scholarly journals Delayed Onset of Lactogenesis Is Associated with Suboptimal Breastfeeding Practices in the TMCHC Study: A Prospective Cohort Study (OR30-05-19)

2019 ◽  
Vol 3 (Supplement_1) ◽  
Author(s):  
Li Huang ◽  
Xi Chen ◽  
Qian Li ◽  
Lixia Lin ◽  
Duan Gao ◽  
...  
Keyword(s):  
Cohort Study ◽  
Cox Regression ◽  
Chinese Women ◽  
Basic Research ◽  
Delivery Mode ◽  
Face To Face ◽  
Delayed Onset ◽  
Funding Sources ◽  
Breastfeeding Practices ◽  
Suboptimal Breastfeeding

Abstract Objectives Whether delayed onset of lactogenesis (delayed OL) was linked to successful breastfeeding is unclear. We aimed to assess the association between delayed OL and breastfeeding practices in Chinese women. Methods Women form the TMCHC (Tongji Maternal and Child Health Cohort) study, who had OL assessment by face-to-face interview at day 4 postpartum and breastfeeding practices collected at 3, 6 and 12 months postpartum, were selected for the study. Poisson regression and Cox regression were used to identify the association between delayed OL and breastfeeding practices. Results Delayed OL was reported by 17.7% of the 2691 participants. After adjusting for maternal age, ethnicity, education, income, parity, pre-pregnancy BMI, GDM, gestational weight gain, gestational age, delivery mode, birth weight and breastfeeding information at day 1 postpartum, delayed OL was significantly associated with a higher risk of an inability to sustain full breastfeeding at 3 months postpartum (RR:1.31, 95% CI: 1.16, 1.48) and 6 months postpartum (RR:1.17, 95% CI: 1.07, 1.28), when compared with timely OL. Delayed OL was also significantly associated with early termination of any breastfeeding (HR:1.17, 95% CI: 1.01, 1.34) in adjusted model. Conclusions This study shows that women with delayed OL had a higher risk of suboptimal breastfeeding practices. Comprehensive efforts should be targeted towards women with delayed OL to promote breastfeeding. Funding Sources Funding was received from National Program on Basic Research Project of China (NO.2013FY114200) and the Fundamental Research Funds for the Central Universities (HUST2016YXZD040) for Nianhong Yang. Supporting Tables, Images and/or Graphs

scholarly journals Delayed Lactogenesis Is Associated with Suboptimal Breastfeeding Practices: A Prospective Cohort Study

2019 ◽  
Vol 150 (4) ◽  
pp. 894-900 ◽  
Author(s):  
Li Huang ◽  
Shangzhi Xu ◽  
Xi Chen ◽  
Qian Li ◽  
Lixia Lin ◽  
...  
Keyword(s):  
Cohort Study ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Cox Regression ◽  
Normal Weight ◽  
Face To Face ◽  
Gestational Weight ◽  
Breastfeeding Practices ◽  
Suboptimal Breastfeeding ◽  
Adjusted Model

ABSTRACT Background Breastfeeding has many established health benefits to both babies and mothers. There is limited evidence on the association between delayed lactogenesis and breastfeeding practices. Objective We assessed the association between delayed lactogenesis and breastfeeding practices in women initiating breastfeeding. Design We used data from a prospective cohort study in Wuhan, China, which enrolled pregnant women at 8–16 weeks of gestation and followed up to postpartum. Women were included who had a singleton live birth, initiated breastfeeding, and provided information on infant feeding. Maternal lactogenesis status was assessed by face-to-face interview at day 4 postpartum. Breastfeeding practices (full breastfeeding and/or any breastfeeding) were queried by telephone interview at 3, 6, and 12 mo postpartum. Poisson regression and Cox regression were used to identify the association between delayed lactogenesis and breastfeeding practices. Results Delayed lactogenesis was reported by 17.9% of the 2877 participants. After adjusting for potential confounders, when compared with timely lactogenesis, delayed lactogenesis was significantly associated with higher risk of inability to sustain full breastfeeding at 3 mo postpartum (RR: 1.24, 95% CI: 1.10, 1.39) and 6 mo postpartum (RR: 1.14, 95% CI: 1.04, 1.24). Delayed lactogenesis was also significantly associated with early termination of any breastfeeding (HR: 1.15, 95% CI: 1.01, 1.30) in the adjusted model. In a combined analysis, women with higher gestational weight gain (GWG, ≥16 kg for underweight and normal weight, 15 kg for overweight/obesity) and who subsequently experienced delayed lactogenesis had the highest risk of ending any breastfeeding earlier (adjusted HR: 1.32, 95% CI: 1.11, 1.55) compared with those who gained less GWG and experienced timely lactogenesis. Conclusions This study shows that delayed lactogenesis was associated with low rate of full breastfeeding and shorter duration of any breastfeeding. Greater efforts to promote breastfeeding should be targeted towards women with delayed lactogenesis.

scholarly journals Predicting Acute Malnutrition in Rural Twins Before Their Second Birthday: Cohort Study

2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 1406-1406
Author(s):  
Franck Garanet
Keyword(s):  
Regression Analysis ◽  
Cohort Study ◽  
Cox Regression ◽  
Dietary Supplementation ◽  
Acute Malnutrition ◽  
P Value ◽  
Cox Regression Analysis ◽  
Funding Sources ◽  
Significance Threshold ◽  
Wealthy Household

Abstract Objectives Identify the predictors of acute malnutrition in rural twins in a context of dietary supplementation in Burkina Faso. Methods This is a prospective cohort study. A cox regression was used to investigate predictors of acute malnutrition. A significance threshold of 0.05 was considered. Results Severe acute malnutria was more common in twins compared to non-twins (22.13% vs. 9.98%, P-0.001). Growth retardation was more common in twins compared to non-twins (34.04% vs. 21.49%, P-0.001). Underweight was more common in twins compared to non-twins (1.70% versus 0.43%). This difference was not statically significant (P-0.06). In multi-varied cox regression analysis, the factors significantly associated with acute malnutrition were: being born twins, episodes of fevers, diarrhea, and wealth level. Twins were almost twice as likely to be malnourished compared to single children (HRa −1.82, IC95% - [1.59–2.07] and P-0.001). Children with a fever were 2.54 more likely to be malnourished than other children. (HRa - 2.15, IC95% - [1.74–2.67] and P-0.001). Children with diarrhea were 2.54 more likely to be malnourished than other children. (HRa - 2.05, IC95% - [1.62–2.59] and P-0.001). Children born in a wealthy household were 25% less likely to be malnourished compared to other children (HRa-0.75; IC95%, [0.61–0.92]; P-value-0.007). Conclusions Particular attention should be paid to twins, in order to reduce the risk of acute malnutrition before their second birthday. Funding Sources None.

scholarly journals Maternal Experience of Intimate Partner Violence Is Associated with Suboptimal Breastfeeding in Malawi, Tanzania, and Zambia: Insights from DHS Analyses (P10-059-19)

2019 ◽  
Vol 3 (Supplement_1) ◽  
Author(s):  
Christine Walters ◽  
Hasina Rakotomanana ◽  
Joel Komakech ◽  
Barbara Stoecker
Keyword(s):  
Intimate Partner Violence ◽  
Partner Violence ◽  
Intimate Partner ◽  
Demographic And Health Surveys ◽  
Maternal Experience ◽  
Funding Sources ◽  
Breastfeeding Practices ◽  
Suboptimal Breastfeeding ◽  
Controlling Behaviors ◽  
Initiation Of Breastfeeding

Abstract Objectives Maternal experience of intimate partner violence (IPV) remains an overlooked variable in the context of breastfeeding in East Africa. Therefore, this study investigated the association between maternal experience of different forms of intimate partner violence (IPV) and frequency of IPV and suboptimal breastfeeding practices in Malawi, Tanzania, and Zambia. Methods Data were obtained from the most recent Demographic and Health Surveys for Malawi (n = 1878), Tanzania (n = 3184), and Zambia (n = 3879) and included mother-infant dyads. Outcomes were early initiation of breastfeeding, exclusive breastfeeding, and continued breastfeeding. IPV was maternal reported experience of physical, sexual, or emotional violence or controlling behaviors and frequency of IPV. Significant bivariate results (P < 0.05) were included in the adjusted models in multivariate logistic regression. Results Most (80.4%) Malawian mothers initiated early breastfeeding, compared to mothers in Tanzania (53.4%) and Zambia (67.7%). Just over half (55.0%) of Tanzanian infants were exclusively breastfed while 60.1% and 70.6% of Malawian and Zambia infants were. Continued breastfeeding at 1 year was high in all countries; Malawi (91.0%), Tanzania (92.4%), Zambia (95.0%). In Zambia, 78.8% of mothers reported experiencing any form of IPV compared to 76.6% and 73.4% of Tanzanian and Malawian mothers who reported experiencing IPV. In all three countries, mothers who experienced emotional IPV were more likely not to initiate breastfeeding in the first hour after birth (Malawi [AOR = 1.37(1.05–1.79)]; Tanzania [AOR = 1.43(1.22–1.68)]; Zambia [AOR = 1.28(1.06–1.54)]). In Malawi and Zambia, women who frequently experienced any form of IPV were more likely not to have exclusively breastfed (Malawi [AOR = 1.88(1.17–3.04)]; Zambia [AOR = 1.96(1.35–2.85)]). Tanzanian mothers who experienced emotional IPV were nearly two times more likely not to continue breastfeeding until the child's first birthday [AOR = 1.94(1.03–3.66)]. Conclusions In all three countries, maternal experience of IPV was associated with suboptimal breastfeeding practices. The potential effects of maternal experience of IPV on breastfeeding should be considered when planning interventions and designing policies to improve breastfeeding in Malawi, Tanzania, and Zambia. Funding Sources None.

Emergency LMS Training During COVID-19 at an African University of Technology

2020 ◽  
Vol 11 (1) ◽  
pp. 113-113
Author(s):  
Leanri van Heerden
Keyword(s):  
South African ◽  
Instructional Designers ◽  
Delivery Mode ◽  
Skills Acquisition ◽  
Online Delivery ◽  
Face To Face ◽  
Department Of Health ◽  
University Of Technology ◽  
E Learning ◽  
Participant Perspectives

After the #FeesMustFall strikes that have been haunting South African universities since 2015, Instructional Designers felt pretty confident that they can drive their institutions through any dilemma. Along came the 2020 COVID-19 epidemic and they realised they have been playing in the kiddie pool all along. On 23 March 2020, President Cyril Ramaphosa announced a national lockdown level 5 to start on 26 March 2020 (Department of Health, 2020). Three days head start for a three-week lockdown (which was eventually extended till the time of writing) was a logistical nightmare for even the most technology driven universities. All staff were sent home with only enough time to grab their office plants and laptops and no idea how they were going to move forward. The issue with staff and students all working from home is that the lecturers working at the Central University of Technology (CUT), being primarily a face-to-face delivery university, was completely unprepared for moving their traditional and blended approaches to completely online. In their study, Mogeni, Ondigi and Mufo (2020) found that most of the investigated teachers were not empowered enough to deliver instruction fully online and either needed to be retrained, receive further specialised training or be trained completely from scratch. A lack of confidence in the delivery mode of instruction will cause even the most knowledgeable subject spcialist to fail in their task. At the CUT lecturers needed a way of quickly acquiring the necessary skills to deliver their content and assessments on the institution Learning Management System (LMS). The aim of this paper is to measure participant perspectives of an emergency intervention to facilitate the process of online delivery skills acquisition quickly and online. To ensure relevant results a systematic process of designing an intervention and recording participant perspectives is necessary. This extended abstract will take a look at the methods used to drive the paper, briefly discuss the results and findings, and lastly explore the implications and significance of the research for the use of higher education institutions for emergency LMS training. Keywords: LMS training; e-Learning; Online Instruction; Instructional Design

scholarly journals Prognostic impact of elevated lactate levels on mortality in critically ill patients with and without preadmission metformin treatment: a Danish registry-based cohort study

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Rene A. Posma ◽  
Trine Frøslev ◽  
Bente Jespersen ◽  
Iwan C. C. van der Horst ◽  
Daan J. Touw ◽  
...  
Keyword(s):  
Cohort Study ◽  
Mortality Rate ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Cox Regression ◽  
Lower Mortality ◽  
Prognostic Impact ◽  
Icu Admission ◽  
Lactate Levels ◽  
Restricted Cubic Splines

Abstract Background Lactate is a robust prognostic marker for the outcome of critically ill patients. Several small studies reported that metformin users have higher lactate levels at ICU admission without a concomitant increase in mortality. However, this has not been investigated in a larger cohort. We aimed to determine whether the association between lactate levels around ICU admission and mortality is different in metformin users compared to metformin nonusers. Methods This cohort study included patients admitted to ICUs in northern Denmark between January 2010 and August 2017 with any circulating lactate measured around ICU admission, which was defined as 12 h before until 6 h after admission. The association between the mean of the lactate levels measured during this period and 30-day mortality was determined for metformin users and nonusers by modelling restricted cubic splines obtained from a Cox regression model. Results Of 37,293 included patients, 3183 (9%) used metformin. The median (interquartile range) lactate level was 1.8 (1.2–3.2) in metformin users and 1.6 (1.0–2.7) mmol/L in metformin nonusers. Lactate levels were strongly associated with mortality for both metformin users and nonusers. However, the association of lactate with mortality was different for metformin users, with a lower mortality rate in metformin users than in nonusers when admitted with similar lactate levels. This was observed over the whole range of lactate levels, and consequently, the relation of lactate with mortality was shifted rightwards for metformin users. Conclusion In this large observational cohort of critically ill patients, early lactate levels were strongly associated with mortality. Irrespective of the degree of hyperlactataemia, similar lactate levels were associated with a lower mortality rate in metformin users compared with metformin nonusers. Therefore, lactate levels around ICU admission should be interpreted according to metformin use.

scholarly journals Changes in physical activity across pregnancy among Chinese women: a longitudinal cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yan Lü ◽  
Yahui Feng ◽  
Shuai Ma ◽  
Yu Jiang ◽  
Liangkun Ma
Keyword(s):  
Physical Activity ◽  
Cohort Study ◽  
Early Pregnancy ◽  
Chinese Women ◽  
Short Form ◽  
Late Pregnancy ◽  
Population Characteristics ◽  
Central China ◽  
Dominant Form ◽  
Activity Questionnaire

Abstract Background Sufficient physical activity (PA) during pregnancy is beneficial for a woman’s health; however, the PA levels of Chinese women at different pregnancy stages are not clear. The aim of our study was to investigate PA changes during pregnancy and the association of population characteristics with PA change among Chinese women. Methods Data were obtained from 2485 participants who were enrolled in the multicentre prospective Chinese Pregnant Women Cohort Study. PA level was assessed in early pregnancy (mean = 10, 5–13 weeks of gestation) and again in mid-to-late pregnancy (mean = 32, 24–30 weeks of gestation) using the International Physical Activity Questionnaire short form (IPAQ-SF). Sufficient PA (≥ 600 MET min/week) in early pregnancy and insufficient PA in mid-to-late pregnancy indicated decreasing PA. Insufficient PA in early pregnancy and sufficient PA in mid-to-late pregnancy indicated increasing PA. The associations between demographic, pregnancy and health characteristics and PA changes were examined by multivariable logistic regression. Results Total energy expenditure for PA increased significantly from early (median = 396 MET min/week) to mid-to-late pregnancy (median = 813 MET min/week) (P < 0.001), and 55.25% of the participants eventually had sufficient PA. Walking was the dominant form of PA. Women with sufficient PA levels in early pregnancy were more likely to have sufficient PA in mid-to-late pregnancy (OR 1.897, 95% CI 1.583–2.274). Women in West China and those in Central China were most and least likely, respectively, to have increasing PA (OR 1.387, 95% CI 1.078–1.783 vs. OR 0.721, 95% CI 0.562–0.925). Smoking was inversely associated with increasing PA (OR 0.480, 95% CI 0.242–0.955). Women with higher educational levels were less likely to have decreasing PA (OR 0.662, 95% CI 0.442–0.991). Conclusions PA increased as pregnancy progressed, and walking was the dominant form of PA among Chinese women. Further research is needed to better understand correlates of PA change.

scholarly journals Metformin use and long-term risk of benign prostatic hyperplasia: a population-based cohort study

BMJ Open ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. e041875
Author(s):  
Mette Nørgaard ◽  
Bianka Darvalics ◽  
Reimar Wernich Thomsen
Keyword(s):  
Cohort Study ◽  
Benign Prostatic Hyperplasia ◽  
Cox Regression ◽  
Population Based ◽  
Prostatic Hyperplasia ◽  
Haemoglobin A1c ◽  
First Line ◽  
Intention To Treat ◽  
Lowering Drug

ObjectiveTo assess whether metformin use affects risk of benign prostatic hyperplasia (BPH) by comparing the risk of BPH in men with type 2 diabetes who initiated first-line treatment with either metformin or sulfonylurea monotherapy between 2000 or 2006 in Northern Denmark. In this period, sulfonylurea and metformin were both frequently used as first-line glucose-lowering drug (GLD) treatment.DesignA population-based cohort study.SettingNorthern Denmark.ParticipantsAll men who filled at least two prescriptions for metformin or for sulfonylurea, respectively, during their first 6 months of GLD treatment. Follow-up started 6 months after treatment start.Primary outcome measuresRates of subsequent BPH, identified based on community prescriptions for BPH-related treatment or hospital BPH diagnoses, and rates of transurethral resection of the prostate (TURP). Rates in metformin and sulfonylurea users were compared overall and stratified by 6-month haemoglobin A1c (HbA1c) using Cox regression and an intention-to-treat (ITT) approach and an as-treated analysis.ResultsDuring follow-up, less than five persons were lost to follow-up due to emigration. In 3953 metformin initiators with a median follow-up of 10 years, the 10-year cumulative BPH incidence was 25.7% (95% CI 24.2 to 27.1). Compared with 5958 sulfonylurea users (median follow-up 8 years, 10-year cumulative incidence 27.4% (95% CI 26.2 to 28.6)), the crude HR for BPH was 0.83 (95% CI 0.77 to 0.89) and adjusted HR in the ITT analyses was 0.97 (95% CI 0.88 to 1.06). For TURP, the adjusted HR was 0.96 (95% CI 0.63 to 1.46). In the as-treated analysis, adjusted HR for BPH was 0.91 (95% CI 0.81 to 1.02).ConclusionsCompared with sulfonylurea, metformin did not substantially reduce the incidence of BPH in men with diabetes.

scholarly journals Effect of introducing human papillomavirus genotyping into real-world screening on cervical cancer screening in China: a retrospective population-based cohort study

2021 ◽  
Vol 13 ◽  
pp. 175883592110109
Author(s):  
Binhua Dong ◽  
Huachun Zou ◽  
Xiaodan Mao ◽  
Yingying Su ◽  
Hangjing Gao ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Cohort Study ◽  
Human Papillomavirus ◽  
Cancer Screening ◽  
Cervical Cancer Screening ◽  
Cox Regression ◽  
Intraepithelial Neoplasia ◽  
Population Based ◽  
Hpv Genotyping ◽  
Cytology Screening

Background: China’s Fujian Cervical Pilot Project (FCPP) transitioned cervical cancer screening from high-risk human papillomavirus (HR-HPV) nongenotyping to genotyping. We investigated the clinical impact of this introduction, comparing performance indicators between HR-HPV genotyping combined with cytology screening (HR-HPV genotyping period) and the previous HR-HPV nongenotyping combined with cytology screening (HR-HPV nongenotyping period). Methods: A retrospective population-based cohort study was performed using data from the FCPP for China. We obtained data for the HR-HPV nongenotyping period from 1 January 2012 to 31 December 2013, and for the HR-HPV genotyping period from 1 January 2014 to 31 December 2016. Propensity score matching was used to match women from the two periods. Multivariable Cox regression was used to assess factors associated with cervical intraepithelial neoplasia of grade 2 or worse (CIN2+). The primary outcome was the incidence of CIN2+ in women aged ⩾25 years. Performance was assessed and included consistency, reach, effectiveness, adoption, implementation and cost. Results: Compared with HR-HPV nongenotyping period, in the HR-HPV genotyping period, more CIN2+ cases were identified at the initial screening (3.06% versus 2.32%; p < 0.001); the rate of colposcopy referral was higher (10.87% versus 6.64%; p < 0.001); and the hazard ratio of CIN2+ diagnosis was 1.64 (95% confidence interval, 1.43–1.88; p < 0.001) after controlling for health insurance status and age. The total costs of the first round of screening (US$66,609 versus US$65,226; p = 0.293) were similar during the two periods. Higher screening coverage (25.95% versus 25.19%; p = 0.007), higher compliance with age recommendations (92.70% versus 91.69%; p = 0.001), lower over-screening (4.92% versus 10.15%; p < 0.001), and reduced unqualified samples (cytology: 1.48% versus 1.73%, p = 0.099; HR-HPV: 0.57% versus 1.34%, p < 0.001) were observed in the HR-HPV genotyping period. Conclusions: Introduction of an HR-HPV genotyping assay in China could detect more CIN2+ lesions at earlier stages and improve programmatic indicators. Evidence suggests that the introduction of HR-HPV genotyping is likely to accelerate the elimination of cervical cancer in China.

scholarly journals Gender- and age-related differences of statin use on incident dementia in patients with rheumatoid arthritis: a Nationwide population-based cohort study

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Tsung-Kun Lin ◽  
Jing-Yang Huang ◽  
Lung-Fa Pan ◽  
Gwo-Ping Jong
Keyword(s):  
Rheumatoid Arthritis ◽  
Cohort Study ◽  
Subgroup Analysis ◽  
Cox Regression ◽  
Population Based ◽  
Age Related ◽  
Hazard Ratios ◽  
Incident Dementia ◽  
Gender And Age ◽  
New Onset

Abstract Background Some observational studies have found a significant association between the use of statin and a reduced risk of dementia. However, the results of these studies are unclear in patients with rheumatoid arthritis (RA). This study is to determine the association between the use of statins and the incidence of dementia according to sex and age-related differences in patients with RA. Methods We conducted a nationwide retrospective cohort study using the Taiwan Health Insurance Review and Assessment Service database (2003–2016). The primary outcome assessed was the risk of dementia by estimating hazard ratios (HRs) and 95% confidence intervals (CIs). Multiple Cox regression was used to estimate the adjusted hazard ratio of new-onset dementia. Subgroup analysis was also conducted. Results Among the 264,036 eligible patients with RA aged > 40 years, statin users were compared with non-statin users by propensity score matching at a ratio of 1:1 (25,764 in each group). However, no association was found between the use of statins and the risk of new-onset dementia (NOD) in patients with RA (HR: 1.01; 95% CI: 0.97–1.06). The subgroup analysis identified the use of statin as having a protective effect against developing NOD in male and older patients. Conclusion No association was observed between the use of a statin and the risk of NOD in patients with RA, including patients of both genders and aged 40–60 years, but these parameters were affected by gender and age. The decreased risk of NOD in patients with RA was greater among older male patients. Use of a statin in older male (> 60 years) patients with RA may be needed in clinical practice to prevent dementia.

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