scholarly journals Towards stronger antenatal care: Understanding predictors of late presentation to antenatal services and implications for obstetric risk management in Rwanda

PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0256415
Author(s):  
Christina N. Schmidt ◽  
Elizabeth Butrick ◽  
Sabine Musange ◽  
Nathalie Mulindahabi ◽  
Dilys Walker
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Antenatal Care ◽  
Low Birthweight ◽  
Secondary Data ◽  
Neonatal Morbidity ◽  
Late Presentation ◽  
Health Centers ◽  
Logistic Regression Models ◽  
Pregnancy Testing

Background Early antenatal care (ANC) reduces maternal and neonatal morbidity and mortality through identification of pregnancy-related complications, yet 44% of Rwandan women present to ANC after 16 weeks gestational age (GA). The objective of this study was to identify factors associated with delayed initiation of ANC and describe differences in the obstetric risks identified at the first ANC visit (ANC-1) between women presenting early and late to care. Methods This secondary data analysis included 10,231 women presenting for ANC-1 across 18 health centers in Rwanda (May 2017-December 2018). Multivariable logistic regression models were constructed using backwards elimination to identify predictors of presentation to ANC at ≥16 and ≥24 weeks GA. Logistic regression was used to examine differences in obstetric risk factors identified at ANC-1 between women presenting before and after 16- and 24-weeks GA. Results Sixty-one percent of women presented to ANC at ≥16 weeks and 24.7% at ≥24 weeks GA, with a mean (SD) GA at presentation of 18.9 (6.9) weeks. Younger age (16 weeks: OR = 1.36, 95% CI: 1.06, 1.75; 24 weeks: OR = 1.33, 95% CI: 0.95, 1.85), higher parity (16 weeks: 1–4 births, OR = 1.55, 95% CI: 1.39, 1.72; five or more births, OR = 2.57, 95% CI: 2.17, 3.04; 24 weeks: 1–4 births, OR = 1.93, 95% CI: 1.78, 2.09; five or more births, OR = 3.20, 95% CI: 2.66, 3.85), lower educational attainment (16 weeks: primary, OR = 0.75, 95% CI: 0.65, 0.86; secondary, OR = 0.60, 95% CI: 0.47,0.76; university, OR = 0.48, 95% CI: 0.33, 0.70; 24 weeks: primary, OR = 0.64, 95% CI: 0.53, 0.77; secondary, OR = 0.43, 95% CI: 0.29, 0.63; university, OR = 0.12, 95% CI: 0.04, 0.32) and contributing to household income (16 weeks: OR = 1.78, 95% CI: 1.40, 2.25; 24 weeks: OR = 1.91, 95% CI: 1.42, 2.55) were associated with delayed ANC-1 (≥16 and ≥24 weeks GA). History of a spontaneous abortion (16 weeks: OR = 0.74, 95% CI: 0.66, 0.84; 24 weeks: OR = 0.70, 95% CI: 0.58, 0.84), pregnancy testing (16 weeks: OR = 0.48, 95% CI: 0.33, 0.71; 24 weeks: OR = 0.41, 95% CI: 0.27, 0.61; 24 weeks) and residing in the same district (16 weeks: OR = 1.55, 95% CI: 1.08, 2.22; 24 weeks: OR = 1.73, 95% CI: 1.04, 2.87) or catchment area (16 weeks: OR = 1.53, 95% CI: 1.05, 2.23; 24 weeks: OR = 1.84, 95% CI: 1.28, 2.66; 24 weeks) as the health facility were protective against delayed ANC-1. Women with a prior preterm (OR, 0.71, 95% CI, 0.53, 0.95) or low birthweight delivery (OR, 0.72, 95% CI, 0.55, 0.95) were less likely to initiate ANC after 16 weeks. Women with no obstetric history were more likely to present after 16 weeks GA (OR, 1.18, 95% CI, 1.06, 1.32). Conclusion This study identified multiple predictors of delayed ANC-1. Focusing existing Community Health Worker outreach efforts on the populations at greatest risk of delaying care and expanding access to home pregnancy testing may improve early care attendance. While women presenting late to care were less likely to present without an identified obstetric risk factor, lower than expected rates were identified in the study population overall. Health centers may benefit from provider training and standardized screening protocols to improve identification of obstetric risk factors at ANC-1.

Abstract 17220: Risk Factors for Recurrent Peripartum Cardiomyopathy in 783 Women in California

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_1) ◽  
Author(s):  
Punag Divanji ◽  
Gregory Nah ◽  
Ian Harris ◽  
Anu Agarwal ◽  
Nisha I Parikh
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Logistic Regression ◽  
Regression Models ◽  
Subsequent Pregnancy ◽  
Peripartum Cardiomyopathy ◽  
Lv Function ◽  
Logistic Regression Models ◽  
Grand Multiparity ◽  
Adjusted Logistic Regression

Introduction: Characterized by significant left ventricular (LV) dysfunction and clinical heart failure (HF), peripartum cardiomyopathy (PPCM) has an incidence of approximately 1/2200 live births (0.04%). Prior studies estimate that approximately 25% of those with recovered LV function will have recurrent clinical PPCM during subsequent pregnancies, compared to 50% of those without recovered LV function. Specific predictors of recurrent PPCM have not been studied in cohorts with large numbers. Methods: From 2005-2011, we identified 1,872,227 pregnancies by International Classification of Diseases, 9th Revision (ICD-9) codes in the California Healthcare Cost and Utilization Project (HCUP) database, which captures over 95% of the California hospitalized population. Excluding 15,765 women with prior cardiovascular disease (myocardial infarction, coronary artery disease, stroke, HF, valve disease, or congenital heart disease), yielded n=1,856,462 women. Among women without prior cardiovascular disease, we identified index and subsequent pregnancies with PPCM to determine episodes of recurrent PPCM. We considered the following potential predictors of PPCM recurrence in both univariate and age-adjusted logistic regression models: age, race, hypertension, diabetes, smoking, obesity, chronic kidney disease, family history, pre-eclampsia, ectopic pregnancy, income, and insurance status. Results: In HCUP, n=783 women had pregnancies complicated by PPCM (mean age=30.8 years). Among these women, n=133 had a subsequent pregnancy (17%; mean age=28.1 years), with a mean follow-up of 4.34 years (±1.71 years). In this group of 133 subsequent pregnancies, n=14 (10.5%) were complicated by recurrent PPCM, with a mean time-to-event of 2.2 years (±1.89 years). Among the risk factors studied, the only univariate predictor of recurrent PPCM was grand multiparity, defined as ≥ 5 previous deliveries (odds ratio: 22; 95% confidence interval 4.43-118.22). The other predictors we studied were not significantly associated with recurrent PPCM in either univariate or multivariable models. Conclusion: In a large population database in California with 783 cases of PPCM over a 6-year period, 17% of women had a subsequent pregnancy, of which 10.5% had recurrent PPCM. In age-adjusted logistic regression models, grand multiparity was the only statistically significant predictor of recurrent PPCM.

Forced Sexual Victimization Among Youth in Custody: Do Risk Factors Vary by Gender and Perpetrator?

2019 ◽  
Vol 100 (2) ◽  
pp. 151-172
Author(s):  
Eileen M. Ahlin
Keyword(s):  
Risk Factors ◽  
Gender Differences ◽  
Logistic Regression ◽  
National Survey ◽  
Regression Models ◽  
Sexual Victimization ◽  
Multivariate Logistic Regression ◽  
Logistic Regression Models ◽  
Factors Associated ◽  
Using Data

There is relatively little literature examining risk factors associated with sexual victimization among youth in custody. The current study explored whether risk of forced sexual victimization among youth in custody differs by gender or perpetrator. Using data from a sample of 8,659 youth who participated in the National Survey of Youth in Custody, multivariate logistic regression models were employed to investigate gender differences in risk factors associated with overall forced sexual victimization and staff-on-inmate and inmate-on-inmate forced sexual victimization. Findings suggest that gender differences are more pronounced when perpetrator type is considered.

scholarly journals Maternal age as a risk factor for cerebral palsy

2021 ◽  
Vol 84 (2) ◽  
pp. 117-131
Author(s):  
Marta Sternal ◽  
Barbara Kwiatkowska ◽  
Krzysztof Borysławski ◽  
Agnieszka Tomaszewska
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Cerebral Palsy ◽  
Regression Model ◽  
Maternal Age ◽  
Logistic Regression Model ◽  
Significant Risk ◽  
Control Group ◽  
Logistic Regression Models ◽  
Pregnancy And Childbirth

Abstract The relationship between maternal age and the occurrence of cerebral palsy is still highly controversial. The aim of the study was to examine the effect of maternal age on the risk of CP development, taking into account all significant risk factors and the division into single, twin, full-term, and pre-term pregnancies. The survey covered 278 children with CP attending selected educational institutions in Poland. The control group consisted of data collected from the medical records of 435 children born at Limanowa county hospital, Poland. The analyses included socio-economic factors, factors related to pregnancy and childbirth, and factors related to the presence of comorbidities and diseases in the child. Constructed logistic regression models were used for statistical analyses. For all age categories included in the estimated models (assessing the effect of demographic factors on the development of CP), only the category of ≤24 years of age (in the group of all children) was significant. It was estimated that in this mother’s age category, the risk of CP is lower (OR 0.6, 95% CI: 0.3–1.0) in comparison to mothers aged 25-29 (p = 0.03). However, estimation with the use of a complex logistic regression model did not show any significant effect of maternal age on the incidence of CP in groups from different pregnancies types. It became apparent that maternal age is a weak predictor of CP, insignificant in the final logistic regression model. It seems correct to assume that the studies conducted so far, showing a significant effect of maternal age in this respect, may be associated with bias in the estimators used to assess the risk of CP due to the fact that other important risk factors for CP development were not included in the research.

scholarly journals Study of risk factors affecting both hypertension and obesity outcome by using multivariate multilevel logistic regression models

2016 ◽  
Vol 19 (3) ◽  
pp. 385-397 ◽  
Author(s):  
Sepedeh Gholizadeh ◽  
Abbas Moghimbeigi ◽  
Jalal Poorolajal ◽  
Mohammadali Khjeian ◽  
Fatemeh Bahramian ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Regression Models ◽  
Multilevel Logistic Regression ◽  
Factors Affecting ◽  
Logistic Regression Models

scholarly journals Analysis of oral risk-factors for ventilator-associated pneumonia in critically ill patients

2020 ◽  
Author(s):  
Ademar Takahama ◽  
Vitoria Iaros de Sousa ◽  
Elisa Emi Tanaka ◽  
Evelise Ono ◽  
Fernanda Akemi Nakanishi Ito ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Logistic Regression ◽  
Physical Examination ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Cross Sectional Study ◽  
Ventilator Associated Pneumonia ◽  
Cross Sectional ◽  
Logistic Regression Models

Abstract Objective: This a cross-sectional study to evaluate the association between oral health findings and ventilator-associated pneumonia (VAP) among critically ill patients in intensive care units (ICU). Material and Methods: Data were collected from medical records, and a detailed oral physical examination was performed on 663 critically ill patients on mechanical ventilation. Data were statistically analysed using univariate and logistic regression models relating the development of VAP with the oral findings. Results: At oral physical examination, the most frequent findings were tooth loss (568 - 85.67%), coated tongue (422 - 63.65%) and oral bleeding (192 - 28.96%). Patients with a coated tongue or oral bleeding on the first day of ICU hospitalization developed more VAP than did patients without these conditions (20.14% vs 13.69%: p=0.02; 23.44% vs 15.50%: p=0.01, respectively). In the logistic regression, a coated tongue and oral bleeding were considered independent risk factors for VAP development [OR=1.60 (1.02-2.47) and OR=1.59 (1.05 – 2.44), respectively]. Conclusions: The presence of a coated tongue and oral bleeding in ICU admission could be considered markers for the development of VAP. Clinical relevance: The results of this paper reinforces the importance of proper maintenance of oral hygiene before intubation, which may lead to a decrease in the incidence of VAP in the ICU. This is particularly important in the COVID-19 current scenario, where more people are expected to need mechanical ventilation, consequently increasing cases of VAP.

scholarly journals Risk factors associated with stillbirth of piglets born from oxytocin-assisted parturitions

2020 ◽  
Vol 13 (10) ◽  
pp. 2172-2177
Author(s):  
Nguyen Hoai Nam ◽  
Peerapol Sukon
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Regression Models ◽  
Significant Risk ◽  
Gestation Length ◽  
Stillbirth Rate ◽  
Multivariate Logistic Regression ◽  
Crown Rump Length ◽  
Logistic Regression Models ◽  
Factors Associated

Aim: The present study aimed to investigate the effects of different risk factors on stillbirth of piglets born from oxytocin-assisted parturitions. Materials and Methods: Data were collected from a total of 1121 piglets born from 74 Landrace x Yorkshire crossbred sows from a herd. Logistic regression models were used to determine the associations between stillbirth and different risk factors including parity (1, 2, 3-5, and 6-10), gestation length (GL) (112-113, 114-116, and 117-119 days), litter size, birth order (BO), sex, birth interval (BI), cumulative farrowing duration, birth weight (BW), crown rump length, BW deviation, body mass index, ponderal index (PI), and the use of oxytocin during expulsive stage of farrowing. Results: The incidence of stillbirth at litter level and stillbirth rate was 59.5% (44/74) and 8.1% (89/1094), respectively. The final multivariate logistic regression selected BO, BI, PI, GL, and parity as the five most significant risk factors for stillbirth. Increased BO and BI, GL <114 and >116 days, parity 6-10, and low PI increased the stillbirth rate in piglets. Conclusion: Several factors previously determined as risks for stillbirth in exogenous oxytocin-free parturitions also existed in exogenous oxytocin-assisted parturitions. One dose of oxytocin at fairly high BO did not increase stillbirth, whereas two doses of oxytocin were potentially associated with increased values.

scholarly journals Antenatal care use and its determinants among migrant women during the first delivery: a nation-wide cross-sectional study in China

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Xue Tang ◽  
Lulu Ding ◽  
Yuejing Feng ◽  
Yi Wang ◽  
Chengchao Zhou
Keyword(s):  
Logistic Regression ◽  
Antenatal Care ◽  
Pregnant Women ◽  
Binary Logistic Regression ◽  
Cross Sectional Study ◽  
Multivariate Logistic Regression Model ◽  
Migrant Women ◽  
Cross Sectional ◽  
Logistic Regression Models ◽  
Primiparous Women

Abstract Background Reasonable use of antenatal care (ANC) services by pregnant women played a crucial role in ensuring maternal and child safety and reducing the risk of complications, disability, and death in mothers and their infants. This study aimed to investigate the ANC use, and to explore the factors associated with ANC use among migrant women during the first delivery in China. Methods This study used the data of National Health and Family Planning Commission of People Republic of China in 2014. A total of 1505 migrant primiparous women were included in our current analysis. Frequencies and proportions were used to describe the data. Chi-square tests and multivariate binary logistic regression models were performed to explore the determinants that affect the number of times migrant women used ANC during their first delivery. Results Of the 1505 participants, 279 (18.54%) women received the ANC less than 5 times, and 1226 (81.46%) women used the ANC at least 5 times during the first delivery. The multivariate logistic regression model showed that migrant primiparous women with college and above education(P < 0.05;OR = 2.57;95%CI = 1.19–5.55), from the households with higher monthly income (P < 0.01;OR = 2.01;95%CI = 1.30–3.13), covered by maternity insurance(P < 0.01;OR = 2.01;95%CI = 1.28–3.18), with maternal health records (P < 0.001;OR = 2.44;95%CI = 1.61–3.69), migrating across county (P < 0.05;OR = 2.57;95%CI = 1.14–5.81), having migration experience before pregnancy(P < 0.05;OR = 1.37;95%CI = 1.03–1.81) were more likely to use ANC for at least five times. Conclusions This study demonstrated that there were still some migrant maternal women (18.54%) who attended the ANC less than 5 times. Targeted policies should be developed to improve the utilization of ANC among migrant pregnant women.

A Decade of Risk Factors in Cerebral Palsy: A Retrospective Review at Thammasat University Hospital, Thailand

2020 ◽  
Vol 103 (7) ◽  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Cerebral Palsy ◽  
Neonatal Sepsis ◽  
Low Birthweight ◽  
University Hospital ◽  
Neonatal Seizure ◽  
Total Risk ◽  
Normal Children ◽  
Multivariable Logistic Regression

Background: Cerebral palsy (CP) causes patients to experience developmental delays, affecting self-help. CP has many risk factors, unfortunately, no total risk summarization exists now. Objective: To study the risk factors for neonate CP, making it possible to diagnosis early and reduce complications. Materials and Methods: The present study was a retrospective case control study in children aged 0 to 2 years, born at Thammasat University Hospital, Thailand between 2005 and 2014. Multivariable logistic regression compared perinatal period risks between normal children (control) and those with CP (case). Results: Within the multivariable logistic regression evaluation, CP risk factors were cerebral and non-cerebral malformations, low birthweight, neonatal sepsis, with adjusted odds ratio 250.43, 16.04, 32.60, and 63.15, respectively. Conclusion: Cerebral and non-cerebral malformations, low birthweight, and neonatal sepsis are CP predictive risks. However, multi-fetal gestation, preterm birth, low Apgar score, fetal distress, uterine and cord anomalies, maternal infection, neonatal seizure, neonatal encephalopathy, congenital infections, and use of ventilator remain undetermined. A multicenter research incorporating the other events is needed. Keywords: Cerebral palsy, Risk factors, Prenatal, Perinatal, Postnatal

Prevalence of risk factors among patients with hepatocellular carcinoma (HCC) and the general population in an employer group database.

2012 ◽  
Vol 30 (4_suppl) ◽  
pp. 190-190
Author(s):  
QuynhChau Diem Doan ◽  
Annette Beiderbeck ◽  
Qingshan Qian
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Liver Disease ◽  
Index Date ◽  
Cohort Analysis ◽  
Alcoholic Cirrhosis ◽  
Cancer Registries ◽  
Research Database ◽  
Multiple Logistic Regression ◽  
Logistic Regression Models

190 Background: Most US studies evaluating risk factors for HCC have used data from hospitals, cancer registries, or Veterans Affairs database. These data sources have small patient populations and limited generalizability. Methods: This study investigated the association between HCC and potential risk factors [hepatitis B and C virus (HBV, HCV), diabetes, alcoholism, cirrhosis, obesity, liver disease, dyslipidemia, hemochromatosis, and hypothyroidism] and compared to the general (non-HCC) population of ~60 million lives from an employer group database. A retrospective cohort analysis was conducted using the Marketscan Research Database from Thomason Reuters. Case patients had an ICD-9 diagnosis for HCC between 1/1/2001 – 12/31/2009 (index date) but no HCC diagnosis during 1-year prior to index date. Randomly selected control patients did not have HCC diagnosis, were matched 3:1 ratio and enrolled during same time period as matched case patients, and matched for age (+/− 1 year), gender, and geographical region. All patients were 18 - 65 years old and did not have any cancer diagnosis (except HCC for case patients). Data from 1-year prior to index date were used to identify risk factors. Demographic variables and prevalence of risk factors were analyzed using descriptive statistics. Multiple logistic regression was used to predict the odds of developing HCC compared to non-HCC patients for these risk factors. Results: The study included 1,208 case and 3,624 control patients. Mean age of cases and controls was 54 years and 67% were male. In unadjusted multiple logistic regression models, the risk for HCC was 48-fold and 135-fold increased for patients with HBV and HCV, respectively [95% confidence interval (CI): 6.2 – 374.4 for HBV, 31.5 – 580.8 for HCV]. Diabetes increased the risk for HCC by 3.85 (95% CI 2.5 – 5.9). Alcoholic cirrhosis and nonalcoholic (NA) fatty liver disease/NA steatohepatitis increased the risk for HCC by nearly 200-fold. Conclusions: Using a larger database, these study findings were consistent with previous research and provided further evidence that the risk of HCC is greatly increased in individuals diagnosed with hepatitis, diabetes, liver disease, and alcoholism.

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