF PACIFIC ISLANDER 3979 03:07:14,600 --> 03:07:17,360 INDIVIDUALS OUTSIDE OF HAWAI'I 3980 03:07:17,360 --> 03:07:23,200 AS A PERCENTAGE AND IN TERMS OF 3981 03:07:23,200 --> 03:07:24,000 THE PROPORTION OF THE 3982 03:07:24,000 --> 03:07:28,560 POPULATION, UTAH IS THE HIGHEST 3983 03:07:28,560 --> 03:07:30,400 IN THE CONTIGUOUS UNITED STATES 3984 03:07:30,400 --> 03:07:32,000 AND GROWING RAPIDLY. 3985 03:07:32,000 --> 03:07:34,200 BETWEEN THE KNOWLEDGE THIS 3986 03:07:34,200 --> 03:07:38,080 POPULATION IS GROWING WITHIN THE 3987 03:07:38,080 --> 03:07:39,240 CONTINENTAL UNITED STATES AND 3988 03:07:39,240 --> 03:07:41,400 ALSO THEY ARE EXPERIENCING 3989 03:07:41,400 --> 03:07:47,120 HAWAI'I -- HIGH BURDEN AND 3990 03:07:47,120 --> 03:07:48,960 PREGNANCY LOSS IMPORTANT 3991 03:07:48,960 --> 03:07:52,400 OUTCOMES IS ANOTHER REASON TO 3992 03:07:52,400 --> 03:07:54,000 UNDERSTAND THE RISK FACTORS THAT 3993 03:07:54,000 --> 03:07:56,000 PLAY INTO THEIR RISK FOR ADVERSE 3994 03:07:56,000 --> 03:07:56,240 OUTCOMES. 3995 03:07:56,240 --> 03:07:58,400 AND WHAT I WANT TO SAY ABOUT 3996 03:07:58,400 --> 03:08:01,680 THAT IS SOMETHING I WAS JUST 3997 03:08:01,680 --> 03:08:03,240 ALLUDING TO WHICH IS NATIVE 3998 03:08:03,240 --> 03:08:04,360 HAWAIIAN PACIFIC ISLANDER PEOPLE 3999 03:08:04,360 --> 03:08:06,720 IN UTAH EXPERIENCE NOT ONLY A 4000 03:08:06,720 --> 03:08:08,440 HIGHER RATE OF PREGNANCY LOSS 4001 03:08:08,440 --> 03:08:11,240 BUT THE HIGHEST RATES OF 4002 03:08:11,240 --> 03:08:19,240 MATERNAL MORBIDITY AND SUDDEN 4003 03:08:19,240 --> 03:08:21,200 INFANT DEATH COMPARED TO OTHER 4004 03:08:21,200 --> 03:08:22,560 ETHNICITY GROUPS IN UTAH AND I 4005 03:08:22,560 --> 03:08:24,760 THINK IT ILLUSTRATES SOMETHING 4006 03:08:24,760 --> 03:08:27,200 I'VE TAKEN TO CALLING STRUCTURAL 4007 03:08:27,200 --> 03:08:28,560 MIRROR SYNDROME. 4008 03:08:28,560 --> 03:08:33,320 FOR THOSE FAMILIAR WITH FETAL 4009 03:08:33,320 --> 03:08:35,400 MIRROR SYNDROME A FETUS UNWELL 4010 03:08:35,400 --> 03:08:39,000 IN UTERO THE MOTHER MAY MIRROR 4011 03:08:39,000 --> 03:08:42,000 THAT SICKNESS AND BECOME ILL 4012 03:08:42,000 --> 03:08:42,920 HERSELF. 4013 03:08:42,920 --> 03:08:45,480 I THINK THE PARALLEL I'D LIKE TO 4014 03:08:45,480 --> 03:08:47,280 DRAW IS THERE ARE STRUCTURAL 4015 03:08:47,280 --> 03:08:50,120 FACTORS INCREASING THE RATES OF 4016 03:08:50,120 --> 03:08:52,320 FOLKS WHO IDENTIFY AS NATIVE 4017 03:08:52,320 --> 03:08:56,120 HAWAIIAN AND PACIFIC ISLANDER 4018 03:08:56,120 --> 03:09:01,800 BEING AT RISK OF GOING OVER THE 4019 03:09:01,800 --> 03:09:04,800 RISK WATER FALL AND WHETHER IT'S 4020 03:09:04,800 --> 03:09:07,920 PREGNANCY LOSS, STILLBIRTH OR 4021 03:09:07,920 --> 03:09:09,680 NEONATAL LOSS AND MATERNAL 4022 03:09:09,680 --> 03:09:11,480 MORBIDITY AND THE STRUCTURAL 4023 03:09:11,480 --> 03:09:13,680 FACTORS LEADING TO THAT RISK ARE 4024 03:09:13,680 --> 03:09:15,120 OVER ALL SIMILAR AND WARRANT OUR 4025 03:09:15,120 --> 03:09:19,840 ATTENTION UPSTREAM. 4026 03:09:19,840 --> 03:09:22,720 SO HOW DO WE GET AT THE 4027 03:09:22,720 --> 03:09:24,280 STRUCTURAL RISKS AND 4028 03:09:24,280 --> 03:09:25,680 UNDERSTANDING WHAT THOSE ARE? 4029 03:09:25,680 --> 03:09:28,280 ONE WAY THAT WE CAN GET AT 4030 03:09:28,280 --> 03:09:29,960 UNDERSTANDING STRUCTURAL RISK IS 4031 03:09:29,960 --> 03:09:32,160 ACTUALLY TO LISTEN TO THE 4032 03:09:32,160 --> 03:09:33,760 COMMUNITIES WHO ARE MOST 4033 03:09:33,760 --> 03:09:34,040 AFFECTED. 4034 03:09:34,040 --> 03:09:38,560 SO WE HAVE TAKEN A QUALITATIVE 4035 03:09:38,560 --> 03:09:41,360 APPROACH TO STRUCTURAL 4036 03:09:41,360 --> 03:09:44,840 UNDERSTANDING USING IN DEPTH 4037 03:09:44,840 --> 03:09:45,840 NARRATIVE DATA TO BUILD THE 4038 03:09:45,840 --> 03:09:48,800 MODEL OF THE HOW AND WHY OF THE 4039 03:09:48,800 --> 03:09:50,080 EPIDEMIOLOGIC DATA WE HAVE AND 4040 03:09:50,080 --> 03:09:51,480 THE RATES WE SHOW AND THE LINE 4041 03:09:51,480 --> 03:09:57,240 GRAPH AND THE MAPS AND ALL THOSE 4042 03:09:57,240 --> 03:10:00,280 THINGS, THEY ARE THE WHAT BUT 4043 03:10:00,280 --> 03:10:02,680 THEY ARE CAN'T TELL US THE HOW 4044 03:10:02,680 --> 03:10:04,960 OR WHY TO ANY GREAT DEGREE AND 4045 03:10:04,960 --> 03:10:07,200 SO WE USE A GROUNDED THEORY 4046 03:10:07,200 --> 03:10:09,600 APPROACH WHICH ALLOWS US TO 4047 03:10:09,600 --> 03:10:11,000 BUILD EVIDENCE FOR THEORIES THAT 4048 03:10:11,000 --> 03:10:13,840 EXPLAIN THE PHENOMENON AND CAN 4049 03:10:13,840 --> 03:10:15,200 BUILD THE FOUNDATION FOR 4050 03:10:15,200 --> 03:10:19,280 HYPOTHESES AND INTERVENTIONS. 4051 03:10:19,280 --> 03:10:21,240 WE ARE CAREFUL TO TAKE AN 4052 03:10:21,240 --> 03:10:22,680 APPROACH THAT CENTERS 4053 03:10:22,680 --> 03:10:24,040 MARGINALIZED COMMUNITY VOICES 4054 03:10:24,040 --> 03:10:25,720 AND BUILD OUR QUALITATIVE 4055 03:10:25,720 --> 03:10:27,120 APPROACHES IN COLLABORATION AND 4056 03:10:27,120 --> 03:10:29,120 PARTNERSHIP WITH COMMUNITY OHS 4057 03:10:29,120 --> 03:10:29,760 AND PEOPLE WITH LIVED 4058 03:10:29,760 --> 03:10:30,080 EXPERIENCE. 4059 03:10:30,080 --> 03:10:33,240 AND THIS REALLY ALLOWS US TO 4060 03:10:33,240 --> 03:10:35,720 CREATE A RICH WELL OF POSSIBLE 4061 03:10:35,720 --> 03:10:37,040 AVENUES FOR UNDERSTANDING 4062 03:10:37,040 --> 03:10:40,840 EPIDEMEPIDEM 4063 03:10:40,840 --> 03:10:41,160 Y 4064 03:10:41,160 --> 03:10:46,560 EPIDEM 4065 03:10:46,560 --> 03:10:48,480 EPIDEMYOLOGIC DATA AND WHAT 4066 03:10:48,480 --> 03:10:49,520 CONTRIBUTES TO RISK. 4067 03:10:49,520 --> 03:10:50,280 WE'RE IN THE PROJECT CALLED 4068 03:10:50,280 --> 03:10:55,120 HEARING THE VOICES OF UTAH 4069 03:10:55,120 --> 03:10:55,360 MOTHERS. 4070 03:10:55,360 --> 03:10:55,960 FOCUS GROUPS DIVIDED INTO TWO 4071 03:10:55,960 --> 03:11:00,280 STUDIES. 4072 03:11:00,280 --> 03:11:01,880 AND THE ELIGIBILITY CRITERIA ARE 4073 03:11:01,880 --> 03:11:06,920 FOR INDIVIDUALS WHO IDENTIFY AS 4074 03:11:06,920 --> 03:11:09,160 NATIVE HAWAIIAN OR PACIFIC AND 4075 03:11:09,160 --> 03:11:11,000 GIVEN BIRTH IN UTAH IN THE LAST 4076 03:11:11,000 --> 03:11:13,800 FIVE YEARS AND THE SECOND ARE 4077 03:11:13,800 --> 03:11:16,680 FOR THOSE WHO IDENTIFY AS NATIVE 4078 03:11:16,680 --> 03:11:18,360 AMERICAN OR ALASKAN NATIVE AND 4079 03:11:18,360 --> 03:11:23,160 INDIGENOUS AND GIVEN BIRTH AND 4080 03:11:23,160 --> 03:11:25,840 WE HAVE LIMITED IT TO ENGLISH 4081 03:11:25,840 --> 03:11:29,160 SPEAKING INDIVIDUALS ON THE 4082 03:11:29,160 --> 03:11:32,760 ADVICE OF OUR PARTNERS GIVEN THE 4083 03:11:32,760 --> 03:11:38,200 AGE RANGE THAT ENGLISH SPEAKING 4084 03:11:38,200 --> 03:11:48,680 WOULD NOT BE -- LEAVE THE 4085 03:11:49,360 --> 03:11:54,400 POSSIBILITY TO MISTRANSLATE AND 4086 03:11:54,400 --> 03:11:59,200 IT'S DEVELOPED WITH LOCAL 4087 03:11:59,200 --> 03:12:02,600 COMMUNITY GROUPS AND LOOKING AT 4088 03:12:02,600 --> 03:12:05,400 COMMUNITY RESILIENCE FACTS AND 4089 03:12:05,400 --> 03:12:06,680 PHYSICAL ENVIRONMENTAL FACTOR 4090 03:12:06,680 --> 03:12:12,680 REDUCE OR CREATE BARRIERS TO 4091 03:12:12,680 --> 03:12:13,840 SUPPORT DURING PREGNANCY AND 4092 03:12:13,840 --> 03:12:15,680 ASKING ABOUT INTERACTION WITH 4093 03:12:15,680 --> 03:12:16,800 THE HEALTH CARE PROVIDERS TO 4094 03:12:16,800 --> 03:12:18,320 UNDERSTAND THE RELATIONSHIP OF 4095 03:12:18,320 --> 03:12:22,880 THEIR STRUCTURAL EXPERIENCES TO 4096 03:12:22,880 --> 03:12:23,560 THEIR HEALTH CARE SYSTEM OR 4097 03:12:23,560 --> 03:12:24,960 OTHER EXPERIENCES WITH 4098 03:12:24,960 --> 03:12:29,200 PROVIDERS. 4099 03:12:29,200 --> 03:12:31,240 THIS IS A SCREEN SHOT FROM A 4100 03:12:31,240 --> 03:12:32,040 VIRTUAL FOCUS GROUP. 4101 03:12:32,040 --> 03:12:35,240 WE CONDUCTED THE FOCUS GROUPS 4102 03:12:35,240 --> 03:12:40,400 WITH NATIVE HAWAIIAN AND PACIFIC 4103 03:12:40,400 --> 03:12:45,920 ISLANDER MOTHERS DURING COVID. 4104 03:12:45,920 --> 03:12:48,840 42 INDIVIDUALS WERE SCREEN AND A 4105 03:12:48,840 --> 03:12:51,200 PERCENTAGE AGREED TO PARTICIPATE 4106 03:12:51,200 --> 03:12:53,320 AND FIVE FOCUS GROUPS WERE HELD 4107 03:12:53,320 --> 03:12:56,520 BETWEEN JUNE AND AUGUST WITH AN 4108 03:12:56,520 --> 03:12:59,200 AVERAGE NUMBER OF PARTICIPANTS 6 4109 03:12:59,200 --> 03:13:05,560 AND UNDER TWO HOURS. 4110 03:13:05,560 --> 03:13:08,280 AMONG THE GROUNDS COMMUNITY THE 4111 03:13:08,280 --> 03:13:11,440 FOCUS GROUPS ARE ONGOING AND HAD 4112 03:13:11,440 --> 03:13:15,840 SCREENING AND 12 PARTICIPATED IN 4113 03:13:15,840 --> 03:13:19,240 THREE GROUPS WITH A FEW OTHER 4114 03:13:19,240 --> 03:13:23,880 URBAN NATIVE COMMUNITY PARTNERS. 4115 03:13:23,880 --> 03:13:27,040 SO AMONG THE THEMES WE HEARD 4116 03:13:27,040 --> 03:13:28,560 FROM OUR PARTICIPANTS, I'M JUST 4117 03:13:28,560 --> 03:13:30,200 GOING TO FOCUS ON A FEW THAT I 4118 03:13:30,200 --> 03:13:32,960 THINK ARE PARTICULARLY RELEVANT 4119 03:13:32,960 --> 03:13:34,200 TO THE EXPERIENCE OF STILLBIRTH 4120 03:13:34,200 --> 03:13:39,440 AND PREGNANCY LOSS AMONG NATIVE 4121 03:13:39,440 --> 03:13:42,040 HAWAIIAN, PACIFIC ISLANDER 4122 03:13:42,040 --> 03:13:44,040 INDIVIDUALS AND THE THEME AMONG 4123 03:13:44,040 --> 03:13:46,440 THOSE WHO PARTICIPATED IN THE 4124 03:13:46,440 --> 03:13:48,280 GROUP, NATIVE HAWAIIAN AND 4125 03:13:48,280 --> 03:13:49,000 PACIFIC ISLANDER REPORTED 4126 03:13:49,000 --> 03:13:50,360 FEELINGS OF DISCRIMINATION 4127 03:13:50,360 --> 03:13:52,320 BECAUSE OF THEIR GROUND SKIN OR 4128 03:13:52,320 --> 03:13:55,160 BIGGER BODIES AND OTHERS 4129 03:13:55,160 --> 03:13:57,360 REPORTED MEDICAID OR INSURANCE 4130 03:13:57,360 --> 03:14:00,160 OR STATUS RESULTED 4131 03:14:00,160 --> 03:14:05,240 DISCRIMINATION AND REPORTED 4132 03:14:05,240 --> 03:14:09,640 MEDICAL PROFESSIONALS CAME 4133 03:14:09,640 --> 03:14:13,040 ACROSS WITH ACTS OF IMPLICIT 4134 03:14:13,040 --> 03:14:14,040 BIAS OR DISCRIMINATION. 4135 03:14:14,040 --> 03:14:15,880 WITH SPECIFIC RELATIONSHIP TO 4136 03:14:15,880 --> 03:14:17,840 INDIVIDUALS WHO EXPERIENCE 4137 03:14:17,840 --> 03:14:20,240 PREGNANCY LOSS OR STILLBIRTH 4138 03:14:20,240 --> 03:14:21,240 WITHIN OUR GROUP OF PARTICIPANTS 4139 03:14:21,240 --> 03:14:23,040 IT'S IMPORTANT TO HEAR THEIR 4140 03:14:23,040 --> 03:14:26,680 WORDS AND SO I'LL READ A COUPLE 4141 03:14:26,680 --> 03:14:27,040 OF THESE. 4142 03:14:27,040 --> 03:14:28,640 ONE PARTICIPANT SAID I DON'T 4143 03:14:28,640 --> 03:14:31,160 REALLY SHARE THIS A LOT BUT I 4144 03:14:31,160 --> 03:14:32,360 WAS PREGNANT WITH MY SECOND 4145 03:14:32,360 --> 03:14:33,680 CHILD AND WE WERE ON THE FREEWAY 4146 03:14:33,680 --> 03:14:37,000 AND I TOLD MY HUSBAND I HAVE TO 4147 03:14:37,000 --> 03:14:38,600 GO TO THE HOSPITAL BECAUSE I 4148 03:14:38,600 --> 03:14:43,240 COULD FEEL PAIN WE WENT TO THE 4149 03:14:43,240 --> 03:14:48,960 E.R. FOR 9 HOURS WITHOUT SEEING 4150 03:14:48,960 --> 03:14:52,840 A DOCTOR AND I SAID I HADN'T 4151 03:14:52,840 --> 03:14:56,840 SEEN A DOCTOR AND I SAID PLEASE, 4152 03:14:56,840 --> 03:14:59,920 I'M PREGNANT AND SOMETHING'S 4153 03:14:59,920 --> 03:15:07,040 WRONG AND I SAT IN THE E.R. AND 4154 03:15:07,040 --> 03:15:10,160 I LOST MY BABY IT'S IMPORTANT 4155 03:15:10,160 --> 03:15:14,800 YOU LISTEN TO US AND OUR BODIES 4156 03:15:14,800 --> 03:15:15,760 AND TAKE US SERIOUSLY. 4157 03:15:15,760 --> 03:15:16,840 THIS IS FROM ANOTHER PARTICIPANT 4158 03:15:16,840 --> 03:15:17,960 WHO SAID WE WERE MOVING AND A 4159 03:15:17,960 --> 03:15:19,640 FELL DOWN THE STAIRS AND IT WAS 4160 03:15:19,640 --> 03:15:21,800 A SCARY THING BUT THE SAME NIGHT 4161 03:15:21,800 --> 03:15:23,720 I WAS EXPERIENCING BAD BACK PAIN 4162 03:15:23,720 --> 03:15:26,440 AND SOMETHING DIDN'T FEEL RIGHT 4163 03:15:26,440 --> 03:15:26,880 AT ALL. 4164 03:15:26,880 --> 03:15:29,720 I ENDED UP GOING TO THE E.R. 4165 03:15:29,720 --> 03:15:32,560 WHEN I CAME IN IT WAS A 4166 03:15:32,560 --> 03:15:33,400 PREDOMINANTLY WHITE STAFF AND 4167 03:15:33,400 --> 03:15:34,920 FELT THEY WERE BEING PLAYFUL AND 4168 03:15:34,920 --> 03:15:36,000 BRUSHING IT OFF. 4169 03:15:36,000 --> 03:15:40,160 I WAS SO -- IT WAS MAKING MY 4170 03:15:40,160 --> 03:15:44,200 BLOOD BOIL I FELT THEY WERE 4171 03:15:44,200 --> 03:15:46,320 SAYING THINGS BEHIND MY BACK 4172 03:15:46,320 --> 03:15:48,600 BECAUSE I HEARD LAUGHING AND 4173 03:15:48,600 --> 03:15:50,680 GIGGLING AND THEY SAID YOUR A 4174 03:15:50,680 --> 03:15:52,240 PAIN IS BECAUSE YOU FELL DOWN 4175 03:15:52,240 --> 03:15:53,600 THE STAIRS YOU CAN TAKE MEDICINE 4176 03:15:53,600 --> 03:15:56,080 AND THEY WEREN'T LISTEN FOR A 4177 03:15:56,080 --> 03:15:56,840 HEARTBEAT OR ANYTHING. 4178 03:15:56,840 --> 03:15:59,040 I WAITED A LONG TIME FOR 4179 03:15:59,040 --> 03:15:59,480 NOTHING. 4180 03:15:59,480 --> 03:16:06,320 THERE'S A LOT OF RACISM GOING 4181 03:16:06,320 --> 03:16:09,160 EVERYWHERE, WE ALL KNOW THAT AND 4182 03:16:09,160 --> 03:16:11,200 UNFORTUNATELY TWO DAYS LATER I 4183 03:16:11,200 --> 03:16:18,000 ENDED UP MISS CAR -- MISCARRYI. 4184 03:16:18,000 --> 03:16:20,480 SOME REPORTED BIAS WHICH WAS AN 4185 03:16:20,480 --> 03:16:23,240 IMPORTANT THEME ARE FOUR FOCUS 4186 03:16:23,240 --> 03:16:26,680 GROUP AND INSTANCES OF 4187 03:16:26,680 --> 03:16:28,240 STEREOTYPING FROM THE MEDICAL 4188 03:16:28,240 --> 03:16:30,400 AND THEIR OWN COMMUNITY. 4189 03:16:30,400 --> 03:16:36,120 MANY FELT OTHER PACIFIC ISLANDER 4190 03:16:36,120 --> 03:16:37,720 OR POLYNESIAN COMMUNITY WERE 4191 03:16:37,720 --> 03:16:42,000 EXPECTED TO SUCK IT UP AND 4192 03:16:42,000 --> 03:16:43,160 OTHERS FELT THEY COULDN'T SHARE 4193 03:16:43,160 --> 03:16:44,440 THEIR STRUGGLE. 4194 03:16:44,440 --> 03:16:47,400 MOST THE DISCRIMINATION AND 4195 03:16:47,400 --> 03:16:48,800 STEREOTYPING CAME FROM MEDICAL 4196 03:16:48,800 --> 03:16:49,880 PROFESSIONALS WHICH OFTEN 4197 03:16:49,880 --> 03:16:52,160 INTERFERED WITH THEIR ABILITY TO 4198 03:16:52,160 --> 03:16:54,040 RECEIVE PROPER TREATMENT AND 4199 03:16:54,040 --> 03:16:56,080 MEDICAL CARE WHILE PREGNANT AND 4200 03:16:56,080 --> 03:16:58,560 IT INCLUDES COMMENTS ABOUT 4201 03:16:58,560 --> 03:17:00,000 INFANTS QUOTE UNQUOTE, BEING 4202 03:17:00,000 --> 03:17:02,200 HUGE, TAKING AFTER THE POLY SIDE 4203 03:17:02,200 --> 03:17:05,400 AND POLYNESIAN WOMEN BEING 4204 03:17:05,400 --> 03:17:09,840 QUOTE, BORN TO BREED. 4205 03:17:09,840 --> 03:17:11,200 ONE PARTICULAR QUOTE THAT 4206 03:17:11,200 --> 03:17:12,600 EXEMPLIFIES THIS ONE PERSON SAID 4207 03:17:12,600 --> 03:17:14,840 IN EACH OF MY INTERACTIONS 4208 03:17:14,840 --> 03:17:17,040 INITIALLY MEETING A PROVIDER OR 4209 03:17:17,040 --> 03:17:21,520 MEETING WITH ANYONE LIKE AN 4210 03:17:21,520 --> 03:17:24,720 ULTRASOUND CONDITION I'D REGULAR 4211 03:17:24,720 --> 03:17:27,480 HEAR, YOU'LL BE POLYNESIAN, YOUR 4212 03:17:27,480 --> 03:17:29,000 BABY WILL BE HUGE. 4213 03:17:29,000 --> 03:17:32,840 I DON'T KNOW IF THAT MAKES IT TO 4214 03:17:32,840 --> 03:17:35,560 ASSUME I WILL HAVE GESTATIONAL 4215 03:17:35,560 --> 03:17:39,200 DIABETES I FELT IT PUT ME INTO A 4216 03:17:39,200 --> 03:17:43,320 PRE DETERMINED QUALITY OF CARE 4217 03:17:43,320 --> 03:17:45,880 BECAUSE I ALWAYS PAY ATTENTION 4218 03:17:45,880 --> 03:17:50,840 AND SAY CAN YOU CHECK THE BABY 4219 03:17:50,840 --> 03:17:53,360 WEIGHT AND THIS PARTICIPANT HAD 4220 03:17:53,360 --> 03:17:55,800 A OF STILLBIRTHING DURING PRIOR 4221 03:17:55,800 --> 03:17:56,680 PREGNANCY. 4222 03:17:56,680 --> 03:17:58,480 AND FINALLY, WE'LL TALK A LITTLE 4223 03:17:58,480 --> 03:18:03,080 BIT ABOUT CULTURAL HUMILITY AND 4224 03:18:03,080 --> 03:18:07,080 MEANING MAKING. 4225 03:18:07,080 --> 03:18:10,080 THE NATIVE HAWAIIAN AND AMERICAN 4226 03:18:10,080 --> 03:18:11,240 INDIAN PARTICIPANTS REPORT 4227 03:18:11,240 --> 03:18:13,560 THERE'S A SENSE OF DISTANCE AND 4228 03:18:13,560 --> 03:18:16,200 ISOLATION BETWEEN THEMSELVES AND 4229 03:18:16,200 --> 03:18:18,360 PREDOMINANTLY WHITE HEALTH CARE 4230 03:18:18,360 --> 03:18:21,360 PROVIDERS AND IT'S ATTRIBUTED TO 4231 03:18:21,360 --> 03:18:26,000 A LACK OF CULTURAL CURIOSITY. 4232 03:18:26,000 --> 03:18:28,960 OR DISMISSAL AND IT'S IMPORTANT 4233 03:18:28,960 --> 03:18:31,680 AROUND MEANING MAKING AROUND 4234 03:18:31,680 --> 03:18:36,680 PREGNANCY AND LACK OF CULTURAL 4235 03:18:36,680 --> 03:18:39,240 HUMILITY AND BEING CURIOSITY OF 4236 03:18:39,240 --> 03:18:44,200 THE CULTURAL ACTIVITIES THAT MAY 4237 03:18:44,200 --> 03:18:49,520 HELP WITH MEANING MAKING MAY BE 4238 03:18:49,520 --> 03:18:49,760 DISMISSED. 4239 03:18:49,760 --> 03:18:50,920 -- DISMISSED. 4240 03:18:50,920 --> 03:18:53,760 THERE'S TWO QUOTES I THINK ARE 4241 03:18:53,760 --> 03:18:54,280 PARTICULARLY RELEVANT. 4242 03:18:54,280 --> 03:19:02,040 ONE PERSON SAID MY DAUGH 4243 03:19:02,040 --> 03:19:02,600 DAUGHTER-IN-LAW RECENTLY 4244 03:19:02,600 --> 03:19:03,400 EXPERIENCED A LOSS AND THERE'S A 4245 03:19:03,400 --> 03:19:05,600 GAP IN UNDERSTANDING. 4246 03:19:05,600 --> 03:19:07,880 I TOOK HER UP TO THE SACRED 4247 03:19:07,880 --> 03:19:10,360 PLACE BUT I WORRY SHE FEELS 4248 03:19:10,360 --> 03:19:11,760 GUILTY ABOUT THE LOSS. 4249 03:19:11,760 --> 03:19:18,680 THAT'S ONE FROM THE ELDERS. 4250 03:19:18,680 --> 03:19:20,480 A PACIFICER ISLANDER PERSON SAID 4251 03:19:20,480 --> 03:19:22,520 WE BURY THE PLACENTA IN THE HOME 4252 03:19:22,520 --> 03:19:24,320 AND IT'S SUPPOSED TO KEEP THE 4253 03:19:24,320 --> 03:19:26,080 KIDS CLOSE TO YOU SO WE TOLD OUR 4254 03:19:26,080 --> 03:19:27,960 DOCTOR AS WELL AS TWO NURSES AND 4255 03:19:27,960 --> 03:19:30,960 THEY ENDED UP LOSING THE 4256 03:19:30,960 --> 03:19:31,240 PLACENTA. 4257 03:19:31,240 --> 03:19:33,040 WHEN WE CAME TO GET IT I FELT 4258 03:19:33,040 --> 03:19:35,040 THE NURSES WERE INSENSITIVE AND 4259 03:19:35,040 --> 03:19:36,880 MADE JOKES SAYING IT WENT TO 4260 03:19:36,880 --> 03:19:38,080 PLACENTA HEAVEN. 4261 03:19:38,080 --> 03:19:40,800 THAT HURT ME TOO BECAUSE YOU 4262 03:19:40,800 --> 03:19:42,960 GIVE BIRTH AND YOU'RE VERY 4263 03:19:42,960 --> 03:19:43,840 EMOTIONAL AND IT WAS IMPORTANT 4264 03:19:43,840 --> 03:19:45,520 FOR ME AND MY HUSBAND TO DO AND 4265 03:19:45,520 --> 03:19:48,720 NOW WE FEEL CONFLICTED ABOUT 4266 03:19:48,720 --> 03:19:59,240 DOING IT WITH OUR OTHER KIDS. 4267 03:20:02,440 --> 03:20:06,360 I THINK WHAT I WOULD HOPE FOLKS 4268 03:20:06,360 --> 03:20:11,200 WOULD TAKE FROM THIS 4269 03:20:11,200 --> 03:20:14,320 PRESENTATION IS THAT THIS DATA 4270 03:20:14,320 --> 03:20:16,560 CAN RESULT IN SOMETHING OF A 4271 03:20:16,560 --> 03:20:17,200 COMMUNITY TRANSLATIONAL 4272 03:20:17,200 --> 03:20:17,800 APPROACH. 4273 03:20:17,800 --> 03:20:19,680 I HAVE NOT COME UP WITH A BETTER 4274 03:20:19,680 --> 03:20:24,080 WORD FOR IT YET BUT I'M KIND OF 4275 03:20:24,080 --> 03:20:26,800 CALLING IT COMMUNITY BENCH TO 4276 03:20:26,800 --> 03:20:29,320 BEDSIDE CREATING NEW INSIGHT IN 4277 03:20:29,320 --> 03:20:30,920 TERMS OF WHAT STRUCTURAL 4278 03:20:30,920 --> 03:20:33,880 BARRIERS INDIVIDUALS ARE FACING. 4279 03:20:33,880 --> 03:20:34,920 PEOPLE WITH LIVED EXPERIENCES 4280 03:20:34,920 --> 03:20:37,520 AND BE MORE RESPONSIVE TO 4281 03:20:37,520 --> 03:20:39,200 COMMUNITY IDENTIFYING NEEDS AND 4282 03:20:39,200 --> 03:20:41,360 CENTER THE COMMUNITIES MOST 4283 03:20:41,360 --> 03:20:51,680 HARMED BY STRUCTURAL INEQUITIES. 4284 03:20:51,680 --> 03:20:56,880 I THINK THERE'S MULTIPLE WAYS TO 4285 03:20:56,880 --> 03:20:59,120 INTERPRET THE DATA AND THINKING 4286 03:20:59,120 --> 03:21:00,200 ABOUT THE FOLKS WHO ARE IN 4287 03:21:00,200 --> 03:21:02,640 HEALTH CARE AND WORKING TO TRY 4288 03:21:02,640 --> 03:21:03,480 TO PREVENT INDIVIDUALS WITH HIGH 4289 03:21:03,480 --> 03:21:07,200 RISK FROM GOING OVER THE WATER 4290 03:21:07,200 --> 03:21:08,960 FALL AND I THINK HEARING FROM 4291 03:21:08,960 --> 03:21:09,560 PARTICIPANTS THEY WANT HEALTH 4292 03:21:09,560 --> 03:21:11,520 CARE PROVIDERS TO LISTEN AND TO 4293 03:21:11,520 --> 03:21:14,040 TAKE THEIR PAIN AND EXPERIENCES 4294 03:21:14,040 --> 03:21:15,720 SERIOUSLY IS SOMETHING THAT 4295 03:21:15,720 --> 03:21:18,080 PARALLELS OTHER THINGS THAT 4296 03:21:18,080 --> 03:21:21,320 WE'VE HEARD FROM BLACK WOMEN WHO 4297 03:21:21,320 --> 03:21:24,800 ARE IMPACTED BY MATERNAL 4298 03:21:24,800 --> 03:21:26,440 MORBIDITY AND MORTALITY AND I 4299 03:21:26,440 --> 03:21:28,040 THINK THERE'S A LOT OF WISDOM WE 4300 03:21:28,040 --> 03:21:33,040 CAN TAKE FROM THESE INDIVIDUALS 4301 03:21:33,040 --> 03:21:34,120 TO FEEL HEARD. 4302 03:21:34,120 --> 03:21:36,040 I THINK WE ALSO HEARD FROM 4303 03:21:36,040 --> 03:21:38,320 PARTICIPANTS AND FROM THE 4304 03:21:38,320 --> 03:21:39,640 EPIDEMIOLOGIC DATA AND SOME OF 4305 03:21:39,640 --> 03:21:41,160 THE NEIGHBORHOOD DATA WE DIDN'T 4306 03:21:41,160 --> 03:21:43,000 HAVE A CHANCE TO GET INTO TODAY 4307 03:21:43,000 --> 03:21:47,800 BUT THERE ARE STRUCTURAL 4308 03:21:47,800 --> 03:21:49,280 INFLUENCES THAT PUT NATIVE 4309 03:21:49,280 --> 03:21:51,200 HAWAIIAN AND PACIFIC ISLANDER 4310 03:21:51,200 --> 03:21:55,200 WOMEN AND OTHER FOLKS FROM 4311 03:21:55,200 --> 03:21:58,240 ETHNICALLY MARGINALIZED WOMEN AT 4312 03:21:58,240 --> 03:22:01,240 RISK OF STILLBIRTH AND CAN BE 4313 03:22:01,240 --> 03:22:02,480 ADDRESSED WHEN CENTERING THE 4314 03:22:02,480 --> 03:22:04,400 STORIES OF PEOPLE WITH LIVED 4315 03:22:04,400 --> 03:22:06,160 EXPERIENCE AND BRINGING THOSE 4316 03:22:06,160 --> 03:22:09,200 STORIES TO BEAR ON POLICY AND 4317 03:22:09,200 --> 03:22:11,200 STRUCTURAL CHANGE AND THEN I 4318 03:22:11,200 --> 03:22:12,720 THINK THERE'S LEARNING TO BE 4319 03:22:12,720 --> 03:22:14,480 DONE FOR THOSE INDIVIDUALS WHO 4320 03:22:14,480 --> 03:22:16,960 FALL OVER THE WATER FALL AND DO 4321 03:22:16,960 --> 03:22:18,120 EXPERIENCE A STILLBIRTH OR 4322 03:22:18,120 --> 03:22:23,280 PREGNANCY LOSS AND THAT IS THAT 4323 03:22:23,280 --> 03:22:27,320 OUR LACK OF LISTENING AND THE 4324 03:22:27,320 --> 03:22:31,240 HEALTH CARE SYSTEM OVER ALL LACK 4325 03:22:31,240 --> 03:22:36,520 OF CULTURAL HUMILITY IMPEDES 4326 03:22:36,520 --> 03:22:37,640 MEANING MAKING AND FOLKS' 4327 03:22:37,640 --> 03:22:39,280 ABILITY TO COPE WITH AND MANAGE 4328 03:22:39,280 --> 03:22:41,400 THE FEELINGS AROUND PREGNANCY 4329 03:22:41,400 --> 03:22:46,520 LOSS AND STILLBIRTH AND BEING 4330 03:22:46,520 --> 03:22:47,520 DISMISSIVE OF DIFFERENT 4331 03:22:47,520 --> 03:22:48,920 INDIVIDUALS' NEEDS IN TERMS OF 4332 03:22:48,920 --> 03:22:53,560 MEANING MAKING AS A PLACE WHERE 4333 03:22:53,560 --> 03:22:54,760 WE CAN IMPROVE. 4334 03:22:54,760 --> 03:22:58,440 IF YOU'LL SKIP AHEAD TO THE 4335 03:22:58,440 --> 03:23:00,880 FINAL SLIDE, I JUST WANT TO GIVE 4336 03:23:00,880 --> 03:23:04,040 IMMENSE GRATITUDE TO BOB SILVER 4337 03:23:04,040 --> 03:23:09,680 AND THE PLANNING GROUP FOR 4338 03:23:09,680 --> 03:23:15,680 INVITING ME TO THE COLLABORATION 4339 03:23:15,680 --> 03:23:20,000 TEAM AND DATA CORE AT THE 4340 03:23:20,000 --> 03:23:23,160 UNIVERSITY AND COLLABORATORS AND 4341 03:23:23,160 --> 03:23:26,760 FUNDERS AND AND ABOVE ALL THE 4342 03:23:26,760 --> 03:23:27,520 MOTHER PARTICIPANTS. 4343 03:23:27,520 --> 03:23:29,360 I LOOK FORWARD TO CONVERSATION 4344 03:23:29,360 --> 03:23:37,360 TO COME. 4345 03:23:37,360 --> 03:23:41,880 >>THANK YOU, THIS WAS GREAT IN 4346 03:23:41,880 --> 03:23:44,000 UNDERSTANDING MORE HOW TO 4347 03:23:44,000 --> 03:23:45,080 IMPLEMENT THE VOICE OF WHAT WE 4348 03:23:45,080 --> 03:23:46,000 WANT TO HEAR. 4349 03:23:46,000 --> 03:23:51,480 YOU BROUGHT UP A LOT OF THE 4350 03:23:51,480 --> 03:23:51,680 VOICE. 4351 03:23:51,680 --> 03:23:52,120 THANK YOU SO MUCH. 4352 03:23:52,120 --> 03:23:55,640 HOW WE'RE LOOKING TO THE LAST 4353 03:23:55,640 --> 03:23:57,720 SPEAKER WHICH IS DR. MENDOLA THE 4354 03:23:57,720 --> 03:24:00,960 CHAIR OF THE DEPARTMENT OF 4355 03:24:00,960 --> 03:24:01,800 EPIDEMIOLOGY AND ENVIRONMENT AT 4356 03:24:01,800 --> 03:24:06,880 THE UNIVERSITY OF BUFFALO. 4357 03:24:06,880 --> 03:24:10,520 THANK YOU. 4358 03:24:10,520 --> 03:24:13,120 >>I'M THANKFUL TO THE WORKING 4359 03:24:13,120 --> 03:24:15,240 GROUP ORGANIZERS FOR INVITING ME 4360 03:24:15,240 --> 03:24:16,280 AND THIS WILL BE A LITTLE BIT 4361 03:24:16,280 --> 03:24:21,400 DIFFERENT FROM THE TOPICS WE 4362 03:24:21,400 --> 03:24:23,120 TALKED ABOUT EARLIER I'M GOING 4363 03:24:23,120 --> 03:24:26,720 TO TALK ABOUT THE WORK LOOKING 4364 03:24:26,720 --> 03:24:28,440 AT ENVIRONMENTAL FACTORS 4365 03:24:28,440 --> 03:24:39,000 ASSOCIATED WITH STILLBIRTH RISK. 4366 03:24:39,800 --> 03:24:43,200 MOST OF WHAT I'LL TALK ABOUT IS 4367 03:24:43,200 --> 03:24:50,440 THE REPRODUCTIVE HEALTH STUDY 4368 03:24:50,440 --> 03:24:54,440 AND LINKED RECORDS TO MODIFIED 4369 03:24:54,440 --> 03:24:55,920 AIR POLLUTION AND WEATHER MODELS 4370 03:24:55,920 --> 03:24:58,800 AND I'LL TALK ABOUT WORK FROM 4371 03:24:58,800 --> 03:25:03,240 THE CONSORTIUM ON SAFE LABOR AND 4372 03:25:03,240 --> 03:25:04,760 I WANT TO TAKE THE OPPORTUNITY 4373 03:25:04,760 --> 03:25:07,560 TO ACKNOWLEDGE THIS WORK WAS ALL 4374 03:25:07,560 --> 03:25:10,400 FUNDED THROUGH THE INTRAMURAL 4375 03:25:10,400 --> 03:25:12,000 RESEARCH PROGRAM AT NICHD SO 4376 03:25:12,000 --> 03:25:19,240 THAT WAS A GREAT BENEFIT TO US 4377 03:25:19,240 --> 03:25:19,640 ALL. 4378 03:25:19,640 --> 03:25:23,440 SO IN OUR STUDIES, STILL BIRTHS 4379 03:25:23,440 --> 03:25:26,240 ARE DELIVERIES, 23 WEEKS OF 4380 03:25:26,240 --> 03:25:27,240 GESTATION OR LATER. 4381 03:25:27,240 --> 03:25:32,320 MOST OF THOSE DEATHS OCCURRED, 4382 03:25:32,320 --> 03:25:34,280 ANTIPARTUM AND 10% DURING 4383 03:25:34,280 --> 03:25:35,200 DELIVERY. 4384 03:25:35,200 --> 03:25:41,120 WE DO NOT HAVE CAUSE OF DEATH 4385 03:25:41,120 --> 03:25:41,560 INFORMATION. 4386 03:25:41,560 --> 03:25:43,880 IN THE CONSORTIUM OF SAFE LABOR 4387 03:25:43,880 --> 03:25:46,320 WE HAVE NEARLY 500 IN THE 4388 03:25:46,320 --> 03:25:48,200 CONSECUTIVE PREGNANCY STUDY. 4389 03:25:48,200 --> 03:25:51,640 THE EXPOSURES I'LL TALK ABOUT 4390 03:25:51,640 --> 03:25:54,840 ARE CHRONIC EXPOSURES AND ACUTE 4391 03:25:54,840 --> 03:25:55,560 EXPOSURES TRIGGERING EVENTS IN 4392 03:25:55,560 --> 03:26:00,720 THE DAYS PRIOR TO DELIVERY AND 4393 03:26:00,720 --> 03:26:03,240 WE'LL LOOK AT TEMPERATURE SMALL 4394 03:26:03,240 --> 03:26:04,920 INCREASES IN TEMPERATURE BUT 4395 03:26:04,920 --> 03:26:06,040 ALSO EXTREMES OF TEMPERATURE AND 4396 03:26:06,040 --> 03:26:08,800 WE'LL LOOK AT AIR POLLUTION AND 4397 03:26:08,800 --> 03:26:10,000 I'LL ALSO SHARE WITH YOU AN 4398 03:26:10,000 --> 03:26:15,200 ANALYSIS WE DID LOOKING AT 4399 03:26:15,200 --> 03:26:15,960 RESIDENTIAL SEGREGATION. 4400 03:26:15,960 --> 03:26:18,680 SO WHERE THE HOUSING AND SOCIAL 4401 03:26:18,680 --> 03:26:21,320 ENVIRONMENT AS WELL AS THE 4402 03:26:21,320 --> 03:26:21,880 AMBIENT TEMPERATURE AND AIR 4403 03:26:21,880 --> 03:26:26,400 POLLUTION ENVIRONMENT. 4404 03:26:26,400 --> 03:26:28,000 THE CONSORTIUM ON SAFE LABOR HAD 4405 03:26:28,000 --> 03:26:29,760 A BIG ROLE IN THE AIR QUALITY 4406 03:26:29,760 --> 03:26:32,360 AND REPRODUCTIVE HEALTH STUDIES. 4407 03:26:32,360 --> 03:26:35,200 IT WAS A NATIONWIDE OBSTETRIC 4408 03:26:35,200 --> 03:26:36,240 COHORT. 4409 03:26:36,240 --> 03:26:42,000 THERE WERE BIRTHS FROM 2002 TO 4410 03:26:42,000 --> 03:26:42,280 2008. 4411 03:26:42,280 --> 03:26:47,480 OVER 223,000 SINGLE DELIVERIES 4412 03:26:47,480 --> 03:26:51,040 AND THIS DATA SET IS BASED ON 4413 03:26:51,040 --> 03:26:53,440 MEDICAL RECORDS, ELECTRONIC 4414 03:26:53,440 --> 03:26:58,040 MEDICAL RECORDS FOR THE 4415 03:26:58,040 --> 03:27:00,480 INTRAPARTUM MISSION AND HAD 4416 03:27:00,480 --> 03:27:01,440 NEONATE CHARTS AND THE 4417 03:27:01,440 --> 03:27:02,880 COMPLICATION CODES AND OTHER 4418 03:27:02,880 --> 03:27:03,560 THINGS WERE IN THE CHARTS IN THE 4419 03:27:03,560 --> 03:27:07,880 ICD 9 CODES AND USED THE 4420 03:27:07,880 --> 03:27:11,200 HOSPITAL REFERRAL REGIONS AS THE 4421 03:27:11,200 --> 03:27:13,640 UNIT OF GEOGRAPHY TO LOOK AT 4422 03:27:13,640 --> 03:27:15,200 TEMPERATURE AND ALSO TO LOOK AT 4423 03:27:15,200 --> 03:27:25,440 AIR POLLUTION. 4424 03:27:31,720 --> 03:27:34,840 WE LOOKED AT MAIN EFFECTS 4425 03:27:34,840 --> 03:27:38,320 RELATED TO CRITERIA AIR 4426 03:27:38,320 --> 03:27:43,200 POLLUTANTS AND LOOKING AT THE 4427 03:27:43,200 --> 03:27:44,520 INTERQUARTILE RANGE FOR THE 4428 03:27:44,520 --> 03:27:46,920 POLLUTION AND AIR WE REGULATE, 4429 03:27:46,920 --> 03:27:54,360 PARTICULATE MATTER, 10 MICRONS 4430 03:27:54,360 --> 03:27:55,560 AND SULFUR DIOXIDE AND OTHERS 4431 03:27:55,560 --> 03:27:59,200 AND THE TEMPERATURE MODELS WE 4432 03:27:59,200 --> 03:28:01,280 LOOKED AT CHRONIC EXTREME THE 4433 03:28:01,280 --> 03:28:05,960 UPPER AND LOWER PERCENTILE FOR 4434 03:28:05,960 --> 03:28:07,680 EACH STUDY SITE AS WELL AS 4435 03:28:07,680 --> 03:28:12,680 LINEAR UNITS PER 1 DEGREE 4436 03:28:12,680 --> 03:28:18,520 CELSIUS IN CROSSOVER MODELS. 4437 03:28:18,520 --> 03:28:22,200 JUST TO GIVE YOU A SCHEMATIC. 4438 03:28:22,200 --> 03:28:25,560 THE FIRST ARM YOU SEE GOING DOWN 4439 03:28:25,560 --> 03:28:27,880 WE HAD METEOROLOGY. 4440 03:28:27,880 --> 03:28:30,800 THIS IS WHERE THE WEATHER PLAYS 4441 03:28:30,800 --> 03:28:32,280 AND FORECASTING MODEL BUT ALL 4442 03:28:32,280 --> 03:28:34,440 SORTS OF METEOR LOGIC DATA FEEDS 4443 03:28:34,440 --> 03:28:35,200 IN THE MODEL. 4444 03:28:35,200 --> 03:28:39,440 ON THE OTHER STREAM OF INPUTS WE 4445 03:28:39,440 --> 03:28:41,240 HAVE THE NATIONAL EMISSION 4446 03:28:41,240 --> 03:28:43,560 INVENTORY FROM THE EPA AND THOSE 4447 03:28:43,560 --> 03:28:49,040 ALSO FEED INTO THE MODEL. 4448 03:28:49,040 --> 03:28:51,760 WE HAVE EVERY HOUR FROM 10 YEARS 4449 03:28:51,760 --> 03:28:53,480 THE METEOROLOGICAL DATA AND 4450 03:28:53,480 --> 03:28:57,040 EMISSIONS DATA. 4451 03:28:57,040 --> 03:28:58,960 THAT'S THE FIRST STAGE OF THE 4452 03:28:58,960 --> 03:29:01,800 MODELS, ONCE WE GET THE 4453 03:29:01,800 --> 03:29:03,760 PREDICTED HOURLY LEVELS FOR THE 4454 03:29:03,760 --> 03:29:07,040 POLLUTANTS WE CORRECT THE MODEL 4455 03:29:07,040 --> 03:29:08,560 FOR REAL TIME MONITORING DATA 4456 03:29:08,560 --> 03:29:11,240 FROM THE AIR QUALITY SYSTEM AND 4457 03:29:11,240 --> 03:29:14,920 ALSO LOOKING AT THINGS LIKE 4458 03:29:14,920 --> 03:29:17,480 PROXIMITY TO MAJOR ROADWAYS AND 4459 03:29:17,480 --> 03:29:19,080 DID INPUTS RELATED TO WILDFIRES 4460 03:29:19,080 --> 03:29:21,320 AND WE ADJUSTED THE 4461 03:29:21,320 --> 03:29:22,920 CONCENTRATIONS IN THE MODEL DATA 4462 03:29:22,920 --> 03:29:26,800 FOR THOSE EXPOSURE ESTIMATESES. 4463 03:29:26,800 --> 03:29:28,320 -- ESTIMATES. 4464 03:29:28,320 --> 03:29:37,080 WHEN YOU'RE THINKING ABOUT WHAT 4465 03:29:37,080 --> 03:29:38,800 THOSE IPOLLUTION LEVEL IS TELLIG 4466 03:29:38,800 --> 03:29:42,520 YOU THE MEDICAL RECORDS WERE ALL 4467 03:29:42,520 --> 03:29:45,040 DE-IDENTIFIED AND WE AVERAGE UP 4468 03:29:45,040 --> 03:29:47,240 ALL THE AVERAGE HOURLY LEVELS 4469 03:29:47,240 --> 03:29:50,080 OVER THE HOSPITAL REFERRAL 4470 03:29:50,080 --> 03:29:50,680 REGION. 4471 03:29:50,680 --> 03:29:53,480 SOMETIMES AVERAGED INTO DAYS. 4472 03:29:53,480 --> 03:29:55,680 OTHER TIMES AVERAGED INTO 4473 03:29:55,680 --> 03:29:58,920 TRIMESTERS OR THE WHOLE 4474 03:29:58,920 --> 03:30:00,320 PREGNANCY AVERAGE BASED ON THOSE 4475 03:30:00,320 --> 03:30:04,440 HOURLY MEASUREMENTS. 4476 03:30:04,440 --> 03:30:06,800 THE CONSORTIUM ON SAFE LABOR WE 4477 03:30:06,800 --> 03:30:09,160 SAW 12 SITES AND 19 HOSPITALS 4478 03:30:09,160 --> 03:30:10,360 WITH 15 HOSPITAL REFERRAL 4479 03:30:10,360 --> 03:30:10,600 REGIONS. 4480 03:30:10,600 --> 03:30:13,240 THE CONSECUTIVE PREGNANCY STUDY 4481 03:30:13,240 --> 03:30:17,440 WAS IN UTAH MOST OF IT IN THE 4482 03:30:17,440 --> 03:30:19,560 UTAH INTERMOUNTAIN HEALTH CARE 4483 03:30:19,560 --> 03:30:21,840 SYSTEM AND HAD 20 HOSPITALS 4484 03:30:21,840 --> 03:30:22,120 THERE. 4485 03:30:22,120 --> 03:30:27,280 ALL OF THE EXPOSURES WERE 4486 03:30:27,280 --> 03:30:29,520 WEIGHTED FOR POPULATION FOR 4487 03:30:29,520 --> 03:30:31,120 POPULATION DENSITY AND IF THEY 4488 03:30:31,120 --> 03:30:32,120 WERE IN THE HOSPITAL REFERRAL 4489 03:30:32,120 --> 03:30:36,960 REGION THAT WERE A LAKE OR WATER 4490 03:30:36,960 --> 03:30:38,680 OR SOMETHING THAT DIDN'T COUNT. 4491 03:30:38,680 --> 03:30:40,760 THEY WERE WEIGHTED. 4492 03:30:40,760 --> 03:30:41,920 AREAS WHERE POPULATION WAS MORE 4493 03:30:41,920 --> 03:30:44,200 DENSE IT WEIGHTED UP. 4494 03:30:44,200 --> 03:30:47,040 WE ALSO DID INVERSE DISTANCE 4495 03:30:47,040 --> 03:30:50,760 WEIGHTING ON THE MONITOR DATA 4496 03:30:50,760 --> 03:30:53,480 FOR THE CRITERIA AIR POLLUTANTS 4497 03:30:53,480 --> 03:30:56,880 AND THE AMBIENT WEATHER CAME 4498 03:30:56,880 --> 03:30:58,040 FROM THE RESEARCHING MODEL. 4499 03:30:58,040 --> 03:30:59,480 SO I'M GOING SHOW DATA FROM 4500 03:30:59,480 --> 03:31:03,200 THREE TIMES OF STUDY DESIGNS. 4501 03:31:03,200 --> 03:31:07,440 THE FIRST TWO ARE COHORT OR CASE 4502 03:31:07,440 --> 03:31:08,280 CONTROL STUDIES WHERE WE COMPARE 4503 03:31:08,280 --> 03:31:11,000 THE PREGNANCIES AND PREGNANT 4504 03:31:11,000 --> 03:31:13,600 PEOPLE WITH THE ADVERSE OUTCOMES 4505 03:31:13,600 --> 03:31:16,840 TO THOSE OUTTHE ADVERSE OUTCOME. 4506 03:31:16,840 --> 03:31:19,720 TO SEE IF THE EXPOSURE IS MORE 4507 03:31:19,720 --> 03:31:20,520 COMMON IN THOSE WITH THE 4508 03:31:20,520 --> 03:31:24,640 OUTCOME. 4509 03:31:24,640 --> 03:31:27,800 SO THIS IS ESSENTIALLY THE MODEL 4510 03:31:27,800 --> 03:31:29,360 USED FOR CHRONIC EFFECT AND 4511 03:31:29,360 --> 03:31:30,400 ANSWERS THE QUESTION WHY THIS 4512 03:31:30,400 --> 03:31:32,800 PERSON, WHY THIS PREGNANCY AND 4513 03:31:32,800 --> 03:31:33,080 NOT ANOTHER. 4514 03:31:33,080 --> 03:31:35,240 THAT WOULD BE THE FIRST TWO 4515 03:31:35,240 --> 03:31:35,480 MODELS. 4516 03:31:35,480 --> 03:31:39,920 ONE IS THE WHOLE PREGNANCY 4517 03:31:39,920 --> 03:31:40,960 CHRONIC ANALYSIS WHERE WE LOOKED 4518 03:31:40,960 --> 03:31:43,880 AT EVERYONE'S PREGNANCY AND IF 4519 03:31:43,880 --> 03:31:46,200 THEY WERE IN THE UPPER OR LOWER 4520 03:31:46,200 --> 03:31:49,720 10th PERCENTILE OF TEMPERATURE 4521 03:31:49,720 --> 03:31:52,440 FOR THEIR CITY, HOSPITAL 4522 03:31:52,440 --> 03:31:57,640 REFERRAL REGION, THEN WE CALLED 4523 03:31:57,640 --> 03:31:59,240 THAT COLD ORE HOT AND COMPARED 4524 03:31:59,240 --> 03:32:02,640 THE PREGNANCIES TO THE 10th OR 4525 03:32:02,640 --> 03:32:05,480 90th PERCENTILE OR MODERATE 4526 03:32:05,480 --> 03:32:07,200 LEVEL AND SECONDLY DID CASE 4527 03:32:07,200 --> 03:32:08,920 CONTROL STUDIES BECAUSE SOME OF 4528 03:32:08,920 --> 03:32:11,200 THE STILL BIRTH CASES ACTUALLY 4529 03:32:11,200 --> 03:32:17,320 HAVE SHORTER GESTATIONS SO WE 4530 03:32:17,320 --> 03:32:18,160 COMPARED THE WHOLE TEMPERATURE 4531 03:32:18,160 --> 03:32:21,240 FOR CASE PREGNANCY TO FOUR 4532 03:32:21,240 --> 03:32:22,080 CONTROL PREGNANCIES THAT WERE 4533 03:32:22,080 --> 03:32:24,240 ONGOING AT THE TIME OF THE STILL 4534 03:32:24,240 --> 03:32:26,840 BIRTH SO THEY WERE TRUNCATED 4535 03:32:26,840 --> 03:32:28,040 ESSENTIALLY AT THE GESTATIONAL 4536 03:32:28,040 --> 03:32:29,400 AGE OF THE CASE. 4537 03:32:29,400 --> 03:32:31,440 SO THOSE ARE THE CHRONIC MODELS 4538 03:32:31,440 --> 03:32:33,160 THAT WE LOOKED AT. 4539 03:32:33,160 --> 03:32:38,840 WE ALSO LOOKED AT A CASE 4540 03:32:38,840 --> 03:32:39,600 CROSSOVER ANALYSIS WHICH 4541 03:32:39,600 --> 03:32:41,400 COMPARES EXPOSURE DURING THE 4542 03:32:41,400 --> 03:32:42,320 HAZARD TIME. 4543 03:32:42,320 --> 03:32:44,840 IN THIS CASE THE WEEK PRIOR TO 4544 03:32:44,840 --> 03:32:47,200 DELIVERY TO A CONTROLLED TIME 4545 03:32:47,200 --> 03:32:50,320 AND IN THIS CASE A PERIOD BEFORE 4546 03:32:50,320 --> 03:32:54,160 AND AFTER THAT WEEK PRIOR TO 4547 03:32:54,160 --> 03:32:59,240 DELIVERY FOR THE SAME PERSON. 4548 03:32:59,240 --> 03:33:02,720 SO WE TRIED TO CONTROL FOR THE 4549 03:33:02,720 --> 03:33:04,000 NON-TIME VARYING FACTORS AND 4550 03:33:04,000 --> 03:33:07,560 THIS CONTROLS FOR GENETICS, 4551 03:33:07,560 --> 03:33:11,280 DIET, DISEASE PREDISPOSITION, 4552 03:33:11,280 --> 03:33:12,680 HABITUAL BEHAVIORAL THINGS LIKE 4553 03:33:12,680 --> 03:33:14,680 SMOKING AND WE USED THIS MODEL 4554 03:33:14,680 --> 03:33:18,200 TO LOOK AT ACUTE EFFECTS DID 4555 03:33:18,200 --> 03:33:20,520 SOMETHING IN THE WEEK PRIOR TO 4556 03:33:20,520 --> 03:33:22,080 THE EVENT THAT'S ASSOCIATED WITH 4557 03:33:22,080 --> 03:33:24,240 RISK. 4558 03:33:24,240 --> 03:33:26,640 SO THE QUESTION HERE IS WHY NOW? 4559 03:33:26,640 --> 03:33:29,800 IS IT THE EXPOSURE THAT'S 4560 03:33:29,800 --> 03:33:30,040 DIFFERENT? 4561 03:33:30,040 --> 03:33:31,240 THE EXPOSURE'S THE ONLY THING 4562 03:33:31,240 --> 03:33:37,440 THAT VARIES OVER TIME IN THOSE 4563 03:33:37,440 --> 03:33:39,240 MODE 4564 03:33:39,240 --> 03:33:44,680 MODELS SO THE FIRST DATA WE 4565 03:33:44,680 --> 03:33:47,080 ANALYZED WAS FROM THE CONSORTIUM 4566 03:33:47,080 --> 03:33:49,200 ON SAFE LABOR. 4567 03:33:49,200 --> 03:33:52,480 WHOLE PREGNANCY EXPOSURES AND 4568 03:33:52,480 --> 03:33:53,520 LOOKED AT SITE SPECIFIC CHRONIC 4569 03:33:53,520 --> 03:33:54,600 TEMPERATURE RANKS AND THIS WAS 4570 03:33:54,600 --> 03:33:58,320 IMPORTANT BECAUSE IF YOU RECALL 4571 03:33:58,320 --> 03:34:03,200 FROM THE MAP I SHOWED, WE HAD 4572 03:34:03,200 --> 03:34:05,400 SITES IN FLORIDA AND CALIFORNIA 4573 03:34:05,400 --> 03:34:09,240 AND SITES IN NEW ENGLAND AND 4574 03:34:09,240 --> 03:34:12,240 UTAH SO THERE'S PLACES WE WOULD 4575 03:34:12,240 --> 03:34:14,440 LIKE TO AVOID COMPARING A SITE 4576 03:34:14,440 --> 03:34:16,480 IN NEW ENGLAND AS COLD TO A SITE 4577 03:34:16,480 --> 03:34:17,360 IN MIAMI AS HOT. 4578 03:34:17,360 --> 03:34:24,400 YOU NEEDED TO DO IT FOR EACH 4579 03:34:24,400 --> 03:34:29,320 PARTICULAR SITE ACCOUNT FOR 4580 03:34:29,320 --> 03:34:30,240 LOCAL ACCLIMATION TO YOUR 4581 03:34:30,240 --> 03:34:31,440 GENERAL CLIMATE AND TO AVOID 4582 03:34:31,440 --> 03:34:41,840 COMPARING ACROSS SITES. 4583 03:34:43,280 --> 03:34:46,520 HERE WE LOOKED AT EXTREMES AND 4584 03:34:46,520 --> 03:34:49,120 THE MODELS WERE ADJUSTED FOR A 4585 03:34:49,120 --> 03:34:53,080 SERIES OF CHARACTERISTICS OF THE 4586 03:34:53,080 --> 03:34:56,880 PARENTS, MOTHERS AND BABIES AS 4587 03:34:56,880 --> 03:34:59,880 WELL AS SITE SEASON OF 4588 03:34:59,880 --> 03:35:04,560 CONCEPTION, HUMIDITY, OZONE WAS 4589 03:35:04,560 --> 03:35:06,160 PREVIOUSLY SHOWN TO BE 4590 03:35:06,160 --> 03:35:08,800 ASSOCIATED WITH STILLBIRTH AND 4591 03:35:08,800 --> 03:35:10,840 WE SAW HIGH RISKS ASSOCIATED 4592 03:35:10,840 --> 03:35:17,520 WITH BEING BOTH IN THE COLD OR 4593 03:35:17,520 --> 03:35:19,040 HOT STRATA. 4594 03:35:19,040 --> 03:35:23,240 ODDS RATIOS FROM 3.7 TO 4.75 AND 4595 03:35:23,240 --> 03:35:24,920 THE ATTRIBUTABLE RISK, HOW MANY 4596 03:35:24,920 --> 03:35:27,520 STILLBIRTHS ANNUALLY IN THE 4597 03:35:27,520 --> 03:35:29,840 U.S. COULD BE ASSOCIATED WITH 4598 03:35:29,840 --> 03:35:30,720 THOSE TEMPERATURES WERE ABOUT 4599 03:35:30,720 --> 03:35:36,000 1,000 CASES IN BOTH THE COLD AND 4600 03:35:36,000 --> 03:35:43,200 WARM SEASONS OF EACH YEAR SO A 4601 03:35:43,200 --> 03:35:45,720 SUBSTANTIAL NUMBER OF DEATHS 4602 03:35:45,720 --> 03:35:47,200 ASSOCIATED POTENTIALLY WITH 4603 03:35:47,200 --> 03:35:51,880 EXTREME HEAT AND COLD. 4604 03:35:51,880 --> 03:35:54,640 WHEN WE DID THE CASE CROSSOVER 4605 03:35:54,640 --> 03:35:57,280 WE'RE WE'RE LOOKING ACUTE 4606 03:35:57,280 --> 03:35:59,240 AFFECTS IN THE DAYS PRIOR TO 4607 03:35:59,240 --> 03:36:04,320 DELIVERY AND FOR EACH 1 DEGREE 4608 03:36:04,320 --> 03:36:05,280 CELSIUS INCREASE IN THE WARM 4609 03:36:05,280 --> 03:36:08,480 SEASON WE SAW A 6% INCREASE IN 4610 03:36:08,480 --> 03:36:10,440 STILLBIRTH ABOUT FOUR ADDITIONAL 4611 03:36:10,440 --> 03:36:12,360 CASES PER 10,000 BIRTHS. 4612 03:36:12,360 --> 03:36:17,360 IN THE CONSORTIUM ON SAFE LABOR 4613 03:36:17,360 --> 03:36:21,840 WE DID NOT SEE AN ACUTE 4614 03:36:21,840 --> 03:36:23,520 ASSOCIATION WITH COLD. 4615 03:36:23,520 --> 03:36:27,240 SO WE LOOKED AT THE NICHD 4616 03:36:27,240 --> 03:36:30,640 CONSECUTIVE PREGNANCY STUDY. 4617 03:36:30,640 --> 03:36:35,040 THIS STUDY DESIGN WAS SIMILAR TO 4618 03:36:35,040 --> 03:36:37,640 THE CONSORTIUM ON SAFE LABOR AND 4619 03:36:37,640 --> 03:36:39,200 INCLUDES WOMEN WITH MORE THAN 4620 03:36:39,200 --> 03:36:41,520 ONE DELIVERY. 4621 03:36:41,520 --> 03:36:43,560 AND ALL OF THE SITES WERE IN 4622 03:36:43,560 --> 03:36:46,120 UTAH SO HERE'S A PICTURE OF 4623 03:36:46,120 --> 03:36:48,520 WHERE THE HOSPITALS WERE AND IF 4624 03:36:48,520 --> 03:36:52,000 YOU COULD ADVANCE ONE MORE TIME 4625 03:36:52,000 --> 03:36:53,760 AS WELL AS HOSPITALS IN THE SALT 4626 03:36:53,760 --> 03:36:55,000 LAKE CITY REGION. 4627 03:36:55,000 --> 03:36:56,880 YOU CAN SEE THE SMALLER BOX WITH 4628 03:36:56,880 --> 03:36:59,240 THE RED DOTS IS EXPLODED IN THE 4629 03:36:59,240 --> 03:37:06,720 UPPER PICTURE. 4630 03:37:06,720 --> 03:37:10,080 THEY HAD AT LEAST TWO DELIVERIES 4631 03:37:10,080 --> 03:37:12,920 AND LOW-RISK WOMEN. 4632 03:37:12,920 --> 03:37:16,520 IN THE CONSORTIUM ON SAFE LABOR 4633 03:37:16,520 --> 03:37:20,280 IT WAS A NATIONWIDE COHORT. 4634 03:37:20,280 --> 03:37:22,800 THERE WAS A LOT MORE ADVERSE 4635 03:37:22,800 --> 03:37:25,760 OUTCOMES IN THE CSL AND AS AN 4636 03:37:25,760 --> 03:37:27,800 EXAMPLE THE PRETERM DELIVERY 4637 03:37:27,800 --> 03:37:29,440 RATE IN THE CONSECUTIVE 4638 03:37:29,440 --> 03:37:30,040 PREGNANCY STUDY WAS LESS THAN 4639 03:37:30,040 --> 03:37:33,680 6%. 4640 03:37:33,680 --> 03:37:36,680 IT WAS MORE THAN 11% IN THE 4641 03:37:36,680 --> 03:37:37,360 CONSORTIUM ON SAFE LABOR. 4642 03:37:37,360 --> 03:37:39,880 IT WAS A SET OF LOW-RISK WOMEN. 4643 03:37:39,880 --> 03:37:43,160 WE HAD ABOUT 50,000 WOMEN, 4644 03:37:43,160 --> 03:37:47,120 114,000 SINGLETONS AGAIN ALMOST 4645 03:37:47,120 --> 03:37:48,360 500 STILLBIRTHS. 4646 03:37:48,360 --> 03:37:51,200 SAME LINKAGE TO THE AIR 4647 03:37:51,200 --> 03:37:53,520 POLLUTION MODELS AND TEMPERATURE 4648 03:37:53,520 --> 03:37:55,760 MODELS BY HOSPITAL AND WE DID 4649 03:37:55,760 --> 03:37:58,800 THE SAME CHRONIC COHORT CASE 4650 03:37:58,800 --> 03:38:00,880 CONTROL MODELS AND ALSO THE 4651 03:38:00,880 --> 03:38:08,840 ACUTE CASE CROSSOVER MODELS. 4652 03:38:08,840 --> 03:38:10,840 BECAUSE THEY WERE SIMILAR IN 4653 03:38:10,840 --> 03:38:14,360 DESIGN AND ONLY DIFFERENT IN 4654 03:38:14,360 --> 03:38:16,480 TERMS OF THE POPULATION STUDY, 4655 03:38:16,480 --> 03:38:18,760 WE COMPARED THE RESULTS WE GOT 4656 03:38:18,760 --> 03:38:22,280 FROM THE CONSORTIUM ON SAFE 4657 03:38:22,280 --> 03:38:24,160 LABOR AND HERE YOU'LL SEE THOSE 4658 03:38:24,160 --> 03:38:26,600 IN THE GRAY BARS AND WITH THE 4659 03:38:26,600 --> 03:38:29,000 LIGHTER COLORED DOTS IN THE 4660 03:38:29,000 --> 03:38:32,600 MIDDLE OF THE EFFECT ESTIMATES 4661 03:38:32,600 --> 03:38:35,520 TO THE CONSECUTIVE STUDY THE 4662 03:38:35,520 --> 03:38:37,040 DARKER COLORED DOTS IN THE WHITE 4663 03:38:37,040 --> 03:38:39,240 BARS AND YOU CAN SEE THAT FOR 4664 03:38:39,240 --> 03:38:41,920 BOTH THE WHOLE PREGNANCY CHRONIC 4665 03:38:41,920 --> 03:38:45,920 ANALYSIS AND FOR THE CASE 4666 03:38:45,920 --> 03:38:47,400 CONTROL ANALYSIS THE RESULTS FOR 4667 03:38:47,400 --> 03:38:50,520 THE CONSECUTIVE PREGNANCY STUDY 4668 03:38:50,520 --> 03:38:52,280 WERE VERY SIMILAR OR SOMETIMES 4669 03:38:52,280 --> 03:38:53,520 HIGHER. 4670 03:38:53,520 --> 03:38:57,040 SO THE RISKS WERE HIGHER IN THE 4671 03:38:57,040 --> 03:38:59,000 LOW-RISK POPULATION THAN WE HAD 4672 03:38:59,000 --> 03:39:00,560 OBSERVED IN THE NATIONWIDE 4673 03:39:00,560 --> 03:39:02,760 STUDY. 4674 03:39:02,760 --> 03:39:04,080 SO THAT AGAIN REALLY SURPRISED 4675 03:39:04,080 --> 03:39:04,960 US. 4676 03:39:04,960 --> 03:39:09,640 SO WHEN WE LOOKED FOR EXAMPLE WE 4677 03:39:09,640 --> 03:39:12,200 WERE SEEING STILL ODDS RATIO IN 4678 03:39:12,200 --> 03:39:15,400 THE 4 TO 5 RANGE BUT ALSO IN THE 4679 03:39:15,400 --> 03:39:17,400 6 TO 7 RANGE FOR THE CASE 4680 03:39:17,400 --> 03:39:19,560 CONTROL ANALYSIS. 4681 03:39:19,560 --> 03:39:21,800 THAT WAS IN THE CONSECUTIVE 4682 03:39:21,800 --> 03:39:27,680 PREGNANCY STUDY. 4683 03:39:27,680 --> 03:39:29,080 SIMILARLY IN THE ACUTE MODEL 4684 03:39:29,080 --> 03:39:30,800 WHERE WE LOOK AT THE DAYS PRIOR 4685 03:39:30,800 --> 03:39:33,120 TO DELIVERY, FOR THE WARM SEASON 4686 03:39:33,120 --> 03:39:35,480 WE SAW SOMETHING FAIRLY SIMILAR 4687 03:39:35,480 --> 03:39:40,440 BETWEEN THE CONSECUTIVE 4688 03:39:40,440 --> 03:39:42,160 PREGNANCY STUDY AND THE 4689 03:39:42,160 --> 03:39:44,240 CONSORTIUM ON SAFE LABOR BUT IN 4690 03:39:44,240 --> 03:39:47,240 THE COLD SEASON WHERE WE DIDN'T 4691 03:39:47,240 --> 03:39:53,080 OBSERVE A RISK WE DID OBSERVE A 4692 03:39:53,080 --> 03:39:54,480 RISK OF 6% INCREASE IN THE 4693 03:39:54,480 --> 03:40:03,640 CONSECUTIVE PREGNANCY STUDY. 4694 03:40:03,640 --> 03:40:05,760 WHEN WE MOVED TO AIR POLLUTION 4695 03:40:05,760 --> 03:40:09,680 AND STILLBIRTH WE LOOKED AT 4696 03:40:09,680 --> 03:40:11,760 CHRONIC EXPOSURE AND WERE 4697 03:40:11,760 --> 03:40:14,000 INTERESTED IN THE PREGNANCY AND 4698 03:40:14,000 --> 03:40:16,800 INTERESTED IN FIRST TRIMESTER 4699 03:40:16,800 --> 03:40:17,520 AVERAGES. 4700 03:40:17,520 --> 03:40:22,440 FIRST TRIMESTER AIR POLLUTION IS 4701 03:40:22,440 --> 03:40:24,880 ASSOCIATED WITH SEVERAL ADVERSE 4702 03:40:24,880 --> 03:40:26,240 OUTCOMES LIKE PRE TERM BIRTH AND 4703 03:40:26,240 --> 03:40:34,040 THE THOUGHT IS IT'S RELATED TO 4704 03:40:34,040 --> 03:40:39,200 POOR PLACENTATION AND WITH THE 4705 03:40:39,200 --> 03:40:43,200 MOTION THERE MAY BE TRIGGERING 4706 03:40:43,200 --> 03:40:47,200 EVENTS THAT SAY, OKAY, HERE'S 4707 03:40:47,200 --> 03:40:50,560 THE ACUTE EXPOSURE ASSOCIATED 4708 03:40:50,560 --> 03:40:52,080 WITH A PREGNANCY LOSS. 4709 03:40:52,080 --> 03:40:55,560 THE FINAL MODELS WERE ADJUSTED 4710 03:40:55,560 --> 03:41:00,960 FOR A LOT OF MATERNAL VARIABLES 4711 03:41:00,960 --> 03:41:02,400 INCLUDING STUDY SITE, YEAR OF 4712 03:41:02,400 --> 03:41:05,960 BIRTH, HERE WE'RE LOOKING AT AIR 4713 03:41:05,960 --> 03:41:07,200 POLLUTION WE ADJUST FOR 4714 03:41:07,200 --> 03:41:11,200 TEMPERATURE AS WELL AS SEASON OF 4715 03:41:11,200 --> 03:41:21,400 CONCEPTION. 4716 03:41:27,880 --> 03:41:29,080 WE FOUND CONSISTENT RISK AND 4717 03:41:29,080 --> 03:41:31,840 DIDN'T SEE IT WITH OTHER AIR 4718 03:41:31,840 --> 03:41:32,120 POLLUTANTS. 4719 03:41:32,120 --> 03:41:33,800 BECAUSE WE HAD DONE ANOTHER 4720 03:41:33,800 --> 03:41:36,520 STUDY LOOKING AT EARLIER 4721 03:41:36,520 --> 03:41:40,080 PREGNANCY LOSS AND THERE AS WELL 4722 03:41:40,080 --> 03:41:46,040 WE SAW RISKED WITH OZONE. 4723 03:41:46,040 --> 03:41:50,640 IT'S AN OXIDATIVE STRESS IT'S 4724 03:41:50,640 --> 03:41:52,520 IMPORTANT FOR THIS EXPOSURE 4725 03:41:52,520 --> 03:41:54,320 OUTCOME RELATIONSHIP AND YOU CAN 4726 03:41:54,320 --> 03:41:56,000 SEE WHEN YOU LOOK AT THE 4727 03:41:56,000 --> 03:41:58,440 EXPOSURE WINDOWS WE STUDY THAT 4728 03:41:58,440 --> 03:42:01,760 THE RISKS WERE NOT ON THE DAY OF 4729 03:42:01,760 --> 03:42:04,480 DELIVERY OR THE DAY BEFORE AND 4730 03:42:04,480 --> 03:42:06,880 THAT REALLY FITS WITH THE MODEL 4731 03:42:06,880 --> 03:42:09,680 THAT WE'RE THINKING ABOUT THESE 4732 03:42:09,680 --> 03:42:12,600 RISKS EVEN FOR TRIGGERING OR 4733 03:42:12,600 --> 03:42:14,880 ACUTE EVENT SINCE 90% OF THE 4734 03:42:14,880 --> 03:42:20,560 STILL BIRTHS WERE ANTE-PARTUM. 4735 03:42:20,560 --> 03:42:23,080 IT MAKES SENSE THE RISKED WOULD 4736 03:42:23,080 --> 03:42:28,280 BE BACKED OFF AND SAW A 22% 4737 03:42:28,280 --> 03:42:30,880 INCREASE IN RISK IN THE WEEK 4738 03:42:30,880 --> 03:42:33,040 PRIOR TO DELIVERY AND SAW 4739 03:42:33,040 --> 03:42:34,160 SIGNIFICANT INCREASE OF 18% FOR 4740 03:42:34,160 --> 03:42:37,880 FIRST TRIMESTER OZONE AND NEARLY 4741 03:42:37,880 --> 03:42:40,440 40% INCREASED RISK FOR WHOLE 4742 03:42:40,440 --> 03:42:48,920 PREGNANCY EXPOSURE TO OZONE. 4743 03:42:48,920 --> 03:42:51,360 AND ABOUT 8,000 STILL BIRTHS PER 4744 03:42:51,360 --> 03:42:55,400 YEAR COULD BE ATTRIBUTED TO 4745 03:42:55,400 --> 03:43:00,160 OZONE EXPOSURE. 4746 03:43:00,160 --> 03:43:03,040 I JUST WANTED TO INTRODUCE A FEW 4747 03:43:03,040 --> 03:43:06,080 THINGS THINKING ABOUT WE DON'T 4748 03:43:06,080 --> 03:43:08,560 HAVE CAUSE OF DEATH DATA BUT WE 4749 03:43:08,560 --> 03:43:11,520 CAN THINK ABOUT MECHANISTICALLY 4750 03:43:11,520 --> 03:43:15,200 WHAT MAY BE HAPPENING. 4751 03:43:15,200 --> 03:43:26,040 WE KNOW AIR PLUS -- POLLUTANTS 4752 03:43:27,280 --> 03:43:29,560 ARE ASSOCIATED WITH ADVERSE 4753 03:43:29,560 --> 03:43:32,600 HEALTH AFFECTS AND THE CHRONIC 4754 03:43:32,600 --> 03:43:36,000 EXPOSURES LEAD TO A CASCADE OF 4755 03:43:36,000 --> 03:43:38,040 POORER OUTCOMES THAT CAN BE 4756 03:43:38,040 --> 03:43:39,560 ASSOCIATED WITH STILLBIRTH AT 4757 03:43:39,560 --> 03:43:40,680 THEN. 4758 03:43:40,680 --> 03:43:45,080 AT THE END. 4759 03:43:45,080 --> 03:43:50,160 AND THEN ALSO TEMPERATURE 4760 03:43:50,160 --> 03:43:51,800 STRESS. 4761 03:43:51,800 --> 03:43:54,360 PREGNANT PEOPLE CAN THERMO 4762 03:43:54,360 --> 03:43:55,240 REGULATE. 4763 03:43:55,240 --> 03:43:56,000 THERE'S TEMPERATURE STRESS OUGHT 4764 03:43:56,000 --> 03:43:59,200 TO BE MANAGEABLE BUT WE DO KNOW 4765 03:43:59,200 --> 03:44:02,480 IN EXTREMES OF TEMPERATURES, 4766 03:44:02,480 --> 03:44:03,040 PARTICULARLY EXTREME HEAT 4767 03:44:03,040 --> 03:44:04,920 THERE'S A LOT OF PROCESSES THAT 4768 03:44:04,920 --> 03:44:09,440 CAN HARM THE FETUS OR PREGNANT 4769 03:44:09,440 --> 03:44:12,040 PERSON LIKE REDUCTION IN 4770 03:44:12,040 --> 03:44:14,840 PLACENTAL BLOOD FLOW AND 4771 03:44:14,840 --> 03:44:19,440 INFLAMMATORY RESPONSES, 4772 03:44:19,440 --> 03:44:25,880 HYPERCOAGULATABILITY AND 4773 03:44:25,880 --> 03:44:27,200 INTERFERING WITH PLACENTAL BLOOD 4774 03:44:27,200 --> 03:44:29,520 FLOW AND OTHER STRESSORS IN THE 4775 03:44:29,520 --> 03:44:35,520 BODY. 4776 03:44:35,520 --> 03:44:37,120 MOVING FROM THE AIR POLLUTION 4777 03:44:37,120 --> 03:44:40,440 AND TEMPERATURE TO LOOK AT 4778 03:44:40,440 --> 03:44:41,000 RESIDENTIAL SEGREGATION. 4779 03:44:41,000 --> 03:44:45,360 THESE DATA ARE ALSO FROM THE 4780 03:44:45,360 --> 03:44:48,120 CONSORTIUM ON SAFE LABOR AS WAS 4781 03:44:48,120 --> 03:44:49,640 NOTED EARLIER WE SAW STILLBIRTH 4782 03:44:49,640 --> 03:44:51,880 RATES IN OUR DATA TWO TO THREE 4783 03:44:51,880 --> 03:44:54,320 TIMES HIGHER FOR BLACK MOTHERS, 4784 03:44:54,320 --> 03:44:57,600 6.7 DEATHS VERSUS 2.9 DEATHS PER 4785 03:44:57,600 --> 03:45:01,960 1,000 DELIVERIES AND WE LOOKED 4786 03:45:01,960 --> 03:45:04,960 AT TWO MEASURES OF SEGREGATION. 4787 03:45:04,960 --> 03:45:06,960 THE ISOLATION INDEX WHICH IS 4788 03:45:06,960 --> 03:45:10,520 INDEX THAT PREDICTS A MEMBER OF 4789 03:45:10,520 --> 03:45:11,880 ONE RACIAL GROUP WITH INTERACT 4790 03:45:11,880 --> 03:45:14,520 WITH A MEMBER OF THE SAME RACIAL 4791 03:45:14,520 --> 03:45:17,240 GROUP AND THEN THE DISSIMILARITY 4792 03:45:17,240 --> 03:45:20,040 INDEX A DISTRIBUTION OF BLACK 4793 03:45:20,040 --> 03:45:23,240 AND WHITE POPULATIONS IN THE 4794 03:45:23,240 --> 03:45:29,200 HOSPITAL REFERRAL REGION. 4795 03:45:29,200 --> 03:45:32,520 AND LOOKING AT THE CENSUS FROM 4796 03:45:32,520 --> 03:45:36,920 1990 TO 2000 AND THE COMMUNITY 4797 03:45:36,920 --> 03:45:39,200 SURVEY AND THE CONSORTIUM ON 4798 03:45:39,200 --> 03:45:41,560 SAFE LABOR DATA WAS FROM 2002 TO 4799 03:45:41,560 --> 03:45:50,200 2008. 4800 03:45:50,200 --> 03:45:53,320 WE FOUND LOWER SEGREGATION HAS 4801 03:45:53,320 --> 03:45:56,440 MORE BENEFIT FOR BLACK MOTHERS. 4802 03:45:56,440 --> 03:45:57,560 FOR CURRENT SEGREGATION SO 4803 03:45:57,560 --> 03:46:01,040 CURRENT AT THE TIME OF THE BIRTH 4804 03:46:01,040 --> 03:46:02,240 AND PERSISTENT SEGREGATION, 4805 03:46:02,240 --> 03:46:05,520 GOING BACK IN TIME AND LOOKING 4806 03:46:05,520 --> 03:46:11,440 AT AREAS THAT WERE PERSISTENTLY 4807 03:46:11,440 --> 03:46:13,920 SEGREGATED, BLACK MOTHERS HAD 4808 03:46:13,920 --> 03:46:17,560 SIGNIFICANTLY REDUCED AREAS OF 4809 03:46:17,560 --> 03:46:18,840 STILLBIRTH RISK IN AREAS OF 4810 03:46:18,840 --> 03:46:20,960 SEGREGATION THAT WAS IN A DOSE 4811 03:46:20,960 --> 03:46:21,600 RESPONSE PATTERN. 4812 03:46:21,600 --> 03:46:23,200 THEY HAD A STRONGER POSITIVE 4813 03:46:23,200 --> 03:46:27,240 EFFECT IN THE AREAS THAT HAD THE 4814 03:46:27,240 --> 03:46:30,400 LOWEST SEGREGATION. 4815 03:46:30,400 --> 03:46:32,280 AND RISK WAS LOWERED AS MUCH AS 4816 03:46:32,280 --> 03:46:38,200 80% FOR BLACK WOMEN WHEN THE 4817 03:46:38,200 --> 03:46:39,200 DESEGREGATION DECREASED OVER 4818 03:46:39,200 --> 03:46:39,440 TIME. 4819 03:46:39,440 --> 03:46:41,320 WHITE MOTHERS HAD SOME BENEFIT 4820 03:46:41,320 --> 03:46:43,120 OF LIVING IN AREAS OF LOW 4821 03:46:43,120 --> 03:46:45,360 SEGREGATION BUT IT WAS NOT 4822 03:46:45,360 --> 03:46:45,680 CONSISTENT. 4823 03:46:45,680 --> 03:46:47,560 SO WHITE MOTHERS HAD NO 4824 03:46:47,560 --> 03:46:50,360 INCREASED RISKS, SOME SPORADIC 4825 03:46:50,360 --> 03:46:51,200 BENEFITS BUT NO CONSISTENT 4826 03:46:51,200 --> 03:46:57,200 BENEFIT AND WHEN WE DID THE 4827 03:46:57,200 --> 03:46:59,240 ATTRIBUTABLE RISK MODEL WE SAW 4828 03:46:59,240 --> 03:47:00,640 REDUCING SEGREGATION CAN RESULT 4829 03:47:00,640 --> 03:47:03,880 IN 900 FEWER STILL BIRTHS PER 4830 03:47:03,880 --> 03:47:06,680 YEAR YOUNG BLACK BUT NO 4831 03:47:06,680 --> 03:47:11,200 SIGNIFICANT CHANGE IN STILL 4832 03:47:11,200 --> 03:47:12,960 BIRTH DEATHS AMONG WHITES. 4833 03:47:12,960 --> 03:47:14,520 SO WHEN WE'RE THINKING ABOUT 4834 03:47:14,520 --> 03:47:15,720 THIS AND THIS IS ACTUALLY 4835 03:47:15,720 --> 03:47:19,200 SIMILAR TO SOME OF THE IDEAS WE 4836 03:47:19,200 --> 03:47:24,720 WERE JUST TALKING ABOUT IN THE 4837 03:47:24,720 --> 03:47:30,040 LAST TALK, WE'RE LOOKING AT 4838 03:47:30,040 --> 03:47:31,360 LARGE POPULATION-BASED STUDIES 4839 03:47:31,360 --> 03:47:34,120 AND SEEING HIGH RISKS FOR 4840 03:47:34,120 --> 03:47:35,640 STILLBIRTH THAT ARE ASSOCIATED 4841 03:47:35,640 --> 03:47:40,080 WITH ENVIRONMENTAL FACTORS. 4842 03:47:40,080 --> 03:47:42,880 INCLUDING AND LOW RISK 4843 03:47:42,880 --> 03:47:43,680 POPULATION SO THERE ARE 4844 03:47:43,680 --> 03:47:47,200 STRESSORS, PHYSIOLOGICAL AND 4845 03:47:47,200 --> 03:47:48,160 PSYCHOLOGICAL THAT IMPACT RISK 4846 03:47:48,160 --> 03:47:50,720 AND SOME OF THESE ARE NOT GOING 4847 03:47:50,720 --> 03:47:53,440 TO GET BETTER ANY TIME SOON. 4848 03:47:53,440 --> 03:47:56,160 SO WE SEE SEGREGATION ACTUALLY 4849 03:47:56,160 --> 03:47:59,200 APPEARS TO BE INCREASING IN THE 4850 03:47:59,200 --> 03:48:00,200 UNITED STATES. 4851 03:48:00,200 --> 03:48:02,000 WE KNOW THAT EXTREMES OF 4852 03:48:02,000 --> 03:48:05,320 TEMPERATURE AND RELATED AIR 4853 03:48:05,320 --> 03:48:06,600 POLLUTION ARE GOING TO GET WORSE 4854 03:48:06,600 --> 03:48:08,600 BECAUSE OF THINGS LIKE CLIMATE 4855 03:48:08,600 --> 03:48:10,680 CHANGE. 4856 03:48:10,680 --> 03:48:12,680 WE SEE WITH CLIMATE CHANGE ALSO 4857 03:48:12,680 --> 03:48:15,920 MORE EXTREME WEATHER EVENTS, 4858 03:48:15,920 --> 03:48:17,560 DROUGHTS, HEAT WAVES AND OTHER 4859 03:48:17,560 --> 03:48:19,760 STRESSORS THAT WE DIDN'T LOOK AT 4860 03:48:19,760 --> 03:48:24,000 HERE LIKE FLOODING, HURRICANES 4861 03:48:24,000 --> 03:48:25,760 AS WELL AS WILDFIRES. 4862 03:48:25,760 --> 03:48:27,920 SO IT IS IMPORTANT WHEN WE'RE 4863 03:48:27,920 --> 03:48:29,320 THINKING ABOUT RISK TO CONSIDER 4864 03:48:29,320 --> 03:48:32,360 THE WHOLE ENVIRONMENT OF 4865 03:48:32,360 --> 03:48:33,440 PREGNANT PEOPLE INCLUDING THE 4866 03:48:33,440 --> 03:48:37,360 SOCIAL CONTEXT, HOUSING QUALITY, 4867 03:48:37,360 --> 03:48:42,000 AND AMBIENT ENVIRONMENTS WHERE 4868 03:48:42,000 --> 03:48:47,200 INDIVIDUALS OFTEN HAVE LITTLE 4869 03:48:47,200 --> 03:48:47,440 CONTROL. 4870 03:48:47,440 --> 03:48:49,040 IN THE CARTOON THINKING ABOUT 4871 03:48:49,040 --> 03:48:54,200 THE NATURAL ENVIRONMENT AND THE 4872 03:48:54,200 --> 03:48:58,200 BUILT AND SOCIAL ENVIRONMENT HOW 4873 03:48:58,200 --> 03:49:01,040 THEY BEHAVE AND INHERENT 4874 03:49:01,040 --> 03:49:02,360 CHARACTERISTICS ARE ALL THINGS 4875 03:49:02,360 --> 03:49:04,680 THAT WORK TOGETHER IN THE 4876 03:49:04,680 --> 03:49:15,200 RELATIONSHIP RELATED TO RISK. 4877 03:49:15,960 --> 03:49:20,200 I'M HAPPY TO TAKE QUESTIONS AND 4878 03:49:20,200 --> 03:49:22,400 MY E-MAIL IS HERE IF PEOPLE WANT 4879 03:49:22,400 --> 03:49:24,360 TO REACH ME ABOUT MORE OF THESE 4880 03:49:24,360 --> 03:49:25,880 OFFLINE AND I LOOK FORWARD TO 4881 03:49:25,880 --> 03:49:27,960 THE DISCUSSION AND THANK YOU 4882 03:49:27,960 --> 03:49:29,560 AGAIN TO THE ORGANIZERS FOR 4883 03:49:29,560 --> 03:49:39,800 INVITING ME. 4884 03:49:53,360 --> 03:50:00,560 >>THANK YOU DR. MENDOLA FOR THE 4885 03:50:00,560 --> 03:50:05,560 PRESENTATION AND IT'S CLEAR WE 4886 03:50:05,560 --> 03:50:07,720 HAVE ETHNIC AND RACIAL 4887 03:50:07,720 --> 03:50:09,760 DISPARITIES AND SOCIAL 4888 03:50:09,760 --> 03:50:10,600 DETERMINATES CONTRIBUTING TO THE 4889 03:50:10,600 --> 03:50:15,440 STILLBIRTHS AND WE NEED TO FIND 4890 03:50:15,440 --> 03:50:17,960 A WAY TO LOOK AT THE DATA AND 4891 03:50:17,960 --> 03:50:18,840 DATA EXPERIENCE IN UNDERSTANDING 4892 03:50:18,840 --> 03:50:29,080 STILL BIRTHS. 4893 03:50:37,760 --> 03:50:41,400 THERE'S A ROLE AND MORE 4894 03:50:41,400 --> 03:50:45,800 CLARIFICATION ABOUT SPECIFICALLY 4895 03:50:45,800 --> 03:50:56,160 THE BLACK POPULATION. 4896 03:51:03,440 --> 03:51:06,320 >>DR. LONGO, WOULD YOU REPEAT 4897 03:51:06,320 --> 03:51:07,200 THE QUESTION. 4898 03:51:07,200 --> 03:51:08,320 I COULDN'T QUITE UNDERSTAND. 4899 03:51:08,320 --> 03:51:11,080 >>THE QUESTION ABOUT IF YOU 4900 03:51:11,080 --> 03:51:14,120 COULD SPECULATE A LITTLE BIT 4901 03:51:14,120 --> 03:51:15,200 MORE ABOUT THE ROLE OF RACISM IN 4902 03:51:15,200 --> 03:51:18,200 THE BLACK COMMUNITY. 4903 03:51:18,200 --> 03:51:19,560 >>THE ROLE OF RACISM? 4904 03:51:19,560 --> 03:51:29,640 YES. 4905 03:51:36,120 --> 03:51:37,640 AND ONE THING WE DISCOVERED IN 4906 03:51:37,640 --> 03:51:40,920 THE CASE CONTROL STUDY WAS THAT 4907 03:51:40,920 --> 03:51:51,360 STRESSFUL LIFE EVENTS, WHICH HAS 4908 03:51:51,360 --> 03:51:53,840 BEEN MEASURED BUT AFFECTS PEOPLE 4909 03:51:53,840 --> 03:51:58,280 IN GENERAL AND I THINK 4910 03:51:58,280 --> 03:52:08,840 ORIGINALLY DEVELOPED AT CDC, WE 4911 03:52:11,240 --> 03:52:16,880 AND WE FOUND THAT INCREASED 4912 03:52:16,880 --> 03:52:23,200 NUMBER OF STRESSFUL LIFE EVENTS 4913 03:52:23,200 --> 03:52:25,680 WAS ASSOCIATED WITH STILLBIRTH 4914 03:52:25,680 --> 03:52:26,160 AT PREGNANCY. 4915 03:52:26,160 --> 03:52:31,040 THERE WAS NO STATISTICAL 4916 03:52:31,040 --> 03:52:31,640 INTERACTION BETWEEN AFRICAN 4917 03:52:31,640 --> 03:52:33,160 AMERICAN, HISPANIC AND WHITE 4918 03:52:33,160 --> 03:52:36,440 WOMEN WITH RESPECT TO THE RISK 4919 03:52:36,440 --> 03:52:39,240 OF STRESSFUL LIFE EVENTS FOR 4920 03:52:39,240 --> 03:52:40,080 STILLBIRTH. 4921 03:52:40,080 --> 03:52:45,120 WHAT WAS STRIKING THOUGH WAS 4922 03:52:45,120 --> 03:52:46,520 THAT THERE WERE FAR MORE 4923 03:52:46,520 --> 03:52:51,720 STRESSFUL LIFE EVENTS IN THE 4924 03:52:51,720 --> 03:52:53,640 LIVES OF AFRICAN AMERICAN WOMEN 4925 03:52:53,640 --> 03:52:55,520 AND THEIR CHANCE WAS INCREASED 4926 03:52:55,520 --> 03:52:58,800 BY THE STRESSFUL LIFE EVENTS 4927 03:52:58,800 --> 03:53:00,040 BECAUSE THEY HAD MORE STRESSFUL 4928 03:53:00,040 --> 03:53:00,800 LIFE EVENTS. 4929 03:53:00,800 --> 03:53:04,440 I THINK THIS IS AN IMPORTANT 4930 03:53:04,440 --> 03:53:05,440 DISTINCTION WHICH ALSO I WAS 4931 03:53:05,440 --> 03:53:09,720 TRYING TO MAKE WITH RESPECT TO 4932 03:53:09,720 --> 03:53:10,600 PRETERM DELIVERY. 4933 03:53:10,600 --> 03:53:21,120 IF THE RISK IS THE SAME, AND IF 4934 03:53:26,600 --> 03:53:28,680 RACISM IS AFFECTING THE 4935 03:53:28,680 --> 03:53:33,160 TRIGGERING OF PRE TERM DELIVERY 4936 03:53:33,160 --> 03:53:36,320 THEN THAT IS IN AFFECT THE 4937 03:53:36,320 --> 03:53:39,320 REASON, THE CAUSE FOR THE 4938 03:53:39,320 --> 03:53:41,600 ASSOCIATION BETWEEN RACISM AND 4939 03:53:41,600 --> 03:53:50,480 STILLBIRTH. 4940 03:53:50,480 --> 03:53:53,120 ONE RISK IS DEPRESSION. 4941 03:53:53,120 --> 03:53:54,760 IN THE SCREEN STUDY WE DID NOT 4942 03:53:54,760 --> 03:53:57,920 ASK ABOUT CURRENT DEPRESSION 4943 03:53:57,920 --> 03:53:59,360 BECAUSE THE WOMEN OF COURSE AT 4944 03:53:59,360 --> 03:54:06,600 THE TIME OF THE DELIVERY WERE 4945 03:54:06,600 --> 03:54:09,320 VERY STRESSED OUT AND KNOW 4946 03:54:09,320 --> 03:54:10,840 REASON TO STRESS THEM FURTHER 4947 03:54:10,840 --> 03:54:11,560 ABOUT THEIR CURRENT SITUATION 4948 03:54:11,560 --> 03:54:12,280 WITH DEPRESSION. 4949 03:54:12,280 --> 03:54:17,280 SO WE WAITED UNTIL THE FOLLOW-UP 4950 03:54:17,280 --> 03:54:25,920 STUDY TO ASK ABOUT HISTORY OF 4951 03:54:25,920 --> 03:54:28,920 DEPRESSION AND THERE WAS A RISK 4952 03:54:28,920 --> 03:54:30,480 FACTOR FOR STILLBIRTH. 4953 03:54:30,480 --> 03:54:31,800 AFRICAN AMERICAN WOMEN ARE AT 4954 03:54:31,800 --> 03:54:33,640 GREATER RISK OF BEING DEPRESSED. 4955 03:54:33,640 --> 03:54:35,200 ONE REASON IS THE NUMBER OF 4956 03:54:35,200 --> 03:54:40,200 STRESSFUL LIFE EVENTS. 4957 03:54:40,200 --> 03:54:44,360 ANOTHER HOWEVER, IS GENDERED 4958 03:54:44,360 --> 03:54:44,600 RACISM. 4959 03:54:44,600 --> 03:54:51,240 I MENTIONED QUICKLY IN PASSING 4960 03:54:51,240 --> 03:54:52,520 THE RACISM MEASURE. 4961 03:54:52,520 --> 03:54:57,800 IN SEPARATE STUDIES WE 4962 03:54:57,800 --> 03:54:59,920 CORRELATED THE ASSOCIATION OF 4963 03:54:59,920 --> 03:55:01,280 INCREASED GENDER RACISM IN 4964 03:55:01,280 --> 03:55:10,680 DEPRESSION IN PREGNANT WOMEN. 4965 03:55:10,680 --> 03:55:15,200 AFRICAN AMERICAN WOMEN ARE UNE 4966 03:55:15,200 --> 03:55:17,600 LIKELY EXPOSED TO CERTAIN KINDS 4967 03:55:17,600 --> 03:55:26,320 OF STRESSORS AND DEVELOPING 4968 03:55:26,320 --> 03:55:28,520 MEASURES OF THE STRESSORS WE 4969 03:55:28,520 --> 03:55:33,920 DEVELOPED THIS OVER A PERIOD OF 4970 03:55:33,920 --> 03:55:38,040 MORE THAN A DECADE AND STARTED 4971 03:55:38,040 --> 03:55:42,080 WITH 68 ITEMS AND NARROWED IT 4972 03:55:42,080 --> 03:55:44,120 DOWN TO ITEMS WHICH CAN BE ASKED 4973 03:55:44,120 --> 03:55:48,920 OF ANYONE BUT TEND TO SHOW A 4974 03:55:48,920 --> 03:55:52,520 MUCH HIRE RACISM INDEX FOR 4975 03:55:52,520 --> 03:55:53,680 AFRICAN AMERICAN WOMEN. 4976 03:55:53,680 --> 03:55:59,240 THIS IS BEING INCORPORATED IN 4977 03:55:59,240 --> 03:56:02,640 SAN FRANCISCO INTO ELECTRONIC 4978 03:56:02,640 --> 03:56:03,760 PRENATAL RECORDS SO WOMEN ARE 4979 03:56:03,760 --> 03:56:08,960 BEING ASKED IN PREGNANCY ABOUT 4980 03:56:08,960 --> 03:56:12,760 THE ITEMS IN THIS SCALE AND IF 4981 03:56:12,760 --> 03:56:13,480 ANYONE'S INTERESTED I CAN 4982 03:56:13,480 --> 03:56:17,600 PROVIDE INFORMATION ABOUT THAT. 4983 03:56:17,600 --> 03:56:22,000 WHAT WE FOUND IS THAT PERCEIVED 4984 03:56:22,000 --> 03:56:23,400 STRESS, WHICH IS ANOTHER MEASURE 4985 03:56:23,400 --> 03:56:26,840 OFTEN USED IN TRYING TO 4986 03:56:26,840 --> 03:56:29,040 DETERMINE RISK FACTORS 4987 03:56:29,040 --> 03:56:31,000 PSYCHOSOCIAL RISK FACTORS FOR 4988 03:56:31,000 --> 03:56:35,600 PREGNANCY OUTCOME, DOES NOT 4989 03:56:35,600 --> 03:56:38,440 REALLY GIVE MUCH ADDITIONAL 4990 03:56:38,440 --> 03:56:40,320 INFORMATION OVER AND ABOVE 4991 03:56:40,320 --> 03:56:43,480 STRESSFUL LIFE EVENTS AND THIS 4992 03:56:43,480 --> 03:56:45,960 MEASURE OF GENDERED RACISM FOR 4993 03:56:45,960 --> 03:56:49,640 THE ASSOCIATION OF THOSE THINGS 4994 03:56:49,640 --> 03:56:50,280 WITH DEPRESSION AFRICAN AMERICAN 4995 03:56:50,280 --> 03:56:58,240 WOMEN. 4996 03:56:58,240 --> 03:57:02,840 IF YOU THINK OF THIS IN A LINEAR 4997 03:57:02,840 --> 03:57:04,480 BASIS THE RACISM INCREASES THE 4998 03:57:04,480 --> 03:57:07,200 RISK OF DEPRESSION AND THEN THE 4999 03:57:07,200 --> 03:57:10,520 DEPRESSION INCREASES THE RISK OF 5000 03:57:10,520 --> 03:57:13,520 EXTREME PRIMA SURE STILL BIRTH. 5001 03:57:13,520 --> 03:57:16,280 >>THANK YOU SO MUCH. 5002 03:57:16,280 --> 03:57:19,120 THANK YOU, THIS IS A WONDERFUL 5003 03:57:19,120 --> 03:57:19,400 EXPLANATION. 5004 03:57:19,400 --> 03:57:29,680 I SEE HANDS UP. 5005 03:57:30,120 --> 03:57:31,200 I WANTED TO ASK FOR ADDITIONAL 5006 03:57:31,200 --> 03:57:32,040 THINGS TO SAY BEFORE WE MOVE 5007 03:57:32,040 --> 03:57:37,960 TOWARDS THE DISCUSSION. 5008 03:57:37,960 --> 03:57:39,200 >>MONICA, LETS TAKE 5009 03:57:39,200 --> 03:57:39,880 DR. DUDLEY'S QUESTION AND THEN I 5010 03:57:39,880 --> 03:57:50,240 HAVE A COUPLE AS WELL. 5011 03:57:54,080 --> 03:57:55,200 >>I HEARD YOU HAD A LITTLE BIT 5012 03:57:55,200 --> 03:57:55,960 OF SNOW. 5013 03:57:55,960 --> 03:58:00,240 MY QUESTION IS ABOUT THE 5014 03:58:00,240 --> 03:58:01,480 MECHANISMS OF THE ASSOCIATION 5015 03:58:01,480 --> 03:58:05,000 AND I THINK YOU'LL ADMIT TO 5016 03:58:05,000 --> 03:58:06,400 SPECULATION IF YOU WERE. 5017 03:58:06,400 --> 03:58:12,400 I KNOW OTHER STUDIES HAVE SHOWN 5018 03:58:12,400 --> 03:58:14,720 POPULATIONS THAT HAVE A SIMILAR 5019 03:58:14,720 --> 03:58:15,480 ASSOCIATION OF STILLBIRTH. 5020 03:58:15,480 --> 03:58:17,320 ARE THERE ANIMAL MODELS THAT 5021 03:58:17,320 --> 03:58:21,520 TRIED TO LOOK AT THIS IN A MORE 5022 03:58:21,520 --> 03:58:23,360 BIO CHEMICAL OR PATHOPHYSIOL 5023 03:58:23,360 --> 03:58:24,760 LOGIC WAY? 5024 03:58:24,760 --> 03:58:26,760 I DON'T KNOW IF THERE'S ANIMAL 5025 03:58:26,760 --> 03:58:32,000 MODELS TO LOOK AT AIR POLLUTION, 5026 03:58:32,000 --> 03:58:33,360 FOR EXAMPLE? 5027 03:58:33,360 --> 03:58:41,720 >>THINGS LIKE LITTER SIZE AND 5028 03:58:41,720 --> 03:58:47,200 IT'S HARD TO LOOK AT STILLBIRTH 5029 03:58:47,200 --> 03:58:50,960 AND PREGNANCY LOSS. 5030 03:58:50,960 --> 03:58:53,600 AND SOME REPRODUCTIVE THINGS 5031 03:58:53,600 --> 03:59:00,200 DON'T TRANSLATE VERY WELL. 5032 03:59:00,200 --> 03:59:03,200 THE TEMPERATURE MODELS ARE NOT 5033 03:59:03,200 --> 03:59:04,800 VERY MUCH DATA AT ALL AND WE 5034 03:59:04,800 --> 03:59:05,800 WERE SHOCKED BY THE LEVEL OF 5035 03:59:05,800 --> 03:59:16,000 RISK WE SAW. 5036 03:59:16,360 --> 03:59:20,160 >>I'D LOVE TO HEAR OMA'S 5037 03:59:20,160 --> 03:59:21,680 COMMENTS AS WELL BUT I'D LIKE TO 5038 03:59:21,680 --> 03:59:23,200 CONGRATULATE ALL OUR SPEAKERS 5039 03:59:23,200 --> 03:59:27,200 FOR OUTSTANDING TALKS, 5040 03:59:27,200 --> 03:59:31,200 DR. HOYERT, DR. HOGUE, 5041 03:59:31,200 --> 03:59:37,080 DR. DEBBINK AND DR. MENDOLA AND 5042 03:59:37,080 --> 03:59:38,480 IT'S TOUGH TO COVER BUT THE 5043 03:59:38,480 --> 03:59:39,600 INFORMATION YOU PROVIDE THE 5044 03:59:39,600 --> 03:59:40,960 PANEL IS PRICELESS. 5045 03:59:40,960 --> 03:59:44,000 I HAVE A QUESTION FOR 5046 03:59:44,000 --> 03:59:48,160 DR. MICHELLE DEBBINK, WHEN YOU 5047 03:59:48,160 --> 03:59:54,880 THINK ABOUT THE VOICES YOU HEARD 5048 03:59:54,880 --> 03:59:57,600 IN UTAH AND YOU LOOK AT THE 5049 03:59:57,600 --> 03:59:59,200 IMPACT OF STRUCTURAL RACISM ON 5050 03:59:59,200 --> 04:00:04,840 THE DELIVERY OF HEALTH CARE, DO 5051 04:00:04,840 --> 04:00:06,760 PATIENTS AND I'M LOOKING AT IT 5052 04:00:06,760 --> 04:00:09,760 FROM THE LENS OF THE MEDICAL 5053 04:00:09,760 --> 04:00:11,640 PROVIDER, THERE ARE ASPECTS OF 5054 04:00:11,640 --> 04:00:15,200 STRUCTURAL RACISM THAT WILL TAKE 5055 04:00:15,200 --> 04:00:18,440 GENERATIONS TO FIX. 5056 04:00:18,440 --> 04:00:21,600 THERE ARE THINGS WE CAN DO IN 5057 04:00:21,600 --> 04:00:23,160 OUR OWN APPROXIMATE CIRCLES 5058 04:00:23,160 --> 04:00:25,720 WHERE GAPS IN DELIVERY CAN BE 5059 04:00:25,720 --> 04:00:25,960 REMOVED. 5060 04:00:25,960 --> 04:00:27,280 HOW DO WE SEPARATE THE TWO AND 5061 04:00:27,280 --> 04:00:31,200 HOW DO BEGIN TO IMPACT THE 5062 04:00:31,200 --> 04:00:35,160 THINGS WE CAN DO IMMEDIATELY? 5063 04:00:35,160 --> 04:00:36,280 >>THANK YOU FOR THE QUESTION. 5064 04:00:36,280 --> 04:00:39,080 IT'S INCREDIBLY IMPORTANT. 5065 04:00:39,080 --> 04:00:42,600 I WOULD SAY THERE ARE A HANDFUL 5066 04:00:42,600 --> 04:00:46,960 OF DIFFERENT AVENUES WE CAN TAKE 5067 04:00:46,960 --> 04:00:49,000 AS HEALTH CARE PROVIDERS AND 5068 04:00:49,000 --> 04:00:50,240 FROM OUR OWN EDUCATION AND 5069 04:00:50,240 --> 04:00:50,520 TRAINING. 5070 04:00:50,520 --> 04:00:51,960 ONE OF WHICH I HAVE THE GREAT 5071 04:00:51,960 --> 04:00:54,120 FORTUNE OF WORKING WITH A 5072 04:00:54,120 --> 04:00:58,160 COLLEGIATE THE UNIVERSITY OF 5073 04:00:58,160 --> 04:00:59,600 UTAH TRANSFORMING SIMULATION 5074 04:00:59,600 --> 04:01:03,200 TRAINING INTO A WAY OF BOTH 5075 04:01:03,200 --> 04:01:05,800 SIMULATING AND THEN SIMULATING 5076 04:01:05,800 --> 04:01:11,200 REPAIR OF CULTURAL RUPTURES AND 5077 04:01:11,200 --> 04:01:14,760 IMPLICIT BIAS AND FROM PROVIDERS 5078 04:01:14,760 --> 04:01:17,560 WHETHER IT'S FROM PROVIDER OR 5079 04:01:17,560 --> 04:01:18,960 IN-PATIENT TRAINING SETTINGS AND 5080 04:01:18,960 --> 04:01:23,000 WE'RE PLANNING WORK TOWARDS 5081 04:01:23,000 --> 04:01:25,040 SIMULATIONS THAT ARE DESIGN TO 5082 04:01:25,040 --> 04:01:27,240 HELP PROVIDERS INTERACT WITH 5083 04:01:27,240 --> 04:01:31,080 PATIENTS IN A WAY THAT CENTERS 5084 04:01:31,080 --> 04:01:33,240 ANTI-BIAS IN PARTICULAR THIS 5085 04:01:33,240 --> 04:01:35,200 UPCOMING SIMULATION WILL BE ON 5086 04:01:35,200 --> 04:01:37,640 STIGMA AND BIAS AROUND SUBSTANCE 5087 04:01:37,640 --> 04:01:40,640 USE DISORDER BUT THERE ARE A 5088 04:01:40,640 --> 04:01:43,000 NUMBER OF GROWING OPPORTUNITIES 5089 04:01:43,000 --> 04:01:43,560 FOR PROVIDERS TO PRACTICE. 5090 04:01:43,560 --> 04:01:47,200 I THINK THAT IS A KEY PIECE OF 5091 04:01:47,200 --> 04:01:48,960 THIS IS TO PRACTICE THE SAME 5092 04:01:48,960 --> 04:01:51,120 WE'D PRACTICE ANYTHING ELSE WE 5093 04:01:51,120 --> 04:01:53,600 DO, BREAKING BAD NEWS OR 5094 04:01:53,600 --> 04:01:59,240 ANYTHING TO PRACTICE HAVING 5095 04:01:59,240 --> 04:02:02,640 RESPECTFUL INTERACTIONS WITH 5096 04:02:02,640 --> 04:02:05,600 THOSE WHO PRACTICE HUMILITY AND 5097 04:02:05,600 --> 04:02:08,880 THE OTHER THING WE CAN DO IS 5098 04:02:08,880 --> 04:02:10,640 LOOKING AT HOW HEALTH DELIVERY 5099 04:02:10,640 --> 04:02:13,080 SYSTEMS OCCURS AS A HEALTH 5100 04:02:13,080 --> 04:02:17,600 SYSTEM AND IN PARTICULAR IN 5101 04:02:17,600 --> 04:02:19,960 ACADEMIC HEALTH SYSTEMS CENTER 5102 04:02:19,960 --> 04:02:23,960 OUR PATIENTS EXPERIENCES MORE 5103 04:02:23,960 --> 04:02:27,200 INTENTIONALLY, MORE OFTEN SO 5104 04:02:27,200 --> 04:02:30,640 BRINGING TOGETHER ADVISORY 5105 04:02:30,640 --> 04:02:35,960 BOARDS WITH REAL TEETH THAT CAN 5106 04:02:35,960 --> 04:02:37,680 INTERACT WITH THE HEALTH CARE 5107 04:02:37,680 --> 04:02:39,880 SYSTEM IN TERMS OF THE DELIVERY 5108 04:02:39,880 --> 04:02:42,280 OF FINANCIAL SERVICE OR HOW 5109 04:02:42,280 --> 04:02:45,280 INSURANCE AND THINGS DO OR HOW 5110 04:02:45,280 --> 04:02:47,000 PATIENTS NAVIGATE THE SYSTEM IN 5111 04:02:47,000 --> 04:02:47,760 ORDER TO ACHIEVE THE OUTCOMES 5112 04:02:47,760 --> 04:02:56,960 THEY DESIRE. 5113 04:02:56,960 --> 04:02:59,200 ONE POTENTIAL ORIENTATION THAT 5114 04:02:59,200 --> 04:03:06,440 IS BENEFICIAL FOR DISRUPTING 5115 04:03:06,440 --> 04:03:08,800 STRUCTURAL AND INTERPERSONAL 5116 04:03:08,800 --> 04:03:10,320 RACISM AND USING A COMMUNITY 5117 04:03:10,320 --> 04:03:13,520 HEALTH WORKER MODEL FOR CARE 5118 04:03:13,520 --> 04:03:15,080 NAVIGATORS YOU INTEGRATE 5119 04:03:15,080 --> 04:03:19,720 INDIVIDUALS FROM THE PATIENT'S 5120 04:03:19,720 --> 04:03:25,160 HOME COMMUNITIES WITH EDUCATION 5121 04:03:25,160 --> 04:03:27,160 AND SYSTEM NAVIGATION STILLS 5122 04:03:27,160 --> 04:03:29,160 THAT ALLOW THE PATIENT TO HAVE 5123 04:03:29,160 --> 04:03:31,200 AUTONOMY TO NAVIGATE OUR QUITE 5124 04:03:31,200 --> 04:03:32,280 OBTUSE SYSTEM THAT LEAVES A LOT 5125 04:03:32,280 --> 04:03:34,400 OF PEOPLE FEELING AS THOUGH 5126 04:03:34,400 --> 04:03:35,800 THEY'RE NOT SURE WHEN TO TURN 5127 04:03:35,800 --> 04:03:37,760 NEXT WHEN THEY'RE NOT SURE ABOUT 5128 04:03:37,760 --> 04:03:39,240 THEIR DIAGNOSIS OR HOW TO 5129 04:03:39,240 --> 04:03:41,040 NAVIGATE THE SYSTEM AND AS WE 5130 04:03:41,040 --> 04:03:43,160 WERE JUST TALKING ABOUT, 5131 04:03:43,160 --> 04:03:45,280 STRUCTURAL RACISM REALLY DEFINES 5132 04:03:45,280 --> 04:03:47,480 THE DISTRIBUTION OF 5133 04:03:47,480 --> 04:03:48,920 OPPORTUNITIES FOR HEALTH AND 5134 04:03:48,920 --> 04:03:50,120 DEFINING THE DISTRIBUTION OF 5135 04:03:50,120 --> 04:03:52,200 OPPORTUNITIES FOR ACCESS TO 5136 04:03:52,200 --> 04:03:54,240 PEOPLE WHO KNOW HOW TO NAVIGATE 5137 04:03:54,240 --> 04:03:54,920 THE SYSTEM. 5138 04:03:54,920 --> 04:03:59,200 ACCESS TO BEING ABLE TO GIVE 5139 04:03:59,200 --> 04:04:08,360 FEEDBACK TO THE SYSTEM. 5140 04:04:08,360 --> 04:04:12,480 AND DISRUPT RACISM WITHIN OUR 5141 04:04:12,480 --> 04:04:12,720 SYSTEMS. 5142 04:04:12,720 --> 04:04:14,560 SEPARATE FROM AND NECESSARY BUT 5143 04:04:14,560 --> 04:04:18,360 INSUFFICIENT AS YOU SAY THE 5144 04:04:18,360 --> 04:04:19,800 OTHER LARGER COMMUNITY 5145 04:04:19,800 --> 04:04:21,120 STRUCTURAL FACTORS WILL TAKE 5146 04:04:21,120 --> 04:04:28,040 DECADES TO UNDUE BUT LIKE THE 5147 04:04:28,040 --> 04:04:28,720 PARABLE OF THE RIVER IT'S ALSO A 5148 04:04:28,720 --> 04:04:38,560 SOLUTION. 5149 04:04:38,560 --> 04:04:41,600 >>ALL FOUR TALKS WERE 5150 04:04:41,600 --> 04:04:42,600 FANTASTIC. 5151 04:04:42,600 --> 04:04:46,320 SO FULL OF INFORMATION AND 5152 04:04:46,320 --> 04:04:48,160 EXCELLENT AND THOUGHT PROVOKING. 5153 04:04:48,160 --> 04:04:49,920 I'D LIKE TO ASK EACH ONE IN 5154 04:04:49,920 --> 04:04:52,040 TERMS OF RESEARCH, WHAT WOULD BE 5155 04:04:52,040 --> 04:04:56,320 YOUR NEXT STEP TO REALLY MAKE AN 5156 04:04:56,320 --> 04:04:56,960 IMPACT ON STILLBIRTH IN THE 5157 04:04:56,960 --> 04:04:59,480 DIFFERENT DOMAINS OF YOUR 5158 04:04:59,480 --> 04:05:00,160 RESEARCH. 5159 04:05:00,160 --> 04:05:02,360 WHAT WOULD BE THE NEXT RESEARCH 5160 04:05:02,360 --> 04:05:05,160 STUDY THAT COULD REALLY HELP 5161 04:05:05,160 --> 04:05:07,200 ELEVATE THE ISSUE IN COMING UP 5162 04:05:07,200 --> 04:05:09,760 WITH SOLUTIONS. 5163 04:05:09,760 --> 04:05:11,840 SO I'LL START WITH DR. HOYERT 5164 04:05:11,840 --> 04:05:12,440 SINCE SHE WENT FIRST FOR THE 5165 04:05:12,440 --> 04:05:22,600 SESSION. 5166 04:05:27,240 --> 04:05:33,120 WE WOULD BE ABLE TO MAKE BETTER 5167 04:05:33,120 --> 04:05:38,840 USE OF THE INFORMATION AND 5168 04:05:38,840 --> 04:05:43,200 LOOKING AT DATA. 5169 04:05:43,200 --> 04:05:48,400 >>SO ADDING ADDITIONAL IN TERMS 5170 04:05:48,400 --> 04:05:51,200 OF RESEARCH ADDITIONAL VARIABLE 5171 04:05:51,200 --> 04:05:53,840 S I'M TRYING TO THINK BIT AS A 5172 04:05:53,840 --> 04:05:54,400 RESEARCH QUESTION. 5173 04:05:54,400 --> 04:05:56,760 SUPPORT FOR FILLING OUT THE 5174 04:05:56,760 --> 04:05:59,200 INSTRUCTIONS HOW TO FILL OUT THE 5175 04:05:59,200 --> 04:06:02,680 FETAL DEATH CERTIFICATE? 5176 04:06:02,680 --> 04:06:05,960 >>YEAH. 5177 04:06:05,960 --> 04:06:08,360 I THINK I CAN MAYBE EXAMINE 5178 04:06:08,360 --> 04:06:09,560 DIFFERENT LOCATIONS AND SEEING 5179 04:06:09,560 --> 04:06:15,920 WHAT THEY HAVE TRIED TO DO TO 5180 04:06:15,920 --> 04:06:22,640 LOWER THE PERCENT UNSPECIFIED 5181 04:06:22,640 --> 04:06:26,120 AND SEE THINGS DIFFERENT PLACES 5182 04:06:26,120 --> 04:06:29,640 HAVE TRIED AND WHAT HAS WORKED 5183 04:06:29,640 --> 04:06:32,200 FOR ONE NOT ANOTHER AND HOW YOU 5184 04:06:32,200 --> 04:06:40,240 CAN GET LESSONS LEARNED. 5185 04:06:40,240 --> 04:06:42,080 WE CAN EXPAND ACROSS THE 5186 04:06:42,080 --> 04:06:42,320 COUNTRY. 5187 04:06:42,320 --> 04:06:43,920 >>IT'S A TERRIFIC IDEA TO MAKE 5188 04:06:43,920 --> 04:06:45,440 THE COMPARISONS TO SEE WHAT 5189 04:06:45,440 --> 04:06:47,200 WORKS. 5190 04:06:47,200 --> 04:06:57,400 DR. HOGUE. 5191 04:06:59,400 --> 04:07:02,960 >>YOU'RE ON MUTE. 5192 04:07:02,960 --> 04:07:06,680 I WOULD LIKE TO SEE PILOT 5193 04:07:06,680 --> 04:07:11,200 STUDIES OF INCREASED MEASURES OF 5194 04:07:11,200 --> 04:07:14,720 RACISM IN PRAMS COUPLED WITH 5195 04:07:14,720 --> 04:07:17,000 LINKING THE FETAL DEATH 5196 04:07:17,000 --> 04:07:22,040 CERTIFICATES INVOLVING 5197 04:07:22,040 --> 04:07:24,800 RECRUITING WOMEN IN AREAS THAT 5198 04:07:24,800 --> 04:07:29,400 HAVE SPECIAL PROPORTION TO 5199 04:07:29,400 --> 04:07:31,120 AFRICAN AMERICAN WOMEN AND 5200 04:07:31,120 --> 04:07:35,240 SUBSTANTIAL TO THE REAL TEST OF 5201 04:07:35,240 --> 04:07:39,720 THIS METHODOLOGY CAN BE 5202 04:07:39,720 --> 04:07:43,720 DETERMINES BECAUSE THERE'S THE 5203 04:07:43,720 --> 04:07:47,200 POSSIBILITY OF LOOKING AT 5204 04:07:47,200 --> 04:07:52,560 CORRELATIONS BETWEEN EXTREME 5205 04:07:52,560 --> 04:08:00,720 PREMATURITY AND STILL BIRTH. 5206 04:08:00,720 --> 04:08:10,960 >>THANK YOU. 5207 04:08:13,320 --> 04:08:16,080 I THINK FOR MY PART THE RESEARCH 5208 04:08:16,080 --> 04:08:18,440 QUESTIONS THAT ARE THE FUTURE 5209 04:08:18,440 --> 04:08:19,120 DIRECTIONS FROM A RESEARCH 5210 04:08:19,120 --> 04:08:24,960 PERSPECTIVE WHERE I'D LOVE TO 5211 04:08:24,960 --> 04:08:27,240 SEE US GO IS DRIVEN BY COMMUNITY 5212 04:08:27,240 --> 04:08:30,160 PARTNERS BUT WE HAVE DONE WORK 5213 04:08:30,160 --> 04:08:32,600 IN COLLABORATION WITH AND 5214 04:08:32,600 --> 04:08:35,200 RELATED TO WHAT DR. HOGUE WAS 5215 04:08:35,200 --> 04:08:37,280 SAYING EARLIER THE NATIVE 5216 04:08:37,280 --> 04:08:38,480 HAWAIIAN PACIFIC ISLANDER 5217 04:08:38,480 --> 04:08:41,840 MOTHERS ASKED FOR IMPLEMENTATION 5218 04:08:41,840 --> 04:08:47,040 OF CULTURALLY IMPLEMENTED AS A 5219 04:08:47,040 --> 04:08:51,000 WAY OF DIMINISHING ADVERSE 5220 04:08:51,000 --> 04:08:52,640 OUTCOMES WRIT BROADLY. 5221 04:08:52,640 --> 04:08:53,640 I'D LIKE TO THINK OF A STEP 5222 04:08:53,640 --> 04:08:58,080 WEDGE DESIGN OR ROLLOUT STUDY 5223 04:08:58,080 --> 04:09:01,760 AND IMPLEMENTATION STUDY OF 5224 04:09:01,760 --> 04:09:03,160 HEALTH CARE OFFERINGS FOR THIS 5225 04:09:03,160 --> 04:09:06,680 COHORT AND THEIR RISK OF 5226 04:09:06,680 --> 04:09:07,920 PREGNANCY OUTCOMES RELATED TO 5227 04:09:07,920 --> 04:09:08,200 THAT. 5228 04:09:08,200 --> 04:09:10,200 I WAS EXCITED TO SEE 5229 04:09:10,200 --> 04:09:15,840 DR. MENDOLA'S DATA BECAUSE WE'RE 5230 04:09:15,840 --> 04:09:18,080 STARTING TO EXPLORE 5231 04:09:18,080 --> 04:09:22,880 ENVIRONMENTAL JUSTICE QUESTIONS 5232 04:09:22,880 --> 04:09:24,680 AND RACIAL SEGREGATION IS 5233 04:09:24,680 --> 04:09:26,120 WIDESPREAD ACROSS THE UNITED 5234 04:09:26,120 --> 04:09:28,000 STATES, IT'S NOT JUST A 5235 04:09:28,000 --> 04:09:31,200 PHENOMENON OF THE RUST BELT OR 5236 04:09:31,200 --> 04:09:34,360 SOUTHEAST UNITED STATES AND IN 5237 04:09:34,360 --> 04:09:38,160 SALT LAKE IT'S TRUE FOR OUR 5238 04:09:38,160 --> 04:09:40,200 PATIENT WHO'S IDENTIFY THIS WAY 5239 04:09:40,200 --> 04:09:45,600 OR THOSE WHO IDENTIFY AS LATINA 5240 04:09:45,600 --> 04:09:47,640 AND WE HAVE A UNIQUE OPPORTUNITY 5241 04:09:47,640 --> 04:09:48,920 TO THINK ABOUT SPIKES IN AIR 5242 04:09:48,920 --> 04:09:49,360 POLLUTION. 5243 04:09:49,360 --> 04:09:53,600 WE HAVE DAY TO DAY VARIATION 5244 04:09:53,600 --> 04:09:58,920 THAT'S NOT COMMON ACROSS THE 5245 04:09:58,920 --> 04:09:59,200 COUNTRY. 5246 04:09:59,200 --> 04:10:00,640 MANY LOCATIONS HAVE AN AVERAGE 5247 04:10:00,640 --> 04:10:02,600 THAT STAYS CON STAND OVER TIME 5248 04:10:02,600 --> 04:10:03,280 AND TEMPERATURE FLUCTUATIONS 5249 04:10:03,280 --> 04:10:09,920 WITHIN THAT. 5250 04:10:09,920 --> 04:10:11,600 WE HAVE QUITE A BIT OF VARIATION 5251 04:10:11,600 --> 04:10:13,920 IN THE DATA THAT MAY ALLOW US TO 5252 04:10:13,920 --> 04:10:15,200 IDENTIFY WEEK BY WEEK EXPOSURES. 5253 04:10:15,200 --> 04:10:18,640 WE'RE LOOKING INTO THAT OND THE 5254 04:10:18,640 --> 04:10:21,560 ADVICE OF PARTICIPANTS IN SOME 5255 04:10:21,560 --> 04:10:23,040 OF THESE FOCUS GROUPS. 5256 04:10:23,040 --> 04:10:26,960 I'M THINKING OF PARTICULAR ONE 5257 04:10:26,960 --> 04:10:29,680 PERSON WHO SAID ONE DENE OR 5258 04:10:29,680 --> 04:10:31,080 NAVAJO MOM SAID I SPENT EVERY 5259 04:10:31,080 --> 04:10:32,800 WEEK IN MY PREGNANCY GOING BACK 5260 04:10:32,800 --> 04:10:34,480 TO THE RESERVATION TO GET CLEAN 5261 04:10:34,480 --> 04:10:34,640 AIR. 5262 04:10:34,640 --> 04:10:45,080 I THINK THAT WAS TELLING. 5263 04:10:48,040 --> 04:10:53,720 >>YOU LISTEN TO OUR FAMILIES 5264 04:10:53,720 --> 04:10:58,040 AND AN LOOK AT COMMUNITIES FOR 5265 04:10:58,040 --> 04:10:59,200 IDEAS FOR WHERE THE RESEARCH 5266 04:10:59,200 --> 04:11:09,360 SHOULD GO. 5267 04:11:15,680 --> 04:11:18,360 >>THIS IS CHALLENGING BECAUSE 5268 04:11:18,360 --> 04:11:19,600 THERE'S MORE IMMEDIATE CLINICAL 5269 04:11:19,600 --> 04:11:21,000 QUESTIONS THAT I THINK COULD BE 5270 04:11:21,000 --> 04:11:30,040 HELPFUL TO PUT RESEARCH DOLLARS 5271 04:11:30,040 --> 04:11:30,680 IN. 5272 04:11:30,680 --> 04:11:32,480 WHEN THERE'S RESEARCH DONE AND 5273 04:11:32,480 --> 04:11:36,800 IF THERE'S MACRO AND 5274 04:11:36,800 --> 04:11:37,440 ENVIRONMENTAL THINGS THAT ARE 5275 04:11:37,440 --> 04:11:45,040 IMPORTANT STRESSORS, THIS IS A 5276 04:11:45,040 --> 04:11:46,320 HUGE AFFECT. 5277 04:11:46,320 --> 04:11:49,560 IT WOULD BE GOOD TO SEE RESULTS 5278 04:11:49,560 --> 04:11:52,520 CONFIRMED IN COHORTS AND LOOKING 5279 04:11:52,520 --> 04:11:57,720 AT LARGER, POPULATION BASED DATA 5280 04:11:57,720 --> 04:11:59,400 AND WE LOOKED AT THE LIFE STUDY 5281 04:11:59,400 --> 04:12:05,000 AND SAW OZONE WAS A STRONG 5282 04:12:05,000 --> 04:12:07,040 PREDICTOR OF EARLY PREGNANCY 5283 04:12:07,040 --> 04:12:07,440 LOSS. 5284 04:12:07,440 --> 04:12:12,400 THE AVERAGE BEING AROUND 7 5285 04:12:12,400 --> 04:12:12,600 WEEKS. 5286 04:12:12,600 --> 04:12:17,000 THERE'S UNAPPRECIATED RISKS. 5287 04:12:17,000 --> 04:12:18,600 WHEN WE SET STANDARDS FOR THINGS 5288 04:12:18,600 --> 04:12:20,840 LIKE AIR POLLUTION OR CONCERNED 5289 04:12:20,840 --> 04:12:22,440 ABOUT THINGS LIKE CLIMATE 5290 04:12:22,440 --> 04:12:23,600 CHANGE, WE'RE NOT TALKING ABOUT 5291 04:12:23,600 --> 04:12:23,880 PREGNANCY. 5292 04:12:23,880 --> 04:12:32,240 I THINK WE SHOULD BE. 5293 04:12:32,240 --> 04:12:34,320 WE SHOULD LOOK AT THIS 5294 04:12:34,320 --> 04:12:35,720 SYSTEMATICALLY AND TRYING TO 5295 04:12:35,720 --> 04:12:38,320 PROVIDE PROTECTION WHERE WE CAN 5296 04:12:38,320 --> 04:12:39,920 AS WELL THE SOCIAL ISSUES AROUND 5297 04:12:39,920 --> 04:12:41,400 THOSE FACTORS. 5298 04:12:41,400 --> 04:12:43,200 PEOPLE CAN'T MITIGATE 5299 04:12:43,200 --> 04:12:45,560 TEMPERATURE RISKS WHEN THEY LIVE 5300 04:12:45,560 --> 04:12:48,480 IN SUBSTANDARD HOUSING AND THEY 5301 04:12:48,480 --> 04:12:49,520 DON'T HAVE PROPER HEATING AND 5302 04:12:49,520 --> 04:12:51,200 POOLING AND ALL THOSE FACTORS AS 5303 04:12:51,200 --> 04:12:55,560 WELL. 5304 04:12:55,560 --> 04:12:57,000 I DON'T FLOW IF THAT'S HELPFUL 5305 04:12:57,000 --> 04:13:00,360 FOR YOUR RESEARCH AGENDA BUT 5306 04:13:00,360 --> 04:13:06,360 THOSE THE KINDS OF THINGS I SEE. 5307 04:13:06,360 --> 04:13:11,680 >>THANK YOU FOR HELPING REMIND 5308 04:13:11,680 --> 04:13:19,520 ME OF WHAT YOU SAID, THERE'S 5309 04:13:19,520 --> 04:13:22,680 POTENTIAL IN THE NEW ASPECTS OF 5310 04:13:22,680 --> 04:13:27,200 MINDFULNESS BASED INTERVENTIONS 5311 04:13:27,200 --> 04:13:31,200 THAT USE GROUP TELEHEALTH AND 5312 04:13:31,200 --> 04:13:35,760 NOT DIRECTED BY CLINICAL 5313 04:13:35,760 --> 04:13:37,400 PSYCHOLOGISTS BUT RATHER TRAINED 5314 04:13:37,400 --> 04:13:40,920 FOLKS FOR WHICH HAVE SUSTAINED 5315 04:13:40,920 --> 04:13:42,280 CLINICAL APPROACH COULD BE DONE 5316 04:13:42,280 --> 04:13:43,640 AFTER THE RESEARCH IF THE 5317 04:13:43,640 --> 04:13:47,680 RESEARCH IS SEQUENCEFUL. 5318 04:13:47,680 --> 04:13:52,000 -- SUCCESSFUL BUT I'M NOT AWARE 5319 04:13:52,000 --> 04:13:53,520 OF AN AFRICAN AMERICAN OR HIGH 5320 04:13:53,520 --> 04:13:54,840 RISK COMMUNITIES INVOLVED IN 5321 04:13:54,840 --> 04:13:55,320 THOSE STUDIES. 5322 04:13:55,320 --> 04:13:59,200 I THINK IF PEOPLE WHO HAVE 5323 04:13:59,200 --> 04:14:03,200 CLINICAL POPULATIONS THAT WOULD 5324 04:14:03,200 --> 04:14:04,840 BENEFIT IT WOULD BE COMBINED 5325 04:14:04,840 --> 04:14:07,200 BECAUSE SOME OF THESE PROCESSES 5326 04:14:07,200 --> 04:14:13,040 ARE ACTUALLY TOTALLY REMOTE 5327 04:14:13,040 --> 04:14:15,240 TELEHEALTH AND COULD BE COMBINED 5328 04:14:15,240 --> 04:14:20,440 ACROSS COMMUNITIES AND ACROSS 5329 04:14:20,440 --> 04:14:21,280 STATES. 5330 04:14:21,280 --> 04:14:21,880 THAT RESEARCH I WOULD 5331 04:14:21,880 --> 04:14:30,280 RECOMMENDATION EXAMINING. 5332 04:14:30,280 --> 04:14:34,560 >>AS WE TRY TO LINK THE MORNING 5333 04:14:34,560 --> 04:14:36,280 PRESENTATIONS TO THE ONES THIS 5334 04:14:36,280 --> 04:14:40,200 AFTERNOON, HOW IMPORTANT IT IS 5335 04:14:40,200 --> 04:14:42,400 TO HAVE ACCURATE DATA AND 5336 04:14:42,400 --> 04:14:46,080 INFORMATION ABOUT STILLBIRTH BUT 5337 04:14:46,080 --> 04:14:51,920 ALSO CRITICAL TO HAVE ACCURATE 5338 04:14:51,920 --> 04:14:53,280 ASSESSMENT OF THE CAUSE OF DEATH 5339 04:14:53,280 --> 04:14:58,280 IN THE ABSENCE OF THE TWO, WE'RE 5340 04:14:58,280 --> 04:15:05,360 BACK TO STRUGGLING, THE STRUGGLE 5341 04:15:05,360 --> 04:15:07,200 COMES AGAINST PUBLIC HEALTH 5342 04:15:07,200 --> 04:15:08,440 POLICIES AND CONVINCING PEOPLE 5343 04:15:08,440 --> 04:15:11,480 TO DO THE RIGHT THING BY MOTHERS 5344 04:15:11,480 --> 04:15:12,360 IMPACTED OVER HERE. 5345 04:15:12,360 --> 04:15:15,200 I'D LOVE TO HEAR THOUGHTS FROM 5346 04:15:15,200 --> 04:15:16,800 ANY OF THE SPEAKERS IN THE 5347 04:15:16,800 --> 04:15:19,040 QUESTION TO THE QUESTION ABOUT 5348 04:15:19,040 --> 04:15:23,240 FRAMING RESEARCH PRIORITIES IN 5349 04:15:23,240 --> 04:15:28,120 THE ENTIRE AREA STARTING WITH 5350 04:15:28,120 --> 04:15:30,520 THE RIGHT INFORMATION FOR 5351 04:15:30,520 --> 04:15:31,200 EXPANDING OPPORTUNITIES FOR 5352 04:15:31,200 --> 04:15:41,160 MINORITIES. 5353 04:15:41,160 --> 04:15:46,320 >>WE NEED A GOOD SOLID CASE 5354 04:15:46,320 --> 04:15:49,240 DEFINITION THAT'S AN IMPORTANT 5355 04:15:49,240 --> 04:15:51,200 STARTING POINT SO WE KNOW WE'RE 5356 04:15:51,200 --> 04:15:54,080 ALL TALKING ABOUT THE SAME 5357 04:15:54,080 --> 04:15:54,360 OUTCOME. 5358 04:15:54,360 --> 04:15:56,080 THE FACT THERE'S DIFFERENT 5359 04:15:56,080 --> 04:15:58,000 CAUSES OF STILLBIRTH. 5360 04:15:58,000 --> 04:15:59,480 BEING ABLE TO SEPARATE THOSE OUT 5361 04:15:59,480 --> 04:16:03,200 ARE IMPORTANT BUT BEING ABLE TO 5362 04:16:03,200 --> 04:16:06,880 DO ANALYSES THAT ARE SPECIFIC TO 5363 04:16:06,880 --> 04:16:08,280 WHETHER IT IS A CORD INCIDENT 5364 04:16:08,280 --> 04:16:10,360 AND IS THERE SOMETHING TO LEARN 5365 04:16:10,360 --> 04:16:11,480 ABOUT CORD INCIDENTS? 5366 04:16:11,480 --> 04:16:12,400 I THINK THERE IS. 5367 04:16:12,400 --> 04:16:13,960 RIGHT NOW IT'S ALL IN ONE GROUP 5368 04:16:13,960 --> 04:16:17,000 AND I THINK THERE'S A LOT TO BE 5369 04:16:17,000 --> 04:16:20,440 GAINED BY BEING ABLE TO LOOK AT 5370 04:16:20,440 --> 04:16:21,280 SUBSETS OF STILLBIRTH AS WELL. 5371 04:16:21,280 --> 04:16:24,120 >>CAN I RESPOND TO THAT 5372 04:16:24,120 --> 04:16:25,000 EXCELLENT COMMENT. 5373 04:16:25,000 --> 04:16:27,240 I THINK THAT'S SO IMPORTANT AND 5374 04:16:27,240 --> 04:16:29,400 I THINK THE RESEARCHERS WHO HAVE 5375 04:16:29,400 --> 04:16:35,200 BEEN IN THE FIELD AND HAVE BEEN 5376 04:16:35,200 --> 04:16:39,240 DOING AS MUCH AS OF WORKUP AS 5377 04:16:39,240 --> 04:16:40,920 POSSIBLE INCLUDING MATERNAL 5378 04:16:40,920 --> 04:16:41,200 INTERVIEWS. 5379 04:16:41,200 --> 04:16:42,720 I THINK THAT'S IMPORTANT AND WE 5380 04:16:42,720 --> 04:16:44,040 TALKED ABOUT IT THIS MORNING. 5381 04:16:44,040 --> 04:16:47,200 I THINK IF WE CAN GET TOGETHER 5382 04:16:47,200 --> 04:16:48,440 AND COLLABORATE AND COMBINE THE 5383 04:16:48,440 --> 04:16:50,360 INFORMATION THAT WOULD BE 5384 04:16:50,360 --> 04:16:51,120 EXTREMELY HELPFUL BECAUSE WE 5385 04:16:51,120 --> 04:16:55,160 HEARD ABOUT WONDERFUL WORK BEING 5386 04:16:55,160 --> 04:16:56,400 DONE IN DIFFERENT PARTS OF THE 5387 04:16:56,400 --> 04:16:57,160 COUNTRY. 5388 04:16:57,160 --> 04:16:58,200 USING THE INFORMATION WE HAVE 5389 04:16:58,200 --> 04:17:00,240 FROM THOSE STUDIES UNTIL WE CAN 5390 04:17:00,240 --> 04:17:01,840 GET BETTER DATA FROM THE FETAL 5391 04:17:01,840 --> 04:17:03,600 DEATH CERTIFICATE. 5392 04:17:03,600 --> 04:17:06,040 BUT THE PROTOCOLS THAT WERE 5393 04:17:06,040 --> 04:17:09,280 PRESENTED THIS MORNING WERE VERY 5394 04:17:09,280 --> 04:17:09,520 SIMILAR. 5395 04:17:09,520 --> 04:17:13,840 THEY WERE CHART EXTRACTION, 5396 04:17:13,840 --> 04:17:14,480 MATERNAL INTERVIEW. 5397 04:17:14,480 --> 04:17:17,720 SOME HAD SPECIMEN COLLECTION. 5398 04:17:17,720 --> 04:17:20,720 WOULD IT BE POSSIBLE TO DO 5399 04:17:20,720 --> 04:17:22,280 BASICALLY AN INDIVIDUAL 5400 04:17:22,280 --> 04:17:22,640 META-ANALYSIS. 5401 04:17:22,640 --> 04:17:23,240 GETTING THE INDIVIDUAL 5402 04:17:23,240 --> 04:17:24,600 INFORMATION AND I'M SURE PARENTS 5403 04:17:24,600 --> 04:17:26,440 WHO PARTICIPATE IN THE STUDIES 5404 04:17:26,440 --> 04:17:28,280 WOULD BE WILLING TO PROVIDE MORE 5405 04:17:28,280 --> 04:17:30,080 INFORMATION BECAUSE IF YOU LOOK 5406 04:17:30,080 --> 04:17:33,200 AT LARGER NUMBER, QUESTIONS WILL 5407 04:17:33,200 --> 04:17:33,720 COME UP. 5408 04:17:33,720 --> 04:17:35,240 JUST THROWING IT OUT AS A 5409 04:17:35,240 --> 04:17:36,440 CHALLENGE FOR ALL THE GROUPS 5410 04:17:36,440 --> 04:17:46,880 DOING THIS TYPE OF WORK. 5411 04:17:59,520 --> 04:18:01,640 >>AS FAR AS THE RESEARCH AND 5412 04:18:01,640 --> 04:18:03,960 DR. DONALD DUDLEY, GO AHEAD. 5413 04:18:03,960 --> 04:18:09,040 >>AS FAR AS RESEARCH IS 5414 04:18:09,040 --> 04:18:11,920 CONCERNED, I'D LIKE TO SEE SOME 5415 04:18:11,920 --> 04:18:14,640 SORT OF IMPLEMENTATION RESEARCH 5416 04:18:14,640 --> 04:18:17,480 ON WAYS TO LINK ELECTRONIC 5417 04:18:17,480 --> 04:18:18,240 MEDICAL RECORDS TO THE FETAL 5418 04:18:18,240 --> 04:18:25,880 DEATH CERTIFICATE SO THAT IT 5419 04:18:25,880 --> 04:18:27,040 TAKES ONUS ON THE FRONT END OF 5420 04:18:27,040 --> 04:18:29,360 THOSE TRYING TO SUBMIT THESE 5421 04:18:29,360 --> 04:18:31,200 BECAUSE IT MAY STANDARDIZE A LOT 5422 04:18:31,200 --> 04:18:33,400 OF THE REPORTING AND MAY IMPROVE 5423 04:18:33,400 --> 04:18:37,720 THE NUMBERS AS WELL. 5424 04:18:37,720 --> 04:18:39,200 SECONDLY TO DEVELOP BEST 5425 04:18:39,200 --> 04:18:41,040 PRACTICES FOR CONSENTING 5426 04:18:41,040 --> 04:18:47,720 FAMILIES, WOMEN AND FAMILIES FOR 5427 04:18:47,720 --> 04:18:56,160 AUTOPSY. 5428 04:18:56,160 --> 04:18:57,840 WHAT'S THE BEST WAY TO INFORM 5429 04:18:57,840 --> 04:18:59,280 PATIENTS OF OPTIONS IN A 5430 04:18:59,280 --> 04:19:02,040 SENSITIVE WAY THAT'S CULTURALLY 5431 04:19:02,040 --> 04:19:03,520 APPROPRIATE AS WELL? 5432 04:19:03,520 --> 04:19:06,960 >>GIVEN THERE ARE 20,000 STILL 5433 04:19:06,960 --> 04:19:10,360 BIRTHS AT LEAST THE ONES THAT 5434 04:19:10,360 --> 04:19:11,680 ARE RECORDED IN THE UNITED 5435 04:19:11,680 --> 04:19:14,040 STATES, WOULD THERE BE -- IS 5436 04:19:14,040 --> 04:19:17,040 THERE AN OPPORTUNITY TO CREATE A 5437 04:19:17,040 --> 04:19:18,920 NATIONAL BIO REPOSITORY. 5438 04:19:18,920 --> 04:19:21,080 THAT'S THE FIRST QUESTION? 5439 04:19:21,080 --> 04:19:24,280 SECOND, IN CASES WHERE THE CAUSE 5440 04:19:24,280 --> 04:19:28,280 OF DEATH IS NOT READILY 5441 04:19:28,280 --> 04:19:31,200 APPARENT, WOULD THERE BE VALUE 5442 04:19:31,200 --> 04:19:37,880 IN GENOME SEQUENCING IN THE 5443 04:19:37,880 --> 04:19:46,320 FETUS' DEATHS THAT I IN UTERO. 5444 04:19:46,320 --> 04:19:56,680 >>I'LL LET UMA ASK. 5445 04:20:09,640 --> 04:20:10,840 AND HIS REQUIRES ENORMOUS AMOUNT 5446 04:20:10,840 --> 04:20:12,160 OF SPACE AND YOU HAVE TO SAY 5447 04:20:12,160 --> 04:20:12,760 WHAT'S THE PURPOSE OF DOING 5448 04:20:12,760 --> 04:20:20,120 THIS. 5449 04:20:20,120 --> 04:20:23,240 YOU HAVE TO BE INTENTIONAL AND 5450 04:20:23,240 --> 04:20:25,320 THOUGHTFUL IN HOW YOU CREATE 5451 04:20:25,320 --> 04:20:27,480 THIS AND U MA YOU WANT TO 5452 04:20:27,480 --> 04:20:30,160 ADDRESS THE GENETIC QUESTION. 5453 04:20:30,160 --> 04:20:31,720 >>I BELIEVE DECEMBER 9 THERE'LL 5454 04:20:31,720 --> 04:20:35,200 BE A SPEAKER BUT BRIEFLY, THE 5455 04:20:35,200 --> 04:20:35,760 STILLBIRTH COLLABORATIVE 5456 04:20:35,760 --> 04:20:38,120 RESEARCH NETWORK WE LOOKED AT 5457 04:20:38,120 --> 04:20:39,200 USING TECHNOLOGY CALLED 5458 04:20:39,200 --> 04:20:49,760 MICROARRAY INSTEAD OF STANDARD 5459 04:20:55,400 --> 04:20:57,000 KARYOTYPE AND WE WERE ABLE TO 5460 04:20:57,000 --> 04:21:00,400 INCREASE THE NUMBER OF GENOMIC 5461 04:21:00,400 --> 04:21:01,080 CAUSES. 5462 04:21:01,080 --> 04:21:02,680 FAMILIES WANT AN UNDERSTANDING 5463 04:21:02,680 --> 04:21:08,360 OF WHAT THE CAUSE IS AND THERE'S 5464 04:21:08,360 --> 04:21:11,200 NETWORK SAMPLES LOOKING AT WHOLE 5465 04:21:11,200 --> 04:21:12,080 EXOME SEQUENCING. 5466 04:21:12,080 --> 04:21:14,320 DIGGING DEEPER DOWN AND BECAUSE 5467 04:21:14,320 --> 04:21:16,160 OF THAT RESEARCH THEY FOUND 5468 04:21:16,160 --> 04:21:18,760 OTHER GENETIC CHANGES ASSOCIATED 5469 04:21:18,760 --> 04:21:19,600 WITH STILLBIRTH. 5470 04:21:19,600 --> 04:21:22,320 BASED ON THE STUDIES, 18% OF ALL 5471 04:21:22,320 --> 04:21:24,400 STILLBIRTHS HAVE A LIKELY 5472 04:21:24,400 --> 04:21:26,640 GENETIC CAUSE WHICH IS IMPORTANT 5473 04:21:26,640 --> 04:21:28,640 FOR FAMILIES TO KNOW ABOUT AND 5474 04:21:28,640 --> 04:21:33,240 INFLUENCES MANAGEMENT OF THE 5475 04:21:33,240 --> 04:21:37,800 NEXT PREGNANCY AND ICHD IS 5476 04:21:37,800 --> 04:21:40,400 FUNDING A STUDY WITH WHOLE 5477 04:21:40,400 --> 04:21:41,600 GENOMIC SEQUENCING AND WHOLE 5478 04:21:41,600 --> 04:21:45,440 SEQUENCING OF THE DNA FOR TRIO. 5479 04:21:45,440 --> 04:21:49,760 FOR BOTH PARENTS WHO'VE HAD 5480 04:21:49,760 --> 04:21:51,520 STILLBIRTH TO UNDERSTAND GENES 5481 04:21:51,520 --> 04:21:53,360 CRITICAL TO DEVELOPMENT AND SO I 5482 04:21:53,360 --> 04:21:54,800 THINK IT WILL BE VERY 5483 04:21:54,800 --> 04:21:58,960 ILLUMINATING. 5484 04:21:58,960 --> 04:21:59,840 >>THANK YOU. 5485 04:21:59,840 --> 04:22:05,720 THE COST OF WHOLE GENOME 5486 04:22:05,720 --> 04:22:10,720 SEQUENCING NOW BELOW 1,000 5487 04:22:10,720 --> 04:22:14,920 DOLLARS PER TEST IING THIS IS 5488 04:22:14,920 --> 04:22:15,960 WITHIN REACH. 5489 04:22:15,960 --> 04:22:19,000 ONE WOULDN'T HAVE TO DO IT FOR 5490 04:22:19,000 --> 04:22:22,320 ALL THE STILLBIRTH BUT EVEN IF 5491 04:22:22,320 --> 04:22:24,760 THERE WERE A CONSORTIUM THAT 5492 04:22:24,760 --> 04:22:28,040 COULD DIG DEEPER INTO CAUSES OF 5493 04:22:28,040 --> 04:22:29,840 STILLBIRTH THAT WOULD BE 5494 04:22:29,840 --> 04:22:31,560 ENORMOUSLY BENEFICIAL. 5495 04:22:31,560 --> 04:22:34,640 MORE TO COME AND THE NEXT 5496 04:22:34,640 --> 04:22:35,240 SESSION ON CAUSES OF 5497 04:22:35,240 --> 04:22:45,440 STILLBIRTHS. 5498 04:22:57,880 --> 04:23:01,400 >>TO GET THE MOST OUT OF THAT 5499 04:23:01,400 --> 04:23:05,760 IS IT IMPORTANT TO HAVE WHOLE 5500 04:23:05,760 --> 04:23:08,280 GENOME SEQUENCING FOR VERY PRE 5501 04:23:08,280 --> 04:23:09,840 TERM BIRTHS OR SIT SUFFICIENT TO 5502 04:23:09,840 --> 04:23:10,760 DO IT FOR STILLBIRTHS FOR 5503 04:23:10,760 --> 04:23:12,520 THEMSELVES? 5504 04:23:12,520 --> 04:23:14,520 >>THAT'S A GREAT QUESTION, 5505 04:23:14,520 --> 04:23:14,800 CAROL. 5506 04:23:14,800 --> 04:23:18,480 SO MY UNDERSTANDING OF THIS 5507 04:23:18,480 --> 04:23:20,640 GRANT IS THEY'RE COMPARING IT TO 5508 04:23:20,640 --> 04:23:26,520 LARGE DATABASES THEY HAVE 5509 04:23:26,520 --> 04:23:29,320 ALREADY AVAILABLE F. 5510 04:23:29,320 --> 04:23:34,200 SO BASICALLY IT'S A MULTI-SITE 5511 04:23:34,200 --> 04:23:34,600 COLLABORATION. 5512 04:23:34,600 --> 04:23:43,920 I THINK BRIGHAM AND WOMEN'S, 5513 04:23:43,920 --> 04:23:45,160 BROAD INSTITUTE AND HAVE 5514 04:23:45,160 --> 04:23:46,120 DATABASES TO COMPARE IT TO. 5515 04:23:46,120 --> 04:23:47,680 >>I HAVE ONE MORE QUESTION THAT 5516 04:23:47,680 --> 04:23:49,680 CAME THROUGH THE CHAT BEFORE WE 5517 04:23:49,680 --> 04:23:50,720 APPROACHING OUR CLOSING AND THIS 5518 04:23:50,720 --> 04:24:00,680 IS FOR DR. MENDOLA, SOMEONE IN 5519 04:24:00,680 --> 04:24:03,200 CALIFORNIA WAS ASKING FOR 5520 04:24:03,200 --> 04:24:06,160 INTERVENTION FOR CLEANER INDOOR 5521 04:24:06,160 --> 04:24:11,200 AIR AND DO YOU THINK COULD 5522 04:24:11,200 --> 04:24:12,720 IMPROVE PREGNANCY OUTCOME. 5523 04:24:12,720 --> 04:24:14,120 BASED ON YOUR ANSWER BEFORE I 5524 04:24:14,120 --> 04:24:15,640 HAVE AN IDEA. 5525 04:24:15,640 --> 04:24:18,320 PLEASE, IF YOU'D LIKE TO ADDRESS 5526 04:24:18,320 --> 04:24:20,080 IT AND IF YOU LOOK AT THE 5527 04:24:20,080 --> 04:24:22,400 MEASUREMENT IN IMPROVING THE 5528 04:24:22,400 --> 04:24:23,800 PRESENTATION OR OTHER COULD 5529 04:24:23,800 --> 04:24:26,520 TRANSLATE TO IMPROVING PREGNANCY 5530 04:24:26,520 --> 04:24:26,720 OUTCOME. 5531 04:24:26,720 --> 04:24:29,360 >>THE DATA I SHOWED IS ALL 5532 04:24:29,360 --> 04:24:30,240 AMBIENT AIR. 5533 04:24:30,240 --> 04:24:32,960 IT'S ALL OUTDOOR AREA. 5534 04:24:32,960 --> 04:24:34,320 OUTDOOR TEMPERATURE. 5535 04:24:34,320 --> 04:24:35,480 NOT THE TEMPERATURE IN THE HOUSE 5536 04:24:35,480 --> 04:24:40,920 OR AIR POLLUTION IN THE HOUSE. 5537 04:24:40,920 --> 04:24:42,960 I HAVE A COLLEAGUE IS THAT LOOKS 5538 04:24:42,960 --> 04:24:46,280 AT IMPROVING PREGNANCY OUTCOMES 5539 04:24:46,280 --> 04:24:47,960 WITH IMPROVING AIR FILTRATION 5540 04:24:47,960 --> 04:24:51,240 AND IT CERTAINLY DOES SEEM TO 5541 04:24:51,240 --> 04:24:53,760 LOWER SOME EXPOSURES IN THE HOME 5542 04:24:53,760 --> 04:24:58,760 BUT NONE OF THOSE STUDIES ARE 5543 04:24:58,760 --> 04:25:01,960 REALLY BIG ENOUGH TO LOOK -- 5544 04:25:01,960 --> 04:25:02,880 DR. LEONARD, WONDERFUL. 5545 04:25:02,880 --> 04:25:05,000 SO NONE OF THOSE STUDIES ARE 5546 04:25:05,000 --> 04:25:07,040 REALLY LARGER ENOUGH TO BE ABLE 5547 04:25:07,040 --> 04:25:10,960 TO LOOK AT SOMETHING LIKE 5548 04:25:10,960 --> 04:25:11,440 STILLBIRTH FOR EXAMPLE. 5549 04:25:11,440 --> 04:25:14,680 SO TO SAY, WELL, YOU'VE GOT A 5550 04:25:14,680 --> 04:25:16,280 SHAM FILTER OR WORKING FILTER IN 5551 04:25:16,280 --> 04:25:19,240 THE HOME, DOES IT REALLY MAKE A 5552 04:25:19,240 --> 04:25:20,600 DIFFERENCE. 5553 04:25:20,600 --> 04:25:21,920 IS THAT WOULD BE AN INTERESTING 5554 04:25:21,920 --> 04:25:22,840 THING TO LOOK AT. 5555 04:25:22,840 --> 04:25:23,360 THANKS FOR THE QUESTION, 5556 04:25:23,360 --> 04:25:33,520 STEPHANIE. 5557 04:25:44,040 --> 04:25:45,440 IF ANYONE WOULD LIKE TO ADD 5558 04:25:45,440 --> 04:25:47,200 ANYTHING? 5559 04:25:47,200 --> 04:25:48,760 >>MONICA, ARE YOU ABLE TO LOOK 5560 04:25:48,760 --> 04:25:51,360 AT THE QUESTIONS IN THE CHAT BOX 5561 04:25:51,360 --> 04:25:52,600 TO MAKE SURE WE HAVE MISSED 5562 04:25:52,600 --> 04:25:53,800 ANYTHING? 5563 04:25:53,800 --> 04:26:04,080 >>WE HAVE LOOKED. 5564 04:26:08,760 --> 04:26:14,480 >>THERE'S ONE MORE MESSAGE. 5565 04:26:14,480 --> 04:26:25,000 IT CAME THROUGH IN AN E-MAIL. 5566 04:26:41,720 --> 04:26:47,200 AND THIS IS FROM COUNTRIES 5567 04:26:47,200 --> 04:26:47,800 WORLDWIDE THE AVERAGE RATE 5568 04:26:47,800 --> 04:26:49,720 ADOPTION OF STILLBIRTHS. 5569 04:26:49,720 --> 04:26:53,400 WE'RE RANKING LOWER IT LOOKS 5570 04:26:53,400 --> 04:26:55,960 LIKE IN OUR CAPABILITY OF 5571 04:26:55,960 --> 04:26:57,360 REDUCED RISK OF STILLBIRTH. 5572 04:26:57,360 --> 04:27:01,640 THE QUESTION IS CAN ANYONE 5573 04:27:01,640 --> 04:27:03,200 ADDRESS WHY UNITED STATES HAS 5574 04:27:03,200 --> 04:27:05,960 BEEN BEHIND SOME OTHER COUNTRIES 5575 04:27:05,960 --> 04:27:15,200 LIKE ENGLAND, NETHERLANDS OR 5576 04:27:15,200 --> 04:27:25,360 OTHERS. 5577 04:27:29,680 --> 04:27:30,800 >>IS THE RACIAL DISPARITY. 5578 04:27:30,800 --> 04:27:33,600 WE HAVE TO GET TO THE ROOT OF 5579 04:27:33,600 --> 04:27:35,240 WHY BLACK WOMEN ARE THREE TIMES 5580 04:27:35,240 --> 04:27:38,960 THE RISK OF STILLBIRTH COMPARED 5581 04:27:38,960 --> 04:27:40,680 TO WHITE WOMEN AND OTHER 5582 04:27:40,680 --> 04:27:42,320 MINORITY GROUPS AND UNDER SERVED 5583 04:27:42,320 --> 04:27:47,200 PATIENT POPULATIONS AND SOME OF 5584 04:27:47,200 --> 04:27:49,480 THE RESEARCH WE'RE HEARING ABOUT 5585 04:27:49,480 --> 04:27:51,200 LISTENING TO THE COMMUNITY AND 5586 04:27:51,200 --> 04:27:57,240 ACCESS TO CARE, QUALITY OF CARE, 5587 04:27:57,240 --> 04:27:58,160 EMPOWERING OUR PREGNANT 5588 04:27:58,160 --> 04:28:00,680 INDIVIDUALS TO ASK QUESTIONS 5589 04:28:00,680 --> 04:28:02,800 ABOUT THEIR CARE SO WE HEARD 5590 04:28:02,800 --> 04:28:04,880 ABOUT THAT BUT THEN WE ALSO 5591 04:28:04,880 --> 04:28:07,360 HEARD ABOUT AUDIT SO THAT'S VERY 5592 04:28:07,360 --> 04:28:12,840 IMPORTANT THIS MORNING THAT WE 5593 04:28:12,840 --> 04:28:16,960 DO NEED TO UNDERSTAND AN 5594 04:28:16,960 --> 04:28:18,520 EVALUATION OF WHY THIS IS 5595 04:28:18,520 --> 04:28:20,320 HAPPENING AND WE CANNOT PREVENT 5596 04:28:20,320 --> 04:28:21,120 WHAT WE DON'T UNDERSTAND. 5597 04:28:21,120 --> 04:28:23,760 THERE'S A LOT THAT NEEDS TO BE 5598 04:28:23,760 --> 04:28:23,960 DONE. 5599 04:28:23,960 --> 04:28:26,360 WE HEARD A WIDE VARIETY OF AREAS 5600 04:28:26,360 --> 04:28:27,440 THAT NEED TO BE ADDRESSED. 5601 04:28:27,440 --> 04:28:29,920 I'D LOVE FOR THE REST OF THE 5602 04:28:29,920 --> 04:28:31,200 PANEL MEMBERS TO WEIGH IN ON THE 5603 04:28:31,200 --> 04:28:38,320 QUESTION. 5604 04:28:38,320 --> 04:28:42,960 >>I WOULD ADD YOU HAVE TO MAKE 5605 04:28:42,960 --> 04:28:45,280 APPLES AND ORANGES AND COMPARE 5606 04:28:45,280 --> 04:28:46,880 THEM AND MANY START COMPARING AT 5607 04:28:46,880 --> 04:28:49,120 26 WEEKS AND WE COUNT AT 20 5608 04:28:49,120 --> 04:28:49,320 WEEKS. 5609 04:28:49,320 --> 04:28:50,880 THERE'S A VERY LARGE PROPORTION 5610 04:28:50,880 --> 04:28:52,480 OF STILLBIRTHS THAT OCCUR 5611 04:28:52,480 --> 04:28:59,680 BETWEEN 20 AND 24 WEEKS. 5612 04:28:59,680 --> 04:29:01,760 SOME DEFINITIONS OF FETAL DEATH 5613 04:29:01,760 --> 04:29:03,200 ARE NOT AS STRICT AS OUR 5614 04:29:03,200 --> 04:29:04,560 DEFINITIONS. 5615 04:29:04,560 --> 04:29:07,200 I'M NOT TRYING TO EXCUSE OUR 5616 04:29:07,200 --> 04:29:12,240 HIGHER RATE BUT I DO THINK THERE 5617 04:29:12,240 --> 04:29:15,040 ARE SOME REASONS THAT BELOW THE 5618 04:29:15,040 --> 04:29:15,640 SURFACE, IF YOU WILL, FOR OUR 5619 04:29:15,640 --> 04:29:17,680 RANGING. 5620 04:29:17,680 --> 04:29:27,880 RANKING. 5621 04:29:31,840 --> 04:29:35,600 >>THERE'S STILL A DISPARITY IT 5622 04:29:35,600 --> 04:29:46,080 STILLBIRTHS ABOVE 28 WEEKS. 5623 04:29:46,800 --> 04:29:49,000 >>THIS IS SOMETHING WE CAN DIG 5624 04:29:49,000 --> 04:29:59,400 DEEPER ON THE QUESTIONS. 5625 04:30:02,720 --> 04:30:03,640 DR. JAIN WERE REACHING THE END 5626 04:30:03,640 --> 04:30:07,520 OF OUR DISCUSSION. 5627 04:30:07,520 --> 04:30:09,960 I WOULD LIKE TO THANK THE PANEL 5628 04:30:09,960 --> 04:30:13,560 AND GIVE IT TO DR. JAIN AND 5629 04:30:13,560 --> 04:30:15,920 DR. REDDY FOR A FINAL WRAP-UP. 5630 04:30:15,920 --> 04:30:17,880 >>THANK YOU, DR. LONGO. 5631 04:30:17,880 --> 04:30:19,360 THANK YOU, DR. BIANCHI FOR THIS 5632 04:30:19,360 --> 04:30:26,680 OPPORTUNITY. 5633 04:30:26,680 --> 04:30:30,120 IT'S ENRICHING TO HEAR THE 5634 04:30:30,120 --> 04:30:33,320 EXPERTS. 5635 04:30:33,320 --> 04:30:38,520 THE WEIGHT OF THE PROBLEM IS 5636 04:30:38,520 --> 04:30:40,960 SINKING IN. 5637 04:30:40,960 --> 04:30:43,200 IT'S SOMETHING WE ALL GRAPPLED 5638 04:30:43,200 --> 04:30:46,360 WITH BUT WHEN YOU LOOK AT THE 5639 04:30:46,360 --> 04:30:50,240 DATA IT'S A DAUNTING TASK TO 5640 04:30:50,240 --> 04:30:51,200 DEAL WITH. 5641 04:30:51,200 --> 04:30:55,840 OUR NEXT WORKING GROUP MEETING 5642 04:30:55,840 --> 04:30:58,840 IS ON DECEMBER 9 FROM 11:00 A.M. 5643 04:30:58,840 --> 04:31:03,680 TO 4:00 P.M. 5644 04:31:03,680 --> 04:31:12,720 THE REQUEST FOR INFORMATION 5645 04:31:12,720 --> 04:31:17,760 INFORMATION IS STILL OUT THERE 5646 04:31:17,760 --> 04:31:22,040 AND SOME DISCUSSION LEADS INTO 5647 04:31:22,040 --> 04:31:25,080 MORE IN DEPTH DISCUSSION ABOUT 5648 04:31:25,080 --> 04:31:26,480 STRATEGIES THAT WILL ULTIMATELY 5649 04:31:26,480 --> 04:31:29,040 LEAD TO CLEARER ANSWERS AROUND 5650 04:31:29,040 --> 04:31:30,400 STILLBIRTH PREVENTION. 5651 04:31:30,400 --> 04:31:32,480 I WANT TO EMPHASIZE A POINT THAT 5652 04:31:32,480 --> 04:31:35,160 DR. BIANCHI MADE IN THE MORNING 5653 04:31:35,160 --> 04:31:38,600 THAT THERE WILL BE A VIRTUAL 5654 04:31:38,600 --> 04:31:39,560 PUBLIC LISTENING SESSION JANUARY 5655 04:31:39,560 --> 04:31:42,280 5 EARLY IN THE NEW YEAR FROM 5656 04:31:42,280 --> 04:31:45,520 3:00 P.M. TO 5:00 P.M. 5657 04:31:45,520 --> 04:31:46,560 MORE DETAILS WILL BE COMING YOUR 5658 04:31:46,560 --> 04:31:49,520 WAY BUT I WANT TO MAKE SURE 5659 04:31:49,520 --> 04:31:51,240 EVERYONE FEELS THEY'VE HAD AN 5660 04:31:51,240 --> 04:31:52,960 OPPORTUNITY TO WEIGH IN AND GIVE 5661 04:31:52,960 --> 04:31:55,400 US THEIR FEEDBACK BOTH THROUGH 5662 04:31:55,400 --> 04:31:57,800 THE Q&A SESSIONS THAT 5663 04:31:57,800 --> 04:31:59,000 ACCOMPANIED THE PRESENTATIONS 5664 04:31:59,000 --> 04:32:02,840 AND ALSO IN THE JANUARY FIFTH 5665 04:32:02,840 --> 04:32:04,920 SESSION THAT WILL BE OPEN TO 5666 04:32:04,920 --> 04:32:05,200 ALL. 5667 04:32:05,200 --> 04:32:10,080 IN OUR FINAL SESSION, WE WILL BE 5668 04:32:10,080 --> 04:32:11,480 TALKING ABOUT TWO OTHER 5669 04:32:11,480 --> 04:32:13,800 IMPORTANT AREAS OF STILL BIRTH 5670 04:32:13,800 --> 04:32:14,120 PREVENTION. 5671 04:32:14,120 --> 04:32:17,120 THE FIRST ONE PSYCHOLOGICAL 5672 04:32:17,120 --> 04:32:20,760 IMPACT AND TREATMENT FOR MOTHERS 5673 04:32:20,760 --> 04:32:23,520 FOLLOWING STILLBIRTH AND THIN 5674 04:32:23,520 --> 04:32:26,920 SECONDLY DEALING WITH KNOWN RISK 5675 04:32:26,920 --> 04:32:28,840 FACTORS FOR STILLBIRTH I HOPE 5676 04:32:28,840 --> 04:32:30,880 WILL LEAD TO A PANEL DISCUSSION 5677 04:32:30,880 --> 04:32:33,880 AROUND THE UNKNOWN RISK FACTORS 5678 04:32:33,880 --> 04:32:35,480 FOR STILLBIRTH AND HOW WE GET TO 5679 04:32:35,480 --> 04:32:37,280 THOSE AS WELL. 5680 04:32:37,280 --> 04:32:45,120 WITH THAT, DIANE WOULD YOU LIKE 5681 04:32:45,120 --> 04:32:46,320 TO SAY FINAL WORDS? 5682 04:32:46,320 --> 04:32:48,720 >>THANK YOU, JAIN AND REDDY AND 5683 04:32:48,720 --> 04:32:50,040 LONGO FOR MODERATING THE 5684 04:32:50,040 --> 04:32:50,920 SESSIONS. 5685 04:32:50,920 --> 04:32:52,960 I'D LIKE TO THANK THE SPEAKERS, 5686 04:32:52,960 --> 04:32:58,400 INCLUDING THE AFTERNOON SPEAKERS 5687 04:32:58,400 --> 04:33:00,400 FOR GIVING HELPFUL AND 5688 04:33:00,400 --> 04:33:01,080 INFORMATIVE TALKS. 5689 04:33:01,080 --> 04:33:02,920 I WANTED TO MENTION TWO 5690 04:33:02,920 --> 04:33:04,160 OPPORTUNITIES FOR RESEARCH. 5691 04:33:04,160 --> 04:33:10,320 FOR THOSE WHO ARE ACADEMICS 5692 04:33:10,320 --> 04:33:13,280 LISTENING, NICHD IS A 5693 04:33:13,280 --> 04:33:14,560 PARTICIPANT IN THE CLIMATE 5694 04:33:14,560 --> 04:33:15,880 CHANGE AND HUMAN HEALTH 5695 04:33:15,880 --> 04:33:24,720 INITIATIVE THAT IS NIH WIDE. 5696 04:33:24,720 --> 04:33:26,880 WE ARE ALREADY CONTRIBUTING 5697 04:33:26,880 --> 04:33:29,360 MONEY TO THE ENVIRONMENTAL 5698 04:33:29,360 --> 04:33:29,760 HEALTH SCIENCES. 5699 04:33:29,760 --> 04:33:32,400 WE'RE HOPING THE PRESIDENT'S 5700 04:33:32,400 --> 04:33:34,920 BUDGET WILL BE INCORPORATED INTO 5701 04:33:34,920 --> 04:33:38,640 THE CONGRESS'S BUDGET WHICH 5702 04:33:38,640 --> 04:33:40,880 WOULD GIVE SPECIFIC FUNDS TO 5703 04:33:40,880 --> 04:33:43,240 LOOK AT THE IMPACT PARTICULARLY 5704 04:33:43,240 --> 04:33:44,320 OF THE TEMPERATURE ISSUES 5705 04:33:44,320 --> 04:33:49,680 DR. MENDOLA TALKED ABOUT. 5706 04:33:49,680 --> 04:33:52,160 I'M ON THE EXECUTIVE COMMITTEE 5707 04:33:52,160 --> 04:33:53,320 PRIMARILY TO REPRESENT OUR 5708 04:33:53,320 --> 04:33:54,440 POPULATIONS INCLUDING PREGNANT 5709 04:33:54,440 --> 04:33:58,720 PEOPLE, CHILDREN, PEOPLE WITH S 5710 04:33:58,720 --> 04:34:00,280 AND TO REMIND EVERYONE THAT 5711 04:34:00,280 --> 04:34:02,200 THERE ARE CONSEQUENCES OF 5712 04:34:02,200 --> 04:34:03,040 CLIMATE CHANGE. 5713 04:34:03,040 --> 04:34:08,280 THE OTHER THING I WANTED TO 5714 04:34:08,280 --> 04:34:11,800 MENTION THE CONSORTIUM ON SAFE 5715 04:34:11,800 --> 04:34:12,000 LABOR. 5716 04:34:12,000 --> 04:34:14,320 WE HAVE A RESOURCE CALLED DASH, 5717 04:34:14,320 --> 04:34:18,880 THE DATA AND SPECIMEN HUB WHICH 5718 04:34:18,880 --> 04:34:23,400 INCORPORATES DEIDENTIFIED 5719 04:34:23,400 --> 04:34:29,440 CLINICAL DATA FROM MANY NICHD 5720 04:34:29,440 --> 04:34:31,600 STUDIES DR. REDDY WAS ALREADY ON 5721 04:34:31,600 --> 04:34:33,640 BUT THE CONSORTIUM ON SAFE LABOR 5722 04:34:33,640 --> 04:34:38,760 IS THE MOST POPULAR DOWNLOADED 5723 04:34:38,760 --> 04:34:40,400 STUDY IN THE DASH DATABASE AND 5724 04:34:40,400 --> 04:34:45,240 RESULTS IN MULTIPLE SECONDARY 5725 04:34:45,240 --> 04:34:47,240 PUBLICATIONS. 5726 04:34:47,240 --> 04:34:49,480 I LIKE TO ALWAYS MENTION DASH AS 5727 04:34:49,480 --> 04:34:50,720 A RESOURCE BECAUSE IT'S A GREAT 5728 04:34:50,720 --> 04:34:51,640 OPPORTUNITY FOR PEOPLE STARTING 5729 04:34:51,640 --> 04:34:58,600 IN RESEARCH WHO CAN DEVELOP A 5730 04:34:58,600 --> 04:35:03,200 HYPOTHESIS YOUTH LOAD THE DATA 5731 04:35:03,200 --> 04:35:07,200 AND TEST THE HYPOTHESIS AND 5732 04:35:07,200 --> 04:35:07,840 THERE'S MANY OTHER PUBLICATIONS 5733 04:35:07,840 --> 04:35:15,040 AS WELL. 5734 04:35:15,040 --> 04:35:17,840 THE OTHER THING I WANTED TO ASK 5735 04:35:17,840 --> 04:35:21,360 DR. LONGO ABOUT ARE THE 5736 04:35:21,360 --> 04:35:23,200 QUESTIONS TYPED IN THE LIVE 5737 04:35:23,200 --> 04:35:25,960 DISCUSSION SITE HOW WILL THEY BE 5738 04:35:25,960 --> 04:35:26,520 ANSWERED? 5739 04:35:26,520 --> 04:35:29,200 PERSONALLY OR HOW WILL THEY BE 5740 04:35:29,200 --> 04:35:30,160 INCORPORATED IN THE DISCUSSION 5741 04:35:30,160 --> 04:35:31,040 TODAY? 5742 04:35:31,040 --> 04:35:39,200 >>THE ONES WE WERE NOT ABLE TO 5743 04:35:39,200 --> 04:35:40,760 ANSWER WE'LL GO THROUGH A BOX. 5744 04:35:40,760 --> 04:35:42,160 >>THEY'RE NOT REALLY LIVE. 5745 04:35:42,160 --> 04:35:43,560 PEOPLE CAN TYPE IN THEIR 5746 04:35:43,560 --> 04:35:46,160 QUESTIONS OR COMMENTS LIVE BUT 5747 04:35:46,160 --> 04:35:47,600 THEY WILL BE ACKNOWLEDGED AND 5748 04:35:47,600 --> 04:35:48,000 WILL GET A RESPONSE. 5749 04:35:48,000 --> 04:35:48,320 >>YES. 5750 04:35:48,320 --> 04:35:55,880 >>OKAY. 5751 04:35:55,880 --> 04:35:56,680 THANK YOU SO MUCH AND THANK YOU 5752 04:35:56,680 --> 04:35:58,880 TO EVERYONE FOR PARTICIPATING IN 5753 04:35:58,880 --> 04:35:59,640 THIS EXTREMELY IMPORTANT 5754 04:35:59,640 --> 04:35:59,960 DISCUSSION. 5755 04:35:59,960 --> 04:36:04,440 WE LOOK FORWARD TO SEEING YOU ON 5756 04:36:04,440 --> 04:36:04,920 DECEMBER 9. 5757 04:36:04,920 --> 04:36:06,520 >>THANK YOU, EVERYONE. 5758 04:36:06,520 --> 04:36:10,880 IT'S 3:00. 5759 04:36:10,880 --> 04:36:12,680 HAVE A WONDERFUL THANKSGIVING. 5760 04:36:12,680 --> 04:36:13,480 AND SAFE TRAVELS TO ALL 5761 04:36:13,480 --> 04:36:14,000 TRAVELLING. 5762 04:36:14,000 --> 04:36:14,760 TAKE CARE. 5763 04:36:14,760 --> 04:36:15,560 >>THANK YOU.