INTRODUCTION:To determine if hypertensive disease of pregnancy (HDP) is associated with adult obesity in offspring.
METHODS:A retrospective cohort study design was used to identify offspring of ...pregnancies complicated by HDP (gestational hypertension, preeclampsia, HELLP syndrome, eclampsia) born between 1947-1997 (now >20 years old) and with at least one adult BMI recorded in the Utah Population Database. These offspring (exposed) were matched by maternal age at birth, birth year, gender, and multiple gestation with offspring of women with no history of HDP (unexposed offspring). A second analysis was done matching the exposed offspring to their unexposed sibling in order to assess and control for the familial and environmental possible confounders. Adjusted relative risk (aRR) for obesity among exposed versus unexposed offspring as well as unexposed siblings were estimated using conditional logistic regression models.
RESULTS:A total of 18,009 exposed offspring were compared to 30,761 unexposed offspring and 12,579 exposed siblings to 26,251 unexposed siblings. The relative risk of obesity was higher for exposed versus unexposed offspring, aRR=1.44 95%CI 1.36-1.52. Maternal obesity increased the relative risk to aRR=2.58 95%CI 2.41-2.77, whereas higher maternal education decreased it to 0.87 0.80-0.95. For the sibling analysis, the risk for obesity was similar, aRR=1.05 95%CI 0.98-1.11, aside from being a male sibling and first born aRR=1.31 1.23-1.40 and aRR=1.18 95%CI 1.09-1.27 respectively, no associated factors significantly increased the risk of obesity.
CONCLUSION:HDP is independently associated with an increased the risk of obesity in adulthood. However this independent association was not demonstrated in the family, sibling environment.
Abstract
Consistent with preferences, home deaths in the US increasing — yet most Americans still die in hospitals or other healthcare facilities. Although declining health has been considered the ...primary factor influencing place of death, few studies have examined how family support and sociodemographic factors influence place of death. This study examined a population-based cohort of 205,932 decedents aged 50+ who died in Utah between 1998 and 2016. Using multivariate logistic regression models, we found that having a living spouse or child was associated with decreased odds of a healthcare facility death (spouse: AOR= 0.62, CI 0.65-0.59; child: AOR = 0.80, CI 0.79-0.82). Additionally, educational attainment (graduate degree: AOR = 0.95, CI 0.91-0.99) and non-Hispanic/Latinx ethnicity (AOR = 0.81, CI 0.79-0.85) were associated with decreased odds of a home death. Our findings highlight the importance of families in place of death and suggest that sociodemographic and economic disparities persist even in death.
The aim of the study is to examine the impact of maternal interpregnancy body mass index (BMI) change on subsequent offspring mortality risk.
This is a retrospective cohort study of women who had two ...consecutive live singleton deliveries of at least 20 weeks' gestation from the Utah Population Database. Our exposure was defined as interpregnancy BMI change from the date of first delivery to the conception date of subsequent pregnancy. We categorized BMI change as: < - 1, -1 to 0, 0 to <1 (reference), 1 to 2, 2 to 4, ≥4 kg/m
. Our primary outcome was all-cause age-specific mortality during four time periods: neonatal (≤28 days), infant (29 days to <1 year old), childhood ((≥1 to <5 years old), and late childhood (5 to <18 years old). We also examined mortality specifically attributed to congenital anomalies. Analyses used Cox proportional hazard models stratified by full term (≥37 weeks) and preterm (<37 weeks) deliveries. All models were adjusted for relevant confounders.
Of 266,752 women, among full-term deliveries, women with a BMI increase of 4 kg/m
or more had an increased risk of neonatal mortality in their subsequent pregnancy (hazard ratio or HR = 1.72, 95% confidence interval or CI: 1.23-2.41) Women who lost 1 kg/m
or more between deliveries also had increased neonatal mortality (HR = 1.46, 95% CI: 1.04-2.05). There were no differences in infant, early, or late childhood mortality by interpregnancy BMI change. Maternal interpregnancy interval weight loss of 1 kg/m
or more and weight gain of ≥4 kg/m
also had increased risk of mortality associated with congenital anomalies or conditions arising during the neonatal period following their subsequent delivery.
Women with significant interpregnancy weight gain and modest weight loss have a significant increased risk of neonatal mortality following their subsequent pregnancy.
· Significant weight gain between deliveries increases the risk of neonatal death.. · Modest weight loss between deliveries increases the risk of neonatal death.. · This risk may be partially explained by increased risk of congenital malformations..
Using data from a workforce training program funded by the Health Resources and Services Administration, the authors de-identified pre- and posttreatment assessments of high-severity and chronic ...substance use disorders (SUDs) to test the effect of integrated comprehensive oral health care for patients with SUDs on SUD therapeutic outcomes.
After 1 through 2 months of treatment at a SUD treatment facility, 158 male self-selected (First Step House) or 128 randomly selected sex-mixed (Odyssey House) patients aged 20 through 50 years with major dental needs received integrated comprehensive dental treatment. The SUD treatment outcomes for these groups were compared with those of matched 862 male or 142 sex-mixed patients, respectively, similarly treated for SUDs, but with no comprehensive oral health care (dental controls). Effects of age, primary drug of abuse, sex, and SUD treatment facility-influenced outcomes were determined with multivariate analyses.
The dental treatment versus dental control significant outcomes were hazard ratio (95% confidence interval CI) 3.24 (2.35 to 4.46) increase for completion of SUD treatment, and odds ratios (95% CI) at discharge were 2.44 (1.66 to 3.59) increase for employment, 2.19 (1.44 to 3.33) increase in drug abstinence, and 0.27 (0.11 to 0.68) reduction in homelessness. Identified variables did not contribute to the outcomes.
Improvement in SUD treatment outcomes at discharge suggests that complementary comprehensive oral health care improves SUD therapeutic results in patients with SUDs. Integrated comprehensive oral health care of major dental problems significantly improves treatment outcomes in patients whose disorders are particularly difficult to manage, such as patients with SUDs.
To better understand determinants and potential disparities in end of life, we model decedents' place of death with explanatory variables describing familial, social, and economic resources. A ...retrospective cohort of 204,041 decedents and their family members are drawn from the Utah Population Database family caregiving dataset. Using multinomial regression, we model place of death, categorized as at home, in a hospital, in another location, or unknown. The model includes family relationship variables, sex, race and ethnicity, and a socioeconomic status score, with control variables for age at death and death year. We identified the effect of a family network of multiple caregivers, with 3+ daughters decreasing odds of a hospital death by 17 percent (OR: 0.83 0.79, 0.87, p < 0.001). Place of death also varies significantly by race and ethnicity, with most nonwhite groups more likely to die in a hospital. These determinants may contribute to disparities in end of life.
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BFBNIB, NUK, PILJ, SAZU, UL, UM, UPUK
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