The Impact of Group Prenatal Care on Interpregnancy Interval

2021 ◽  
Author(s):  
Justine M. Keller ◽  
Jessica A. Norton ◽  
Fan Zhang ◽  
Rachel Paul ◽  
Tessa Madden ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Prenatal Care ◽  
Maternal Education ◽  
Stepwise Logistic Regression ◽  
Group Prenatal Care ◽  
Interpregnancy Interval ◽  
Inclusion Criteria ◽  
Postpartum Contraception ◽  
Infant Birth ◽  
The Impact

Objective To evaluate whether participation in CenteringPregnancy group prenatal care is associated with decreased risk of an interpregnancy interval (IPI) ≤6 months. Study Design We conducted a retrospective cohort study of women enrolled in Missouri Medicaid from 2007 to 2014 using maternal Medicaid data linked to infant birth certificate records. Inclusion criteria were women ≥11 years old, ≥1 viable singleton delivery during the study period, residency in St. Louis city or county, and ≥2 prenatal visits. The primary outcome was an IPI ≤6 months. Secondary outcomes included IPI ≤12 months, IPI ≤18 months, postpartum long-acting reversible contraception (LARC) uptake, and postpartum LARC or depot medroxyprogesterone acetate (DMPA) uptake. Data were analyzed using descriptive statistics and logistic regression. Backward stepwise logistic regression was used to adjust for potential confounders including maternal age, race, obesity, nulliparity, marital status, diabetes, hypertension, prior preterm birth, and maternal education. Results Of the 54,968 pregnancies meeting inclusion criteria, 1,550 (3%) participated in CenteringPregnancy. CenteringPregnancy participants were less likely to have an IPI ≤6 months (adjusted odds ratio [aOR]: 0.61; 95% confidence interval [CI]: 0.47–0.79) and an IPI ≤12 months (aOR: 0.74; 95% CI: 0.62–0.87). However, there was no difference for an IPI ≤18 months (aOR: 0.89; 95% CI: 0.77–1.13). Women in CenteringPregnancy were more likely to use LARC for postpartum contraception (aOR: 1.37; 95% CI: 1.20–1.57). Conclusion Participation in CenteringPregnancy is associated with a significant decrease in an IPI ≤6 and ≤12 months and a significant increase in postpartum LARC uptake among women enrolled in Missouri Medicaid compared with women in traditional prenatal care. Key Points

The impact of Centering Pregnancy Group Prenatal Care on postpartum family planning

2014 ◽  
Vol 210 (1) ◽  
pp. 50.e1-50.e7 ◽  
Author(s):  
Nathan Hale ◽  
Amy H. Picklesimer ◽  
Deborah L. Billings ◽  
Sarah Covington-Kolb
Keyword(s):  
Family Planning ◽  
Prenatal Care ◽  
Group Prenatal Care ◽  
Centering Pregnancy ◽  
Postpartum Family Planning ◽  
The Impact

196: The impact of centeringpregnancy group prenatal care on preterm birth

2018 ◽  
Vol 218 (1) ◽  
pp. S130-S131
Author(s):  
Misty L. McDowell ◽  
Chelsea Abshire ◽  
Amy H. Crockett ◽  
Nancy L. Fleischer
Keyword(s):  
Preterm Birth ◽  
Prenatal Care ◽  
Group Prenatal Care ◽  
The Impact

Risk Factors for Delirium in Trauma Patients: The Impact of Ethanol Use and Lack of Insurance

2011 ◽  
Vol 77 (5) ◽  
pp. 621-626 ◽  
Author(s):  
Bernardino C. Branco ◽  
Kenji Inaba ◽  
Marko Bukur ◽  
Peep Talving ◽  
Matthew Oliver ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Logistic Regression ◽  
Chronic Ethanol ◽  
Ethanol Ingestion ◽  
Stepwise Logistic Regression ◽  
Trauma Patients ◽  
Stepwise Logistic Regression Analysis ◽  
Independent Risk Factors ◽  
The Impact

The purpose of this study was to examine independent risk factors, and in particular the impact of alcohol on the development of delirium, in a cohort of trauma patients screened for ethanol ingestion on admission to hospital. The National Trauma Databank (v. 7.0) was used to identify all patients 18 years or older screened for ethanol on admission. Patients who developed delirium were compared with those who did not. Stepwise logistic regression analysis was used to identify independent risk factors for the development of delirium. A total of 504,839 patients with admission ethanol levels were identified. Of those, 2,909 (0.6%) developed delirium. Patients developing delirium were significantly older, more frequently male, and more likely to sustain thermal injuries and falls. Patients developing delirium had more comorbidities including chronic ethanol use (19.1% vs 4.5%, P < 0.001) and cardiovascular disease (21.5% vs 12.2%, P < 0.001). On admission, patients developing delirium were more likely to be intoxicated with ethanol (55.4% vs 26.5%, P < 0.001) and were more likely to be uninsured (17.8% vs 0.9%, P < 0.001). A stepwise logistic regression model identified lack of insurance, positive ethanol on admission, chronic ethanol use, Intensive Care Unit admission, age ≥ 55 years, burns, Medicare insurance, falls, and history of cardiovascular disease as independent risk factors for the development of delirium. The incidence of delirium in this trauma patient cohort was 0.6 per cent. The above risk factors were independently associated with the development of delirium. This data may be helpful in designing interventions to prevent delirium.

The Effects of Domestic Violence During Pregnancy on Maternal and Infant Health

2002 ◽  
Vol 17 (2) ◽  
pp. 169-185 ◽  
Author(s):  
Alissa C. Huth-Bocks ◽  
Alytia A. Levendosky ◽  
G. Anne Bogat
Keyword(s):  
Domestic Violence ◽  
Birth Weight ◽  
Prenatal Care ◽  
Infant Health ◽  
Health Problems ◽  
Maternal And Infant Health ◽  
Violence During Pregnancy ◽  
Maternal Social Support ◽  
Infant Birth ◽  
The Impact

The present study examined the impact of domestic violence on maternal and infant health by assessing maternal health during pregnancy and infant health at two months postpartum. Two hundred and two women (68 battered and 134 non-battered) were recruited from the community and completed both pregnancy and 2-month postpartum interviews. Results revealed that domestic violence during pregnancy was associated with numerous health problems for mothers and infants including more health problems during pregnancy, more likelihood of premature labor, later entrance into prenatal care, lower infant birth weight, greater utilization of health care resources, and more prenatal substance use. After income was controlled, the relationship between violence and timing of prenatal care and infant birth weight became nonsignificant. Maternal social support was found to protect against the effects of violence for several health outcomes. The current findings suggest the need for domestic violence screening during pregnancy, as well as clinical interventions for battered, pregnant women in order to prevent serious physical and emotional problems for both mothers and their infants.

scholarly journals 2203. Patient-Specific Risk Stratification to Identify Patients at High and Low Risk for P. aeruginosa in Community-Acquired Pneumonia

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S751-S751
Author(s):  
William Justin Moore ◽  
Caroline Cruce ◽  
Karolina Harkabuz ◽  
Shereen Salama ◽  
Sarah Sutton ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Risk Stratification ◽  
Antibiotic Use ◽  
Community Acquired Pneumonia ◽  
Low Risk ◽  
Patient Specific ◽  
Stepwise Logistic Regression ◽  
Case Status ◽  
The Impact

Abstract Background Pseudomonas aeruginosa (PsA) is an infrequent pathogen associated with poor outcomes in community-acquired pneumonia (CAP). Identifying patients at high and low-risk for PsA in CAP is necessary to reduce inappropriate and overly broad-spectrum antibiotic use. We evaluated the distribution of risk-factors in hospitalized CAP patients with and without PsA infection. Methods Design: retrospective, single-center, case–control study. Inclusion: hospitalized CAP patients admitted to the general medicine wards between January 1, 2014 and May 29, 2018. Exclusion: cystic fibrosis, ≥ 3 admissions within 30 days, CAP requiring ICU admission, and death within 48 hours of admission. Case patients had PsA in respiratory or blood cultures during the index CAP admission. Controls were randomly selected targeting a 3:1 ratio. Comorbidities, pneumonia severity index, and m-APACHE II were assessed. Gram-negative risk factors defined by Shindo et al. 2013 (PMID: 23855620) and validated by Kobayashi et al. (2018; PMID: 30349327) were scored for each patient. Stepwise logistic regression was used to identify covariates that distinguished cases from controls at a P < 0.2; these were then used to generate propensity weights (i.e., inverse-probability conditioned on covariates). Unadjusted and adjusted odds ratios for case status were estimated using logistic regression according to: the total number of risk factors present and threshold values, respectively. All analyses were conducted using IC Stata (v.14.2). Results 54 cases and 152 controls were included. The distribution of the patient-specific sum of risk factors for PsA is shown in Figure 1. The univariate OR for case status was 4.29 (95% CI:1.55–11.9) at n = 3 risk factors, which was similar after propensity weight adjustment [aOR = 4.64 (95% CI: 1.32–16.3)]. The univariate OR of case status was 2.98 among patients with ≥ 3 risk factors (95% CI: 1.34–6.62), which was similar after propensity weight adjustment [aOR = 2.8 (95% CI: 1.02–7.72)], and correct classification was 73.8%. Conclusion At a threshold of ≥ 3 PsA risk factors, cases and controls were well classified, even after adjusting for propensity weights. The impact of patient-specific PsA risk-stratification on CAP outcomes and appropriate antibiotic use should be evaluated. Disclosures All authors: No reported disclosures.

scholarly journals The French implementation study PARENTHESE to improve prenatal care of immigrant women

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
E Azria ◽  
F Eboue ◽  
M Fallon ◽  
O Khomry ◽  
P Sauvegrain ◽  
...  
Keyword(s):  
Pilot Study ◽  
Prenatal Care ◽  
Immigrant Women ◽  
Group Model ◽  
Group Prenatal Care ◽  
Migrant Women ◽  
Optimal Care ◽  
Mortality And Morbidity ◽  
Increased Risk ◽  
The Impact

Abstract Numerous studies have shown that non-Western immigrant women have higher maternal and perinatal mortality and morbidity than women and children from host countries. This increased risk is partly explained by less access to quality antenatal care and more sub-optimal care. The organisation and provision of prenatal care in France remain unchanged on a model that is not very sensitive and adaptable to the specific needs of certain groups such as non-Western migrant women. Group prenatal care, an alternative and innovative model, can theoretically be rigorously implemented within the framework of the recommendations for prenatal care set by the French Haute Autorité de Santé and thus meet the objectives assigned to it. This alternative method of monitoring, implemented in different US settings, seems to increase access and adherence to prenatal monitoring, as well as women's involvement in its monitoring. Some studies also suggest that this type of prenatal monitoring could also reduce maternal and perinatal risk. Such intervention has never been tested in France and moving away from a prenatal monitoring model based on individual monitoring towards a group model requires overcoming significant cultural barriers. Before being able to test the impact of a complex intervention such as group prenatal care for migrant women and wider deployment, we set up a pilot study with the aim of precisely defining the intervention and preparing and documenting its implementation process in three different sites using qualitative and quantitative approaches. It is also to evaluate its acceptability for women who participate in these groups as well as for professionals. In addition to presenting this pilot study at this workshop, the objective of this presentation is also to highlight the importance of contextual considerations in the design of the intervention or its implementation in the particular context of intervention aimed at improving migrant populations' health.

scholarly journals Association of Expanded Prenatal Care Coverage for Immigrant Women With Postpartum Contraception and Short Interpregnancy Interval Births

2021 ◽  
Vol 4 (8) ◽  
pp. e2118912
Author(s):  
Maria I. Rodriguez ◽  
Menolly Kaufman ◽  
Stephan Lindner ◽  
Aaron B. Caughey ◽  
Ana Lopez DeFede ◽  
...  
Keyword(s):  
Prenatal Care ◽  
Immigrant Women ◽  
Interpregnancy Interval ◽  
Postpartum Contraception ◽  
Short Interpregnancy Interval

scholarly journals Factors influencing exclusive breastfeeding duration in Pakistan: a population-based cross-sectional study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sidra Arif ◽  
Hina Khan ◽  
Muhammad Aslam ◽  
Muhammad Farooq
Keyword(s):  
Logistic Regression ◽  
Survival Analysis ◽  
Exclusive Breastfeeding ◽  
Maternal Education ◽  
Binary Logistic Regression ◽  
World Health ◽  
Breastfeeding Duration ◽  
The Impact ◽  
The Relationship

Abstract Background Breastfeeding has the most profound impact on infant health and wellness, and also have significant implications for the mother. The duration of the breastfeeding determines the infant’s protection from malnutrition and other common infectious diseases; consequently, the World Health Organization (WHO) recommends exclusive breastfeeding (EBF) six months, followed by gradual weaning and breastfeeding until the baby is two years old. In Pakistan, the practice of breastfeeding is heavily dependent upon certain demographic, economic, social, and biological factors, which ultimately impact the quality of care provided to the infant and their health. The aim of this paper, therefore, is to measure the impact of these factors on the exclusive breastfeeding duration in Pakistan. Methods The data for the study has been collected from Pakistan Demographic and Health Survey (PDHS) for the year 2017–18. Binary logistic regression model and survival analysis are used to determine the relationship between the independent and dependent variables. Results We use a binary logistic regression to estimate the effect of each factor on the duration of EBF. The binary logistic regression finds significant relationships between region, maternal education, wealth index, size of a child, watching television, delivery by cesarean, and maternal age and EBF. We then use log-likelihood, AIC, BIC criteria to determine if a parametric or non-parametric model would provide a better fit; based on these results we fit an Inverse Gaussian (Weibull) distribution for the survival analysis. These results show that there are more significant factors associated with EBF duration in parametric survival analysis than in the binary logistic regression results. Thus, the survival analysis is a better method for predicting the relationship between the duration of EBF and its factors. Furthermore, logically EBF is designated to be done for six months which would not be properly gauged with a binary response variable. Conclusions The results of this study provide proof that exclusive breastfeeding is a common practice among women in Pakistan, and to improve the quality of post-natal care, health policy in the country needs to focus on the existing demographic and social factors which are found significant in this study.

scholarly journals The influence of paramedic qualification level on the administration of analgesia in the prehospital setting

2019 ◽  
Vol 4 (2) ◽  
Author(s):  
Bill Lord ◽  
Toby Keene ◽  
Cassie Luck
Keyword(s):  
Logistic Regression ◽  
Predictor Variables ◽  
Future Research ◽  
Sample Population ◽  
Practice Setting ◽  
Patient Records ◽  
Inclusion Criteria ◽  
Chi Square ◽  
Chi Square Test ◽  
The Impact

<p><strong>Background</strong></p><p>Undertreatment of pain has been reported in the paramedic literature, and reasons for these disparities are not well understood.</p><p><strong>Aims</strong></p><p>As the qualification level of the paramedic may affect analgesia administration, the primary aim of this study was to determine the impact of paramedic qualification on the provision of any analgesia for patients reporting pain.</p><p><strong>Methods</strong></p><p>Retrospective study of de-identified patient care records from one Australian ambulance service over a period of 6 months. Inclusion criteria were age was &gt; 17 years, initial pain severity score was &gt; 3/10 and Glasgow Coma Score &gt;13. Data were descriptively analysed for analgesia administration and type of analgesic by predictor variables: age, sex, pain score and case nature. Pearson’s chi-square test was used to test for associations between the outcome of interest and predictor variables. Adjusted logged odds of patients receiving analgesia was tested with binomial logistic regression.</p><p><strong>Findings</strong></p><p>3173 patient records met the inclusion criteria. ICP treated 86% of the sample population. Of those treated by an AP, 76.2% (n=340) received analgesia, whereas 71.6% (n=1952) of patients treated by an ICP received analgesia (p=0.042). Methoxyflurane was the most frequently administered analgesic, with 39.9% of the patients (n=1,264) receiving this agent; 31.1% of patients (n=988) received morphine, and 14.2% (n=452) received fentanyl. The unadjusted regression model found that AP have higher odds of administering analgesia than ICP paramedics (OR 1.264, p &lt;0.05). However, once other covariates are included in the logistic regression, the significance no longer exists.</p><p><strong>Conclusion</strong></p><p>Paramedic qualification is not associated with the administration of analgesia in this setting. This study contributes to the gap in knowledge regarding disparities in analgesia for adults experiencing pain and may inform future research that aims to identify and reduce barriers to appropriate pain management in the paramedic practice setting.</p>

Abstract WP46: FLAIR Vascular Hyperintensity ASPECTS (FVH-ASPECTS) Pattern Predicts Outcome in Endovascular Therapy in Acute M1-MCA Occlusion

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Dezhi Liu ◽  
Fabien Scalzo ◽  
Sidney Starkman ◽  
Neal M Rao ◽  
Jason D Hinman ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Clinical Outcome ◽  
Endovascular Treatment ◽  
Endovascular Therapy ◽  
Arterial Occlusion ◽  
Cerebral Hypoperfusion ◽  
Slow Flow ◽  
Inclusion Criteria ◽  
Mca Occlusion ◽  
The Impact

Introduction: In acute arterial occlusion, the FLAIR vascular hyperintensity (FVH) sign have been linked to slow flow in leptomeningeal collaterals and cerebral hypoperfusion, but the impact on clinical outcome is still controversial. In this study, we aimed to investigate the association between FVH-ASPECTS pattern and outcome in acute M1-MCA occlusion patients with endovascular treatment. Methods: We included acute M1-MCA occlusion patients treated with endovascular therapy. All patients had DWI and FLAIR before endovascular therapy. Distal FVH ASPECT score was evaluated according to distal MCA-ASPECT area (M1-M6) and acute DWI lesion was also reviewed. Presence of FVH inside DWI positive lesion and outside DWI positive lesion was separately analyzed. We analyzed clinical outcome after endovascular therapy based on these different FVH-ASPECTS patterns. Results: Among 101 patients that met inclusion criteria for the study, mean age was 66.2±17.8 and median NIHSS was 17.0 (IQR 12.0-21.0). FVH-ASPECTS measured outside of the DWI lesion was significantly higher in patients with good outcome (mRS 0-2), (8.0 vs 4.0, p<0.001). Logistic regression demonstrated that FVH-ASPECTS outside of the DWI lesion was independently associated with clinical outcome of these patients (OR 1.3, p=0.013). FVH-ASPECTS inside the DWI lesion was associated with hemorrhage transformation (OR 1.3, p=0.019). Conclusion: Higher FVH-ASPECTS measured outside the DWI lesion is associated with good clinical outcomes in patients undergoing endovascular therapy. FVH-ASPECTS measured inside the DWI lesion was predictive of hemorrhage transformation. FVH pattern, not number, can predict outcome of acute M1-MCA occlusion patients after endovascular therapy.

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