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BMC Geriatrics Jun 2024To our knowledge, only one study has examined the association between glucose variability (GV) and mortality in the elderly population with diabetes. GV was assessed by...
BACKGROUND
To our knowledge, only one study has examined the association between glucose variability (GV) and mortality in the elderly population with diabetes. GV was assessed by HbA1c, and a J-shaped curve was observed in the relationship between HbA1c thresholds and mortality. No study of GV was conducted during the COVID-19 pandemic and its lockdown. This study aims to evaluate whether GV is an independent predictor of all-cause mortality in patients aged 75 years or older with and without COVID-19 who were followed during the first year of the COVID-19 pandemic and its lockdown measures.
METHODS
This was a retrospective cohort study of 407,492 patients from the AGED-MADRID dataset aged 83.5 (SD 5.8) years; 63.2% were women, and 29.3% had diabetes. GV was measured by the coefficient of variation of fasting plasma glucose (CV-FPG) over 6 years of follow-up (2015-2020). The outcome measure was all-cause mortality in 2020. Four models of logistic regression were performed, from simple (age, sex) to fully adjusted, to assess the effect of CV-FPG on all-cause mortality.
RESULTS
During follow-up, 34,925 patients died (14,999 women and 19,926 men), with an all-cause mortality rate of 822.3 per 10,000 person-years (95% confidence interval (CI), 813.7 to 822.3) (739 per 10,000; 95% CI 728.7 to 739.0 in women and 967.1 per 10,000; 95% CI 951.7 to 967.2 in men). The highest quartile of CV-FPG was significantly more common in the deceased group (40.1% vs. 23.6%; p < 0.001). In the fully adjusted model including dementia (Alzheimer's disease) and basal FPG, the odds ratio for mortality ranged from 1.88 to 2.06 in patients with T2DM and from 2.30 to 2.61 in patients with normoglycaemia, according to different sensitivity analyses.
CONCLUSIONS
GV has clear implications for clinical practice, as its assessment as a risk prediction tool should be included in the routine follow-up of the elderly and in a comprehensive geriatric assessment. Electronic health records can incorporate tools that allow its calculation, and with this information, clinicians will have a broader view of the medium- and long-term prognosis of their patients.
Topics: Humans; COVID-19; Female; Male; Aged, 80 and over; Blood Glucose; Aged; Retrospective Studies; Glycated Hemoglobin; Diabetes Mellitus; Pandemics; Spain; Mortality; SARS-CoV-2; Cause of Death
PubMed: 38902647
DOI: 10.1186/s12877-024-05149-0 -
BMC Public Health Jun 2024The economic crisis that began in 2008 has severely affected Southern (Greece, Italy, Portugal, Spain) Western European (SWE) countries of Western Europe (WE) and may...
BACKGROUND
The economic crisis that began in 2008 has severely affected Southern (Greece, Italy, Portugal, Spain) Western European (SWE) countries of Western Europe (WE) and may have affected ongoing efforts to eliminate viral hepatitis. This study was conducted to investigate the impact of the economic crisis on the burden of HBV and HCV disease.
METHODS
Global Burden of Diseases 2019 data were used to analyse the rates of epidemiological metrics of HBV and HCV acute and chronic infections in SWE and WE. Time series modelling was performed to quantify the impact of healthcare expenditure on the time trend of HBV and HCV disease burden in 2000-2019.
RESULTS
Declining trends in incidence and prevalence rates of acute HBV (aHBV) and chronic HBV were observed in SWE and WE, with the pace of decline being slower in the post-austerity period (2010-2019) and mortality due to HBV stabilised in SWE. Acute HCV (aHCV) metrics and chronic HCV incidence and mortality showed a stable trend in SWE and WE, whereas the prevalence of chronic HCV showed an oscillating trend, decreasing in WE in 2010-2019 (p < 0.001). Liver cancer due to both hepatitis infections showed a stagnant burden over time. An inverse association was observed between health expenditure and metrics of both acute and chronic HBV and HCV.
CONCLUSIONS
Epidemiological metrics for HBV and HCV showed a slower pace of decline in the post-austerity period with better improvement for HBV, a stabilisation of mortality and a stagnant burden for liver cancer due to both hepatitis infections. The economic crisis of 2008 had a negative impact on the burden of hepatitis B and C. Elimination of HBV and HCV by 2030 will be a major challenge in the SWE countries.
Topics: Humans; Europe; Economic Recession; Hepatitis B; Cost of Illness; Incidence; Hepatitis C; Prevalence; Health Expenditures; Female; Male; Hepatitis C, Chronic; Global Burden of Disease; Hepatitis B, Chronic
PubMed: 38902642
DOI: 10.1186/s12889-024-18912-0 -
PLOS Global Public Health 2024Uterotonics are essential in preventing postpartum hemorrhage (PPH), the leading direct cause of maternal death worldwide. However, uterotonics are often substandard in...
Uterotonics are essential in preventing postpartum hemorrhage (PPH), the leading direct cause of maternal death worldwide. However, uterotonics are often substandard in low- and middle-income countries, contributing to poor maternal health outcomes. This study examines the health and economic impact of substandard uterotonics in Ghana. A decision-tree model was built to simulate vaginal and cesarean section births across health facilities, uterotonic quality and utilization, PPH risk and diagnosis, and resulting health and economic outcomes. We utilized delivery data from Ghana's maternal health survey, risks of health outcomes from a Cochrane review, and E-MOTIVE trial data for health outcomes related to oxytocin quality. We compared scenarios with and without substandard uterotonics, as well as scenarios altering uterotonic use and care-seeking behaviors. We found that substandard uterotonic use contributes to $18.8 million in economic burden annually, including $6.3 million and $4.8 million in out-of-pocket expenditures in public and private sectors, respectively. Annually, the National Health Insurance Scheme bears $1.6 million in costs due to substandard uterotonic use. Substandard uterotonics contribute to $6 million in long-term productivity losses from maternal mortality annually. Improving the quality of uterotonics could reduce 20,000 (11%) PPH cases, 5,000 (11%) severe PPH cases, and 100 (11%) deaths due to PPH annually in Ghana. Ensuring the quality of uterotonics would result in millions of dollars in cost savings and improve maternal health outcomes for the government and families in Ghana. Cost savings from improving uterotonic quality would provide financial protection and help Ghana advance toward Universal Health Coverage.
PubMed: 38900726
DOI: 10.1371/journal.pgph.0003181 -
BMC Public Health Jun 2024Neonatal mortality is a significant public health problem in Sub-Saharan Africa, particularly in Somalia, where limited data exists about this. Mogadishu, the densely...
INTRODUCTION
Neonatal mortality is a significant public health problem in Sub-Saharan Africa, particularly in Somalia, where limited data exists about this. Mogadishu, the densely populated capital, faces a high rate of neonatal mortality, but this has not been widely studied on a national level. Healthcare providers and policymakers are working to reduce newborn deaths, but a comprehensive understanding of the contributing factors is crucial for effective strategies. Therefore, this study aims to determine the magnitude of neonatal death and identify factors associated with it in Mogadishu, Somalia.
METHOD
A multicenter hospital-based cross-sectional study was conducted to collect data from participants at 5 purposively selected hospitals in Mogadishu, Somalia. A well-structured, reliable, self-developed, validated questionnaire containing socio-demographic, maternal, and neonatal characteristics was used as a research tool. Descriptive statistics were used for categorical and continuous variables presented. Chi-square and logistic regression were used to identify factors associated with neonatal mortality at a significant level of α = 0.05.
RESULTS
A total of 513 participants were recruited for the study. The prevalence of neonatal mortality was 26.5% [95%CI = 22.6-30.2]. In a multivariable model, 9 variables were found: female newborns (AOR = 1.98, 95%CI = 1.22-3.19), those their mothers who did not attend ANC visits (AOR = 2.59, 95%CI = 1.05-6.45), those their mothers who did not take tetanus toxoid vaccination (AOR = 1.82, 95%CI = 1.01-3.28), those their mothers who delivered in instrumental assistant mode (AOR = 3.01, 95%CI = 1.38-6.56), those who had neonatal sepsis (AOR = 2.24, (95%CI = 1.26-3.98), neonatal tetanus (AOR = 16.03, 95%CI = 3.69-69.49), and pneumonia (AOR = 4.06, 95%CI = 1.60-10.31) diseases during hospitalization, premature (AOR = 1.99, 95%CI = 1.00-3.94) and postmature (AOR = 4.82, 95%CI = 1.64-14.16) neonates, those with a birth weight of less than 2500 gr (AOR = 4.82, 95%CI = 2.34-9.95), those who needed resuscitation after delivery (AOR = 2.78, 95%CI = 1.51-5.13), and those who did not initiate early breastfeeding (AOR = 2.28, 95%CI = 1.12-4.66), were significantly associated with neonatal mortality compared to their counterparts.
CONCLUSION
In this study, neonatal mortality was high prevalence. Therefore, the intervention efforts should focus on strategies to reduce maternal and neonatal factors related to neonatal mortality. Healthcare workers and health institutions should provide appropriate antenatal, postnatal, and newborn care.
Topics: Humans; Cross-Sectional Studies; Infant, Newborn; Female; Somalia; Male; Adult; Infant Mortality; Risk Factors; Young Adult; Infant; Pregnancy
PubMed: 38898456
DOI: 10.1186/s12889-024-19149-7 -
BMC Public Health Jun 2024The world health organization's global health observatory defines maternal mortality as annual number of female deaths, regardless of the period or location of the...
BACKGROUND
The world health organization's global health observatory defines maternal mortality as annual number of female deaths, regardless of the period or location of the pregnancy, from any cause related to or caused by pregnancy or its management (aside from accidental or incidental causes) during pregnancy and childbirth or within 42 days of termination of pregnancy and an estimated 287 000 women worldwide passed away from maternal causes between 2016 and 2020, that works out to be about 800 deaths per day or about one every two minutes.
METHOD
The most recent 2018-2023 DHS data set of 14 SSA countries was used a total of 89,489 weighted mothers who gave at list one live birth 3 years preceding the survey were included, a multilevel analysis was conducted. In the bi-variable analysis variables with p-value ≤ 0.20 were included in the multivariable analysis, and in the multivariable analysis, variables with p-value less than ≤ 0.05 were considered to be significant factors associated with having eight and more ANC visits.
RESULT
The magnitude of having eight and more ANC visits in 14 sub-Saharan African countries was 8.9% (95% CI: 8.76-9.13) ranging from 3.66% (95% CI: 3.54-3.79) in Gabon to 18.92% (95% CI: 18.67-19.17) in Nigeria. The multilevel analysis shows that maternal age (40-44, AOR;2.09, 95%CI: 1.75-2.53), maternal occupational status (AOR;1.14, 95%CI; 1.07-1.22), maternal educational level (secondary and above, AOR;1.26, 95%CI; 1.16-1.38), wealth status(AOR;1.65, 95%CI; 1.50-1.82), media exposure (AOR;1.20, 95%CI; 1.11-1.31), pregnancy intention (AOR;1.12, 95%CI; 1.05-1.20), ever had terminated pregnancy (AOR;1.16 95%CI; 1.07-1.25), timely initiation of first ANC visit (AOR;4.79, 95%CI; 4.49-5.10), empowerment on respondents health care (AOR;1.43, 95%CI; 1.30-1.56), urban place of residence (AOR;1.33, 95%CI; 1.22-1.44) were factors highly influencing the utilization of AN. On the other hand higher birth order (AOR;0.54, 95%CI; 0.53-0.66), not using contraceptive (AOR;0.80, 95%CI; 0.75-0.86) and survey year (AOR;0.47, 95%CI; 0.34-0.65) were factors negatively associated with having eight and more ANC visits.
CONCLUSION
In the 14 SSA included in this study, there is low adherence to WHO guidelines of eight and more ANC visits. Being educated, having jobs, getting access to media being from rural residence and rich wealth group contribute to having eight and more ANC visits, so we highly recommend policy implementers to advocate this practices.
Topics: Humans; Female; Adult; Africa South of the Sahara; Multilevel Analysis; Young Adult; Pregnancy; Prenatal Care; Adolescent; Middle Aged; Mothers
PubMed: 38898450
DOI: 10.1186/s12889-024-19145-x -
Genetics, Selection, Evolution : GSE Jun 2024There are 13 known chicken blood systems, which were originally detected by agglutination of red blood cells by specific alloantisera. The genomic region or specific...
BACKGROUND
There are 13 known chicken blood systems, which were originally detected by agglutination of red blood cells by specific alloantisera. The genomic region or specific gene responsible has been identified for four of these systems (A, B, D and E). We determined the identity of the gene responsible for the chicken blood system I, using DNA from multiple birds with known chicken I blood system serology, 600K and 54K single nucleotide polymorphism (SNP) data, and lowpass sequence information.
RESULTS
The gene responsible for the chicken I blood system was identified as RHCE, which is also one of the genes responsible for the highly polymorphic human Rh blood group locus, for which maternal/fetal antigenic differences can result in fetal hemolytic anemia with fetal mortality. We identified 17 unique RHCE haplotypes in the chicken, with six haplotypes corresponding to known I system serological alleles. We also detected deletions in the RHCE gene that encompass more than 6000 bp and that are predicted to remove its last seven exons.
CONCLUSIONS
RHCE is the gene responsible for the chicken I blood system. This is the fifth chicken blood system for which the responsible gene and gene variants are known. With rapid DNA-based testing now available, the impact of I blood system variation on response against disease, general immune function, and animal production can be investigated in greater detail.
Topics: Animals; Chickens; Polymorphism, Single Nucleotide; Haplotypes; Rh-Hr Blood-Group System; Alleles
PubMed: 38898419
DOI: 10.1186/s12711-024-00911-9 -
BMJ Paediatrics Open Jun 2024To determine the dose-dependent associations between antenatal corticosteroids (ANS) exposure and the rates of major morbidities, and the early weight loss percentage...
Association of different doses of antenatal corticosteroids exposure with early major outcomes and early weight loss percentage in extremely preterm infants or extremely low birthweight infants: a multicentre cohort study.
OBJECTIVES
To determine the dose-dependent associations between antenatal corticosteroids (ANS) exposure and the rates of major morbidities, and the early weight loss percentage (EWLP) in hospital among extremely preterm infants (EPI) or extremely low birthweight infants (ELBWI).
METHODS
A multicentre, retrospective cohort study of EPI or ELBWI born between 2017 and 2018 was conducted. Infants were classified into no ANS, partial ANS and complete ANS exposure group; three subgroups were generated by gestational age and birth weight. Multiple logistic regression and multiple linear regression were performed.
RESULTS
There were 725 infants included from 32 centres. Among no ANS, partial ANS and complete ANS exposure, there were significant differences in the proportions of bronchopulmonary dysplasia (BPD) (24.5%, 25.4% and 16.1%), necrotising enterocolitis (NEC) (6.7%, 2.0% and 2.0%) and death (29.6%, 18.5% and 13.5%), and insignificant differences in the proportions of intraventricular haemorrhage (IVH) (12.5%, 13.2% and 12.2%), and extrauterine growth restriction (EUGR) (50.0%, 56.6% and 59.5%). In the logistic regression, compared with no ANS exposure, complete ANS reduced the risk of BPD (OR 0.58, 95% CI 0.37 to 0.91), NEC (OR 0.21, 95% CI 0.08 to 0.57) and death (OR 0.36, 95% CI 0.23 to 0.56), and partial ANS reduced the risk of NEC (OR 0.23, 95% CI 0.07 to 0.72) and death (OR 0.54, 95% CI 0.34 to 0.87). Compared with partial ANS exposure, complete ANS decreased the risk of BPD (OR 0.58, 95% CI 0.37 to 0.91). There were insignificant associations between ANS exposure and IVH, EUGR. In the multiple linear regression, partial and complete ANS exposure increased EWLP only in the ≥28 weeks (w) and <1000 g subgroup (p<0.05).
CONCLUSIONS
Different doses of ANS (dexamethasone) exposure were protectively associated with BPD, NEC, death in hospital, but not EUGR at discharge among EPI or ELBWI. Beneficial dose-dependent associations between ANS (dexamethasone) exposure and BPD existed. ANS exposure increased EWLP only in the ≥28 w and<1000 g subgroup. ANS administration, especially complete ANS, is encouraged before preterm birth.
TRIAL REGISTRATION NUMBER
NCT06082414.
Topics: Humans; Infant, Newborn; Female; Infant, Extremely Low Birth Weight; Retrospective Studies; Infant, Extremely Premature; Male; Pregnancy; Weight Loss; Enterocolitis, Necrotizing; Bronchopulmonary Dysplasia; Dose-Response Relationship, Drug; Adrenal Cortex Hormones; Gestational Age; Infant, Premature, Diseases
PubMed: 38897621
DOI: 10.1136/bmjpo-2024-002506 -
Social Science & Medicine (1982) Jun 2024Irregular legal status is a recognized health risk factor in the context of migration. However, undocumented migrants are rarely included in health surveys and register...
BACKGROUND
Irregular legal status is a recognized health risk factor in the context of migration. However, undocumented migrants are rarely included in health surveys and register studies. Adverse perinatal outcomes are especially important because they have long-term consequences and societal risk factors are modifiable. In this study, we compare perinatal outcomes in undocumented migrants to foreign-born and Norwegian-born residents, using a population-based register.
METHODS
We included women 18-49 years old giving birth to singletons as registered in the Medical Birth Registry of Norway from 1999 to 2020. Women were categorized as 'undocumented migrants' (without an identity number), 'documented migrants' (with an identity number and born abroad), and 'non-migrants' (with an identity number and born in Norway). The main outcome was perinatal mortality, i.e., death of a foetus ≥ gestational week 22, or neonate up to seven days after birth. We used log-binominal regression to estimate the association between legal status and perinatal mortality, adjusting for several maternal pre-gestational and gestational factors. Direct standardization was used to adjust for maternal region of origin.
ETHICAL APPROVAL
Regional Ethical Committee (REK South East, case number 68329).
RESULTS
We retrieved information on 5856 undocumented migrant women who gave birth during the study period representing 0.5% of the 1 247 537 births in Norway. Undocumented migrants had a relative risk of 6.17 (95% confidence interval 5.29 ̶7.20) of perinatal mortality compared to non-migrants and a relative risk of 4.17 (95% confidence interval 3.51 ̶4.93) compared to documented migrants. Adjusting for maternal region of origin attenuated the results slightly.
CONCLUSION
Being undocumented is strongly associated with perinatal mortality in the offspring. Disparities were not explained by maternal origin or maternal health factors, indicating that social determinants of health through delays in receiving adequate care and factors negatively influencing gestational length may be of importance.
PubMed: 38897075
DOI: 10.1016/j.socscimed.2024.117055 -
Sao Paulo Medical Journal = Revista... 2024Concerns regarding high open surgery-related maternal morbidity have led to improvements in minimally invasive fetal surgeries.
BACKGROUND
Concerns regarding high open surgery-related maternal morbidity have led to improvements in minimally invasive fetal surgeries.
OBJECTIVE
To analyze the perinatal and maternal outcomes of minimally invasive fetal surgery performed in Rio de Janeiro, Brazil.
DESIGN AND SETTING
Retrospective cohort study conducted in two tertiary reference centers.
METHODS
This retrospective descriptive study was conducted using medical records from 2011 to 2019. The outcomes included maternal and pregnancy complications, neonatal morbidity, and mortality from the intrauterine period to hospital discharge.
RESULTS
Fifty mothers and 70 fetuses were included in this study. The pathologies included twin-twin transfusion syndrome, congenital diaphragmatic hernia, myelomeningocele, lower urinary tract obstruction, pleural effusion, congenital upper airway obstruction syndrome, and amniotic band syndrome. Regarding maternal complications, 8% had anesthetic complications, 12% had infectious complications, and 6% required blood transfusions. The mean gestational age at surgery was 25 weeks, the mean gestational age at delivery was 33 weeks, 83% of fetuses undergoing surgery were born alive, and 69% were discharged from the neonatal intensive care unit.
CONCLUSION
Despite the small sample size, we demonstrated that minimally invasive fetal surgeries are safe for pregnant women. Perinatal mortality and prematurity rates in this study were comparable to those previously. Prematurity remains the most significant problem associated with fetal surgery.
Topics: Humans; Female; Pregnancy; Retrospective Studies; Brazil; Adult; Infant, Newborn; Minimally Invasive Surgical Procedures; Pregnancy Outcome; Fetal Diseases; Pregnancy Complications; Gestational Age; Young Adult; Perinatal Mortality
PubMed: 38896578
DOI: 10.1590/1516-3180.2023.0159.R1.16022024 -
Lakartidningen Jun 2024Despite improved survival of extremely preterm infants born at <28 weeks gestational age (GA) since the 1990s, only few reports on long-term outcomes have been...
Despite improved survival of extremely preterm infants born at <28 weeks gestational age (GA) since the 1990s, only few reports on long-term outcomes have been published. The aim of our study was to determine risk factors among mothers and outcomes for their children born at the limit of viability (GA 22 + 0 - 23 + 6 weeks) at the Karolinska university hospital in 2009-19, before and after the introduction of new national interventionist guidelines in 2016. We hypothesized that infant survival, morbidity and cognitive functions at 2 years' corrected age had improved after the new clinical practice. Maternal risk factors were identified, which emphasize the need of standardized follow-up and counseling for women at increased risk of extreme preterm birth. The intrauterine fetal death rates were unchanged. Among births at 22 weeks, the neonatal mortality tended to decrease 96 vs. 76 percent of live births (p = 0,05), and the 2-year survival tended to increase 4 vs 24 percent (p = 0,05). At 23 weeks, the neonatal mortality decreased 56 vs 27 percent of live births (p = 0,01), and the 2-year survival increased 42 vs 64 percent (p = 0,03). In contrast, the morbidity and cognitive disability at 2 years' corrected age were unchanged. Our results were in accordance with previous reports where no substantial improvement in cognitive functions are reported among infants born at GA <24 weeks since the 1990s. They highlight the importance of comprehensive ethical considerations before active interventions at threatening preterm birth < 24 weeks.
Topics: Humans; Female; Infant, Newborn; Infant, Extremely Premature; Risk Factors; Infant Mortality; Pregnancy; Gestational Age; Infant; Sweden; Child, Preschool; Male; Adult; Fetal Viability
PubMed: 38895759
DOI: No ID Found