scholarly journals A Spatiotemporal Analysis of Socio-Environmental Patterns in Severe Maternal Morbidity: A Retrospective Birth Cohort

2021 ◽  
Author(s):  
Stella Harden ◽  
Jennifer D Runkle ◽  
Margaret Mae Sugg
Keyword(s):  
Risk Factors ◽  
South Carolina ◽  
High Risk ◽  
Maternal Morbidity ◽  
Spatial Clustering ◽  
Spatiotemporal Analysis ◽  
Severe Maternal Morbidity ◽  
Spatial Scan Statistic ◽  
Black Patients ◽  
The Impact

Objectives. Severe Maternal Morbidity (SMM) is a group of pregnancy complications in which a woman nearly dies. Despite its increasing prevalence, there is little research that evaluates geographic patterns of SMM and the underlying social determinants that influence excess risk. This study examines the spatial clustering of SMM across South Carolina, US, and its associations with place-based social and environmental factors. Methods. Hospitalized deliveries from 1999 to 2017 were analyzed using Kulldorff's spatial scan statistic to locate areas with abnormally high rates of SMM. Patients inside and outside risk clusters were compared using Generalized Estimating Equations (GEE) to determine underlying risk factors. Results. Final models revealed that the odds of living in a high-risk cluster were 84% higher among Black patients (OR=1.84, p<.001), 30% higher among Hispanic and Latina patients (OR=1.3, p<.05), and 1.51 times more likely among women living in highly segregated and poorer minority communities (OR=1.51 p<.001). Odds for residing in a high-risk cluster were 23% higher for those who gave birth during a period with temperatures above 30.65C/87.3F (OR=1.23, p<.001). Conclusions. This study is the first to characterize the geographic clustering of SMM risk in the US. Our geospatial approach contributes a novel understanding to factors which influence SMM beyond patient-level characteristics and identifies the impact of systemic racism on maternal morbidity. Findings address an important literature gap surrounding place-based risk factors by explaining the contextual social and built environment variables that drive SMM risk.

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 Population-Based Study of Risk Factors for Severe Maternal Morbidity

2012 ◽  
Vol 26 (6) ◽  
pp. 506-514 ◽  
Author(s):  
Kristen E. Gray ◽  
Erin R. Wallace ◽  
Kailey R. Nelson ◽  
Susan D. Reed ◽  
Melissa A. Schiff
Keyword(s):  
Risk Factors ◽  
Maternal Morbidity ◽  
Population Based ◽  
Severe Maternal Morbidity ◽  
Population Based Study

The impact of multiple high-risk factors on survival outcome of surgically treated early-stage cervical cancer

2014 ◽  
Vol 133 ◽  
pp. 62
Author(s):  
K. Matsuo ◽  
S. Mabuchi ◽  
M. Okazawa ◽  
Y. Matsumoto ◽  
K. Yoshino ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cervical Cancer ◽  
High Risk ◽  
Early Stage ◽  
Survival Outcome ◽  
High Risk Factors ◽  
Early Stage Cervical Cancer ◽  
The Impact

Prostate cancer treatment disparities during the COVID-19 pandemic, lessons from a multi-institutional collaborative.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 6542-6542
Author(s):  
Adrien Bernstein ◽  
Ruchika Talwar ◽  
Elizabeth A. Handorf ◽  
Kaynaat Syed ◽  
Serge Ginzburg ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Risk Factors ◽  
Safety Net ◽  
Mitigation Strategies ◽  
Categorical Variables ◽  
Gleason Grade ◽  
Grade Group ◽  
Black Patients ◽  
The Impact ◽  
White Patients

6542 Background: Minority communities have been disproportionately affected by COVID-19, however the impact of the pandemic on prostate cancer (PCa) treatment is unknown. To that end, we sought to determine the racial impact on PCa surgery during the first wave of the COVID-19 pandemic. Methods: After receiving institutional review board approval, the Pennsylvania Urologic Regional Collaborative (PURC) database was queried to evaluate practice patterns for Black and White patients with untreated non-metastatic PCa during the initial lockdown of the COVID-19 pandemic (March-May 2020) compared to prior (March-May 2019). PURC is a prospective collaborative, which includes private practice and academic institutions within both urban and rural settings including regional safety-net hospitals. As data entry was likely impacted by the pandemic, we limited our search to only practices that had data entered through June 1, 2020 (5 practice sites). We compared patient and disease characteristics by race using Fisher’s exact and Pearson’s chi-square to compare categorical variables and Wilcoxon rank sum to evaluate continuous covariates. Patients were stratified by risk factors for severe COVID-19 infection as described by the CDC. We determined the covariate-adjusted impact of year and race on surgery, using logistic regression models with a race*year interaction term. Results: 647 men with untreated non-metastatic PCa were identified, 269 during the pandemic and 378 from the year prior. During the pandemic, Black men were significantly less likely to undergo prostatectomy compared to White patients (1.3% v 25.9%;p < 0.001), despite similar COVID-19 risk-factors, biopsy Gleason grade group, and comparable surgery rates prior (17.7% vs. 19.1%;p = 0.75). White men had lower pre-biopsy PSA (7.2 vs. 8.8 vs. p = 0.04) and were older (24.4% vs. 38.2% < 60yr;p = 0.09). The regression model demonstrated an 94% decline in odds of surgery(OR = 0.06 95%CI 0.007-0.43;p = 0.006) for Black patients and increase odds of surgery for White patients (OR = 1.41 95%CI 0.89-2.21;p = 0.142), after adjusting for covariates. Changes in surgical volume varied by site (33% increase to complete shutdown), with sites that experienced the largest reduction in cancer surgery, caring for a greater proportion of Black patients. Conclusions: In a large multi-institutional regional collaborative, odds of PCa surgery declined only among Black patients during the initial wave of the COVID-19 pandemic. While localized prostate cancer does not require immediate treatment, the lessons from this study illuminate systemic inequities within healthcare, likely applicable across oncology. Public health efforts are needed to fully recognize the unintended consequence of diversion of cancer resources to the pandemic in order to develop balanced mitigation strategies as viral rates continue to fluctuate.

scholarly journals Spatiotemporal Analysis of Serogroup C Meningococcal Meningitis Spread in Niger and Nigeria and Implications for Epidemic Response

2019 ◽  
Vol 220 (Supplement_4) ◽  
pp. S244-S252 ◽  
Author(s):  
Laura V Cooper ◽  
Olivier Ronveaux ◽  
Katya Fernandez ◽  
Clement Lingani ◽  
Kadade Goumbi ◽  
...  
Keyword(s):  
Spatial Clustering ◽  
Spatiotemporal Analysis ◽  
Meningococcal Meningitis ◽  
High Coverage ◽  
Alternative Strategies ◽  
High Incidence ◽  
Epidemic Response ◽  
Vaccination Campaigns ◽  
Global And Local ◽  
The Impact

Abstract Background After the re-emergence of serogroup C meningococcal meningitis (MM) in Nigeria and Niger, we aimed to re-evaluate the vaccination policy used to respond to outbreaks of MM in the African meningitis belt by investigating alternative strategies using a lower incidence threshold and information about neighboring districts. Methods We used data on suspected and laboratory-confirmed cases in Niger and Nigeria from 2013 to 2017. We calculated global and local Moran’s I-statistics to identify spatial clustering of districts with high MM incidence. We used a Pinner model to estimate the impact of vaccination campaigns occurring between 2015 and 2017 and to evaluate the impact of 3 alternative district-level vaccination strategies, compared with that currently used. Results We found significant clustering of high incidence districts in every year, with local clusters around Tambuwal, Nigeria in 2013 and 2014, Niamey, Niger in 2016, and in Sokoto and Zamfara States in Nigeria in 2017. We estimate that the vaccination campaigns implemented in 2015, 2016, and 2017 prevented 6% of MM cases. Using the current strategy but with high coverage (85%) and timely distribution (4 weeks), these campaigns could have prevented 10% of cases. This strategy required the fewest doses of vaccine to prevent a case. None of the alternative strategies we evaluated were more efficient, but they would have prevented the occurrence of more cases overall. Conclusions Although we observed significant spatial clustering in MM in Nigeria and Niger between 2013 and 2017, there is no strong evidence to support a change in methods for epidemic response in terms of lowering the intervention threshold or targeting neighboring districts for reactive vaccination.

The Impact of Severe Maternal Morbidity on Very Preterm Infant Outcomes

2020 ◽  
Vol 75 (5) ◽  
pp. 281-282
Author(s):  
Jennifer Zeitlin ◽  
Natalia N. Egorova ◽  
Teresa Janevic ◽  
Paul L. Hebert ◽  
Elodie Lebreton ◽  
...  
Keyword(s):  
Preterm Infant ◽  
Maternal Morbidity ◽  
Severe Maternal Morbidity ◽  
Infant Outcomes ◽  
Very Preterm ◽  
Very Preterm Infant ◽  
The Impact

Second Primary Melanoma: Risk Factors, Histopathologic Features, Survival, and Implications for Follow-Up

2016 ◽  
Vol 82 (10) ◽  
pp. 1009-1013 ◽  
Author(s):  
Maris S. Jones ◽  
Hitoe Torisu-Itakura ◽  
Devin C. Flaherty ◽  
Hans F. Schoellhammer ◽  
Jihey Lee ◽  
...  
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Cutaneous Melanoma ◽  
Primary Melanoma ◽  
Second Primary ◽  
Melanoma Risk ◽  
Impact On Survival ◽  
The Impact ◽  
Histopathologic Features

The impact on survival of a second primary melanoma (SPM) is unclear. We used our melanoma center's database to examine clinicopathologic risk factors and outcomes of stage 0 to IV cutaneous melanoma in patients with one versus two primaries. Among 12,325 patients with primary melanoma, 969 (7.86%) developed SPM. SPMs were significantly thinner than autologous primary melanomas ( P = 0.01), and 451 SPM patients had better overall and melanoma-specific survival than 451 prognostically matched non-SPM patients ( P < 0.0001 and 0.0001, respectively) at a median follow-up of 142.37 months. Patients with cutaneous melanoma are at high risk for development of SPM, but the development of SPM does not seem to impair survival.

Modifying Pro-Drug Risk Factors in Adolescents: Results From Project ALERT

2004 ◽  
Vol 31 (3) ◽  
pp. 318-334 ◽  
Author(s):  
Bonnie Ghosh-Dastidar ◽  
Douglas L. Longshore ◽  
Phyllis L. Ellickson ◽  
Daniel F. McCaffrey
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Drug Use ◽  
Eighth Graders ◽  
Risk Groups ◽  
Drug Prevention ◽  
School Environments ◽  
School Based ◽  
Drug Risk ◽  
The Impact

The objective of this study was to evaluate the impact of a revised state-of-the-art drug prevention program, Project ALERT, on risk factors for drug use in mostly rural midwestern schools and communities. Fifty-five middle schools from South Dakota were randomly assigned to treatment or control conditions. Treatment-group students received 11 lessons in Grade 7 and 3 more in Grade 8. Effects for 4,276 eighth graders were assessed 18 months after baseline. Results indicate that Project ALERT had statistically significant effects on all the targeted risk factors associated with cigarette and marijuana use and more modest gains with the pro-alcoholrisk factors. The program helped adolescents at low, moderate, and high risk for future use, with the effect sizes typically stronger for the low- and moderate-risk groups. Thus, school-based drug prevention programs can lower risk factors that correlate with drug use, help low- to high-risk adolescents, and be effective in diverse school environments.

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