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- Ivert, A., et al.
(författare)
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Maternal and pregnancy predictive risk factors for having a compensated maternal injury claim : a Swedish nationwide cohort study
- 2023
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Ingår i: Scientific Reports. - 2045-2322. ; 13:1
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Tidskriftsartikel (refereegranskat)abstract
- To describe trends and identify maternal and pregnancy predictive risk factors for having a compensated claim for a maternal injury during delivery, as a proxy for having received suboptimal care. This nationwide retrospective cohort study included 1 754 869 births in Sweden between 2000 and 2016, including 4488 maternal injury claims filed with The National Swedish Patient Insurance Company (Löf), of which 1637 were compensated. Descriptive statistics on maternal and pregnancy characteristics, trends in filed/compensated claims over time, and distribution of compensated claims by clinical classification are presented. Characteristics associated with suboptimal care were identified using multivariable logistic regression, with mutual adjustment in the final model. Compensated claims were sorted into 14 clinical classifications (ICD-10 codes for main condition, injury, and causality). Overall, there was a two-fold increase in filed claims from 2000 to 2016, peaking in 2014. The rate of compensated claims only increased marginally, and 36.5% of filed claims were deemed avoidable. Perineal and pelvic floor injuries, as well as medical and diagnostic errors, were responsible for the majority of compensated claims. Women with a previous caesarean section, post term delivery, chronic or gestational disease, > 13 antenatal visits, or a multiple pregnancy had increased risk of having a compensated claim for a maternal injury during delivery. Understanding the risk factors for having a compensated maternal injury claim may guide health workers and maternity wards in improving the quality and organisation of care to reduce the risk of childbirth related injuries.
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- Holowko, N., et al.
(författare)
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More than time : travel time to the delivery ward and maternal outcomes – onset of labour, postpartum haemorrhage and obstetric anal sphincter injury
- 2023
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Ingår i: Public Health. - : Elsevier. - 0033-3506 .- 1476-5616. ; 217, s. 105-114
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Tidskriftsartikel (refereegranskat)abstract
- Background: Closing delivery units increases travel time for some women. Whether increased travel time is associated with maternal outcomes is important for understanding the consequences of such closures. Previous studies are limited in measuring travel time and restricted to the outcome of caesarean section. Methods: Our population-based cohort includes data from the Swedish Pregnancy Register for women giving birth between 2014 and 2017 (N = 364,630). We estimated travel time from home to the delivery ward using coordinate pairs of actual addresses. The association between travel time and onset of labour was modelled using multinomial logistic regression, and logistic regression was used for the outcomes postpartum haemorrhage (PPH) and obstetric anal sphincter injury (OASIS). Findings: Over three-quarters of women had ≤30 min travel time (median 13.9 min). Women who travelled ≥60 min arrived to care sooner and laboured there longer. Women with further to travel had increased adjusted odds ratio (aOR) of having an elective caesarean section (31–59 min aOR 1.11; 95% confidence interval [CI] 1.07–1.16; ≥60 min aOR 1.25; 95% CI 1.16–1.36) than spontaneous onset of labour. Women (at full term with spontaneous onset) living ≥60 min away had reduced odds of having a PPH (aOR 0.84; 95% CI 0.76–0.94) or OASIS (aOR 0.79; 95% CI 0.66–0.94). Interpretation: Longer travel time increased the odds of elective caesarean section. Women with furthest to travel arrived sooner and spent more time in care; although they had a lower risk of PPH or OASIS, they also tended to be younger, have a higher body mass index and were Nordic born.
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| 7. |
- Holowko, N., et al.
(författare)
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Socioeconomic Position and Reproduction : Findings from the Australian Longitudinal Study on Women's Health
- 2018
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Ingår i: Maternal and Child Health Journal. - : Springer Science and Business Media LLC. - 1092-7875 .- 1573-6628. ; 22:12, s. 1713-1724
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To investigate the association of socioeconomic position (SEP) with reproductive outcomes among Australian women. Methods: Data from the Australian Longitudinal Study on Women's Health's (population-based cohort study) 1973-1978 cohort were used (N = 6899, aged 37-42 years in 2015). The association of SEP (childhood and own, multiple indicators) with age at first birth, birth-to-pregnancy (BTP) intervals and total number of children was analysed using multinomial logistic regression. Results: 14% of women had their first birth aged < 24 years. 29% of multiparous women had a BTP interval within the WHO recommendation (18-27 months). Women with a low SEP had increased odds of a first birth < 24 years: low (OR 7.0: 95% C.I. 5.3, 9.3) or intermediate education (OR 3.8: 2.8, 5.1); living in rural (OR 1.8: 1.5, 2.2) or remote (OR 2.1: 1.7, 2.7) areas; who found it sometimes (OR 1.8: 1.5, 2.2) or always difficult (OR 2.0: 1.6, 2.7) to manage on their income; and did not know their parent's education (OR 4.5: 3.2, 6.4). Low SEP was associated with having a much longer than recommended BTP interval. Conclusion: As the first Australian study describing social differences in reproductive characteristics, these findings provide a base for reducing social inequalities in reproduction. Assisting adequate BTP spacing is important, particularly for women with existing elevated risks due to social disadvantage; including having a first birth < 24 years of age and a longer than recommended BTP interval. This includes reviewing services/access to postnatal support, free family planning/contraception clinics, and improved family policies.
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| 9. |
- Jimenez-Redal, R, et al.
(författare)
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Evaluating Equity and Inclusion in Access to Water and Sanitation for Persons Living with HIV/AIDS in Wukro, Ethiopia
- 2018
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Ingår i: WATER. - : MDPI AG. - 2073-4441. ; 10:9
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- For more than a decade, foreign aid-supported water interventions focusing on an increase in household private connections have been implemented in the small urban center of Wukro. However, little has been investigated about the effectiveness of these interventions in achieving equitable and inclusive access to water and sanitation for all, including the most vulnerable. With this purpose, a cross-sectional comparative analysis of service provision between the HIV-infected population (n = 199) and non-infected population (n = 199) was undertaken. Findings suggest significant inequalities regarding the primary water source, monthly expenditure in water, water consumption, and time employed to fetch water, as well as the type of toilet facility, number of users, and the time employed to access it. Results also show a reported feeling of discrimination with regard to service provision within the HIV-positive population. This study provides evidence on local-scale interventions increasing the number of household water connections but overlooking the pursuit of equity and inclusion for the most vulnerable. The study also presents recommendations on how to specifically target the needs of persons living with HIV/AIDS in order to achieve equitable and inclusive access to water and sanitation for all.
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