Risky Fertility Behavior, Breastfeeding Practices and Neonatal Mortality Risk: Evidence from Repeated Cross-Sectional Nationally Representative Data

Background: Notwithstanding government efforts in improving maternal and child health, childhood mortality still remains a serious burden in the country, with neonatal mortality rate of 39 deaths and under-five mortality rate of 132 per 1,000 live births. This has implication on Sustainable Development Goals (SDGs) targeted towards reducing under-fiver mortality rate to 25 deaths per 1,000 live births by the year 2030. This study examined risky fertility behavior, breastfeeding practices, and neonatal mortality risk in Nigeria. Materials and methods: This study involved the analysis of secondary data, Nigeria Demographic and Health Survey (pooled dataset of the three most recent surveys, NDHS, 2008, 2013 and 2018). The sample size was a weighted sample of 94,062 women aged 15-49 years with 172, 252 live births for the ten years period. Descriptive statistics and cox-proportional hazard model were performed using Stata 14.1 software. Results: Nearly two thirds (64.0%) of births were high risk. The practice of breastfeeding among the women was quite poor, just (39.5%) initiated breastfeeding within one hour of childbirth, though (74.0%) reported breastfeeding their child for a minimum of 12 months. The independent effect of risky fertility behavior (RFB) was associated with elevated hazards of neonatal mortality, with the highest risk observed among births belonging to the multiple high-risk group (HR=2.1, p<0.01). Adjusting for breastfeeding practices, maternal/child characteristics and maternal health seeking behavior was associated with elevated hazard of neonatal mortality with the highest hazard observed among births belonging to the multiple high-risk group (HR=1.76, p<0.05). Other factors associated with elevated hazard for neonatal mortality are sex of the child, maternal level of education and breastfeeding duration. Conclusion: RFB was associated with elevated hazard for neonatal mortality, even after adjusting for breastfeeding practices, maternal and child characteristics and maternal health-seeking behavior thereby lending credence to Mosley and Chen theory.

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Statistical Design of Phase II/III Clinical Trials for Testing Therapeutic Interventions in COVID-19 Patients

10.21203/rs.3.rs-30558/v2 ◽

2020 ◽

Author(s):

Shesh Rai ◽

Chen Qian ◽

Jianmin Pan ◽

Anand Seth ◽

Deo Kumar Srivast ◽

...

Keyword(s):

High Risk ◽

Mortality Rate ◽

Sample Size ◽

Risk Group ◽

Primary Response ◽

High Risk Group ◽

Intermediate Risk ◽

Group Sequential Design ◽

Interim Analyses ◽

Toxicity Monitoring

Abstract Background Due to unknown features of the COVID-19 disease and complexity of the patient population, traditional clinical trial designs on treatments may not be optimal in such patients. We propose two independent clinical trials designs based on careful grouping of patient and outcome measures.Methods Using the World Health Organization ordinal scale on patient status, we classify treatable patients (Stages 3-7) into two risk groups. Patients in Stages 3, 4 and 5 are categorized as the intermediate-risk group while patients in Stages 6 and 7 are categorized as the high-risk group. To ensure that an intervention, if deemed efficacious, is promptly made available to vulnerable patients, we propose a group sequential design incorporating four factors stratification, two interim analyses, and a toxicity monitoring rule for the intermediate-risk group. The primary response variable (binary variable) is based on the proportion of patients discharged from hospital by the 15th day. The goal is to detect a meaningful improvement in this response rate. For the high-risk group, we propose a group sequential design incorporating three factors stratification, two interim analyses, and without toxicity monitoring. The primary response variable for this design is the 30 days mortality, and the goal is to detect a meaning reduction in mortality rate.Results Required sample size and toxicity boundaries are calculated for each scenario. Sample size requirements for the designs with interim analyses are marginally greater than the ones without. In addition, for both the intermediate-risk group and the high-risk group, conducting two interim analyses have almost identical required sample size compared with just one interim analysis. Conclusions We recommend using composite endpoints, with binary outcome for those in Stages 3, 4 and 5 with a power of 90% to detect an improvement of 20% in response rate, and 30 days mortality rate outcome for those in Stages 6 and 7 with a power of 90% to detect 15% (effect size) reduced mortality rate, in the trial design. For the intermediate-risk group, two interim analyses for efficacy evaluation along with toxicity monitoring are encouraged. For the high-risk group, two interim analyses without toxicity monitoring is advised.

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Perioperative outcomes of segmentectomies versus lobectomies in high-risk patients: an ESTS database analysis

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezaa308 ◽

2020 ◽

Author(s):

Alessandro Brunelli ◽

Herbert Decaluwe ◽

Dominique Gossot ◽

Francesco Guerrera ◽

Zalan Szanto ◽

...

Keyword(s):

High Risk ◽

Mortality Rate ◽

Risk Group ◽

Mortality Rates ◽

High Risk Group ◽

Low Risk ◽

Perioperative Outcomes ◽

Database Analysis ◽

Risk Of Mortality ◽

Risk Patients

Abstract OBJECTIVES We queried the European Society of Thoracic Surgeons (ESTS) database with the aim to assess cardiopulmonary morbidity and 30-day mortality of segmentectomies and lobectomies in patients with a Eurolung-predicted mortality above the upper interquartile and classified as high risk. METHODS A total of 61 492 patients registered in the ESTS database (2007–2018) and submitted to lobectomy (55 353) or segmentectomy (6139) were divided into high risk or low risk according to a Eurolung-predicted mortality cut-off of 2.5% (corresponding in our population to the upper interquartile). Predicted versus observed mortalities were compared within each type of operation by using binomial test of proportion. Observed morbidity and mortality rates were compared between the 2 procedures using the χ2 test. RESULTS A total of 14 007 lobectomies and 1251 segmentectomies were classified as high risk. In the high-risk group, the cardiopulmonary morbidity and 30-day mortality rates observed in segmentectomies were lower than in lobectomies (morbidity: 12% vs 17%, P < 0.0001; mortality: 2.4% vs 3.7%, P = 0.018). In segmentectomy patients, the observed mortality rate was lower than the Eurolung-predicted one (2.4% vs 3.8%, P = 0.009), while in the lobectomy patients, there was no difference between observed and predicted mortality (3.7% vs 3.8%, P = 0.9). In the low-risk group, the cardiopulmonary morbidity and 30-day mortality rates observed in segmentectomies were lower than in lobectomies (morbidity: 4.5% vs 7.8%, P < 0.0001; mortality: 0.6% vs 1.0%, P = 0.01). In segmentectomy patients, the observed mortality rate was lower than the Eurolung-predicted one (0.6% vs 1.0%, P = 0.0003), while in the lobectomy patients, there was no difference between observed and predicted mortality (1.0% vs 1.1%, P = 0.06). CONCLUSIONS Segmentectomy was found associated with a 0.65 relative risk of mortality rate compared to lobectomy in patients deemed at higher surgical risk.

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Statistical Design of Phase II/III Clinical Trials for Testing Therapeutic Interventions in COVID-19 Patients

10.21203/rs.3.rs-30558/v3 ◽

2020 ◽

Author(s):

Shesh Rai ◽

Chen Qian ◽

Jianmin Pan ◽

Anand Seth ◽

Deo K Srivast ◽

...

Keyword(s):

High Risk ◽

Mortality Rate ◽

Sample Size ◽

Risk Group ◽

Primary Response ◽

High Risk Group ◽

Intermediate Risk ◽

Group Sequential Design ◽

Interim Analyses ◽

Toxicity Monitoring

Abstract Background Due to unknown features of the COVID-19 disease and complexity of the patient population, standard clinical trial designs on treatments may not be optimal in such patients. We propose two independent clinical trials designs based on careful grouping of patient and outcome measures.Methods Using the World Health Organization ordinal scale on patient status, we classify treatable patients (Stages 3-7) into two risk groups. Patients in Stages 3, 4 and 5 are categorized as the intermediate-risk group while patients in Stages 6 and 7 are categorized as the high-risk group. To ensure that an intervention, if deemed efficacious, is promptly made available to vulnerable patients, we propose a group sequential design incorporating four factors stratification, two interim analyses, and a toxicity monitoring rule for the intermediate-risk group. The primary response variable (binary variable) is based on the proportion of patients discharged from hospital by the 15th day. The goal is to detect a meaningful improvement in this response rate. For the high-risk group, we propose a group sequential design incorporating three factors stratification, two interim analyses, and without toxicity monitoring. The primary response variable for this design is the 30 days mortality, and the goal is to detect a meaning reduction in mortality rate.Results Required sample size and toxicity boundaries are calculated for each scenario. Sample size requirements for the designs with interim analyses are marginally greater than the ones without. In addition, for both the intermediate-risk group and the high-risk group, conducting two interim analyses have almost identical required sample size compared with just one interim analysis. Conclusions We recommend using binary outcome with composite endpoints for those in Stages 3, 4 and 5 with a power of 90% to detect an improvement of 20% in response rate, and 30 days mortality rate outcome for those in Stages 6 and 7 with a power of 90% to detect 15% (effect size) reduced mortality rate, in the trial design. For the intermediate-risk group, two interim analyses for efficacy evaluation along with toxicity monitoring are encouraged. For the high-risk group, two interim analyses without toxicity monitoring is advised.

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Disseminated intravascular coagulation in acute promyelocytic leukaemia and its impact on the induction failure: a single centre study

Bangladesh Medical Research Council Bulletin ◽

10.3329/bmrcb.v39i2.19642 ◽

2014 ◽

Vol 39 (2) ◽

pp. 57-60 ◽

Cited By ~ 1

Author(s):

F Rahman ◽

AL Kabir ◽

MR Khan ◽

A Aziz ◽

MN Baqui ◽

...

Keyword(s):

High Risk ◽

Mortality Rate ◽

Disseminated Intravascular Coagulation ◽

Risk Group ◽

Remission Rate ◽

Early Death ◽

High Risk Group ◽

P Value ◽

Intravascular Coagulation ◽

The Status

Life-threatening coagulopathy associated with acute promyelocytic leukemia (APL) has been the defining clinical characteristic and is an important risk factor for fatal haemorrhage and early death. Pathogenesis of coagulopathy in APL is complex and mainly includes disseminated intravascular coagulation (DIC). The study was done to see the status of DIC and its impact on the outcome of APL in our setting. Among the total 60 patients, induction mortality rate was 30% and remission rate was 70%. The main cause of induction mortality was bleeding that accounts for 66.7% of mortality. DIC was present among 32 out of 60 patients (53.33%). Induction mortality has significant relationship to DIC as the induction mortality rate is 47% in patients with DIC and 11% in patient without DIC (P value 0.0009 ). Induction motality rate in low, intermediate and high risk group is 6.7%, 24% and 58% respectively (p value <0.0001). Finally, risk group subclassification revealed presence of DIC in high risk group has the highest early mortality rate DOI: http://dx.doi.org/10.3329/bmrcb.v39i2.19642 Bangladesh Med Res Counc Bull 2013; 39: 57-60

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Analysis of VTE Multiple Risk Factors and Active Prevention in High Risk Group

Advanced Emergency Medicine ◽

10.18686/aem.v4i2.1 ◽

2015 ◽

Vol 4 (2) ◽

pp. 1

Author(s):

Wei Ni

Keyword(s):

Risk Factors ◽

Risk Assessment ◽

High Risk ◽

Mortality Rate ◽

Disease Risk ◽

Risk Group ◽

High Risk Group ◽

Way Of Life ◽

Multiple Risk Factors ◽

Multiple Risk

<p>Deeper understanding of venous thrombosis’s risk factors and pathogenesis for patients at high risk group and the patient would be informed the disease risk and be advised of the need to improve the way of life. Strengthening of the hospitalized patients with VTE multiple risk factors for risk assessment and the active prevention are effective in reducing the morbidity and mortality rate of VTE.</p>

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Acromegaly and Obstructive Sleep Apnea: Identifying the High-Risk Group

10.1055/s-0039-1679596 ◽

2019 ◽

Author(s):

Xiaojun Zhan ◽

Chandala Chitguppi ◽

Ethan Berman ◽

Gurston Nyquist ◽

Tomas Garzon-Muvdi ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

High Risk ◽

Risk Group ◽

High Risk Group ◽

Obstructive Sleep

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Recommendations from male students help shape mental health support for this high-risk group

10.3310/alert_42077 ◽

2020 ◽

Keyword(s):

Mental Health ◽

High Risk ◽

Risk Group ◽

High Risk Group ◽

Male Students ◽

Mental Health Support ◽

Health Support

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Anamnestic factors that shape reproductive health of women with repeated unsuccessful popygamy in vitro fertilization

HEALTH OF WOMAN ◽

10.15574/hw.2016.114.140 ◽

2016 ◽

pp. 140-143

Author(s):

N.V. Cotsabin ◽

◽

O.M. Makarchuk ◽

Keyword(s):

High Risk ◽

Risk Group ◽

Polycystic Ovary ◽

High Risk Group ◽

Stress Factors ◽

Control Group ◽

Fertilization In Vitro ◽

Infertile Women ◽

Group I

The proportion of patients with multiple unsuccessful attempts of assisted reproductive technology (ART) is about 30% of all patients treated with the use of ART. Women with history of unsuccessful ART attempts - a special category of patients who require emergency attention and a thorough examination at the stage of preparation for superovulation stimulation,the selection of embryos and endometrium preparation for embryo transfer. The objective: to distinguish high-risk group of unsuccessful attempts based on a detailed analysis of anamnestic and clinical data of infertile women with repeated unsuccessful ART attempts that requires more in-depth study of hormonal features, ovarian reserve and condition of the endometrium. Materials and methods. For better understanding of the problem of repeated unsuccessful ART attempts and сreation of efficient infertility treatment algorithms for these couples we conducted a thorough analysis of anamnestic data of three groups of infertile women (105 patients), which were distributed by age: group I – younger than 35, the II group – from 35 to 40, the III group - over 40 years. These groups of patients were compared with each other and with the control group of healthy women (30 persons). Results. Leading stress factors in the percentage three times prevailed in the group of infertile women and had a direct connection with the fact of procedure «fertilization in vitro» and chronic stressors caused by prolonged infertility. Primary infertility was observed significantly more frequent in patients younger than 35 years (p <0.05), secondary infertility - mostly in the second and third experimental groups (p <0.05). Noteworthy significant percentage of wellknown causes of infertility and idiopathic factor in all groups, and the prevalence of tubal-peritoneal factor in the second and third experimental groups, and endocrine dysfunction in the I experimental group. The most common disorder among this category of woman was polycystic ovary syndrome. Frequency of usual miscarriage among patients of I ana II groups was two times higher than in the third group (p <0.05). Among the experimental groups the leading place belongs urinary tract infection, respiratory tract diseases, pathologies of the cardiovascular system. Data of the stratified analysis show an increase likelihood of repeated unsuccessful ART attempts under the influence of constant chronic stress (odds ratio OR=2.06; 95% CI: 0.95–3.17; p<0.05). Conclusions. Among infertile patients with repeated unsuccessful ART attempts must be separated a high risk group of failures. The identity depends on the duration of infertility, female age and leading combination of factors. Key words: repeated unsuccessful ART attempts, anamnesis, infertility, high risk.

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