scholarly journals Outcomes of multiple gestation births compared to singleton: analysis of multicenter KID database

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Renjithkumar Kalikkot Thekkeveedu ◽  
Nilesh Dankhara ◽  
Jagdish Desai ◽  
Angelle L. Klar ◽  
Jaimin Patel
Keyword(s):  
Survey Design ◽  
Age Groups ◽  
Population Data ◽  
Higher Order ◽  
Multiple Gestation ◽  
Complex Survey ◽  
Statistical Analysis System ◽  
Complex Survey Design ◽  
Analysis System ◽  
Inpatient Database

Abstract Background The available data regarding morbidity and mortality associated with multiple gestation births is conflicting and contradicting. Objective To compare morbidity, mortality, and length of stay (LOS) outcomes between multiple gestation (twin, triplet and higher-order) and singleton births. Methods Data from the national multicenter Kids’ Inpatient Database of the Healthcare Cost and Utilization Project from the years 2000, 2003, 2006, 2009, 2012, and 2016 were analyzed using a complex survey design using Statistical Analysis System (SAS) 9.4 (SAS Institute, Cary NC). Neonates with ICD9 and ICD10 codes indicating singletons, twins or triplets, and higher-order multiples were included. Mortality was compared between these groups after excluding transfer outs to avoid duplicate inclusion. To analyze LOS, we included inborn neonates and excluded transfers; who died inpatient and any neonates who appear to have been discharged less than 33 weeks PMA. The LOS was compared by gestational age groups. Results A total of 22,853,125 neonates were analyzed for mortality after applying inclusion-exclusion criteria; 2.96% were twins, and 0.13% were triplets or more. A total of 22,690,082 neonates were analyzed for LOS. Mean GA, expressed as mean (SD), for singleton, twins and triplets, were 38.30 (2.21), 36.39 (4.21), and 32.72 (4.14), respectively. The adjusted odds for mortality were similar for twin births compared to singleton (aOR: 1.004, 95% CI:0.960–1.051, p = 0.8521). The adjusted odds of mortality for triplet or higher-order gestation births were higher (aOR: 1.33, 95% CI: 1.128–1.575, p = 0.0008) when compared to the singleton births. Median LOS (days) was significantly longer in multiple gestation compared to singleton births overall (singletons: 1.59 [1.13, 2.19] vs. twins 3.29 [2.17, 9.59] vs. triplets or higher-order multiples 19.15 [8.80, 36.38], p < .0001), and this difference remained significant within each GA category. Conclusion Multiple gestation births have higher mortality and longer LOS when compared to singleton births. This population data from multiple centers across the country could be useful in counseling parents when caring for multiple gestation pregnancies.

scholarly journals Outcomes of Multiple Gestation Births Compared to Singleton: Analysis of Multicenter KID Database

2021 ◽  
Author(s):  
Renjithkumar Kalikkot Thekkeveedu ◽  
Nilesh Dankhara ◽  
Jagdish Desai ◽  
Angelle L Klar ◽  
Jaimin M Patel
Keyword(s):  
Length Of Stay ◽  
Gestational Age ◽  
Survey Design ◽  
Age Groups ◽  
Population Data ◽  
Higher Order ◽  
Multiple Gestation ◽  
Complex Survey ◽  
Complex Survey Design ◽  
Inpatient Database

Abstract BackgroundThe available data regarding morbidity and mortality associated with multiple gestation births is also conflicting and contradictingObjectiveTo compare morbidity, mortality, and length of stay (LOS) outcomes between multiple gestation (twin, triplet and higher-order) and singleton births.Methods Data from national multicenter Kids’ Inpatient Database of the Healthcare Cost and Utilization Project from the years 2000, 2003, 2006, 2009, 2012, and 2016 were analyzed using complex survey design using SAS. Neonates with ICD9 and ICD10 codes indicating singletons, twins or triplets, and higher-order multiples were included. Mortality was compared between these groups after excluding transfer outs to avoid duplicate inclusion. To analyze LOS, we included inborn neonates, and excluded transfers and who died inpatient and any neonates who appear to have been discharged less than 33 weeks PMA. The LOS was compared by gestational age groups. ResultsA total of 22,853,125 neonates were analyzed for mortality after inclusion-exclusion; 2.96% were twins, and 0.13% were triplets or more. A total of 22,690,082 neonates were analyzed for LOS. Mean GA, expressed as mean (SD), for singleton, twins and triplets were 38.30(2.21), 36.39 (4.21), and 32.72(4.14), respectively. The adjusted odds for mortality were similar for twin births compared to singleton (aOR: 1.004, 95% CI:0.960-1.051, p=0.8521). The adjusted odds of mortality for triplet or higher-order gestation births were higher (aOR: 1.33, 95% CI: 1.128-1.575, p =0.0008) as compared to singleton. Median LOS (in days) was significantly longer in multiple gestation compared to singleton overall (Singletons: 1.59 [1.13, 2.19] vs twins 3.29 [2.17, 9.59] vs triplets or higher order multiples 19.15 [8.80, 36.38], p <.0001), and this difference remained significant within each GA category. ConclusionMultiple gestation births have higher mortality and longer LOS when compared to singleton births. This population data from multiple centers across the country could be useful in counseling parents when caring for multiple gestation pregnancies.

scholarly journals Brazilians’ experiences with iron fortification: evidence of effectiveness for reducing inadequate iron intakes with fortified flour policy

2016 ◽  
Vol 20 (2) ◽  
pp. 363-370 ◽  
Author(s):  
Diva Aliete dos Santos Vieira ◽  
Josiane Steluti ◽  
Eliseu Verly-Jr ◽  
Dirce Maria Marchioni ◽  
Regina Mara Fisberg
Keyword(s):  
Survey Design ◽  
Age Groups ◽  
Substantial Reduction ◽  
Population Based ◽  
Reproductive Age ◽  
Cross Sectional ◽  
Complex Survey ◽  
Before And After ◽  
Complex Survey Design ◽  
Fortified Flour

AbstractObjectiveTo assess Fe intake, calculate the prevalence of inadequate Fe intake and identify food contributors to Fe intake during 2003 and 2008 in a population-based study, reflecting before and after the mandatory fortification of flour with Fe.DesignTwo cross-sectional population-based studies conducted in 2003 and 2008. Dietary intake was evaluated by 24 h recall and the Software for Intake Distribution Estimation (PC-SIDE) was used to estimate within-person variance and prevalence of inadequate Fe intake. The statistical analysis was conducted considering the complex survey design.SettingSão Paulo, Brazil.SubjectsAdolescents, adults and elderly adults of both sexes, interviewed in 2003 (n 2386) and 2008 (n 1661).ResultsThe Fe intake mean increased in all populations in the post-fortification period. A reduction of over 90 % was observed in the prevalence of inadequate Fe intake among men for all age groups analysed. When evaluating women, despite the substantial reduction (over 63 %), prevalence of inadequate Fe intake remained high (34 %) in those aged 19–50 years. Major food contributors to Fe intake before fortification were beans, beef, vegetables and dairy. There was an alteration in the contributors in the post-fortification period, with bread, beef, beans and biscuits as main contributors.ConclusionsThe mandatory fortification with Fe significantly furthered the reduction in the prevalence of inadequacy, except among women of reproductive age, and changed the main contributors to this nutrient in the studied population. Therefore, monitoring of Fe addition in flour is essential to assess compliance to the fortified flour policy and to guarantee a safe Fe intake for all the population.

scholarly journals Relationship between mean length of utterance and vocabulary in children with typical language development

Revista CEFAC ◽  
2019 ◽  
Vol 21 (6) ◽  
Author(s):  
Letícia Arruda Nóro ◽  
Helena Bolli Mota
Keyword(s):  
Statistical Analysis ◽  
Language Development ◽  
Age Groups ◽  
Significance Level ◽  
The Public ◽  
Statistical Analysis System ◽  
Gender And Age ◽  
Analysis System ◽  
Mean Length Of Utterance ◽  
Age Range

ABSTRACT Purpose: to investigate the existence of a relationship between vocabulary and measures of mean length of utterance in children in their language development phase. Methods: the sample consisted of 72 children aged 2 to 4 years, 11 months and 29 days, 36 boys and 36 girls, with typical language development, evenly distributed into age groups, enrolled in kindergartens with the public school system, in Santa Maria, RS, Brazil. Videos of the spontaneous speech of each subject were made, and then, the analysis of the vocabulary and Mean Length of Utterance took place. Statistical analysis was performed using the Statistical Analysis System program, version 9.2 and Spearman correlation coefficient, with a significance level of p <0.05. Results: the influence of gender in the Mean Length of Utterance correlation and vocabulary was observed. There was a difference between the ages of 2 and 4 years. Conclusion: vocabulary development promotes mean length utterance, indicating positive correlation between gender and age range.

scholarly journals Adherence to DASH Dietary Pattern Is Inversely Associated with Osteoarthritis in Americans (P18-012-19)

2019 ◽  
Vol 3 (Supplement_1) ◽  
Author(s):  
Ellen Francis ◽  
Karen Kemper ◽  
Joel Williams ◽  
Liwei Chen
Keyword(s):  
Dietary Pattern ◽  
Survey Design ◽  
Dietary Factors ◽  
Common Disease ◽  
Dash Score ◽  
Complex Survey ◽  
Logistic Regression Models ◽  
Funding Sources ◽  
Lower Likelihood ◽  
Complex Survey Design

Abstract Objectives Osteoarthritis (OA) is a common disease which significantly contributes to disability among older adults. Dietary factors are suggested to play a role in preventing OA, however, studies in this area spare. The objective of this study was to assess the association between adherence to the Dietary Approaches to Stop Hypertension (DASH) and OA in American adults. Methods This study included United States (US) adults (≥aged 20 years) who participated NHANES cycles 2007–2016. The Dietary Approaches to Stop Hypertension (DASH) score was calculated from nine food items with a higher DASH score indicating better adherence to the DASH dietary pattern. Multivariable logistic regression models adjusted for age, education, race/ethnicity, household income, smoking, alcohol consumption, and total energy intake were used to estimate the adjusted odds ratios (aOR) and 95% confidence intervals (CI) of DASH with OA. All analyses accounted for the complex survey design. Results Among the 17,349 participants included in this study, 9.05% reported OA. The DASH score was inversely associated with OA. The aOR (95% CI) were 1.00 (ref), 0.09 (0.70, 1.16), and 0.74 (0.58, 0.94) (Ptrend = 0.01) across the DASH score tertiles. When analyses were stratified by BMI categories (normal, overweight, obese) the magnitude of the association was stronger and remained significant only among obese participants (i.e., BMI ≥ 30 kg/m2). Among participants with an obese BMI, participants with a DASH score in the highest tertile compared to participants with a DASH score in the lowest tertile had a 17% lower likelihood of having OA (P = 0.009). Conclusions In a representative sample of American adults, higher adherence to the DASH dietary pattern was associated with lower likelihood of having OA and this association was particularly evident among obese individuals. Funding Sources N/A. Supporting Tables, Images and/or Graphs

scholarly journals The impact of complex survey design on prevalence estimates of intakes of food groups in the Australian National Children's Nutrition and Physical Activity Survey

2011 ◽  
Vol 15 (8) ◽  
pp. 1362-1372 ◽  
Author(s):  
Sandy Burden ◽  
Yasmine Probst ◽  
David Steel ◽  
Linda Tapsell
Keyword(s):  
Physical Activity ◽  
Survey Design ◽  
Food Groups ◽  
Sample Design ◽  
Complex Survey ◽  
Children's Nutrition ◽  
Prevalence Estimates ◽  
Complex Survey Design ◽  
Activity Survey ◽  
The Impact

AbstractObjectiveTo assess the impact of the complex survey design used in the 2007 Australian National Children's Nutrition and Physical Activity Survey (ANCNPAS07) on prevalence estimates for intakes of groups of foods in the population of children.DesignThe impacts on prevalence estimates were determined by calculating design effects for values for food group consumption. The implications of ignoring elements of the sample design including stratification, clustering and weighting are discussed.SettingThe ANCNPAS07 used a complex sample design involving stratification, a high degree of clustering and estimation weights.SubjectsAustralian children aged 2–16 years.ResultsDesign effects ranging from <1 to 5 were found for the values of mean consumption and proportion of the population consuming the food groups. When survey weights were ignored, prevalence estimates were also biased.ConclusionsIgnoring the complex survey design used in the ANCNPAS07 could result in underestimating the width of confidence intervals, higher mean square errors and biased estimators. The magnitude of these effects depends on both the parameter under consideration and the chosen estimator.

scholarly journals Physical violence and violent threats reported by Aboriginal and Torres Strait Islander people with a disability: cross sectional evidence from a nationally representative survey

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Jeromey B. Temple ◽  
Heather Wong ◽  
Angeline Ferdinand ◽  
Scott Avery ◽  
Yin Paradies ◽  
...  
Keyword(s):  
Torres Strait Islander ◽  
Physical Violence ◽  
Survey Design ◽  
Exposure To Violence ◽  
Royal Commission ◽  
Torres Strait Islander People ◽  
Cross Sectional ◽  
Complex Survey ◽  
Complex Survey Design ◽  
Torres Strait

Abstract Background A recent Royal Commission into the treatment of Australians living with disabilities has underscored the considerable exposure to violence and harm in this population. Yet, little is known about exposure to violence among Aboriginal and Torres Strait Islander people living with disabilities. The objective of this paper was to examine the prevalence, disability correlates and aspects of violence and threats reported by Aboriginal and Torres Strait Islander people living with disabilities. Methods Data from the 2014–15 National Aboriginal and Torres Strait Islander Social Survey were used to measure physical violence, violent threats and disability. Multivariable logistic and ordinal logistic regression models adjusted for complex survey design were used to examine the association between measures of disability and exposure to violence and violent threats. Results In 2014–15, 17% of Aboriginal and Torres Strait Islander people aged 15–64 with disability experienced an instance of physical violence compared with 13% of those with no disability. Approximately 22% of those with a profound or severe disability reported experiencing the threat of physical violence. After adjusting for a comprehensive set of confounding factors and accounting for complex survey design, presence of a disability was associated with a 1.5 odds increase in exposure to physical violence (OR = 1.54 p < 0.001), violence with harm (OR = 1.55 p < 0.001), more frequent experience of violence (OR = 1.55 p < 0.001) and a 2.1 odds increase (OR = 2.13 p < 0.001) in exposure to violent threats. Severity of disability, higher numbers of disabling conditions as well as specific disability types (e.g., psychological or intellectual) were associated with increased odds of both physical violence and threats beyond this level. Independent of these effects, removal from one’s natural family was strongly associated with experiences of physical violence and violent threats. Aboriginal and Torres Strait Islander women, regardless of disability status, were more likely to report partner or family violence, whereas men were more likely to report violence from other known individuals. Conclusion Aboriginal and Torres Strait Islander people with disability are at heightened risk of physical violence and threats compared to Aboriginal and Torres Strait Islander people without disability, with increased exposure for people with multiple, severe or specific disabilities.

scholarly journals The Association between Stressful Events and Food Insecurity: Cross-Sectional Evidence from Australia

2018 ◽  
Vol 15 (11) ◽  
pp. 2333 ◽  
Author(s):  
Jeromey Temple
Keyword(s):  
Food Insecurity ◽  
Stressful Life Events ◽  
Survey Design ◽  
General Social Survey ◽  
Stressful Events ◽  
Economic Policies ◽  
Cross Sectional ◽  
Complex Survey ◽  
Complex Survey Design ◽  
Nationally Representative

A considerable body of empirical evidence exists on the demographic and socio-economic correlates of food insecurity in Australia. An important omission from recent studies, however, is an understanding of the role of stressful life events, or stressors in explaining exposure to food insecurity. Using nationally representative data from the 2014 General Social Survey and multivariable logistic regression, this paper reports on the association between 18 discrete stressors and the likelihood of reporting food insecurity in Australia. The results, adjusted for known correlates of food insecurity and complex survey design, show that exposure to stressors significantly increased the likelihood of experiencing food insecurity. Importantly, stressors related to employment and health approximately doubled the odds of experiencing food insecurity. The results underscore the complex correlates of food insecurity and indicates that conceptually it interacts with many important social and economic problems in contemporary Australia. There is no simple fix to food insecurity and solutions require co-ordination across a range of social and economic policies.

scholarly journals Modeling excess zeros and heterogeneity in count data from a complex survey design with application to the demographic health survey in sub-Saharan Africa

2016 ◽  
Vol 27 (1) ◽  
pp. 208-220 ◽  
Author(s):  
Lin Dai ◽  
Michael D Sweat ◽  
Mulugeta Gebregziabher
Keyword(s):  
Count Data ◽  
Regional Variation ◽  
Rate Ratio ◽  
Negative Binomial ◽  
Survey Design ◽  
Negative Binomial Model ◽  
Binomial Model ◽  
Complex Survey ◽  
Excess Zeros ◽  
Complex Survey Design

Purpose To show a novel application of a weighted zero-inflated negative binomial model in modeling count data with excess zeros and heterogeneity to quantify the regional variation in HIV-AIDS prevalence in sub-Saharan African countries. Methods Data come from latest round of the Demographic and Health Survey (DHS) conducted in three countries (Ethiopia-2011, Kenya-2009 and Rwanda-2010) using a two-stage cluster sampling design. The outcome is an aggregate count of HIV cases in each census enumeration area of each country. The outcome data are characterized by excess zeros and heterogeneity due to clustering. We compare scale weighted zero-inflated negative binomial models with and without random effects to account for zero-inflation, complex survey design and clustering. Finally, we provide marginalized rate ratio estimates from the best zero-inflated negative binomial model. Results The best fitting zero-inflated negative binomial model is scale weighted and with a common random intercept for the three countries. Rate ratio estimates from the final model show that HIV prevalence is associated with age and gender distribution, HIV acceptance, HIV knowledge, and its regional variation is associated with divorce rate, burden of sexually transmitted diseases and rural residence. Conclusions Scale weighted zero-inflated negative binomial with proper modeling of random effects is shown to be the best model for count data from a complex survey design characterized by excess zeros and extra heterogeneity. In our data example, the final rate ratio estimates show significant regional variation in the factors associated with HIV prevalence indicating that HIV intervention strategies should be tailored to the unique factors found in each country.

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