Association between the number of visits during prenatal care and the occurrence of low birth weight in the United States

BackgroundLow birth weight (LBW) is one of the major child and infant health issues in the United States, standing as one of the main causes of child and infant mortality. While the importance of prenatal visits regarding pregnancy outcomes is recognized, its relationship with birth weight is still a matter of debate.ObjectivesThis study examines the relationship between the number of prenatal visits and low birth weight among children born in the United States in 2017.Study designData from the CDCs Online Birth Databases are used for this study. 3,864,754 registered children born in the U.S. in 2017 are included in the analyses. The databases also include information on maternal characteristics, pregnancy history and prenatal care characteristics, pregnancy risk factors, delivery characteristics, and infant characteristics. The outcome variable is low birth weight, defined as weight at birth lower than 2500 grams. The independent variable is the number of prenatal visits grouped in three categories (no visit, 10 visits or less, and more than 10 visits. Confounding and covariates include prematurity and plurality among others. Multiple logistic regression modeling was used, reporting unadjusted and adjusted odds ratios with corresponding 95% confidence intervals.ResultsData from the CDCs Online Birth Databases are used for this study. 3,864,754 registered children born in the U.S. in 2017 are included in the analyses. The databases also include information on maternal characteristics, pregnancy history and prenatal care characteristics, pregnancy risk factors, delivery characteristics, and infant characteristics. The outcome variable is low birth weight, defined as weight at birth lower than 2500 grams. The independent variable is the number of prenatal visits grouped in three categories (no visit, 10 visits or less, and more than 10 visits. Confounding and covariates include prematurity and plurality among others. Multiple logistic regression modeling was used, reporting unadjusted and adjusted odds ratios with corresponding 95% confidence intervals. ConclusionThis study reveals that the number of prenatal visits has an inverse relationship with low birth weight, even when confounding and other factors are accounted for. These findings are compatible with the notion that the more a woman goes for prenatal visits, the more likely it is to detect risks of negative pregnancy outcomes.

Household catastrophic health expenditure and its effective factors: a case of Iran

Background The World Health Organization (WHO) has placed special emphasis on protecting households from health care expenditures. Many households face catastrophic health expenditures (CHEs) from a combination of economic poverty and financing the treatment of medical conditions. The present study aimed to measure the percentage of households facing catastrophic CHEs and the factors associated with the occurrence of CHEs in Shiraz, Iran in 2018. Methods The present cross-sectional study was performed on 740 randomly selected households from different districts of Shiraz, Iran in 2018 using a multi-stage sampling method. Data were collected using the Persian version of the “WHO Global Health Survey” questionnaire. CHEs were defined as health expenditures exceeding 40% of households’ capacity to pay. Households living below the poverty line before paying for health services were excluded from the study. The associations between the households’ characteristics and facing CHEs were determined using the Chi-Square test as well as multiple logistic regression modeling in SPSS 23.0 at the significance level of 5%. Results The results showed that 16.48% of studied households had faced CHEs. The higher odds of facing CHEs were observed in the households living in rented houses (OR = 3.14, P-value < 0.001), households with disabled members (OR = 27.98, P-value < 0.001), households with children under 5 years old (OR = 2.718, P-value = 0.02), and those without supplementary health insurance coverage (OR = 1.87, P-value = 0.01). Conclusion CHEs may be reduced by increasing the use of supplementary health insurance coverage by individuals and households, increasing the support of the Social Security and the State Welfare Organizations for households with disabled members, developing programs such as the Integrated Child Care Programs, and setting home rental policies and housing policies for tenants.

Investigation of the Leading Causes of Injury and Violence in South-East Iran

Introduction: Injuries and violence are significant causes of death and health problems in all countries; however, they are not equally distributed across the world or within countries. Injuries result from road traffic crashes, falls, drowning, burns, poisoning, and acts of violence against oneself or others, among other causes. The present study aimed to describe the causes, their characteristics, frequencies, types, and outcomes of the injuries reported to the Forensic Medicine Center, Zahedan, Iran. Methods: This cross-sectional study was conducted in the Forensic Medicine Center, Zahedan, South-East Iran. A total of 1400 intentional and unintentional injuries were systematically extracted from the administrative records between January 1, 2008, and December 31, 2018. The data were analyzed using the Chi-square test and multiple logistic regression models. Furthermore, the Stata statistical software (version 14; StataCorp, USA) was used for all analyses. Results: In this study, three major causes of injuries included accident, fight, and burn in the order of priority. The overall frequencies of intentional and unintentional injuries among the subjects were 40.3% and 59.7%, respectively. Moreover, death occurred in 45.6% of the cases. Here, the odds of death in unintentional injuries were more than those in intentional ones (P<0.001). Multiple logistic regression modeling showed that increasing age (P=0.001), education level (P<0.001), holiday time (P=0.02), and urban setting (P=0.02) for injury were associated with increased odds of intentional injuries. Conclusion: According to the results, younger age groups were more likely to be injured, compared to other categories. Therefore, it is necessary to implement any planning and prioritization for the reduction of family injuries and violence in school education by instructing this age group regarding injuries and their health risk consequences. Decision-makers should focus their attention on the issue locally. The implications of this study could be highly influential to identify intervention opportunities and determine local and cultural problematic health issues.

Individual and institutional predictors of sexual orientation and gender identity data collection in oncology practice: An ASCO survey.

6520 Background: Most oncology practices do not collect patients’ sexual orientation (SO) or gender identity (GI) (SOGI), prohibiting assessment of sexual and gender minority (SGM) patients’ cancer disparities and identification of such patients in cancer care or research. Studies report that 90% of SGM patients would disclose their SOGI, while 78% of clinicians believe that patients would not. Preliminary evidence indicates that SOGI disclosure improves health outcomes. Organizations, including ASCO and NIH, have called for routine SOGI data collection, but institutional barriers, e.g. lack of SOGI fields in EMRs, hinder progress. This study aimed to delineate institutional and individual-level factors related to SOGI data collection in oncology. Methods: From Oct to Nov 2020, an anonymous 54 item online survey was distributed to ASCO members via direct outreach, listservs and social media. The survey assessed whether respondents’ institutions collect SOGI data, factors related to SOGI data collection, respondents’ attitudes about SOGI data and SGM patients, and demographics. Simple and multiple logistic regression modeling determined factors associated with respondents’ reports of SOGI data collection at their institutions. Results: Nearly half of 257 respondents reported their institutions collect SO and GI data (42%, 48%, respectively); over a third reported their institutions did not collect SO or GI data (36%, 34%, respectively); and a fifth were unsure (22%, 18%, respectively). Collection of both SO and GI was associated in unadjusted models with leadership support and having resources for SOGI data collection. SO collection was also associated with type of institution, having an SGM family member, and belief that knowing SO is important for providing quality care. GI collection was associated with the respondent’s role, SO, political leaning, past SGM training, and belief that knowing GI is important for providing care. Odds ratios (OR) from adjusted models with 95% confidence intervals (CI) comparing respondents who reported SO or GI collection as “Yes” vs. “No” are reported (comparisons to “Unsure” not presented). Most respondents (79%) felt it was important to know both SO and GI to provide quality care, while 14% felt neither was important. Conclusions: Whether or not institutions collect SOGI data is related to many factors. Despite limited statistical power, the same three factors emerged as drivers of data collection: leadership support, resources and individuals’ attitudes. These are critical and possibly self-reinforcing elements for collecting SOGI data.[Table: see text]

Refracture of the cemented vertebrae after percutaneous vertebroplasty: risk factors and imaging findings

Background To determine the related imaging findings and risk factors to refracture of the cemented vertebrae after percutaneous vertebroplasty (PVP) treatment. Methods Patients who were treated with PVP for single vertebral compression fractures (VCFs) and met this study’s inclusion criteria were retrospectively reviewed from January 2012 to January 2019. The follow-up period was at least 2 years. Forty-eight patients with refracture of the cemented vertebrae and 45 non-refractured patients were included. The following variates were reviewed: age, sex, fracture location, bone mineral density (BMD), intravertebral cleft (IVC), kyphotic angle (KA), wedge angle, endplate cortical disruption, cement volume, surgical approach, non-PMMA-endplate-contact (NPEC), cement leakage, other vertebral fractures, reduction rate (RR), and reduction angle (RA). Multiple logistic regression modeling was used to identify the independent risk factors of refracture. Results Refracture was found in 48 (51.6%) patients. Four risk factors, including IVC (P = 0.005), endplate cortical disruption (P = 0.037), larger RR (P = 0.007), and NPEC (P = 0.006) were found to be significant independent risk factors for refracture. Conclusions Patients with IVC or larger RR, NPEC, or endplate cortical disruption have a high risk of refracture in the cemented vertebrae after PVP.

Characteristics of Opioid Prescriptions to Veterans With Chronic Gastrointestinal Symptoms and Disorders Dually Enrolled in the Department of Veterans Affairs and Medicare Part D

ABSTRACT Introduction Gastrointestinal (GI) symptoms and disorders affect an increasingly large group of veterans. Opioid use may be rising in this population, but this is concerning from a patient safety perspective, given the risk of dependence and lack of evidence supporting opioid use to manage chronic pain. We examined the characteristics of opioid prescriptions and factors associated with chronic opioid use among chronic GI patients dually enrolled in the DVA and Medicare Part D. Materials and Methods In this retrospective cohort study, we used linked, national patient-level data (from April 1, 2011, to December 31, 2014) from the VA and Centers for Medicare & Medicaid Services to identify chronic GI patients and observe opioid use. Veterans who had a chronic GI symptom or disorder were dually enrolled in VA and Part D and received ≥1 opioid prescription dispensed through the VA, Part D, or both. Chronic GI symptoms and disorders included chronic abdominal pain, chronic pancreatitis, inflammatory bowel diseases, and functional GI disorders. Key outcome measures were outpatient opioid prescription dispensing overall and chronic opioid use, defined as ≥90 consecutive days of opioid receipt over 12 months. We described patient characteristics and opioid use measures using descriptive statistics. Using multiple logistic regression modeling, we generated adjusted odds ratios and 95% CIs to determine variables independently associated with chronic opioid use. The final model included variables outlined in the literature and our conceptual framework. Results We identified 141,805 veterans who had a chronic GI symptom or disorder, were dually enrolled in VA and Part D, and received ≥1 opioid prescription dispensed from the VA, Part D, or both. Twenty-six percent received opioids from the VA only, 69% received opioids from Medicare Part D only, and 5% were “dual users,” receiving opioids through both VA and Part D. Compared to veterans who received opioids from the VA or Part D only, dual users had a greater likelihood of potentially unsafe opioid use outcomes, including greater number of days on opioids, higher daily doses, and higher odds of chronic use. Conclusions Chronic GI patients in the VA may be frequent users of opioids and may have a unique set of risk factors for unsafe opioid use. Careful monitoring of opioid use among chronic GI patients may help to begin risk stratifying this group. and develop tailored approaches to minimize chronic use. The findings underscore potential nuances within the opioid epidemic and suggest that components of the VA’s Opioid Safety Initiative may need to be adapted around veterans at a higher risk of opioid-related adverse events.

Prevalence and Factors Associated With Body Pain: Results of a Nationally Representative Survey of 9,586 Chinese Adults Aged 60 and Over

Background: Pain management has become a critical problem worldwide with the aging population. More than half of older people have experienced pain with different severity. The aim of this research is to identify the characteristics of older people with body pain and the associations between pain and characteristics of demographic, health status, and health services use amongst Chinese seniors.Methods: This cross-sectional study was based on the China Health and Retirement Longitudinal Study (CHARLS), using follow-up survey data in 2015. The national survey comprised 20,284 women and men aged 45 years or older who completed questionnaires. Data of older people who were asked whether they had troubles with body pain were extracted and analyzed. Multiple logistic regression modeling was used to determine the important indicators (demographic, health status, and health services use) amongst Chinese elderly with pain.Results: Analyses revealed that 32.5% (n = 9,586) of Chinese people aged over 60 reported having body pain. Pain is positively associated with female gender (OR = 2.08, 95% CI 1.80–2.39, p &lt; 0.001), living in non-urban areas (OR = 1.49, 95% CI 1.25–1.77, p &lt; 0.001), having physical disabilities (OR = 1.45, 95% CI 1.15–1.82, p = 0.002), diagnosed with stomach diseases (OR = 1.40, 95% CI 1.20–1.64, p &lt; 0.001), diagnosed with arthritis (OR = 1.91, 95% CI 1.66–2.20, p &lt; 0.001), self-rating with poor health status (OR = 7.03, 95% CI 5.63–8.78, p &lt; 0.001), self-purchased over-the-counter western medications (OR = 1.50, 95% CI 1.30–1.73, p &lt; 0.001) and self-purchased Chinese herbal medicine (OR = 1.52, 95% CI 1.24–1.85, p &lt; 0.001).Conclusion: Body pain is common amongst the Chinese elderly. This research highlights the need for further nationwide studies exclusively focusing on people with pain including the elder population, and provides evidence-based insights for healthcare providers and policy-makers, to improve the quality of pain management. Future research should also pay attention to the importance of health literacy for health outcomes with regard to pain management.

Refracture of the Cemented Vertebrae after Percutaneous Vertebroplasty: Risk Factors and Imaging Findings

Background: To determine the related imaging findings and risk factors to refracture of the cemented vertebrae after percutaneous vertebroplasty (PVP) treatment. Methods: Patients who were treated with PVP for single vertebral compression fractures (VCFs) and met this study’s inclusion criteria were retrospectively reviewed from January 2012 to January 2019. The follow-up period was at least 2 years. Forty-eight patients with refracture of the cemented vertebrae and 45 non-refractured patients were included. The following variates were reviewed: age, sex, fracture location, bone mineral density (BMD), intravertebral cleft (IVC), kyphotic angle (KA), wedge angle, endplate cortical disruption, cement volume, surgical approach, non-PMMA-endplate-contact (NPEC), cement leakage, other vertebral fractures, reduction rate (RR), and reduction angle (RA). Multiple logistic regression modeling was used to identify the independent risk factors of refracture. Results: Refracture was found in 48 (51.6%) patients. Four risk factors, including IVC (P=0.005), endplate cortical disruption (P=0.037), larger RR (P=0.007), and NPEC (P=0.006) were found to be significant independent risk factors for refracture. Conclusions: Patients with IVC or larger RR, NPEC, or endplate cortical disruption have a high risk of refracture in the cemented vertebrae after PVP.

Factors Associated With Lameness in Tie Stall Housed Dairy Cows in South Germany

Lameness remains a major concern for animal welfare and productivity in modern dairy production. Even though a trend toward loose housing systems exists and the public expects livestock to be kept under conditions where freedom of movement and the expression of natural behavior are ensured, restrictive housing systems continue to be the predominant type of housing in some regions. Factors associated with lameness were evaluated by application of multiple logistic regression modeling on data of 1,006 dairy cows from 56 tie stall farms in Bavaria, South Germany. In this population, approximately every fourth cow was lame (24.44% of scored animals). The mean farm level prevalence of lameness was 23.28%. In total, 22 factors were analyzed regarding their association with lameness. A low Body Condition Score (BCS) (OR 1.54 [95%-CI 1.05–2.25]) as well as increasing parity (OR 1.41 [95%-CI 1.29–1.54]) entailed greater odds of lameness. Moreover, higher milk yield (OR 0.98 [95%-CI 0.96–1.00]) and organic farming (OR 0.48 [95%-0.25–0.92]) appeared to be protectively associated with lameness. Cows with hock injuries (OR 2.57 [95%-CI 1.41–4.67]) or with swellings of the ribs (OR 2.55 [95%-CI 1.53–4.23]) had higher odds of lameness. A similar association was observed for the contamination of the lower legs with distinct plaques of manure (OR 1.88 [95%-CI 1.14–3.10]). As a central aspect of tie stall housing, the length of the stalls was associated with lameness; with stalls of medium [(&gt;158–171 cm) (OR 2.15 [95%-CI 1.29–3.58]) and short (≤158 cm) length (OR 4.07 [95%-CI 2.35–7.05]) increasing the odds compared with long stalls (&gt;171 cm). These results can help both gaining knowledge on relevant factors associated with lameness as well as approaching the problem of dairy cow lameness in tie stall operations.

Upper extremity musculoskeletal symptoms among Iranian hand-woven shoe workers

BACKGROUND: Studies have demonstrated that upper extremity musculoskeletal disorders (UEMSDs) are highly prevalent among weavers. In Iran, little information is available regarding the prevalence of MSDs and their causal risk factors among hand-woven shoe workers. This cross-sectional study aimed to determine the prevalence of UEMSDs and to identify risk factors associated with UEMSDs symptoms among 586 Iranian hand-woven shoe workers. METHODS: The data were collected using the Nordic Musculoskeletal Questionnaire and by direct observation of working postures via the Rapid Upper Limb Assessment (RULA) technique to determine ergonomic risks. RESULTS: The prevalence of MSDs symptoms was high among the hand-woven shoe workers. The mean RULA grand score of 6.3 indicated that in most cases the workers’ postures at their workstations needs to be investigated and changed immediately to prevent musculoskeletal injuries. The highest prevalence rates of MSDs were observed in the shoulders, wrists and arms. The result of multiple logistic regression modeling showed that risk factors associated with UEMSD symptoms were job experience, daily working hours, job satisfaction, working posture, work pressure, and discomfort at workstation, as well as individual factors, such as age, gender, BMI, material status, working conditions, education level, and lack of regular sport/physical activities. CONCLUSIONS: The findings of the present study emphasize that any interventional program in this industry has to focus on improving working conditions particularly by designing ergonomics-oriented workstations and hand tools.