1,721,138 research outputs found
Quantifying the proportion of child growth failure attributable to low birth weight and short gestation
Get PDFThesis (Master's)--University of Washington, 2019Child growth failure is associated with poor health outcomes, including premature death, increased susceptibility to disease in childhood, and cognitive and motor loss in adulthood. Low birth weight and short gestation are two risk factors that are likely associated with the risk of child growth failure. However, some major comparative risk assessments, such as the risk assessment conducted by the Global Burden of Disease, do not account for the mediation between child growth failure, low birth weight, and short gestation in their estimations of attributable burden. This analysis aims to quantify the proportion of child growth failure attributable to low birth weight and short gestation as a first step towards disentangling the contributions of child growth failure and poor fetal growth towards disease burden. In this analysis, the proportion of child growth failure attributable to low birth weight and short gestation is also used to model how interventions aimed at increasing birth weight and gestational age could lead to averted cases of child growth failure
Global, Regional and National Estimation of Firstborn Prevalence, 1990-2022
No full textThesis (Master's)--University of Washington, 2020Introduction: Birth order, and in particular whether or not a child is firstborn, is known to be directly correlated with risk of specific neonatal diseases and indirectly associated with health outcomes beyond the neonatal period. Accurate and detailed knowledge of firstborn prevalence is therefore important in its own right and also a powerful tool for improving our understanding of multiple child health conditions. Data on birth order is not available in every location or year, so modeling is required. Previous models have used all age total fertility rate as a covariate which, although simpler, obscures important cohort fertility trends and subsequently may bias results. This analysis develops a new modeling strategy for estimating firstborn prevalence that explicitly incorporates the interaction between maternal age and historical fertility trends of maternal cohorts, exploring the model and prediction performance comparisons between the two approaches. Methods: Data on birth order from population-representative surveys and vital registration statistics were extracted and tabulated to inform an annual model of firstborn prevalence. Total fertility rate estimates from the Institute for Health Metrics and Evaluation were recomputed to derive a measure of fertility specific to maternal age and cohort, and the new age-specific measure was used as a covariate in a three step spatiotemporal Gaussian process regression to estimate maternal-age-specific firstborn prevalence across all GBD 2020 locations annually from 1990 to 2022. To first directly compare the effect of modeling by maternal age compared to across all ages, one dataset restricted to sources with complete coverage of the reproductive age range was modeled using both approaches and assessed through in-sample error metrics and qualitative comparison. To generate more comprehensive final estimates, a third model was then run using the age-specific model settings and full dataset (no restrictions on complete age coverage). Results: When run on the same data, the age-specific model performed better than the all age model in terms of in-sample fit. Both models had a small negative bias (-3.55% in the all-age model and -2.85% in the age-specific model). When the age-specific model was run on the full dataset, firstborn prevalence globally in 2019 was estimated to be 38.9% (36.9 – 40.9), an increase of 8.72% (1.50 – 16.8) since 1990. Firstborn prevalence in 2019 was highest in the Republic of Korea and Taiwan and lowest in Guinea-Bissau and the Solomon Islands. In 1990 firstborn prevalence was highest in San Marino and Greenland and lowest in Tuvalu and Qatar. Globally, firstborn prevalence was highest among women 10-14 years old and lowest among women 45-49 years old. Discussion: Modeling firstborn prevalence by maternal age improves upon modeling across all ages by improving in-sample fit, removing assumptions about comparability of maternal age ranges, and producing age-specific estimates that are more informative and more actionable. The set of complete and cross-nationally comparable estimates of firstborn prevalence can be used as predictive covariates to model other health outcomes, and the age-specific modeling framework reveals more specific drivers of changes in firstborn prevalence and presents opportunities for modeling additional fertility scenarios
Abortion in the United States: Occurrence, trends, cross-state care-seeking and unmet need
No full textThesis (Master's)--University of Washington, 2016-08Introduction: Nationally, the abortion rate has fallen over the last two decades. During the same period, the number restrictions and regulations on abortion have increased, especially after 2010. From 2001 to 2008 the percent of unintended pregnancies ending in abortion has fallen by 7 percentage points indicating a potential decrease in access to abortion services or decreased demand. Therefore, it is crucial to determine the drivers of these declines to tease apart the effect of access, restrictions, family planning, demographic and socioeconomic factors. Methods: This study utilizes data from the Alan Guttmacher Institute (AGI) alongside the Center for Disease Control’s (CDC) abortion surveillance data to estimate the trends and levels in state-level abortion by occurrence, age-standardized occurrence, and residence from 1990 to 2012. These values are then used to model resident in-state care-seeking for abortion services controlling for sociodemographic characteristics, access and restrictions. Counterfactual scenarios are constructed to measure unmet need. Results: In almost every state, the abortion ratio by occurrence decreased between 1990 and 2012 with the largest decreases seen in those states with the lowest ratios. Few differences were observed between the birth-rate standardized ratio to the crude estimated occurrence ratio. Over half of the residents in Wyoming, Mississippi and Missouri sought their abortions from other states in 2012. The estimated unmet need in 2012 was 70.5 abortions per 1,000 live births to women aged 10-49. The largest single impact for reducing this unmet need was predicted for eliminating restrictions in Medicaid funding for abortions. Conclusion: Despite an overall decrease in the abortion ratio over the past decade, the expected abortion ratio would be considerably higher controlling for socioeconomic, demographic and cultural factors if there were more providers, if providers were distributed so every woman had access to a provider in her county and given changes in legislation and abortion restrictions. The largest impact on reducing unmet need was observed for lifting Medicaid funding restrictions, suggesting a disproportionate level of unmet need among low income women. There is also a need for more standardized data on abortion reporting at the state level to monitor the effect of restrictions on access to abortion services and to bolster family planning services in areas with the most unmet need
Going Beyond Counting First Authors in Author Co-citation Analysis
Get PDFThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Global, Regional, and National Estimates of Complete Coverage of Maternal Obstetric Care Interventions, 1990-2019
No full textThesis (Master's)--University of Washington, 2020Introduction: Tracking coverage of maternal obstetric care interventions is a major component of policies and programs aimed at reducing maternal and child mortality around the world. Previous work quantifying coverage of these interventions has been limited in scope and cross-national comparability. In this analysis, we estimate coverage of five essential maternal obstetric care interventions and a new indicator of receipt of the full maternal obstetric care continuum. Methods: We synthesized 898 unique data sources covering 4,141 unique country-years of data to model coverage of antenatal care (4+ visits), in-facility delivery, skilled birth attendance, caesarean section delivery, postnatal care, and full maternal care coverage. We used a 3-step spatiotemporal Gaussian process regression modeling technique to produce estimates of coverage at the global, regional, and national levels from 1990 to 2019. Results: In 2019, we estimate 68.3% (95% UI 67.5 – 69.1) of women received four or more antenatal care visits during pregnancy, 81.1% (80.1 – 82.2) of women gave birth in a health facility, 83.1% (82.1 – 84.0) of births were attended by a skilled birth attendant, 22.3% (21.2 – 23.5) of births were delivered via caesarean section, and 70.5% (69.8 – 71.1) of women received a postnatal care visit within two days of delivery. We estimate that 56% (55.1 – 56.9) of women received the recommended full continuum of maternal care indicators. While significant progress has been made in expanding coverage since 1990, we demonstrate large remaining geographic coverage gaps. These gaps resulted in an estimated 58.3 million live births in 2019 that were not covered by the full continuum of recommended maternal obstetric care interventions. Discussion: While significant progress has been made in expanding access to essential maternal obstetric care interventions, coverage remains comparatively low in regions with the highest maternal and child morbidity and mortality. Estimates of intervention coverage can help policymakers and practitioners identify locations for program and policy focus, and estimates of full maternal care coverage expand beyond traditional monitoring frameworks and focus on the full maternal obstetric care continuum and health systems’ capacity to provide care throughout the duration of pregnancy, delivery, and post-partum
Variations on the Author
Get PDF“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Get PDFWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Examining the Effect of Hydroxyurea Treatment on Acute Care Spending and Utilization among Patients with Sickle Cell Disease
No full textThesis (Master's)--University of Washington, 2022Background: Sickle cell disease (SCD) is one of the most common inherited diseases in the U.S. and disproportionately affects African Americans and Hispanic Americans. People with SCD suffer acute pain crises and chronic pain throughout the lifespan and since disease cure is often unattainable, most turn to intensive and costly disease management, often with particularly high emergency care use. Hydroxyurea (HU), an inexpensive therapeutic drug, has proven to be effective at reducing pain crises. However, HU is underutilized for a variety of reasons including lack of insurance coverage, misperceptions and negative beliefs, and lack of provider awareness of guidelines. This paper aims to quantify how healthcare utilization, spending, and pain crises in SCD patients change before and after prescription of hydroxyurea, as well as estimate the potential averted burden if those not prescribed hydroxyurea were to be placed on the treatment regimen. Methods: MarketScan Commercial Claims and Encounters databases person-specific information on healthcare utilization, healthcare spending, prescriptions, and diagnoses from 2016 to 2019 was aggregated into 90-day periods. 2-tailed t-tests were used to compare their mean outcomes in care utilization, spending, and pain crises per 90 days, pre and post receipt of that prescription and negative binomial regressions were run to estimate mean outcomes over 5, 90-day time periods. Control SCD patients who had never received a prescription for hydroxyurea were matched 1:1 using propensity score matching to the previously established treated group on age, sex and genotype. T-tests and regressions were repeated to compare mean outcomes between control and treated groups. The ratio of change in outcome pre and post HU prescription among treated patients was then applied to the control group to estimate the potential averted care utilization, pain, and spending if the control received the treatment. Results: 7,793 patients between the ages of 0 and 65 with a diagnosis of SCD from ICD-10 with a minimum of 1 year data coverage were selected, of whom 25.7% (n =2008) received a prescription for hydroxyurea at any point. 631 patients met the inclusion criteria for at least 90 days prior to initial prescription of hydroxyurea and 360 days post prescription. Prior to initiating treatment, hydroxyurea-treated patients had worse outcomes per 90 days with an estimated total of 5.4 (95% confidence interval 5.0-5.9) visits, 4,319 (3,750 – 4,975) total net pay, and 0.3 (0.3-0.3) pain crises. Though outcomes among those initiating hydroxyurea remained significantly higher than controls, across care utilization, spending, and pain crises, patient 90-day outcomes were significantly lower post hydroxyurea initiation, in all types of care except outpatient visits and outpatient net pay, and the greatest declines were in inpatient settings. Interpretation: SCD patients have high care utilization, spending, and pain outcomes. Those treated with hydroxyurea may experience greater disease severity, but this study indicates that if hydroxyurea were more widely utilized, their outcomes may be improved, and a large health and financial burden could be averted
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