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Cantrell A, Booth A, Chambers D. A systematic review case study of urgent and emergency care configuration found citation searching of Web of Science and Google Scholar of similar value. Health Info Libr J 2024; 41:166-181. [PMID: 35289476 DOI: 10.1111/hir.12428] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 09/29/2021] [Accepted: 10/05/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Supplementary search methods, including citation searching, are essential if systematic reviews are to avoid producing biased conclusions. Little evidence exists on how to prioritise databases for citation searching or to establish whether using multiple sources is beneficial. OBJECTIVES A systematic review examining urgent and emergency care reconfiguration was used to investigate the utility of citation searching on Web of Science (WOS) and/or Google Scholar (GS). METHODS This case study investigated numbers of studies, additional studies and unique studies retrieved from both sources. In addition, the time to search, the ease of adding references to reference management software and obtaining abstracts of studies for screening are briefly considered. RESULTS WOS retrieved 62 references after deduplication of the results, 52 being additional references not retrieved during the database searching. GS retrieved 134 unique references with 63 additional references. WOS and GS retrieved the same three additional included studies. WOS was less time intensive to search given the facility to restrict to English language papers and availability of abstracts. CONCLUSIONS In a single systematic review case study, citation searching was required to identify all included studies. Citation searching on WOS is more efficient, where a subscription is available. Both databases identified the same studies but GS required additional time to remove non-English language studies and locate abstracts.
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Affiliation(s)
- Anna Cantrell
- Health Economics and Decision Science Section, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Andrew Booth
- Health Economics and Decision Science Section, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Duncan Chambers
- Public Health Section, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
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Örtqvist AK, Haas J, Ahlberg M, Norman M, Stephansson O. Association between travel time to delivery unit and unplanned out-of-hospital birth, infant morbidity and mortality: A population-based cohort study. Acta Obstet Gynecol Scand 2021; 100:1478-1489. [PMID: 33779982 DOI: 10.1111/aogs.14156] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 03/24/2021] [Accepted: 03/26/2021] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Over the last decade, a number of delivery units have been closed in Sweden, justified by both economic incentives and patient safety issues. However, concentrating births to larger delivery units naturally increases travel time for some parturient women, which may lead to unintended negative consequences. We aimed to investigate the association between travel time to delivery unit and unplanned out-of-hospital birth, and subsequent infant morbidity and mortality. MATERIAL AND METHODS We performed a population-based cohort study including 365 604 women in the Swedish Pregnancy Register, giving birth between 2014 and 2017. Modified Poisson regression was used to investigate the association between travel time from home address to actual delivery unit, based on geographic information system analysis, and risk of an unplanned out-of-hospital birth. Analyses were stratified by parity and urban/rural residence. Lastly, the associations between an unplanned out-of-hospital birth and severe infant morbidity, stillbirth, peripartum, perinatal and neonatal mortality were investigated. RESULTS Of those with an unplanned out-of-hospital birth (n = 2159), 65% had a travel time up to 30 minutes. A travel time between 31 and 60 minutes was associated with a doubled risk of unplanned out-of-hospital birth (adjusted risk ratio [RR] 1.96, 95% confidence interval [CI] 1.74-2.22) and women with a travel time of more than 1 hour had an adjusted RR of 3.19 (95% CI 2.64-3.86), compared with those with a travel time of <30 minutes. No difference in results was seen when stratified for parity and urban/rural residence. No association was found between unplanned out-of-hospital birth and severe infant morbidity. Significant associations were found in crude analyses for stillbirth (RR 1.85, 95% CI 1.09-3.13), peripartum (RR 1.93, 95% CI 1.18-3.16), perinatal (RR 2.03, 95% CI 1.28-3.23) and neonatal mortality (RR 3.08, 95% CI 1.27-7.46), although neonatal mortality was very rare (2.3/1000 out-of-hospital births). Similar effect estimates were found in the adjusted analyses, though no longer significant. CONCLUSIONS Although the majority of unplanned out-of-hospital births occurred in the group of women with a travel time of 0-30 minutes, increasing travel time to a delivery unit is associated with unplanned out-of-hospital birth, which may increase the risk of mortality.
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Affiliation(s)
- Anne K Örtqvist
- Clinical Epidemiology Division, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Obstetrics and Gynecology, Visby County Hospital, Visby, Sweden
| | - Jan Haas
- Department of Environmental and Life Sciences, Faculty of Health, Science and Technology, Geomatics, Karlstad University, Karlstad, Sweden
| | - Mia Ahlberg
- Clinical Epidemiology Division, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Women's Health, Karolinska University Hospital, Stockholm, Sweden
| | - Mikael Norman
- Department of Clinical Science, Intervention and Technology, Division of Pediatrics, Karolinska Institutet, Stockholm, Sweden.,Department of Neonatal Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Olof Stephansson
- Clinical Epidemiology Division, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Women's Health, Karolinska University Hospital, Stockholm, Sweden
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Chambers D, Cantrell A, Baxter SK, Turner J, Booth A. Effects of increased distance to urgent and emergency care facilities resulting from health services reconfiguration: a systematic review. HEALTH SERVICES AND DELIVERY RESEARCH 2020. [DOI: 10.3310/hsdr08310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundService reconfigurations sometimes increase travel time and/or distance for patients to reach their nearest hospital or other urgent and emergency care facility. Many communities value their local services and perceive that proposed changes could worsen outcomes for patients.ObjectivesTo identify, appraise and synthesise existing research evidence regarding the outcomes and impacts of service reconfigurations that increase the time and/or distance for patients to reach an urgent and emergency care facility. We also aimed to examine the available evidence regarding associations between distance to a facility and outcomes for patients and health services, together with factors that may influence (moderate or mediate) these associations.Data sourcesWe searched seven bibliographic databases in February 2019. The search was supplemented by citation-tracking and reference list checking. A separate search was conducted to identify the current systematic reviews of telehealth to support urgent and emergency care.MethodsBrief inclusion and exclusion criteria were as follows: (1) population – adults or children with conditions that required emergency treatment; (2) intervention/comparison – studies comparing outcomes before and after a service reconfiguration, which affects the time/distance to urgent and emergency care or comparing outcomes in groups of people travelling different distances to access urgent and emergency care; (3) outcomes – any patient or health system outcome; (4) setting – the UK and other developed countries with relevant health-care systems; and (5) study design – any. The search results were screened against the inclusion criteria by one reviewer, with a 10% sample screened by a second reviewer. A quality (risk-of-bias) assessment was undertaken using The Joanna Briggs Institute Checklist for Quasi-Experimental Studies. We performed a narrative synthesis of the included studies and assessed the overall strength of evidence using a previously published method.ResultsWe included 44 studies in the review, of which eight originated from the UK. For studies of general urgent and emergency care populations, there was no evidence that reconfiguration that resulted in increased travel time/distance affected mortality rates. By contrast, evidence of increased risk was identified from studies restricted to patients with acute myocardial infarction. Increases in mortality risk were most obvious within the first 1–4 years after reconfiguration. Evidence for other conditions was inconsistent or very limited. In the absence of reconfiguration, evidence mainly from cohort studies indicated that increased travel time or distance is associated with increased mortality risk for the acute myocardial infarction and trauma populations, whereas for obstetric emergencies the evidence was inconsistent. We included 12 systematic reviews of telehealth. Meta-analyses suggested that telehealth technologies can reduce time to treatment for people with stroke and ST elevation myocardial infarction.LimitationsMost studies came from non-UK settings and many were at high risk of bias because there was no true control group. Most review processes were carried out by a single reviewer within a constrained time frame.ConclusionsWe found no evidence that increased distance increases mortality risk for the general population of people requiring urgent and emergency care, although this may not be true for people with acute myocardial infarction or trauma. Increases in mortality risk were most likely in the first few years after reconfiguration.Future workResearch is needed to better understand how health systems plan for and adapt to increases in travel time, to quantify impacts on health system outcomes, and to address the uncertainty about how risk increases with distance in circumstances relevant to UK settings.Study registrationThis study is registered as PROSPERO CRD42019123061.FundingThis project was funded by the NIHR Health Services and Delivery Research programme and will be published in full inHealth Services and Delivery Research; Vol. 8, No. 31. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Duncan Chambers
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Anna Cantrell
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Susan K Baxter
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Janette Turner
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Andrew Booth
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
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Darling EK, Lawford KMO, Wilson K, Kryzanauskas M, Bourgeault IL. Distance from Home Birth to Emergency Obstetric Services and Neonatal Outcomes: A Cohort Study. J Midwifery Womens Health 2018; 64:170-178. [PMID: 30325580 DOI: 10.1111/jmwh.12896] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 07/11/2018] [Accepted: 07/13/2018] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Little is known about the relationship between distance from hospital services and the outcomes of planned home births. We examined whether greater driving distance from a hospital with continuous cesarean capability was associated with a higher risk of adverse neonatal outcome among individuals who were planning to give birth at home. METHODS Using an intention-to-treat analysis, we conducted a population-based cohort study of 11,869 individuals who planned to give birth at home in Ontario, Canada, between April 1, 2012, and March 31, 2015. We used postal codes to determine the driving time from maternal residence to the closest hospital offering level 2 or higher maternity care services (ie, hospital with continuous cesarean birth capability). We used log binomial regression analysis to compare the outcomes of individuals who planned a birth more than a 30-minute drive from a level 2 hospital with those of individuals whose births were planned to occur within 30 minutes. We adjusted for maternal age, parity, gestational age, season, and maternal material deprivation quintile. RESULTS We found no statistically significant difference in the rates of 5-minute Apgar scores less than 7 (adjusted relative risk [aRR], 1.02; 95% CI, 0.95-1.10; P = .58), perinatal mortality, meconium aspiration syndrome, and emergency medical service usage. Neonates born to individuals who planned to give birth at a greater distance from a hospital had a lower rate of neonatal intensive care unit admission (aRR, 0.6; 95% CI, 0.44-0.81; P = .001). DISCUSSION We found no increased risk of adverse neonatal outcomes for births that were planned to occur more than 30 minutes from a hospital. Our findings can be considered, along with individual risk factors and contextual factors, in decision making about the choice of home birth for individuals who live more than half an hour from a hospital with cesarean capacity.
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Padilla CM, Kihal-Talantikit W, Perez S, Deguen S. Use of geographic indicators of healthcare, environment and socioeconomic factors to characterize environmental health disparities. Environ Health 2016; 15:79. [PMID: 27449640 PMCID: PMC4957910 DOI: 10.1186/s12940-016-0163-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Accepted: 06/30/2016] [Indexed: 05/21/2023]
Abstract
BACKGROUND An environmental health inequality is a major public health concern in Europe. However just few studies take into account a large set of characteristics to analyze this problematic. The aim of this study was to identify and describe how socioeconomic, health accessibility and exposure factors accumulate and interact in small areas in a French urban context, to assess environmental health inequalities related to infant and neonatal mortality. METHODS Environmental indicators on deprivation index, proximity to high-traffic roads, green space, and healthcare accessibility were created using the Geographical Information System. Cases were collected from death certificates in the city hall of each municipality in the Nice metropolitan area. Using the parental addresses, cases were geocoded to their census block of residence. A classification using a Multiple Component Analysis following by a Hierarchical Clustering allow us to characterize the census blocks in terms of level of socioeconomic, environmental and accessibility to healthcare, which are very diverse definition by nature. Relation between infant and neonatal mortality rate and the three environmental patterns which categorize the census blocks after the classification was performed using a standard Poisson regression model for count data after checking the assumption of dispersion. RESULTS Based on geographic indicators, three environmental patterns were identified. We found environmental inequalities and social health inequalities in Nice metropolitan area. Moreover these inequalities are counterbalance by the close proximity of deprived census blocks to healthcare facilities related to mother and newborn. So therefore we demonstrate no environmental health inequalities related to infant and neonatal mortality. CONCLUSION Examination of patterns of social, environmental and in relation with healthcare access is useful to identify census blocks with needs and their effects on health. Similar analyzes could be implemented and considered in other cities or related to other birth outcomes.
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Affiliation(s)
- Cindy M. Padilla
- />Department of Quantitative Methods in Public Health, EHESP School of Public Health, Sorbonne-Paris Cité, 35043 Rennes, France
| | - Wahida Kihal-Talantikit
- />Department of Environmental and Occupational Health, EHESP School of Public Health, Sorbonne-Paris Cité, 35043 Rennes, France
- />INSERM U1085-IRSET – Research institute of environmental and occupational health, Rennes, France
| | - Sandra Perez
- />UMR ESPACE 7300, University of Nice Sophia, Nice, France
| | - Severine Deguen
- />Department of Environmental and Occupational Health, EHESP School of Public Health, Sorbonne-Paris Cité, 35043 Rennes, France
- />INSERM U1085-IRSET – Research institute of environmental and occupational health, Rennes, France
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Pilcher J, Kruske S, Barclay L. A review of rural and remote health service indexes: are they relevant for the development of an Australian rural birth index? BMC Health Serv Res 2014; 14:548. [PMID: 25491346 PMCID: PMC4265404 DOI: 10.1186/s12913-014-0548-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Accepted: 10/22/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Policy informs the planning and delivery of rural and remote maternity services and influences the perinatal outcomes of the 30 per cent of Australian women and their babies who live outside the major cities. Currently however, there are no planning tools that identify the optimal level of birthing services for rural and remote communities in Australia. To address this, the Australian government has prioritised the development of a rigorous methodology in the Australian National Maternity Services Plan to inform the planning of rural and remote maternity services. METHODS A review of the literature was undertaken to identify planning indexes with component variables as outlined in the Australian National Maternity Services Plan. The indexes were also relevant if they described need associated with a specific type and level of health service in rural and remote areas of high income countries. Only indexes that modelled a range of socioeconomic and or geographical variables, identified access or need for a specific service type in rural and remote communities were included in the review. RESULTS Four indexes, two Australian and two Canadian met the inclusion criteria. They used combinations of variables including: geographical placement of services; isolation from services and socioeconomic vulnerability to identify access to a type and level of health service in rural and remote areas within 60 minutes. Where geographic isolation reduces access to services for high needs populations, additional measures of disadvantage including indigeneity could strengthen vulnerability scores. CONCLUSION Current planning indexes are applicable for the development of an Australian rural birthing index. The variables in each of the indexes were relevant, however use of flexible sized catchments to accurately account for population births and weighting for extreme geographic isolation needs to be considered. Additionally, socioeconomic variables are required that will reflect need for services particularly for isolated high needs populations. These variables could be used with Australian data and appropriate cut-off points to confirm applicability for maternity services. All of the indexes used similar types of variables and are relevant for the development of an Australian Rural Birth Index.
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Affiliation(s)
- Jennifer Pilcher
- University Centre for Rural Health, University of Sydney, Uralba st, Lismore, NSW, Australia.
| | - Sue Kruske
- University Centre for Mothers and Babies, University of Queensland, St Lucia, Brisbane, Australia.
| | - Lesley Barclay
- University Centre for Rural Health, University of Sydney, Uralba st, Lismore, NSW, Australia.
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Paranjothy S, Watkins WJ, Rolfe K, Adappa R, Gong Y, Dunstan F, Kotecha S. Perinatal outcomes and travel time from home to hospital: Welsh data from 1995 to 2009. Acta Paediatr 2014; 103:e522-7. [PMID: 25197024 DOI: 10.1111/apa.12800] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 07/15/2014] [Accepted: 09/01/2014] [Indexed: 11/28/2022]
Abstract
AIM To study the association between travel time from home to hospital and birth outcomes. METHODS For all registrable births to women resident in Wales (1995-2009), we calculated the travel time between the mother's residence and the postcode-based location for both the birth hospital and all hospitals with maternity services that were open. Using logistic regression, we obtained odds ratios for the association between travel time and each birth outcome, adjusted for confounders. RESULTS In our analysis of 412 827 singleton births, for every 15-min increase in travel time to the birth hospital, there was an increased risk of early (n = 609; OR: 1.13; 95%CI: 1.07, 1.20) and late neonatal death (n = 251; OR: 1.15; 95%CI: 1.05, 1.26). Results for intrapartum stillbirth were inconclusive (n = 135; OR: 1.13; 95%CI: 0.98, 1.30). For the above-combined (n = 995) results, we get OR: 1.15, 95%CI: 1.09, 1.20. No association was found with travel time to the nearest hospital (OR: 1.01; 95%CI: 0.90, 1.13 per 15-min increase in travel time) for the composite outcome of intrapartum stillbirth and neonatal deaths. CONCLUSION Longer travel time to the birth hospital was associated with increased risk of neonatal deaths, but there was no strong evidence of association with the geographical location of maternity services.
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Affiliation(s)
- Shantini Paranjothy
- Institute of Primary Care and Public Health; School of Medicine; Cardiff University; Cardiff UK
| | - W John Watkins
- Department of Child Health; School of Medicine; Cardiff University; Cardiff UK
| | - Kim Rolfe
- Department of Child Health; School of Medicine; Cardiff University; Cardiff UK
| | - Roshan Adappa
- Cardiff and Vale University Health Board; Cardiff UK
| | - Yi Gong
- Institute of Primary Care and Public Health; School of Medicine; Cardiff University; Cardiff UK
| | - Frank Dunstan
- Institute of Primary Care and Public Health; School of Medicine; Cardiff University; Cardiff UK
| | - Sailesh Kotecha
- Department of Child Health; School of Medicine; Cardiff University; Cardiff UK
- Cardiff and Vale University Health Board; Cardiff UK
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Pilkington H, Blondel B, Drewniak N, Zeitlin J. Where does distance matter? Distance to the closest maternity unit and risk of foetal and neonatal mortality in France. Eur J Public Health 2014; 24:905-10. [PMID: 24390464 PMCID: PMC4245008 DOI: 10.1093/eurpub/ckt207] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: The number of maternity units has declined in France, raising concerns about the possible impact of increasing travel distances on perinatal health outcomes. We investigated impact of distance to closest maternity unit on perinatal mortality. Methods: Data from the French National Vital Statistics Registry were used to construct foetal and neonatal mortality rates over 2001–08 by distance from mother’s municipality of residence and the closest municipality with a maternity unit. Data from French neonatal mortality certificates were used to compute neonatal death rates after out-of-hospital birth. Relative risks by distance were estimated, adjusting for individual and municipal-level characteristics. Results: Seven percent of births occurred to women residing at ≥30 km from a maternity unit and 1% at ≥45 km. Foetal and neonatal mortality rates were highest for women living at <5 km from a maternity unit. For foetal mortality, rates increased at ≥45 km compared with 5–45 km. In adjusted models, long distance to a maternity unit had no impact on overall mortality but women living closer to a maternity unit had a higher risk of neonatal mortality. Neonatal deaths associated with out-of-hospital birth were rare but more frequent at longer distances. At the municipal-level, higher percentages of unemployment and foreign-born residents were associated with increased mortality. Conclusion: Overall mortality was not associated with living far from a maternity unit. Mortality was elevated in municipalities with social risk factors and located closest to a maternity unit, reflecting the location of maternity units in deprived areas with risk factors for poor outcome.
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Affiliation(s)
- Hugo Pilkington
- 1 Département de Géographie, Université Paris 8 Vincennes-Saint-Denis, UMR7533 Ladyss, 2 rue de la Liberté, F-93526 Saint-Denis, France
| | - Béatrice Blondel
- 2 INSERM, UMRS 953, Epidemiological Research Unit on Perinatal and Women's and Children's Health, Paris, France 3 UPMC University Paris06, Paris, France
| | - Nicolas Drewniak
- 2 INSERM, UMRS 953, Epidemiological Research Unit on Perinatal and Women's and Children's Health, Paris, France 3 UPMC University Paris06, Paris, France
| | - Jennifer Zeitlin
- 2 INSERM, UMRS 953, Epidemiological Research Unit on Perinatal and Women's and Children's Health, Paris, France 3 UPMC University Paris06, Paris, France
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The impact of centralization of obstetric care resources in Japan on the perinatal mortality rate. ISRN OBSTETRICS AND GYNECOLOGY 2013; 2013:709616. [PMID: 24167731 PMCID: PMC3791613 DOI: 10.1155/2013/709616] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Accepted: 08/20/2013] [Indexed: 01/19/2023]
Abstract
Objective. We investigated the effects of the centralization of obstetricians and obstetric care facilities on the perinatal mortality rate in Japan. Methods. We used the Gini coefficient as an index to represent the centralization of obstetricians and obstetric care facilities. The Gini coefficients were calculated for the number of obstetricians and obstetric care facilities of 47 prefectures using secondary medical care zones as units. To measure the effects of the centralization of obstetricians and obstetric care facilities on the outcomes (perinatal mortality rates), we performed multiple regression analysis using the perinatal mortality rate as the dependent variable. Results. Obstetric care facilities were more evenly distributed than obstetricians. The perinatal mortality rate was found to be significantly negatively correlated with the number of obstetricians per capita and the Gini coefficient of obstetric care facilities. The latter had a slightly stronger effect on the perinatal mortality rate. Conclusion. The centralization of obstetric care facilities can improve the perinatal mortality rate, even when increasing the number of obstetricians is difficult.
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Combier E, Charreire H, Le Vaillant M, Michaut F, Ferdynus C, Amat-Roze JM, Gouyon JB, Quantin C, Zeitlin J. Perinatal health inequalities and accessibility of maternity services in a rural French region: closing maternity units in Burgundy. Health Place 2013; 24:225-33. [PMID: 24177417 DOI: 10.1016/j.healthplace.2013.09.006] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Revised: 06/01/2013] [Accepted: 09/18/2013] [Indexed: 11/19/2022]
Abstract
Maternity unit closures in France have increased travel time for pregnant women in rural areas. We assessed the impact of travel time to the closest unit on perinatal outcomes and care in Burgundy using multilevel analyses of data on deliveries from 2000 to 2009. A travel time of 30min or more increased risks of fetal heart rate anomalies, meconium-stained amniotic fluid, out-of-hospital births, and pregnancy hospitalizations; a positive but non-significant gradient existed between travel time and perinatal mortality. The effects of long travel distances on perinatal outcomes and care should be factored into closure decisions.
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Affiliation(s)
- Evelyne Combier
- Centre d'épidémiologie et de santé publique Bourgogne (EA4184). Faculté de Médecine, Dijon, France.
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Charreire H, Combier E, Michaut F, Ferdynus C, Blondel B, Drewniak N, Le Vaillant M, Pilkington H, Amat-Roze JM, Zeitlin J. Une géographie de l’offre de soins en restructuration : les territoires des maternités en Bourgogne. ACTA ACUST UNITED AC 2012. [DOI: 10.7202/1008891ar] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Résumé
En France, l’organisation des services de santé périnatale subit actuellement de profondes mutations en raison de la restructuration de l’offre de soins et notamment en raison de la fermeture des petites ou moyennes maternités. Au-delà des polémiques suscitées lors de la suppression d’un établissement, ces restructurations ont-elles des répercussions sur l’accessibilité aux maternités pour les parturientes ? À la suite des fermetures successives de maternités, notre étude a pour objectif de présenter les recompositions des pratiques spatiales des femmes et de lire les nouvelles aires d’attraction. Le territoire d’étude est la région Bourgogne, territoire hétérogène, aux forces centrifuges associant des zones urbaines, périurbaines et rurales enclavées. Cette étude met en évidence les inégalités spatiales d’accès aux soins et apporte des éléments d’analyse face aux questions d’équité que se posent les décideurs et les professionnels de santé publique.
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Affiliation(s)
- Hélène Charreire
- Lab-Urba, Institut d’urbanisme de Paris, Université Paris Est-Créteil
| | - Evelyne Combier
- Centre d’épidémiologie des populations EA4184, Cellule d’évaluation des réseaux de soins, CHU-Hôpital du Bocage, Dijon
| | - Francis Michaut
- Centre d’épidémiologie des populations EA4184, Cellule d’évaluation des réseaux de soins, CHU-Hôpital du Bocage, Dijon
| | - Cyril Ferdynus
- Centre d’épidémiologie des populations EA4184, Cellule d’évaluation des réseaux de soins, CHU-Hôpital du Bocage, Dijon
| | | | | | - Marc Le Vaillant
- CERMES3, UMR 8211-U988, CNRS, INSERM, Université Paris Descartes, EHESS, Villejuif
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Ravelli ACJ, Eskes M, Jager KJ, Mol BW. Travel time from home to hospital and adverse perinatal outcomes in women at term in the Netherlands. BJOG 2011. [DOI: 10.1111/j.1471-0528.2011.02946.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Ravelli ACJ, Jager KJ, de Groot MH, Erwich JJHM, Rijninks-van Driel GC, Tromp M, Eskes M, Abu-Hanna A, Mol BWJ. Travel time from home to hospital and adverse perinatal outcomes in women at term in the Netherlands. BJOG 2010; 118:457-65. [PMID: 21138515 DOI: 10.1111/j.1471-0528.2010.02816.x] [Citation(s) in RCA: 102] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To study the effect of travel time, at the start or during labour, from home to hospital on mortality and adverse outcomes in pregnant women at term in primary and secondary care. DESIGN Population-based cohort study from 2000 up to and including 2006. SETTING The Netherlands Perinatal Registry. POPULATION A total of 751,926 singleton term hospital births. METHODS We assessed the impact of travel time by car, calculated from the postal code of the woman's residence to the 99 maternity units, on neonatal outcome. Logistic regression modelling with adjustments for gestational age, maternal age, parity, ethnicity, socio-economic status, urbanisation, tertiary care centres and volume of the hospital was used. MAIN OUTCOME MEASURES Mortality (intrapartum, and early and late neonatal mortality) and adverse neonatal outcomes (mortality, Apgar <4 and/or admission to a neonatal intensive care unit). RESULTS The mortality was 1.5 per 1000 births, and adverse outcomes occurred in 6.0 per 1000 births. There was a positive relationship between longer travel time (≥20 minutes) and total mortality (OR 1.17, 95% CI 1.002-1.36), neonatal mortality within 24 hours (OR 1.51, 95% CI 1.13-2.02) and with adverse outcomes (OR 1.27, 95% CI 1.17-1.38). In addition to travel time, both delivery at 37 weeks of gestation (OR 2.23, 95% CI 1.81-2.73) or 41 weeks of gestation (OR 1.52, 95% CI 1.29-1.80) increased the risk of mortality. CONCLUSIONS A travel time from home to hospital of 20 minutes or more by car is associated with an increased risk of mortality and adverse outcomes in women at term in the Netherlands. These findings should be considered in plans for the centralisation of obstetric care.
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Affiliation(s)
- A C J Ravelli
- Department of Medical Informatics, Academic Medical Centre, Amsterdam, the Netherlands.
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Cruz-Anguiano V, Talavera JO, Vázquez L, Antonio A, Castellanos A, Lezana MA, Wacher NH. The importance of quality of care in perinatal mortality: a case-control study in Chiapas, Mexico. Arch Med Res 2005; 35:554-62. [PMID: 15631884 DOI: 10.1016/j.arcmed.2004.11.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2004] [Accepted: 08/26/2004] [Indexed: 10/26/2022]
Abstract
BACKGROUND This study was undertaken in order to ascertain the relative importance of different risk factors for perinatal mortality (PM) in a community of Chiapas, Mexico stressing the importance of antenatal and neonatal medical care. METHODS Cases were stillbirth and early neonatal death (END). Two children born in the same hospital and/or day as the case were randomly selected as controls, in Tapachula, Chiapas, Mexico. Socioeconomic, cultural, maternal, pregnancy, delivery, product and medical care factors were recorded. Two analyses were performed using multiple logistic regression: one for stillbirths, the other for END. RESULTS PM rate was 46.7/1000; 142 cases and 284 controls were studied. Fifteen cases were excluded due to congenital malformations; 62 stillbirth and 65 END were analyzed. For stillbirth, pregnancy-delivery and maternal medical care factors resulted in the most strongly associated risk factors for PM (OR=27.5 95% CI 6.4-116.8), and within this index insufficient prenatal care had the strongest impact on PM (%population attributable risk (%PAR)=24%). For END, fetal conditions and the newborn medical care index had the strongest association with PM (OR=9.5 95% CI 1.5-60.3), and within the index inappropriate medical care of the newborn (%PAR=27%) was the most important variable. CONCLUSIONS Our results support the fact that insufficient prenatal care and failure to comply with the standards of care for labor, delivery and for the care of the newborn are strong predictors of PM.
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Affiliation(s)
- Veronica Cruz-Anguiano
- Hospital General de Zona #1, Instituto Mexicano del Seguro Social (IMSS), Tapachula, Chiapas, Mexico
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