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Novillo-Del-Álamo B, Martínez-Varea A, Nieto-Tous M, Morales-Roselló J. Deprived areas and adverse perinatal outcome: a systematic review. Arch Gynecol Obstet 2024; 309:1205-1218. [PMID: 38063892 DOI: 10.1007/s00404-023-07300-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 11/10/2023] [Indexed: 02/25/2024]
Abstract
PURPOSE This systematic review aimed to assess if women living in deprived areas have worse perinatal outcomes than those residing in high-income areas. METHODS Datasets of PubMed, ScienceDirect, CENTRAL, Embase, and Google Scholar were searched for studies comparing perinatal outcomes (preterm birth, small-for-gestational age, and stillbirth) in deprived and non-deprive areas. RESULTS A total of 46 studies were included. The systematic review of the literature revealed a higher risk for adverse perinatal outcomes such as preterm birth, small for gestational age, and stillbirth in deprived areas. CONCLUSION Deprived areas are associated with adverse perinatal outcomes. More multifactorial studies are needed to assess the weight of each factor that composes the socioeconomic gradient of health in adverse perinatal outcomes.
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Affiliation(s)
- Blanca Novillo-Del-Álamo
- Department of Obstetrics and Gynaecology, La Fe University and Polytechnic Hospital, Avenida Fernando Abril Martorell 106, 46026, Valencia, Spain
| | - Alicia Martínez-Varea
- Department of Obstetrics and Gynaecology, La Fe University and Polytechnic Hospital, Avenida Fernando Abril Martorell 106, 46026, Valencia, Spain.
| | - Mar Nieto-Tous
- Department of Obstetrics and Gynaecology, La Fe University and Polytechnic Hospital, Avenida Fernando Abril Martorell 106, 46026, Valencia, Spain
| | - José Morales-Roselló
- Department of Obstetrics and Gynaecology, La Fe University and Polytechnic Hospital, Avenida Fernando Abril Martorell 106, 46026, Valencia, Spain
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Nanninga EK, Menting MD, van der Hijden EJE, Portrait FRM. Do women living in a deprived neighborhood have higher maternity care costs and worse pregnancy outcomes? A retrospective population-based study. BMC Health Serv Res 2024; 24:360. [PMID: 38509560 PMCID: PMC10956252 DOI: 10.1186/s12913-024-10737-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 02/16/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND Living in a deprived neighborhood is associated with poorer health, due to factors such as lower socio-economic status and an adverse lifestyle. There is little insight into whether living in deprived neighborhood is associated with adverse maternity care outcomes and maternity health care costs. We expect women in a deprived neighborhood to experience a more complicated pregnancy, with more secondary obstetric care (as opposed to primary midwifery care) and higher maternity care costs. This study aimed to answer the following research question: to what extent are moment of referral from primary to secondary care, mode of delivery, (extreme or very) preterm delivery and maternity care costs associated with neighborhood deprivation? METHODS This retrospective cohort study used a national Dutch database with healthcare claims processed by health insurers. All pregnancies that started in 2018 were included. The moment of referral from primary to secondary care, mode of delivery, (extreme or very) preterm delivery and maternity care costs were compared between women in deprived and non-deprived neighborhoods. We reported descriptive statistics, and results of ordinal logistic, multinomial and linear regressions to assess whether differences between the two groups exist. RESULTS Women in deprived neighborhoods had higher odds of being referred from primary to secondary care during pregnancy (adjusted OR 1.49, 95%CI 1.41-1.57) and to start their pregnancy in secondary care (adjusted OR 1.55, 95%CI 1.44-1.66). Furthermore, women in deprived neighborhoods had lower odds of assisted delivery than women in non-deprived neighborhoods (adjusted OR 0.73, 95%CI 0.66-0.80), and they had higher odds of a cesarean section (adjusted OR 1.19, 95%CI 1.13-1.25). On average, women in a deprived neighborhood had higher maternity care costs worth 156 euros (95%CI 104-208). CONCLUSION This study showed that living in a deprived neighborhood is associated with more intensive maternal care and higher maternal care costs in the Netherlands. These findings support the needs for greater attention to socio-economic factors in maternity care in the Netherlands.
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Affiliation(s)
- Eline K Nanninga
- School of Business and Economics Department of Health Sciences, Ethics, Governance and Society, Vrije Universiteit Amsterdam, De Boelelaan 1085, 1081 HV, Amsterdam, The Netherlands
- Dutch Healthcare Authority, Newtonlaan 1-41, 3584 BX, Utrecht, The Netherlands
| | - Malou D Menting
- Dutch Healthcare Authority, Newtonlaan 1-41, 3584 BX, Utrecht, The Netherlands.
| | - Eric J E van der Hijden
- School of Business and Economics Department of Health Sciences, Ethics, Governance and Society, Vrije Universiteit Amsterdam, De Boelelaan 1085, 1081 HV, Amsterdam, The Netherlands
- Zilveren Kruis Health Insurance , Dellaertweg 1, 2316 WZ, Leiden, The Netherlands
| | - France R M Portrait
- School of Business and Economics Department of Health Sciences, Ethics, Governance and Society, Vrije Universiteit Amsterdam, De Boelelaan 1085, 1081 HV, Amsterdam, The Netherlands
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Michel M, Hariz AJ, Chevreul K. Association of mental disorders with costs of somatic admissions in France. L'ENCEPHALE 2023; 49:453-459. [PMID: 35973851 DOI: 10.1016/j.encep.2022.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 04/12/2022] [Accepted: 04/22/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Mentally ill patients have worse health outcomes when they suffer from somatic conditions compared to other patients. The objective of this study was to assess the association of mental illness with hospital inpatient costs for somatic reasons. METHODS All adult inpatient stays for somatic reasons in acute care hospitals between 2009 and 2013 were included using French exhaustive hospital discharge databases. Total inpatient costs were calculated from the all-payer perspective and compared in patients with and without a mental disorder. Only patients who had been admitted at least once for a mental disorder (either full-time or part-time) were considered to be mentally ill in this study. Generalized linear models with and without interaction terms studied the factors associated with hospital inpatient costs. RESULTS 17,728,424 patients corresponding to 37,458,810 admissions were included. 1,163,972 patients (6.57%) were identified as having a mental illness. A previous full-time or part-time admission for a mental disorder significantly increased hospital inpatient costs (+32.64%, 95%CI=1.3243-1.3284). Interaction terms found an increased impact of mental disorders on costs in patients with low socio-economic status, as well as in men, patients aged between 45 and 60, and patients with a cardiovascular disease or diabetes. CONCLUSION Mentally ill patients have higher hospital costs than non-mentally ill patients. Improving curative and preventive treatments in those patients could improve their health and decrease the burden on healthcare systems.
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Affiliation(s)
- M Michel
- Faculté de médecine de l'Université de Paris-site Villemin, ECEVE UMR 1123 Université Paris Cité, 10, avenue de Verdun, 75010 Paris, France; Inserm, UMR 1123, 75010 Paris, France; Assistance Publique-Hôpitaux de Paris, DRCI, URC Eco, 75004 Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Unité d'Epidémiologie Clinique, 75019 Paris, France.
| | - A J Hariz
- Faculté de médecine de l'Université de Paris-site Villemin, ECEVE UMR 1123 Université Paris Cité, 10, avenue de Verdun, 75010 Paris, France; Inserm, UMR 1123, 75010 Paris, France; Assistance Publique-Hôpitaux de Paris, DRCI, URC Eco, 75004 Paris, France
| | - K Chevreul
- Faculté de médecine de l'Université de Paris-site Villemin, ECEVE UMR 1123 Université Paris Cité, 10, avenue de Verdun, 75010 Paris, France; Inserm, UMR 1123, 75010 Paris, France; Assistance Publique-Hôpitaux de Paris, DRCI, URC Eco, 75004 Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Unité d'Epidémiologie Clinique, 75019 Paris, France
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Crequit S, Chatzistergiou K, Bierry G, Bouali S, La Tour AD, Sgihouar N, Renevier B. Association between social vulnerability profiles, prenatal care use and pregnancy outcomes. BMC Pregnancy Childbirth 2023; 23:465. [PMID: 37349672 DOI: 10.1186/s12884-023-05792-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 06/15/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND Evaluating social vulnerability is a challenging task. Indeed, former studies demonstrated an association between geographical social deprivation indicators, administrative indicators, and poor pregnancy outcomes. OBJECTIVE To evaluate the association between social vulnerability profiles, prenatal care use (PCU) and poor pregnancy outcomes (Preterm birth (PTB: <37 gestational weeks (GW)), small for gestational age (SGA), stillbirth, medical abortion, and late miscarriage). METHODS Retrospective single center study between January 2020 and December 2021. A total of 7643 women who delivered a singleton after 14 GW in a tertiary care maternity unit were included. Multiple component analysis (MCA) was used to assess the associations between the following social vulnerabilities: social isolation, poor or insecure housing conditions, not work-related household income, absence of standard health insurance, recent immigration, linguistic barrier, history of violence, severe dependency, psychologic vulnerability, addictions, and psychiatric disease. Hierarchical clustering on principal component (HCPC) from the MCA was used to classify patients into similar social vulnerability profiles. Associations between social vulnerability profiles and poor pregnancy outcomes were tested using multiple logistic regression or Poisson regression when appropriate. RESULTS The HCPC analysis revealed 5 different social vulnerability profiles. Profile 1 included the lowest rates of vulnerability and was used as a reference. After adjustment for maternal characteristics and medical factors, profiles 2 to 5 were independently associated with inadequate PCU (highest risk for profile 5, aOR = 3.14, 95%CI[2.33-4.18]), PTB (highest risk for profile 2, aOR = 4.64, 95%CI[3.80-5.66]) and SGA status (highest risk for profile 5, aOR = 1.60, 95%CI[1.20-2.10]). Profile 2 was the only profile associated with late miscarriage (adjusted incidence rate ratio (aIRR) = 7.39, 95%CI[4.17-13.19]). Profiles 2 and 4 were independently associated with stillbirth (highest association for profile 2 (aIRR = 10.9, 95%CI[6.11-19.99]) and medical abortion (highest association for profile 2 (aIRR = 12.65, 95%CI[5.96-28.49]). CONCLUSIONS This study unveiled 5 clinically relevant social vulnerability profiles with different risk levels of inadequate PCU and poor pregnancy outcomes. A personalized patient management according to their profile could offer better pregnancy management and reduce adverse outcomes.
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Affiliation(s)
- Simon Crequit
- Centre Hospitalier Intercommunal de Montreuil, 56 Boulevard de la Boissière, Montreuil, 93100, France.
| | | | - Gregory Bierry
- Centre Hospitalier Intercommunal de Montreuil, 56 Boulevard de la Boissière, Montreuil, 93100, France
| | - Sakina Bouali
- Centre Hospitalier Intercommunal de Montreuil, 56 Boulevard de la Boissière, Montreuil, 93100, France
| | - Adelaïde Dupre La Tour
- Centre Hospitalier Intercommunal de Montreuil, 56 Boulevard de la Boissière, Montreuil, 93100, France
| | - Naima Sgihouar
- GHT Grand Paris Nord Est, GHI Raincy Montfermeil, 10 rue du Général Leclerc, Montfermeil, 93370, France
| | - Bruno Renevier
- Centre Hospitalier Intercommunal de Montreuil, 56 Boulevard de la Boissière, Montreuil, 93100, France
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Crequit S, Bierry G, Maria P, Bouali S, La Tour AD, Sgihouar N, Renevier B. Use of pregnancy personalised follow-up in case of maternal social vulnerability to reduce prematurity and neonatal morbidity. BMC Pregnancy Childbirth 2023; 23:289. [PMID: 37101271 PMCID: PMC10131299 DOI: 10.1186/s12884-023-05604-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 04/13/2023] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND Social deprivation is a major risk factor of adverse pregnancy outcomes. Yet, there is few studies evaluating interventions aiming at reducing the impact of social vulnerability on pregnancy outcomes. OBJECTIVE To compare pregnancy outcomes between patients that received personalized pregnancy follow-up (PPFU) to address social vulnerability versus standard care. METHODS Retrospective comparative cohort in a single institution between 2020 and 2021. A total of 3958 women with social vulnerability that delivered a singleton after 14 gestational weeks were included, within which 686 patients had a PPFU. Social vulnerability was defined by the presence of at least one of the following characteristics: social isolation, poor or insecure housing conditions, no work-related household income, and absence of standard health insurance (these four variables were combined as a social deprivation index (SDI)), recent immigration (< 12 month), interpersonal violence during pregnancy, being handicaped or minor, addiction during pregnancy. Maternal characteristics and pregnancy outcomes were compared between patients that received PPFU versus standard care. The associations between poor pregnancy outcomes (premature birth before 37 gestational weeks (GW), premature birth before 34 GW, small for gestational age (SGA) and PPFU were tested using multivariate logistic regression and propensity score matching. RESULTS After adjustment on SDI, maternal age, parity, body mass index, maternal origin and both high medical and obstetrical risk level before pregnancy, PPFU was an independent protective factor of premature birth before 37 gestational weeks (GW) (aOR = 0.63, 95%CI[0.46-0.86]). The result was similar for premature birth before 34 GW (aOR = 0.53, 95%CI [0.34-0.79]). There was no association between PPFU and SGA (aOR = 1.06, 95%CI [0.86 - 1.30]). Propensity score adjusted (PSa) OR for PPFU using the same variables unveiled similar results, PSaOR = 0.63, 95%CI[0.46-0.86] for premature birth before 37 GW, PSaOR = 0.52, 95%CI [0.34-0.78] for premature birth before 34 GW and PSaOR = 1.07, 95%CI [0.86 - 1.33] for SGA. CONCLUSIONS This work suggests that PPFU improves pregnancy outcomes and emphasizes that the detection of social vulnerability during pregnancy is a major health issue.
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Affiliation(s)
- Simon Crequit
- Service de Gynécologie Obstétrique, Centre Hospitalier Intercommunal de Montreuil, 56 Boulevard de la Boissière, 93100, Montfermeil, France.
| | - Gregory Bierry
- Service de Gynécologie Obstétrique, Centre Hospitalier Intercommunal de Montreuil, 56 Boulevard de la Boissière, 93100, Montfermeil, France
| | - Perbellini Maria
- Service de Gynécologie Obstétrique, Centre Hospitalier Intercommunal de Montreuil, 56 Boulevard de la Boissière, 93100, Montfermeil, France
| | - Sakina Bouali
- Service de Gynécologie Obstétrique, Centre Hospitalier Intercommunal de Montreuil, 56 Boulevard de la Boissière, 93100, Montfermeil, France
| | - Adelaïde Dupre La Tour
- Service de Gynécologie Obstétrique, Centre Hospitalier Intercommunal de Montreuil, 56 Boulevard de la Boissière, 93100, Montfermeil, France
| | - Naima Sgihouar
- Responsable de L'Unité de Recherche Clinique / GHT Grand Paris Nord Est, GHI Raincy Montfermeil, 10 Rue du Général Leclerc, 93370, Montfermeil, France
| | - Bruno Renevier
- Service de Gynécologie Obstétrique, Centre Hospitalier Intercommunal de Montreuil, 56 Boulevard de la Boissière, 93100, Montfermeil, France
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Rayment-Jones H, Harris J, Harden A, Turienzo CF, Sandall J. Project20: Maternity care mechanisms that improve (or exacerbate) health inequalities. A realist evaluation. Women Birth 2022; 36:e314-e327. [PMID: 36443217 DOI: 10.1016/j.wombi.2022.11.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 11/09/2022] [Accepted: 11/14/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Women with low socioeconomic status and social risk factors are at a disproportionate risk of poor birth outcomes and experiences of maternity care. Specialist models of maternity care that offer continuity are known to improve outcomes but underlying mechanisms are not well understood. AIM To evaluate two UK specialist models of care that provide continuity to women with social risk factors and identify specific mechanisms that reduce, or exacerbate, health inequalities. METHODS Realist informed interviews were undertaken throughout pregnancy and the postnatal period with 20 women with social risk factors who experienced a specialist model of care. FINDINGS Experiences of stigma, discrimination and paternalistic care were reported when women were not in the presence of a known midwife during care episodes. Practical and emotional support, and evidence-based information offered by a known midwife improved disclosure of social risk factors, eased perceptions of surveillance and enabled active participation. Continuity of care offered reduced women's anxiety, enabled the development of a supportive network and improved women's ability to seek timely help. Women described how specialist model midwives knew their medical and social history and how this improved safety. Care set in the community by a team of six known midwives appeared to enhance these benefits. CONCLUSION The identification of specific maternity care mechanisms supports current policy initiatives to scale up continuity models and will be useful in future evaluation of services for marginalised groups. However, the specialist models of care cannot overcome all inequalities without improvements in the maternity system as a whole.
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Michel M, Alberti C, Carel JC, Chevreul K. Social inequalities in access to care at birth and neonatal mortality: an observational study. Arch Dis Child Fetal Neonatal Ed 2022; 107:380-385. [PMID: 34656994 DOI: 10.1136/archdischild-2021-321967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 09/27/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To look at the association of socioeconomic status (SES) with the suitability of the maternity where children are born and its association with mortality. DESIGN Retrospective analysis of a prospective cohort constituted using hospital discharge databases. SETTING France POPULATION: Live births in 2012-2014 in maternity hospitals in mainland France followed until discharge from the hospital. MAIN OUTCOME MEASURE Unsuitability of the maternity to newborns' needs based on birth weight and gestational age, early transfers (within 24 hours of birth) and in-hospital mortality. RESULTS 2 149 454 births were included, among which 155 646 (7.2%) were preterm. Preterm newborns with low SES were less frequently born in level III maternities than those with high SES. They had higher odds of being born in an unsuitable maternity (OR=1.174, 95% CI 1.114 to 1.238 in the lowest SES quintile compared with the highest), and no increase in the odds of an early transfer (OR=0.966, 95% CI 0.849 to 1.099 in the lowest SES quintile compared with the highest). Overall, newborns from the lowest SES quintile had a 40% increase in their odds of dying compared with the highest (OR=1.399, 95% CI 1.235 to 1.584). CONCLUSIONS Newborns with the lowest SES were less likely to be born in level III maternity hospitals compared with those with the highest SES, despite having higher prematurity rates. This was associated with a significantly higher mortality in newborns with the lowest SES. Strategies must be developed to increase health equity among mothers and newborns.
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Affiliation(s)
- Morgane Michel
- ECEVE, Université de Paris, Paris, France .,URC Eco, Hôtel Dieu / Unité d'épidémiologie clinique, Hôpital Robert Debré, Assistance Publique - Hôpitaux de Paris, Paris, France.,UMR 1123, Inserm, Paris, France
| | - Corinne Alberti
- ECEVE, Université de Paris, Paris, France.,Unité d'épidémiologie clinique / Unité de recherche clinique, Hôpital Robert Debré, Assistance Publique - Hôpitaux de Paris, Paris, France.,UMR 1123 / CIC-EC 1426, Inserm, Paris, France
| | - Jean-Claude Carel
- Pediatric Endocrinology and Diabetology Department and Centre de Référence des Maladies Endocriniennes Rares de la Croissance, Hôpital Robert Debré, Assistance Publique - Hôpitaux de Paris, Paris, France.,NeuroDiderot, Inserm, Université de Paris, Paris, France
| | - Karine Chevreul
- ECEVE, Université de Paris, Paris, France.,URC Eco, Hôtel Dieu / Unité d'épidémiologie clinique, Hôpital Robert Debré, Assistance Publique - Hôpitaux de Paris, Paris, France.,UMR 1123, Inserm, Paris, France
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Zadeh SM, Léger S, Guiguet-Auclair C, Gallot D, Celse MP, Vendittelli F, Debost-Legrand A. Validation of the 'EPICES' social deprivation score in a population of women who have just given birth: a French cross-sectional study. Public Health 2021; 201:19-25. [PMID: 34742113 DOI: 10.1016/j.puhe.2021.09.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 08/11/2021] [Accepted: 09/23/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To assess the diagnostic performance of the EPICES score for identifying social deprivation during pregnancy in a population of women in the immediate postpartum period. STUDY DESIGN This cross-sectional survey took place between 5th June and 5th August 2017, among women who had just given birth in either of the maternity units in Clermont-Ferrand, France. METHODS A self-administered questionnaire was completed by women. The questionnaire came in two parts: the EPICES index and the criteria for social deprivation defined by French law. These criteria were chosen to define the reference standard. The women were classified into two groups, living in precarious circumstances or not, according to the criteria defined by the French law (reference standard). To determine the most relevant threshold of the EPICES score, the precision associated with the threshold (the fraction of those predicted positive who are true positives: positive predictive value) was balanced with its sensitivity. EPICES scores above the threshold were classified as deprived, those below as non-deprived. RESULTS Of the 947 women who gave birth during the study period, 700 (73.9%) completed the self-administered questionnaire. The best trade-off between precision and sensitivity was obtained with a threshold of 22. For this threshold value, the positive predictive value was 42.3% and the sensitivity 70.3%. CONCLUSIONS The EPICES score with a threshold validated in the population of pregnant women is a useful, rapid, and easy-to-use tool that makes it possible to identify maternal deprivation at an individual level.
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Affiliation(s)
- S M Zadeh
- Université Clermont Auvergne, CNRS-UMR 6602, Institut Pascal, Axe TGI, Péprade, Clermont-Ferrand, France
| | - S Léger
- Laboratoire de Mathématiques UMR CNRS 6620, Université Blaise Pascal; CNRS, UMR 6620, Laboratoire de Mathématiques, Aubière, France
| | - C Guiguet-Auclair
- Université Clermont Auvergne, CNRS-UMR 6602, Institut Pascal, Axe TGI, Péprade, Clermont-Ferrand, France
| | - D Gallot
- GReD, CNRS UMR 6293, INSERM U1103, Université Clermont Auvergne, Clermont-Ferrand, France; Equipe « Translational Approach to Epithelial Injury and Repair », Université Clermont Auvergne, CNRS, Inserm, GReD, Clermont-Ferrand, 63000, France
| | - M-P Celse
- Service de Maternité, Clinique Privée de La Chataigneraie, Beaumont, 63400, France
| | - F Vendittelli
- Université Clermont Auvergne, CNRS-UMR 6602, Institut Pascal, Axe TGI, Péprade, Clermont-Ferrand, France
| | - A Debost-Legrand
- Université Clermont Auvergne, CNRS-UMR 6602, Institut Pascal, Axe TGI, Péprade, Clermont-Ferrand, France.
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Ginnell L, Boardman JP, Reynolds RM, Fletcher-Watson S. Parent priorities for research and communication concerning childhood outcomes following preterm birth. Wellcome Open Res 2021; 6:151. [PMID: 34746441 PMCID: PMC8546737 DOI: 10.12688/wellcomeopenres.16863.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Children born preterm (before 37 weeks of gestation) are at risk for several adverse childhood outcomes. Parent priorities for research into these outcomes, and preferences for receiving information about these risks, have not previously been established. Here we report the results of an online survey designed to understand parent priorities for research and their preferences for receiving information about childhood outcomes. Methods: An online survey was circulated through social media and was completed by 148 parents of preterm children between the ages of 0 and 12 years from around the United Kingdom (UK). Survey questions were in the form of rating scale, multiple choice, ranking or open-ended free text questions. Descriptive analysis was applied to the quantitative data. Illustrative quotes were extracted from the qualitative free text data and a subset of these questions were analysed using framework analysis. Results: Parent priorities for research centre around identification of factors which can protect against or improve adverse cognitive or developmental outcomes. The majority of parents would prefer for communication to begin within the first year of the child's life. Parents reported a knowledge gap among health visitors, early years educators and schools. Conclusions: In order to align with parent preferences, research should prioritise identification of protective factors and the development of effective interventions to improve outcomes. Training for health visitors and educational professionals could improve the experiences of families and children.
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Affiliation(s)
- Lorna Ginnell
- Salvesen Mindroom Research Centre, University of Edinburgh, Edinburgh, UK
| | - James P. Boardman
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
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Ginnell L, Boardman JP, Reynolds RM, Fletcher-Watson S. Parent priorities for research and communication concerning childhood outcomes following preterm birth. Wellcome Open Res 2021; 6:151. [PMID: 34746441 PMCID: PMC8546737 DOI: 10.12688/wellcomeopenres.16863.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2021] [Indexed: 04/05/2024] Open
Abstract
Background: Children born preterm (before 37 weeks of gestation) are at risk for several adverse childhood outcomes. Parent priorities for research into these outcomes, and preferences for receiving information about these risks, have not previously been established. Here we report the results of an online survey designed to understand parent priorities for research and their preferences for receiving information about childhood outcomes. Methods: An online survey was circulated through social media and was completed by 148 parents of preterm children between the ages of 0 and 12 years from around the United Kingdom (UK). Survey questions were in the form of rating scale, multiple choice, ranking or open-ended free text questions. Descriptive analysis was applied to the quantitative data. Illustrative quotes were extracted from the qualitative free text data and a subset of these questions were analysed using framework analysis. Results: Parent priorities for research centre around identification of factors which can protect against or improve adverse cognitive or developmental outcomes. The majority of parents would prefer for communication to begin within the first year of the child's life. Parents reported a knowledge gap among health visitors, early years educators and schools. Conclusions: In order to align with parent preferences, research should prioritise identification of protective factors and the development of effective interventions to improve outcomes. Training for health visitors and educational professionals could improve the experiences of families and children.
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Affiliation(s)
- Lorna Ginnell
- Salvesen Mindroom Research Centre, University of Edinburgh, Edinburgh, UK
| | - James P. Boardman
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
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Roussot A, Goueslard K, Cottenet J, Von Theobald P, Rozenberg P, Quantin C. Extremely and Very Preterm Deliveries in a Maternity Unit of Inappropriate Level: Analysis of Socio-Residential Factors. Clin Epidemiol 2021; 13:273-285. [PMID: 33883947 PMCID: PMC8053703 DOI: 10.2147/clep.s288046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 03/04/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To analyze the socio-residential factors associated with extremely and very preterm deliveries occurring in non-level 3 maternity units in France. MATERIALS AND METHODS This is a population-based observational retrospective study using national hospital data from 2012 to 2014. A generalized estimating equations regression model was used to study the characteristics of women who delivered very preterm and the socio-residential risk factors for not delivering in a level 3 maternity unit at 24-31+6d weeks of gestation. RESULTS Among deliveries resulting in live births and without contraindication to in-utero transfer, we identified 9198 extremely or very preterm deliveries; 2122 (23.1%) of these were managed in a non-level 3 unit. Our study showed that young maternal age (women under 20 years at delivery) was associated with the risk of giving birth prematurely in a non-level 3 maternity, and particularly in a level 1 maternity unit (adjusted relative risk, 1.53; 95% CI 1.09-2.16). Living more than 30 minutes away from the closest level 3 unit increased the risk of delivering very preterm in a level 1 or 2 unit. Living in an urban area or urban periphery increased the risk of giving birth in a level 2 maternity unit (adjusted relative risk, 1.53; 95% CI 1.28-1.83 and 1.42; 95% CI 1.17-1.71, respectively). CONCLUSION This study shows that young pregnant women living more than 30 minutes from a level 3 hospital have an increased risk of delivering in a maternity unit that is not equipped to deal with premature births. The risk also increases with an urban place of residence when the delivery occurs in a level 2 unit. A clearer understanding of the population at risk of delivering prematurely in a non-level 3 maternity could lead to improvements in structuring healthcare to encourage earlier management and better support.
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Affiliation(s)
- Adrien Roussot
- Biostatistics and Bioinformatics (DIM), University Hospital, Dijon, France
- Bourgogne Franche-Comté University, Dijon, France
| | - Karine Goueslard
- Biostatistics and Bioinformatics (DIM), University Hospital, Dijon, France
- Bourgogne Franche-Comté University, Dijon, France
| | - Jonathan Cottenet
- Biostatistics and Bioinformatics (DIM), University Hospital, Dijon, France
- Bourgogne Franche-Comté University, Dijon, France
- Inserm, CIC 1432, Dijon, France
- Clinical Investigation Center, Clinical Epidemiology/Clinical Trials Unit, Dijon University Hospital, Dijon, France
| | - Peter Von Theobald
- Department of Gynecology and Obstetrics, Hospital Felix Guyon, CHU La Reunion, France
| | - Patrick Rozenberg
- EA 7285, Versailles Saint Quentin University, Versailles, France
- The Department of Obstetrics and Gynecology, Poissy-Saint Germain Hospital, Poissy, France
| | - Catherine Quantin
- Biostatistics and Bioinformatics (DIM), University Hospital, Dijon, France
- Bourgogne Franche-Comté University, Dijon, France
- Inserm, CIC 1432, Dijon, France
- Clinical Investigation Center, Clinical Epidemiology/Clinical Trials Unit, Dijon University Hospital, Dijon, France
- High-Dimensional Biostatistics for Drug Safety and Genomics, CESP, Inserm, Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Villejuif, France
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12
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Perra O, Wass S, McNulty A, Sweet D, Papageorgiou KA, Johnston M, Bilello D, Patterson A, Alderdice F. Very preterm infants engage in an intervention to train their control of attention: results from the feasibility study of the Attention Control Training (ACT) randomised trial. Pilot Feasibility Stud 2021; 7:66. [PMID: 33712090 PMCID: PMC7952829 DOI: 10.1186/s40814-021-00809-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 03/02/2021] [Indexed: 08/29/2023] Open
Abstract
Background Very premature birth (gestational age between 28 and 31 + 6 weeks) is associated with increased risk of cognitive delay and attention deficit disorder, which have been linked to anomalies in the development of executive functions (EFs) and their precursors. In particular, very preterm (VP) infants display anomalies in controlling attention and gathering task-relevant information. Early interventions that support attention control may be pivotal in providing a secure base for VP children’s later attainments. The Attention Control Training (ACT) is a cognitive training intervention that targets infants’ abilities to select visual information according to varying task demands but had not been tested in VP infants. We conducted a feasibility study to test the processes we intend to use in a trial delivering the ACT to VP infants. Methods and design We tested recruitment and retention of VP infants and their families in a randomised trial, as well as acceptability and completion of baseline and outcome measures. To evaluate these aims, we used descriptive quantitative statistics and qualitative methods to analyse feedback from infants’ caregivers. We also investigated the quality of eye-tracking data collected and indicators of infants’ engagement in the training, using descriptive statistics. Results Twelve VP infants were recruited, and 10 (83%) completed the study. Participants’ parents had high education attainment. The rate of completion of baseline and outcome measures was optimal. VP infants demonstrated engagement in the training, completing on average 84 min of training over three visits, and displaying improved performance during this training. Eye-tracking data quality was moderate, but this did not interfere with infants’ engagement in the training. Discussion The results suggest the ACT can be delivered to VP infants. However, challenges remain in recruitment of numerous and diverse samples. We discuss strategies to overcome these challenges informed by results of this study. Trial registration Registered Registration ID: NCT03896490. Retrospectively registered at Clinical Trials Protocol Registration and Results System (clinicaltrials.gov). Supplementary Information The online version contains supplementary material available at 10.1186/s40814-021-00809-z.
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Affiliation(s)
- Oliver Perra
- School of Nursing and Midwifery, Queen's University Belfast, Medical Biology Building, 97 Lisburn Road, Belfast, BT9 7BL, UK. .,Centre for Evidence and Social Innovation, Queen's University Belfast, Medical Biology Centre, 97 Lisburn Road, Belfast, BT9 7BL, Northern Ireland, UK.
| | - Sam Wass
- School of Psychology, University of East London, London, UK
| | - Alison McNulty
- TinyLife, The Premature Baby Charity for Northern Ireland, Belfast, Northern Ireland, UK
| | - David Sweet
- Health and Social Care Belfast Trust, Belfast, Northern Ireland, UK
| | | | - Matthew Johnston
- School of Nursing and Midwifery, Queen's University Belfast, Medical Biology Building, 97 Lisburn Road, Belfast, BT9 7BL, UK.,Centre for Evidence and Social Innovation, Queen's University Belfast, Medical Biology Centre, 97 Lisburn Road, Belfast, BT9 7BL, Northern Ireland, UK.,School of Psychology, Queen's University Belfast, Belfast, UK
| | - Delfina Bilello
- School of Nursing and Midwifery, Queen's University Belfast, Medical Biology Building, 97 Lisburn Road, Belfast, BT9 7BL, UK.,Centre for Evidence and Social Innovation, Queen's University Belfast, Medical Biology Centre, 97 Lisburn Road, Belfast, BT9 7BL, Northern Ireland, UK.,School of Psychology, Queen's University Belfast, Belfast, UK
| | - Aaron Patterson
- School of Psychology, Queen's University Belfast, Belfast, UK
| | - Fiona Alderdice
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
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McCall SJ, Green DR, Macfarlane GJ, Bhattacharya S. Spontaneous very preterm birth in relation to social class, and smoking: a temporal-spatial analysis of routinely collected data in Aberdeen, Scotland (1985-2010). J Public Health (Oxf) 2020; 42:534-541. [PMID: 31125067 DOI: 10.1093/pubmed/fdz042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 03/18/2019] [Accepted: 03/28/2019] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To examine trends of spontaneous very preterm birth (vPTB) and its relationship with maternal socioeconomic status and smoking. METHODS This was a population-based cohort study in Aberdeen Maternity Hospital, UK. The cohort was restricted to spontaneous singleton deliveries occurring in Aberdeen from 1985 to 2010. The primary outcome was very preterm birth which was defined as <32 weeks gestation and the comparison group was deliveries ≥37 weeks of gestation. The main exposures were parental Social Class based on Occupation, Carstairs' deprivation index and smoking during pregnancy. Logistic regression was used to estimate the association between vPTB and the exposures. RESULTS There was an increased likelihood of vPTB in those with unskilled-occupations compared to professional-occupations [aOR:2.77 (95%CI:1.54-4.99)], in those who lived in the most deprived areas compared to those in the most affluent [aOR: 2.16 (95% CI: 1.27-3.67)] and in women who smoked compared to those who did not [aOR: 1.74 (95% CI: 1.36-2.21)]. The association with Carstairs index was no longer statistically significant when restricted to smokers but remained significant when restricted to non-smokers. CONCLUSION The strongest risk factor for vPTB was maternal smoking while socioeconomic deprivation showed a strong association in non-smokers. Smoking cessation interventions may reduce vPTB. Modifiable risk factors should be explored in deprived areas.
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Affiliation(s)
- Stephen J McCall
- Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, Foresterhill, University of Aberdeen, UK.,National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - David R Green
- Medical & Health GIS Research, School of Geoscience, University of Aberdeen, UK
| | - Gary J Macfarlane
- Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, Foresterhill, University of Aberdeen, UK
| | - Sohinee Bhattacharya
- Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, Foresterhill, University of Aberdeen, UK
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Michel M, Alberti C, Carel JC, Chevreul K. Socioeconomic Status of Newborns and Hospital Efficiency: Implications for Hospital Payment Methods. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2020; 23:335-342. [PMID: 32197729 DOI: 10.1016/j.jval.2019.10.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 10/10/2019] [Accepted: 10/16/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Studies have shown a consistent impact of socioeconomic status at birth for both mother and child; however, no study has looked at its impact on hospital efficiency and financial balance at birth, which could be major if newborns from disadvantaged families have an average length of stay (LOS) longer than other newborns. Our objective was therefore to study the association between socioeconomic status and hospital efficiency and financial balance in that population. METHODS A study was carried out using exhaustive national hospital discharge databases. All live births in a maternity hospital located in mainland France between 2012 and 2014 were included. Socioeconomic status was estimated with an ecological indicator and efficiency by variations in patient LOS compared with different mean national LOS. Financial balance was assessed at the admission level through the ratio of production costs and revenues and at the hospital level by the difference in aggregated revenues and production costs for said hospital. Multivariate regression models studied the association between those indicators and socioeconomic status. RESULTS A total of 2 149 454 births were included. LOS was shorter than the national means for less disadvantaged patients and longer for the more disadvantaged patients, which increased when adjusted for gestational age, birth weight, and severity. A 1% increase in disadvantaged patients in a hospital's case mix significantly increased the probability that the hospital would be in deficit by 2.6%. CONCLUSIONS Reforms should be made to hospital payment methods to take into account patient socioeconomic status so as to improve resource allocation efficiency.
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Affiliation(s)
- Morgane Michel
- AP-HP, Hôtel Dieu, URC Eco Ile-de-France, Paris, France; AP-HP, Hôpital Robert Debré, Unité d'Epidémiologie Clinique, Paris, France; Université de Paris, French National Institute of Health and Medical Research, Épidémiologie clinique et évaluation économique applique aux populations vulnérables, Paris, France; French National Institute of Health and Medical Research, Paris, France.
| | - Corinne Alberti
- AP-HP, Hôpital Robert Debré, Unité d'Epidémiologie Clinique, Paris, France; Université de Paris, French National Institute of Health and Medical Research, Épidémiologie clinique et évaluation économique applique aux populations vulnérables, Paris, France; French National Institute of Health and Medical Research, Paris, France; French National Institute of Health and Medical Research, Clinical Investigation Centers, CIC, Paris, France
| | - Jean-Claude Carel
- AP-HP, Hôpital Robert Debré, Pediatric Endocrinology and Diabetology Department and Centre de Référence des Maladies Endocriniennes Rares de la Croissance, Paris, France; INSERM, NeuroDiderot, Université de Paris, Paris, France
| | - Karine Chevreul
- AP-HP, Hôtel Dieu, URC Eco Ile-de-France, Paris, France; AP-HP, Hôpital Robert Debré, Unité d'Epidémiologie Clinique, Paris, France; Université de Paris, French National Institute of Health and Medical Research, Épidémiologie clinique et évaluation économique applique aux populations vulnérables, Paris, France; French National Institute of Health and Medical Research, Paris, France
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15
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Kroll ME, Kurinczuk JJ, Hollowell J, Macfarlane A, Li Y, Quigley MA. Ethnic and socioeconomic variation in cause-specific preterm infant mortality by gestational age at birth: national cohort study. Arch Dis Child Fetal Neonatal Ed 2020; 105:56-63. [PMID: 31123058 PMCID: PMC6951229 DOI: 10.1136/archdischild-2018-316463] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 04/08/2019] [Accepted: 04/12/2019] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To describe ethnic and socioeconomic variation in cause-specific infant mortality of preterm babies by gestational age at birth. DESIGN National birth cohort study. SETTING England and Wales 2006-2012. SUBJECTS Singleton live births at 24-36 completed weeks' gestation (n=256 142). OUTCOME MEASURES Adjusted rate ratios for death in infancy by cause (three groups), within categories of gestational age at birth (24-27, 28-31, 32-36 weeks), by baby's ethnicity (nine groups) or area deprivation score (Index of Multiple Deprivation quintiles). RESULTS Among 24-27 week births (5% of subjects; 47% of those who died in infancy), all minority ethnic groups had lower risk of immaturity-related death than White British, the lowest rate ratios being 0.63 (95% CI 0.49 to 0.80) for Black Caribbean, 0.74 (0.64 to 0.85) for Black African and 0.75 (0.60 to 0.94) for Indian. Among 32-36 week births, all minority groups had higher risk of death from congenital anomalies than White British, the highest rate ratios being 4.50 (3.78 to 5.37) for Pakistani, 2.89 (2.10 to 3.97) for Bangladeshi and 2.06 (1.59 to 2.68) for Black African; risks of death from congenital anomalies and combined rarer causes (infection, intrapartum conditions, SIDS and unclassified) increased with deprivation, the rate ratios comparing the most with the least deprived quintile being, respectively, 1.54 (1.22 to 1.93) and 2.05 (1.55 to 2.72). There was no evidence of socioeconomic variation in deaths from immaturity-related conditions. CONCLUSIONS Gestation-specific preterm infant mortality shows contrasting ethnic patterns of death from immaturity-related conditions in extremely-preterm babies, and congenital anomalies in moderate/late-preterm babies. Socioeconomic variation derives from congenital anomalies and rarer causes in moderate/late-preterm babies. Future research should examine biological origins of extremely preterm birth.
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Affiliation(s)
- Mary E Kroll
- Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Jennifer J Kurinczuk
- Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Jennifer Hollowell
- Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Alison Macfarlane
- Department of Midwifery, School of Health Sciences, City University, London, UK
| | - Yangmei Li
- Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Maria A Quigley
- Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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16
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Uchitel J, Alden E, Bhutta ZA, Goldhagen J, Narayan AP, Raman S, Spencer N, Wertlieb D, Wettach J, Woolfenden S, Mikati MA. The Rights of Children for Optimal Development and Nurturing Care. Pediatrics 2019; 144:peds.2019-0487. [PMID: 31771960 DOI: 10.1542/peds.2019-0487] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/19/2019] [Indexed: 11/24/2022] Open
Abstract
Millions of children are subjected to abuse, neglect, and displacement, and millions more are at risk for not achieving their developmental potential. Although there is a global movement to change this, driven by children's rights, progress is slow and impeded by political considerations. The United Nations Convention on the Rights of the Child, a global comprehensive commitment to children's rights ratified by all countries in the world except the United States (because of concerns about impingement on sovereignty and parental authority), has a special General Comment on "Implementing Child Rights in Early Childhood." More recently, the World Health Organization and United Nations Children's Fund have launched the Nurturing Care Framework for Early Childhood Development (ECD), which calls for public policies that promote nurturing care interventions and addresses 5 interrelated components that are necessary for optimal ECD. This move is also complemented by the Human Capital Project of the World Bank, providing a focus on the need for investments in child health and nutrition and their long-term benefits. In this article, we outline children's rights under international law, the underlying scientific evidence supporting attention to ECD, and the philosophy of nurturing care that ensures that children's rights are respected, protected, and fulfilled. We also provide pediatricians anywhere with the policy and rights-based frameworks that are essential for them to care for and advocate for children and families to ensure optimal developmental, health, and socioemotional outcomes. These recommendations do not necessarily reflect American Academy of Pediatrics policy.
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Affiliation(s)
| | - Errol Alden
- International Pediatric Association and Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Zulfiqar A Bhutta
- Division of Women and Child Health, Aga Khan University, Karachi, Pakistan.,Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada
| | - Jeffrey Goldhagen
- Division of Community and Societal Pediatrics, Department of Pediatrics, College of Medicine, University of Florida, Jacksonville, Florida
| | | | - Shanti Raman
- International Pediatrics Association Standing Committee, International Society of Social Pediatrics and Child Health, Geneva, Switzerland.,Division of Community Pediatric, South Western Sydney Local Health District, Sydney, New South Wales, Australia
| | - Nick Spencer
- Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Donald Wertlieb
- Eliot-Pearson Department of Child Study and Human Development, School of Arts and Sciences, Tufts University, Medford, Massachusetts
| | - Jane Wettach
- Duke Children's Law Clinic, School of Law, Duke University, Durham, North Carolina; and
| | - Sue Woolfenden
- Discipline of Paediatrics, School of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Mohamad A Mikati
- Division of Pediatric Neurology and .,Early Childhood Development Standing Advisory Group, International Pediatrics Association, St Louis, Missouri
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17
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Michel M, Alberti C, Carel JC, Chevreul K. Association of Pediatric Inpatient Socioeconomic Status With Hospital Efficiency and Financial Balance. JAMA Netw Open 2019; 2:e1913656. [PMID: 31626320 PMCID: PMC6813670 DOI: 10.1001/jamanetworkopen.2019.13656] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
IMPORTANCE In health care systems in which hospital reimbursement is based on a national mean length of stay (LOS), disadvantaged patients with an increased LOS may be a source of inefficiency. This implication has been reported in adult patients, but pediatric data have been scarce. OBJECTIVE To examine the association of patient socioeconomic status with hospital efficiency and financial balance in pediatrics. DESIGN, SETTING, AND PARTICIPANTS This cohort study obtained data from the French national hospital discharge database covering a 3-year period, from January 1, 2012, to December 31, 2014. Statistical analyses were performed between June 2016 and December 2018. All inpatient stays in hospital pediatric wards in mainland France by children older than 28 days or younger than 18 years (n = 4 121 187) were included. Admissions with coding errors or missing values for social disadvantage and/or cost calculations were excluded. EXPOSURE Social disadvantage was estimated with an ecological indicator, the FDep, available at the patient's postcode of residence and divided into national quintiles. MAIN OUTCOMES AND MEASURES Efficiency was assessed through the variations in patient LOS compared with different national mean LOS (for pediatric patients, pediatric patients with a similar condition, and pediatric patients with a similar condition and severity level). Hospital financial balance was assessed at the admission level through the ratio of production costs to revenues and at the hospital level through the difference between aggregated revenues and production costs. Multivariate regression models examined the association between these indicators and socioeconomic status. RESULTS A total of 4 121 187 admissions were included (2 336 540 [56.7%] male; mean [SD] age, 7.4 [5.8] years). In all, 1 561 219 patients (37.9%) were in the 2 most disadvantaged quintiles. Patient LOS was shorter than the national mean LOS (mean [SD], 1.73 [4.21] days) for patients in the least disadvantaged quintile and longer for those in the more disadvantaged quintile (mean [SD], 1.67 [4.33] days vs 1.82 [4.14] days). This difference was higher for diagnosis related groups that included both adult and pediatric patients (mean [SD], 1.46 [4.22] days vs 1.61 [4.13] days) compared with those dedicated to pediatric patients (2.22 [4.13] days vs 2.12 [4.53] days). Patients in the most disadvantaged quintile were associated with a 3.2% increase in LOS (odds ratio, 1.0322; 95% CI, 1.0302-1.0341) compared with the national mean LOS. Social disadvantage was also associated with a significant increase in financial deficit for hospitals with 20% to 60% of patients in the 2 most disadvantaged quintiles (estimate: -€146 389; 95% CI, -€279 566 to -€13 213). CONCLUSIONS AND RELEVANCE Patient socioeconomic status appears to be statistically significantly associated with an increase in LOS and cost in French hospitals with pediatric departments. This finding suggests that initiating reform in hospital payment methods may improve resource allocation efficiency and equity in access to pediatric care.
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Affiliation(s)
- Morgane Michel
- Unité de Recherche Clinique en Économie de la Santé Eco Ile de France, Hôtel Dieu, Assistance Publique-Hôpitaux de Paris, Paris, France
- Unité d'Epidémiologie Clinique, Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Paris, France
- Université de Paris, Epidémiologie Clinique et Évaluation Économique Appliquées aux Populations Vulnérables (ECEVE), Inserm, Paris, France
- Inserm, Epidémiologie Clinique et Évaluation Économique Appliquées aux Populations Vulnérables (ECEVE), U1123, Paris, France
| | - Corinne Alberti
- Unité d'Epidémiologie Clinique, Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Paris, France
- Université de Paris, Epidémiologie Clinique et Évaluation Économique Appliquées aux Populations Vulnérables (ECEVE), Inserm, Paris, France
- Inserm, Epidémiologie Clinique et Évaluation Économique Appliquées aux Populations Vulnérables (ECEVE), U1123, Paris, France
- Inserm, Centre d'Investigation Clinique (CIC) 1426, Paris, France
| | - Jean-Claude Carel
- Centre de Référence des Maladies Endocriniennes Rares de la Croissance, Department of Pediatric Endocrinology and Diabetology, Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Paris, France
- Inserm, NeuroDiderot, Université de Paris, Paris, France
| | - Karine Chevreul
- Unité de Recherche Clinique en Économie de la Santé Eco Ile de France, Hôtel Dieu, Assistance Publique-Hôpitaux de Paris, Paris, France
- Unité d'Epidémiologie Clinique, Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Paris, France
- Université de Paris, Epidémiologie Clinique et Évaluation Économique Appliquées aux Populations Vulnérables (ECEVE), Inserm, Paris, France
- Inserm, Epidémiologie Clinique et Évaluation Économique Appliquées aux Populations Vulnérables (ECEVE), U1123, Paris, France
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18
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Ene D, Der G, Fletcher-Watson S, O’Carroll S, MacKenzie G, Higgins M, Boardman JP. Associations of Socioeconomic Deprivation and Preterm Birth With Speech, Language, and Communication Concerns Among Children Aged 27 to 30 Months. JAMA Netw Open 2019; 2:e1911027. [PMID: 31509207 PMCID: PMC6739726 DOI: 10.1001/jamanetworkopen.2019.11027] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
IMPORTANCE Successful acquisition of language is foundational for health and well-being across the life course and is patterned by medical and social determinants that operate in early life. OBJECTIVE To investigate the associations of neighborhood disadvantage, gestational age, and English as first language with speech, language, and communication concerns among children aged 27 to 30 months. DESIGN, SETTING, AND PARTICIPANTS This cohort study used birth data from the National Health Service maternity electronic medical record linked to the Child Health Surveillance Programme for preschool children. The cohort included 28 634 children in the United Kingdom (NHS Lothian, Scotland) born between January 2011 and December 2014 who were eligible for a health review at age 27 to 30 months between April 2013 and April 2016. Data analysis was conducted between January 2018 and February 2019. EXPOSURES The associations of neighborhood deprivation (using the Scottish Index of Multiple Deprivation 2016 quintiles), gestational age, and whether English was the first language spoken in the home with preschool language function were investigated using mutually adjusted logistic regression models. MAIN OUTCOMES AND MEASURES Speech, language, and communication (SLC) concern ascertained at age 27 to 30 months. RESULTS Records of 28 634 children (14 695 [51.3%] boys) with a mean (SD) age of 27.7 (2.2) months were matched. After excluding records with missing data, there were 26 341 records. The prevalence of SLC concern was 13.0% (3501 of 26 963 children with SLC data). In fully adjusted analyses, each 1-week increase in gestational age from 23 to 36 weeks was associated with an 8.8% decrease in the odds of a child having an SLC concern reported at 27 months (odds ratio, 0.92; 95% CI, 0.90-0.93). The odds of a child for whom English is not the first language of having SLC concern at age 27 to 30 months were 2.1-fold higher than those for a child whose first language is English (OR, 2.09; 95% CI, 1.66-2.64). The odds ratio for having an SLC concern among children living in the most deprived neighborhoods, compared with the least deprived neighborhoods, was 3.15 (95% CI, 2.79-3.56). The estimated probabilities for preterm children having an SLC concern were highest for those living in the most deprived areas. CONCLUSIONS AND RELEVANCE This study found that SLC concerns at age 27 to 30 months are common and independently associated with increasing levels of neighborhood deprivation and lower gestational age. Policies that reduce childhood deprivation could be associated with improved preschool language ability and potentially avoid propagation of disadvantage across the life course, including for children born preterm.
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Affiliation(s)
- Daniela Ene
- Information Services Division, NHS Lothian, NHS Scotland, Edinburgh, United Kingdom
| | - Geoff Der
- Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, University of Glasgow, Glasgow, United Kingdom
| | | | - Sinéad O’Carroll
- Patrick Wild Centre, University of Edinburgh, Edinburgh, United Kingdom
| | - Graham MacKenzie
- Information Services Division, NHS Lothian, NHS Scotland, Edinburgh, United Kingdom
| | - Martin Higgins
- Public Health and Health Policy, NHS Lothian, NHS Scotland, Edinburgh, United Kingdom
| | - James P. Boardman
- Medical Research Council Centre for Reproductive Health, University of Edinburgh, Edinburgh, United Kingdom
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
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Opondo C, Gray R, Hollowell J, Li Y, Kurinczuk JJ, Quigley MA. Joint contribution of socioeconomic circumstances and ethnic group to variations in preterm birth, neonatal mortality and infant mortality in England and Wales: a population-based retrospective cohort study using routine data from 2006 to 2012. BMJ Open 2019; 9:e028227. [PMID: 31371291 PMCID: PMC6677942 DOI: 10.1136/bmjopen-2018-028227] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 07/14/2019] [Accepted: 07/16/2019] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES This study aimed to describe the variation in risks of adverse birth outcomes across ethnic groups and socioeconomic circumstances, and to explore the evidence of mediation by socioeconomic circumstances of the effect of ethnicity on birth outcomes. SETTING England and Wales. PARTICIPANTS The data came from the 4.6 million singleton live births between 2006 and 2012. EXPOSURE The main exposure was ethnic group. Socioeconomic circumstances, the hypothesised mediator, were measured using the Index of Multiple Deprivation (IMD), an area-level measure of deprivation, based on the mother's place of residence. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcomes were birth outcomes, namely: neonatal death, infant death and preterm birth. We estimated the slope and relative indices of inequality to describe differences in birth outcomes across IMD, and the proportion of the variance in birth outcomes across ethnic groups attributable to IMD. We investigated mediation by IMD on birth outcomes across ethnic groups using structural equation modelling. RESULTS Neonatal mortality, infant mortality and preterm birth risks were 2.1 per 1000, 3.2 per 1000 and 5.6%, respectively. Babies in the most deprived areas had 47%-129% greater risk of adverse birth outcomes than those in the least deprived areas. Minority ethnic babies had 48%-138% greater risk of adverse birth outcomes compared with white British babies. Up to a third of the variance in birth outcomes across ethnic groups was attributable to differences in IMD, and there was strong statistical evidence of an indirect effect through IMD in the effect of ethnicity on birth outcomes. CONCLUSION There is evidence that socioeconomic circumstances could be contributing to the differences in birth outcomes across ethnic groups.
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Affiliation(s)
- Charles Opondo
- Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Ron Gray
- Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Jennifer Hollowell
- Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Yangmei Li
- Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Jennifer J Kurinczuk
- Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Maria A Quigley
- Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Seppänen AV, Bodeau-Livinec F, Boyle EM, Edstedt-Bonamy AK, Cuttini M, Toome L, Maier RF, Cloet E, Koopman-Esseboom C, Pedersen P, Gadzinowski J, Barros H, Zeitlin J. Specialist health care services use in a European cohort of infants born very preterm. Dev Med Child Neurol 2019; 61:832-839. [PMID: 30508225 DOI: 10.1111/dmcn.14112] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/06/2018] [Indexed: 12/27/2022]
Abstract
AIM Children born very preterm require additional specialist care because of the health and developmental risks associated with preterm birth, but information on their health service use is sparse. We sought to describe the use of specialist services by children born very preterm in Europe. METHOD We analysed data from the multi-regional, population-based Effective Perinatal Intensive Care in Europe (EPICE) cohort of births before 32 weeks' gestation in 11 European countries. Perinatal data were abstracted from medical records and parents completed a questionnaire at 2 years corrected age (4322 children; 2026 females, 2296 males; median gestational age 29wks, interquartile range [IQR] 27-31wks; median birthweight 1230g, IQR 970-1511g). We compared parent-reported use of specialist services by country, perinatal risk (based on gestational age, small for gestational age, and neonatal morbidities), maternal education, and birthplace. RESULTS Seventy-six per cent of the children had consulted at least one specialist, ranging across countries from 53.7% to 100%. Ophthalmologists (53.4%) and physiotherapists (48.0%) were most frequently consulted, but individual specialists varied greatly by country. Perinatal risk was associated with specialist use, but the gradient differed across countries. Children with more educated mothers had higher proportions of specialist use in three countries. INTERPRETATION Large variations in the use of specialist services across Europe were not explained by perinatal risk and raise questions about the strengths and limits of existing models of care. WHAT THIS PAPER ADDS Use of specialist services by children born very preterm varied across Europe. This variation was observed for types and number of specialists consulted. Perinatal risk was associated with specialist care, but did not explain country-level differences. In some countries, mothers' educational level affected use of specialist services.
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Affiliation(s)
- Anna-Veera Seppänen
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Center for Epidemiology and Statistics, Sorbonne Paris Cité, Paris, France.,Collège Doctoral, Sorbonne Université, Paris, France
| | - Florence Bodeau-Livinec
- Ecole des Hautes Etudes en Santé Publique, Rennes, France.,DHU Risks in Pregnancy, Paris Descartes University, Paris, France
| | - Elaine M Boyle
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Anna-Karin Edstedt-Bonamy
- Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.,Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Marina Cuttini
- Clinical Care and Management Innovation Research Area, Bambino Gesù Children's Hospital, Rome, Italy
| | - Liis Toome
- Tallinn Children's Hospital, Tallinn, Estonia.,University of Tartu, Tartu, Estonia
| | - Rolf F Maier
- Children's Hospital, University Hospital, Philipps University Marburg, Marburg, Germany
| | - Eva Cloet
- Public Health, Vrije Universiteit Brussel Faculteit Geneeskunde en Farmacie, Brussels, Belgium.,Paediatric Neurology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Corine Koopman-Esseboom
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, the Netherlands
| | | | - Janusz Gadzinowski
- Department of Neonatology, Poznan University of Medical Sciences, Poznań, Poland
| | | | - Jennifer Zeitlin
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Center for Epidemiology and Statistics, Sorbonne Paris Cité, Paris, France
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21
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Puthussery S, Li L, Tseng PC, Kilby L, Kapadia J, Puthusserry T, Thind A. Ethnic variations in risk of preterm birth in an ethnically dense socially disadvantaged area in the UK: a retrospective cross-sectional study. BMJ Open 2019; 9:e023570. [PMID: 30852531 PMCID: PMC6429724 DOI: 10.1136/bmjopen-2018-023570] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To investigate ethnic variations in risk of preterm birth (PTB), including extreme preterm birth (EPTB) and moderately preterm birth (MPTB), among mothers in an ethnically dense, socially disadvantaged area, and to examine whether any variations were dependent of area deprivation and maternal biological and behavioural factors. DESIGN Retrospective cross-sectional study using routinely collected data. SETTING A large UK National Health Service maternity unit. PARTICIPANTS 46 307 women who gave singleton births between April 2007 and March 2016. OUTCOME MEASURES PTB defined as <37 weeks of gestation and further classified into EPTB (<28 weeks of gestation) and MPTB (28 to <37 weeks of gestation). RESULTS Overall prevalence of PTB was higher (8.3%) compared with the national average (7.8%). Black Caribbean (2.2%) and black African (2.0%) mothers had higher absolute risk of EPTB than white British mothers (1.3%), particularly black Caribbean mothers whose relative risk ratio (RRR) was nearly twice after adjustment for all covariates (RRR=1.93[1.20 to 3.10]). Excess relative risk of EPTB among black African mothers became non-significant after adjustment for prenatal behavioural factors (RRR=1.41[0.99 to 2.01]). Bangladeshi mothers had the lowest absolute risk of EPTB (0.6%), substantially lower than white British mothers (1.3%); the difference in relative risk remained significant after adjustment for area deprivation (RRR=0.59[0.36 to 0.96]), but became non-significant after adjustment for maternal biological factors. Changes were evident in the relative risk of EPTB and MPTB among some ethnic groups compared with the white British on adjustment for different covariates. CONCLUSIONS Higher than national rates of PTB point to the need for evidence-based antenatal and neonatal care programmes to support preterm babies and their families in ethnically dense socially disadvantaged areas. Differential impact of area deprivation and the role of modifiable behavioural factors highlight the need for targeted preventive interventions for groups at risk.
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Affiliation(s)
- Shuby Puthussery
- Maternal and Child Health Research Centre, Institute for Health Research, University of Bedfordshire, Luton, UK
| | - Leah Li
- Population, Policy and Practice Programme, Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Pei-Ching Tseng
- Maternal and Child Health Research Centre, Institute for Health Research, University of Bedfordshire, Luton, UK
| | - Lesley Kilby
- Neonatal Unit, Luton and Dunstable University Hospital NHS Foundation Trust, Luton, UK
| | - Jogesh Kapadia
- Neonatal Unit, Luton and Dunstable University Hospital NHS Foundation Trust, Luton, UK
| | | | - Amardeep Thind
- Schulich School of Medicine and Dentistry, University of Western Ontario, London, Canada
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22
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Edstedt Bonamy AK, Zeitlin J, Piedvache A, Maier RF, van Heijst A, Varendi H, Manktelow BN, Fenton A, Mazela J, Cuttini M, Norman M, Petrou S, Reempts PV, Barros H, Draper ES. Wide variation in severe neonatal morbidity among very preterm infants in European regions. Arch Dis Child Fetal Neonatal Ed 2019; 104:F36-F45. [PMID: 29353260 PMCID: PMC6762001 DOI: 10.1136/archdischild-2017-313697] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Revised: 11/22/2017] [Accepted: 11/27/2017] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To investigate the variation in severe neonatal morbidity among very preterm (VPT) infants across European regions and whether morbidity rates are higher in regions with low compared with high mortality rates. DESIGN Area-based cohort study of all births before 32 weeks of gestational age. SETTING 16 regions in 11 European countries in 2011/2012. PATIENTS Survivors to discharge from neonatal care (n=6422). MAIN OUTCOME MEASURES Severe neonatal morbidity was defined as intraventricular haemorrhage grades III and IV, cystic periventricular leukomalacia, surgical necrotizing enterocolitis and retinopathy of prematurity grades ≥3. A secondary outcome included severe bronchopulmonary dysplasia (BPD), data available in 14 regions. Common definitions for neonatal morbidities were established before data abstraction from medical records. Regional severe neonatal morbidity rates were correlated with regional in-hospital mortality rates for live births after adjustment on maternal and neonatal characteristics. RESULTS 10.6% of survivors had a severe neonatal morbidity without severe BPD (regional range 6.4%-23.5%) and 13.8% including severe BPD (regional range 10.0%-23.5%). Adjusted inhospital mortality was 13.7% (regional range 8.4%-18.8%). Differences between regions remained significant after consideration of maternal and neonatal characteristics (P<0.001) and severe neonatal morbidity rates were not correlated with mortality rates (P=0.50). CONCLUSION Severe neonatal morbidity rates for VPT survivors varied widely across European regions and were independent of mortality rates.
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Affiliation(s)
- Anna Karin Edstedt Bonamy
- Department of Women’s and Children’s Health, Karolinska Institute, Stockholm, Sweden
- Clinical Epidemiology Section, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Jennifer Zeitlin
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in pregnancy, Paris Descartes, Paris, France
| | - Aurélie Piedvache
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in pregnancy, Paris Descartes, Paris, France
| | - Rolf F Maier
- Children’s Hospital, University Hospital, Philipps University Marburg, Marburg, Germany
| | - Arno van Heijst
- Department of Neonatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Heili Varendi
- Department of Pediatrics, University of Tartu, Tartu University Hospital, Tartu, Estonia
| | | | - Alan Fenton
- Newcastle University, Newcastle upon Tyne, UK
| | - Jan Mazela
- Research Unit of Perinatal Epidemiology, Clinical Care and Management Innovation Research Area, Bambino Gesù Children’s Hospital, Institute for Research and Health Care, Rome, Italy
| | - Marina Cuttini
- Department of Neonatology, Poznan University of Medical Sciences, Poznan, Poland
| | - Mikael Norman
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Neonatal Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Stavros Petrou
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Patrick Van Reempts
- Department of Neonatolog, Antwerp University Hospital, University of Antwerp, Antwerp and Study Centre for Perinatal Epidemiology Flanders, Belgium, Europe
| | - Henrique Barros
- EPIUnit-Institute of Public Health, University of Porto, Porto, Portugal
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23
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Peregrino AB, Watt RG, Heilmann A, Jivraj S. Breastfeeding practices in the United Kingdom: Is the neighbourhood context important? MATERNAL & CHILD NUTRITION 2018; 14:e12626. [PMID: 29888866 PMCID: PMC6865869 DOI: 10.1111/mcn.12626] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 03/23/2018] [Accepted: 04/20/2018] [Indexed: 01/27/2023]
Abstract
Breastfeeding is an important public health issue worldwide. Breastfeeding rates in the United Kingdom, particularly for exclusive breastfeeding, are low compared with other OECD countries, despite its wide-ranging health benefits for both mother and child. There is evidence that deprivation in the structural and social organisation of neighbourhoods is associated with adverse child outcomes. This study aimed to explore whether breastfeeding initiation, exclusive breastfeeding for at least 3 months, and any type of breastfeeding for at least 6 months were associated with neighbourhood context measured by neighbourhood deprivation and maternal neighbourhood perceptions in a nationally representative U.K. SAMPLE A cross-sectional analysis was conducted using data from the Millennium Cohort Study. Logistic regression was carried out on a sample of 17,308 respondents, adjusting for individual- and familial-level socio-demographic characteristics. Neighbourhood deprivation was independently and inversely associated with breastfeeding initiation. Compared with the least deprived areas, the likelihood of initiating breastfeeding was 40% lower in the most deprived neighbourhoods (OR: 0.60, 95% CI [0.50, 0.72]). The relationship between both exclusive and any type of breastfeeding at 3 and 6 months respectively with neighbourhood deprivation after adjustment for potential confounders was not entirely linear. Breastfeeding initiation (OR: 0.78, 95% CI [0.71, 0.85]), exclusivity for 3 months (OR: 0.84, 95% CI [0.75, 0.95]), and any breastfeeding for 6 months (OR: 0.82, 95% CI [0.73, 0.93]) were each reduced by about 20% among mothers who perceived their neighbourhoods lacking safe play areas for children. Policies to improve breastfeeding rates should consider area-based approaches and the broader determinants of social inequalities.
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Affiliation(s)
- Andressa B. Peregrino
- Research Department of Epidemiology and Public HealthUniversity College LondonTorrington PlaceLondonUK
| | - Richard G. Watt
- Research Department of Epidemiology and Public HealthUniversity College LondonTorrington PlaceLondonUK
| | - Anja Heilmann
- Research Department of Epidemiology and Public HealthUniversity College LondonTorrington PlaceLondonUK
| | - Stephen Jivraj
- Research Department of Epidemiology and Public HealthUniversity College LondonTorrington PlaceLondonUK
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24
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Roussel A, Michel M, Lefevre-Utile A, De Pontual L, Faye A, Chevreul K. Impact of social deprivation on length of stay for common infectious diseases in two French university-affiliated general pediatric departments. Arch Pediatr 2018; 25:359-364. [PMID: 30041884 DOI: 10.1016/j.arcped.2018.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 05/14/2018] [Accepted: 06/20/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Adult deprived patients consume more healthcare resources than others, particularly in terms of increased length of stay (LOS) and costs. Very few pediatric studies have focused on LOS, although the effect of deprivation could be greater in children due to the vulnerability of this population. Our objective was to compare LOS between deprived and nondeprived children hospitalized for acute infectious diseases in two university-affiliated pediatric departments located in a low-income area of northern Paris. METHODS We performed a prospective observational multicenter study in two university-affiliated hospitals, Hôpital Robert-Debré and Hôpital Jean-Verdier. All the patients under 15 years of age admitted to the general pediatric department for pneumonia, bronchiolitis, gastroenteritis, or pyelonephritis between 20 October 2016 and 20 March 2017 were included. Deprivation was assessed with an individual questionnaire and score (EPICES). Endpoints included length of stay, costs, and readmission rates at 15 days in each quintile of deprivation. Multivariate regression assessed the association between deprivation and each endpoint. RESULTS A total of 556 patients were included in the study and 540 were analyzed. Sixty percent were boys and the mean age was 9 months±18. Bronchiolitis was the most frequent diagnosis (67.8%). Fifty-six percent of patients were considered to be deprived based on the EPICES questionnaire. Mean LOS was 4.6±3.5 days and we found no significant difference in LOS between the different deprivation quintiles (P=0.83). Multivariate regression did not show an association between LOS and deprivation. CONCLUSION There was no difference between deprived and nondeprived patients in terms of LOS. Deprivation may therefore impact hospitals in other ways such as admission rates. The impact of deprivation during hospitalization for chronic diseases should also be investigated.
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Affiliation(s)
- A Roussel
- Service de pédiatrie générale, hôpital Robert-Debré, Assistance publique des Hôpitaux de Paris, 48, boulevard Sérurier, 75019 Paris, France; Inserm, ECEVE, U1123, 10, boulevard de Verdun, 75010 Paris, France; Université Paris Diderot, Sorbonne Paris Cité, 10, boulevard de Verdun, 75010 Paris, France.
| | - M Michel
- Inserm, ECEVE, U1123, 10, boulevard de Verdun, 75010 Paris, France; Université Paris Diderot, Sorbonne Paris Cité, 10, boulevard de Verdun, 75010 Paris, France; URC Eco Île-de-France, DRCD, Assistance publique-Hôpitaux de Paris, Hôtel Dieu, 1, place du Parvis-de-Notre-Dame, 75004 Paris, France
| | - A Lefevre-Utile
- Service de pédiatrie générale, hôpital Robert-Debré, Assistance publique des Hôpitaux de Paris, 48, boulevard Sérurier, 75019 Paris, France
| | - L De Pontual
- Service de pédiatrie générale, hôpital Jean-Verdier, Assistance publique-Hôpitaux de Paris, avenue du 14-Juillet, 93143 Bondy cedex, France
| | - A Faye
- Service de pédiatrie générale, hôpital Robert-Debré, Assistance publique des Hôpitaux de Paris, 48, boulevard Sérurier, 75019 Paris, France; Inserm, ECEVE, U1123, 10, boulevard de Verdun, 75010 Paris, France; Université Paris Diderot, Sorbonne Paris Cité, 10, boulevard de Verdun, 75010 Paris, France
| | - K Chevreul
- Inserm, ECEVE, U1123, 10, boulevard de Verdun, 75010 Paris, France; Université Paris Diderot, Sorbonne Paris Cité, 10, boulevard de Verdun, 75010 Paris, France; URC Eco Île-de-France, DRCD, Assistance publique-Hôpitaux de Paris, Hôtel Dieu, 1, place du Parvis-de-Notre-Dame, 75004 Paris, France
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25
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Howell EA, Janevic T, Hebert PL, Egorova NN, Balbierz A, Zeitlin J. Differences in Morbidity and Mortality Rates in Black, White, and Hispanic Very Preterm Infants Among New York City Hospitals. JAMA Pediatr 2018; 172:269-277. [PMID: 29297054 PMCID: PMC5796743 DOI: 10.1001/jamapediatrics.2017.4402] [Citation(s) in RCA: 137] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Substantial quality improvements in neonatal care have occurred over the past decade yet racial and ethnic disparities in morbidity and mortality remain. It is uncertain whether disparate patterns of care by race and ethnicity contribute to disparities in neonatal outcomes. OBJECTIVES To examine differences in neonatal morbidity and mortality rates among non-Hispanic black (black), Hispanic, and non-Hispanic white (white) very preterm infants and to determine whether these differences are explained by site of delivery. DESIGN, SETTING, AND PARTICIPANTS Population-based retrospective cohort study of 7177 nonanomalous infants born between 24 and 31 completed gestational weeks in 39 New York City hospitals using linked 2010 to 2014 New York City discharge abstract and birth certificate data sets. Mixed-effects logistic regression with a random hospital-specific intercept was used to generate risk-adjusted neonatal morbidity and mortality rates for very preterm infants in each hospital. Hospitals were ranked using this measure, and differences in the distribution of black, Hispanic, and white very preterm births were assessed among these hospitals. The statistical analysis was performed in 2016-2017. EXPOSURE Race/ethnicity. MAIN OUTCOMES AND MEASURES Composite of mortality (neonatal or in-hospital up to 1 year) or severe neonatal morbidity (bronchopulmonary dysplasia, severe necrotizing enterocolitis, retinopathy of prematurity stage 3 or greater, or intraventricular hemorrhage grade 3 or greater). RESULTS Among 7177 very preterm births (VPTBs), morbidity and mortality occurred in 2011 (28%) and was higher among black (893 [32.2%]) and Hispanic (610 [28.1%]) than white (319 [22.5%]) VPTBs (2-tailed P < .001). The risk-standardized morbidity and mortality rate was twice as great for VPTB infants born in hospitals in the highest morbidity and mortality tertile (0.40; 95% CI, 0.38-0.41) as for those born in the lowest morbidity and mortality tertile (0.16; 95% CI, 0.14-0.18). Black (1204 of 2775 [43.4%]) and Hispanic (746 of 2168 [34.4%]) VPTB infants were more likely than white (325 of 1418 [22.9%]) VPTB infants to be born in hospitals in the highest morbidity and mortality tertile (2-tailed P < .001; black-white difference, 20%; 95% CI, 18%-23% and Hispanic-white difference, 11%; 95% CI, 9%-14%). The largest proportion of the explained disparities can be attributed to differences in infant health risks among black, Hispanic, and white VPTB infants. However, 40% (95% CI, 30%-50%) of the black-white disparity and 30% (95% CI, 10%-49%) of the Hispanic-white disparity was explained by birth hospital. CONCLUSIONS AND RELEVANCE Black and Hispanic VPTB infants are more likely to be born at hospitals with higher risk-adjusted neonatal morbidity and mortality rates, and these differences contribute to excess morbidity and mortality among black and Hispanic infants.
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Affiliation(s)
- Elizabeth A. Howell
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York,Women’s Health Research Institute, 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
| | - Teresa Janevic
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York,Women’s Health Research Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Paul L. Hebert
- Department of Health Services, University of Washington School of Public Health, Seattle, Washington
| | - Natalia N. Egorova
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York,Women’s Health Research Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Amy Balbierz
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York,Women’s Health Research Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jennifer Zeitlin
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York,INSERM Joint Research Unit 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Biostatistics Sorbonne Paris Cité, University Hospital Department Risks in Pregnancy, Paris Descartes University, Paris, France
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Influence of Socioeconomic Context on the Rehospitalization Rates of Infants Born Preterm. J Pediatr 2017; 190:174-179.e1. [PMID: 28893384 DOI: 10.1016/j.jpeds.2017.08.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 05/30/2017] [Accepted: 08/01/2017] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To investigate the impact of social inequalities on the risk of rehospitalization in the first year after discharge from the neonatal unit in a population of preterm-born children. STUDY DESIGN Preterm infants were included if they were born between 2006 and 2013 at ≤32 + 6 weeks of gestation and who received follow-up in a French regional medical network with a high level of healthcare. Socioeconomic context was estimated using a neighborhood-based socioeconomic deprivation index. Univariate and logistic regression analyses were used to identify risk factors associated with rehospitalization. RESULTS For the 2325 children, the mean gestational age was 29 ± 2 weeks and the mean birth weight was 1315 ± 395 g. In the first year, 22% were rehospitalized (n = 589); respiratory diseases were the primary cause (44%). The multiple rehospitalization rate was 18%. Multivariable analysis showed that living in the most deprived neighborhoods (socioeconomic deprivation index of 5) was associated with overall rehospitalization (OR, 2.2; 95% CI, 1.5-3.6; P <.001), and multiple rehospitalizations (OR, 2.5; 95% CI, 1.2-4.9; P <.01); with socioeconomic deprivation index of 1 (least deprived) as reference. Deprivation was associated with all causes of hospitalization. Female sex (P <.001) and living in an urban area (P = .001) were protective factors. CONCLUSIONS Despite regional routine follow-up for all children, rehospitalization after very preterm birth was higher for children living in deprived neighborhoods. Families' social circumstances need to be considered when evaluating the health consequences of very preterm birth.
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Human Development Index (HDI) of the maternal country of origin as a predictor of perinatal outcomes - a longitudinal study conducted in Spain. BMC Pregnancy Childbirth 2017; 17:314. [PMID: 28934940 PMCID: PMC5609033 DOI: 10.1186/s12884-017-1515-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 09/18/2017] [Indexed: 11/11/2022] Open
Abstract
Background In an era of worldwide population displacement, recent studies have identified strong associations between social situations and perinatal outcomes among immigrants. Little is known about the effect of maternal social background on pregnancy outcomes. The Human Development Index (HDI) assesses the following dimensions of human development: life expectancy, education level and income. The objective of our study was to determine if maternal HDI may be used to identify women at increased odds of poor pregnancy outcomes. Methods We conducted a longitudinal population-based study in a tertiary centre in Madrid, Spain. The outcome variables were maternal and perinatal/antenatal mortality, preeclampsia (PE), low birth weight (LBW), gestational diabetes mellitus (GDM), preterm delivery (PTD) before 37 and 34 gestational weeks, abnormal cardiotocography (CTG) during delivery, C-section (CS) due to abnormal CTG, pH < 7.10 at birth, Apgar at 5 min ≤ 7, and resuscitation type ≥3. We performed multivariate logistic regression analyses adjusted for potential confounding variables to evaluate the associations between maternal HDI and perinatal outcomes. Results In total, 38,719 singleton infants who were born in our maternity ward between 2010 and 2016 and had perinatal outcome data available were included in this study. The neonates of women from medium/low HDI countries had significantly lower odds of low birth weight (LBW) than their very high HDI country counterparts (OR 0.63, 95% CI 0.55–0.72). However, the odds of PTD before 37 gestational weeks and PE were higher in the medium/low HDI group than the very high HDI group (OR 1.26, 95% CI 1.04–1.53; OR 1.35, 95% CI 1.02–1.79, respectively). Poorer neonatal outcomes were identified in the medium/low HDI group than the very high HDI group, including greater odds of abnormal CTG, CS due to abnormal CTG and Apgar 2 ≤ 7 (p < 0.05). Conclusions Our findings suggest that the infants of mothers from medium/low HDI had lower odds of LBW but higher odds of PTD, PE and poor neonatal outcomes. These results support the hypothesis that maternal HDI can be used to understand the impact of maternal origin on pregnancy outcomes. Further studies are needed to confirm its validity.
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Risk factors of preterm birth in France in 2010 and changes since 1995: Results from the French National Perinatal Surveys. J Gynecol Obstet Hum Reprod 2017; 46:19-28. [DOI: 10.1016/j.jgyn.2016.02.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 02/09/2016] [Accepted: 02/24/2016] [Indexed: 11/22/2022]
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Impact of neonatal risk and temperament on behavioral problems in toddlers born preterm. Early Hum Dev 2016; 103:175-181. [PMID: 27701040 DOI: 10.1016/j.earlhumdev.2016.09.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 09/14/2016] [Accepted: 09/21/2016] [Indexed: 02/02/2023]
Abstract
Children born preterm are at risk for later developmental disorders. The present study examined the predictive effects of neonatal, sociodemographic, and temperament characteristics on behavioral outcomes at toddlerhood, in children born preterm. The sample included 100 toddlers born preterm and with very-low-birth-weight, and their mothers. Neonatal characteristics were evaluated using medical records. The mothers were interviewed using the Early Childhood Behavior Questionnaire for temperament assessment, and the Child Behavior Checklist for behavioral assessment. Multiple linear regression analyses were performed. Predictors of 39% of the variability of the total behavioral problems in toddlers born prematurely were: temperament with more Negative Affectivity and less Effortful Control, lower family socioeconomic status, and younger mothers at childbirth. Temperament with more Negative Affectivity and less Effortful Control and lower family socioeconomic status were predictors of 23% of the variability of internalizing behavioral problems. Additionally, 37% of the variability of externalizing behavioral problems was explained by temperament with more Negative Affectivity and less Effortful Control, and younger mothers at childbirth. The neonatal characteristics and stressful events in the neonatal intensive care unit did not predict behavioral problems at toddlerhood. However, temperament was a consistent predictor of behavioral problems in toddlers born preterm. Preventive follow-up programs could assess dispositional traits of temperament to provide early identification of preterm infants at high-risk for behavioral problems.
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Prescott SL, Logan AC. Transforming Life: A Broad View of the Developmental Origins of Health and Disease Concept from an Ecological Justice Perspective. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13111075. [PMID: 27827896 PMCID: PMC5129285 DOI: 10.3390/ijerph13111075] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 10/21/2016] [Accepted: 10/28/2016] [Indexed: 12/20/2022]
Abstract
The influential scientist Rene J. Dubos (1901–1982) conducted groundbreaking studies concerning early-life environmental exposures (e.g., diet, social interactions, commensal microbiota, housing conditions) and adult disease. However, Dubos looked beyond the scientific focus on disease, arguing that “mere survival is not enough”. He defined mental health as fulfilling human potential, and expressed concerns about urbanization occurring in tandem with disappearing access to natural environments (and elements found within them); thus modernity could interfere with health via “missing exposures”. With the advantage of emerging research involving green space, the microbiome, biodiversity and positive psychology, we discuss ecological justice in the dysbiosphere and the forces—financial inequity, voids in public policy, marketing and otherwise—that interfere with the fundamental rights of children to thrive in a healthy urban ecosystem and learn respect for the natural environment. We emphasize health within the developmental origins of health and disease (DOHaD) rubric and suggest that greater focus on positive exposures might uncover mechanisms of resiliency that contribute to maximizing human potential. We will entrain our perspective to socioeconomic disadvantage in developed nations and what we have described as “grey space”; this is a mental as much as a physical environment, a space that serves to insidiously reinforce unhealthy behavior, compromise positive psychological outlook and, ultimately, trans-generational health. It is a dwelling place that cannot be fixed with encephalobiotics or the drug-class known as psychobiotics.
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Affiliation(s)
- Susan L Prescott
- International Inflammation (in-FLAME) Network, Worldwide Universities Network (WUN), 35 Stirling Hwy, Crawley 6009, Australia.
- School of Paediatrics and Child Health Research, University of Western Australia, P.O. Box D184, Princess Margaret Hospital, Perth 6001, Australia.
| | - Alan C Logan
- International Inflammation (in-FLAME) Network, Worldwide Universities Network (WUN), 35 Stirling Hwy, Crawley 6009, Australia.
- PathLight Synergy, 23679 Calabassas Road, Suite 542, Calabassas, CA 91302, USA.
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Opatowski M, Blondel B, Khoshnood B, Saurel-Cubizolles MJ. New index of social deprivation during pregnancy: results from a national study in France. BMJ Open 2016; 6:e009511. [PMID: 27048631 PMCID: PMC4823460 DOI: 10.1136/bmjopen-2015-009511] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To identify precariousness markers in pregnant women that differ from the usual socioeconomic variables. METHODS Data were obtained from the National Perinatal Survey, a representative sample of women giving birth in France in 2010. From six indicators of social vulnerability, four were selected by multiple correspondence analysis. The first axis of this analysis was used, characterised by the following contributory variables: receiving RSA (Revenu de Solidarité Active) allowance; benefitting from the CMU (Couverture Maladie Universelle) system (French social security) or not being insured; not living in own accommodation; and not living with a partner. These four variables were summed to create a deprivation index. RESULTS This index was strongly associated with social maternal characteristics and correctly identified women who were socially vulnerable. Furthermore, it was highly related to the psychosocial context, access to care, behaviours during pregnancy, and pregnancy outcomes. These associations remained significant after adjustment for social variables: compared with no deprivation (no factors), a high level of deprivation (≥3 factors) was associated with late prenatal care (OR 5.8, 95% CI 4.6 to 7.2) and small for gestational age (OR 1.5, 95% CI 1.1 to 1.9). CONCLUSIONS This index of social deprivation was associated with health issues and behaviours during pregnancy, even after adjustment for social variables, revealing a dimension not measured by the usual variables. Moreover, it is simple to use and easily reproducible.
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Affiliation(s)
- Marion Opatowski
- INSERM UMR 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
| | - Béatrice Blondel
- INSERM UMR 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
| | - Babak Khoshnood
- INSERM UMR 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
| | - Marie-Josèphe Saurel-Cubizolles
- INSERM UMR 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
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Abstract
PURPOSE OF REVIEW In countries with comparable levels of development and healthcare systems, preterm birth rates vary markedly--a range from 5 to 10% among live births in Europe. This review seeks to identify the most likely sources of heterogeneity in preterm birth rates, which could explain differences between European countries. RECENT FINDINGS Multiple risk factors impact on preterm birth. Recent studies reported on measurement issues, population characteristics, reproductive health policies as well as medical practices, including those related to subfertility treatments and indicated deliveries, which affect preterm birth rates and trends in high-income countries. We showed wide variation in population characteristics, including multiple pregnancies, maternal age, BMI, smoking, and percentage of migrants in European countries. SUMMARY Many potentially modifiable population factors (BMI, smoking, and environmental exposures) as well as health system factors (practices related to indicated preterm deliveries) play a role in determining preterm birth risk. More knowledge about how these factors contribute to low and stable preterm birth rates in some countries is needed for shaping future policy. It is also important to clarify the potential contribution of artifactual differences owing to measurement.
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LELONG A, JIROFF L, BLANQUET M, MOURGUES C, LEYMARIE MC, GERBAUD L, LÉMERY D, VENDITTELLI F. Is individual social deprivation associated with adverse perinatal outcomes? Results of a French multicentre cross-sectional survey. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2015; 56:E95-E101. [PMID: 26789995 PMCID: PMC4718350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 05/27/2015] [Indexed: 11/04/2022]
Abstract
INTRODUCTION French national health programmes take into account social deprivation in their implementation, those targeting perinatal outcomes, especially. The main aim of the present work was to assess the association between individual social deprivation and adverse perinatal outcomes. METHODS A multicentre cross-sectional population-based survey was performed between October and December 2007. Eligible women delivered a baby in one of the three maternity hospitals of Clermont-Ferrand area, and read and spoke French fluently. Women who had undergone voluntary termination of pregnancy were excluded. Individual social deprivation was measured by the EPICES score. Standard prenatal follow-up defined by having less than 7 consultations and quality of prenatal care defined by having at least four consultations were measured. Adverse perinatal outcomes were measured by a composite criterion defined by women who had the occurrence of the three main causes of pregnancy-related disorders: preterm delivery, and/or diabetes, and/or obstetrical hypertension. RESULTS Of the 471 eligible women, 464 were finally included. One hundred and fifteen (24.78%) women were socially deprived. The most deprived women had poor standard prenatal follow-up (p = 0.003) and poor quality of prenatal care (0.03). Nationality was the sole confounding factor identified. Deprived women had a two-fold greater risk of adverse perinatal outcomes, adjusted odds ratio 1.95 [1.15; 3.29]. DISCUSSION Social deprivation was associated with adverse perinatal outcomes. Social deprivation should be systematically screened in pregnant women standard follow-up, among migrant women, especially.
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Affiliation(s)
- A. LELONG
- Service de Santé Publique, CHU de Clermont-Ferrand, Clermont-Ferrand Cedex 1, France;, Clermont Université, Université d'Auvergne, EA 4681, Peprade (Périnatalité, grossesse, Environnement, PRAtiques médicales et DEveloppement), Clermont-Ferrand, France;,Correspondence: Audrey Lelong, Service de Santé Publique, CHU de Clermont-Ferrand, 7, place Henri Dunant, 63058 Clermont- Ferrand Cedex 1, France - Tel. +33 473750604 - Fax +33 473750619 - E-mail:
| | - L. JIROFF
- Service de Gynécologie Obstétrique, CHU de Clermont-Ferrand
| | - M. BLANQUET
- Service de Santé Publique, CHU de Clermont-Ferrand, Clermont-Ferrand Cedex 1, France;, Clermont Université, Université d'Auvergne, EA 4681, Peprade (Périnatalité, grossesse, Environnement, PRAtiques médicales et DEveloppement), Clermont-Ferrand, France
| | - C. MOURGUES
- Service de Santé Publique, CHU de Clermont-Ferrand, Clermont-Ferrand Cedex 1, France;, Clermont Université, Université d'Auvergne, EA 4681, Peprade (Périnatalité, grossesse, Environnement, PRAtiques médicales et DEveloppement), Clermont-Ferrand, France
| | - M.-C. LEYMARIE
- Service de Santé Publique, CHU de Clermont-Ferrand, Clermont-Ferrand Cedex 1, France;, Clermont Université, Université d'Auvergne, EA 4681, Peprade (Périnatalité, grossesse, Environnement, PRAtiques médicales et DEveloppement), Clermont-Ferrand, France
| | - L. GERBAUD
- Service de Santé Publique, CHU de Clermont-Ferrand, Clermont-Ferrand Cedex 1, France;, Clermont Université, Université d'Auvergne, EA 4681, Peprade (Périnatalité, grossesse, Environnement, PRAtiques médicales et DEveloppement), Clermont-Ferrand, France
| | - D. LÉMERY
- Service de Gynécologie Obstétrique, CHU de Clermont-Ferrand;, Clermont Université, Université d'Auvergne, EA 4681, Peprade (Périnatalité, grossesse, Environnement, PRAtiques médicales et DEveloppement), Clermont-Ferrand, France;, Réseau de Santé Périnatale d'Auvergne, France
| | - F. VENDITTELLI
- Service de Santé Publique, CHU de Clermont-Ferrand, Clermont-Ferrand Cedex 1, France;, Service de Gynécologie Obstétrique, CHU de Clermont-Ferrand;, Clermont Université, Université d'Auvergne, EA 4681, Peprade (Périnatalité, grossesse, Environnement, PRAtiques médicales et DEveloppement), Clermont-Ferrand, France;, Réseau de Santé Périnatale d'Auvergne, France
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Allen M, Spencer A, Gibson A, Matthews J, Allwood A, Prosser S, Pitt M. Right cot, right place, right time: improving the design and organisation of neonatal care networks – a computer simulation study. HEALTH SERVICES AND DELIVERY RESEARCH 2015. [DOI: 10.3310/hsdr03200] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundThere is a tension in many health-care services between the expertise and efficiency that comes with centralising services and the ease of access for patients. Neonatal care is further complicated by the organisation of care into networks where different hospitals offer different levels of care and where capacity across, or between, networks may be used when local capacity is exhausted.ObjectivesTo develop a computer model that could mimic the performance of a neonatal network and predict the effect of altering network configuration on neonatal unit workloads, ability to meet nurse staffing guidelines, and distance from the parents’ home location to the point of care. The aim is to provide a model to assist in planning of capacity, location and type of neonatal services.DesignDescriptive analysis of a current network, economic analysis and discrete event simulation. During the course of the project, two meetings with parents were held to allow parent input.SettingThe Peninsula neonatal network (Devon and Cornwall) with additional work extending to the Western network.Main outcome measuresAbility to meet nurse staffing guidelines, cost of service provision, number and distance of transfers, average travel distances for parents, and numbers of parents with an infant over 50 km from home.Data sourcesAnonymised neonatal data for 7629 infants admitted into a neonatal unit between January 2011 and June 2013 were accessed from Badger patient care records. Nurse staffing data were obtained from a daily ring-around audit. Further background data were accessed from NHS England general practitioner (GP) Practice Profiles, Hospital Episode Statistics, Office for National Statistics and NHS Connecting for Health. Access to patient care records was approved by the Research Ethics Committee and the local Caldicott Guardian at the point of access to the data.ResultsWhen the model was tested against a period of data not used for building the model, the model was able to predict the occupancy of each hospital and care level with good precision (R2 > 0.85 for all comparisons). The average distance from the parents’ home location (GP location used as a surrogate) was predicted to within 2 km. The number of transfers was predicted to within 2%. The model was used to forecast the effect of centralisation. Centralisation led to reduced nurse requirements but was accompanied by a significant increase in parent travel distances. Costs of nursing depend on how much of the time nursing guidelines are to be met, rising from £4500 per infant to meet guidelines 80% of the time, to £5500 per infant to meet guidelines 95% of the time. Using network capacity, rather than local spare capacity, to meet local peaks in workloads can reduce the number of nurses required, but the number of transfers and the travel distance for parents start to rise significantly above ≈ 70% network capacity utilisation.ConclusionsWe have developed a model that predicts performance of a neonatal network from the perspectives of both the service provider and the parents of infants in care.Future workApplication of the model at a national level.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
| | | | - Andy Gibson
- University of Exeter Medical School, Exeter, UK
| | | | | | - Sue Prosser
- Neonatal Unit, Royal Devon and Exeter Hospital, Exeter, UK
| | - Martin Pitt
- University of Exeter Medical School, Exeter, UK
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Germany L, Saurel-Cubizolles MJ, Ehlinger V, Napoletano A, Alberge C, Guyard-Boileau B, Pierrat V, Genolini C, Ancel PY, Arnaud C. Social context of preterm delivery in France in 2011 and impact on short-term health outcomes: the EPIPAGE 2 cohort study. Paediatr Perinat Epidemiol 2015; 29:184-95. [PMID: 25847031 DOI: 10.1111/ppe.12189] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Low socio-economic context increases the risk of preterm delivery and may affect short-term outcomes in children born preterm. We described the social context of preterm delivery in France in 2011 and compared it with the general population of deliveries over the same period. We also studied how social context influenced pregnancy and delivery characteristics in the preterm population, and how it affected mortality and short-term morbidity in liveborn preterm children (<35 weeks). METHODS We created an individual socio-economic vulnerability index, derived from multiple correspondence analysis based on maternal social information in the French National Perinatal Survey (NPS-2010). Weighted coordinates were applied to families from the EPIPAGE 2 study, a population-based cohort of preterm infants born in 2011, to quantify the infant's exposure to socio-economic vulnerability. Multivariable logistic models were used to relate the socio-economic context to pregnancy and delivery characteristics, and to assess its impact on short-term outcomes of the infants. RESULTS Among mothers of preterm infants, gestational age decreased as socio-economic conditions worsened. In the most deprived group, women had more irregular pregnancy care, a higher prevalence of infection during pregnancy, and a lower rate of antenatal corticosteroid administration. The most deprived group was associated with a higher risk of severe morbidity for the preterm neonates. CONCLUSION Our results emphasise the need for a large population-based surveillance system to identify the most deprived mothers, and to propose appropriate follow-up and care to these women and their infants in order to enhance long-term health.
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Affiliation(s)
- Laurence Germany
- Research Unit on Perinatal Epidemiology, Childhood Disabilities and Adolescent Health, INSERM UMR 1027, Toulouse, France; Paul Sabatier University, Toulouse, France
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Wood S, McNeil D, Yee W, Siever J, Rose S. Neighbourhood socio-economic status and spontaneous premature birth in Alberta. Canadian Journal of Public Health 2014; 105:e383-8. [PMID: 25365274 DOI: 10.17269/cjph.105.4370] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Revised: 10/10/2014] [Accepted: 08/24/2014] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To evaluate a possible association between neighbourhood socio-economic status and spontaneous premature birth in Alberta births. METHODS The study design was a retrospective cohort of all births in Alberta for the years 2001 and 2006. The primary outcome was spontaneous preterm birth at <37 weeks gestation. Neighbourhood socio-economic status was measured by the Pampalon Material Deprivation Index for each Statistics Canada census dissemination area. Births were linked to dissemination area using maternal postal codes. RESULTS The analysis comprised 73,585 births, in which the rate of spontaneous preterm delivery at <37 weeks was 5.3%. The rates of spontaneous preterm delivery for each neighbourhood socio-economic category ranged from 4.9% (95% CI 4.5%-5.2%) in the highest category to 6.3% (95% CI 6.0%-6.7%) in the lowest (p<0.001). After controlling for smoking, parity, maternal age and year, we found that women living in the highest socio-economic status neighbourhoods had an adjusted spontaneous preterm birth rate of 5.1% (95% CI 4.7%-5.5%) compared to 6.0% (95% CI 5.6%-6.4%) for women living in the lowest (p=0.003). CONCLUSION This study documented a modest increase in the risk of spontaneous preterm birth with low socio-economic status. The possibility of confounding bias cannot be ruled out.
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Pilkington H, Blondel B, Drewniak N, Zeitlin J. Where does distance matter? Distance to the closest maternity unit and risk of foetal and neonatal mortality in France. Eur J Public Health 2014; 24:905-10. [PMID: 24390464 PMCID: PMC4245008 DOI: 10.1093/eurpub/ckt207] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: The number of maternity units has declined in France, raising concerns about the possible impact of increasing travel distances on perinatal health outcomes. We investigated impact of distance to closest maternity unit on perinatal mortality. Methods: Data from the French National Vital Statistics Registry were used to construct foetal and neonatal mortality rates over 2001–08 by distance from mother’s municipality of residence and the closest municipality with a maternity unit. Data from French neonatal mortality certificates were used to compute neonatal death rates after out-of-hospital birth. Relative risks by distance were estimated, adjusting for individual and municipal-level characteristics. Results: Seven percent of births occurred to women residing at ≥30 km from a maternity unit and 1% at ≥45 km. Foetal and neonatal mortality rates were highest for women living at <5 km from a maternity unit. For foetal mortality, rates increased at ≥45 km compared with 5–45 km. In adjusted models, long distance to a maternity unit had no impact on overall mortality but women living closer to a maternity unit had a higher risk of neonatal mortality. Neonatal deaths associated with out-of-hospital birth were rare but more frequent at longer distances. At the municipal-level, higher percentages of unemployment and foreign-born residents were associated with increased mortality. Conclusion: Overall mortality was not associated with living far from a maternity unit. Mortality was elevated in municipalities with social risk factors and located closest to a maternity unit, reflecting the location of maternity units in deprived areas with risk factors for poor outcome.
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Affiliation(s)
- Hugo Pilkington
- 1 Département de Géographie, Université Paris 8 Vincennes-Saint-Denis, UMR7533 Ladyss, 2 rue de la Liberté, F-93526 Saint-Denis, France
| | - Béatrice Blondel
- 2 INSERM, UMRS 953, Epidemiological Research Unit on Perinatal and Women's and Children's Health, Paris, France 3 UPMC University Paris06, Paris, France
| | - Nicolas Drewniak
- 2 INSERM, UMRS 953, Epidemiological Research Unit on Perinatal and Women's and Children's Health, Paris, France 3 UPMC University Paris06, Paris, France
| | - Jennifer Zeitlin
- 2 INSERM, UMRS 953, Epidemiological Research Unit on Perinatal and Women's and Children's Health, Paris, France 3 UPMC University Paris06, Paris, France
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