Dissertations / Theses on the topic 'Adverse infant health outcomes'
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1
Salemi, Jason Lee. "Elective Early Term Delivery and Adverse Infant Outcomes in a Population-Based Multiethnic Cohort." Scholar Commons, 2014. https://scholarcommons.usf.edu/etd/5118.
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The length of human pregnancy, arguably the most natural of physiological processes, is undergoing subtle but consequential modification in order to adapt to modern societal demands. The gestational age distribution of births in the United States has been shifting to lower gestational ages over the past two decades, parallel to a concomitant rise in obstetrical intervention in pregnancy. The result has been an increase in elective deliveries at 37-38 weeks (early term).
A population-based retrospective cohort study of over 616,000 live-born full-term singleton infants was conducted to investigate the association between elective early term delivery and subsequent infant morbidity, mortality, and health care utilization in the first year of life. Data were examined from a statewide, multi-year, clinically-enhanced database created by linking birth certificate records to maternal and infant hospital discharge records, and to infant death certificates, for all infants born to Florida-resident mothers from 2005-09. All infants delivered to mothers with an established medical condition that could have justified early delivery were excluded from the study, as it would not be possible to determine if an early delivery in those cases was elective or medically-necessary. Based on the timing and reason for delivery initiation, the study population was categorized into four exposure groups: 1) early electively induced delivery at 37-38 weeks (EED-I), 2) early elective cesarean delivery at 37-38 weeks (EED-CS), 3) early spontaneous delivery at 37-38 weeks (ESD), 4) early medically-indicated delivery at 37-38 weeks (EID). The comparison group consisted of all expectantly managed infants who were full term deliveries (FTD) at ≥39 weeks. Adverse infant outcomes in the first year of life included respiratory morbidities, neonatal sepsis, feeding difficulties, admission to the neonatal intensive care unit, the frequency and duration of hospital encounters, and infant mortality. Multivariable generalized linear mixed models were used to estimate odds ratios (OR) or rate ratios (RR) and 95% confidence intervals (CI) between exposure and each outcome, adjusting for maternal, infant, and hospital characteristics and accounting for the correlation among infants born at the same facility.
Infants who were delivered by EED-I or EED-CS comprised 13% of the study population, and 40% of infants born in the early term period. Infants who were delivered by EED-I experienced the lowest likelihoods of respiratory morbidities, neonatal sepsis, and admission to the NICU when compared to FTD infants. In contrast, infants delivered by EED-CS had significantly increased risks several adverse birth outcomes, with magnitudes ranging from a 9% to 40% increase. Only 8.3% of all infants were re-admitted to the hospital after birth. Despite having the lowest likelihood of the birth morbidities studied, infants delivered by EED-I had a small 10-15% increased odds of being re-hospitalized in the first year of life, compared to FTD infants. These infants also had a slightly higher mean number of visits and combined LOS during post-birth hospitalizations, although the absolute differences from other exposure groups was small. Elective early term cesarean infants actually had a slightly lower risk of re-hospitalization, particularly re-hospitalizations that occurred between weeks 3-52 of life. Neonatal and post-neonatal deaths were rare events (0.3 and 1.3 deaths per 1,000 live births, respectively) in this comparatively low-risk study population. There were no differences in survival when comparing the EED-I and EED-CS groups to the FTD group.
The results of this study raise the concern that these public health efforts to reduce elective early term inductions have been based on biased evidence from a limited number of studies in which artificially elevated risks for early electively-induced infants were reported. In stark contrast to the current dogma, this study found that when a methodologically appropriate comparison group was used (i.e., expectant management), elective induction prior to 39 weeks was NOT associated with an increased risk of any adverse infant outcomes in early life. In contrast, our findings do support the avoidance of purely elective cesarean sections prior to 39 weeks in lieu of expectant management. The evidence presented in this large, methodologically-sound study should caution against a general avoidance of ALL elective early term deliveries, and foster support for continued research in this still relatively new arena.
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Novelli, Lauren. "Racism and Infant Mortality: Links Between Racial Stress and Adverse Birth Outcomes for African American Women and their Infants." University of Cincinnati / OhioLINK, 2015. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1439305228.
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Mburia, Ingrid. "Adverse Birth Outcomes and Associated Risk Factors." Thesis, University of Nevada, Reno, 2017. http://pqdtopen.proquest.com/#viewpdf?dispub=10244872.
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The cause for adverse birth outcomes such as prematurity, low birth weight, small for gestational age, among others, is not clearly understood. Despite medical advancements, infants that overcome poor birth outcomes face significant cognitive, behavioral, and developmental challenges in their childhood and throughout their lifespan.
It has been established that some race/ethnic groups and populations in the lower economic strata are disproportionately affected by adverse birth outcomes. It is of utmost importance to continue exploring factors that contribute to race/ethnic disparities in order to develop targeted intervention strategies. In Nevada, several initiatives have been developed to address disparities in poor birth outcomes, however, the state faces challenges such as: provider shortages, long distance to hospitals and/or areas that offer health care services, low high school graduation rates, exposure to environmental tobacco smoke among casino workers, a growing prescription and illicit drug use problem, among others.
The goals of this epidemiological study were to: 1) determine whether distance was a barrier in obtaining specialized care for very low birth weight (VLBW) infants, 2) asses the association between working in the service industry and preterm birth among Hispanic women and 3) evaluate the relationship between depression, substance use, and low birth weight.
In study one, distance of more than 50 miles was found to be associated with delivery of a VLBW infant in a non-level III hospital. Study two revealed that Hispanic women working in the service industry had increased odds of preterm birth compared to those working in administrative support positions. Results of study three showed that mothers who used prescription drugs during pregnancy had higher odds of delivering a low birth weight baby. Additionally, women with a clinical diagnoses of depression prior to becoming pregnant had higher odds of using substances during pregnancy (OR: 3.51; 95% CI = 3.46–3.56) compared to women who did not have a clinical diagnoses of depression prior to pregnancy. The findings of this dissertation support avenues to further explore factors associated with adverse birth outcomes and barriers to accessing health care services among pregnant women.
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Reulen, Raoul. "Adverse health outcomes in survivors of childhood cancer." Thesis, University of Birmingham, 2009. http://etheses.bham.ac.uk//id/eprint/265/.
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This thesis concerns investigations into adverse health outcomes among survivors of childhood cancer using the British Childhood Cancer Survivor Study (BCCSS). The BCCSS is a large-scale population-based cohort of 17,981 survivors of childhood cancer who were diagnosed with childhood cancer (age 0-14 years) between 1940 and 1991, in Britain, and had survived for at least five years. The specific aims were to investigate, within the BCCSS cohort; (1) the psychometric properties of the SF-36 health-status questionnaire, (2) the self-reported health-status by using the SF-36, (3) the effect of therapeutic radiation on the offspring sex ratio, (4) the risks of adverse pregnancy outcomes, and (5) the risks of second primary breast cancer. This thesis demonstrates that the SF-36 questionnaire exhibits good validity and reliability when used in long-term survivors of childhood cancer. Survivors rate their physical and mental health similarly to those in the general population, apart from bone and central nervous system tumour survivors who rate their physical health below population norms. Therapeutic irradiation does not alter the sex ratio of offspring. Female survivors exposed to abdominal irradiation are at a three-fold risk of delivering premature and two-fold risk of producing low birth-weight offspring. Lastly, the risk of breast cancer among female survivors is two-fold that of the general population, but is not sustained into ages at which the risk of breast cancer in the general population becomes substantial.
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Gheorghe, Mihaela. "Adverse Health Outcomes Among Organ Replacement Patients in Canada." Thèse, Université d'Ottawa / University of Ottawa, 2011. http://hdl.handle.net/10393/19863.
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BACKGROUND: Organ transplantation is one of the best modalities for treating fatal organ failure. Despite the success of this procedure, an increasing incidence of cancer in this population has drawn the attention of public health officials in recent years.
OBJECTIVES: The overall objective of this study is to conduct a detailed examination of adverse health outcomes among Canadian organ transplant recipients, with an emphasis on cancer incidence and mortality.
METHODS: This project employed a retrospective cohort follow-up study design, whereby Canadian Organ Replacement Registry records were linked to the Canadian Mortality Database and the Canadian Cancer Registry Database. The study population consisted of more than 16,000 solid organ transplant recipients registered between January 1, 1981 and December 31, 1998. This study was designed to assess the risks of developing cancer, overall and site-specific, in transplant recipients in comparison to the general Canadian population using Standardized Incidence Ratios (SIR), Standardized Mortality Ratios (SMR), and Proportionate Mortality Ratios (PMR). In addition, Cox and logistic models were used to assess the effects of various risk factors on cancer incidence and mortality in transplant sub-populations, while cumulative incidence was used to study the patient survival pattern. Lastly, Population Attributable Risk (PAR) was used to quantify the impact of organ transplantation on cancer incidence and mortality.
RESULTS: Among major causes of death, the highest PMRs are due to genitourinary diseases, followed by endocrine, nutritional and metabolic diseases, and infectious diseases. SIRs indicate that cancer incidence and mortality were relatively lower than that observed for other major causes of death, and slightly higher than that observed in the general Canadian population. Lastly, logistic regression results indicate that age, year of surgery, and smoking status were significant risk factors in mortality due to all causes, while the Cox regression model shows that age, sex and year of surgery were significant risk factors for cancer incidence. Overall, the PAR in this cohort was very minimal, indicating that the risk in mortality and cancer incidence due to organ transplantation is negligible.
CONCLUSION: Life threatening diseases such as those of the genitourinary system, as well as endocrine, nutritional and metabolic diseases and infectious diseases are leading causes of death. Future research should be directed at ways of reducing incidence and subsequent mortality due to these causes.
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Hall, Ashleigh J. "Adverse Childhood Experiences and Resilience: Health Outcomes in Adolescents." Master's thesis, Temple University Libraries, 2018. http://cdm16002.contentdm.oclc.org/cdm/ref/collection/p245801coll10/id/595952.
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Urban BioethicsM.A.
Adverse childhood experiences, known as ACEs, have been shown to negatively impact an individual’s health as an adult. While efforts to decrease children’s exposure to these traumatic experiences are beneficial, they are not able to fully eliminate these experiences and do not address how to help children who have already been exposed. Resilience, which has been defined as managing and adapting to significant sources of trauma, has been thought to be a protective factor against the toxic stress of ACEs. While the relationship between ACEs and poor health outcomes has been established, the relationship between resilience and health outcomes is largely unknown. This study seeks to determine the association between resilience scores on a validated resilience questionnaire and health outcomes in adolescents. Looking specifically at body mass index, blood pressure, and depression scores on a validated depression screen we hypothesize that higher resilience scores will be associated with better health outcomes. In addition, we examine the relationship between ACE scores and resilience scores. If this validated resilience instrument is able to help predict health outcomes, this can direct development of intervention programs to build resilience in those living in ACE-heavy environments.
Temple University--Theses
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Alisio, Michelle. "Adverse impact of hospitalisation on infant breastfeeding practices: a prospective cohort study." Master's thesis, Faculty of Health Sciences, 2019. http://hdl.handle.net/11427/31164.
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Background: In South Africa, the exclusive breastfeeding prevalence at six months is low at 24% and the under-5 mortality rate remains high. Improving breastfeeding rates is the most cost-effective intervention to reduce under-5 mortality and morbidity. Data on the effect of infant hospitalisation on breastfeeding may inform facility-based interventions to protect and support exclusive and prolonged breastfeeding. Aim: To assess the impact of hospitalisation on breastfeeding and explore reasons for stopping or continuing breastfeeding. Methods: We conducted a prospective cohort study of infant feeding practices among mother-infant dyads admitted to general paediatric wards at a tertiary children’s hospital in Cape Town, South Africa. Medical, demographic and feeding practice data were collected through semi-structured interviews on admission, again during hospitalisation and a third interview was conducted telephonically post discharge. Logistic regression analysis was used to assess factors associated with different feeding practices. Results: Between January and April 2018, 119 mothers (median age 26 years, IQR 22-32; 28% HIV-positive) were interviewed at admission; 39% (46/119) breastfed exclusively (EBF) and 28 (24%) reported no breastfeeding. Most infants (median age 1.8 months, IQR 1.0-3.2; 34% preterm) were admitted for lower respiratory tract infection (59%) or diarrhoea (14%). EBF at admission was associated with younger infant age (per month increase, aOR 0.18, 95% CI 0.07-0.43); none of the children admitted for diarrhoea had been EBF. A second in-hospital interview occurred at median 4 days (IQR 2-6) after admission. The overall prevalence of any breastfeeding declined from 77% at admission to 61% in-hospital. Risk factors for in-hospital breastfeeding cessation included low birth weight (<2500g; OR 3.81, 95% CI 1.35-10.74) and feeding via either bottle/tube (OR 51.00, 95% CI 6.38-407.71). Maternal expression of breastmilk (vs no expression in-hospital) was protective against in hospital breastfeeding cessation (OR 0.07, 95% CI 0.01-0.33). Post-discharge telephonic interviews (median 5 months after discharge) were available for 92 mother-infant dyads; 21 infants were ≤ six months of age, of whom 24% (5/21) were still exclusively breastfeeding. Breastfeeding cessation at any time after admission and before post-discharge telephonic interview was associated with maternal HIV infection (OR 2.82, 95% CI 0.84-9.40), full time employment (OR 4.95, 95% CI 1.40-17.46) and preterm birth (OR 3.53, 95% CI 1.27-9.81). Conclusion: Prevalence of both any and exclusive breastfeeding was low at admission to hospital, and lack of breastfeeding strongly correlated with increased risk of an infectious morbidity diagnosis. In addition, hospitalisation substantially reduced the probability of continued breastfeeding. In-hospital breastfeeding support and facilitation of breastmilk expression while infants are unable to breastfeed should be increased. Implementation research may define effective in-hospital breastfeeding support interventions.
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Crispo, James Alexander George. "Pharmacotherapies in Parkinson Disease: Investigating Trends and Adverse Health Outcomes." Thesis, Université d'Ottawa / University of Ottawa, 2016. http://hdl.handle.net/10393/35065.
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Parkinson disease (PD) is the second most common neurodegenerative disease worldwide, with estimates suggesting that PD prevalence and incidence will increase with aging populations. Therapeutic options and clinical guidelines for PD have significantly changed over the past 15 years; however, pharmacoepidemiology data in PD are lacking, especially regarding adverse effects of non-ergot dopamine agonists (DAs) and outcomes associated with anticholinergic burden. The objectives of this doctoral research are threefold: 1) examine patterns of antiparkinson drug use in relation to clinical guideline publication, drug availability, and emerging safety concerns; 2) determine whether PD patients treated with non-ergot DAs are at increased risk of adverse cardiovascular or cerebrovascular outcomes; and 3) determine whether anticholinergic burden is associated with adverse outcomes in PD. Specific research questions were investigated using epidemiological methods and electronic health data from Cerner Health Facts®, an electronic medical record database that stores time-stamped patient records for more than 300 Cerner subscribing facilities across the United States. Findings from this work are reported in a series of manuscripts, all of which have been published. Key findings include: 1) DA use began declining in 2007, from 34% to 27% in 2012. The decline followed publication of the American Academy of Neurology’s practice parameter refuting levodopa toxicity, pergolide withdrawal, and pramipexole label revisions; 2) heart failure was the only adverse cardiovascular or cerebrovascular outcome that demonstrated a significant association with non-ergot DA use, mainly pramipexole; and 3) anticholinergic burden in PD was associated with the diagnosis of fracture and delirium, and significantly increased the risk of emergency department visit and readmission post inpatient discharge. Reported antiparkinson prescribing trends suggest that safety and best practice information may be communicated effectively in PD. Although findings warrant replication, individuals with PD and independent risk factors for or a history of heart failure may benefit from limited use of pramipexole. Similarly, individuals with PD may benefit from substituting non-PD medications with anticholinergic effects for equally effective non-anticholinergic agents. Additional pharmacovigilance studies are needed to better understand health risks and the impact of population health interventions in PD.
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Kwok, Man-ki, and 郭文姬. "Short and medium term health outcomes of infant lifestyle." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2010. http://hub.hku.hk/bib/B4475873X.
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Guha, Joyeeta. "Risks of adverse health and social outcomes among childhood cancer survivors." Thesis, University of Birmingham, 2016. http://etheses.bham.ac.uk//id/eprint/6612/.
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As a result of improvement in survival after childhood cancer, there are now increasing numbers of long-term survivors of childhood cancer living in the United Kingdom and across Europe. Specific groups of these childhood cancer survivors experience substantial excess risks of adverse health and social outcomes. Using the population-based British Childhood Cancer Survivor Study (BCCSS) the following areas were investigated: (I) The proportion of survivors on regular long-term hospital follow-up using risk stratification levels of care developed by the BCCSS in partnership with the National Cancer Survivorship Initiative. (2) The risks of adverse health and social outcomes using record-linkage and a self-reported questionnaire to assess which survivors of central nervous system tumours were at excess risk compared to the general population. (3) The risk of hospitalisation due to cerebrovascular conditions among childhood cancer survivors by electronic record linkage with Hospital Episode Statistics. Using the European PanCareSurFup cohort, the excess risks of genitourinary subsequent primary neoplasms were investigated among five-year survivors of childhood cancer. This thesis quantifies the risks experienced by childhood cancer survivors in four areas and provides an evidence-base for risk stratification by healthcare professionals caring for survivors.
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Lydon-Rochelle, Mona Theresa. "Method of delivery and risk of subsequent adverse maternal health outcomes /." Thesis, Connect to this title online; UW restricted, 1999. http://hdl.handle.net/1773/7286.
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Onyebuchi, Chinyere. "Effects of Neighborhood Membership and Hypertensive Disorders in Pregnancy on Adverse Birth Outcomes." ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/6935.
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Infant mortality (IM) rates in the United States remains high. The higher rates of IM among specific groups in the United States is believed to be fueled by the high rates of adverse birth outcomes including low birthweight (LBW) and preterm births (PTB) among these groups. Adverse birth outcomes have also been linked to the presence of hypertensive disorders during pregnancy. The purpose of this cross-sectional study was to explore the association between hypertensive disorders during pregnancy and adverse birth outcomes and the impact of the residential neighborhood of expectant mothers on this association. The life course health development theory guided the framework for this study. Study data were obtained from the 2010 New York City birth records and the 2010 US Census. Descriptive statistics and logistic regression analysis were used to address the 3 research hypotheses of the study. The study found that prepregnancy hypertension (HTN) (AOR: 2.84 & 3.25), gestational HTN (AOR: 2.28 & 3.33) and eclampsia (AOR: 4.41 & 6.70) were significantly associated with PTB and LBW respectively. Neighborhood segregation was not significant for PTB (AOR: 1.01) or LBW (AOR: 1.03). Neighborhood poverty was significant for PTB (AOR: 0.86) but not for LBW (AOR: 1.05). Neighborhood segregation and poverty had significant moderating effects on the prepregnancy HTN (p = 0.00), gestational HTN (p = 0.00), eclampsia (p = 0.00) and PTB and LBW association. Results from this study can help to address disparities in birth outcomes among women of differing races and ethnicities and thereby contribute to positive social change.
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Yaya, Getinet Ayano. "Adverse mental health and educational outcomes in offspring of parents with mental health problems." Thesis, Curtin University, 2021. http://hdl.handle.net/20.500.11937/87665.
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This thesis investigated the risk of psychiatric disorders and symptoms and adverse educational outcomes in offspring of parents with mental health problems. The data for this thesis came from both primary (longitudinal birth cohort data) and secondary (published studies). Findings suggested that, after adjusting for potential confounders, parental mental health problems were associated with increased risk of a wide range of mental health problems in the offspring during childhood, adolescence, and young adulthood.
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Steele, Larry Lee. "Occupational exposures and adverse pregnancy outcomes among a cohort of female veterinarians /." The Ohio State University, 1992. http://rave.ohiolink.edu/etdc/view?acc_num=osu1487760357821299.
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Forsythe, Grace Williams. "Infant feeding practices and growth outcomes of Rastafarian children." FIU Digital Commons, 1987. http://digitalcommons.fiu.edu/etd/3336.
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This study was undertaken to determine Rastafarian infancy and childhood feeding practices and to analyze the effects of this vegan diet on the nutrient intake and growth of Rastafarian infants and children.
The Rastafarian cult originated in Jamaica, West Indies. Rastafarians have special religious, dietary and social guidelines, including many dietary prohibitions. The daily spiritual ritual includes smoking marijuana. Forty children of immigrant Rastafarians living in Miami were assessed to analyze their vegan diet and its effects on their nutrient intake and growth. All children had been breast-fed for an average of two years in conjunction with the early addition of foods. Bush teas were preferred to soy formulas and were used medicinally.
Excluding the three infants, the children were grouped according to age; one to three years old, n=ll; four to six years old, n=16; over six years, n=10. Among all groups, calories, calcium and B12 intakes were below 100% of the RDA. In the two older groups, B12 intake was less than 67% of the RDA and in the oldest group, calories were also less than 67% of the RDA.
Z-scores were used to compare anthropometric data obtained at various ages. Although weights, lengths and weight of length were above the means, there was a negative correlation of weight for length with age. Growth percentile categories for weight, weight for length, and triceps skinfold decreased with age.
The B12 intake and weight of one to three year olds were correlated (p=.01). Among four to six year olds, there was a correlation between B12 intake and both length (p=.01) and weight for length (p=.04). Among the oldest group, there are a negative correlation between B12 and weight (p=.O4); calories and length (p=.O3); and calories and weight for length (p=.006).
Sub-optimal nutrient intakes of B12, calories and calcium in this population are similar to findings in other vegan groups.
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Tzemos, Kallirroe Kelly. "Maternal and Infant Outcomes of Pregnancy in Women with Cystic Fibrosis." The Ohio State University, 2011. http://rave.ohiolink.edu/etdc/view?acc_num=osu1306875106.
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Doudna, Aaron Seth II. "Examining Adverse Patient Outcomes: The Role of Task Demand and Fatigue." Ohio University / OhioLINK, 2019. http://rave.ohiolink.edu/etdc/view?acc_num=ohiou1574380981746224.
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Magadi, Monica Akinyi. "The determinants of poor maternal health care and adverse pregnancy outcomes in Kenya." Thesis, University of Southampton, 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.310540.
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Moore, Shana L. "Is There a Trade-off? Infant Health Outcomes and Managed Care Competition." UKnowledge, 2016. http://uknowledge.uky.edu/msppa_etds/16.
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This study offers insights into the impact of competition among Managed Care organizations (MCOs) on infant birthing charges and birth outcomes. Kentucky provides one of the nation’s first case studies to determine successes and failures of Medicaid MCOs, and by doing so, provides a prediction of the impact of Patient Protection Affordable Care Act (PPACA) competition on healthcare costs and birth outcomes. An analysis of a natural policy experiment in the state of Kentucky reveals that infants insured by a Medicaid MCO stay longer in hospitals, are less healthy, and cost more than those insured under Traditional Medicaid prior to a policy change. Utilizing a difference-in-difference-in-difference (DDD) estimation, this study found initial evidence in a competitive MCO environment of Traditional Medicaid average birth charges substantially more than births under a Medicaid MCO, while outcomes also revealed the incidence of normal delivery increased almost identical to that of private insurance. However, after a short time, average birth charges for infants born under Medicaid MCO climb higher than other payer-types and infant health begins to decline. Outcomes of this study signal that Managed Care infants are actually less healthy and cost substantially more than anticipated but it is possible that these outcomes can be attributed to insurance selection.
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Buttling, Lauren G. "Maternal Residential Proximity to Central Appalachian Surface Mining and Adverse Birth Outcomes." Thesis, Virginia Tech, 2020. http://hdl.handle.net/10919/98651.
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Maternal residency in Central Appalachian coalfields has been associated with low birth weight at the county-level. To refine the relationship between proximity and adverse birth outcomes, this study employs finer spatial scales of exposure. Spatiotemporal characterizations of surface mining boundaries in Central Appalachia between 1986-2015 were developed using Landsat data. The maternal address field on births records from VA, WV, KY, and TN were geocoded and assigned amount of surface mining within a 5km radius of residence (street-level). Births were also assigned exposures based on the amount of surface mining within residential ZIP code tabulation area (ZCTA) (ZIP code-level). Using linear and logistic regression, associations between surface mining activities during gestation and birth weight, preterm birth, low birth weight, and term low birth weight were determined, adjusting for available demographic factors. An increase in surface mining activities was negatively associated with birth weight at the street-level (β = −8.93g; (95% CI = -12.69 -5.7, P= <0.001) and ZIP code-level (β = −4.41g ; 95% CI = -6.30, -2.52, P= <0.001). Small, statistically significant associations were also found between preterm birth and mining within 5km of residence (OR = 1.003; 95% CI = 1.001, 1.005, P= 0.003) and within maternal ZCTA (OR = 1.002; 95% CI = 1.001, 1.003, P=0.001). Relationships were also found between amount of mining within 5km of residence and low birth weight and term low birth weight outcomes. This study found subtle, but significant associations between proximity to active surface mining during gestation and adverse birth outcomes.M.S.
Central Appalachian surface mining produces air, water, and noise pollution, all of which have been associated with increased risk of adverse birth outcomes. Previous studies examining associations between surface mining and adverse birth outcomes rely upon relatively coarse county-level data. This research compares outcomes from hundreds of thousands of individual birth records and proximity of maternal home address to surface mines for a fine-scale, epidemiological study. Surface mining boundaries between 1986-2015 were developed using satellite imagery. Birth records from VA, WV, KY, and TN were geocoded and assigned the amount of surface mining within a 5km radius of residence. Births were also assigned exposures based on the amount of surface mining within residential ZIP code since geocoding led to a considerable loss of records. Associations between proximity to surface mining during gestation and birth weight, preterm birth (PTB), low birth weight (LBW), and term low birth weight (tLBW) were determined by linear and logistic regression, adjusting for available demographic factors. Results demonstrate significantly decreased birth weights were found near active mining operations. Mothers living near active surface mining also saw a slight increase in the odds of their birth being PTB, LBW or tLBW. These results suggest there is a subtle, but significant relationship between proximity to surface mining and adverse birth outcomes.
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Jourdain, Angela Rosa. "Racial Disparities, Fragmentation of Care, and Adverse Outcomes Associated with Ectopic Pregnancy." ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/7673.
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Ectopic pregnancy (EP) is a rare condition that occurs in 1% of all pregnancies. However, women of lower socioeconomic status (SES) and ethnic minority groups are at greater risk of adverse outcomes associated with EP than White women. The purpose of this study was to examine data from the 2014 National Inpatient Sample to identify predictors of complications from EP in 2,626 females ages 15-44 in the United States. The theoretical framework used to guide this study was the theory of fundamental causes to explain why the association between SES and mortality has persisted despite progressive advances in the diseases and risk factors that are believed to explain it. Independent t-tests were conducted to determine whether significant differences in patient outcomes existed between EP participants who required one medical intervention during hospitalization and those with two or more medical interventions. Multiple linear regression analyses were used to examine the association between race, primary expected payer, income, number of procedure codes on record, number of diagnoses on record, and length of stay. The key findings were that for every increase in number of procedures (β = 0.13, p <.001) the length of stay also increased by 0.13 units; for every increase in number of diagnoses (β = 0.37, p <.001) length of stay increased by .37 units, and within the Black racial/ethnicity (β = 0.05, p < .05) length of stay increased by 0.05 units. Finally, for females within a higher income quartile of $45,000 or more (β = .08, p < .001), length of stay decreased by -0.08 units. Positive social change implications may include assistance to public health professionals in identifying individual factors that place women at increased risk for EP and the ability to increase EP prevention activity in populations that may be more susceptible to the condition and complications.
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Bright, Chloe Jayne. "Adverse health outcomes among long-term survivors of childhood, teenage and young adult cancer." Thesis, University of Birmingham, 2017. http://etheses.bham.ac.uk//id/eprint/7455/.
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Survivors of childhood, teenage and young adult cancer are at increased risk of developing adverse health outcomes. This thesis aims to address the gaps in knowledge regarding the most severe adverse health outcomes. The Teenage and Young Adult Cancer Survivor Study (TYACSS) provides 200,945 survivors of cancer diagnosed aged 15-39 years. The PanCare Childhood and Adolescent Cancer Survivor Care and Follow-Up Studies (PanCareSurFup) provides 69,460 survivors of cancer diagnosed aged < 20 years. Within the TYACSS cohort 1) cancer survivors had increased risk of developing subsequent primary neoplasms, particularly in previously irradiated sites; 2) cancer survivors who likely received cranial irradiation had increased risk of a cerebrovascular event; and 3) central nervous system tumour survivors experienced premature mortality due to neoplastic and nonneoplastic causes. Within the PanCareSurFup cohort 1) the excess number of subsequent softtissue sarcoma was low, except leiomyosarcoma after retinoblastoma; and 2) the excess number of subsequent breast cancers remained elevated beyond 40 years of age among survivors of Hodgkin lymphoma, Wilms tumour and sarcoma. This thesis focuses on the most severe adverse health outcomes among childhood, teenage and young adult cancer survivors and provides evidence for developing clinical follow-up guidelines aimed at reducing such adverse health outcomes.
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Li, Se. "Adverse health outcomes associated with conditions during the reproductive years in U.S. black women." Thesis, Boston University, 2012. https://hdl.handle.net/2144/12477.
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Thesis (Ph.D.)--Boston University
PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you.Conditions during women's reproductive years may influence both adult and infant health. Parity, age at first and last birth, and age at menopause, are the common reproductive factors that have been investigated for adult morbidity and mortality, while prepregnancy obesity is one of the most important maternal factors associated with infant health. Relative few studies have provided informative data on these relations in black women, who have a high prevalence of obesity and a disproportionately high morbidity and mortality from many causes. In this dissertation, I examined the relation of several conditions during women's reproductive years to adverse health outcomes in black women. Data from the Black Women's Health Study (BWHS), a cohort study of 59,000 African American women aged 21-69 at baseline in 1995, was used for all three analyses. In the first and second studies, the relations of both childbearing factors and age at natural menopause to all-cause and cause-specific mortality were assessed in 13 years of follow-up in the BWHS. Information on parity, age at first and last birth, lactation duration, menopause type and menopause age was collected at baseline and updated on biennial follow-up questionnaires. The first study results support the hypothesis that somatic resources used for reproduction may compete with resources required for longevity. Among parous women, late age at last birth may be a marker of reduced reproductive or somatic aging. For women who survived beyond 55 years, the impact of reproductive history on all-cause or cause-specific mortality is negligible. The second study results provide support for the theory that an early natural menopause may serve as a marker of accelerated somatic aging. The association between age at natural menopause and mortality appeared to be modified by female hormone use. Third study was a nested case-control analysis of participants aged 21 to 44 years who had delivered 6,687 full-term singleton births during 1995-2003. Mothers of 691 infants with a birth weight ≥4000g (macrosomia) were compared with mothers of 5,996 infants with a birth weight ≤4000g. Our results indicated that overall obesity, gestational weight gain, and waist circumference were independent risk factors for macrosomia.
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Al, Reesi Abdullah. "Sickle cell disease in the emergency department Predictors of adverse outcomes: A prospective cohort study." Thesis, University of Ottawa (Canada), 2009. http://hdl.handle.net/10393/28182.
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Introduction. Current evidence does not provide a clear risk stratification strategy for sickle cell disease patients in the emergency department (ED). The goal of this study was to develop a better understanding of the clinical features among patients with sickle cell disease and to determine the risk factors for short term adverse events.
Methods. We conducted a prospective cohort study of sickle cell disease patients presenting to a tertiary care ED over six consecutive months. All patients were assessed by emergency physicians during the ED visit. All the patients had a 2 week structured telephone follow-up or a chart review if they had a repeat ED visit within 2 weeks or admitted. The adverse outcomes were classified as a clinically significant outcome (death, cerebrovascular accidents, acute chest syndrome, sepsis, hyper-hemolytic crisis and exchange blood transfusion) or not. We also classified patients as having acute chest syndrome or not. We analyzed the predictors of adverse outcomes using descriptive statistics and multiple logistic regression.
Results. Over six consecutive months, we enrolled 732 patients. Seventy-five patients had a clinically significant outcome and 42 had acute chest syndrome. Using multivariate analysis, we found nine statistically significant predictors of a clinically significant adverse outcome: a prolonged painful episode (OR 10.1; 95%CI 5.3-19.3), age less than 8 years (OR 2.4; 95%CI 1.001 -5.9), oxygen saturation less than 96% (OR 3.9; 95%CI 1.6-10.9), patient appearing toxic (OR 7.8; 95%CI 2.2-27.2), presence of chest crackles (OR 6.5; 95%CI 2.3-18.6), splenomegaly (OR 2.6; 95%CI 1.2-5.5), local limb tenderness (OR 0.2; 95%CI 0.08-0.7), hemoglobin less than 7 g/dL (OR 3.6; 95%CI 1.1-11.6), reticulocyte count more than 15% (OR 4.0; 95%CI 1.4-11.5). Using multivariate analysis, we found seven statistically significant predictors of acute chest syndrome: a prolonged painful episode (OR 22.0; 95%CI 8.7-55.3), oxygen saturation less than 92% (OR 17.7; 95%CI 1.7-184.9), history of cough (OR 4.5; 95%CI 1.7-12.0), history of pneumococcal vaccine (OR 0.33; 95%CI 0.11-0.98), presence of chest crackles (OR 9.5; 95%CI 2.6-34.7), local limb tenderness (OR 0.20; 95%CI 0.05-0.80), and reticulocyte count more than 15% (OR 4.9; 95%CI 1.2-19.7).
Conclusion. Our study of a tertiary hospital emergency department found nine identifiable variables which can help to predict the possibility of developing a clinically significant outcome. We also found seven identifiable variables which can help to predict the possibility of developing acute chest syndrome. This might be used in the future to risk stratify the sickle cell disease patients who presents to the emergency department and develop strategies to prevent those adverse outcomes.
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Cil, Gulcan. "Effects of Behavioral and Environmental Factors on Infant Health." Thesis, University of Oregon, 2015. http://hdl.handle.net/1794/19316.
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Health at birth is considered an important indicator of health outcomes in adulthood. It is also shown to have a strong association with future educational attainment and labor market outcomes. I examine the effects of behavioral and environmental factors on infant health. The factors I focus on include alcohol consumption during pregnancy, extreme weather events associated with climate change, and pollution that may result from unconventional oil and natural gas development.
In Chapter II, I examine the effects of point-of-sale alcohol warning signage that alcohol retailers are required to post in some states on alcohol use during pregnancy and on birth outcomes. I find that point-of-sale warning signs discourage alcohol consumption among pregnant women and are associated with a decrease in the odds of newborns having very low birth weight or being very pre-term. The findings of this research inform decision makers about a potentially effective mechanism through which alcohol consumption among pregnant women can be reduced. They also suggest causal evidence for the link between prenatal alcohol exposure and inferior health at birth.
Chapter III documents that exposure to heat waves during pregnancy is associated with increased likelihood of the mother experiencing an adverse health condition during pregnancy and the newborn having an abnormal condition at birth. The results provide an assessment of the magnitude and timing of the effects of extreme heat events associated with climate change on infant health which is potentially helpful in enhancing the effectiveness of adaptation efforts.
Finally, Chapter IV provides an empirical investigation of the link between unconventional oil and natural gas development and infant health. The results indicate that unconventional drilling activity is associated with a small, but statistically significant, decline in birth outcomes, especially for those living in rural areas. Given that it is estimated that the rapid expansion in unconventional oil and gas extraction will continue for at least a few more decades, the results of this study may contribute to the discussions related to initiation or tightening of regulations and monitoring efforts to control pollution.
This dissertation includes previously unpublished co-authored material.
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Price, Tabitha. "Periodontal Disease and Adverse Pregnancy Outcomes: Treatment Recommendations for the Pregnant Patient." Digital Commons @ East Tennessee State University, 2010. https://dc.etsu.edu/etsu-works/2530.
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Larm, Peter. "Long-term adverse outcomes and resilience of individuals who misused substances as adolescents." Stockholm, 2010. http://diss.kib.ki.se/2010/978-91-7409-770-2/.
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Dickerson, Kristen Baker. "Impact of Adverse Childhood Experiences on Maternal Health and Birth Weight in Appalachia." ScholarWorks, 2017. https://scholarworks.waldenu.edu/dissertations/4438.
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Adverse birth outcomes and adverse childhood experiences (ACE) are concerns in the United States, with potential to impact health indices now and in the future. The purpose of this study was to quantitatively examine the association between maternal exposure to ACE, low birth weight, and county of residence in the Appalachian population using the Life Course Approach as the theoretical framework. A cross-sectional study design and clustering strategy was used to randomly select potential respondents from a data set that was provided by Ohio Department of Health. Self-administered questionnaires were sent to potential respondents to collect information about ACE in the maternal population of Appalachia, Ohio with an overall response rate of 29.5% and 212 total participants. A chi-square analysis was completed and no significant association was found between county of residence and risk of low birth weight. However, statistically significant associations were found between the different types of ACE exposure and low birth weight delivery as well as Appalachian county of residence and exposure to ACE. As the sample of low birth weight deliveries was small, it is recommended that the relationship between ACE exposure and low birth weight be further studied to develop more purposeful health interventions to improve maternal health in Appalachia, Ohio specifically, as well as other rural communities. Reducing rates of adverse birth outcomes and chronic disease burden in Appalachia have potential to reduce health disparities between urban and Appalachian communities, allowing for positive social change for many socioeconomically disadvantaged communities and improving population health.
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Rowell, Tiffany A. "Examining the Impact of Pregnant Black Women's Adverse Childhood Experiences through Maternal Health and Birth Outcomes." Kent State University / OhioLINK, 2020. http://rave.ohiolink.edu/etdc/view?acc_num=kent1587137374251612.
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譚月明 and Y. M. Tam. "A case control study on infant outcomes in subjects with diabetes mellitus in pregnancy." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2002. http://hub.hku.hk/bib/B42576441.
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Jordan, Nicole. "The Effects of Touch on the Preterm Infant." Honors in the Major Thesis, University of Central Florida, 2007. http://digital.library.ucf.edu/cdm/ref/collection/ETH/id/1175.
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This item is only available in print in the UCF Libraries. If this is your Honors Thesis, you can help us make it available online for use by researchers around the world by following the instructions on the distribution consent form at http://library.ucf.edu/Systems/DigitalInitiatives/DigitalCollections/InternetDistributionConsentAgreementForm.pdf You may also contact the project coordinator, Kerri Bottorff, at kerri.bottorff@ucf.edu for more information.Bachelors
Nursing
Nursing
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Magnani, Jared W. "The electrocardiographic PR interval and adverse outcomes in older adults: the health aging, body and composition study." Thesis, Boston University, 2012. https://hdl.handle.net/2144/12498.
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Thesis (M.S.)--Boston University
PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you.Background: The electrocardiographic PR interval increases with aging, has been shown to differ by race, and has been associated with atrial fibrillation (AF), pacemaker implantation and all-cause mortality. To our knowledge the relation of the PR interval to heart failure (HF) has not been examined. We sought to determine the associations between the PR interval and heart failure, AF, and mortality in a biracial cohort of older adults. Methods: The Health, Aging, and Body Composition (Health ABC) Study is a prospective, biracial cohort. We employed multivariable Cox proportional hazards models to examine the PR interval (hazard ratios expressed per standard deviation (SO) increase) and 10-year risks of HF, AF , and all-cause mortality. Results: We examined 2722 Health ABC participants (age 74±3 years , 51 .9% women, and 41% black). We did not identify significant interaction by race for the outcomes studied. Following multivariable adjustment, every SO increase in PR interval was associated with a 13% greater 10-year risk of HF (95% confidence interval, [CI] 1.02 to 1.25) and a 13% increased risk of incident AF (95% Cl, 1.04 to 1.23). PR interval >200 ms was associated with a 49% increased risk of incident HF (95% Cl, 1.16 to 1.93). PR was not associated with increased mortality. Discussion: We identified significant relations of the PR interval to selected outcomes in older adults. Our findings extend prior investigations by examining the PR interval and associations with adverse outcomes in a biracial cohort of elderly men and women.
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Reid, Alison. "The health outcomes of women exposed to blue asbestos at Wittenoom." University of Western Australia. School of Population Health, 2008. http://theses.library.uwa.edu.au/adt-WU2009.0031.
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[Truncated abstract] This thesis examines the health outcomes of women exposed to blue asbestos at Wittenoom, Western Australia. Blue asbestos was mined and milled from 1943 to 1966 by the Australian Blue Asbestos Company (ABA) at Wittenoom, 1,600km from Perth in the remote Pilbara region of Western Australia. The original work for this thesis is presented in six manuscripts, some of which have been published in peer-reviewed Journals. The following aims have been investigated. 1. (a) To compare the all-cause mortality rates of women who lived at Wittenoom compared with all-cause mortality rates of the Western Australian female population (b) To assess the exposure-response relationship between asbestos and mortality in women. 2. (a) To compare the incidence rates of common cancers in women who lived at Wittenoom, compared with the incidence rates of these cancers in the Western Australian female population. (b) To assess the exposure-response relationship between asbestos and cancer incidence at various sites in women. 3. (a) To determine if reproductive cancers (ovarian, uterine cervical and corpus and breast) and gestational trophoblastic diseases are associated with asbestos exposure. v (b) To determine if ovarian cancer has been misclassified as malignant peritoneal mesothelioma or vice versa. (c) To determine if colon cancer has been misclassified as malignant peritoneal mesothelioma or vice versa. (d) To assess the exposure-response relationship between asbestos and reproductive cancer incidence. 4. To assess the susceptibility of women to asbestos exposure in comparison with men with similar exposure histories. 5. To predict the future mortality from malignant mesothelioma among women who lived at Wittenoom. '...' The Wittenoom crocidolite industry has had a damaging impact upon the health of the women workers and residents who lived there. Wittenoom women are more likely to die from malignant mesothelioma and lung cancer, all cancers and all causes than women in the Western Australian population. This brief period of crocidolite mining in Western Australia's history will continue to exert a detrimental impact upon the future of the women who lived there, with another 66 to 87 mesotheliomas predicted to occur to the end of 2030.
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Pickham, David M. "Prevalence of and predictors for QT interval prolongation and adverse outcomes in an acutely ill cohort: The QTIP Study." Diss., Search in ProQuest Dissertations & Theses. UC Only, 2009. http://gateway.proquest.com/openurl?url_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:dissertation&res_dat=xri:pqdiss&rft_dat=xri:pqdiss:3390072.
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Bonomo, Tiago Pucheu. "Impacts of Bolsa Família Program on infant health." reponame:Repositório Institucional do FGV, 2018. http://hdl.handle.net/10438/24458.
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The objective of this dissertation is to evaluate the impacts of the introduction of a cash transfer for pregnant women in the design of the Bolsa Família Program (BFP) on infant health. In particular, I focus on the effects on birth weight and on the incidence of low birth weight, but I also assess the impacts on pregnancy outcomes such as the incidence of preterm births and prenatal care. The new benefit consists of nine monthly transfers which start to be paid when the woman is identified as pregnant by the health management system of the BFP, regardless of the stage of pregnancy at the moment of the identification. The empiracal strategy explores the fact that when the transfer was implemented eligible women at different stages of pregnancy were exposed to different income shocks before giving birth. Using administrative data from the BFP and from the Brazilian Ministry of Health, I create links between benficiary women and their children's natality outcomes. The main results show that the transfer had a positive impact on birth weight and reduced significantly the likelihood of low birth weight. I also find that higher exposures to the transfer during pregnancy reduced the incidence of preterm births. While I don't find significant impacts on the number of prenatal visits, the results show that the transfer reduced the likelihood of delayed prenatal care.
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LeMay, Carrie, Jill D. Stinson, and Megan Quinn. "THE RELATIONSHIP BETWEEN ADVERSE CHILDHOOD EXPERIENCES, MENTAL HEALTH OUTCOMES, AND POLYPHARMACY AMONG PSYCHIATRIC INPATIENTS IN SECURE FORENSIC CARE." Digital Commons @ East Tennessee State University, 2018. https://dc.etsu.edu/asrf/2018/schedule/168.
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Persons exposed to adverse childhood experiences (ACEs) are at increased risk of developing long-term negative health consequences. ACEs have a cumulative negative impact on mental health outcomes in particular. Evidence suggests that those in forensic psychiatric settings are disproportionally exposed to ACEs, lending to potentially greater complexity in the relationship between ACEs, psychiatric comorbidity, and behavioral problems. Additionally, within this population a common intervention for mental health symptomology includes pharmacology, particularly as health issues compound. As a medication regimen becomes more complex, the risk for negative consequences – including drug interactions, side effects, and even death – increases.
Limited empirical research describing associations between ACEs, mental health outcomes, and polypharmacy is available. Furthermore, no published studies to date have examined these relationships in forensic inpatient mental health populations, despite the evidence that these populations are disproportionately exposed to maltreatment and household dysfunction in childhood, frequently have higher rates of physical and mental health problems, and are usually treated with multiple forms of medications in response to health and behavioral needs. To address gaps in existing research, the relationship between ACEs, mental health outcomes, and prescription practices will be examined within a forensic inpatient sample.
The current study seeks to investigate the impact of ACEs on mental health outcomes and the relationship to polypharmacy practices within a forensic psychiatric setting. A total of 182 patients residing in a secure forensic psychiatric hospital were selected. The sample is predominantly male (80.8%, n=147) and majority Caucasian (55.5%, n=101) or African American (40.1%, n=73), with a mean age of 43.5 (SD=13.2). Participants range from persons with at least one mental health disorder (100%, n=182) to persons with at least one chronic illness (74.5%, n=132).
It is expected that greater experiences of childhood maltreatment and household dysfunction will result in greater negative mental health outcomes and associated behaviors. This relationship is expected to contribute to polypharmacy practices among prescribing physicians. Because high rates of polypharmacy yield a potential for increased aversive health outcomes, understanding the association between ACEs and other predictive factors and polypharmacy practice has valuable implications for the treatment and rehabilitation of persons in forensic mental health settings.
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Mainolfi, Maria B. "Low Level Exposure to Air Pollution and Risk of Adverse Birth Outcomes in Hillsborough County, Florida." Scholar Commons, 2012. http://scholarcommons.usf.edu/etd/4140.
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In this retrospective cohort from 2002 through 2007, 104,003 singleton live births in Hillsborough County, Florida were analyzed to elucidate the relationship between feto-infant morbidity outcomes and prenatal exposure to six criteria air pollutants. This study is based on three linked databases: The Florida Hospital Discharge database; The vital statistics records of singleton live births; Air Pollution meteorological data from the Environmental Protection Agency. There are six common air pollutants, particulate matter 2.5 (PM2.5), particulate matter 10 (PM10), ground-level ozone (O3), carbon monoxide (CO), nitrogen (NOx), and lead (Pb). These pollutants are harmful to human health and the environment. The primary outcomes of interest were low birth weight (LBW), preterm births, and small for gestational age (SGA). The intent of this project is to address these issues of air pollution effects and the methodology surrounding the study of air pollution.
Using modeling, exposure values of the six criteria air pollutants were assigned to mothers over their period of pregnancy. To address these methodological concerns, this study utilizes the structural equation modeling, quartile groupings with dose response, and trimester groupings to evaluate the relationship between air pollution and birth outcomes of pregnant residents.
Using structural equation modeling a significant B value of 0.35 indicated that exposure to the six criteria pollutant in pregnancy may have a significant relationship to all five birth outcomes if they are broken down into latent variables. Quartile data demonstrated that NOx seemed to have most significant associations with all outcomes with a dose response for SGA. PM10 and PM2.5 had some association to LBW and VLBW at high levels. PM10 demonstrated significance in the higher doses for SGA. However, the only dose response relationship that was demonstrated for PM10 and PM2.5 was in VLBW. PM10 also demonstrated a dose response with very preterm. If sub-divided into trimester data, PM10 demonstrated a significant relationship between exposures in all trimesters and LBW, VLBW, and SGA. PM2.5 demonstrated a significant relationship between exposures in all trimesters and VLBW. CO demonstrated a significant relationship in the 2nd trimester for LBW as well as for SGA.
Mothers and their babies are a vulnerable population who are more susceptible to lower levels of pollution. These air pollutants can possibly have long-term effect on their children. Implantation of laws and regulations, warning system, or more strict EPA standards may be needed to adequately control the cost to our society.
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Weaver, Raven H. "Service Use and Health Outcomes of Low Income Older Adults with Unmet Needs." Diss., Virginia Tech, 2017. http://hdl.handle.net/10919/84981.
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The goal of this investigation was to assess service use, self-management strategies, and health status of older adults (60+ years) with perceived need who sought assistance from the Virginia Medicaid Elderly and Disabled Consumer-Direction (EDCD) waiver services. A sequential explanatory mixed method design was used to address the overall research question: How do older adults manage unmet needs? Using health services data from two independent State agencies, regression techniques were used to examine predictors of service use, hospitalization, and mortality among 1,008 individuals. A purposive subsample of eight rural-dwelling waiver-ineligible individuals was identified for follow-up semi-structured telephone interviews to explore self-management strategies for confronting functional care needs. Waiver-ineligible individuals were at risk for hospitalization and mortality; rural-dwelling individuals were more likely to be waiver-ineligible and had increased risk of mortality. Analysis of interviews revealed individuals had ongoing unmet needs and relied on family and community services and used internal and external strategies to manage them; plans were not in place should their health continued to decline. For this group of near-risk older adults who are waiver-ineligible and do not have financial means to pay for more help, accessible preventive services are necessary to reduce risk of adverse health outcomes. Policymakers are encouraged to advocate for preventive services that assist individuals before care needs become unmanageable. Agencies responsible for service delivery need to target efforts toward this group, particularly those residing in rural areas. Researchers must continue forging partnerships that permit use of health services data to identify when and how older adults use services, and explore how self-management strategies influence health and functioning over time.Ph. D.
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LeMay, Carrie. "Impact of Adverse Childhood Experiences on Mental Health Outcomes and Related Prescription Practices in a Psychiatric Inpatient Sample." Digital Commons @ East Tennessee State University, 2019. https://dc.etsu.edu/etd/3636.
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A definitive association between adverse childhood experiences (ACEs) and negative physical and mental health outcomes has been established. There is evidence that individuals in forensic psychiatric facilities are disproportionately exposed to ACEs, which may impact severity, prognosis, and age of onset of psychiatric symptoms, including behavioral concerns of institutional aggression, self-harm behaviors, and suicide attempts. Such psychiatric and behavioral concerns are often managed through multiple psychotropic prescriptions, leading to psychotropic polypharmacy. This study evaluated the relationship between ACEs, mental health and behavioral concerns, and psychotropic polypharmacy through analysis of archival data from a forensic inpatient psychiatric facility. A total of 182 patients met inclusion criteria. Through a comprehensive record review, ACE scores, mental health outcomes, behavioral concerns, and prescription practices were ascertained and subjected to a series of regression analyses. Results indicate that the current participants experience greater prevalence of ACEs and mental health outcomes, as well as higher rates of psychotropic polypharmacy. These relationships are mediated by history of self-harm behaviors. The higher polypharmacy rates yield greater negative side effects with the need to manage with additional medications. Taken as a whole, ACEs are a relevant consideration, as childhood adversity may lead to a lifetime of difficulty with managing emotional distress and symptoms of psychopathology. Pharmacological treatment may be necessary, particularly with those who experience more complex mental health outcomes. However, a primary focus on psychotropic intervention can result in high rates of medications and polypharmacy with significant side effects. Incorporation of non-pharmacological intervention should be a primary consideration with forensic inpatients to circumvent the potential for psychotropic polypharmacy and related negative consequences.
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Quansah, Reginald. "Occupational determinants of adverse pregnancy outcomes : work in healthcare and exposure to welding fumes and metal dust." Thesis, University of Birmingham, 2011. http://etheses.bham.ac.uk//id/eprint/676/.
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The goal of this thesis is to (i) systematically review all epidemiologic studies reporting on the relationship between occupational exposures and adverse pregnancy outcomes among nurses and physicians, (ii) compare the risk of adverse pregnancy outcomes between singleton newborns of nurses, midwives, and physicians and those of women in other occupations (reference groups) and (iii) investigate the risk of adverse pregnancy outcomes among parents exposed to welding fumes or metal dust. Data were obtained from all epidemiologic studies reporting on the relation between occupational exposures and adverse pregnancy outcomes among nurses and physicians, the 1990–2006 Finnish Medical Birth Register, and the Finnish Prenatal Environment and Health Study (FPEHS). Occupational exposure to anaesthetic gases was associated with spontaneous abortion and congenital malformation among nurses and physicians. Chemotherapy agents were associated with spontaneous abortion among nurses. There was moderate to substantial heterogeneity in the studied relations. In the FHCPS, singleton newborns of nurses have increased risk of low birth weight, post-term delivery, and small-for-gestational-age compared to those of teachers (reference group). Maternal employment as a midwife was not related to adverse pregnancy outcomes. The risk of high birth weight and post-term delivery were lower among singleton newborns of the physicians compared to those of other upper-level employees (reference group), but the risk of SGA and LGA did not differ between the newborns of physicians and those of the reference group. In the FPEHS, paternal exposure to welding fumes only was related to small-for-gestational-age. Maternal exposure to metal dust only was related to low birth weight and pre-term delivery and the joint effect of welding fumes and metal dust was related to small-for-gestational age. In conclusion, maternal employment as a nurses and parental occupational exposure to welding fumes or metal dust may increase the risk of adverse pregnancy outcomes.
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Picucci, R. "Are breastfeeding outcomes predicted by prenatal mental health, maternal orientation and postnatal affective attitude toward the infant?" Thesis, University of Liverpool, 2016. http://livrepository.liverpool.ac.uk/3001293/.
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Okwori, Glory. "Adverse Childhood Experiences (ACES): Assessing Their Impact on Mental Health Outcomes Among US Children and the Mitigating Role of Resilience." Digital Commons @ East Tennessee State University, 2021. https://dc.etsu.edu/etd/3941.
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ACEs are traumatic life events occurring during childhood that can have negative effects. Common mental disorders that are diagnosed in childhood are attention-deficit/hyperactivity disorder (ADHD), behavior disorders, anxiety and depression. The associations between ACEs and such problems in children have not been significantly examined. There are protective factors that can help reduce the effects of exposure to ACEs that have not been fully explored.
The purpose of this research study was to examine: 1) the prevalence of mental health outcomes in children; 2) the associations between ACEs, resilience and mental health outcomes; and 3) the role of resiliency as a moderating variable between ACEs and mental health outcomes. A secondary data analysis utilizing data from the 2018 National Survey of Children’s Health (NSCH) was used to examine the proposed aims. The study population consisted of children between the ages of 3 and 17. Chi-square analyses were utilized, and logistic regression models were constructed.
Weighted prevalence estimates were calculated. 8.6%, 6.9%, 8.0% and 3.7% currently had ADHD, behavioral disorders, anxiety and depression. The prevalence of each disorder was higher for older age, Whites, public insurance, single parent homes or homes without parents, caregivers with mental health problems and non-users of medical home. Children exposed to 4 or more ACEs had greater odds of ADHD (adjusted odds ratio [aOR]= 2.03; 95% confidence interval [CI], 1.52-2.72), behavioral disorders (aOR: 2.47; CI: 1.81-3.37), anxiety (aOR: 2.66; CI: 2.00-3.53) and the strongest relationship was seen with depression (aOR: 4.53; CI: 3.13-6.54). Individual resilience, family resilience and community resilience were associated with decreased odds of mental health outcomes and the strongest relationship was seen with individual resilience. There were significant interactions between exposure to ACEs and child resilience for ADHD (aOR: 0.14; CI: 0.08-0.23), current behavioral disorders (aOR: 0.10; CI: 0.06-0.16), anxiety and (aOR: 0.21; CI: 0.13-0.35) depression (aOR: 0.24; CI: 0.13-0.43) as well as significant interactions between ACE exposure and community resilience for depression (aOR: 0.25; CI: 0.10-0.61).
The findings of this research have implications for the improvement of mental health diagnosis, promotion of resilient measures and future research.
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Kirby, Christopher E. "A spatial correlation analysis of broad scale use of agricultural pesticides and infant health outcomes in the United States." Thesis, University of Ottawa (Canada), 2007. http://hdl.handle.net/10393/27466.
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Introduction. Birth defects and low birth weight/preterm delivery are the leading causes of a infant mortality in the United States. However, their etiologies remain mostly unknown. There is evidence suggestive of a link between exposure to pesticides and reduced infant health. We sought to answer the question of whether spatial variation in the incidence of infant mortality in the general population is correlated with variation in agricultural pesticide use. Methods. We examined the variation during 1996--2001 among 48 U.S. states of rates of infant mortality due to birth defects, and rates of infant mortality due to low birth weight or preterm delivery. We also examined the incidence of 41 specific birth defects through 1989--2001 in 33 states. We related these variables to the rate of agricultural pesticide use per state. Results. After controlling for socio-economic and behavioural risk factors, among-state variation in the rate of pesticide use accounted for over one quarter of the variation in infant mortality rates due to birth defects (r2=0.29). We did not find a significant relationship between pesticide use and infant mortality due to low birth weight/preterm delivery. Conclusion. Our results support the hypothesis that adverse effects on infant health in the general population are associated with broad scale pesticide use. To overcome the inferential limitations of this study, further research using individual exposure and outcome data is needed.
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Arey, Kelly Marie. "Examination of Birth Outcomes with Mode of Delivery for Breech Presentation." VCU Scholars Compass, 2007. http://hdl.handle.net/10156/1686.
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Buie, Mary Elizabeth. "An Examination of the Impact of Preconception Health on Adverse Pregnancy Outcomes through the Theoretical Lens of Reciprocal Determinism." Scholar Commons, 2011. http://scholarcommons.usf.edu/etd/3021.
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Statement of Purpose
The purpose of this study is to examine the impact of preconception health on adverse pregnancy outcomes through the theoretical lens of reciprocal determinism. Thus, this study aims to develop a preconception health conceptual framework that accounts for the interactive relationships among behavior, the environment, and the person.
Rationale for the Study
Women may not recognize a pregnancy until the first or second missed menstrual cycle, a full four to eight weeks or more after conception. Once a woman realizes the possibility of a pregnancy, it takes further time to confirm the pregnancy with a home pregnancy kit or a visit to the health care provider. In that time period, the woman may have unknowingly exposed her embryo to nutritional deficiencies, over-the-counter drugs, tobacco, alcohol, or other toxins. Because nearly half of all pregnancies are unintended, yielding about three million unintended pregnancies in the U.S. annually, there is a need to shift care to an earlier period in a woman's life cycle with greater potential to prevent birth defects and other adverse pregnancy outcomes, also known as preconception care.
The preconception health movement began with the rationale that many adverse pregnancy outcomes are determined prior to prenatal care initiation. Thus, in addition to prenatal care, the need for preconception health arose. The empirical literature makes a strong case for the benefit of individual preconception health components and their effects on adverse pregnancy outcomes. However, the actual effectiveness of collective preconception health in reducing adverse pregnancy outcomes has not yet been demonstrated. In an effort to evaluate the impact of preconception health on maternal morbidity, infant morbidity, and infant mortality, this study examined the reciprocal relationships between environmental, personal, and preconception behavioral factors and their associations with adverse pregnancy outcomes.
Methods
A secondary data analysis was conducted using the Pregnancy Risk Assessment Monitoring System (PRAMS) data from 2005-2008 to test a preconception framework. Project 1 examined all variables in the preconception framework among the following states: Maine, New Jersey, Ohio, and Utah. Project 2 examined all variables except of two among all PRAMS-participating states. All of the variables in the proposed framework were derived from questions in the PRAMS survey or from PRAMS-linked birth certificate data. The research questions posed in this study were resolved through the path analyses of reduced and full iterations of the preconception framework in Projects 1 and 2.
Results
In Project 1, list-wise deletion of missing data resulted in a decrease from the original 27,933 participants to 12,239 participants. In Project 2, this action resulted in a decrease from the original 200,008 participants to 128,551 participants. The analysis of the reduced frameworks for both projects revealed extremely low R-squared values (1.1% or less). Subsequent analyses examining the full framework in Projects 1 and 2, as well as an additional post hoc analysis with supplementary PRAMS variables, resulted in R-squared values of 13.1%, 11.4%, and 30.5%, respectively.
Implications
This study examined the impact of preconception health behaviors on adverse pregnancy outcomes through the theoretical lens of reciprocal determinism. Preconception health behaviors alone accounted for a negligible portion of the variance associated with adverse pregnancy outcomes. As hypothesized, preconception health behaviors work in concert with environmental factors, personal influences, prenatal and natal factors. Significant predictors supported in the literature included lower socioeconomic status, pregnancy intention, pregnancy history, older maternal age, black maternal race, Hispanic ethnicity, overweight maternal BMI, tobacco use prior to pregnancy, maternal complications, hospitalization during pregnancy, later prenatal care initiation, fewer prenatal care visits, plurality, and cesarean section. Even so, there is a large portion of the variance in adverse pregnancy outcomes that is not accounted for, and further examination is required.
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Doolittle, Ashley K., and Jennifer Zorotovich. "Among Emerging Adulthood Adverse Childhood Experiences (ACEs) Relate to Anxiety, Depression, Life Satisfaction, and Survivor’s Guilt." Digital Commons @ East Tennessee State University, 2018. https://dc.etsu.edu/secfr-conf/2018/schedule/1.
Full textAbstract:
Adverse childhood experiences (ACEs) are events that take place during one’s youth that may be stressful or traumatic (Adverse Childhood Experiences, 2017) and a strong focus within this body of knowledge has been on the experiences of childhood neglect and abuse. Emerging adulthood is a distinct developmental phase of the life course characterized by extensive self-exploration and consideration about the future (Arnett, 2000). Given that identity exploration continues to be important during emerging adulthood, it is important to study ACEs and the effects they have on the emerging adult who is making decisions regarding their future. Much of the literature on ACEs has been dedicated to establishing the relationship between ACEs and negative health outcomes. For instance, research has shown that ACEs have been linked to increased risks for suicide attempt and ideation throughout one’s lifespan (Sachs-Ericsson et. al, 2016) and has also been associated with feelings of anxiety (Briggs & Price, 2009), guilt (Kaess et. al, 2013), and depression (Briggs & Price, 2009). Therefore, ACEs and negative health outcomes have already been strongly confirmed. The positive psychology movement (Seligman & Csikszentmihalyi, 2014) has brought to scholars’ attention the need to expand on conceptualizations of what it means to be doing well. Specifically, it is no longer sufficient to define optimal well-being only in terms of the absence of negative outcomes. In order to assess holistic well-being, consideration must also be given to positive factors. A recent review of the literature yielded no studies that have explored the presence, or absence, of positive well-being factors in conjunction to negative health outcomes among those having experienced ACEs. In order to obtain a true understanding of holistic well-being at critical developmental junctures, the current study moves beyond a sole focus on pathology by also considering how life satisfaction and subjective happiness manifest during emerging adulthood in relation to ACEs.
Data on 284 participants were collected and analysis is forthcoming. Participants were recruited through the use of physical flyer postings, social media advertisements, and through Amazon’s Mechanical Turk (mTurk) system. Regression analysis and bivariate assessments will be used to explore the relationship between ACEs and depression, anxiety, life satisfaction, subjective happiness, and survivor’s guilt.
Findings will be discussed in terms of broadening our understanding of the impacts to holistic well being for as related to ACEs during a rather critical and busy developmental juncture, emerging adulthood. Moving beyond pathology-focused models will expand on professional practice by utilizing frameworks embedded within a strengths-based approach. Educators, advocates, practitioners, and clinicians can utilize this this knowledge to enhance their work with clients and the services provided.
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Agarwal, Gaurav. "Adverse Anesthesia Outcomes: A Retrospective Study of an Ambulatory Surgical Center versus a Dental Office Setting." VCU Scholars Compass, 2007. http://hdl.handle.net/10156/1532.
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Bezerra, Roberto C. R. "Evaluation of the Epidemiologic Impact of a National Primary Health Care Policy on Infant Health Outcomes in Brazil, from 1999 to 2002." Diss., The University of Arizona, 2006. http://hdl.handle.net/10150/194486.
Full textAbstract:
Programa de Saude da Familia-PSF was initially proposed as a novel model of primary health care in Brazil in 1994 as it was implemented in several Brazilian municipalities. This national policy embraces different dimensions of primary care, but has a primary reliance on maternal and child health, especially on the survival of infants, given the unfavorable Brazilian child health scenario. This study has proposed that an improvement on infant health is expected to occur through three major mechanisms: overcoming of socio-cultural and geographical barriers of access to maternal and child health services; integrality of care; and community empowerment. An ecological longitudinal study design was utilized to assess the impact of the policy implementation on municipal indicators of infant health of 1201 municipalities, from 1999 to 2002. A group of municipalities that first implemented PSF in 1999 and were covered continuously from 1999 from 2002 were compared to a group of municipalities that didn't implement this policy within the same time period. This study has found that PSF has had an overall positive impact on infant health. Overall, it might be concluded that PSF implementation has brought an important short-term improvement on municipal indicators of infant health from 1999 to 2002, especially on the infant mortality rate. Such beneficial impact tended to be stronger in socially disadvantaged municipalities, commonly with unfavorable health care scenario. Thus, the expansion of primary health care capacity and overcoming of major gaps within the access to MCH services might explain such beneficial impact of PSF implementation in Brazilian municipalities.
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Christopher, Kenneth E. "The Effects of Hurricane and Tornado Disasters on Pregnancy Outcomes." ScholarWorks, 2017. https://scholarworks.waldenu.edu/dissertations/3436.
Full textAbstract:
Maternal prenatal exposure to hurricanes and tornadoes could contribute to an increased risk for adverse birth outcomes. Little is known about the effects of Hurricane Katrina of August 2005, on pregnancy outcomes in Mississippi. Additionally, little is known about the influence of the April 2011 Alabama tornado disaster on births in that state. The purpose of this study was to bridge this knowledge gap by examining the relationship between maternal prenatal exposure to these storms and adverse infant health outcomes. The theoretical framework guiding this retrospective, cross-sectional study was the life course approach. Data for this investigation included 2,000 records drawn from the Linked Infant Births and Deaths registers. Chi-square and logistic regression analyses were performed. Results indicated hurricane exposure was not a predictor of preterm birth (OR = .723, 95% CI = [.452, 1.16]; p = 1.76) or low birth weight (OR = .608, 95% CI = [.329-1.13]; p = .113). However, an association was observed between tornado exposure and preterm birth (OR = 1.68, 95% CI = [1.19-2.39]; p = < 0.05) and low birthweight (OR = 1.91, 95% CI = [1.27-2.87]; p = < 0.05). Findings suggest pregnant women are vulnerable to natural disaster storms, and are at risk for adverse pregnancy outcomes. The implications for social change include informing preparedness efforts to reduce vulnerability to increased pregnancy risk factors and adverse birth outcomes, consequential to hurricane and tornado disasters.
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Huang, Pinchia. "Implications of False-Positive Trisomy 18 or 21 Screening Test Results in Predicting Adverse Pregnancy Outcomes." Case Western Reserve University School of Graduate Studies / OhioLINK, 2009. http://rave.ohiolink.edu/etdc/view?acc_num=case1247627814.
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