Birth defects are a major public health concern as they are the leading cause of neonatal and infant mortality. Observational studies have linked environmental pollution to adverse birth outcomes, ...including congenital anomalies. This study examined potential associations between ambient air pollution and congenital heart defects and cleft lip or palate among births in Brisbane, Australia (1998-2004).
Ambient air pollution levels were averaged over weeks 3-8 of pregnancy among 150,308 births. Using a case-control design, we used conditional logistic regression and matched cases to 5 controls. Analyses were conducted using all births, and then births where the mother resided within 6 and 12 kilometers of an ambient air quality monitor.
When analyzing all births there was no indication that ambient air pollution in Brisbane was associated with a higher risk of cardiac defects. Among births where the mother resided within 6 kilometers of an ambient air quality monitor, a 5 ppb increase in O(3) was associated with an increased risk of pulmonary artery and valve defects (OR 2.96, 95% CI: 1.34, 7.52) while a 0.6 ppb increase in SO(2) was associated with an increased risk of aortic artery and valve defects (OR 10.76, 95% CI: 1.50, 179.8). For oral cleft defects among all births, the only adverse association was between SO(2) and cleft lip with or without cleft palate (OR 1.27, 95% CI: 1.01, 1.62). However, various significant inverse associations were also found between air pollutants and birth defects.
This study found mixed results and it is difficult to conclude whether ambient air pollution in Brisbane has an adverse association with the birth defects examined. Studies using more detailed estimates of air pollution exposure are needed.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
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•Few studies have identified susceptible windows for air pollution and gestational diabetes mellitus (GDM) at a weekly level.•Most susceptible exposure window for SO2 is from 4th–10th ...gestational weeks.•The risk of GDM might be greater among women taking folic acid supplements.
Evidence concerning the effect of ambient air pollution exposure on gestational diabetes mellitus (GDM) is limited. No published studies have examined maternal weekly air pollution exposure and GDM, and the possible effect modification by folic acid supplementation has not been assessed.
To evaluate the association between air pollution exposure and GDM at trimester and weekly levels, and to explore the potential effect modification by folic acid supplementation.
A total of 5421 pregnant women were recruited during 2011–2014 in Guangzhou, China. Daily PM2.5, PM10, SO2 and NO2 levels were collected from 10 monitoring stations. Individual's exposure during pregnancy was estimated using inverse-distance weighting approach. Binary logistic regression was used to examine the trimester-specific association between air pollution exposure and GDM. Distributed lag models (DLMs) were applied to estimate maternal weekly air pollution exposure and GDM. Stratified analyses by folic acid supplementation and interaction test were performed.
The GDM incidence was 11.69%. An interquartile range (IQR) increase in first trimester SO2 was associated with increased GDM risk in the single pollutant model, the adjusted odds ratio (aOR) and 95% confidence interval (CI) was 1.22 (1.02–1.47). In DLMs, an IQR increase in SO2 during 4th to 10th gestational weeks was associated with increased GDM risk, with the strongest effect in the 7th gestational week. When stratified by maternal folic acid supplementation, first trimester exposure to SO2 was associated with increased GDM risk among women taking folic acid supplements (aOR = 1.25, 95% CI: 1.03–1.53) and P value for interaction was 0.13. No significant effects were observed for PM2.5, PM10 and NO2.
First trimester exposure to SO2 was associated with increased GDM risk, especially during the 4th to 10th gestational weeks. The effect might be stronger among women taking folic acid supplements.
Administrative data are used to examine variation in thirty-day mortality across health services in several jurisdictions. Hospital performance measurement may be error-prone as information about ...disease severity is not typically available in routinely collected data to incorporate into case-mix adjusted analyses. Using ischaemic stroke as a case study, we tested the extent to which accounting for disease severity impacts on hospital performance assessment.
We linked all recorded ischaemic stroke admissions between July, 2011 and June, 2014 to death registrations and a measure of stroke severity obtained at first point of patient contact with health services, across New South Wales, Australia's largest health service jurisdiction. Thirty-day hospital standardised mortality ratios were adjusted for either comorbidities, as is typically done, or for both comorbidities and stroke severity. The impact of stroke severity adjustment on mortality ratios was determined using 95% and 99% control limits applied to funnel plots and by calculating the change in rank order of hospital risk adjusted mortality rates.
The performance of the stroke severity adjusted model was superior to incorporating comorbidity burden alone (c-statistic = 0.82 versus 0.75; N = 17,700 patients, 176 hospitals). Concordance in outlier classification was 89% and 97% when applying 95% or 99% control limits to funnel plots, respectively. The sensitivity rates of outlier detection using comorbidity adjustment compared with gold-standard severity and comorbidity adjustment was 74% and 83% with 95% and 99% control limits, respectively. Corresponding positive predictive values were 74% and 91%. Hospital rank order of risk adjusted mortality rates shifted between 0 to 22 places with severity adjustment (Median = 4.0, Inter-quartile Range = 2-7).
Rankings of mortality rates varied widely depending on whether stroke severity was taken into account. Funnel plots yielded largely concordant results irrespective of severity adjustment and may be sufficiently accurate as a screening tool for assessing hospital performance.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Depression is a leading source of morbidity and health loss in Australian women. This study investigates the determinants of antenatal depressive symptoms and postnatal depressive symptoms in an ...Australian population, including people from culturally and linguistically diverse (CALD) backgrounds.
The study used a retrospective cohort of mothers of all live births in public health facilities in 2014 (N = 17,564) within South Western Sydney Local Health District and Sydney Local Health District in New South Wales, Australia. Prevalence of antenatal and postnatal depressive symptoms were estimated for the cohort. Multivariate logistic regression models were conducted to investigate the sociodemographic, psychological and health service determinants of antenatal and postnatal depressive symptoms, measured using the Edinburgh Postnatal Depression Scale (EPDS).
The prevalence of antenatal and postnatal depressive symptoms was 6.2% and 3.3% of the cohort, respectively. Significant risk factors for maternal depressive symptoms during pregnancy were, a lack of partner support, history of intimate partner violence, being from the CALD population and low socioeconomic status. Self-reported antenatal depressive symptoms were strongly associated with postnatal depressive symptoms. Risk factors for postnatal depressive symptoms were similar to those for antenatal depressive symptoms, as well as assisted delivery.
Factors relating to demographic and psychosocial disadvantage were associated with subsequent antenatal and postnatal depressive symptoms in New South Wales, Australia. Our study suggests that screening for probable depression and timely referral for expert assessment of at-risk mothers may be an effective strategy to improve maternal mental health outcomes.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Although ambient temperature has been linked to asthma exacerbation, impacts associated with extreme temperature events remain unclear. This study aims to identify the events characteristics that ...elevate risk of asthma hospital visits, and to assess whether healthy behavior changes due to the COVID-19 prevention and control policy may modify the relationships. Data of asthma hospital visits from all medical facilities in Shenzhen, China during 2016–2020 were assessed in relation to extreme temperature events using a distributed lag model. Stratified analysis was conducted by gender, age and hospital department to identify susceptible populations. Through events defined by various duration days and temperature thresholds, we explored the modification by events intensity, length, occurrence time and healthy behaviors. The cumulative relative risk of asthma during heat waves compared to other days was 1.06 (95%CI: 1.00–1.13) and for cold spells was 1.17 (95%CI: 1.05–1.30), and that of males and school-aged children were generally higher than other sub-groups. There were significant effects of heat waves and cold spells on asthma hospital visits when the mean temperature was above 90th percentile (30 °C) and below 10th percentile (14 °C) respectively, and the relative risks were higher when events lasted longer, became stronger, occurred in daytime and in early summer or winter. During the healthy behaviors maintaining period, the risk of heat waves increased whilst the risk of cold spells reduced. Extreme temperatures may pose considerable impact on asthma and the health effect can be modified by the event characteristics and anti-epidemic healthy behaviors. Strategies of asthma control should consider the heightened threats of the intense and frequent extreme temperature events in the context of climate change.
•Heat waves and cold spells increased the risk of asthma hospital visits.•Extreme temperatures have larger impact on asthma when last longer, become stronger and occur earlier in the seasons.•Anti-epidemic healthy behaviors may strengthen the effect of heat waves but reduce that of cold spells on asthma.
From 2000 a routine survey of mothers with newborn infants was commenced in South Western Sydney. The survey included the Edinburgh Postnatal Depression Scale (EPDS). The aim of the study was to ...determine the prevalence and risk factors for postnatal depressive symptoms in women living in metropolitan Sydney, Australia.
Mothers (n=15,389) delivering in 2002 and 2003 were assessed at 2-3 weeks after delivery for risk factors for depressive symptoms. The binary outcome variables were EPDS>9 and >12. Logistic regression was used for the multivariate analysis.
The prevalence of EPDS>9 was 16.93 per 100 (95% CI: 16.34 to 17.52) and EPDS>12 was 7.73 per 100 (95% CI: 6.96 to 7.78). The final parsimonious logistic regression models included measures of infant behaviour, financial stress, mother's expectation of motherhood, emotional support, sole parenthood, social support and mother's country of birth.
Infant temperament and unmet maternal expectations have a strong association with depressive symptoms with implications for the design of both preventative and treatment strategies. The findings also support the proposition that social exclusion and social isolation are important determinants of maternal depression.
Indigenous Australians experience significantly poorer health compared to other Australians, with chronic disease contributing to two-thirds of the health gap. We report on an evaluation of an ...innovative model that leverages mainstream and Aboriginal health resources to enable safe, supported transfer of care for Aboriginal adults with chronic conditions leaving hospital. The multisite evaluation was Aboriginal-led and underpinned by the principles of self-determination and equity and Indigenous research protocols. The qualitative study documented processes and captured service user and provider experiences. We found benefits for patients and their families, the hospital and the health system. The new model enhanced the patient journey and trust in the health service and was a source of staff satisfaction. Challenges included staff availability, patient identification and complexity and the broader issue of cultural safety. Critical success factors included strong governance with joint cultural and clinical leadership and enduring relationships and partnerships at the service delivery, organisation and system levels. A holistic model of care, bringing together cultural and clinical expertise and partnering with Indigenous community organisations, can enhance care coordination and safety across the hospital-community interface. It is important to consider context as well as specific program elements in design, implementation and evaluation.
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