scholarly journals Social and ethnic disparities in stillbirth and infant death in Denmark, 2005–2016

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Trine Damsted Rasmussen ◽  
Sarah Fredsted Villadsen ◽  
Per Kragh Andersen ◽  
Signe Smith Jervelund ◽  
Anne-Marie Nybo Andersen
Keyword(s):  
Infant Death ◽  
Maternity Care ◽  
Household Income ◽  
Lower Risk ◽  
Ethnic Disparities ◽  
Population Based ◽  
Novel Approach ◽  
High Conflict ◽  
Migration And Health ◽  
Rule Out

AbstractEthnic disparity in stillbirth and infant death has been demonstrated in Europe. As the relation between migration and health change over time, this population based register study investigated the recent figures and explored if potential differences could be explained by the well-known educational and income inequalities in stillbirth and infant death using a novel approach. Stillbirth and infant mortality varied considerably according to country of origin, with only immigrants from China, Norway, and Poland having an overall lower risk than Danish women. Women of Pakistani, Turkish, and Somali origin had a particularly high risk of both outcomes. Women from recent high conflict areas displayed a pattern with increased stillbirth risk. An observed excess risks across generations was found, which is disturbing and rule out factors related to language barriers or newness. Differences in educational level and household income explained only part of the observed inequalities. Strengthening of the maternity care system to better understand and meet the needs of immigrant women seems needed to mitigate the disparities.

scholarly journals Workshop: The Danish MAMAACT trial as an example for discussing evaluation methods in complex interventions

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
Keyword(s):  
Antenatal Care ◽  
Vulnerable Populations ◽  
Infant Death ◽  
Maternity Care ◽  
Sociological Theory ◽  
Immigrant Women ◽  
Complex Interventions ◽  
Ethnic Disparities ◽  
Care Systems ◽  
The Impact

Abstract Over recent years, immigration to Europe has risen significantly. This development has led to increasing birth rates by non-Western immigrant women. Maternity care systems are not yet adapted to this increased diversity of women. In Denmark, 13 % of all children are currently born by women originating from non-Western countries. Despite a publically funded antenatal care, non-Western immigrant women have lower utilization of Danish antenatal care compared to other women giving birth. Many non-Western immigrant women have an increased prevalence of severe maternal morbidity and higher risks of maternal death, stillbirth and infant death compared to the majority populations. Poor health status at birth can impair the cognitive, sensory and motor development and lead to learning disabilities during school age, and thus reduce equality in life chances. Suboptimal care is a contributing factor to these ethnic disparities. Provision of appropriate antenatal care is pivotal to reduce these serious disparities and challenges to public health, however little is known about models of care, which can overcome these barriers. The MAMAACT intervention was developed to increase response to symptoms of pregnancy complications among maternity care providers as well as non-Western immigrant women. The intervention consisted of postgraduate training of midwives in intercultural communication and health education materials (leaflet and an app) for non-Western immigrant women describing how to respond to warning signs during pregnancy in six different languages, The intervention was implemented at 10 out of 20 Danish maternity wards as part of a national trial from the year 2018 to 2019, potentially reaching 25.000 pregnant women, including 2500 of non-Western origin. This workshop shares insight into innovative ways of providing antenatal care for non-Western immigrant women and will focus on methodological aspects of scientific evaluation of complex interventions for vulnerable populations. The workshop includes an introduction, three presentations, and a discussion with the audience. Using quantitative data, the first presentation will give an overview of ethnic disparities in stillbirth and infant death in Denmark. The second presentation will present qualitative data from the implementation evaluation of the MAMAACT intervention with a focus on the interventions program theory, methodological considerations and evaluation results. Finally, the third presentation will illuminate how the concepts of Health Literacy and cultural health capital contribute to an understanding of mechanisms leading to ethnic disparities and how they can be used for evaluating the impact of the MAMAACT intervention. The final discussion will stimulate knowledge sharing between the participants on how to combine quantitative and qualitative insights in trials, how to build partnerships and recruit vulnerable populations in evaluations, and how to use sociological theory in evaluations. Key messages Reducing ethnic disparity in reproductive health requires maternity care systems to rethink their antenatal care services so they are better equipped to support non-Western immigrant women’s needs. Sharing knowledge on the use of mixed methods, recruitment of vulnerable populations, and the use of sociological theory can contribute to future approaches to evaluate complex interventions.

Fracture Risk in Patients with Myasthenia Gravis: A Population-Based Cohort Study

2021 ◽  
pp. 1-8
Author(s):  
Charles Kassardjian ◽  
Jessica Widdifield ◽  
J. Michael Paterson ◽  
Alexander Kopp ◽  
Chenthila Nagamuthu ◽  
...  
Keyword(s):  
Myasthenia Gravis ◽  
Lower Risk ◽  
Cox Regression ◽  
Large Population ◽  
Population Based ◽  
Osteoporosis Prevention ◽  
Inception Cohort ◽  
Hazard Ratios ◽  
Multiple Covariates ◽  
Region Of Residence

Background: Prednisone is a common treatment for myasthenia gravis (MG), and osteoporosis is a known potential risk of chronic prednisone therapy. Objective: Our aim was to evaluate the risk of serious fractures in a population-based cohort of MG patients. Methods: An inception cohort of patients with MG was identified from administrative health data in Ontario, Canada between April 1, 2002 and December 31, 2015. For each MG patient, we matched 4 general population comparators based on age, sex, and region of residence. Fractures were identified through emergency department and hospitalization data. Crude overall rates and sex-specific rates of fractures were calculated for the MG and comparator groups, as well as rates of specific fractures. Adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox regression. Results: Among 3,823 incident MG patients (followed for a mean of 5 years), 188 (4.9%) experienced a fracture compared with 741 (4.8%) fractures amongst 15,292 matched comparators. Crude fracture rates were not different between the MG cohort and matched comparators (8.71 vs. 7.98 per 1000 patient years), overall and in men and women separately. After controlling for multiple covariates, MG patients had a significantly lower risk of fracture than comparators (HR 0.74, 95% CI 0.63–0.88). Conclusions: In this large, population-based cohort of incident MG patients, MG patients were at lower risk of a major fracture than comparators. The reasons for this finding are unclear but may highlight the importance osteoporosis prevention.

scholarly journals From Multiplex Serology to Serolomics—A Novel Approach to the Antibody Response against the SARS-CoV-2 Proteome

Viruses ◽  
2021 ◽  
Vol 13 (5) ◽  
pp. 749
Author(s):  
Julia Butt ◽  
Rajagopal Murugan ◽  
Theresa Hippchen ◽  
Sylvia Olberg ◽  
Monique van Straaten ◽  
...  
Keyword(s):  
Antibody Response ◽  
High Throughput ◽  
Large Population ◽  
High Sensitivity ◽  
Population Based ◽  
Antibody Responses ◽  
Hek293 Cells ◽  
Novel Approach ◽  
Assay Performance ◽  
Multiplex Serology

The emerging SARS-CoV-2 pandemic entails an urgent need for specific and sensitive high-throughput serological assays to assess SARS-CoV-2 epidemiology. We, therefore, aimed at developing a fluorescent-bead based SARS-CoV-2 multiplex serology assay for detection of antibody responses to the SARS-CoV-2 proteome. Proteins of the SARS-CoV-2 proteome and protein N of SARS-CoV-1 and common cold Coronaviruses (ccCoVs) were recombinantly expressed in E. coli or HEK293 cells. Assay performance was assessed in a COVID-19 case cohort (n = 48 hospitalized patients from Heidelberg) as well as n = 85 age- and sex-matched pre-pandemic controls from the ESTHER study. Assay validation included comparison with home-made immunofluorescence and commercial enzyme-linked immunosorbent (ELISA) assays. A sensitivity of 100% (95% CI: 86–100%) was achieved in COVID-19 patients 14 days post symptom onset with dual sero-positivity to SARS-CoV-2 N and the receptor-binding domain of the spike protein. The specificity obtained with this algorithm was 100% (95% CI: 96–100%). Antibody responses to ccCoVs N were abundantly high and did not correlate with those to SARS-CoV-2 N. Inclusion of additional SARS-CoV-2 proteins as well as separate assessment of immunoglobulin (Ig) classes M, A, and G allowed for explorative analyses regarding disease progression and course of antibody response. This newly developed SARS-CoV-2 multiplex serology assay achieved high sensitivity and specificity to determine SARS-CoV-2 sero-positivity. Its high throughput ability allows epidemiologic SARS-CoV-2 research in large population-based studies. Inclusion of additional pathogens into the panel as well as separate assessment of Ig isotypes will furthermore allow addressing research questions beyond SARS-CoV-2 sero-prevalence.

scholarly journals Sense of Purpose in Life Is Associated with Lower Risk of Incident Dementia: A Meta-Analysis

2021 ◽  
pp. 1-10
Author(s):  
Angelina R. Sutin ◽  
Damaris Aschwanden ◽  
Martina Luchetti ◽  
Yannick Stephan ◽  
Antonio Terracciano
Keyword(s):  
Lower Risk ◽  
Meta Analysis ◽  
Random Effect ◽  
Purpose In Life ◽  
Population Based ◽  
Primary Data ◽  
Or Education ◽  
Total N ◽  
Sense Of Purpose ◽  
Incident Dementia

Background: A sense of purpose in life has been associated with healthier cognitive outcomes across adulthood, including risk of dementia. The robustness and replicability of this association, however, has yet to be evaluated systematically. Objective: To test whether a greater sense of purpose in life is associated with lower risk of dementia in four population-based cohorts and combined with the published literature. Methods: Random-effect meta-analysis of prospective studies (individual participant data and from the published literature identified through a systematic review) that examined sense of purpose and risk of incident dementia. Results: In six samples followed up to 17 years (four primary data and two published; total N = 53,499; n = 5,862 incident dementia), greater sense of purpose in life was associated with lower dementia risk (HR = 0.77, 95%CI = 0.73–0.81, p <  0.001). The association was generally consistent across cohorts (I2 = 47%), remained significant controlling for clinical (e.g., depression) and behavioral (e.g., physical inactivity) risk factors, and was not moderated by age, gender, or education. Conclusion: Sense of purpose is a replicable and robust predictor of lower risk of incident dementia and is a promising target of intervention for cognitive health outcomes.

scholarly journals Neighbourhood maternal socioeconomic status indicators and risk of congenital heart disease

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Qun Miao ◽  
Sandra Dunn ◽  
Shi Wu Wen ◽  
Jane Lougheed ◽  
Jessica Reszel ◽  
...  
Keyword(s):  
Socioeconomic Status ◽  
Congenital Heart Disease ◽  
Heart Disease ◽  
Household Income ◽  
Congenital Heart ◽  
Population Based ◽  
Income Poverty ◽  
Lower Odds ◽  
Logistic Regression Models ◽  
Chd Risk

Abstract Background This study aimed to examine the relationships between various maternal socioeconomic status (SES) indicators and the risk of congenital heart disease (CHD). Methods This was a population-based retrospective cohort study, including all singleton stillbirths and live births in Ontario hospitals from April 1, 2012 to March 31, 2018. Multivariable logistic regression models were performed to examine the relationships between maternal neighbourhood household income, poverty, education level, employment and unemployment status, immigration and minority status, and population density and the risk of CHD. All SES variables were estimated at a dissemination area level and categorized into quintiles. Adjustments were made for maternal age at birth, assisted reproductive technology, obesity, pre-existing maternal health conditions, substance use during pregnancy, rural or urban residence, and infant’s sex. Results Of 804,292 singletons, 9731 (1.21%) infants with CHD were identified. Compared to infants whose mothers lived in the highest income neighbourhoods, infants whose mothers lived in the lowest income neighbourhoods had higher likelihood of developing CHD (adjusted OR: 1.29, 95% CI: 1.20–1.38). Compared to infants whose mothers lived in the neighbourhoods with the highest percentage of people with a university or higher degree, infants whose mothers lived in the neighbourhoods with the lowest percentage of people with university or higher degree had higher chance of CHD (adjusted OR: 1.34, 95% CI: 1.24–1.44). Compared to infants whose mothers lived in the neighbourhoods with the highest employment rate, the odds of infants whose mothers resided in areas with the lowest employment having CHD was 18% higher (adjusted OR: 1.18, 95% CI: 1.10–1.26). Compared to infants whose mothers lived in the neighbourhoods with the lowest proportion of immigrants or minorities, infants whose mothers resided in areas with the highest proportions of immigrants or minorities had 18% lower odds (adjusted OR: 0.82, 95% CI: 0.77–0.88) and 16% lower odds (adjusted OR: 0.84, 95% CI: 0.78–0.91) of CHD, respectively. Conclusion Lower maternal neighbourhood household income, poverty, lower educational level and unemployment status had positive associations with CHD, highlighting a significant social inequity in Ontario. The findings of lower CHD risk in immigrant and minority neighbourhoods require further investigation.

scholarly journals Exercise and the Risk of Dementia in Patients with Newly Diagnosed Atrial Fibrillation: A Nationwide Population-Based Study

2021 ◽  
Vol 10 (14) ◽  
pp. 3126
Author(s):  
Jaehyun Lim ◽  
So-Ryoung Lee ◽  
Eue-Keun Choi ◽  
Kyung-Do Han ◽  
Jin-Hyung Jung ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Risk Reduction ◽  
Lower Risk ◽  
Population Based ◽  
Newly Diagnosed ◽  
Incident Dementia ◽  
Before And After ◽  
Korean National Health Insurance ◽  
New Diagnosis ◽  
New Onset

Background: It is unclear whether exercise would reduce dementia in patients with a new diagnosis of atrial fibrillation (AF). Therefore, we aimed to evaluate the association between the change in physical activity (PA) before and after new-onset AF and the risk of incident dementia. Methods: Using the Korean National Health Insurance Service database, we enrolled a total of 126,555 patients with newly diagnosed AF between 2010 and 2016, who underwent health examinations within two years before and after their diagnosis of AF. The patients were divided into four groups: persistent non-exercisers, exercise starters, exercise quitters, and exercise maintainers. Results: Based on a total of 396,503 person-years of follow-up, 5943 patients were diagnosed with dementia. Compared to persistent non-exercisers, exercise starters (adjusted hazard ratio (aHR) 0.87; 95% confidence interval (CI) 0.81–0.94), and exercise maintainers (aHR 0.66; 95% CI 0.61–0.72) showed a lower risk of incident dementia; however, the risk was similar in exercise quitters (aHR 0.98; 95% CI 0.92–1.05) (p-trend < 0.001). There was a J-shaped relationship between the dose of exercise and the risk of dementia, with the risk reduction maximized at 5–6 times per week of moderate-to-vigorous PA among exercise starters. Conclusion: Patients who initiated or continued regular exercise after diagnosis of AF were associated with a lower risk of dementia than persistent non-exercisers, with no risk reduction associated with exercise cessation. Our findings may provide evidence for the benefit of exercise prescription to patients with new-onset AF to prevent incident dementia regardless of their current exercise status.

Novel glucose lowering agents are associated with a lower risk of cardiovascular and adverse events in type 2 diabetes: A population based analysis

2020 ◽  
Vol 310 ◽  
pp. 147-154 ◽  
Author(s):  
Malik Elharram ◽  
Cristiano S. Moura ◽  
Michal Abrahamowicz ◽  
Sasha Bernatsky ◽  
Hassan Behlouli ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Adverse Events ◽  
Lower Risk ◽  
Population Based ◽  
Glucose Lowering

scholarly journals Maternal bisphenol urine concentrations, fetal growth and adverse birth outcomes: A population-based prospective cohort

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Chalana M. Sol ◽  
Charissa van Zwol - Janssens ◽  
Elise M. Philips ◽  
Alexandros G. Asimakopoulos ◽  
Maria-Pilar Martinez-Moral ◽  
...  
Keyword(s):  
Birth Outcomes ◽  
Fetal Growth ◽  
Head Circumference ◽  
Lower Risk ◽  
First Trimester ◽  
Population Based ◽  
Third Trimester ◽  
Bisphenol S ◽  
Fetal Head ◽  
Urine Concentrations

Abstract Background Exposure to bisphenols may affect fetal growth and development. The trimester-specific effects of bisphenols on repeated measures of fetal growth remain unknown. Our objective was to assess the associations of maternal bisphenol urine concentrations with fetal growth measures and birth outcomes and identify potential critical exposure periods. Methods In a population-based prospective cohort study among 1379 pregnant women, we measured maternal bisphenol A, S and F urine concentrations in the first, second and third trimester. Fetal head circumference, length and weight were measured in the second and third trimester by ultrasound and at birth. Results An interquartile range increase in maternal pregnancy-averaged bisphenol S concentrations was associated with larger fetal head circumference (difference 0.18 (95% confidence interval (CI) 0.01 to 0.34) standard deviation scores (SDS), p-value< 0.05) across pregnancy. When focusing on specific critical exposure periods, any detection of first trimester bisphenol S was associated with larger second and third trimester fetal head circumference (difference 0.15 (95% CI 0.05 to 0.26) and 0.12 (95% CI 0.02 to 0.23) SDS, respectively) and fetal weight (difference 0.12 (95% CI 0.02 to 0.22) and 0.16 (95% CI 0.06 to 0.26) SDS, respectively). The other bisphenols were not consistently associated with fetal growth outcomes. Any detection of bisphenol S and bisphenol F in first trimester was also associated with a lower risk of being born small size for gestational age (Odds Ratio 0.56 (95% CI 0.38 to 0.74) and 0.55 (95% CI 0.36 to 0.85), respectively). Bisphenols were not associated with risk of preterm birth. Conclusions Higher maternal bisphenol S urine concentrations, especially in the first trimester, seem to be related with larger fetal head circumference, higher weight and a lower risk of being small size for gestational age at birth.

scholarly journals Physical Activity and the Risk of COVID-19 Infection and Mortality: A Nationwide Population-Based Case-Control Study

2021 ◽  
Vol 10 (7) ◽  
pp. 1539
Author(s):  
Dong-Hyuk Cho ◽  
Sun Ju Lee ◽  
Sae Young Jae ◽  
Woo Joo Kim ◽  
Seong Jun Ha ◽  
...  
Keyword(s):  
Physical Activity ◽  
Lower Risk ◽  
Population Based ◽  
Control Group ◽  
Metabolic Equivalent ◽  
South Korean ◽  
Public Health Screening ◽  
Metabolic Equivalent Of Task ◽  
Korean National Health Insurance ◽  
Respiratory Coronavirus

Regular physical activity (PA) is known to reduce the risk of serious community-acquired infections. We examined the association of PA with the morbidity and mortality resulting from coronavirus disease (COVID-19) infection in the South Korean population. Patients who tested positive for severe acute respiratory coronavirus 2 and who underwent public health screening between 2014 and 2017 (n = 6288) were included. Age- and sex-matched controls (n = 125,772) were randomly selected from the Korean National Health Insurance Service database. Leisure-time PA was assessed using a self-reported questionnaire. The mean PA levels were lower in the patient than in the control group (558.2 ± 516.3 vs. 580.2 ± 525.7 metabolic equivalent of task (MET)-min/week, p = 0.001). Patients with moderate to vigorous PA (MVPA) were associated with a lower risk of COVID-19 morbidity (odds ratio (OR), 0.90; 95% confidence interval (CI), 0.86–0.95). In addition, a standard deviation (SD) increment in MET/week (525.3 MET-min/week) was associated with a 4% decrease in the risk of COVID-19 morbidity (OR, 0.96; 95% CI, 0.93–0.99). MVPA and an SD increment in MET/week were associated with lower mortality (MVPA: OR, 0.47; 95% CI, 0.26–0.87; per SD increment: OR, 0.65; 95% CI, 0.48–0.88). Higher levels of regular PA were associated with a lower risk of COVID-19 infection and mortality, highlighting the importance of maintaining appropriate levels of PA along with social distancing amid the COVID-19 pandemic.

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