Evaluating an electronic monitoring system for people who wander

Wandering away from home, or elopement, is a behavior that places persons with dementia at risk of serious injury and may lead family caregivers to place their loved ones in institutions or to severely restrict their independence. Funding from the National Institute on Aging (NIA) was used to evaluate the Mobile Locater, an electronic device designed to help caregivers quickly locate a person who has eloped. This 6-month pilot study included case studies of seven users and an opinion survey of family caregivers, professional caregivers and search and rescue workers. The survey results showed that respondents were positively impressed by the device, only identifying cost as a potential drawback. Case studies revealed that the equipment was easy to use, effective, and helpful to caregivers' peace of mind. These results suggest that the Mobile Locater is a valuable tool deserving of further study.

Racial disparities in pregnancy-related drinking reduction

OBJECTIVE

The purpose of this study was to investigate the likelihood that women of different racial and ethnic groups would reduce their alcohol consumption during pregnancy.

METHODS

Data came from 22 states participating in the Pregnancy Risk Assessment Monitoring System from 2001 to 2005. After stratifying the sample by preconception drinking level, logistic regressions were used to predict drinking reduction and cessation by the third trimester by race, controlling for age, education, marital status, Medicaid status, pregnancy intention, smoking status, and state.

RESULTS

Overall, Black, Asian/Pacific Islander and Hispanic women were all significantly less likely than White women to reduce their heavy drinking after becoming pregnant. American Indian/Alaskan Native women who were moderate drinkers before conception were over 2 times more likely than White women to reduce drinking after becoming pregnant (OR 2.19, CI 0.71, 6.76), although this difference was non-significant (P = .17). Among those who binge drank in the months before pregnancy, compared to White women, Black (OR 0.26, CI 0.17-0.39), Hispanic (OR 0.19, CI 0.12-0.29), American Indian/Alaskan Native (OR 0.44 CI 0.20, 0.96), and Asian/Pacific Islander women (OR 0.11, CI 0.06-0.22) were all less likely to quit binge drinking while pregnant.

CONCLUSION

Significant racial differences in pregnancy-related drinking reduction are evident, and may help explain racial disparities in FAS. Results suggest that more targeted efforts are needed to meet the national goals of preventing alcohol-exposed pregnancies.

Exploring pregnancy-related changes in alcohol consumption between black and white women

BACKGROUND

Although epidemiological data indicate that White women are more likely to drink and binge drink before pregnancy, fetal alcohol syndrome (FAS) is more common in the Black population than among Whites in the United States. Differences in drinking cessation between Black and White women who become pregnant may help explain the disparity in FAS rates.

METHODS

The study sample was comprised of 280,126 non-Hispanic Black and White women, ages 18 to 44, from the Behavioral Risk Factor Surveillance System (BRFSS) 2001 to 2005 data sets. Predictors of reduction in alcohol consumption (in drinks per month) and binge drinking (>4 drinks on one occasion) by pregnant and non-pregnant women were identified with logistic regression. The effect of interactions of pregnancy status with age, education, and Black or White race on drinks per month and binge occasions were explored using analysis of variance (ANOVA).

RESULTS

Pregnant White women averaged 79.5% fewer drinks per month than non-pregnant White women (F = 1250.1, p < 0.001), and 85.4% fewer binge drinking occasions (F = 376, p < 0.001). Pregnant Black women averaged 58.2% fewer drinks per month than non-pregnant Black women (F = 31.8, p < 0.001) and 64.0% fewer binge occasions (F = 13.8, p < 0.001). Compared to Black women, White women appear to make a 38% greater reduction in drinks per month, and a 33% greater reduction in binge occasions.

CONCLUSIONS

Non-Hispanic White women appear more likely to reduce drinks per month and binge drinking occasions than non-Hispanic Black women during pregnancy. These findings may help explain disparities in FAS in the United States, though this cross-sectional sample does not permit claims of causation. To better describe the impact of differential drinking reduction on FAS rates, future studies of longitudinal data should be done.

Surveillance of preconception health indicators in behavioral risk factor surveillance system: emerging trends in the 21st century

OBJECTIVES

This article assesses emerging trends in the 21st century, if any, in preconception health indicators among women of reproductive age.

METHODS

This is a secondary analysis of cross-sectional data from the Behavioral Risk Factor Surveillance System (BRFSS), 2003-2010. Subjects were a sample of noninstitutionalized, 18-44-year-old, nonpregnant, women in the United States (n=547,177) grouped into two categories, 2003-2006 (n=275,630) and 2007-2010 (n=271,547). Overall crude and adjusted prevalence odds ratios were calculated for preconception indicators before 2006 and after 2006.

RESULTS

Significant improvements were found for any and heavy alcohol use, smoking, social and emotional support, moderate/vigorous physical activity, and having had an influenza shot in the last year. In contrast, binge drinking, having a medical condition (i.e., diabetes, high blood pressure, asthma, or obesity), and self-reported health significantly worsened. No change was found for mental distress, HIV testing, and having a routine checkup.

CONCLUSIONS

As the 21st century unfolds, emerging trends suggest that we need to focus on educating women, providers, and public health advocates about improved health before pregnancy, especially for women with chronic conditions and those who binge drink alcohol.

Differences in pregnancy planning between women aged 18-44, with and without diabetes: behavioral risk factor surveillance system analysis

AIM

Assess differences in pregnancy planning and behavioral risk factors among women of reproductive age, by diabetes status.

METHODS

A secondary analysis of cross-sectional data from the Behavioral Risk Factor Surveillance System (2002 and 2004) was conducted. Subjects were 18-44-year-old, non-pregnant, fertile women, grouped into two categories: non-diabetes (n=57,436), and diabetes (n=2929). Multivariable logistic regression was used to estimate adjusted prevalence odds ratios and 95% confidence intervals.

RESULTS

Approximately 93% of women of reproductive age with or without diabetes are not intending a pregnancy, and yet among them, women with diabetes are 22% more likely not to use any birth control at all. Women with diabetes are 3.4 times more likely to be obese, 1.4 times more likely to be overweight, 35% less likely to drink any alcohol, and 27% less likely to binge drink alcohol, than women without diabetes. There were no differences in risk factors between women with diabetes that were and were not intending a pregnancy.

CONCLUSIONS

Birth control nonuse for women with diabetes not intending a pregnancy and lack of behavioral change for women with diabetes intending a pregnancy, combined with an increasing prevalence in diabetes, will likely result in significant economic and social tolls on society.

Residential characteristics and household risk factors and respiratory diseases in Chinese women: the Seven Northeast Cities (SNEC) study

BACKGROUND

Few studies have assessed the impact of residential home characteristics and home environmental risk factors on respiratory diseases in Chinese women. Therefore, this study sought to determine the association between residential home features, domestic pets, home renovation and other indoor environmental risk factors with respiratory health outcomes of Chinese women.

METHODS

This cross-sectional study included a study sample of 30,780 Chinese women aged 23 to 49 from 25 districts of seven cities in Liaoning Province, Northeast China. Information on respiratory health, residential characteristics, and indoor air pollution sources was obtained by a standard questionnaire from the American Thoracic Society. Multivariable logistic regression was used to estimate prevalence odds ratios (POR) and 95% confidence interval (95%CI).

RESULTS

The odds of respiratory diseases were higher for those who lived near the main road, or near ambient air pollution sources. Pet-keeping was associated with increased odds of chronic bronchitis (POR=1.40; 95%CI: 1.09-1.81) and doctor-diagnosed asthma (POR=2.07; 95%CI: 1.18-3.64). Additionally, humidifier use was associated with increased odds of chronic bronchitis (POR=1.44; 95%CI: 1.07-1.94). Home renovation in recent 2 years was associated with increased likelihood of allergic rhinitis (POR=1.39; 95%CI 1.17-1.64).

CONCLUSION

Home renovation and residential home environmental risk factors were associated with an increased likelihood of respiratory morbidity among Chinese women.

Non-linear Relationship of Maternal Age With Risk of Spontaneous Abortion: A Case-Control Study in the China Birth Cohort

Background

Spontaneous abortion is one of the prevalent adverse reproductive outcomes, which seriously threatens maternal health around the world.

Objective

The current study is aimed to evaluate the association between maternal age and risk for spontaneous abortion among pregnant women in China.

Methods

This was a case-control study based on the China Birth Cohort, we compared 338 cases ending in spontaneous abortion with 1,352 controls resulting in normal live births. The main exposure indicator and outcome indicator were maternal age and spontaneous abortion, respectively. We used both a generalized additive model and a two-piece-wise linear model to determine the association. We further performed stratified analyses to test the robustness of the association between maternal age and spontaneous abortion in different subgroups.

Results

We observed a J-shaped relationship between maternal age and spontaneous abortion risk, after adjusting for multiple covariates. Further, we found that the optimal threshold age was 29.68 years old. The adjusted odds ratio (95% confidence interval) of spontaneous abortion per 1 year increase in maternal age were 0.97 (0.90–1.06) on the left side of the turning point and 1.25 (1.28–1.31) on the right side. Additionally, none of the covariates studied modified the association between maternal age and spontaneous abortion (P > 0.05).

Conclusions

Advanced maternal age (>30 years old) was significantly associated with increased prevalence of spontaneous abortion, supporting a J-shaped association between maternal age and spontaneous abortion.

Association between maternal outdoor physical exercise and the risk of preterm birth: a case-control study in Wuhan, China

BACKGROUND

China had the second largest proportion of preterm birth (PTB) internationally. However, only 11% of pregnant women in China meet international guidelines for maternal physical activity, a significantly lower proportion than that in Western countries. This study aims to examine the association between outdoor physical exercise during pregnancy and PTB among Chinese women in Wuhan, China.

METHODS

A case-control study was conducted among 6656 pregnant women (2393 cases and 4263 controls) in Wuhan, China from June 2011 to June 2013. Self-reported measures of maternal physical exercise (frequency per week and per day in minutes) were collected. Adjusted odds ratios were estimated using Bayesian hierarchical logistic regression and a generalized additive mixed model (GAMM).

RESULTS

Compared to women not involved in any physical activity, those who participated in physical exercise 1-2 times, 3-4 times, and over five times per week had 20% (aOR: 0.80, 95% credible interval [95% CI]: 0.68-0.92), 30% (aOR: 0.70, 95% CI: 0.60-0.82), and 32% (aOR: 0.68, 95% CI: 0.59-0.78) lower odds of PTB, respectively. The Bayesian GAMM showed that increasing physical exercise per day was associated with lower risk of PTB when exercise was less than 150 min per day; however, this direction of association is reversed when physical exercise was more than 150 min per day.

CONCLUSION

Maternal physical exercise, at a moderate amount and intensity, is associated with lower PTB risk. More data from pregnant women with high participation in physical exercise are needed to confirm the reported U-shape association between the physical exercise and risk of preterm birth.

Predictors of size for gestational age in St. Louis City and County

OBJECTIVE

To identify social, behavioral, and physiological risk factors associated with small for gestational age (SGA) by gestational age category in St. Louis City and County.

METHODS

A retrospective cohort study was conducted using birth certificate and fetal death records from 2000 to 2009 (n = 142,017). Adjusted associations of risk factors with SGA were explored using bivariate logistic regression. Four separate multivariable logistic regression analyses, stratified by gestational age, were conducted to estimate adjusted odds ratios.

RESULTS

Preeclampsia and inadequate weight gain contributed significantly to increased odds for SGA across all gestational age categories. The point estimates ranged from a 3.41 increased odds among women with preeclampsia and 1.76 for women with inadequate weight gain at 24-28 weeks' gestational age to 2.19 and 2.11 for full-term infants, respectively. Among full-term infants, smoking (aOR = 2.08), chronic hypertension (aOR = 1.46), and inadequate prenatal care (aOR = 1.25) had the next most robust and significant impact on SGA.

CONCLUSION

Preeclampsia and inadequate weight gain are significant risk factors for SGA, regardless of gestational age. Education on the importance of nutrition and adequate weight gain during pregnancy is vital. In this community, disparities in SGA and smoking rates are important considerations for interventions designed to improve birth outcomes.

Association of types of diabetes and insulin dependency on birth outcomes

BACKGROUND

Diabetes rates among pregnant women in the United States have been increasing and are associated with adverse pregnancy outcomes.

AIM

To investigate differences in birth outcomes (preterm birth, macrosomia, and neonatal death) by diabetes status.

METHODS

Cross-sectional design, using linked Missouri birth and death certificates (singleton births only), 2010 to 2012 (n = 204057). Exposure was diabetes (non-diabetic, pre-pregnancy diabetes-insulin dependent (PD-I), pre-pregnancy diabetes-non-insulin dependent (PD-NI), gestational diabetes- insulin dependent (GD-I), and gestational diabetes-non-insulin dependent (GD-NI)]. Outcomes included preterm birth, macrosomia, and infant mortality. Confounders included demographic characteristics, adequacy of prenatal care, body mass index, smoking, hypertension, and previous preterm birth. Bivariate and multivariate logistic regression assessed differences in outcomes by diabetes status.

RESULTS

Women with PD-I, PD-NI, and GD-I remained at a significantly increased odds for preterm birth (aOR 2.87, aOR 1.77, and aOR 1.73, respectively) and having a very large baby [macrosomia] (aOR 3.01, aOR 2.12, and aOR 1.96, respectively); in reference to non-diabetic women. Women with GD-NI were at a significantly increased risk for macrosomia (aOR1.53), decreased risk for their baby to die before their first birthday (aOR 0.41) and no difference in risk for preterm birth in reference to non-diabetic women.

CONCLUSION

Diabetes is associated with the poor birth outcomes. Clinical management of diabetes during pregnancy and healthy lifestyle behaviors before pregnancy can reduce the risk for diabetes and poor birth outcomes.

Are Statutory Requirements Followed in the Certification of Traumatic, Unexpected, and Unattended Deaths in Missouri?

Medical examiners and coroners (ME/Cs) investigate deaths important to public health. This cross-sectional study evaluated 343,412 death certificates from 2007 to 2012 in Missouri. We examined agreement between cause and manner of death by year and ME/C contact as well as 2010-2012 trends in ME/C contact. There was near perfect agreement between cause and manner of death when an ME/C was contacted (kappa=0.97, p < 0.0001) and a significant increase in the proportion of deaths with ME/C contact from 2010 to 2012 (p =< 0.0001). There was a significantly higher proportion of ME/C-certified deaths using the electronic system in 2010-2012 (aOR = 1.18, 95% CI 1.15, 1.21) compared to the manual system in 2007-2009. Black, non-Hispanic (aOR = 1.50, 95% CI 1.43,1.57) and Hispanic (aOR = 1.31, 95% CI 1.13, 1.51) deaths, compared to White, non-Hispanic deaths, were associated with a significantly greater odds of ME/C certification. Race as an independent predictor of ME/C death certification warrants further research.

Disparities rank high in prioritized research, systems and service delivery needs in Missouri

OBJECTIVES

An essential function of public health is to conduct research and in Missouri, a research agenda was initiated to promote the health and well being of women and children. In 2005, a survey was emailed to 180 maternal and child health (MCH) researchers throughout the state, with 130 responding for a 72.2% response rate. These individuals were asked to select research priorities out of a list of 130 research agenda items, identify personal areas of expertise, and to recommend new research topics.

RESULTS

Results focused on identifying research priorities and research experts. The first, of the five leading research priorities, was researching disparities in terms of age, race, ethnicity, and gender, regarding sexually transmitted diseases, chronic disease, birth outcomes, prenatal care, access to care, childhood exposure to lead, immunizations and vaccinations, mental health, substance abuse, and oral health. The four remaining, of the top five specific research priorities, in order of priority, included (2) reducing barriers to health care access, (3) constructing research ecologically, (4) increasing access to oral health care for children, and (5) reducing the prevalence of children who are at-risk for being overweight. Of the 130 respondents, 83.1% reported at least one area of expertise, with a mean of 7.4 areas of expertise per respondent (range 0-41). Forty percent of the respondents reported health care access as an area of expertise, followed by school health, community development, family support, and pre/post natal care (38.5%, 36.2%, 30.0%, 28.5%, and 26.9%) respectively. Interestingly, only 17.7% of the respondents reported disparities as their area of expertise.

CONCLUSIONS

The goal of moving innovations towards changes in practice can only happen when resources are available to assess innovations and communities are ready to implement those innovations. The prioritization of this MCH research agenda, prioritized by a community of MCH researchers with expertise in conducting MCH related research, is the first step towards changes in practice, ultimately leading to improvements in the health of women and children in Missouri.

Refreshing the Perinatal Periods of Risk: A New Reference Group and Nationwide Large-County-Level Analyses

INTRODUCTION

The Perinatal Periods of Risk approach (PPOR) is designed for use by communities to assess and address the causes of high fetal-infant mortality rates using vital records data. The approach is widely used by local health departments and their community and academic partners to inform and motivate systems changes. PPOR was developed and tested in communities based on data years from 1995 to 2002. Unfortunately, a national reference group has not been published since then, primarily due to fetal death data quality limitations.

METHODS

This paper assesses data quality and creates a set of unbiased national reference groups using 2014-2016 national vital records data. Phase 1 and Phase 2 analytic methods were used to divide excess mortality into six components and create percentile plots to summarize the distribution of 100 large US counties for each component.

RESULTS

Eight states with poor fetal death data quality were omitted from the reference groups to reduce bias due to missing maternal demographic information. There are large Black-White disparities among reference groups with the same age and education restrictions, and these vary by component. PPOR results vary by region, maternal demographics, and county. The magnitude of excess mortality components varies widely across US counties.

DISCUSSION

New national reference groups will allow more communities to do PPOR. Percentile plots of 100 large US counties provide an additional benchmark for new communities using PPOR and help emphasize problem areas and potential solutions.