The Italian Obstetric Surveillance System: Implementation of a bundle of population-based initiatives to reduce haemorrhagic maternal deaths

In this before and after cross-sectional analysis, the authors aim to assess the impact of the bundle of research and training initiatives implemented between 2013 and 2018, and coordinated by the Italian Obstetric Surveillance System (ItOSS) to reduce obstetric haemorrhagic emergencies in five selected Italian Regions. To this purpose, the haemorrhagic Maternal Mortality Ratios (MMR) per 100,000 live births were estimated before and after implementing the bundle, through the ItOSS’s vital statistic linkage procedures and incident reporting and Confidential Enquiries. The research and training bundle was offered to all health professionals involved in pregnancy and birth care in the selected regions, representing 40% of national live births, and participating in the ItOSS audit cycle since its institution. The haemorrhagic MMR significantly decreased from 2.49/100,000 live births [95% CI 1.75 to 3.43] in the years 2007–2013 prior to the bundle implementation, to 0.77/100,000 live births [95% CI 0.31 to 1.58] in the years 2014–2018 after its implementation. According to the study results, the bundle of population-based initiatives might have contributed to reducing the haemorrhagic MMR in the participating regions, thus improving the quality of care of the major obstetric haemorrhage.

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Comparing regional neonatal mortality rates: the influence of registration of births as live born for birth weight <500 g in Taiwan

BMJ Paediatrics Open ◽

10.1136/bmjpo-2019-000526 ◽

2019 ◽

Vol 3 (1) ◽

pp. e000526

Author(s):

Liang-Yi Wang ◽

Yu-Shan Chang ◽

Fu-Wen Liang ◽

Yung-Chieh Lin ◽

Yuh-Jyh Lin ◽

...

Keyword(s):

Birth Weight ◽

Neonatal Mortality ◽

Ecological Study ◽

Population Based ◽

Cross Sectional ◽

Neonatal Deaths ◽

Live Births ◽

Taipei City ◽

The Impact ◽

The City

ObjectiveTo investigate regional variation in the registration of births (still+live) as live born for birth weight <500 g and the impact on the city/county ranking of neonatal mortality rate (NMR) in Taiwan.DesignPopulation-based cross-sectional ecological study.Setting20 cities/counties in Taiwan.ParticipantsRegistered births for birth weight <500 g and neonatal deaths in 2015–2016.Main outcome measuresCity/county percentage of births <500 g registered as live born and ranking of city/county NMR (deaths per 1000 live births) including and excluding live births <500 g.ResultsThe percentage of births <500 g registered as live born ranged from 0% in Keelung City (0/26) and Penghu County (0/4) to 20% in Taipei City (112/558), 24% in Hsinchu County (5/21) and 28% in Hualien County (9/32). The change in city/county ranking of NMR from including to excluding live births <500 g was most prominent in Taipei City (from the 15th to the 1st) followed by Kaohsiung City (from the 18th to the 14th).ConclusionsThe city/county NMR in Taiwan is influenced by variation in the registration of live born for births with uncertain viability. We recommend presenting city/county NMR using both criteria (with or without minimum threshold of gestation period or birth weight) for better interpretation of the findings of comparisons of city/county NMR.

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Maternal depression and loss of children under the one-child family planning policy in China: a cross-sectional study of 300 000 women

BMJ Open ◽

10.1136/bmjopen-2020-048554 ◽

2021 ◽

Vol 11 (7) ◽

pp. e048554

Author(s):

Hanyu Wang ◽

Eric Frasco ◽

Jie Shang ◽

Minne Chen ◽

Tong Xin ◽

...

Keyword(s):

Family Planning ◽

Maternal Depression ◽

Urban Areas ◽

The Elderly ◽

Population Based ◽

Cross Sectional Study ◽

Only Child ◽

Cross Sectional ◽

Live Births ◽

Child Group

ObjectivesThis study aims to explore the association between maternal depression and the loss of the only child under the family-planning (FP) policy.DesignCross-sectional data from a Chinese population-based study were analysed.SettingPopulation from 10 (5 rural and 5 urban) areas in China.ParticipantsAround 300 000 females were included in the study. The FP group was defined as women with one or two live births. Those with no surviving child were classified into the loss-of-only-child group. The non-FP group included women who had more than two live births. Logistic regression was used to assess the relationship between major depressive disorder (MDD) and family types, after stratification and adjustment.OutcomeMDD was assessed using the Composite International Diagnostic Inventory.ResultsThe odds of MDD are 1.42 times higher in the FP group in general (OR=1.42, 95% CI: 1.28 to 1.57), as opposed to the non-FP group. In particular, the odds of MDD are 1.36 times greater in the non-loss-of-only-child group (OR=1.36, 95% CI: 1.21 to 1.51) and 2.80 (OR=2.80, 95% CI: 0.88 to 8.94) times greater in the loss-of-only-child group, compared with the non-FP group. The associations between FP groups and MDD appeared to be stronger in the elderly population, in those who were married, less educated and those with a higher household income. The association was found progressively stronger in those who lost their only child.ConclusionsPeople in the FP group, especially those who lost their only child, are more susceptible to MDD than their counterparts in the non-FP group. Mental health programmes should give special care to those who lost their only child and take existing social policies and norms, such as FP policies, into consideration.

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Impact of dementia education and training on health and social care staff knowledge, attitudes and confidence: a cross-sectional study

BMJ Open ◽

10.1136/bmjopen-2020-039939 ◽

2021 ◽

Vol 11 (1) ◽

pp. e039939

Author(s):

Sahdia Parveen ◽

Sarah Jane Smith ◽

Cara Sass ◽

Jan R Oyebode ◽

Andrea Capstick ◽

...

Keyword(s):

Online Survey ◽

Social Care ◽

Education And Training ◽

Care Staff ◽

Cross Sectional ◽

Health And Social Care ◽

Training Content ◽

The Impact ◽

And Training ◽

Dementia Education

ObjectivesThe aim of this study was to establish the impact of dementia education and training on the knowledge, attitudes and confidence of health and social care staff. The study also aimed to identify the most effective features (content and pedagogical) of dementia education and training.DesignCross-sectional survey study. Data collection occurred in 2017.SettingsHealth and social care staff in the UK including acute care, mental health community care trusts, primary care and care homes.ParticipantsAll health and social care staff who had completed dementia education and training meeting the minimal standards as set by Health Education England, within the past 5 years were invited to participate in an online survey. A total of 668 health and social care staff provided informed consent and completed an online survey, and responses from 553 participants were included in this study. The majority of the respondents were of white British ethnicity (94.4%) and identified as women (88.4%).OutcomesKnowledge, attitude and confidence of health and social care staff.ResultsHierarchical multiple regression analysis was conducted. Staff characteristics, education and training content variables and pedagogical factors were found to account for 29% of variance in staff confidence (F=4.13, p<0.001), 22% of variance in attitude (knowledge) (F=3.80, p<001), 18% of the variance in staff knowledge (F=2.77, p<0.01) and 14% of variance in staff comfort (attitude) (F=2.11, p<0.01).ConclusionThe results suggest that dementia education and training has limited impact on health and social care staff learning outcomes. While training content variables were important when attempting to improve staff knowledge, more consideration should be given to pedagogical factors when training is aiming to improve staff attitude and confidence.

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Variation in performance on common content items at UK medical schools

BMC Medical Education ◽

10.1186/s12909-021-02761-1 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

David Hope ◽

David Kluth ◽

Matthew Homer ◽

Avril Dewar ◽

Richard Fuller ◽

...

Keyword(s):

Undergraduate Students ◽

Standard Setting ◽

Medical Schools ◽

Cross Sectional Study ◽

Pass Rates ◽

Cross Sectional ◽

Study Results ◽

Institutional Differences ◽

Common Content ◽

The Impact

Abstract Background Due to differing assessment systems across UK medical schools, making meaningful cross-school comparisons on undergraduate students’ performance in knowledge tests is difficult. Ahead of the introduction of a national licensing assessment in the UK, we evaluate schools’ performances on a shared pool of “common content” knowledge test items to compare candidates at different schools and evaluate whether they would pass under different standard setting regimes. Such information can then help develop a cross-school consensus on standard setting shared content. Methods We undertook a cross-sectional study in the academic sessions 2016-17 and 2017-18. Sixty “best of five” multiple choice ‘common content’ items were delivered each year, with five used in both years. In 2016-17 30 (of 31 eligible) medical schools undertook a mean of 52.6 items with 7,177 participants. In 2017-18 the same 30 medical schools undertook a mean of 52.8 items with 7,165 participants, creating a full sample of 14,342 medical students sitting common content prior to graduation. Using mean scores, we compared performance across items and carried out a “like-for-like” comparison of schools who used the same set of items then modelled the impact of different passing standards on these schools. Results Schools varied substantially on candidate total score. Schools differed in their performance with large (Cohen’s d around 1) effects. A passing standard that would see 5 % of candidates at high scoring schools fail left low-scoring schools with fail rates of up to 40 %, whereas a passing standard that would see 5 % of candidates at low scoring schools fail would see virtually no candidates from high scoring schools fail. Conclusions Candidates at different schools exhibited significant differences in scores in two separate sittings. Performance varied by enough that standards that produce realistic fail rates in one medical school may produce substantially different pass rates in other medical schools – despite identical content and the candidates being governed by the same regulator. Regardless of which hypothetical standards are “correct” as judged by experts, large institutional differences in pass rates must be explored and understood by medical educators before shared standards are applied. The study results can assist cross-school groups in developing a consensus on standard setting future licensing assessment.

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Prevalence of nocturia among community-dwelling adults: a population-based study in Malaysia

BMC Urology ◽

10.1186/s12894-021-00860-1 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Hui-Yin Yow ◽

John Jeh Lung Tiong ◽

Chun-Wai Mai ◽

Esther van der Werf ◽

Zulkifli Md Zainuddin ◽

...

Keyword(s):

Medical Condition ◽

Population Based ◽

Community Dwelling ◽

Medical Attention ◽

Night Time ◽

Cross Sectional ◽

Population Based Study ◽

Waking Up ◽

The Impact

Abstract Background Nocturia is widely prevalent condition with detrimental effects on quality of life and general health. In Malaysia, there is a lack of up-to-date prevalence study on nocturia. This study aimed to investigate the prevalence of nocturia and awareness pertaining to nocturia among Malaysian adults. Methods A cross-sectional population-based study was conducted among Malaysian adults aged ≥ 18 years old. The data was collected by mixed mode self-administered questionnaire from May 2019 to September 2019. Nocturia was defined as one or more voids at night. Results There were a total of 4616 respondents with 74.5% of response rate. The overall prevalence of nocturia among Malaysian adults was found to be 57.3%. In multivariate analysis, respondents aged 31–40 (1.91 [1.52–2.40]) or > 60 years old (2.03 [1.48–2.71]), and those who presented with hypertension (2.84 [2.28–3.53]), diabetes mellitus (1.78 [1.42–2.25]), renal disease (3.58 [1.93–6.63]) or overactive bladder (1.61 [1.10–2.35]) were associated with higher prevalence of nocturia. A significantly lower disease prevalence (p < 0.05) was noted among those aged 41–50 (0.73 [0.59–0.91]), male (0.78 [0.69–0.88]) and Chinese (0.47 [0.30–0.74]) or Indian (0.34 [0.21–0.54]) ethnicities. A total of 37.3% of respondents with nocturia reported that they faced sleeping difficulty about half the time or more after waking up in the middle of night. Those who had ≥ 2 voids per night experienced significantly higher mean bother score than those who had 1 void per night (p < 0.001). Approximately half (56.7%) of all respondents were not aware that night time urination is a medical condition. Only 25.2% of respondents with nocturia had sought medical attention for their nocturia. Conclusions The prevalence of nocturia among Malaysian adults is high and strongly influenced by age, sex, race and comorbidities. However, the general awareness pertaining to nocturia being a health issue remains low among Malaysians. The findings also highlighted the impact of nocturia on sleep and the need for nocturia education to better address this disease.

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Resilience and vulnerability of maternity services in Zimbabwe: a comparative analysis of the effect of Covid-19 and lockdown control measures on maternal and perinatal outcomes, a single-centre cross-sectional study at Mpilo Central Hospital

BMC Pregnancy and Childbirth ◽

10.1186/s12884-021-03884-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Clare Shakespeare ◽

Handsome Dube ◽

Sikhangezile Moyo ◽

Solwayo Ngwenya

Keyword(s):

Perinatal Outcomes ◽

Control Measures ◽

Central Hospital ◽

Cross Sectional ◽

Maternity Services ◽

Before And After ◽

The Mean ◽

Significant Change ◽

The Impact ◽

Mpilo Central Hospital

Abstract Background On the 27th of March 2020 the Zimbabwean government declared the Covid-19 pandemic a ‘national disaster’. Travel restrictions and emergency regulations have had significant impacts on maternity services, including resource stock-outs, and closure of antenatal clinics during the lockdown period. Estimates of the indirect impact of Covid-19 on maternal and perinatal mortality was expected it to be considerable, but little data was yet available. This study aimed to examine the impact of Covid-19 and lockdown control measures on non-Covid outcomes in a government tertiary level maternity unit in Bulawayo, Zimbabwe, by comparing maternal and perinatal morbidity and mortality before, and after the lockdown was implemented. Methods This was a retrospective, observational study, using a cross-sectional design to compare routine monthly maternal and perinatal statistics three months before and after Covid-19 emergency measures were implemented at Mpilo Central Hospital. Results Between January-March and April-June 2020, the mean monthly deliveries reduced from 747.3 (SD ± 61.3) in the first quarter of 2020 to 681.0 (SD ± 17.6) during lockdown, but this was not statistically significant, p = 0.20. The Caesarean section rates fell from a mean of 29.8% (SD ± 1.7) versus 28.0% (SD ± 1.7), which was also not statistically significant, p = 0.18. During lockdown, the percentage of women delivering at Mpilo Central Hospital who were booked at the hospital fell from a mean of 41.6% (SD ± 1.1) to 35.8% (SD ± 4.3) which was statistically significant, p = 0.03. There was no significant change, however, in maternal mortality or severe maternal morbidity (such as post-partum haemorrhage (PPH), uterine rupture, and severe preeclampsia/eclampsia), stillbirth rate or special care baby unit admission. There was an increase in the mean total number of early neonatal deaths (ENND) (mean 18.7 (SD ± 2.9) versus 24.0 (SD ± 4.6), but this was not statistically significant, p = 0.32. Conclusions Overall, maternity services at Mpilo showed resilience during the lockdown period, with no significant change in maternal and perinatal adverse outcomes, with the same number of man-hours worked before and during the lockdown Maternal and perinatal outcomes should continue to be monitored to assess the impact of Covid-19 and the lockdown measures as the pandemic in Zimbabwe unfolds. Further studies would be beneficial to explore women’s experiences and understand how bookings and deliveries at local clinics changed during this time.

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The Impact of Bariatric Surgery on Menstrual Abnormalities—a Cross-Sectional Study

Obesity Surgery ◽

10.1007/s11695-020-04840-6 ◽

2020 ◽

Vol 30 (11) ◽

pp. 4505-4509

Author(s):

Anna Różańska-Walędziak ◽

Paweł Bartnik ◽

Joanna Kacperczyk-Bartnik ◽

Krzysztof Czajkowski ◽

Maciej Walędziak

Keyword(s):

Bariatric Surgery ◽

Menstrual Cycle ◽

Cross Sectional Study ◽

Reproductive Age ◽

Obese Women ◽

Sectional Study ◽

Cross Sectional ◽

Contraception Use ◽

Before And After ◽

The Impact

Abstract Introduction Obesity is associated with hyperestrogenism along with other hormonal abnormalities affecting the menstrual cycle. The most effective and decisive method of obesity treatment is bariatric surgery. The aim of this study was to analyze the impact of bariatric surgery on menstrual cycle, the incidence of menstrual abnormalities, hyperandrogenism manifestation, and contraception use. Materials and Methods It was a cross-sectional study of 515 pre-menopausal women who had undergone bariatric surgery between 1999 and 2017 in a bariatric center. Data was collected via anonymous questionnaire, and the questions covered a 1-year period before the surgery and the last year before questionnaire completion. Results Before the surgery, 38.6% of the patients reported irregular menstruations in comparison with 25.0% after bariatric surgery (RR = 0.65; 95%CI 0.53–0.79). The mean number of menstruations per year did not differ before and after surgery (10.2 ± 3.9 vs 10.4 ± 3.3; p < .45). There were no statistically significant differences in terms of prolonged menstruations, acne, and hirsutism prevalence. A total of 14.4% of patients before surgery reported estrogen-based contraception use in comparison with 15.0% after the surgery (p < .95). There were no significant differences in the frequency of OC use (11.0% before surgery vs 13.6% 12 months after the surgery vs 11.5% at the moment of survey administration; p < 0.46). Conclusion Bariatric surgery improves the regularity of the menstrual cycle in obese women in reproductive age. The lack of any changes in the combined hormonal contraception (CHC) use, especially OC, before and after bariatric surgery may be a result of a possibly low level of contraception counseling.

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What Is the Impact of Prior Authorization on the Incidence of Pediatric Tonsillectomy?

Otolaryngology ◽

10.1177/0194599820969631 ◽

2020 ◽

pp. 019459982096963

Author(s):

Vanessa F. Torrecillas ◽

Kaden Neuberger ◽

Alexander Ramirez ◽

Paul Krakovitz ◽

Jeremy D. Meier

Keyword(s):

Elective Surgery ◽

Lag Time ◽

Cross Sectional Study ◽

Health Claims ◽

Third Party ◽

Prior Authorization ◽

Cross Sectional ◽

Before And After ◽

The Mean ◽

The Impact

Objective Third-party payers advocate for prior authorization (PA) to reduce overutilization of health care resources. The impact of PA in elective surgery is understudied, especially in cases where evidence-based clinical practice guidelines define operative candidacy. The objective of this study is to investigate the impact of PA on the incidence of pediatric tonsillectomy. Study Design Cross-sectional study. Setting Health claims database from a third-party payer. Methods Any pediatric patient who had evaluation for tonsillectomy from 2016 to 2019 was eligible for inclusion. A time series analysis was used to evaluate the change in incidence of tonsillectomy before and after PA. Lag time from consultation to surgery before and after PA was compared with segmented regression. Results A total of 10,047 tonsillectomy claims met inclusion and exclusion criteria. Female patients made up 51% of claims, and the mean age was 7.9 years. Just 1.5% of claims were denied after PA implementation. There was no change in the incidence of tonsillectomy for all plan types ( P = .1). Increased lag time from consultation to surgery was noted immediately after PA implementation by 2.38 days (95% CI, 0.23-4.54; P = .030); otherwise, there was no significant change over time ( P = .98). Conclusion A modest number of tonsillectomy claims were denied approval after implementation of PA. The value of PA for pediatric tonsillectomy is questionable, as it did not result in decreased incidence of tonsillectomy in this cohort.

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Support for cigarette filter waste policies among US adults

Tobacco Control ◽

10.1136/tobaccocontrol-2020-056451 ◽

2021 ◽

pp. tobaccocontrol-2020-056451

Author(s):

Minal Patel ◽

Alison F Cuccia ◽

Shanell Folger ◽

Adam F Benson ◽

Donna Vallone ◽

...

Keyword(s):

Smoking Status ◽

Population Based ◽

Tobacco Product ◽

Cross Sectional ◽

Cigarette Filter ◽

Logistic Regression Models ◽

Knowledge And Beliefs ◽

Cigarette Butts ◽

Using Data ◽

The Impact

IntroductionLittle is known on whether cigarette filter-related knowledge or beliefs are associated with support for policies to reduce their environmental impact.MethodsA cross-sectional, population-based sample of US adults aged 18–64 years (n=2979) was used to evaluate filter-related knowledge and beliefs by smoking status using data collected between 24 October 2018 and 17 December 2018. Multivariate logistic regression models explored whether these knowledge and belief items were associated with support for two policies, a US$0.75 litter fee and a ban on sales of filtered cigarettes, controlling for demographic characteristics and smoking status.ResultsRegardless of smoking status, 71% did not know plastic was a cigarette filter component and 20% believed filters were biodegradable. Overall, 23% believed filters reduce health harms and 60% believed filters make it easier to smoke; 90% believed cigarette butts are harmful to the environment. Individuals believing cigarette butts harmed the environment were more likely to support a litter fee (adjusted OR (aOR)=2.33, 95% CI: 1.71 to 3.17). Individuals believing that filters are not biodegradable had higher odds of supporting a litter fee (OR=1.47, 95% CI: 1.15 to 1.88). Respondents believing that filters do not make cigarettes less harmful were more likely to support a litter fee (aOR=1.50, 95% CI: 1.20 to 1.88) and filter ban (aOR=2.03, 95% CI: 1.64 to 2.50). Belief that filters make it easier to smoke was associated with decreased support for a filter ban (aOR=0.69, 95% CI: 0.58 to 0.83).ConclusionsComprehensive efforts are needed to educate the public about the impact of cigarette filters in order to build support for effective tobacco product waste policy.

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Impact of inquiry-based English teaching through digital applications on primary schoolchildren's reading comprehension and autonomy in pandemic situation

Linguistics and Culture Review ◽

10.21744/lingcure.v5ns3.1845 ◽

2021 ◽

Vol 5 (S3) ◽

Author(s):

Ekaterine Pipia ◽

Irina Chikovani

Keyword(s):

Academic Performance ◽

Reading Comprehension ◽

English Language ◽

Language Teaching ◽

English Language Teaching ◽

Autonomy Development ◽

Study Results ◽

Before And After ◽

Quantitative Manner ◽

The Impact

Considering the urgency of integrating technologies in the contemporary classrooms, the aim of the presented study has been shaped to outline the impact of inquiry-based English language teaching through digital applications on primary learners’ reading comprehension and autonomy development during a pandemic outbreak of COVID-19. The research context has been designed in a quantitative manner to analyze experiment results and compare control and treatment group learners’ reading comprehension and academic achievement levels as well as to measure primary schoolchildren’s level of autonomy before and after the treatment. The subjects’ autonomy level, curiosity and interest in reading through digital applications before and after the experiment have been evaluated through pre and post-experimental questionnaires. Learning processes of two experimental and two control groups were compared to create four research contexts for the study. Discrepancy between inquiry-based teaching through a digital library and a traditional way of teaching reading has been emphasized in the study results. The obtained data has been analyzed using SPSS to compare the academic performance results. The study revealed that inquiry-based English language teaching through digital applications highly enhanced the primary learners’ academic performance in reading and increased their motivation level to study independently.

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