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Patient journey during and after a pre-eclampsia-complicated pregnancy: a cross-sectional patient registry study

Por: Bijl · R. C. · Bangert · S. E. · Shree · R. · Brewer · A. N. · Abrenica-Keffer · N. · Tsigas · E. Z. · Koster · M. P. H. · Seely · E. W.
Objectives

To gain insight into the patient journey through a pre-eclampsia-complicated pregnancy.

Design

Cross-sectional patient registry study.

Setting

Online patient registry initiated by the Preeclampsia Foundation.

Participants

Women with a history of pre-eclampsia enrolled in The Preeclampsia Registry (TPR).

Primary and secondary outcome measures

Retrospective patient-reported experience measures concerning awareness of pre-eclampsia, timing and type of information on pre-eclampsia received, involvement in decision making regarding medical care, mental/emotional impact of the pre-eclampsia-complicated pregnancy and impact on future pregnancy planning.

Results

Of 3618 TPR-participants invited to complete the Patient Journey questionnaire, data from 833 (23%) responders were available for analysis. Most responders were white (n=795, 95.4%) and lived in the USA (n=728, 87.4%). Before their pre-eclampsia diagnosis, 599 (73.9%) responders were aware of the term ‘pre-eclampsia’, but only 348 (43.7%) were aware of its associated symptoms. Women with a lower level of education were less likely to have heard of pre-eclampsia (OR 0.36, 95% CI 0.21 to 0.62). Around the time of diagnosis, 29.2% of responders did not feel involved in the decision making, which was associated with reporting a serious mental/emotional impact of the pre-eclampsia experience (OR 2.46, 95% CI 1.58 to 3.84). Over time, there was an increase in the proportion of women who were aware of the symptoms of pre-eclampsia (32.2% before 2011 to 52.5% after 2016; p

Conclusions

This study demonstrates that improved patient education regarding pre-eclampsia is needed, that shared decision making is of great importance to patients to enhance their healthcare experience, and that healthcare providers should make efforts to routinely incorporate counselling about the later-life health risks associated with pre-eclampsia.

Trial registration number

NCT02020174.

Food insecurity status is of added value in explaining poor health: a cross-sectional study among parents living in disadvantaged neighbourhoods in the Netherlands

Objectives

The aim of this study was to examine the added value of food insecurity in explaining poor physical and mental health beyond other socioeconomic risk factors.

Design, setting, participants and outcome measures

Data for this cross-sectional study were collected using questionnaires with validated measures for food insecurity status and health status, including 199 adult participants with at least 1 child living at home, living in or near disadvantaged neighbourhoods in The Hague, the Netherlands. To assess the added value of food insecurity, optimism-corrected goodness-of-fit statistics of multivariate regression models with and without food insecurity status as a covariate were compared.

Results

In the multivariable models explaining poor physical health (Physical Component Summary: PCS) and mental health (Mental Component Summary: MCS), from all included socioeconomic risk factors, food insecurity score was the most important covariate. Including food insecurity score in those models led to an improvement of explained variance from 6.3% to 9.2% for PCS, and from 5.8% to 11.0% for MCS, and a slightly lower root mean square error. Further analyses showed that including food insecurity score improved the discriminative ability between those individuals most at risk of poor health, reflected by an improvement in C-statistic from 0.64 (95% CI 0.59 to 0.71) to 0.69 (95% CI 0.62 to 0.73) for PCS and from 0.65 (95% CI 0.55 to 0.68) to 0.70 (95% CI 0.61 to 0.73) for MCS. Further, explained variance in these models improved with approximately one-half for PCS and doubled for MCS.

Conclusions

From these results it follows that food insecurity score is of added value in explaining poor physical and mental health beyond traditionally used socioeconomic risk factors (ie, age, educational level, income, living situation, employment status and migration background) in disadvantaged communities. Therefore, routine food insecurity screening may be important for effective risk stratification to identify populations at increased risk of poor health and provide targeted interventions.

Qualitative analysis of the impact of the SARS-CoV-2 pandemic response on paediatric health services in North of Scotland and North of England

Por: Gadsby · E. W. · Christie-de Jong · F. · Bhopal · S. · Corlett · H. · Turner · S.
Objective

To capture the extent and impact of changes in the delivery of child health services in the UK, resulting from the SARS-CoV-2 pandemic response, from the perspectives of a range of child healthcare providers.

Setting

National Health Service commissioned/delivered healthcare services in two regional settings in the UK: North of Scotland (NOS) and North East and North Cumbria (NENC) in England.

Participants

Purposive sample of 39 child healthcare professionals including paediatricians, community/specialist nurses, allied health professionals and mental health professionals, from across the two regions (22 in NOS, 17 in NENC).

Methods

Semistructured qualitative interviews conducted via telephone between June and October 2020, fully transcribed and analysed in NVivo V.11 using thematic analysis.

Results

Extensive changes across a range of paediatric services were rapidly implemented to support the pandemic response and ongoing healthcare delivery. New ways of working emerged, principally to control the spread of the virus. Keeping users and their families out of hospital was an urgent driver for change. The changes had considerable impact on the health and well-being of staff with many experiencing radical changes to their working conditions and roles. However, there were some positive changes noted: some practitioners felt empowered and listened to by decision makers; some of the usual bureaucratic barriers to change were lifted; staff saw improved collaboration and joint working across the system; and some new ways of working were seen to be more efficient. Interviewees perceived the implications for children and their families to be profound, particularly with regard to self-care, relationships with practitioners and timely access to services.

Conclusions

Despite the challenges experienced by staff, the pandemic provided an opportunity for positive, lasting change. It is vital to capitalise on this opportunity to benefit patient outcomes and to ‘build back’ services in a more sustainable way.

Safety and effectiveness of low-dose aspirin for the prevention of gastrointestinal cancer in adults without atherosclerotic cardiovascular disease: a population-based cohort study

Por: Shami · J. J. P. · Zhao · J. · Pathadka · S. · Wan · E. Y. F. · Blais · J. E. · Vora · P. · Soriano-Gabarro · M. · Cheung · K. S. · Leung · W. K. · Wong · I. C. K. · Chan · E. W.
Objective

To assess the association between low-dose aspirin and the incidence of colorectal cancer (CRC), gastric cancer (GC), oesophageal cancer (EC) and gastrointestinal bleeding (GIB) in adults without established atherosclerotic cardiovascular disease.

Design

Cohort study with propensity score matching of new-users of aspirin to non-users.

Setting

Clinical Data Analysis and Reporting System database, Hong Kong.

Participants

Adults ≥40 years with a prescription start date of either low-dose aspirin (75–300 mg/daily) or paracetamol (non-aspirin users) between 1 January 2004 to 31 December 2008 without a history of atherosclerotic cardiovascular disease.

Main outcome measures

The primary outcome was the first diagnosis of gastrointestinal cancer (either CRC, GC or EC) and the secondary outcome was GIB. Individuals were followed from index date of prescription until the earliest occurrence of an outcome of interest, an incident diagnosis of any type of cancer besides the outcome, death or until 31 December 2017. A competing risk survival analysis was used to estimate HRs and 95% CIs with death as the competing risk.

Results

After matching, 49 679 aspirin and non-aspirin users were included. The median (IQR) follow-up was 10.0 (6.4) years. HRs for low-dose aspirin compared with non-aspirin users were 0.83 for CRC (95% CI, 0.76 to 0.91), 0.77 for GC (95% CI, 0.65 to 0.92) and 0.88 for EC (95% CI, 0.67 to 1.16). Patients prescribed low-dose aspirin had an increased risk of GIB (HR 1.15, 95% CI, 1.11 to 1.20), except for patients prescribed proton pump inhibitors or histamine H2-receptor antagonists (HR 1.03, 95% CI, 0.96 to 1.10).

Conclusion

In this cohort study of Chinese adults, patients prescribed low-dose aspirin had reduced risks of CRC and GC and an increased risk of GIB. Among the subgroup of patients prescribed gastroprotective agents at baseline, however, the association with GIB was attenuated.

Association between youth homicides and state spending: a Chicago cross-sectional case study

Por: Mason · M. · McLone · S. · Monuteaux · M. C. · Sheehan · K. · Lee · L. K. · Fleegler · E. W.
Objective

To identify contributing factors associated with rapid spikes and declines in Chicago youth homicide from 2009 to 2018.

Setting

City of Chicago, Illinois, US 2009–2018.

Participants

Homicide count data come from the National Violent Death Reporting System. The study included information on 2271 homicide decedents between the ages of 15 and 24 who died between 1 January 2009 and 31 December 2018. Of these decedents, 92.9% were male; 79.1% were non-Hispanic black; and 94.9% died from a firearm injury.

Primary and secondary outcome measures

(A) Temporal shifts in monthly homicide rates and (B) temporal associations between social, environmental and economic conditions/events and fluctuations in homicides.

Results

We found statistically significant shifts in homicide rates over time: a 77% rise in monthly youth homicide rates per 100 000 persons from 2015 to 2016 (4.3 vs 7.5); dropping back to pre-2015 rates (4.3) by mid-2017. There was a temporal co-occurrence between the rapid rise in youth homicides and absence of a state budget. Conversely, we found a temporal co-occurrence of the sharp decline in homicides with the reinstatement of a state budget. Adjusting for seasonality, we found death rates were greater in the months without a budget compared with months with a budget (1.48, 95% CI 1.29 to 1.70).

Conclusions

Our findings suggest that state funding may be a potential protective factor against youth homicide.

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