Evaluation of Training Program for the Maternal and Child Health Workforce at Tulane University

Abstract

Objectives Despite significant investments in Maternal and Child Health (MCH), the United States still lags behind other countries in key MCH indicators. A well-trained workforce is needed to improve MCH. The Division of MCH Workforce Development of HRSA's Maternal and Child Health Bureau provides funding to schools of Public Health to support Centers of Excellence in MCH, which is focused on preparing the next generation of MCH leaders through specialized training and mentorship. One such center, the Tulane Center of Excellence in MCH (CEMCH), is housed at the Tulane University School of Public Health and Tropical Medicine. This study evaluated the perceived effectiveness and acceptability of the CEMCH leadership training program. Methods A mixed-methods approach was used, consisting of semi-structured interviews and quantitative surveys which were analyzed through inductive methods based in grounded theory and non-parametric methods respectively. Results Results indicated an overall high level of program satisfaction by all stakeholders. Mentorship and personal attention emerged as an important benefit for both former and current Scholars. The opportunity to gain real-world understanding of MCH work through program activities was an added benefit, although these activities also presented the most challenges. Community stakeholders generally did not view the program as providing immediate organizational benefit, but recognized the distal benefit of contributing to a well-trained MCH workforce. Conclusions for Practice These results will be used to inform other MCH training programs and strengthen Tulane's CEMCH. A well-trained MCH workforce is essential to improving MCH, and high-quality training its foundation.

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Editorial Board

Publication date: June 2018

Source: Arab Journal of Gastroenterology, Volume 19, Issue 2

Author(s):

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Table of Contents

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The Suicidal Outpatient: Balancing Autonomy, Trust, and Responsibilities

The intersection where mental health and rehabilitation care converge can raise ethical questions involving boundaries, duties, and perhaps more importantly, our role in recovery, adjustment, and flourishing. The patient with a stroke-related depression is one prototypical example. We know that damage to specific parts of the brain can cause depressive symptomatology as well as the fact that the adjustment process during rehabilitation itself can impact well-being and a sense of self-efficacy. In this column, we explore a case of when a patient becomes severely depressed and suicidal and expresses this ideation during an outpatient physical therapy session.

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Editorial Board

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Academy News – July PM&R

As the primary medical society for the specialty of PM&R, your Academy is focused on moving the specialty and you forward. Our mission is to lead the advancement of physiatry's impact throughout health care. Your Academy will ensure that:

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ABPMR Certification Exams

On September 9, 2017, the American Board of Physical Medicine and Rehabilitation (ABPMR), in conjunction with the American Board of Anesthesiology (ABA), administered the examination for the subspecialty of pain medicine. The following individuals were certified:

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Spanish Translated Abstracts

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Copyright Page

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Information for Authors

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Impact of obesity and overweight on DNA stability: Few facts and many hypotheses

Publication date: Available online 11 July 2018

Source: Mutation Research/Reviews in Mutation Research

Author(s): Tahereh Setayesh, Armen Nersesyan, Miroslav Mišík, Franziska Ferk, Sabine Langie, Vanessa M. Andrade, Alexander Haslberger, Siegfried Knasmüller

Abstract

Health authorities are alarmed worldwide about the increase of obesity and overweight in the last decades which lead to adverse health effects including inflammation, cancer, accelerated aging and infertility. We evaluated the state of knowledge concerning the impact of elevated body mass on genomic instability. Results of investigations with humans (39 studies) in which DNA damage was monitored in lymphocytes and sperm cells, are conflicting and probably as a consequence of heterogeneous study designs and confounding factors (e.g. uncontrolled intake of vitamins and minerals and consumption of different food types). Results of animal studies with defined diets (23 studies) are more consistent and show that excess body fat causes DNA damage in multiple organs including brain, liver, colon and testes. Different molecular mechanisms may cause genetic instability in overweight/obese individuals. ROS formation and lipid peroxidation were found in several investigations and may be caused by increased insulin, fatty acid and glucose levels or indirectly via inflammation. Also reduced DNA repair and formation of advanced glycation end products may play a role but more data are required to draw firm conclusions. Reduction of telomere lengths and hormonal imbalances are characteristic for overweight/obesity but the former effects are delayed and moderate and hormonal effects were not investigated in regard to genomic instability in obese individuals. Increased BMI values affect also the activities of drug metabolizing enzymes which activate/detoxify genotoxic carcinogens, but no studies concerning the impact of these alterations of DNA damage in obese individuals are available. Overall, the knowledge concerning the impact of increased body weight and DNA damage is poor and further research is warranted to shed light on this important issue.

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Identifying normal embryos from reciprocal translocation carriers by whole chromosome haplotyping

Publication date: Available online 11 July 2018

Source: Journal of Genetics and Genomics

Author(s): Zhiqiang Yan, Yuqian Wang, Yanli Nie, Xu Zhi, Xiaohui Zhu, Meng Qin, Shuo Guan, Yixin Ren, Ying Kuo, Di Chang, Wei Chen, Peng Yuan, Liying Yan, Jie Qiao

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Racial/Ethnic Differences in the Utilization of Infertility Services: A Focus on American Indian/Alaska Natives

Abstract

Objectives Previous studies have identified racial/ethnic disparities in infertility care, but patterns among American Indian/Alaska Natives (AI/AN) have not been reported. Our objective was to evaluate infertility services use in the US by race/ethnicity using data from the National Survey of Family Growth (NSFG). Methods We analyzed female respondent data from the pooled NSFG cycles 2002, 2006–2010 and 2011–2013. Respondents reported use of infertility services and types of services. We calculated weighted crude and adjusted prevalence proportion ratios (PPR) and 95% confidence intervals (95% CI) using modified Poisson regression with robust error variances accounting for the complex survey design to compare infertility services use across race/ethnicities. Results Overall, 8.7% of women reported using medical services to get pregnant. The prevalence of using any medical service to help get pregnant was lower for American Indian/Alaska Native (AI/AN) (PPR: 0.60, 95% CI 0.43–0.83) and black (PPR: 0.53, 95% CI 0.44–0.63) compared to white women and in Hispanic compared to non-Hispanic women (PPR: 0.57, 95% CI 0.48–0.67). The prevalence of accessing treatment, testing, and advice also differed by race and ethnicity. Conclusions for Practice We observed disparities in accessing services to get pregnant among AI/AN and black women and reduced use of advice among Asian/Pacific Islanders compared to whites. We also observed reduced service utilization for Hispanic compared to non-Hispanic women. Differential utilization of specific services suggests barriers to infertility care may contribute to reproductive health disparities among underserved populations.

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Histology of Barrett’s Metaplasia: Do Goblet Cells Matter?

Abstract

This review has provided a summary of the biology of goblet cell metaplasia in CLE as it pertains to BE. Goblet cells are terminally differentiated nonproliferative cells that have many overlapping histochemical characteristics with mucinous columnar cells and pseudogoblet cells. There is an abundance of evidence that suggests that use of goblet cells as a biomarker of BE, and its progression to malignancy, is problematic. Some of these limitations include the fact that the background non-goblet epithelium in most patients with CLE is biologically intestinalized and contains molecular abnormalities similar to goblet cell CLE, goblet cells fluctuate with time and decrease in number with progression of neoplasia, and pathologists have problems with interpretation, and distinction, of goblet cells from other types of cells in the esophagus. Sampling error results in sensitivity and specificity issues that limit its positive predictive value. Goblet cells are fewest in number in the same population of patients with CLE that are hardest to detect endoscopically (i.e., those with short or ultrashort CLE). Nevertheless, the risk of cancer in patients with short-segment BE, a condition difficult to distinguish from the stomach, is very low regardless of the presence or absence of goblet cells so it is unclear what the role of goblet cells is in these patients as a biomarker. Nevertheless, if the answer to the following question, "Would you as a gastroenterologist recommend surveillance for a patient with clear endoscopic evidence of CLE, particularly if it is ≥ 3 cm in length, but in which goblet cells were not reported to be present by the pathologist," is yes, then the US requirement for goblet cells as part of the criteria for "BE" is superfluous.

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Screening for Barrett’s Esophagus: Are New High-Volume Methods Feasible?

Abstract

New improved methods are required for the early detection of esophageal adenocarcinoma in order to reduce mortality from this aggressive cancer. In this review we discuss different screening methods which are currently under evaluation ranging from image-based methods to cell collection devices coupled with biomarkers. As Barrett's esophagus is a low prevalence disease, potential screening tests must be applied to an enriched population to reduce the false-positive rate and improve the cost-effectiveness of the program.

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Diagnosis and management of Cornelia de Lange syndrome: first international consensus statement

Diagnosis and management of Cornelia de Lange syndrome: first international consensus statement

Diagnosis and management of Cornelia de Lange syndrome: first international consensus statement, Published online: 11 July 2018; doi:10.1038/s41576-018-0031-0

Cornelia de Lange syndrome is a genetic disorder affecting multiple organ systems that exhibits great phenotypic heterogeneity. This Consensus Statement summarizes recommendations for the diagnosis and management of patients with Cornelia de Lange syndrome.

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Evaluation of a Training for Health and Social Service Providers on Abortion Referral-Making

Abstract

Purpose Engaging trusted care providers and empowering them with information and skills about abortion is a critical opportunity to improve coordination of care for women seeking abortion, if and when these services are needed. Description Provide, a nonprofit that works in partnership with health and social service providers to build a health system that is equipped to respond to women's health care needs around abortion, launched a referrals training program in 2013. To assess the effectiveness of this training program, we conducted an evaluation of satisfaction with training and the impact of the intervention on provider knowledge of safety of abortion, self-efficacy to provide abortion referrals, and intention to provide pregnancy options counseling and referrals in the future. Assessment Approximately 90% of participants were "very satisfied" with their training experience. Results show significant increase in intention to provide non-judgmental pregnancy options counseling and referrals for abortion care after participants went through training. Post-training, significantly more reported that they would present all pregnancy options without judgment or bias (94 vs. 82%, p < .0001), provide a referral for abortion care if needed (80 vs. 50%, p < .0001), and follow-up with the client (71 vs. 39%, p < .0001). Further, more also reported they would refer a client for prenatal care if the client requested it (78 vs. 67%, p < .0001). Conclusion Our results suggest that abortion referrals training hold potential to build the capacity of health and social service providers' ability to meet client needs related to pregnancy and could be implemented at a larger scale.

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Placebo Rates in Randomized Controlled Trials of Pouchitis Therapy

Abstract

Background

Approximately half of the patients with ulcerative colitis (UC) who undergo restorative proctocolectomy develop pouchitis within 10 years of surgery. Currently, there are no approved pouchitis treatments. It is important to quantify, and ultimately minimize, placebo rates to design and conduct efficient pouchitis trials.

Aims

To quantify the placebo rate observed in pouchitis randomized controlled trials (RCTs) in meta-analysis.

Methods

Embase, MEDLINE, and the Cochrane Library were searched from inception to November 3, 2017, for placebo-controlled RCTs enrolling adult UC patients with, or at risk for developing, pouchitis. A fixed-effect binomial-normal model was used to pool placebo rates on the log-odds (logit) scale. Proportions and 95% confidence intervals were reported. Outcomes of interest included development of pouchitis, induction of remission/response, and maintenance of remission/response. The Cochrane risk of bias tool was used to evaluate study quality.

Results

Twelve trials (five prevention, five induction, and two maintenance) enrolling a total of 229 placebo patients were eligible for inclusion. The pooled placebo rates for development of pouchitis and induction of response were 47% (95% CI 39–56%) and 24% (95% CI 14–37%), respectively. An insufficient number of trials prevented additional data pooling and meta-regression analysis and no consistent definitions of outcome were identified.

Conclusions

No consistent methods for measuring pouchitis disease activity or defining response and remission were identified, highlighting the need for standardized definitions of outcomes for use in pouchitis trials. Additional high-quality trials are required to evaluate existing and novel therapies in this area.

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Gastroesophageal Reflux Disease Might Induce Certain—Supposedly Adaptive—Changes in the Esophagus: A Hypothesis

Abstract

Background

The increasing prevalence of GERD has become a major concern due to its major health and economic impacts. Beyond the typical unpleasant symptoms, reflux can also be the source of severe, potentially life-threatening complications, such as aspiration.

Aim

Our aim was to support our hypothesis that the human body may in some cases develop various protective mechanisms to prevent these conditions.

Methods

Based on our experiences and review of the literature, we investigated the potential adaptive nature of seven reflux complications (hypertensive lower esophageal sphincter, achalasia, hypertensive upper esophageal sphincter, Zenker's diverticulum, Schatzki's ring, esophageal web, and Barrett's esophagus).

Results

Patients with progressive GERD may develop diverse structural and functional esophageal changes that narrow the lumen of the esophagus and therefore reduce the risk of regurgitation and protect the upper aerodigestive tract from aspiration. The functional changes (hypertensive lower esophageal sphincter, achalasia, hypertensive upper esophageal sphincter) seem to be adaptive reactions aimed at easing the unpleasant symptoms and reducing acid regurgitation. The structural changes (Schatzki's ring, esophageal web) result in very similar outcomes, but we consider these are rather secondary consequences and not real adaptive mechanisms. Barrett's esophagus is a special form of adaptive protection. In these cases, patients report significant relief of their previous heartburn as Barrett's esophagus develops because of the replacement of the normal squamous epithelium of the esophagus by acid-resistant metaplastic epithelium.

Conclusion

We believe that GERD may induce different self-protective reactions in the esophagus that result in reduced acid regurgitation or decreased reflux symptoms.

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Stool Microbiota Composition Differs in Patients with Stomach, Colon, and Rectal Neoplasms

Abstract

Background

Microbial ecosystems that inhabit the human gut form central component of our physiology and metabolism, regulating and modulating both health and disease. Changes or disturbances in the composition and activity of this gut microbiota can result in altered immunity, inflammation, and even cancer.

Aim

To compare the composition and diversity of gut microbiota in stool samples from patient groups based on the site of neoplasm in the gastrointestinal tract (GIT) and to assess the possible contribution of the bacterial composition to tumorigenesis.

Methods

We studied gut microbiota by16S RNA gene sequencing from stool DNA of 83 patients, who were diagnosed with different GIT neoplasms, and 13 healthy individuals.

Results

As compared to healthy individuals, stools of patients with stomach neoplasms had elevated levels of Enterobacteriaceae, and those with rectal neoplasms had lower levels of Bifidobacteriaceae. Lower abundance of Lactobacillaceae was seen in patients with colon neoplasms. Abundance of Lactobacillaceae was higher in stools of GIT patients sampled after cancer treatment compared to samples collected before start of any treatment. In addition to site-specific differences, higher abundances of Ruminococcus, Subdoligranulum and lower abundances of Lachnoclostridium and Oscillibacter were observed in overall GIT neoplasms as compared to healthy controls

Conclusion

Our study demonstrates that the alterations in gut microbiota vary according to the site of GIT neoplasm. The observed lower abundance of two common families, Lactobacillaceae and Bifidobacteriaceae, and the increased abundance of Enterobacteriaceae could provide indicators of compromised gut health and potentially facilitate GIT disease monitoring.

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Diagnosis and management of Cornelia de Lange syndrome: first international consensus statement

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The genetics of loneliness

The genetics of loneliness

The genetics of loneliness, Published online: 11 July 2018; doi:10.1038/s41576-018-0036-8

One in four UK adults over the age of 65 suffers from loneliness. An analysis of UK Biobank data has identified 15 genomic loci associated with loneliness and reports a possible causal link between obesity and loneliness and depression.

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Large-volume paracentesis effects plasma disappearance rate of indo-cyanine green in critically ill patients with decompensated liver cirrhosis and intraabdominal hypertension

Annals of Intensive Care

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Risk factors for post-ERCP pancreatitis in high-risk patients receiving post-procedure rectal indomethacin

Journal of Gastrointestinal Surgery

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Can sarcopenia be a predictor of prognosis for patients with non-metastatic colorectal cancer? A systematic review and meta-analysis

International Journal of Colorectal Disease

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Novel Methodologies in Regional Anesthesia for Knee Arthroplasty

Publication date: Available online 11 July 2018

Source: Anesthesiology Clinics

Author(s): Rodney A. Gabriel, Brian M. Ilfeld

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Perioperative Considerations for the Patient with Opioid Use Disorder on Buprenorphine, Methadone, or Naltrexone Maintenance Therapy

Publication date: Available online 11 July 2018

Source: Anesthesiology Clinics

Author(s): Thomas Kyle Harrison, Howard Kornfeld, Anuj Kailash Aggarwal, Anna Lembke

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Update on Selective Regional Analgesia for Hip Surgery Patients

Publication date: Available online 11 July 2018

Source: Anesthesiology Clinics

Author(s): Dario Bugada, Valentina Bellini, Luca F. Lorini, Edward R. Mariano

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Updates on Multimodal Analgesia for Orthopedic Surgery

Publication date: Available online 11 July 2018

Source: Anesthesiology Clinics

Author(s): Darsi N. Pitchon, Amir C. Dayan, Eric S. Schwenk, Jaime L. Baratta, Eugene R. Viscusi

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Updates in Enhanced Recovery Pathways for Total Knee Arthroplasty

Publication date: Available online 11 July 2018

Source: Anesthesiology Clinics

Author(s): Lisa Kumar, Amanda H. Kumar, Stuart A. Grant, Jeff Gadsden

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Firefighter/Paramedic - TRAVIS COUNTY E.S.D. NO. 2

Travis County ESD No. 2/Pflugerville Fire Department is currently accepting applications for the position of Firefighter/Paramedic. Please review the job summary, qualifications, and instructions before applying for this position. Only applicants meeting the required qualifications listed below need apply. If interested, please submit all required documents by deadline in person or by mail. Incomplete ...

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Firefighter/EMT - TRAVIS COUNTY E.S.D. NO. 2

Travis County ESD No. 2/Pflugerville Fire Department is currently accepting applications for the position of Firefighter/EMT. Please review the job summary, qualifications, and instructions before applying for this position. Only applicants meeting the required qualifications listed below need apply. If interested, please submit all required documents by deadline in person or by mail. Incomplete applications ...

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Three renal failure cases successfully treated with ombitasvir/paritaprevir/ritonavir for genotype 1b hepatitis C virus reinfection after liver transplantation

Abstract

We report three cases of genotype 1b hepatitis C virus (HCV) reinfection after liver transplantation. When antiviral treatment was considered, all three patients had renal dysfunction and had been treated with immunosuppressive agents for a long time; one with tacrolimus (TAC) and the others with cyclosporine A (CyA). Therefore, the possible antiviral regimens among direct-acting antivirals (DAA) were limited and so we treated all three patients with ombitasvir/paritaprevir/ritonavir (OBV/PTV/r). Because ritonavir is known to markedly increase the blood concentration of TAC and CyA through drug–drug interactions, close monitoring of blood concentrations of TAC or CyA and dose adjustments of immunosuppressive agents were needed. Sustained virus response was achieved in all the patients treated, and there were no adverse effects or transplant rejection. OBV/PTV/r might be a useful DAA regimen for patients with genotype 1 HCV reinfection in the setting of renal dysfunction.

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The genetics of loneliness

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Extent of intraluminal exfoliated malignant cells during surgery for colon cancer: Differences in cell abundance ratio between laparoscopic and open surgery

Asian Journal of Endoscopic Surgery, EarlyView.


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Absorbable barbed suture device for laparoscopic peritoneal closure after hernia repair via the transabdominal preperitoneal approach: A single‐center experience with 257 cases

Asian Journal of Endoscopic Surgery, EarlyView.


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Correction to: Influences to ADHD Problem Recognition: Mixed-Method Investigation and Recommendations to Reduce Disparities for Latino Youth

The original version of this article unfortunately contained a mistake. The co-author, Dr. Araujo's name and the affiliation for Dr. Pfiffner was incorrect in the original version of the article. The correct information is given below.

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Is physical rehabilitation effective for Wernicke–Korsakoff syndrome? A case report

Wernicke–Korsakoff syndrome is a type of brain disorder caused by the lack of thiamine, most commonly because of chronic alcohol misuse. It consists of two separate conditions including Wernicke's encephalopathy and Korsakoff syndrome. Various levels of cognitive impairments are associated with the severity of the syndrome. Although the effectiveness of thiamine replacement in the early phases of the syndrome is proven, the efficacy of subsequent treatments, which mainly include rehabilitation protocols after the development of Korsakoff syndrome, is not clear. This is the first report showing the positive effects of physical rehabilitation in a 48-year-old male patient with Wernicke–Korsakoff syndrome. Correspondence to Aysun Genç, MD, Ankara Universitesi Tip Fakultesi Ibn-i Sina Hastanesi, 4, kat Fiziksel Tip ve Rehabilitasyon AD, 06230, Sihhiye/Ankara, Turkey Tel: +90 312 508 2822; fax: +90 312 508 3935; e-mail: draysung@yahoo.com Received June 20, 2018 Accepted June 25, 2018 Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Game analysis and clinical use of the Xbox-Kinect for stroke rehabilitation

Whole-body movement is required to interact (play) with Microsoft Xbox with the 3D Kinect sensor (Xbox-Kinect) and, therefore, may be suitable for encouraging and practicing movements as part of stroke rehabilitation. We aimed to describe (i) game analysis, (ii) clinical use, and (iii) to characterize the Xbox-Kinect game experience with individuals with chronic stroke. Four therapists played the Xbox-Kinect games and then carried out a games analysis on the basis of the categories suggested by Deutsch. Eleven participants (age 29–69 years) with chronic stroke and varying motor deficits played Xbox-Kinect games for 4–22 sessions as part of a video-game group intervention and the clinical use was documented. The game experience of 'Bowling' (Kinect-Sport) and '20 000 leaks' (Kinect Adventures) was characterized by self-report questionnaires. Detailed tables of game analysis are provided. The clinical use of the console with the participants is presented. Participants reported high enjoyment and 'somewhat-high' perceived exertion after playing the two games and stated that overall the console suited their therapeutic goals. This information can assist clinicians with their clinical reasoning and decision-making for incorporating the Xbox-Kinect into stroke rehabilitation. Potentially, the Xbox-Kinect could be used as an on-going tool to facilitate whole-body movement and physical activity of individuals with chronic stroke. Correspondence to Debbie Rand, OT, PhD, Department of Occupational Therapy, School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 39040, Israel Tel: +972 36 406 551; fax: +972 36 409 933; e-mail: drand@post.tau.ac.il Received May 21, 2018 Accepted June 17, 2018 Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Complex Systems Approaches to Understand Drivers of Mental Health and Inform Mental Health Policy: A Systematic Review

Abstract

We conducted a systematic review of studies employing complex systems approaches (i.e., agent based and system dynamics models) to understand drivers of mental health and inform mental health policy. We extracted key data (e.g., purpose, design, data) for each study and provide a narrative synthesis of insights generated across studies. The studies investigated drivers and policy intervention strategies across a diversity of mental health outcomes. Based on these studies and the extant literature, we propose a typology of mental health research and policy areas that may benefit from complex systems approaches.

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Examining the Association Between Maternal Smoking During Pregnancy and Child Behavior Problems Using Quality-Adjusted Life Years

Abstract

Objectives Examining the association between maternal smoking and losses in childhood health-related quality of life due to behavior problems provides parents and policymakers another tool for the valuation of smoking cessation during pregnancy. Methods Using the National Longitudinal Survey of Youth 1979 Child and Young Adult data, this study retrospectively examined a cohort of 4114 women and 8668 children. In addition to questions focusing on maternal smoking and general demographics, each survey included the Behavior Problems Index (BPI), a 28-item questionnaire with six subscales measuring childhood behavior problems (antisocial behavior, anxiousness/depression, headstrongness, hyperactivity, immature dependency, and peer conflict/social withdrawal). Responses to the BPI, completed by mothers with children ages 4–14, were summarized on a QALY scale using published preference weights. Results Children whose mothers smoked during pregnancy experience additional QALY losses of 0.181, on average, per year due to increased behavior problems. Boys suffered larger QALY losses associated with maternal smoking (0.242) compared to girls (0.119; p value = .021), regardless of age. Moreover, heavier smoking during pregnancy (i.e., 1 or more packs/day) was associated with larger QALY losses (0.282; p-value < .001). Conclusions for Practice These findings illustrate the burden of maternal smoking during pregnancy on child health, namely behavioral problems. The losses in QALYs may be incorporated into economic evaluations for smoking cessation interventions during pregnancy. Future research will investigate how maternal smoking following childbirth is associated with child QALYs.

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Title V Maternal and Child Health Services Block Grant Priority Needs and Linked Performance Measures: Current Patterns and Trends (2000–2015)

Abstract

Objective As part of the Title V Maternal and Child Health (MCH) Services Block Grant, administered by the Health Resources and Services Administration's (HRSA's) Maternal and Child Health Bureau (MCHB), states are required to conduct a comprehensive needs assessment identifying MCH priorities every 5 years. The most current needs assessment (2015) occurred after a transformation of the program, in which a new performance measurement framework was created. This analysis examined current patterns and trends in state MCH priorities and selected performance measures to identify changing needs and inform technical support. Methods Multiple coders categorized: (1) state priority needs from 2000 to 2015 into focus areas and subcategories for examination of current, diminishing, and emerging needs; and (2) the selection of linked national and state performance measures in 2015 for all 59 states and jurisdictions. Results Between 2000 and 2015, the proportion of states with a need around pre- and inter-conception care increased from 19% to 66%. More states had needs in the breastfeeding subcategory (42%) compared with 20% of states or less in previous years. Fewer states had needs around data capacity than in past years. Emerging needs included supporting families/relationships. The most commonly selected national performance measures (NPMs) were around breastfeeding and well-woman visits. The state performance measures (SPMs) analysis also emphasized assets, with measures around community/context and positive development. Teen births and postpartum depression were areas where multiple states had SPMs. Conclusions for practice Increasing and emerging needs may help to inform technical assistance and future national measures for the Title V program.

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