1
|
Korb D, Azria E, Sauvegrain P, Carbillon L, Langer B, Seco A, Chiesa-Dubruille C, Bouvier-Colle MH, Deneux-Tharaux C. Population-based study of eclampsia: Lessons learnt to improve maternity care. PLoS One 2024; 19:e0301976. [PMID: 38696427 PMCID: PMC11065303 DOI: 10.1371/journal.pone.0301976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 03/26/2024] [Indexed: 05/04/2024] Open
Abstract
BACKGROUND Among hypertensive disorders of pregnancy (HDP), eclampsia is a rare but serious event, often considered avoidable. Detailed assessment of the adequacy of care for the women who have eclampsia can help identify opportunities for improvement and for prevention of the associated adverse maternal and neonatal outcomes. OBJECTIVE 1/ To estimate the incidence and describe the characteristics of women with eclampsia and to compare them with those of women with non-eclamptic hypertensive disorders of pregnancy (HDP)-related severe maternal morbidity (SMM) and of control women without SMM 2/ To analyse the quality of management in women who had eclampsia, at various stages of their care pathway. METHODS It was a planned ancillary analysis of the EPIMOMS population-based study, conducted in six French regions in 2012-2013. Among the 182,309 maternities of the source population, all women with eclampsia (n = 51), with non-eclamptic HDP-related SMM (n = 351) and a 2% representative sample of women without SMM (n = 3,651) were included. Main outcome was the quality of care for eclampsia assessed by an independent expert panel at three different stages of management: antenatal care, care for pre-eclampsia and care for eclampsia. RESULTS The eclampsia incidence was 2.8 per 10,000 (95%CI 2.0-4.0). Antenatal care was considered completely inadequate or substandard in 39% of women, as was pre-eclampsia care in 76%. Care for eclampsia was judged completely inadequate or substandard in 50% (21/42), mainly due to inadequate use of magnesium sulphate. CONCLUSION The high proportion of inadequate quality of care underlines the need for an evidence-based standardisation of care for HDP.
Collapse
Affiliation(s)
- Diane Korb
- CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Université Paris Cité, Paris, France
- Department of Obstetrics and Gynaecology, Robert Debré Hospital, AP-HP, Université de Paris, Paris, France
| | - Elie Azria
- CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Université Paris Cité, Paris, France
- Maternity Unit, Groupe Hospitalier Paris Saint Joseph, FHU PREMA, Université de Paris, Paris, France
| | - Priscille Sauvegrain
- CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Université Paris Cité, Paris, France
- Department of Obstetrics and Gynaecology, Pitié-Salpêtrière Hospital, AP-HP, Sorbonne Université, Paris, France
| | - Lionel Carbillon
- Department of Obstetrics and Gynaecology, Jean Verdier Hospital, AP-HP, Bondy, Sorbonne North Paris University, Paris, France
| | - Bruno Langer
- Pôle de Gynécologie-Obstétrique, Hôpital de Hautepierre, Avenue Molière, Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Aurélien Seco
- CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Université Paris Cité, Paris, France
- Clinical Research Unit Paris Centre, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Coralie Chiesa-Dubruille
- CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Université Paris Cité, Paris, France
| | - Marie Hélène Bouvier-Colle
- CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Université Paris Cité, Paris, France
| | | | - Catherine Deneux-Tharaux
- CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Université Paris Cité, Paris, France
| |
Collapse
|
2
|
Sauvegrain P, Schantz C, Rousseau A, Gaucher L, Dupont C, Chantry EAA. Midwifery research in France: Current dynamics and perspectives. Midwifery 2024; 131:103935. [PMID: 38382416 DOI: 10.1016/j.midw.2024.103935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 01/18/2024] [Accepted: 01/25/2024] [Indexed: 02/23/2024]
Affiliation(s)
- P Sauvegrain
- Sorbonne Université, Department of Maïeutics, F-75013, Paris, France; Université Paris Cité, Epidemiology and Statistics Research Center/CRESS/EPOPé Research Team, INSERM, INRA, F-75014 Paris, France.
| | - Clémence Schantz
- Université Paris Cité, IRD, Inserm, Ceped, F-75006 Paris, France
| | - Anne Rousseau
- Université Paris-Saclay, Inserm U1018, CESP, Epidémiologie Clinique Team, F-78180, Montigny le Bretonneux, France; Poissy-Saint Germain-en-Laye Hospital, Maternity Ward, F-78498 Poissy, France
| | - Laurent Gaucher
- Université Claude Bernard Lyon 1, INSERM U1290, Research on Healthcare Performance (RESHAPE), F-69000, Lyon, France; Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Geneva, Switzerland
| | - Corinne Dupont
- Université Claude Bernard Lyon 1, INSERM U1290, Research on Healthcare Performance (RESHAPE), F-69000, Lyon, France; Université Lyon 1, University of Medicine and Maieutics, F-69921, Lyon, France
| | - Et Anne Alice Chantry
- Université Paris Cité, Epidemiology and Statistics Research Center/CRESS/EPOPé Research Team, INSERM, INRA, F-75014 Paris, France; Université Paris-Cité, Departement of Maïeutics, F-75006 Paris, France
| |
Collapse
|
3
|
FILALI A, OSEI L, VIGNIER N. [Taking origins into account in medical reasoning in infectious and tropical diseases? A critical look]. MEDECINE TROPICALE ET SANTE INTERNATIONALE 2024; 4:mtsi.v4i1.2024.362. [PMID: 38846114 PMCID: PMC11151904 DOI: 10.48327/mtsi.v4i1.2024.362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 12/04/2023] [Indexed: 06/09/2024]
Abstract
Healthcare discriminations based on one's ethnic background is increasingly being studied in medicine. The scale of the Covid-19 pandemic has played an important role in bringing them to light. Data, although scarce, exist in France. These discriminations have an impact on the care pathway and contribute to the renunciation of care by the most affected populations. The issue of discrimination is particularly relevant in infectious diseases. Although the epidemiology of infectious diseases is unevenly distributed worldwide, erroneous social representations are prevalent and expose to a harmful prejudice against migrants with regard to infectious diseases. The transmissible nature of some infectious diseases reinforces their stigmatizing potential. In this context, it seems important to discuss the dimension to be given to social determinants, geographical origin, phenotype, and ethnicity in teaching and medical reasoning. The English-speaking world uses the concept of "race" in a structural way, whereas this "international standard" has not been applied in France until now. To improve the care of people from minority groups, it seems important to better document and teach a more nuanced clinical reasoning based on origin, without neglecting the importance of collecting and taking into account social determinants of health and environmental factors.
Collapse
Affiliation(s)
- Amel FILALI
- Policlinique de médecine tropicale, voyages et vaccinations, Centre universitaire de médecine générale et santé publique, Lausanne, Suisse
| | - Lindsay OSEI
- Service de pédiatrie, Centre hospitalier de Cayenne, Cayenne, Guyane, France
- Centre d'investigation clinique INSERM 1424, Centre hospitalier de Cayenne, Cayenne, Guyane, France
| | - Nicolas VIGNIER
- Service des maladies infectieuses et tropicales, Hôpitaux universitaires Paris Seine-Saint-Denis, Hôpitaux Avicenne et Jean Verdier, AP-HP, Bobigny, France
- IAME (Infection, Antimicrobiens, Modélisation, Évolution), INSERM UMR 1137, Université de Paris, Université Sorbonne Paris Nord, Bobigny, France
- Institut Convergences Migrations, CNRS, Aubervilliers, France
| |
Collapse
|
4
|
Lorthe E, Severo M, Hamwi S, Rodrigues T, Teixeira C, Barros H. Obstetric Interventions Among Native and Migrant Women: The (Over)use of Episiotomy in Portugal. Int J Public Health 2024; 69:1606296. [PMID: 38577390 PMCID: PMC10991787 DOI: 10.3389/ijph.2024.1606296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 02/28/2024] [Indexed: 04/06/2024] Open
Abstract
Objective: Episiotomy, defined as the incision of the perineum to enlarge the vaginal opening during childbirth, is one of the most commonly performed surgical interventions in the world. We aimed to determine if migrant status is associated with episiotomy, and if individual characteristics mediate this association. Methods: We analyzed data from the Bambino study, a national, prospective cohort of migrant and native women giving birth at a public hospital in mainland Portugal between 2017 and 2019. We included all women with vaginal delivery. The association between migrant status and episiotomy was assessed using multivariable multilevel random-effect logistic regression models. We used path analysis to quantify the direct, indirect and total effects of migrant status on episiotomy. Results: Among 3,583 women with spontaneous delivery, migrant parturients had decreased odds of episiotomy, especially those born in Africa, compared to native Portuguese women. Conversely, with instrumental delivery, migrant women had higher odds of episiotomy. Disparities in episiotomy were largely explained by maternity units' factors, and little by maternal and fetal characteristics. Conclusion: Our results suggest non-medically justified differential episiotomy use during childbirth and highlight the importance of developing evidence-based recommendations for episiotomy use in a country with a high frequency of medical interventions during delivery.
Collapse
Affiliation(s)
- Elsa Lorthe
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
- Unit of Population Epidemiology, Department of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Milton Severo
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
- Departamento de Ciências de Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Sousan Hamwi
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
| | - Teresa Rodrigues
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
- Department of Gynecology and Obstetrics, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Cristina Teixeira
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
- Polytechnic Institute of Bragança, Bragança, Portugal
| | - Henrique Barros
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
- Departamento de Ciências de Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| |
Collapse
|
5
|
Pattillo M, Stieglitz S, Angoumis K, Gottlieb N. Racism against racialized migrants in healthcare in Europe: a scoping review. Int J Equity Health 2023; 22:201. [PMID: 37770879 PMCID: PMC10540333 DOI: 10.1186/s12939-023-02014-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 09/14/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND Racism is frequently mentioned as a social determinant of migrants' health and a barrier to health services. However, in the European context, racism and its impact on racialized migrants' access to healthcare is remarkably under-researched. This scoping review makes a first step toward filling this void by mapping the existing literature on racial and ethnic discrimination against racialized migrants in healthcare in Europe, identifying evidence gaps, and offering recommendations for future research on this topic. METHODS Following PRISMA guidelines, four databases were searched for empirical studies published in English between 1992 and 2022. Studies were included if they report findings on manifestations, experiences and/or impacts of racial or ethnic discrimination against racialized migrants in a healthcare setting in a European country. They were summarized by study characteristics (geographical scope, study design, research question and measures) and research findings were synthesized. RESULTS Out of 2365 initial hits, 1724 records were included in the title/abstract-screening, 87 records in the full text-screening, and 38 records in the data extraction. For many country and healthcare contexts, evidence on racism in healthcare is lacking. Most studies apply an explorative qualitative research design; comparability and generalizability of research results are low. Our analysis furthermore shows a near-exclusive research focus on racism on the interpersonal level as compared to institutional and structural levels. Our synthesis of study results identifies three interrelated ways in which racism manifests in and impacts migrants' healthcare: 1) general anti-migration bias, 2) health- and healthcare-related prejudice, and 3) differential medical treatment. CONCLUSIONS Our review underscores how racism reinforces inequities in healthcare access and quality for racialized migrants. It also highlights the need for more research on racism in Europe across a greater scope of country contexts, healthcare settings and migrant/racialized categories in order to understand specific forms of racism and capture race as a context-contingent social construct. It is critical that future research includes the consideration of individual-level racism as embedded in racism on institutional and structural levels. Methods and insights from other disciplines may help to critically examine concepts in light of underlying historical, sociopolitical and socioeconomic processes and structures, and to improve methods for researching racialization and racism in healthcare.
Collapse
Affiliation(s)
- Mia Pattillo
- Weill Cornell Medicine, 1300 York Avenue, New York, NY, 10021, USA
| | - Sigsten Stieglitz
- Bielefeld School of Public Health, Universitätsstrasse 25, 33615, Bielefeld, Germany
| | - Konstantinos Angoumis
- Bielefeld School of Public Health, Universitätsstrasse 25, 33615, Bielefeld, Germany
| | - Nora Gottlieb
- Bielefeld School of Public Health, Universitätsstrasse 25, 33615, Bielefeld, Germany.
| |
Collapse
|
6
|
Eslier M, Deneux-Tharaux C, Schmitz T, Luton D, Mandelbrot L, Estellat C, Radjack R, Azria E. Association between language barrier and inadequate prenatal care utilization among migrant women in the PreCARE prospective cohort study. Eur J Public Health 2023:7165277. [PMID: 37192057 DOI: 10.1093/eurpub/ckad078] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND Inadequate prenatal care utilization (PCU) is involved in the higher risk of adverse maternal outcomes among migrant vs. native women. Language barrier may be a risk factor for inadequate PCU. We aimed to assess the association between this barrier and inadequate PCU among migrant women. METHODS This analysis took place in the French multicentre prospective PreCARE cohort study, conducted in four university hospital maternity units in the northern Paris area. It included 10 419 women giving birth between 2010 and 2012. Migrants' language barrier to communication in French were categorized into three groups: migrants with no, partial or total language barrier. Inadequate PCU was assessed by the date prenatal care began, the proportion of recommended prenatal visits completed and ultrasound scans performed. The associations between these language barrier categories and inadequate PCU were tested with multivariable logistic regression models. RESULTS Among the 4803 migrant women included, the language barrier was partial for 785 (16.3%) and total for 181 (3.8%). Compared to migrants with no language barrier, those with partial [risk ratio (RR) 1.23, 95% confidence interval (CI) 1.13-1.33] and total (RR 1.28, 95% CI 1.10-1.50) language barrier were at higher risk of inadequate PCU. Adjustment for maternal age, parity and region of birth did not modify these associations, which were noted particularly among socially deprived women. CONCLUSION Migrant women with language barrier have a higher risk of inadequate PCU than those without. These findings underscore the importance of targeted efforts to bring women with language barrier to prenatal care.
Collapse
Affiliation(s)
- Maxime Eslier
- Université Paris Cité, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Paris, France
- Department of Obstetrics and Gynaecology, ELSAN-Polyclinique du Parc, Caen, France
| | - Catherine Deneux-Tharaux
- Université Paris Cité, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Paris, France
| | - Thomas Schmitz
- Department of Obstetrics and Gynaecology, Robert Debré Hospital, AP-HP, Paris Diderot University, Paris, France
| | - Dominique Luton
- Department of Obstetrics and Gynaecology, Beaujon-Bichat Hospital, AP-HP, Paris Diderot University, Paris, France
| | - Laurent Mandelbrot
- Department of Obstetrics and Gynaecology, Louis Mourier Hospital, AP-HP, Paris Diderot University, Colombes, France
| | - Candice Estellat
- Département de Santé Publique, Centre de Pharmacoépidémiologie (Cephepi), Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpital Pitié Salpêtrière, CIC-1901, Paris, France
| | - Rahmethnissah Radjack
- Maison des Adolescents-Youth Department, Paris University Hospital, University Hospital Cochin, Paris, France
- University Paris-Saclay, UVSQ, Inserm, CESP, Team DevPsy, Villejuif, France
| | - Elie Azria
- Université Paris Cité, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Paris, France
- Maternity Unit, Groupe Hospitalier Paris Saint Joseph, Paris, France
| |
Collapse
|
7
|
Schuft L, Sauvegrain P, Delotte J. Customizing Health Recommendations About Physical Activity During Pregnancy: A Qualitative Study Among Practitioners in France. QUALITATIVE HEALTH RESEARCH 2023; 33:471-480. [PMID: 36927248 DOI: 10.1177/10497323231159621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
While studies have long shown the beneficial health effects of physical activity during pregnancy, such recommendations have been rarely analyzed in terms of how practitioners adapt such health messages to patients' social profiles. The present study sought to apprehend the logics underlying practitioner (non)recommendations of physical activity and exercise during pregnancy, and how these were associated with social distinctions made between patients. Semi-directive interviews were conducted with 20 midwives and 17 gynaecologists and obstetricians in south-eastern France. Based on thematic analyses, the results show how recommendations draw from both medical and social knowledge, mobilizing social representations regarding physical activity, (non)normative bodies and othered social categories of class, ethnicity or obesity. The othering processes reiterate gendered social hierarchies as well as moral orders surrounding normative bodies and health-enhancing behaviours. The findings demonstrate how social hierarchies and beliefs intertwine with public health discourses about the body and health-enhancing practices, suggesting directions for reducing their impact in contexts of medicine and health.
Collapse
|
8
|
de-Graft Aikins A, Sanuade O, Baatiema L, Adjaye-Gbewonyo K, Addo J, Agyemang C. How chronic conditions are understood, experienced and managed within African communities in Europe, North America and Australia: A synthesis of qualitative studies. PLoS One 2023; 18:e0277325. [PMID: 36791113 PMCID: PMC9931108 DOI: 10.1371/journal.pone.0277325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 10/24/2022] [Indexed: 02/16/2023] Open
Abstract
This review focuses on the lived experiences of chronic conditions among African communities in the Global North, focusing on established immigrant communities as well as recent immigrant, refugee, and asylum-seeking communities. We conducted a systematic and narrative synthesis of qualitative studies published from inception to 2022, following a search from nine databases-MEDLINE, EMBASE, PsycINFO, Web of Science, Social Science Citation Index, Academic Search Complete, CINAHL, SCOPUS and AMED. 39 articles reporting 32 qualitative studies were included in the synthesis. The studies were conducted in 10 countries (Australia, Canada, Denmark, France, Netherlands, Norway, Sweden, Switzerland, United Kingdom, and the United States) and focused on 748 participants from 27 African countries living with eight conditions: type 2 diabetes, hypertension, prostate cancer, sickle cell disease, chronic hepatitis, chronic pain, musculoskeletal orders and mental health conditions. The majority of participants believed chronic conditions to be lifelong, requiring complex interventions. Chronic illness impacted several domains of everyday life-physical, sexual, psycho-emotional, social, and economic. Participants managed their illness using biomedical management, traditional medical treatment and faith-based coping, in isolation or combination. In a number of studies, participants took 'therapeutic journeys'-which involved navigating illness action at home and abroad, with the support of transnational therapy networks. Multi-level barriers to healthcare were reported across the majority of studies: these included individual (changing food habits), social (stigma) and structural (healthcare disparities). We outline methodological and interpretive limitations, such as limited engagement with multi-ethnic and intergenerational differences. However, the studies provide an important insights on a much-ignored area that intersects healthcare for African communities in the Global North and medical pluralism on the continent; they also raise important conceptual, methodological and policy challenges for national health programmes on healthcare disparities.
Collapse
Affiliation(s)
- Ama de-Graft Aikins
- Institute of Advanced Studies, University College London, London, United Kingdom
- * E-mail:
| | - Olutobi Sanuade
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, Utah, United States of America
| | - Leonard Baatiema
- Department of Health Policy, Planning and Management, School of Public Health, University of Ghana, Legon, Accra, Ghana
| | - Kafui Adjaye-Gbewonyo
- Faculty of Education, Health and Human Sciences, University of Greenwich, London, United Kingdom
| | - Juliet Addo
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Charles Agyemang
- Department of Public Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
9
|
Perrenoud P, Kaech C, Chautems C. Immigrant women looking for information about the perinatal period on digital media: A qualitative study. Women Birth 2022; 36:e341-e352. [PMID: 36266178 DOI: 10.1016/j.wombi.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 10/11/2022] [Accepted: 10/12/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Smartphones' development has allowed continuous access to information about the perinatal period on digital media. Knowing about immigrant women's experience on digital media may help health and social care professionals to fine-tune their care. AIM Our primary aim is to analyse how immigrant women experience information about the perinatal period on digital media. Our secondary aim is to discuss how health and social care professionals perceive the experiences of these women. METHODS A qualitative study conducted in Switzerland encompassing semi-directed interviews with immigrant women (n = 20), health and social care professionals (n = 30) and interpreters (n = 12) completed with ethnographic observations and interviews. FINDINGS AND DISCUSSION Immigrant women form a diverse social group. They consequently use an array of social media to find information about the perinatal period depending on their linguistic and digital skills. Reflexively, they expect information found online to be of unequal quality and value information provided by professionals. They adapt their practices to their experience and may avoid media that negatively affects them. Their experience with digital media reflects the overall perinatal experience, providing clues for carers. Professionals worry about the difficult situations some immigrant women live in and stress that digital portals form barriers to services. Professionals may overlook immigrant women's use of digital media and their need for guidance. CONCLUSIONS Immigrant women use digital media to find information about the perinatal period to prepare for birth and the post-partum. They rely on unequal capabilities to do so and need translated information and holistic woman-centred support.
Collapse
Affiliation(s)
- Patricia Perrenoud
- School of Health Sciences (HESAV), Department of Midwifery, Avenue de Beaumont 21, CH-1011 Lausanne, Switzerland; University of Applied Sciences and Arts, Western Switzerland (HES-SO), Rte de Moutier 14, CH-2800 Délémont, Switzerland.
| | - Christelle Kaech
- School of Health Sciences (HESAV), Department of Midwifery, Avenue de Beaumont 21, CH-1011 Lausanne, Switzerland; University of Applied Sciences and Arts, Western Switzerland (HES-SO), Rte de Moutier 14, CH-2800 Délémont, Switzerland
| | - Caroline Chautems
- School of Health Sciences (HESAV), Department of Midwifery, Avenue de Beaumont 21, CH-1011 Lausanne, Switzerland; University of Applied Sciences and Arts, Western Switzerland (HES-SO), Rte de Moutier 14, CH-2800 Délémont, Switzerland; University of Lausanne, Faculté des sciences sociales et politiques, CH-1015 Lausanne, Switzerland
| |
Collapse
|
10
|
Sauvegrain P, Camilleri C, Tessier V, Deneux C. [Women's Opinions on Information about Preeclampsia: An Online Survey]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2022; 50:499-501. [PMID: 35085714 DOI: 10.1016/j.gofs.2022.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 11/19/2021] [Accepted: 01/18/2022] [Indexed: 06/14/2023]
Affiliation(s)
- P Sauvegrain
- Équipe de recherche en épidémiologie obstétricale, périnatale et pédiatrique (Epopé), université de Paris, CRESS, Inserm, INRA, Paris, France; Service de maternité, AP-HP Pitié-Salpêtrière, DMU Origyne, France.
| | - C Camilleri
- Association Grossesse Santé contre la Prééclampsie, Paris, France
| | | | - C Deneux
- Équipe de recherche en épidémiologie obstétricale, périnatale et pédiatrique (Epopé), université de Paris, CRESS, Inserm, INRA, Paris, France
| |
Collapse
|
11
|
Sauvegrain P. Violences dites « gynécologiques et obstétricales » envers les femmes immigrées de l’Afrique subsaharienne en France. SANTE PUBLIQUE (VANDOEUVRE-LES-NANCY, FRANCE) 2022; 33:627-628. [PMID: 36574509 DOI: 10.3917/spub.215.0627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
|
12
|
Eslier M, Deneux-Tharaux C, Sauvegrain P, Schmitz T, Luton D, Mandelbrot L, Estellat C, Azria E. Severe maternal morbidity among undocumented migrant women in the PreCARE prospective cohort study. BJOG 2022; 129:1762-1771. [PMID: 35157345 DOI: 10.1111/1471-0528.17124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 01/04/2022] [Accepted: 01/21/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess the risk of severe maternal outcomes among migrant women, considering both their legal status and birthplace; in Europe, migrant women, especially from sub-Saharan Africa, have higher risks of adverse maternal outcomes compared with non-migrants and legal status, a component of migrant condition, may be an important, and potentially actionable, risk factor. DESIGN Prospective cohort study. SETTING Four maternity units around Paris in 2010-12. SAMPLE A total of 9599 women with singleton pregnancies. METHODS Legal status was categorised in four groups: reference group of non-migrant native Frenchwomen, legal migrants with French or European citizenship, other legal migrants with non-European citizenship, and undocumented migrants. The risk of severe maternal morbidity was assessed with multivariable logistic regression models according to women's legal status and birthplace. MAIN OUTCOME MEASURE Binary composite criterion of severe maternal morbidity. RESULTS Undocumented migrants had resided for less time in France, experienced social isolation, linguistic barriers and poor housing conditions more frequently and had a pre-pregnancy medical history at lower risk than other migrants. The multivariable analysis showed that they had a higher risk of severe maternal morbidity than non-migrants (33/715 [4.6%] versus 129/4523 [2.9%]; adjusted odds ratio [aOR] 1.68, 95% CI 1.12-2.53). This increased risk was significant for undocumented women from sub-Saharan Africa (18/308 [5.8%] versus 129/4523 [2.9%]; aOR 2.26, 95% CI 1.30-3.91), and not for those born elsewhere (15/407 [3.7%] versus 129/4523 [2.9%]; aOR 1.44, 95% CI 0.82-2.53). CONCLUSION Undocumented migrants are the migrant subgroup at highest risk of severe maternal morbidity, whereas the prevalence of risk factors does not appear to be higher in this subgroup. This finding suggests that their interaction with maternity care services may be sub-optimal.
Collapse
Affiliation(s)
- Maxime Eslier
- Université de Paris, CRESS, Obstetric Perinatal and Paediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Paris, France.,Department of Obstetrics and Gynaecology, Caen Hospital, Caen, France
| | - Catherine Deneux-Tharaux
- Université de Paris, CRESS, Obstetric Perinatal and Paediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Paris, France
| | - Priscille Sauvegrain
- Université de Paris, CRESS, Obstetric Perinatal and Paediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Paris, France
| | - Thomas Schmitz
- Université de Paris, CRESS, Obstetric Perinatal and Paediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Paris, France.,Department of Obstetrics and Gynaecology, Robert Debré Hospital, Paris, France
| | - Dominique Luton
- Department of Obstetrics and Gynaecology, Beaujon-Bichat Hospital, FHU PREMA, Paris, France
| | - Laurent Mandelbrot
- Department of Obstetrics and Gynaecology, Louis Mourier Hospital, FHU PREMA, Colombes, France
| | - Candice Estellat
- Department of Biostatistics, Public Health and Medical Information, Clinical Research Unit, Pharmacoepidemiology Center (Céphépi), Sorbonne University, INSERM UMR-S 1136 - Pierre Louis Institute of Epidemiology and Public Health, Paris, France
| | - Elie Azria
- Université de Paris, CRESS, Obstetric Perinatal and Paediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Paris, France.,Maternity Unit, Paris Saint Joseph Hospital, FHU PREMA, Paris, France
| |
Collapse
|
13
|
Brebion M, Bonnet MP, Sauvegrain P, Saurel-Cubizolles MJ, Blondel B, Deneux-Tharaux C, Azria E. Use of labour neuraxial analgesia according to maternal immigration status: a national cross-sectional retrospective population-based study in France. Br J Anaesth 2021; 127:942-952. [PMID: 34511258 DOI: 10.1016/j.bja.2021.08.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 07/27/2021] [Accepted: 08/02/2021] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Disparities in neuraxial analgesia use for childbirth by maternal origin have been reported in high-resource countries. We explored the association between maternal immigrant status (characterised separately by geographic continental origin and Human Development Index [HDI] of maternal country of birth) and neuraxial analgesia use. We hypothesised that immigrant women from low-resource countries may have more limited access to neuraxial analgesia than native French women. METHODS The study population, extracted from the 2016 National Perinatal Survey, a cross-sectional study of a representative sample of births in France, included only women who initially wished to deliver with neuraxial analgesia. We used multivariable multilevel logistic regression to explore the association between immigrant status and both use of neuraxial analgesia and its timely administration. RESULTS Among the 6070 women included, 88.1% gave birth with neuraxial analgesia and 15.8% were immigrants. There was no difference in neuraxial analgesia use between native French women and either immigrant women by geographic continental region of origin, or immigrants from countries with low HDI. However, immigrants from countries with very high HDI were more likely to give birth with neuraxial analgesia (adjusted odds ratio [aOR]=2.6; 95% confidence interval (CI), 1.2-5.8; P=0.018) and its timeliness <60 min after admission (aOR=1.8; 95% CI, 1.2-2.7; P=0.005) compared with native French women. CONCLUSIONS In France, immigrant women from low-resource countries have similar access to labour neuraxial analgesia to native French women. Our results suggest differential neuraxial analgesia use in favour of immigrant women from very high HDI countries compared with native women.
Collapse
Affiliation(s)
- Myriam Brebion
- Paris University, Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Obstetric Perinatal and Paediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Paris, France.
| | - Marie-Pierre Bonnet
- Paris University, Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Obstetric Perinatal and Paediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Paris, France; Sorbonne University, GRC 29, DMU DREAM, Department of Anaesthesia and Intensive Care, Armand Trousseau Hospital, AP-HP, Paris, France
| | - Priscille Sauvegrain
- Paris University, Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Obstetric Perinatal and Paediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Paris, France
| | - Marie-Josèphe Saurel-Cubizolles
- Paris University, Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Obstetric Perinatal and Paediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Paris, France
| | - Béatrice Blondel
- Paris University, Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Obstetric Perinatal and Paediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Paris, France
| | - Catherine Deneux-Tharaux
- Paris University, Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Obstetric Perinatal and Paediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Paris, France
| | - Elie Azria
- Paris University, Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Obstetric Perinatal and Paediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Paris, France; Maternity Unit, Notre Dame de Bon Secours - Groupe Hospitalier Paris-Saint-Joseph Hospital, Paris University, Paris, France
| | | |
Collapse
|
14
|
Poncet L, Panjo H, Schmitz T, Luton D, Mandelbrot L, Estellat C, Andro A, Ringa V, Azria E. Gestational weight gain in a migration context: are migrant women more at risk of inadequate or excessive weight gain during pregnancy? J Epidemiol Community Health 2021; 76:230-238. [PMID: 34389663 DOI: 10.1136/jech-2021-216619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 07/20/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Inadequate or excessive gestational weight gain (GWG) is associated with adverse maternal and neonatal outcomes. Little is known on adequacy of GWG in migrant women. This study investigates whether migrant women in France are at higher risk of inadequate or excessive GWG, and what characteristics are associated with GWG in migrant and non-migrant groups. METHODS We used data from the PreCARE multicentric prospective cohort (N=10 419). The study includes 5403 women with singleton deliveries, with non-migrant (n=2656) and migrant (n=2747) status. We used multinomial logistic regression, adjusting for maternal age and parity, to investigate the association of migrant status, socioeconomic status-related variables and GWG. In stratified analyses, we identified factors associated with GWG in both groups. RESULTS Compared with non-migrant women, migrant women had increased risk of inadequate GWG (adjusted odds ratio (aOR) 1.18; 95% CI 1.03 to 1.34). Non-migrant women with foreign origins had increased risk of excessive GWG (aOR 1.58; 95% CI 1.30 to 1.92). Women born in Sub-Saharan Africa had increased risk of both inadequate and excessive GWG. Regardless of migration status, women with lower education and women who did not start pregnancy with a normal weight were less likely to gain adequately. Inadequate prenatal care was associated with inadequate GWG only among non-migrant women. CONCLUSION Migrant women are at higher risk of inadequate GWG.
Collapse
Affiliation(s)
- Lorraine Poncet
- CESP Primary Care and Prevention Team, Université Paris-Saclay, UVSQ, Université Paris-Sud, INSERM, Villejuif, France .,French Collaborative Institute on Migrations, France, Paris, France
| | - Henri Panjo
- CESP Primary Care and Prevention Team, Université Paris-Saclay, UVSQ, Université Paris-Sud, INSERM, Villejuif, France
| | - Thomas Schmitz
- Obstetrical, Perinatal and Pediatric Epidemiology (EPOPé research team), DHU Risks in Pregnancy, Paris Descartes University, 53 Avenue de l'Observatoire, INSERM U1153, Paris, France.,Department of Obstetrics and Gynecology, Hopital Universitaire Mere-enfant Robert-Debre, Paris, France
| | - Dominique Luton
- Department of Obstetrics and Gynecology, DHU Risks in Pregnancy, Hopital Bichat - Claude-Bernard, Paris, France
| | - Laurent Mandelbrot
- Department of Obstetrics and Gynecology, DHU Risks in Pregnancy, Hopital Louis-Mourier, Colombes, France
| | - Candice Estellat
- Department of Biostatistics, Public Health and Medical Information, Clinical research unit, Pharmacoepidemiology center, Hopital Universitaire Pitie Salpetriere, Paris, France
| | - Armelle Andro
- French Collaborative Institute on Migrations, France, Paris, France.,Institute of demography research center, Université Paris 1 Panthéon-Sorbonne, Paris, France
| | - Virginie Ringa
- CESP Primary Care and Prevention Team, Université Paris-Saclay, UVSQ, Université Paris-Sud, INSERM, Villejuif, France
| | - Elie Azria
- Obstetrical, Perinatal and Pediatric Epidemiology (EPOPé research team), DHU Risks in Pregnancy, Paris Descartes University, 53 Avenue de l'Observatoire, INSERM U1153, Paris, France.,Department of Obstetrics, Groupe hospitalier Paris Saint-Joseph, Paris, France
| |
Collapse
|
15
|
"Whatsapping" the continuity of postpartum care in Switzerland: A socio-anthropological study. Women Birth 2021; 35:e263-e274. [PMID: 34226154 DOI: 10.1016/j.wombi.2021.06.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 06/24/2021] [Accepted: 06/25/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Digital media such as Apps, Internet and social networks have become integral parts of the maternity experience for more than a decade. These media can support or undermine women's experiences as has been shown in digital sociology research. Using Immediate Messaging Applications to provide information and support to women during the perinatal period is an emerging practice. AIM This article analyses how health and social care professionals - with a focus on community midwives - and women communicate between postpartum home visits through Immediate Message Applications in Switzerland. METHODS A socio-anthropological study that relied on qualitative methods including semi-directed interviews with midwives and health and social care professionals (n = 30) and immigrant women (n = 20). FINDINGS Since the introduction of Immediate Messaging Applications, women and their carer converse more regularly between post-partum home visits. Women send questions, pictures and videos to them, often allowing swift responses to their concerns. Midwives encounter difficulties answering women's questions when they cannot be solved through quick communication (e.g. infant crying). To them, texting frequency forms a clinical clue to women's mental health. Not all women contact their carer through digital messages; immigrant women are less likely to know and use this service. DISCUSSION AND CONCLUSION Immediate Messaging Applications form a promising communication tool, complementary to home visits, and contribute to woman-centered care and continuity of care. As an emergent practice, it has not been framed by a guideline yet. Policy makers and practitioners should ensure that its use does not contribute to unequal access to care.
Collapse
|
16
|
Jatta F, Sundby J, Vangen S, Lindskog BV, Sørbye IK, Owe KM. Association between Maternal Origin, Pre-Pregnancy Body Mass Index and Caesarean Section: A Nation-Wide Registry Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18115938. [PMID: 34205921 PMCID: PMC8197892 DOI: 10.3390/ijerph18115938] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 05/28/2021] [Accepted: 05/29/2021] [Indexed: 02/03/2023]
Abstract
Aims: To explore the association between maternal origin and birthplace, and caesarean section (CS) by pre-pregnancy body mass index (BMI) and length of residence. Methods: We linked records from 118,459 primiparous women in the Medical Birth Registry of Norway between 2013 and 2017 with data from the National Population Register. We categorized pre-pregnancy BMI (kg/m2) into underweight (<18.5), normal weight (18.5–24.9) and overweight/obese (≥25). Multinomial regression analysis estimated crude and adjusted relative risk ratios (RRR) with 95% confidence intervals (CI) for emergency and elective CS. Results: Compared to normal weight women from Norway, women from Sub-Saharan Africa and Southeast Asia/Pacific had a decreased risk of elective CS (aRRR = 0.57, 95% CI 0.37–0.87 and aRRR = 0.56, 0.41–0.77, respectively). Overweight/obese women from Europe/Central Asia had the highest risk of elective CS (aRRR = 1.42, 1.09–1.86). Both normal weight and overweight/obese Sub-Saharan African women had the highest risks of emergency CS (aRRR = 2.61, 2.28-2.99; 2.18, 1.81-2.63, respectively). Compared to women from high-income countries, the risk of elective CS was increasing with a longer length of residence among European/Central Asian women. Newly arrived migrants from Sub-Saharan Africa had the highest risk of emergency CS. Conclusion: Women from Sub-Saharan Africa had more than two times the risk of emergency CS compared to women originating from Norway, regardless of pre-pregnancy BMI.
Collapse
Affiliation(s)
- Fatou Jatta
- Institute of Health and Society, Department of Community Medicine and Global Health, University of Oslo, 0317 Oslo, Norway; (F.J.); (J.S.)
| | - Johanne Sundby
- Institute of Health and Society, Department of Community Medicine and Global Health, University of Oslo, 0317 Oslo, Norway; (F.J.); (J.S.)
| | - Siri Vangen
- Norwegian Research Centre for Women’s Health, Department of Obstetrics and Gynecology, Oslo University Hospital, 0424 Oslo, Norway; (S.V.); (I.K.S.)
- Institute of Clinical Medicine, University of Oslo, 0318 Oslo, Norway
| | | | - Ingvil Krarup Sørbye
- Norwegian Research Centre for Women’s Health, Department of Obstetrics and Gynecology, Oslo University Hospital, 0424 Oslo, Norway; (S.V.); (I.K.S.)
| | - Katrine Mari Owe
- Norwegian Research Centre for Women’s Health, Department of Obstetrics and Gynecology, Oslo University Hospital, 0424 Oslo, Norway; (S.V.); (I.K.S.)
- Department of Child health and development, Norwegian Institute of Public Health, 0213 Oslo, Norway
- Correspondence: ; Tel.: +47-91683023
| |
Collapse
|
17
|
Reuveny R. Climate-related migration and population health: social science-oriented dynamic simulation model. BMC Public Health 2021; 21:598. [PMID: 33771138 PMCID: PMC7996123 DOI: 10.1186/s12889-020-10120-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 12/23/2020] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Social science models find the ecological impacts of climate change (EICC) contribute to internal migration in developing countries and, less so, international migration. Projections expect massive climate-related migration in this century. Nascent research calls to study health, migration, population, and armed conflict potential together, accounting for EICC and other factors. System science offers a way: develop a dynamic simulation model (DSM). We aim to validate the feasibility and usefulness of a pilot DSM intended to serve as a proof-of-concept and a basis for identifying model extensions to make it less simplified and more realistic. METHODS Studies have separately examined essential parts. Our DSM integrates their results and computes composites of health problems (HP), health care (HC), non-EICC environmental health problems (EP), and environmental health services (ES) by origin site and by immigrants and natives in a destination site, and conflict risk and intensity per area. The exogenous variables include composites of EICC, sociopolitical, economic, and other factors. We simulate the model for synthetic input values and conduct sensitivity analyses. RESULTS The simulation results refer to generic origin and destination sites anywhere on Earth. The effects' sizes are likely inaccurate from a real-world view, as our input values are synthetic. Their signs and dynamics are plausible, internally consistent, and, like the sizes, respond logically in sensitivity analyses. Climate migration may harm public health in a host area even with perfect HC/ES qualities and full access; and no HP spillovers across groups, conflict, EICC, and EP. Deviations from these conditions may worsen everyone's health. We consider adaptation options. CONCLUSIONS This work shows we can start developing DSMs to understand climate migration and public health by examining each case with its own inputs. Validation of our pilot model suggests we can use it as intended. We lay a path to making it more realistic for policy analysis.
Collapse
Affiliation(s)
- Rafael Reuveny
- School of Public and Environmental Affairs, Indiana University, Bloomington, USA.
| |
Collapse
|
18
|
[Advocacy for the measurement and reduction of COVID-19 disparities according to migratory status and ethnic category in France]. Rev Epidemiol Sante Publique 2021; 69:96-98. [PMID: 33610336 PMCID: PMC7889442 DOI: 10.1016/j.respe.2021.01.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 01/26/2021] [Accepted: 01/27/2021] [Indexed: 01/29/2023] Open
|
19
|
Eslier M, Morello R, Azria E, Dreyfus M. Comparative study of changes in maternal and perinatal morbidity inequalities among migrant and native women over time, between 2008 and 2014 in France. Eur J Obstet Gynecol Reprod Biol 2020; 253:76-82. [DOI: 10.1016/j.ejogrb.2020.07.047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 07/24/2020] [Accepted: 07/27/2020] [Indexed: 10/23/2022]
|
20
|
Siddiqui A, Deneux-Tharaux C, Luton D, Schmitz T, Mandelbrot L, Estellat C, Howell EA, Khoshnood B, Bertille N, Azria E. Maternal obesity and severe pre-eclampsia among immigrant women: a mediation analysis. Sci Rep 2020; 10:5215. [PMID: 32251320 PMCID: PMC7089990 DOI: 10.1038/s41598-020-62032-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 03/05/2020] [Indexed: 11/29/2022] Open
Abstract
We investigated the extent to which pre-pregnancy obesity mediates the association between maternal place of birth and severe pre-eclampsia in the PreCARE cohort of pregnant women in Paris (n = 9,579). Adjusted path analysis logistic regression models were used to assess the role of pre-pregnancy obesity as a mediator in the association between maternal place of birth and the development of severe pre-eclampsia. We calculated 1. adjusted odds ratios and 95% confidence intervals for the total exposure-outcome association and for the direct and indirect/obesity-mediated components 2. the indirect/obesity-mediated effect. Ninety-five (0.99%) women developed severe pre-eclampsia, 47.6% were non-European immigrants, 16.3% were born in Sub-Saharan Africa, and 12.6% were obese (BMI > = 30 kg/m2). Women experiencing severe pre-eclampsia were more likely to be from Sub-Saharan Africa (p = 0.023) and be obese (p = 0.048). Mothers from Sub-Saharan Africa had an increased risk of severe pre-eclampsia compared to European-born mothers (aOR 2.53, 95% CI 1.39-4.58) and the obesity-mediated indirect effect was 18% of the total risk (aOR 1.18, 95%CI 1.03-1.35). In conclusion, Sub-Saharan African immigrant women have a two-fold higher risk of developing severe pre-eclampsia as compared to European-born women, one-fifth of which is mediated by pre-pregnancy obesity. Our results quantify the potential benefit of decreasing obesity among at-risk women.
Collapse
Affiliation(s)
- Ayesha Siddiqui
- INSERM U1153 Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center for Epidemiology and Statistics Sorbonne Paris Cité, Risks in Pregnancy DHU, Paris Descartes University, Paris, France.
- Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Catherine Deneux-Tharaux
- INSERM U1153 Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center for Epidemiology and Statistics Sorbonne Paris Cité, Risks in Pregnancy DHU, Paris Descartes University, Paris, France
| | - Dominique Luton
- Department of Obstetrics and Gynecology, Beaujon-Bichat Hospital, University Hospital Department (DHU) Risks in Pregnancy, Paris Diderot University, Paris, France
| | - Thomas Schmitz
- Department of Obstetrics and Gynecology, Robert Debré Hospital, Paris Diderot University, Paris, France
| | - Laurent Mandelbrot
- Department of Obstetrics and Gynecology, Louis Mourier Hospital, University Hospital Department (DHU) Risks in Pregnancy, Paris Diderot University, Colombes, France
| | - Candice Estellat
- Pitié-Salpêtrière Hospital - Charles Foix; Department of Biostatistics, Public Health and Medical Information, Clinical Research Unit, Pharmacoepidemiology Center (Céphépi), Sorbonne University; INSERM UMR-S 1136 - Pierre Louis Institute of Epidemiology and Public Health, Paris, France
| | - Elizabeth A Howell
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Blavatnik Family Women's Health Research Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Babak Khoshnood
- INSERM U1153 Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center for Epidemiology and Statistics Sorbonne Paris Cité, Risks in Pregnancy DHU, Paris Descartes University, Paris, France
| | - Nathalie Bertille
- INSERM U1153 Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center for Epidemiology and Statistics Sorbonne Paris Cité, Risks in Pregnancy DHU, Paris Descartes University, Paris, France
| | - Elie Azria
- INSERM U1153 Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center for Epidemiology and Statistics Sorbonne Paris Cité, Risks in Pregnancy DHU, Paris Descartes University, Paris, France
- Maternity Unit, Notre Dame de Bon Secours -Paris Saint Joseph Hospital/ University Hospital Department (DHU) Risks in Pregnancy, Paris Descartes University, Paris, France
| |
Collapse
|
21
|
Korb D, Schmitz T, Seco A, Goffinet F, Deneux-Tharaux C. Risk factors and high-risk subgroups of severe acute maternal morbidity in twin pregnancy: A population-based study. PLoS One 2020; 15:e0229612. [PMID: 32109258 PMCID: PMC7048407 DOI: 10.1371/journal.pone.0229612] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 02/10/2020] [Indexed: 11/19/2022] Open
Abstract
Objective To determine risk factors of severe acute maternal morbidity in women with twin pregnancies and identify subgroups at high risk. Methods In a prospective, population-based study of twin deliveries, the JUMODA cohort, all women with twin pregnancies at or after 22 weeks of gestation were recruited in 176 French hospitals. Severe acute maternal morbidity was a composite criterion. We determined its risk factors by multilevel multivariate Poisson regression modeling and identified high-risk subgroups by classification and regression tree (CART) analysis, in two steps: first considering only characteristics known at the beginning of pregnancy and then adding factors arising during its course. Results Among the 8,823 women with twin pregnancies, 542 (6.1%, 95% confidence interval (CI) 5.6–6.6) developed severe acute maternal morbidity. Risk factors for severe maternal morbidity identified at the beginning of pregnancy were maternal birth in sub-Saharan Africa (adjusted relative risk (aRR) 1.6, 95% CI 1.1–2.3), preexisting insulin-treated diabetes (aRR 2.2, 95% CI 1.1–4.4), nulliparity (aRR 1.6, 95% CI 1.3–2.0), IVF with autologous oocytes (aRR, 1.3, 95% CI, 1.0–1.6), and oocyte donation (aRR 2.0, 95% CI 1.4–2.8); CART analysis identified nulliparous women with oocyte donation as the subgroup at highest risk (SAMM rate: 14.7%, 95% CI, 10.3–19.1). At the end of pregnancy, additional risk factors identified were placenta praevia (aRR 3.5, 95% CI 2.3–5.3), non-severe preeclampsia (aRR 2.5, 95% CI 1.9–3.2), and macrosomia for either twin (aRR 1.7, 95% CI 1.3–2.1); CART analysis identified women with both oocyte donation and non-severe preeclampsia (SAMM rate: 28.9%, 95% CI, 19.9–37.9) and sub-Saharan nulliparous women with non-severe preeclampsia (SAMM rate: 26.9%, 95% CI, 9.9–43.9) as the two subgroups at highest risk. Conclusion In woman with twin pregnancy, rates of severe acute maternal morbidity vary between subgroups from 4.6% to 14.7% and from 3.8% to 28.9% at the beginning and at the end of pregnancy respectively, depending on the combined presence of risk factors.
Collapse
Affiliation(s)
- Diane Korb
- Université de Paris, Epidemiology and Statistics Research Center/CRESS, INSERM, INRA, Paris, France
- Department of Obstetrics and Gynecology, Robert Debré Hospital, APHP, Paris, France
- * E-mail:
| | - Thomas Schmitz
- Université de Paris, Epidemiology and Statistics Research Center/CRESS, INSERM, INRA, Paris, France
- Department of Obstetrics and Gynecology, Robert Debré Hospital, APHP, Paris, France
| | - Aurélien Seco
- Université de Paris, Epidemiology and Statistics Research Center/CRESS, INSERM, INRA, Paris, France
- Clinical Research Unit of Paris Descartes Necker Cochin, APHP, Paris, France
| | - François Goffinet
- Université de Paris, Epidemiology and Statistics Research Center/CRESS, INSERM, INRA, Paris, France
- Port-Royal Maternity Unit, Cochin Hospital, APHP, Paris, France
| | - Catherine Deneux-Tharaux
- Université de Paris, Epidemiology and Statistics Research Center/CRESS, INSERM, INRA, Paris, France
| | | |
Collapse
|
22
|
Fair F, Raben L, Watson H, Vivilaki V, van den Muijsenbergh M, Soltani H. Migrant women's experiences of pregnancy, childbirth and maternity care in European countries: A systematic review. PLoS One 2020; 15:e0228378. [PMID: 32045416 PMCID: PMC7012401 DOI: 10.1371/journal.pone.0228378] [Citation(s) in RCA: 102] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 01/14/2020] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Across Europe there are increasing numbers of migrant women who are of childbearing age. Migrant women are at risk of poorer pregnancy outcomes. Models of maternity care need to be designed to meet the needs of all women in society to ensure equitable access to services and to address health inequalities. OBJECTIVE To provide up-to-date systematic evidence on migrant women's experiences of pregnancy, childbirth and maternity care in their destination European country. SEARCH STRATEGY CINAHL, MEDLINE, PubMed, PsycINFO and Scopus were searched for peer-reviewed articles published between 2007 and 2017. SELECTION CRITERIA Qualitative and mixed-methods studies with a relevant qualitative component were considered for inclusion if they explored any aspect of migrant women's experiences of maternity care in Europe. DATA COLLECTION AND ANALYSIS Qualitative data were extracted and analysed using thematic synthesis. RESULTS The search identified 7472 articles, of which 51 were eligible and included. Studies were conducted in 14 European countries and focused on women described as migrants, refugees or asylum seekers. Four overarching themes emerged: 'Finding the way-the experience of navigating the system in a new place', 'We don't understand each other', 'The way you treat me matters', and 'My needs go beyond being pregnant'. CONCLUSIONS Migrant women need culturally-competent healthcare providers who provide equitable, high quality and trauma-informed maternity care, undergirded by interdisciplinary and cross-agency team-working and continuity of care. New models of maternity care are needed which go beyond clinical care and address migrant women's unique socioeconomic and psychosocial needs.
Collapse
Affiliation(s)
- Frankie Fair
- Department of Nursing and Midwifery, Sheffield Hallam University, Sheffield, England, United Kingdom
| | - Liselotte Raben
- Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Helen Watson
- Department of Nursing and Midwifery, Sheffield Hallam University, Sheffield, England, United Kingdom
| | - Victoria Vivilaki
- Department of Midwifery, Faculty of Health and Caring Sciences, University of West Attica, Athens, Greece
| | - Maria van den Muijsenbergh
- Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, Netherlands
- Pharos, Centre of Expertise on Health Disparities, Utrecht, Netherlands
| | - Hora Soltani
- Department of Nursing and Midwifery, Sheffield Hallam University, Sheffield, England, United Kingdom
- * E-mail:
| | | |
Collapse
|
23
|
Eslier M, Morello R, Azria E, Dreyfus M. Comparative study between women born in France and migrant women with regard to their mode of delivery. J Gynecol Obstet Hum Reprod 2019; 49:101648. [PMID: 31760182 DOI: 10.1016/j.jogoh.2019.101648] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 11/02/2019] [Accepted: 11/06/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To compare the mode of delivery between women born in France and migrants. STUDY DESIGN The study was a retrospective, observational, single-center study conducted at the university maternity unit in Caen. All women who gave birth in 2008 or 2014 were included. Women with multiple pregnancies and women whose pregnancies ended before 22 weeks of gestational age were excluded. The pre-existing characteristics at the time of pregnancy, mode of delivery and postpartum were collected from the University Hospital's medical and administrative computer database. We first compared women born in France to those born abroad with regard to the characteristics of mode of delivery for 2008, then for 2014. Secondly, we compared migrant women between 2008 and 2014 to see if the change in the migration profile was associated with a change in the mode of delivery. RESULTS Of the 3038 and 3001 women included in 2008 and 2014 respectively, 272 and 385 women were migrants. We observed a significant decrease in the number of spontaneous labors (adjusted odds ratio (aOR) 0.5 [0.4-0.6]) with a significant increase in emergency cesarean sections before (aOR 2.1 [1.4-3.0]) and during labor (aOR 2.2 [1.6-3.2]) among women born in sub-Saharan Africa compared to non-migrants. And we showed a higher risk of cesarean section prior to labor (aOR 1.2 [1.01-1.4]) and a significant decrease in cesarean section during labor (aOR 0.8 [0.7-0.99]) in 2014 compared to 2008. CONCLUSION We observed a significant increase in all types of Cesarean sections among women born abroad compared to those born in France, especially in the subgroup of women born in sub-Saharan Africa.
Collapse
Affiliation(s)
- Maxime Eslier
- Department of Obstetrics and Gynaecology, Caen University Hospital, Avenue Côte-de-Nacre, 14033 Caen Cedex 9, France.
| | - Rémy Morello
- Unit of Biostatistics and Clinical Research, Caen CHU, Avenue Côte-de-Nacre, 14033 Caen Cedex 9, France; Caen University of Medicine, 19 rue Claude Bloch, 14000 Caen, France
| | - Elie Azria
- Maternity Unit, Paris Saint Joseph Hospital, DHU Risks in Pregnancy, Paris Descartes University, Paris, France; Université de Paris, CRESS, INSERM, INRA, F-75004 Paris, France
| | - Michel Dreyfus
- Department of Obstetrics and Gynaecology, Caen University Hospital, Avenue Côte-de-Nacre, 14033 Caen Cedex 9, France; Caen University of Medicine, 19 rue Claude Bloch, 14000 Caen, France
| |
Collapse
|
24
|
Linard M, Deneux-Tharaux C, Luton D, Schmitz T, Mandelbrot L, Estellat C, Sauvegrain P, Azria E. Differential rates of cesarean delivery by maternal geographical origin: a cohort study in France. BMC Pregnancy Childbirth 2019; 19:217. [PMID: 31248386 PMCID: PMC6598349 DOI: 10.1186/s12884-019-2364-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 06/14/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In many Western countries, higher rates of cesarean have been described among migrant women compared to natives of receiving countries. We aimed to estimate this difference comparing women originating from France and Sub-Saharan Africa (SSA), identify the clinical situations explaining most of this difference and assess whether maternal origin was independently associated with cesarean risk. METHODS The PreCARE prospective multicenter cohort study was conducted in 2010-2012 in the north Paris area. Our sample was restricted to 1500 women originating from Sub-Saharan Africa and 2206 from France. Profiles of cesarean section by maternal origin were described by the Robson classification. Independent associations between maternal origin and 1) cesarean before labor versus trial of labor, then 2) intrapartum cesarean versus vaginal delivery were assessed by logistic regression models to adjust for other maternal and pregnancy characteristics. RESULTS Rates of cesarean for women originating from France and SSA were 17 and 31%. The Robson 5A category "unique uterine scar, single cephalic ≥37 weeks" was the main contributor to this difference. Within this category, SSA origin was associated with cesarean before labor after adjustment for medical risk factors (adjusted odds ratio [aOR] = 2.30 [1.12-4.71]) but no more significant when adjusting on social deprivation (aOR = 1.45 [0.63-3.31]). SSA origin was associated with cesarean during labor after adjustment for both medical and social factors (aOR = 2.95 [1.35-6.44]). CONCLUSIONS The wide difference in cesarean rates between SSA and French native women is mainly explained by the Robson 5A category. Within this group, medical factors alone do not explain the increased risk of cesarean in SSA women.
Collapse
Affiliation(s)
- Morgane Linard
- INSERM U1153 - Obstetrical, Perinatal and Pediatric Epidemiology (EPOPé research team), DHU Risks in Pregnancy, Paris Descartes University, 53 Avenue de l'Observatoire, 75014, Paris, France
| | - Catherine Deneux-Tharaux
- INSERM U1153 - Obstetrical, Perinatal and Pediatric Epidemiology (EPOPé research team), DHU Risks in Pregnancy, Paris Descartes University, 53 Avenue de l'Observatoire, 75014, Paris, France
| | - Dominique Luton
- Department of Obstetrics and Gynecology, Bichat Hospital, DHU Risks in Pregnancy, APHP, Paris Diderot University, Paris, France
| | - Thomas Schmitz
- INSERM U1153 - Obstetrical, Perinatal and Pediatric Epidemiology (EPOPé research team), DHU Risks in Pregnancy, Paris Descartes University, 53 Avenue de l'Observatoire, 75014, Paris, France
- Department of Obstetrics and Gynecology, Robert Debré Hospital, AP-HP, Paris Diderot University, Paris, France
| | - Laurent Mandelbrot
- Department of Obstetrics and Gynecology, Louis Mourier Hospital, DHU Risks in Pregnancy, APHP, Paris Diderot University, Colombes, France
| | - Candice Estellat
- INSERM UMR 1123, CIC-P 1421, Department of Biostatistics, Public Health and Medical Information, Clinical research unit, Pharmacoepidemiology center (Céphépi), Pitié-Salpêtrière Hospital, APHP, Paris, France
| | - Priscille Sauvegrain
- INSERM U1153 - Obstetrical, Perinatal and Pediatric Epidemiology (EPOPé research team), DHU Risks in Pregnancy, Paris Descartes University, 53 Avenue de l'Observatoire, 75014, Paris, France
| | - Elie Azria
- INSERM U1153 - Obstetrical, Perinatal and Pediatric Epidemiology (EPOPé research team), DHU Risks in Pregnancy, Paris Descartes University, 53 Avenue de l'Observatoire, 75014, Paris, France.
- Department of Obstetrics, Paris Saint Joseph Hospital, DHU Risks in Pregnancy, Paris Descartes University, Paris, France.
| |
Collapse
|
25
|
Siddiqui A, Azria E, Howell EA, Deneux-Tharaux C, Dupont C, Rudigoz R, Vendittelli F, Beucher G, Rozenberg P, Carbillon L, Baunot N, Crenn‐Hebert C, Kayem G, Fresson J, Mignon A, Touzet S, Bonnet M, Bouvier‐Colle M, Chantry AA, Chiesa‐Dubruille C, Seco A. Associations between maternal obesity and severe maternal morbidity: Findings from the French EPIMOMS population-based study. Paediatr Perinat Epidemiol 2019; 33:7-16. [PMID: 30328636 DOI: 10.1111/ppe.12522] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Revised: 09/02/2018] [Accepted: 09/13/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Maternal obesity is increasing. There is growing evidence of its effect on severe maternal morbidity. We assessed prepregnancy obesity as an independent risk factor for severe maternal morbidity by timing and cause. METHODS We designed a case-control analysis within the EPIMOMS prospective population-based study conducted in six French regions in 2012-2013 (182 309 women who delivered at ≥22 weeks). Cases were all women who experienced severe maternal morbidity during pregnancy to 42 days postpartum as per a multicriteria definition derived by national expert consensus (n = 2540, severe maternal morbidity prevalence 1.4%). Controls were randomly selected from the same health centres (n = 3651). The association between obesity and severe maternal morbidity was assessed from fitting multivariable logistic regression models: overall, by timing (antepartum and intrapartum/ postpartum), and by cause. RESULTS Prepregnancy obesity was associated with overall severe maternal morbidity (adjusted odds ratio [OR] 1.34, 95% confidence interval [CI] 1.14, 1.59) and antepartum severe maternal morbidity (OR 2.07, 95% CI 1.61, 2.65), but not with intra/postpartum severe maternal morbidity (OR 1.15, 95% CI 0.96, 1.38). Among antepartum severe maternal morbidity, severe hypertensive disorders were most strongly associated with obesity (OR 2.50, 95% CI 1.85, 3.40) but the risk of antepartum severe maternal morbidity due to other causes was also increased among obese women (OR 1.64, 95% CI 1.13, 2.37). Obesity was not associated with severe postpartum haemorrhage (OR 1.12, 95% CI 0.92, 1.37). CONCLUSION Obesity is associated with an increased risk of antepartum, but not intra/ postpartum, severe maternal morbidity.
Collapse
Affiliation(s)
- Ayesha Siddiqui
- National Institute for Health and Medical Research (INSERM) Unit 1153 Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France.,Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Elie Azria
- National Institute for Health and Medical Research (INSERM) Unit 1153 Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France.,Maternity Unit, Notre Dame de Bon Secours -Paris Saint Joseph Hospital/University Hospital Department (DHU) Risks in Pregnancy, Paris Descartes University, Paris, France
| | - Elizabeth A Howell
- Blavatnik Family Women's Health Research Institute, Icahn School of Medicine at Mount Sinai, New York, New York.,Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York.,Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Catherine Deneux-Tharaux
- National Institute for Health and Medical Research (INSERM) Unit 1153 Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
26
|
[Hypertension in black patients]. JOURNAL DE MÉDECINE VASCULAIRE 2018; 43:213-217. [PMID: 29754732 DOI: 10.1016/j.jdmv.2018.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 02/24/2018] [Indexed: 11/22/2022]
|