Negative birth experience – what matters most? Risk factors from three time periods during pregnancy: a register-based study

Objective: To explore the impact of risk factors from three different time periods on negative birth experience. Design: Register-based cohort study. Setting: Sweden. Population: Nulliparous women giving birth to singleton, term infants in 2013–2018 (n = 83 335), elective caesarean sections (CS) excluded. Methods: Hierarchical logistic regression was performed to calculate adjusted odds ratios (aOR) with 95% confidence intervals (CIs) in three blocks, each representing risk factors from one of three time periods: I) before pregnancy, II) pregnancy, III) labour. Main Outcome Measurement: Negative birth experience, defined as ratings of ≤ 4 on a ten-point scale. Results: Poor self-rated health (SRH) was the only pre-gestational factor remaining associated with negative birth experience after adjustment for pregnancy- and labour-related factors (aOR 1.22, 95% CI 1.10–1.36). Fear of childbirth and treatment for psychiatric disorder during pregnancy were both associated with negative birth experience (aOR 1.53, 95% CI 1.36–1.73; aOR 1.51, 95% CI 1.35–1.68), as were all labour-related factors included in the model. Women giving birth by operative vaginal delivery or unplanned CS under regional anaesthesia had three-fold higher ORs for rating their overall birth experience as negative (aOR 3.23, 95% CI 2.99–3.50; aOR 3.04, 95% CI 2.77–3.33). The highest OR, 5.38, was seen among women undergoing unplanned CS under general anaesthesia (95% CI 4.52–6.40). Conclusions: The main contributing factors to a negative birth experience are labour-related. Poor SRH, psychiatric treatment and fear of childbirth places the woman in a vulnerable position requiring extra attention.

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The Impact of Intervention-Related Risk Factors on the Risk of Ventilator-Associated Pneumonia Is High in a Neurosurgical Intensive Care Unit

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.1059 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s407-s409

Author(s):

Ksenia Ershova ◽

Oleg Khomenko ◽

Olga Ershova ◽

Ivan Savin ◽

Natalia Kurdumova ◽

...

Keyword(s):

Risk Factors ◽

Mechanical Ventilation ◽

Negative Slope ◽

Infection Prevention And Control ◽

Ventilator Associated Pneumonia ◽

Related Factors ◽

Icu Patients ◽

The Impact ◽

Adf Test ◽

Over Time

Background: Ventilator-associated pneumonia (VAP) represents the highest burden among all healthcare-associated infections (HAIs), with a particularly high rate in patients in neurosurgical ICUs. Numerous VAP risk factors have been identified to provide a basis for preventive measures. However, the impact of individual factors on the risk of VAP is unclear. The goal of this study was to evaluate the dynamics of various VAP risk factors given the continuously declining prevalence of VAP in our neurosurgical ICU. Methods: This prospective cohort unit-based study included neurosurgical patients who stayed in the ICU >48 consecutive hours in 2011 through 2018. The infection prevention and control (IPC) program was implemented in 2010 and underwent changes to adopt best practices over time. We used a 2008 CDC definition for VAP. The dynamics of VAP risk factors was considered a time series and was checked for stationarity using theAugmented Dickey-Fuller test (ADF) test. The data were censored when a risk factor was present during and after VAP episodes. Results: In total, 2,957 ICU patients were included in the study, 476 of whom had VAP. Average annual prevalence of VAP decreased from 15.8 per 100 ICU patients in 2011 to 9.5 per 100 ICU patients in 2018 (Welch t test P value = 7.7e-16). The fitted linear model showed negative slope (Fig. 1). During a study period we observed substantial changes in some risk factors and no changes in others. Namely, we detected a decrease in the use of anxiolytics and antibiotics, decreased days on mechanical ventilation, and a lower rate of intestinal dysfunction, all of which were nonstationary processes with a declining trend (ADF testP > .05) (Fig. 2). However, there were no changes over time in such factors as average age, comorbidity index, level of consciousness, gender, and proportion of patients with brain trauma (Fig. 2). Conclusions: Our evidence-based IPC program was effective in lowering the prevalence of VAP and demonstrated which individual measures contributed to this improvement. By following the dynamics of known VAP risk factors over time, we found that their association with declining VAP prevalence varies significantly. Intervention-related factors (ie, use of antibiotics, anxiolytics and mechanical ventilation, and a rate of intestinal dysfunction) demonstrated significant reduction, and patient-related factors (ie, age, sex, comorbidity, etc) remained unchanged. Thus, according to the discriminative model, the intervention-related factors contributed more to the overall risk of VAP than did patient-related factors, and their reduction was associated with a decrease in VAP prevalence in our neurosurgical ICU.Funding: NoneDisclosures: None

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Deep brain stimulation hardware–related infections: 10-year experience at a single institution

Journal of Neurosurgery ◽

10.3171/2017.9.jns1780 ◽

2019 ◽

Vol 130 (2) ◽

pp. 629-638 ◽

Cited By ~ 4

Author(s):

Kingsley O. Abode-Iyamah ◽

Hsiu-Yin Chiang ◽

Royce W. Woodroffe ◽

Brian Park ◽

Francis J. Jareczek ◽

...

Keyword(s):

Risk Factors ◽

Deep Brain Stimulation ◽

Brain Stimulation ◽

Single Institution ◽

Chi Square ◽

Related Factors ◽

Exact Test ◽

Vancomycin Powder ◽

The Impact ◽

Deep Brain

OBJECTIVEDeep brain stimulation is an effective surgical treatment for managing some neurological and psychiatric disorders. Infection related to the deep brain stimulator (DBS) hardware causes significant morbidity: hardware explantation may be required; initial disease symptoms such as tremor, rigidity, and bradykinesia may recur; and the medication requirements for adequate disease management may increase. These morbidities are of particular concern given that published DBS-related infection rates have been as high as 23%. To date, however, the key risk factors for and the potential preventive measures against these infections remain largely uncharacterized. In this study, the authors endeavored to identify possible risk factors for DBS-related infection and analyze the efficacy of prophylactic intrawound vancomycin powder (VP).METHODSThe authors performed a retrospective cohort study of patients who had undergone primary DBS implantation at a single institution in the period from December 2005 through September 2015 to identify possible risk factors for surgical site infection (SSI) and to assess the impact of perioperative (before, during, and after surgery) prophylactic antibiotics on the SSI rate. They also evaluated the effect of a change in the National Healthcare Safety Network’s definition of SSI on the number of infections detected. Statistical analyses were performed using the 2-sample t-test, the Wilcoxon rank-sum test, the chi-square test, Fisher’s exact test, or logistic regression, as appropriate for the variables examined.RESULTSFour hundred sixty-four electrodes were placed in 242 adults during 245 primary procedures over approximately 10.5 years; most patients underwent bilateral electrode implantation. Among the 245 procedures, 9 SSIs (3.7%) occurred within 90 days and 16 (6.5%) occurred within 1 year of DBS placement. Gram-positive bacteria were the most common etiological agents. Most patient- and procedure-related characteristics did not differ between those who had acquired an SSI and those who had not. The rate of SSIs among patients who had received intrawound VP was only 3.3% compared with 9.7% among those who had not received topical VP (OR 0.32, 95% CI 0.10–1.02, p = 0.04). After controlling for patient sex, the association between VP and decreased SSI risk did not reach the predetermined level of significance (adjusted OR 0.32, 95% CI 0.10–1.03, p = 0.06). The SSI rates were similar after staged and unstaged implantations.CONCLUSIONSWhile most patient-related and procedure-related factors assessed in this study were not associated with the risk for an SSI, the data did suggest that intrawound VP may help to reduce the SSI risk after DBS implantation. Furthermore, given the implications of SSI after DBS surgery and the frequency of infections occurring more than 90 days after implantation, continued follow-up for at least 1 year after such a procedure is prudent to establish the true burden of these infections and to properly treat them when they do occur.

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Impact of Risk Factors on Construction Projects’ Completion Cost in Nigeria

LAUTECH Journal of Civil and Environmental Studies ◽

10.36108/laujoces/1202.60.0270 ◽

2021 ◽

Vol 6 (2) ◽

Author(s):

Z. H Ishaq

Keyword(s):

Risk Factors ◽

Construction Projects ◽

Sampling Technique ◽

Related Factors ◽

Cash Flow Management ◽

Project Completion ◽

Contract Administration ◽

Potential Risks ◽

The Impact ◽

Cost Of Construction

Construction projects are prone to a number of risks due to their complexity, dynamic nature, capital intensive nature and involvement of many stakeholders. These risks if left unmanaged will negatively influence the completion cost and other primary objectives of construction projects. Numerous studies have been conducted globally to determine the potential risks that negatively impacts construction projects; however, the risks aren’t alike across all the regions and the potential degree of impact may changes with time. This study assessed the impact of risk factors on completion cost of construction projects in Nigeria. Data was collected using structured questionnaires administered to 192 construction practitioners using convenience sampling technique. Descriptive statistics (mean and standard deviation) were used to analyse the data. The study found ‘inadequate cost estimate’ (MS = 4.39), ‘risk incurred due to bribery and corruption’ (4.30), ‘increase in prices of materials’ (4.25), ‘increase in cost of labour’’ (4.11), ‘poor cash flow management’ (4.04) ‘mistakes/errors in design’ (4.04) and ‘mistakes during construction’ to be the topmost risk factors that impact on project completion cost. The study concludes that ‘economic’, ‘financial’ and ‘contract administration and project management’ related factors group are those with high impact on project completion cost.

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Prevalence of PTSD Symptoms Among Psychiatric Patients During the COVID-19 Pandemic

10.21203/rs.3.rs-139931/v1 ◽

2021 ◽

Author(s):

Lirong Tang ◽

Yue Gao ◽

Shuangyi Qi ◽

Jie Cui ◽

Li Zhou ◽

...

Keyword(s):

Risk Factors ◽

Psychiatric Symptoms ◽

Psychiatric Patients ◽

Depression Scale ◽

Psychiatric Hospitals ◽

Health Concern ◽

Ptsd Symptoms ◽

Related Factors ◽

Event Scale ◽

The Impact

Abstract Background: The outbreak of the COVID-19 pandemic has caused extensive public health concern and posed great challenges to the medical services, including the mental health concern for psychiatric patients who were one of neglected groups. The current study aimed to assess the prevalence and risk factors of post-traumatic stress disorder (PTSD) symptoms among psychiatric patients in China during the pandemic. Method: Self-reported questionnaires were distributed to psychiatric patients in several psychiatric hospitals in Beijing China from 28 April to 30 May 2020. The socio-demographic information and psychiatric symptoms such as PTSD, anxiety and depressive symptoms were collected by using The Impact of Event Scale- Revised (IES-R), the 7-item Generalized Anxiety Disorder Scale (GAD-7) and the 9-item Patient Health Questionnaire depression scale (PHQ-9). Multivariate regression was used to analysis the related factors for PTSD symptoms. Results: 1,055 psychiatric patients were included in the final sample. The prevalence of PTSD symptoms was 41.3%. Risk factors for PTSD symptoms and its subscales included old age, high risk perception, symptoms of anxiety, symptoms of depression. Conclusions: The prevalence of PTSD symptoms is high among psychiatric patients during the COVID-19 pandemic in China. We call for more concern and PTSD interventions to relieve the psychological stress of psychiatric patients during the pandemic.

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A Cross-Sectional Epizootiological Study and Risk Assessment of Foot-Related Lesions and Lameness in Intensive Dairy Sheep Farms

Animals ◽

10.3390/ani11061614 ◽

2021 ◽

Vol 11 (6) ◽

pp. 1614

Author(s):

Marios Moschovas ◽

Aphrodite I. Kalogianni ◽

Panagiotis Simitzis ◽

Georgios Pavlatos ◽

Stavros Petrouleas ◽

...

Keyword(s):

Risk Factors ◽

Dairy Sheep ◽

Related Factors ◽

White Line ◽

Cross Sectional ◽

Total N ◽

Foot Health ◽

Foot Diseases ◽

Foot Lesions ◽

The Impact

Foot-related lameness, foot-diseases and lesions are emerging issues in dairy sheep; however, relevant epizootiological studies are scarce, and risk factors have not been elucidated. The objectives of this cross-sectional study were (i) to address this dearth of knowledge by investigating the epizootiology of lameness-related foot-lesions and diseases, and (ii) to assess the impact of potential risk factors on foot health, in intensive dairy sheep farms. Thirty farms were assigned in two representative clusters using a multivariate statistical analysis. Three farms per cluster and 100 multiparous milking ewes per farm (total n = 600) were selected and enrolled in the study. Foot-related lameness, ovine interdigital dermatitis (OID), infectious footrot (IFR), white line disease, hoof wall cracks, as well as health and welfare traits were recorded. Overall prevalence of foot-related lameness was 9.0% and was primarily associated with IFR; however, additional infectious and non-infectious foot diseases and lesions also contributed. Among infectious foot diseases, OID was the most prevalent (21.3%) followed by IFR (8.0%); WLD and hoof wall cracks were the most prevalent non-infectious foot-lesions (37.7% and 15.3%, respectively). IFR and OID prevalence increased with age (p < 0.05) and BCS (p < 0.01), respectively, suggesting that host-related factors and husbandry practices are important determinants of its occurrence.

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Sexual function in primiparous women: a prospective study

International Urogynecology Journal ◽

10.1007/s00192-021-05029-w ◽

2022 ◽

Author(s):

Hedda Dahlgren ◽

Markus H. Jansson ◽

Karin Franzén ◽

Ayako Hiyoshi ◽

Kerstin Nilsson

Keyword(s):

Risk Factors ◽

Prospective Study ◽

Sexual Function ◽

Sexual Activity ◽

Early Pregnancy ◽

Significant Risk ◽

Nulliparous Women ◽

And Function ◽

The Impact ◽

Primiparous Women

Abstract Introduction and hypothesis The aim of this prospective study was to examine the impact of sociodemographic, pregnancy and obstetric characteristics on sexual function 12 months postpartum in primiparous women. We hypothesized that sexual function would decrease after childbirth. Methods Between 1 October 2014 and 1 October 2017, all nulliparous women in early pregnancy registering for maternity health care in Region Örebro County, Sweden, were invited to participate in this prospective study. A total of 958 women were included. Sexual activity and function were measured at early pregnancy, 8 weeks postpartum and 12 months postpartum using the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12). The associations between sociodemographic, pregnancy and obstetric characteristics and sexual activity and function from early pregnancy to 12 months postpartum were examined using linear and logistic models based on generalized estimating equations. Results We found that the prevalence of sexually active women decreased from 98.0% in early pregnancy to 66.7% at 8 weeks postpartum, but increased to 90.0% at 12 months postpartum. Age ≥ 35 years, second-degree perineal tear and current breastfeeding were statistically significant risk factors for sexual inactivity at 12 months postpartum. Poor self-reported health in early pregnancy was statistically significantly associated with decreased sexual function at 12 months postpartum. Conclusions A majority of women resumed sexual activity at 8 weeks postpartum and most women at 12 months postpartum; the decrease in sexual function at 12 months postpartum was small and few risk factors were observed.

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Association of individual and device usage factors with musculoskeletal disorders amongst handheld devices users during homestay due to pandemic

International Journal of Workplace Health Management ◽

10.1108/ijwhm-06-2020-0104 ◽

2021 ◽

Vol ahead-of-print (ahead-of-print) ◽

Author(s):

Rahul Jain ◽

Kunj Bihari Rana ◽

Makkhan Lal Meena

Keyword(s):

Risk Factors ◽

Musculoskeletal Disorders ◽

Office Workers ◽

Upper Body ◽

Handheld Devices ◽

Body Parts ◽

Related Factors ◽

Content Type ◽

Chi Square Analysis ◽

The Impact

PurposeThe COVID-19 pandemic is spreading in India and different parts of the world. The outbreak delivered not only the condition of dying from infection but also forced people (especially office workers and students) to perform all working (office work, classes, assignments, etc.) and non-working activities (leisure activities such as social media, gaming, etc.) at home using handheld devices (HHDs). In this situation, HHD usage for longer durations is mainly responsible for work-related health issues. Therefore, the paper aims to explore HHD usage patterns and musculoskeletal disorders (MSDs) amongst HHD users during homestay and the impact of individual and HHD usage–related factors on MSDs.Design/methodology/approachFrom different states of India, 651 people (especially HHD users from universities and industries) were sampled by using systematic cluster random sampling. In addition, an online questionnaire was used to collect data on the prevalence and risk factors of MSDs. Finally, mean comparisons and chi-square analysis was used to analyse the collected data.FindingsThe prevalence rate of MSDs was higher in upper body parts as compared to the lower body parts. The association of gender with MSDs in various body parts was substantial. The time spent on various working and non-working activities using HHDs was significantly associated with MSDs in upper body parts.Practical implicationsHomestay work may be used as an alternative working arrangement, and the risk factors that have the most significant impact on the health of HHD users may be identified by organizations. The findings suggest the proper use of HHDs as per their essential need with intermediate recreational activities.Originality/valueIt is observed that the musculoskeletal health of office workers and university students is a cause for concern during homestay. The current study provides the prevalence of MSDs experienced by HHD users and the association of individual and HHD usage factors with MSDs.

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Pan-cancer analysis demonstrates that integrating polygenic risk scores with modifiable risk factors improves risk prediction

Nature Communications ◽

10.1038/s41467-020-19600-4 ◽

2020 ◽

Vol 11 (1) ◽

Author(s):

Linda Kachuri ◽

Rebecca E. Graff ◽

Karl Smith-Byrne ◽

Travis J. Meyers ◽

Sara R. Rashkin ◽

...

Keyword(s):

Risk Factors ◽

Family History ◽

Cancer Risk ◽

Cancer Risk Assessment ◽

Risk Scores ◽

Modifiable Risk Factors ◽

Related Factors ◽

Polygenic Risk ◽

Incident Cancer ◽

The Impact

AbstractCancer risk is determined by a complex interplay of environmental and heritable factors. Polygenic risk scores (PRS) provide a personalized genetic susceptibility profile that may be leveraged for disease prediction. Using data from the UK Biobank (413,753 individuals; 22,755 incident cancer cases), we quantify the added predictive value of integrating cancer-specific PRS with family history and modifiable risk factors for 16 cancers. We show that incorporating PRS measurably improves prediction accuracy for most cancers, but the magnitude of this improvement varies substantially. We also demonstrate that stratifying on levels of PRS identifies significantly divergent 5-year risk trajectories after accounting for family history and modifiable risk factors. At the population level, the top 20% of the PRS distribution accounts for 4.0% to 30.3% of incident cancer cases, exceeding the impact of many lifestyle-related factors. In summary, this study illustrates the potential for improving cancer risk assessment by integrating genetic risk scores.

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Risk factors for invasive aspergillosis in ICU patients with COVID-19: current insights and new key elements

Annals of Intensive Care ◽

10.1186/s13613-021-00923-4 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

G. Montrucchio ◽

T. Lupia ◽

D. Lombardo ◽

G. Stroffolini ◽

S. Corcione ◽

...

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Intensive Care ◽

Influenza Infection ◽

Invasive Pulmonary Aspergillosis ◽

Diagnostic Category ◽

Pulmonary Aspergillosis ◽

Related Factors ◽

Epidemiological Characteristics ◽

The Impact

AbstractInvasive pulmonary aspergillosis (IPA) has always been a challenging diagnosis and risk factors an important guide to investigate specific population, especially in Intensive Care Unit. Traditionally recognized risk factors for IPA have been haematological diseases or condition associated with severe immunosuppression, lately completed by chronic conditions (such as obstructive pulmonary disease, liver cirrhosis, chronic kidney disease and diabetes), influenza infection and Intensive Care Unit (ICU) admission. Recently, a new association with SARS-CoV2 infection, named COVID-19-associated pulmonary aspergillosis (CAPA), has been reported worldwide, even if its basic epidemiological characteristics have not been completely established yet. In this narrative review, we aimed to explore the potential risk factors for the development of CAPA and to evaluate whether previous host factors or therapeutic approaches used in the treatment of COVID-19 critically ill patients (such as mechanical ventilation, intensive care management, corticosteroids, broad-spectrum antibiotics, immunomodulatory agents) may impact this new diagnostic category. Reviewing all English-language articles published from December 2019 to December 2020, we identified 21 papers describing risk factors, concerning host comorbidities, ICU management, and COVID-19 therapies. Although limited by the quality of the available literature, data seem to confirm the role of previous host risk factors, especially respiratory diseases. However, the attention is shifting from patients’ related risk factors to factors characterizing the hospital and intensive care course, deeply influenced by specific features of COVID treatment itself. Prolonged invasive or non-invasive respiratory support, as well as the impact of corticosteroids and/or immunobiological therapies seem to play a pivotal role. ICU setting related factors, such as environmental factors, isolation conditions, ventilation systems, building renovation works, and temporal spread with respect to pandemic waves, need to be considered. Large, prospective studies based on new risk factors specific for CAPA are warranted to guide surveillance and decision of when and how to treat this particular population.

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Controlling Inflammation in Peritoneal Dialysis: The Role of PD-Related Factors as Potential Intervention Targets

Peritoneal Dialysis International ◽

10.1177/089686080702702s14 ◽

2007 ◽

Vol 27 (2_suppl) ◽

pp. 76-81

Author(s):

Paulo C. Fortes ◽

Priscilla H. Versari ◽

Andréa E.M. Stinghen ◽

Roberto Pecoits–Filho

Keyword(s):

Risk Factors ◽

Peritoneal Dialysis ◽

Mineral Metabolism ◽

Therapeutic Strategies ◽

Chronic Infections ◽

Related Factors ◽

Related Risk ◽

Traditional Risk Factors ◽

Cv Disease ◽

The Impact

Cardiovascular (CV) disease is the main cause of death in peritoneal dialysis (PD) patients, but the mechanisms mediating the increased CV risk observed in this group of patients are still largely unknown, which limits the perspective on effective therapeutic strategies. Patients on PD are already exposed to a number of traditional risk factors from the start of their chronic kidney disease (CKD), because many of those risk factors are common to CV disease and CKD alike. As renal dysfunction progresses, CKD-related risk factors are introduced, changing the profile of both the CV disease and the markers of risk. In this phase, which usually starts when glomerular filtration rate falls below 60 mL/min, the list of risk factors is expanded to include disturbances of mineral metabolism, anemia, fluid overload, uremic toxicity, and increased signs of oxidative stress and inflammation. Although many of the risk factors linked to CV burden are not related to the dialytic procedure, additional harm is introduced after the initiation of PD—with, for example, the presence of chronic infections and factors related to PD fluids, particularly reabsorption of glucose. In the present article, we review the impact of the novel risk factors introduced with the initiation of PD therapy, and we propose potential therapeutic strategies (which remain to be tested) for reducing CV mortality in this group of patients.

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