Maternal morbidity and mortality

Top PDF Maternal morbidity and mortality:

Maternal near-miss and mortality in Sayaboury Province, Lao PDR.

Maternal near-miss and mortality in Sayaboury Province, Lao PDR.

However, despite the high maternal morbidity ratios in many resource-poor settings, maternal deaths are still rare in absolute numbers [6]. The study of women who survive life-threatening complications related to preg- nancy, called maternal near-miss cases, may represent a practical alternative to surveillance of maternal morbidity and mortality [11]. There have been no official reports of maternal near-miss in the Lao PDR. The Ministry of Health (MOH) of Lao PDR, in cooperation with inter- national agencies, has recently made serious efforts to im- prove maternal and child health. They have attempted to reduce maternal mortality through implementing new or additional maternal and child health (MCH) service- related activities, such as trained traditional birth atten- dances (TBA) at the village, trained skill birth attendances (SBA) in the health centers, supported family planning and EPI etc. Despite the efforts, maternal health status was still relatively poor in some areas of the country, and major capacity strengthening is still required in the areas of poor MCH services for instance in mountainous remote areas. Official statistics on MCH indicators have been im- proving over the past decades, but they remain below international standards. The lack of reliable and up-to- date statistics on maternal deaths and morbidities remains a major challenge for achieving accelerated progress to- wards the Millennium Development Goal related to ma- ternal health (MDG-5) [1,4,12].
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Mortality and severe morbidity of very preterm infants: comparison of two French cohort studies

Mortality and severe morbidity of very preterm infants: comparison of two French cohort studies

By identifying pre-existing medical conditions, risk fac- tors, and negative health behaviours through a range of medical and educational interventions, prenatal care can improve health outcomes for mothers and their infants. Interestingly, prenatal access to risk-appropriate neo- natal care in La Réunion seemed adequate as suggested by higher proportions of inborn infants and antenatal steroid therapy. Importantly, these latter factors, recog- nized as life-saving interventions, are also protective against severe neonatal morbidities such as intraventric- ular haemorrhage in preterm infants [ 18 – 20 ]. Regional- isation of obstetrical care, especially prenatal transfer, may be facilitated by the small geographical size of the island and higher proportion of maternal disease in La Réunion. Though Reunionese women were younger, they were more prone to hypertensive disorders and dia- betes mellitus. These findings are in agreement with the results of other studies in reproductive health, which show a poorer health status of ultramarine DOM popu- lations [ 21 , 22 ]. Indeed, maternal disease is often associ- ated with excess mortality or with severe morbidities among preterm infants. Finally, the use of caesarean sec- tion as mode of delivery was higher in the EPIPAGE-2 cohort, despite lesser maternal morbidity. Caesarean sec- tion has been shown to improve the survival for ex- tremely preterm infants as well as for VPT infants aged
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Prenatal diagnosis of abnormally invasive placenta reduces maternal peripartum hemorrhage and morbidity.

Prenatal diagnosis of abnormally invasive placenta reduces maternal peripartum hemorrhage and morbidity.

Objective. Abnormally invasive placenta (AIP) poses diagnostic and therapeutic challenges. We analyzed clinical cases with confirmed placenta increta or per- creta. Design. Retrospective case series. Setting. Multicenter study. Popula- tion. Pregnant women with AIP. Methods. Chart review. Main outcome measures. Prenatal detection rates, treatment choices, morbidity, mortality and short-term outcome. Results. Sixty-six cases were analyzed. All women and all but three fetuses survived; 57/64 women (89%) had previous uterine surgery. In 26 women (39%) the diagnosis was not known before delivery (Group 1), in the remaining 40 (61%) diagnosis had been made between 14 and 37 weeks of gestation (Group 2). Placenta previa was present in 36 women (54%). In Groups 1 and 2, 50% (13/26) and 62% (25/40) of the women required hyster- ectomy, respectively. In Group 1 (unknown at the time of delivery) 69% (9/13) required (emergency) hysterectomy for severe hemorrhage in the immediate peripartum period compared with only 12% (3/25) in Group 2 (p = 0.0004). Mass transfusions were more frequently required in Group 1 (46%, 12/26 vs. 20%, 8/40; p = 0.025). In 18/40 women (45%) from Group 2 the placenta was intentionally left in situ; secondary hysterectomies and infections were equally frequent (18%) among these differently treated women. Overall, postpartum infections occurred in 11% and 20% of women in Groups 1 and 2, respec- tively. Conclusions. AIP was known before delivery in more than half of the cases. Unknown AIP led to significantly more emergency hysterectomies and mass transfusions during or immediately after delivery. Prenatal diagnosis of AIP reduces morbidity. Future studies should also address the selection criteria for cases appropriate for leaving the placenta in situ.
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Maternal psychosocial
maladjustment and child internalizing symptoms: Investigating the modulating role of
maternal sensitivity

Maternal psychosocial maladjustment and child internalizing symptoms: Investigating the modulating role of maternal sensitivity

withdrawal, and somatic complaints (without medical explanation). Research has demonstrated that internalizing symptoms can be detected in early childhood. Indeed, high levels of internalizing problems, as operationalized, for instance, by symptoms of depression and anxiety, show prevalence rates up to 28% in toddlers (e.g., Wilens et al., 2002). Furthermore, longitudinal data has been used to investigate developmental trajectories of internalizing symptomatology. For instance, Côté et al. (2009) identified three different trajectory groups among children aged 1.5 to 5 years. Those groups included children with stable low symptom levels (29.9% of their sample), children with moderate but increasing levels (55.4% of their sample), and children with high and increasing levels (14.7% of their sample). Internalizing symptoms have also been identified as predictors of increased risk for psychopathology later in life (e.g., Bittner et al., 2007; Moffitt et al., 2007; Weissman et al., 2005), and are associated with disturbances in several domains including interpersonal relationships, academic performance, and substance abuse (Birmaher et al., 1996; Hammen & Rudolph, 2003). Overall, research suggests that internalizing symptoms are common among very young children, are not often transient, and constitute risk factors for
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Vitamin D, cardiovascular disease and mortality

Vitamin D, cardiovascular disease and mortality

to coronary angiography, as well as in diabetic dialysis patients. 81,82 Regarding specific cardiovascular events, a significant association of low 25(OH)D and fatal strokes was reported. 64 This finding may also have clinical relevance because post-stroke patients with such increased risk of vitamin D deficiency may be more prone to develop musculoskeletal complications. 64 Associations of vitamin D deficiency with incident CVD seem particularly strong in patients with CVD or at high risk of CVD and some indication exists for a nonlinear relationship with pronounced CVD risk increase at 25(OH)D concentrations below ~37.5 nmol/L. 65-82 Meta- analyses performed so far on this topic support the notion that low 25(OH)D concentrations are associated with incident CVD. 63,66 In this context, Grandi et al. found that the risk of
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Socioeconomic Position and Mortality—Reply

Socioeconomic Position and Mortality—Reply

importance of air pollution as an explanatory factor for social inequalities in health.. Similarly, Dr Gross raises the possibility of psychological distress as a factor.[r]

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Prescription opioid analgesic use in France: Trends and impact on morbidity-mortality

Prescription opioid analgesic use in France: Trends and impact on morbidity-mortality

Nevertheless, the USA opioid epidemic is far from hitting France and Europe more broadly, which con- trast strongly with America in terms of legislation, practice, and drug consumption patterns (Weisberg et al., 2014; van Amsterdam and van den Brink, 2015; Heilig and T€agil, 2018) In France, PO analgesics can be obtained only through prescription (except for <20 mg doses of codeine). Strong opioids are on the list of narcotics with prescription limited to 28 days following a strict framework based on a secure pre- scription form. Also, a new clinical evaluation needs to be performed before any strong opioid refill. These regulation measures are also accompanied by guideli- nes and recommendations (Vergne-Salle et al., 2012; Moisset et al., 2016) from pain specialists defining the best practice of opioid prescribing in CNCP. The European Pain Federation (EFIC) also recently pro- vided guidelines for appropriate opioid prescribing in chronic pain management (O’Brien et al., 2017). However, France can still benefit from the USA’s resulting experience, such as the recent updated measures proposed by the Food and Drug Adminis- tration (Califf et al., 2016) and the Centers for Dis- ease Control (Dowell et al., 2016) as a proactive response to growing opioid abuse and overdose, where implementing prescription drug monitoring programmes and enforcement of regulatory actions seem to be helping reduce abuse (Dart et al., 2015; Levy et al., 2015; Compton et al., 2016).
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Association of Maternal Weight and Gestational Weight Gain with Maternal and Neonate Outcomes: A Prospective Cohort Study.

Association of Maternal Weight and Gestational Weight Gain with Maternal and Neonate Outcomes: A Prospective Cohort Study.

A strength of our prospective study was the homogeneity of our general population. With predominantly Caucasian (>98%) women and a public health system where all pregnant women have access to similar pregnancy follow up and monitoring, the possibility of sampling bias is reduced. With regards to socioeconomic aspects, the free access to perinatal care for the Quebec population may limit biases and contributes to generalizability of the results. However, the socioeconomic status had an effect on the perinatal outcomes even within a similar setting of universal access to health care [ 31 ]. This is why we integrated the mother’s level of education and familial annual income in the adjustments of relative risks. Moreover, the homogenous origin of our cohort does not allow measuring the impact of ethnicity such as African origin. Women of African origin are more susceptible to being affected by obesity and excessive weight gain during pregnancy [ 32 ]. Gestational weight gain recommendations specific for the Asian population are also necessary [ 33 ]. Thus, external validity of our results should be tested in populations of different ethnic backgrounds. The lack of information on ppBMI or weight during pregnancy for 956 (12%) women of the cohort could be considered as a potential limitation. The exclusion of 956 (12.2%) women from the cohort due to the absence of information on ppBMI or weight during pregnancy may represent a selection bias. As explained above, the fact that some of the results confirm those of previous studies limits this bias [ 34 ].
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Morbidity before and after HAART initiation in Sub-Saharan African HIV-infected adults: a recurrent event analysis.: HIV morbidity recurrence in Abidjan

Morbidity before and after HAART initiation in Sub-Saharan African HIV-infected adults: a recurrent event analysis.: HIV morbidity recurrence in Abidjan

Regarding HIV-morbidity recurrence, recurrence rates of tuberculosis and of pneumococcal invasive diseases have previously been reported to be higher than rates of first episodes in HIV-infected untreated Kenyan adults, (24, 25). In our study, we considered up to three episodes of each disease, and we found that the rates of second and third episodes were systematically higher than the rate of first episode for all groups of diseases, even after stratifying by CD4 count and by HAART on/off status. This has three important implications both in terms of patients care and in terms of knowledge on HIV morbidity in Africa. First, for the physicians: when investigating the cause of a given syndrome, physicians should take into account the HAART on/off status, the current CD4 count, but also the past history of morbidity, including the past history of morbidity “off” HAART if the patient is “on” HAART (26-29). Second, for the epidemiologists: in patients on HAART, the first episode of a disease may be the “truly first” episode (no past history of this disease before HAART initiation) or a recurrent episode (this disease already occurred once before HAART initiation). Our findings mean that the incidence of a given disease in a population on HAART may vary depending on the frequency of the past history of this disease in this population. This should be carefully taken into account when comparing rates of morbidity on HAART between different populations and different settings, or within the same population between the pre-HAART and on-HAART periods. Third, for the researchers: the possibility that some patients with past history of a given disease before HAART initiation could benefit
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Depression and PTSD Co-Morbidity: What are We Missing?

Depression and PTSD Co-Morbidity: What are We Missing?

Suicidal ideation was assessed using one item from the SCL-90 ('thoughts about ending your life'). Self-destructive behavior was assessed using the Revised Structured Interview for Disorders of Extreme Stress-NOS (SIDES-R; for full details regarding psychometric properties of this instrument see [24]). The questionnaire is based on a translation and adaptation of the structured interview into a self-report questionnaire [25]. Participants were asked to note if they had undergone the mentioned experience in the previous month (yes vs. no). The three items were: a) did you have any accidents or near accidents, such as kitchen accidents or car accidents?; b) did you do anything dangerous? Or, did you not protect yourself when you could have been hurt?; c) did you try to hurt yourself on purpose because you were upset?. We created a binary variable in which ‘yes’ represented engagement in at least one of the described behaviors and ‘no’ represented not doing so.
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Mortality, family and lifestyles

Mortality, family and lifestyles

The goal of this paper is to re-examine the intergenerational transmission of healthy lifestyles, by generalizing the previous paper by Ponthiere (2010), in such a way as to better identify the role played by the family in the dynamics of health and longevity outcomes. For that purpose, we develop a three-period OLG model where agents face a probability of survival to the old age, which depends on the lifestyle adopted during childhood. For simplicity, the lifestyle coincides here either with a healthy lifestyle, yielding a higher survival probabil- ity to the old age, or an unhealthy lifestyle, leading to a lower life expectancy. In comparison with Ponthiere (2010), which relies on continuous longevity func- tions, this discrete longevity model is simpler, and allows us to focus more on the role of the family in the socialization process. To do this, two extensions of the model are proposed. First, whereas parents want, in Ponthiere (2010), their children to have the same way of life as themselves, the present model will, in addition, introduce parental altruism, to account for the fact that par- ents may care also about the health prospects of their children, and may adjust their socialization e¤orts accordingly. Second, we expand also Ponthiere (2010) by introducing asymmetric socialization costs, to account for the fact that it may be more painful, for parents, to transmit a healthy lifestyle rather than an unhealthy one. As we shall see, parental altruism and asymmetric social- ization costs a¤ect the long-run dynamics of heterogeneity signi…cantly, and, in particular, the issue of the long-run persistence of unhealthy lifestyles.
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en
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en fr Intrauterine growth restriction and very preterm birth : impact on mortality and short and medium-term morbidity Le retard de croissance intra-utérin et la grande prématurité : impact sur la mortalité et les morbidités à court et à moyen terme

Tableau 2.1 Les étiologies du retard de croissance intra-utérin ...37 Tableau 2.2 Terminologies et définitions selon les sociétés savantes anglaise, américaine et française ...39 T[r]

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View of Participation of registered nurses in meetings — Morbidity and mortality reviews: experience of the intensive care team of the Montreuil-sous-Bois hospital centre

View of Participation of registered nurses in meetings — Morbidity and mortality reviews: experience of the intensive care team of the Montreuil-sous-Bois hospital centre

SESSION SUR L ’ORGANISATION DES SOINS (SOS) INFIRMIER Implication des IDE dans les réunions — Revues de morbimortalité : expérience de l ’équipe de la réanimation du CH de Montreuil-sous-Bois Participation of registered nurses in meetings — Morbidity and mortality reviews: experience of the intensive care team of the Montreuil-sous-Bois hospital centre

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Morbidity, comorbidity et multimorbidity : polysémie et pléthore terminologique

Morbidity, comorbidity et multimorbidity : polysémie et pléthore terminologique

multimorbidity apparaît pour la première fois dans la traduction du résumé d’un article écrit en allemand dans le milieu des années 70 (Multimorbidität 48 en allemand). Au fil des ans, il est repris par les Européens, majoritairement les Néerlandais, dans le domaine de l’épidémiologie des maladies chroniques. Il n’est utilisé par les auteurs anglophones qu’à partir de 1998. Van den Akker définit le terme comme suit : « the co-occurrence of multiple chronic or acute diseases and medical conditions

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Maternal nutrition and the risk of preeclampsia

Maternal nutrition and the risk of preeclampsia

remerciement particulier à Yuquan Wu, Fabienne Simonet, Spogmai Wassimi, et An Na pour leur amitié et leur aide durant les cinq années passées. De tout mon cœur, merci à ma famille pour leur amour et leur soutien, quoi qu’il m’arrive dans la vie; cette dissertation aurait simplement été impossible sans eux. À mes parents, Xingxin Xu and Guidi Xu, je dois une gratitude immesurable pour leur dévotion. Typiques d’une famille chinoise, mes parents travaillèrent fort pour subvenir aux besoins de la famille et furent tout dans la mesure du possible pour que je puisse atteindre ce niveau d’études. Ils ne se sont jamais plaints, malgré des temps difficiles. Je ne pourrais en demander plus, et il n’y a pas de mots pour décrire l’amour infaillible qu’ils me portent. Je suis fière également des talents de ma sœur Haixia, modèle que je suivis inconsciemment dans mon adolescence et qui m’a toujours portée d’excellent conseil.
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Unemployment and Mortality in France, 1982-2002

Unemployment and Mortality in France, 1982-2002

Ruhm and suggests a potential role for institutions in the relationship between economic cycles and health. We extend this literature by investigating the relationship between local area unemployment rates and mortality in France. We see four reasons why an analysis of the relationship between economic cycles and mortality in France offers insights: first, the collection of country case studies already at hand (the US, Germany, Spain, and Sweden) demonstrates that the strength and significance of the relationship vary across country. Adding any country would therefore be of interest. However, our analysis is of special interest due to the nature of the country we study: France has a much stronger set of regulations of the labor market (regarding employment protection and working conditions) than three of the other countries (US, Germany, and Spain), and is only comparable to Sweden in that respect (Nickell 1997; Chor and Freeman 2005). However, it is bigger than Sweden (60 million inhabitants versus 9) and the French economy is more diversified than the Swedish one. France also undertook a major reform of its labor market regulation in 1987 (more market oriented), and we can split our study period into two sub-periods, testing if the pro-cyclical nature of mortality increased after the reform. A third reason why France is an interesting case is that unemployment was considerably higher in France than in the US, Germany or Sweden (though lower than in Spain) during the whole study period (1982-2002). Long term (more than a year) unemployment represented almost half of total unemployment in France versus a third in Germany and less than 10% in the US and Sweden (Nickell, 1997). Therefore, it is also possible that the case of France could be one of pathological unemployment, where downturns could bring more anomy, offsetting the positive effect of shorter hours on health. 3
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Efficacy and morbidity of a novel induction treatment for locally advanced NSCLC

Efficacy and morbidity of a novel induction treatment for locally advanced NSCLC

Background: The disappointing results of surgical therapy in patients wtth locally advanced non small cell lung cancer (NSCLC) have led to the investigation of in[r]

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Longitudinal study of maternal body mass index, gestational weight gain, and offspring asthma.:  Maternal BMI, gestational weight gain, and asthma

Longitudinal study of maternal body mass index, gestational weight gain, and offspring asthma.: Maternal BMI, gestational weight gain, and asthma

16 report of physician-diagnosed diseases in generic questionnaires. However, 88% of child’s reported asthma diagnoses were confirmed by their nurse mothers. Although children’s and mothers’ reports of allergy were less consistent, our results were systematically confirmed when using more stringent definitions for asthma as well as for allergy. Second, the possibility of unmeasured or residual confounding cannot be ruled out, especially when studying risk factors strongly related to lifestyle and socioeconomic characteristics. Although no data was available regarding maternal smoking during pregnancy, we adjusted for maternal smoking during child’s early life. In addition, mothers reflected a relatively homogenous population (registered nurses) in terms of education and socioeconomic status, and we controlled for other sources of socioeconomic disparities (husband’s education, household income). Finally, although GUTS design is prospective, maternal risk factors as well as outcomes were assessed retrospectively. In particular, pre-pregnancy weight and GWG were collected 12-17 years after pregnancy. Recall of GWG was not specifically assessed in NHSII nurses but a moderate agreement between recalled and documented GWG was suggested in another study (43). However, validity may be higher among NHSII nurses; indeed, a high validity of recalled weight, pre-pregnancy weight, and other pregnancy-related events up to 30 years later, has been demonstrated in NHSII participants (44,45). A possible misclassification bias may still have driven some associations towards the null and limited power to detect modest associations. However, it is unlikely that our results are affected by a differential misclassification bias (which would lead to spurious associations) since our main analyses use an asthma definition based on the child’s report only, while exposures were based on mother’s reports in separate questionnaires.
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View of Maternal Mortality in West Sumatra Province: An Analysis of the Impact of Quality of Midwifery Care in the Hospital

View of Maternal Mortality in West Sumatra Province: An Analysis of the Impact of Quality of Midwifery Care in the Hospital

considering the level of hospital, there was the unmatched midwives’ placement that caused maternal mortality of 3.86 times compared with the matched midwives’ placement. WHO and several other health organizations have identified midwives as key to reducing maternal and infant mortality and disability globally.[14] They play an important role in the lives of mothers and their babies,[13] boosting self- confidence in women and strengthening their commitment to parenthood. Results from the research and the interviews undertaken in this study found that the level of competence of Indonesian midwives has not yet reached international standards due to inadequate training and the number of midwifery institutions without proper practice fields for their students. Therefore, midwifery institutions must continue to develop curriculum and learning strategies in order to reach the expected competencies. Improved education and training of lecturers are needed to address these challenges. A high quality of care depends on competent midwifery services and thus proper planning should be taken to meet these needs.Midwives, as professionals, are obliged to provide services to the public and must have core competencies to be able to carry out their function in providing quality midwifery services.[19] The assessment of quality services can be done by using ServQual dimensions, namely Responsiveness, Assurance, Tangible, Empathy, and
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Untangling glycaemia and mortality in critical care

Untangling glycaemia and mortality in critical care

they clearly define the median and any percentile likeli- hood (y-axis) for any given SI or %ΔSI values (x-axis). Hypothesis testing was used to examine differences, with p ≤ 0.05 used as a threshold for statistical signifi- cance. The Kolmogorov-Smirnov test was used to identify bias and shape difference in distributions of %ΔSI. Although it is not certain if each family of com- parisons is strictly independent (i.e., each 6-h block may depend on surrounding blocks), for completeness and to be conservative, a Bonferroni correction for multiple comparisons was used to generalise the results. In both Cohorts 1 and 2, there were 12 comparisons made, bringing the significance level to p = 0.004 (0.05/12) [55]. Owing to a relatively large number of data points, bootstrapping was used to examine the difference between median SI and median %ΔSI between survivor and non-survivor cohorts [55]. Data were bootstrapped 1000 times with replacement to generate cohorts of the same size as the original data for a given 6-h block. A 95% CI for the difference between median SI values and between median % ΔSI values was generated. Where this CI does not cross zero, differences in medians are statisti- cally significant with p ≤ 0.05 [55]. A 99.6% CI, consistent Table 1 Baseline data of Cohort 1, comprising 145 patients treated according to Specialised Relative Insulin Nutrition Tables protocol
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