scholarly journals Recurrence of postpartum hemorrhage, maternal and paternal contribution, and the effect of offspring birthweight and sex: a population-based cohort study

Author(s):  
Lorentz Erland Linde ◽  
Cathrine Ebbing ◽  
Dag Moster ◽  
Jörg Kessler ◽  
Elham Baghestan ◽  
...  

Abstract Purpose This study examines individual aggregation of postpartum hemorrhage (PPH), paternal contribution and how offspring birthweight and sex influence recurrence of PPH. Further, we wanted to estimate the proportion of PPH cases attributable to a history of PPH or current birthweight. Methods We studied all singleton births in Norway from 1967 to 2017 using data from Norwegian medical and administrational registries. Subsequent births in the parents were linked. Multilevel logistic regression was used to calculate odds ratios (ORs) with 95% confidence intervals (CI) for PPH defined as blood loss > 500 ml, blood loss > 1500 ml, or the need for blood transfusion in parous women. Main exposures were previous PPH, high birthweight, and fetal sex. We calculated adjusted population attributable fractions for previous PPH and current high birthweight. Results Mothers with a history of PPH had three- and sixfold higher risks of PPH in their second and third deliveries, respectively (adjusted OR 2.9; 95% CI 2.9–3.0 and 6.0; 5.5–6.6). Severe PPH (> 1500 ml) had the highest risk of recurrence. The paternal contribution to recurrence of PPH in deliveries with two different mothers was weak, but significant. If the neonate was male, the risk of PPH was reduced. A history of PPH or birthweight ≥ 4000 g each accounted for 15% of the total number of PPH cases. Conclusion A history of PPH and current birthweight exerted strong effects at both the individual and population levels. Recurrence risk was highest for severe PPH. Occurrence and recurrence were lower in male fetuses, and the paternal influence was weak.

2015 ◽  
Vol 22 (4) ◽  
pp. 461-469 ◽  
Author(s):  
IAF van der Mei ◽  
RM Lucas ◽  
BV Taylor ◽  
PC Valery ◽  
T Dwyer ◽  
...  

Aim: We examined the combined effect of having multiple key risk factors and the interactions between the key risk factors of multiple sclerosis (MS). Methods: We performed an incident case-control study including cases with a first clinical diagnosis of central nervous system demyelination (FCD) and population-based controls. Results: Compared to those without any risk factors, those with one, two, three, and four or five risk factors had increased odds of being an FCD case of 2.12 (95% confidence interval (CI), 1.11–4.03), 4.31 (95% CI, 2.24–8.31), 7.96 (95% CI, 3.84–16.49), and 21.24 (95% CI, 5.48–82.40), respectively. Only HLA-DR15 and history of infectious mononucleosis interacted significantly on the additive scale (Synergy index, 3.78; p = 0.03). The five key risk factors jointly accounted for 63.8% (95% CI, 43.9–91.4) of FCD onset. High anti-EBNA IgG was another important contributor. Conclusions: A high proportion of FCD onset can be explained by the currently known risk factors, with HLA-DR15, ever smoking and low cumulative sun exposure explaining most. We identified a significant interaction between HLA-DR15 and history of IM in predicting an FCD of CNS demyelination, which together with previous observations suggests that this is a true interaction.


2021 ◽  
Author(s):  
Wyllians Vendramini Borelli ◽  
Vanessa Bielefeldt Leotti ◽  
Matheus Zschornack Strelow ◽  
Márcia Lorena Fagundes Chaves ◽  
Raphael Machado Castilhos

2020 ◽  
Author(s):  
Shahrzad Nematollahi ◽  
Mohammad Ali Mansournia ◽  
Abbas Rahimi-Foroushani ◽  
Ali Mouseli ◽  
Hossein Shabkhiz ◽  
...  

Abstract BackgroundTo estimate Population Attributable Fractions (PAFs) and Generalized Impact Fractions (GIFs) for LBW following scenarios to remove or decrease prenatal use of caffeine or water pipe.Methods‎Using data of 861 pregnant women from a population-based prospective cohort study ‎in suburbs of Bandar Abbas city (2016-2018), PAFs and GIFs were calculated based on the relative risk scale. Practical interventional scenarios to reduce the exposure prevalence were developed for calculation of GIFs. ResultsThe cumulative incidence of LBW was 16.1%. An estimated 19% (95%CI: 6, 30%) of LBW neonates was attributed to dietary caffeine intake of >100 mg/day and 11% (95%CI: 8,14%) to water pipe smoking. Action plans to reduce caffeine intake and water pipe smoking suggested an avoidable burden of LBW cases of approximately 10.7% (95% CI: 6.6, 25.3%) and 5.7% ‎‎(95%CI: ‎5.0, 6.8%), respectively.‎ConclusionsWater pipe smoking and excessive consumption of caffeine during pregnancy decreased birth weight. Practical action plans to control water pipe smoking ‎and to prevent excessive intake of ‎caffeine ‎among pregnant women would substantially reduce LBW burden in the south of Iran. ‎


2016 ◽  
Vol 28 (6) ◽  
pp. 550-557 ◽  
Author(s):  
Souradet Y Shaw ◽  
Deborah L Nowicki ◽  
Erin Schillberg ◽  
Christopher G Green ◽  
Craig P Ross ◽  
...  

Population attributable fractions help to convey public health significance of differential disease risk for chlamydia and gonorrhoea. Geographical residence serves as a useful proxy for complex processes creating ill health. Using population-based data, Poisson regression models were used to examine factors associated with chlamydia and gonorrhoea incidence. Population attributable fractions due to residency in the Winnipeg Health Region’s inner-core were determined for chlamydia/gonorrhoea infections among 15–59-year olds (2005–2013), stratified by age group. For both chlamydia and gonorrhoea, it was found that the 15–24-year old age group had the highest incidence rates. There was also a stronger association between residency in the inner-core and incidence for gonorrhoea, compared to chlamydia. Overall, 24% (95% CI: 12–34%) of chlamydia infections were attributable to residency in the inner-core, compared to 46% (95% CI: 35–54%) for gonorrhoea ( p < .05). Within chlamydia/gonorrhoea, no statistically significant differences in population attributable fraction were observed by age group. The conclusion was that a concentration of efforts towards inner-core residents with gonorrhoea infections may result in a relatively larger decrease in incidence.


2016 ◽  
Vol 44 (4) ◽  
Author(s):  
Christian Bamberg ◽  
Katja Niepraschk-von Dollen ◽  
Laura Mickley ◽  
Anne Henkelmann ◽  
Larry Hinkson ◽  
...  

AbstractTo evaluate the incidence of postpartum hemorrhage (PPH) and severe PPH via routine use of a pelvic drape to objectively measure blood loss after vaginal delivery in connection with PPH management.This prospective observational study was undertaken at the obstetrical department of the Charité University Hospital from December 2011 to May 2013 and evaluated an unselected cohort of planned vaginal deliveries (n=1019 live singletons at term). A calibrated collecting drape was used to meassure blood loss in the third stage of labor. PPH and severe PPH were defined as blood loss ≥500 mL and ≥1000 mL, respectively. Maternal hemoglobin content was evaluated at admission to delivery and at the first day after childbirth.During the study period, 809 vaginal deliveries were analysed. Direct measurement revealed a median blood loss of 250 mL. The incidences of PPH and severe PPH were 15% and 3%, respectively. Mean maternal hemoglobin content at admission was 11.9±1.1 g/dL, with a mean decrease of 1.0±1.1 g/dL. Blood loss measured after vaginal delivery correlated significantly with maternal hemoglobin decrease.This study suggests that PPH incidence may be higher than indicated by population-based data. Underbuttocks drapes are simple, objective bedside tools to diagnose PPH. Blood loss should be quantified systematically if PPH is suspected.


2014 ◽  
Vol 143 (5) ◽  
pp. 1020-1028 ◽  
Author(s):  
W. X. YAN ◽  
Y. DAI ◽  
Y. J. ZHOU ◽  
H. LIU ◽  
S. G. DUAN ◽  
...  

SUMMARYTo determine risk factors for sporadicVibrio parahaemolyticusgastroenteritis, we conducted a population-based case-control study in sentinel hospital surveillance areas of Shanghai and Jiangsu province, China. Seventy-one patients with diarrhoea and confirmedV. parahaemolyticusinfections were enrolled, and they were matched with 142 controls for gender, age and residential area. From the multivariable analysis,V. parahaemolyticusinfections were associated with antibiotics taken during the 4 weeks prior to illness [odds ratio (OR) 8·1, 95% confidence interval (CI) 1·2–56·4)], frequent eating out (OR 3·3, 95% CI 1·1–10·1), and shellfish consumption (OR 3·2, 95% CI 1·0–9·9), with population-attributable fractions of 0·09, 0·25, and 0·14, respectively. Protective factors included keeping the aquatic products refrigerated (OR 0·4, 95% CI 0·1–0·9) and pork consumption (OR 0·2, 95% CI 0·1–0·8). Further study of the association ofV. parahaemolyticusgastroenteritis with prior antibiotic use and shellfish consumption is needed.


2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S507-S508
Author(s):  
Jacob Bodilsen ◽  
Michael Dalager-Pedersen ◽  
Diederik van de Beek ◽  
Matthijs C Brouwer ◽  
Henrik Nielsen

Abstract Background Knowledge of risk factors for brain abscess is limited and relies on single-center cohorts without control groups. Methods We accessed nationwide medical registries to conduct a population-based nested case–control study of risk factors for brain abscess. We applied risk set sampling for selection of population controls (1:10) individually matched by age, sex, and area of residence. Conditional logistic regression was used to compute adjusted odds ratios (aOR) with 95% confidence intervals (CIs). Next, population attributable fractions were calculated. Results We identified 1,384 brain abscess patients in Denmark from 1982 through 2016 and 13,839 matched population controls. The median age was 50 years (interquartile range 33–63) and 37% were female. Cases often had a Charlson comorbidity score>2 (16%) compared with controls (3%). Adjusted ORs were: head trauma 2.15 (1.72–2.70), neurosurgery 19.3 (14.3–26.0), dental infection 4.61 (3.39–6.26) or surgery 2.57 (1.71–3.84), ear-nose-throat infection 3.81 (3.11–4.67) or surgery 2.85 (2.21–3.70), congenital heart disease 15.6 (9.57–25.4), diabetes mellitus 1.74 (1.33–2.29), alcohol abuse 2.22 (1.58–3.11), liver disease 2.37 (1.53–3.68), kidney disease 2.04 (1.30–3.20), and lung abscess or bronchiectasis 8.15 (3.59–18.5). The aORs were 4.12 (3.37–5.04) and 8.77 (5.66–13.6) for solid and hematological cancer, 12.0 (6.13–23.7) for HIV, and 5.71 (4.22–7.75) for immuno-modulating treatments. Risks were twice as high when risk factors were observed within 5 years before brain abscess. Population attributable fractions showed that neurosurgery (12%), solid cancer (11%), ear-nose-throat infections (7%) and immuno-modulating treatments (5%) were substantial contributors to occurrence of brain abscess. Conclusion Important risk factors included neurosurgery, cancer, ear-nose-throat infections and immuno-modulating treatments Disclosures All authors: No reported disclosures.


2003 ◽  
Vol 182 (2) ◽  
pp. 117-122 ◽  
Author(s):  
Elizabeth Cantor-Graae ◽  
Carsten Bøcker Pedersen ◽  
Thomas F. Mcneil ◽  
Preben Bo Mortensen

BackgroundA growing body of evidence suggests that migration is a risk factor for the development of schizophrenia, although the putative mechanism remains obscure.AimsTo examine immigrant background and history of foreign residence as risk factors for schizophrenia.MethodUsing data from the Danish Civil Registration System, we established a population-based cohort of 2.14 million persons resident in Denmark by their fifteenth birthday. Schizophrenia in cohort members and parental psychiatric disorder were identified by cross-linkage with the Danish Psychiatric Case Register.ResultsThe relative risk of developing schizophrenia was 2.45 (95% CI 2.25–2.67) and 1.92 (95% CI 1.74–2.12) among first- and second-generation immigrants respectively, and 1.60 (95% CI 1.25–2.05) among Danes with a history of foreign residence.ConclusionsMigration confers an increased risk for schizophrenia that is not solely attributable to selection factors and may also be independent of foreign birth.


1998 ◽  
Vol 173 (1) ◽  
pp. 75-79 ◽  
Author(s):  
Patrick F. Sullivan ◽  
Cynthia M. Bulik ◽  
Kenneth S. Kendler

BackgroundBulimia nervosa is typically defined as the combination of the behaviours of binging and vomiting. We sought to clarify the relationship of these behaviours from a genetic epidemiological perspective.MethodUsing data on the lifetime history of binging and vomiting from a personally interviewed population-based sample of female twins (n = 1897), we applied bivariate twin modelling to estimate the sources of variation for these traits.ResultsThe association between having ever binged (23.6%) and having ever induced vomiting (4.8%) was very strong (odds ratio=8.78, P < 0.0001). The best-fitting model indicated that lifetime binging and vomiting were both heritable (46% and 72%) and influenced by individual-specific environmental factors (54% and 28%). The overlap between the genetic (ra = 0.74) and individual-specific environmental factors (re = 0.48) for the two traits was substantial. No violations of the equal environment assumption were evident.ConclusionsIncluding binging and vomiting under the rubric of bulimia nervosa appears to be appropriate. Our data are consistent with the identification of binging and vomiting as complex traits resulting from the interplay of multiple genes and individual-specific environmental influences. In contrast to ‘environmentalist’ theories, our results suggest that genetic influences may be of particular relevance to the aetiology of binging and vomiting.


2019 ◽  
Author(s):  
Anas Rattani ◽  
J’Neka S. Claxton ◽  
Mohammed K. Ali ◽  
Lin Y. Chen ◽  
Elsayed Z. Soliman ◽  
...  

AbstractHypertension is an established risk factor for the development of atrial fibrillation (AF). We evaluated the association and population impact of hypertension, defined using the new 2017 guidelines, on risk of AF. In this analysis, we included 9,207 participants in the Atherosclerosis Risk in Communities study without history of cardiovascular disease or diabetes. Participants underwent blood pressure measurements at baseline and their antihypertensive medication use was assessed. AF was ascertained from study electrocardiograms, hospital records and death certificates. Cox proportional models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) of AF among individuals with hypertension based on the JNC7 and 2017 ACC/AHA guidelines. Poisson models were used to obtain risk ratios and calculate population-attributable fractions (PAFs). We identified 1,573 cases of incident AF during 22.1 years of mean follow-up. Prevalence of hypertension was 29% and 43% under the JNC7 and 2017 ACC/AHA definitions, respectively. HRs (95%CI) of AF in hypertensives versus non-hypertensives were 1.54 (1.39, 1.72) and 1.45 (1.31, 1.61) after multivariable adjustment under the old and new guidelines, respectively. The corresponding PAF (95%CI) using the old and new guidelines were 12% (9%, 14%) and 14% (10%, 18%), respectively. Overall, our analysis shows that even though the prevalence of hypertension using the new criteria is 50% higher than with the old criteria, this does not translate into meaningful increases in AF attributable to hypertension. These results suggest that prevention or treatment of hypertension based on the new (versus old) guidelines may have limited impact on AF incidence.


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