He hurts her womb: Physical-sexual violence and pregnancy complications among women in Afghanistan

Background: Though some studies show the association between intimate partner violence and pregnancy complications in developed countries, the association remains understudied in less developed and low-income settings. This study examines the association of physical and sexual violence with pregnancy complications among women in Afghanistan. Methods: This study used the data from the 2015 Afghanistan Demographic and Health Survey (AfDHS). The analysis included 7229 women aged between 15 and 49 and used logistic regression to show the association of physical and sexual violence with pregnancy compilations. The analysis controlled for some potential variables and followed complex survey design factors such as strata, clusters, and survey weights. Results: Fully adjusted regression model shows that the women who experienced physical violence were 21% (adjusted odds ratio [OR]=1.21; confidence interval [CI]=0.98, 1.50; P<0.1) more likely to endure pregnancy complications compared to those who did not face the violence. Likewise, the women experiencing sexual violence were 89% (adjusted OR=1.89; CI=1.37, 2.62; P<0.01) higher to face pregnancy complications than those who did not face any of sexual violence. More specifically, physically and sexually violated women were highly prey to the complications that increased with the increment of the violence. Conclusion: This study adds that policymakers may formulate policies for ensuring 3C (caring couple counselling) by readdressing couple relationships, raising gender rights and awareness, providing reproductive health literacy, and increasing mental health awareness during pregnancy.

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

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.

Multimorbidity and Disability Among Venezuelan Migrants: A Population-Based Survey in Peru

The political and economic crisis in Venezuela has originated an unprecedented migration. As of November 2020, 1.04 million Venezuelans have moved to Peru. Understanding their health profile is needed to identify their needs, provide care and secure resources without affecting the healthcare of nationals. We quantified the burden of multimorbidity and disability in the Venezuelan population in Peru. We analyzed the 2018 Survey of Venezuelan Population Living in Peru; population-based with random sampling survey in six cities in Peru. Participants were asked about the presence of 12 chronic conditions (self-reported); this information was grouped into 0, 1 and ≥ 2 conditions (i.e., multimorbidity). Disability was also ascertained with a self-reported questionnaire adapted from the short version of the Washington Group on Disability Statistics. Socioeconomic variables were analyzed as potential determinants. Variables were described with frequencies and 95% confidence interval (95% CI), compared with Chi2 test, and association estimates were derived with a Poisson regression reporting prevalence ratio and 95% CI. Results accounted for the complex survey design. The analysis included 7554 migrants, mean age 31.8 (SD: 10.2), 46.6% were women, 31.7% migrated alone and 5.6% had refugee status. The prevalence of multimorbidity was 0.6% (95% CI 0.4–0.9%), and was often present in women (p < 0.001), people ≥ 50 years (p < 0.001) and those without recent job (p < 0.001). The prevalence of disability was 2.0% (95% CI 1.5–2.7%), and was common among people ≥ 50 years (p < 0.001) and those without recent job (p < 0.001). Migration alone and refugee status were not associated with multimorbidity or disability. The self-reported prevalence of multimorbidity and disability in Venezuelan migrants in Peru was low, and were not strongly influenced by migration status. While these results could suggest a healthy migrant effect, the healthcare system should be prepared to deliver acute and preventive care for these migrants, while also securing primary prevention to delay the onset of chronic conditions in this population.

Association of Parental Height With Offspring Stunting in 14 Low- and Middle-Income Countries

Background: Maternal height has been confirmed to be associated with offspring stunting in low- and middle-income countries (LMICs), but only limited studies have examined the paternal-offspring association, and few studies have examined the joint effect of maternal and paternal height on stunting.Objective: To investigate the association between parental height and stunting of children aged under five in LMICs.Methods: We obtained data from the Demographic and Health Surveys (DHS) conducted in 14 LMICs from 2006 to 2016. The association between maternal and paternal height and height-for-age z score (HAZ) of children aged under five was analyzed using a linear regression model in consideration of complex survey design, and regression coefficients (β) with 95% confidence intervals (CIs) were reported. Then, the association between maternal and paternal height quintile and child stunting was analyzed using a modified Poisson regression approach with robust error variance in consideration of complex survey design with adjustment for covariates. The effect estimates were expressed as relative risks (RRs) with 95% CIs.Results: A total of 50,372 singleton children were included and the weighted prevalence of stunting was 34.5%. Both maternal height and paternal height were associated with child HAZ (β = 0.047; 95% CI, 0.043, 0.050; and β = 0.022; 95% CI, 0.018, 0.025, respectively). Compared with those born to the tallest mothers and fathers, children from the shortest mothers and the shortest fathers had higher risks of stunting (adjusted RR = 1.89; 95% CI, 1.78, 2.01; adjusted RR = 1.56; 95% CI, 1.47, 1.65, respectively). The mother-offspring associations are substantively larger than the father-offspring associations for each corresponding height quintile. Children from the shortest parents had the highest risk of stunting compared with children from the tallest parents (adjusted RR = 3.23; 95% CI, 2.83, 3.68).Conclusions: Offspring born to short parents are at increased risk of stunting in LMICs, and this intergenerational effect is partly driven by maternal intrauterine influence. This suggests the importance of improving the nutritional status of children and adults in LMICs, especially female caregivers.

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

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.

Survey design and analysis considerations when utilizing misclassified sampling strata

Background A large multi-center survey was conducted to understand patients’ perspectives on biobank study participation with particular focus on racial and ethnic minorities. In order to enrich the study sample with racial and ethnic minorities, disproportionate stratified sampling was implemented with strata defined by electronic health records (EHR) that are known to be inaccurate. We investigate the effect of sampling strata misclassification in complex survey design. Methods Under non-differential and differential misclassification in the sampling strata, we compare the validity and precision of three simple and common analysis approaches for settings in which the primary exposure is used to define the sampling strata. We also compare the precision gains/losses observed from using a disproportionate stratified sampling scheme compared to using a simple random sample under varying degrees of strata misclassification. Results Disproportionate stratified sampling can result in more efficient parameter estimates of the rare subgroups (race/ethnic minorities) in the sampling strata compared to simple random sampling. When sampling strata misclassification is non-differential with respect to the outcome, a design-agnostic analysis was preferred over model-based and design-based analyses. All methods yielded unbiased parameter estimates but standard error estimates were lowest from the design-agnostic analysis. However, when misclassification is differential, only the design-based method produced valid parameter estimates of the variables included in the sampling strata. Conclusions In complex survey design, when the interest is in making inference on rare subgroups, we recommend implementing disproportionate stratified sampling over simple random sampling even if the sampling strata are misclassified. If the misclassification is non-differential, we recommend a design-agnostic analysis. However, if the misclassification is differential, we recommend using design-based analyses.

Deprescribing and Polypharmacy for Medicare Beneficiaries Under Guardianship in Long-Term Care Facilities

Local judicial courts vary in the amount of supervision they provide guardians, which makes the practice of guardianship uneven. To begin to address the evidence gap to inform best practices for persons under guardianship care, this study examines the issues of polypharmacy and prescribing patterns for four therapeutic classes most commonly targeted for deprescribing for older adults. The Medicare Current Beneficiary Survey (MCBS) for 2015 and 2016 is used to examine facility-dwelling Medicare beneficiaries under guardianship compared with those that are not. Logistic regression is used to examine association of polypharmacy outcomes and guardianship care controlling for patient and facility characteristics. Statistical models are adjusted using Fay’s Method with replicate weights for the MCBS complex survey design. Approximately 12% of the facility-dwelling Medicare population in 2015 and 2016 are persons under guardianship care. Persons under guardianship were more likely to have polypharmacy or to be prescribed 5 or more medications (Odd Ratio (OR)=1.168, 95% Confidence Interval (CI)=1.156 to 1.180, p&lt;0.001) than facility-dwelling Medicare beneficiaries not under guardianship care. Medicare beneficiaries under guardianship were more likely to be prescribed PPIs (OR=1.229, 95% CI=1.222 to 1.237, p&lt;0.001) or antipsychotic medications (OR=1.240, 95% CI=1.232 to 1.247, p&lt;0.001) but less likely to be prescribed benzodiazepines (OR=0.920, 95% CI=0.913 to 0.927, p&lt;0.001) or antihyperglycemics (OR-0.726, 95% CI=0.721 to 0.731, p&lt;0.001). Medical decision support services, such as guardianship care, are increasing in importance as shared decision making between patients and physicians evolves to address polypharmacy and deprescribing for older adults.

Perceived Cognitive Ability in Lesbian, Gay, Bisexual, and Heterosexual Vietnam Era Veterans

Lesbian, gay, and bisexual (LGB) Veterans report stress (e.g., discrimination under Don’t Ask Don’t Tell policies) and mental health conditions (e.g., depression) that may increase risk for neurocognitive changes like dementia. Subjective cognitive decline (SCD) can be an early indicator of neurocognitive change – yet no known studies have examined SCD in LGB Veterans. Cross-sectional data from the Vietnam Era Health Retrospective Observational Study (VE-HEROeS) were examined for 260 LGB and 17,796 heterosexual Veterans. VE-HEROeS is the latest probability-based survey of Vietnam Era Veterans (1961–1975) as older adults (2016-2017). SCD was assessed using two subscales of the Functional Assessment of Cancer Therapy-Cognitive Instrument Version-3 (FACT-Cog). Good reliability was observed in this sample: Cronbach’s alpha =.94 for the 7-item Perceived Cognitive Abilities subscale and .88 for the 4-item Comments from Others. Analyses were weighted to account for the complex survey design. LGB Veterans were slightly younger (M=68.3, range 59-84) than heterosexual Veterans (M=69.1, range 58-99, p=.03); were more likely to be female (13% vs 3%, p&lt;.01); and had fewer people living in the household (M=1.7 vs. M=2.1, p&lt;.01). LGB Veterans were also more likely than heterosexual Veterans to report feeling depressed most or all of the time over the past 30 days (5.7% vs. 3.6%, respectively, p&lt;0.01) on a single 5-point Likert-scale. SCD indicators did not vary by Veteran sexual orientation (M=19.69 and M=19.69; M=14.2 and M=14.1) and were elevated compared to published studies in healthy adult samples. More work is needed to examine neurocognitive risk factors in aging LGB Veterans.