Do Hospitals with a Higher Level of Maternal Care Designation Have Better Maternal Outcomes?

2018 ◽  
Vol 36 (06) ◽  
pp. 653-658 ◽  
Author(s):  
Sindhu Srinivas ◽  
Katy Kozhimannil ◽  
Peiyin Hung ◽  
Laura Attanasio ◽  
Judy Jou ◽  
...  
Keyword(s):  
High Risk ◽  
Maternal Care ◽  
Maternal Morbidity ◽  
Cross Sectional Study ◽  
Severe Maternal Morbidity ◽  
Maternal Outcomes ◽  
Cross Sectional ◽  
Discharge Data ◽  
Logistic Regression Models ◽  
The Impact

Background A recent document by the American Congress of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine introduced the concept of uniform levels of maternal care (LMCs). Objective We assessed LMC across hospitals and measured their association with maternal morbidity, focusing on women with high-risk conditions. Study Design We collected data from hospitals from May to November 2015 and linked survey responses to Statewide Inpatient Databases (SID) hospital discharge data in a retrospective cross-sectional study of 247,383 births admitted to 236 hospitals. Generalized logistic regression models were used to examine the associations between hospitals' LMC and the risk of severe maternal morbidity. Stratified analyses were conducted among women with high-risk conditions. Results High-risk pregnancies were more likely to be managed in hospitals with higher LMC (p < 0.001). Women with cardiac conditions had lower odds of maternal morbidity when delivered in level I compared with level IV units (adjusted odds ratio: 0.29; 95% confidence interval: 0.08–0.99; p = 0.049). There were no other significant associations between the LMC and severe maternal morbidity. Conclusion A higher proportion of high-risk pregnancies were managed within level IV units, although there was no overall evidence that these births had superior outcomes. Further prospective evaluation of LMC designation with patient outcomes is necessary to determine the impact of regionalization on maternal outcomes.

scholarly journals The Global Impact of COVID-19 on Craniomaxillofacial Surgeons

2020 ◽  
Vol 13 (3) ◽  
pp. 157-167 ◽  
Author(s):  
Justin van der Tas ◽  
Thomas Dodson ◽  
Daniel Buchbinder ◽  
Stefano Fusetti ◽  
Michael Grant ◽  
...  
Keyword(s):  
Virus Disease ◽  
Statistical Significance ◽  
Binary Logistic Regression ◽  
Cross Sectional Study ◽  
Geographic Region ◽  
Outcome Variable ◽  
Cross Sectional ◽  
Logistic Regression Models ◽  
Long Term Impact ◽  
The Impact

Study Design: The COrona VIrus Disease-19 (COVID-19) pandemic has disrupted craniomaxillofacial (CMF) surgeons practice worldwide. We implemented a cross-sectional study and enrolled a sample of CMF surgeons who completed a survey. Objective: To measure the impact that COVID-19 has had on CMF surgeons by (1) identifying variations that may exist by geographic region and specialty and (2) measuring access to adequate personal protective equipment (PPE) and identify factors associated with limited access to adequate PPE. Methods: Primary outcome variable was availability of adequate PPE for health-care workers (HCWs) in the front line and surgeons. Descriptive and analytic statistics were computed. Level of statistical significance was set at P < .05. Binary logistic regression models were created to identify variables associated with PPE status (adequate or inadequate). Results: Most of the respondents felt that hospitals did not provide adequate PPE to the HCWs (57.3%) with significant regional differences ( P = .04). Most adequate PPE was available to surgeons in North America with the least offered in Africa. Differences in PPE adequacy per region ( P < .001) and per country ( P < .001) were significant. In Africa and South America, regions reporting previous virus outbreaks, the differences in access to adequate PPE evaporated compared to Europe ( P = .18 and P = .15, respectively). Conclusion: The impact of COVID-19 among CMF surgeons is global and adversely affects both clinical practice and personal lives of CMF surgeons. Future surveys should capture what the mid- and long-term impact of the COVID-19 crisis will look like.

scholarly journals The impact of diabetes on multiple avoidable admissions: a cross-sectional study

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Joana Seringa ◽  
Ana Patrícia Marques ◽  
Bruno Moita ◽  
Cátia Gaspar ◽  
João Filipe Raposo ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Age Groups ◽  
Health Care Expenditures ◽  
Cross Sectional Study ◽  
Health Concern ◽  
Diabetes Diagnosis ◽  
Cross Sectional ◽  
Younger Adults ◽  
Logistic Regression Models ◽  
The Impact

Abstract Background Multiple admissions for ambulatory care sensitive conditions (ACSC) are responsible for an important proportion of health care expenditures. Diabetes is one of the conditions consensually classified as an ACSC being considered a major public health concern. The aim of this study was to analyse the impact of diabetes on the occurrence of multiple admissions for ACSC. Methods We analysed inpatient data of all public Portuguese NHS hospitals from 2013 to 2015 on multiple admissions for ACSC among adults aged 18 or older. Multiple ACSC users were identified if they had two or more admissions for any ACSC during the period of analysis. Two logistic regression models were computed. A baseline model where a logistic regression was performed to assess the association between multiple admissions and the presence of diabetes, adjusting for age and sex. A full model to test if diabetes had no constant association with multiple admissions by any ACSC across age groups. Results Among 301,334 ACSC admissions, 144,209 (47.9%) were classified as multiple admissions and from those, 59,436 had diabetes diagnosis, which corresponded to 23,692 patients. Patients with diabetes were 1.49 times (p < 0,001) more likely to be admitted multiple times for any ACSC than patients without diabetes. Younger adults with diabetes (18–39 years old) were more likely to become multiple users. Conclusion Diabetes increases the risk of multiple admissions for ACSC, especially in younger adults. Diabetes presence is associated with a higher resource utilization, which highlights the need for the implementation of adequate management of chronic diseases policies.

scholarly journals The prevalence of neonatal near miss and associated factors in Nepal: A cross-sectional study

2020 ◽  
Author(s):  
Sushma Rajbanshi ◽  
Norhayati Mohd Noor ◽  
Nik Hazlina Nik Hussain
Keyword(s):  
Caesarean Section ◽  
Maternal Morbidity ◽  
Newborn Infants ◽  
Cross Sectional Study ◽  
Near Miss ◽  
Infant Mortality Rate ◽  
Severe Maternal Morbidity ◽  
Sectional Study ◽  
Cross Sectional ◽  
Neonatal Near Miss

Abstract Background: Unlike the infant mortality rate, the rate of neonatal mortality has not declined and remains a major health challenge in low- and middle-income countries. There is an urgent need to focus on newborn care, especially during the first 24 hours of birth and the early neonatal period. Determining which factors contribute to neonatal near miss (NNM) can be used to assess health care quality and identify factors capable of correction in the healthcare system to improve neonatal care. Thus, the objective of the current study was to establish the prevalence of NNM and identify its associated factors.Methods: A hospital-based cross-sectional study was conducted at Koshi Hospital, Nepal. Neonates and their mothers (unspecified maternal age and number of gestational weeks) were enrolled. The key inclusion criterion was the admission of newborn infants to the neonatal intensive care unit at Koshi Hospital. Non-Nepali citizens were excluded. Consecutive sampling was used until the required sample size (i.e., 1,000 newborn infants) was reached. Simple and multiple logistic regression analysis was performed using SPSS ® version 24.0.Results: One thousand respondents were recruited. The prevalence of NNM was 79 per 1,000 live births. Maternal secondary (adjusted odds ratio (AOR]: 0.46, 95% confidence interval (CI]: 0.24–0.88) and tertiary education (AOR: 0.18, 95% CI: 0.05–0.56), multiparity (AOR: 0.52, 95% CI: 0.39–0.86), Caesarean section (AOR: 0.48, 95% CI: 0.19–0.99), and severe maternal morbidity (AOR: 4.51, 95% CI: 2.07–9.84) were significantly associated with NNM.Conclusions: Parity, severe maternal morbidity, mode of delivery, and maternal education were significantly associated with NNM. Healthcare workers should be aware of the impact of obstetric factors so that earlier interventions, especially the Caesarean section, can be exercised.

scholarly journals Severe maternal morbidity and its associated factors: A cross-sectional study in Morang district, Nepal

PLoS ONE ◽  
2021 ◽  
Vol 16 (12) ◽  
pp. e0261033
Author(s):  
Sushma Rajbanshi ◽  
Mohd Noor Norhayati ◽  
Nik Hussain Nik Hazlina
Keyword(s):  
Maternal Morbidity ◽  
Associated Factors ◽  
Maternal Education ◽  
Multiple Logistic Regression Analysis ◽  
Cross Sectional Study ◽  
World Health ◽  
Severe Maternal Morbidity ◽  
Sectional Study ◽  
Cross Sectional ◽  
Health Organization

Background Understanding maternal morbidity and its determinants can help identify opportunities to prevent obstetric complications and improvements for maternal health. This study was conducted to determine the prevalence of severe maternal morbidity (SMM) and the associated factors. Methods A hospital-based cross-sectional study was conducted at Koshi Hospital, Nepal, from January to March 2020. All women who met the inclusion criteria of age ≥18 years of age, Morang residents of Nepalese nationality, had received routine antenatal care, and given birth at Koshi Hospital were recruited consecutively. The World Health Organization criteria were used to identify the women with SMM. A multiple logistic regression analysis was performed. Overall, 346 women were recruited. Findings The prevalence of SMM was 6.6%. Among the SMM cases, the most frequently occurring SMM conditions were hypertensive disorders (12, 56.5%), hemorrhagic disorders (6, 26.1%), and severe management indicators (8, 34.8%). Women with no or primary education (adjusted odds ratio: 0.10, 95% confidence interval: 0.01, 0.76) decreased the odds of SMM compared to secondary education. Conclusion The approximately 7% prevalence of SMM correlated with global studies. Maternal education was significantly associated with SMM. If referral hospitals were aware of the expected prevalence of potentially life-threatening maternal conditions, they could plan to avert future reproductive complications.

scholarly journals The Impact of High Carbohydrate Intake on Physical Frailty in Older Korean Adults: a Cohort-based Cross-sectional Study

2022 ◽  
Author(s):  
Narae Yang ◽  
Yunhwan Lee ◽  
Mi Kyung Kim ◽  
Kirang Kim
Keyword(s):  
Energy Intake ◽  
Nutritional Intervention ◽  
Cross Sectional Study ◽  
Physical Frailty ◽  
Cross Sectional ◽  
Logistic Regression Models ◽  
Nutrient Density ◽  
Korean Elderly ◽  
The Impact ◽  
The Relationship

Abstract Background: The relationship between macronutrients and frailty is unclear. Previous studies have confirmed the relationships between energy and protein intake and physical frailty, while few studies have examined the role of carbohydrate or fat intake in the prevalence of frailty. The aim of this study is to investigate the relationship of energy and macronutrients with physical frailty in the Korean elderly population who had a high proportion of energy intake from carbohydrates.Methods: This study included 954 adults aged 70 to 84 years who have completed the assessment of frailty and 24-h recall upon enrolment in the Korean Frailty and Aging Cohort Study and have no extreme intake under 400 kcal (n = 2). The relationship between energy or macronutrients and frailty was evaluated using multivariate logistic regression models and multivariate nutrient density models.Results: In the subjects with low energy intake (odds ratio [OR] = 2.94, 95% confidence interval [CI] = 1.34–6.45) and total subjects (OR = 2.01, 95% CI = 1.03–3.93), consuming carbohydrates above the acceptable macronutrient distribution range (65% of energy) was related to a higher risk of frailty. Substituting the energy from fat with carbohydrates was related to a higher risk of frailty (1%, OR = 1.05, 95% CI = 1.00–1.09; 5%, OR = 1.26, 95% CI = 1.02–1.56; 10%, OR = 1.59, 95% CI = 1.03–2.43).Conclusions: This study showed that the proportion of energy intake from carbohydrates and fats may be an important nutritional intervention factor for reducing the risk of frailty.

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