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17. Prevalence of diminished kidney function in a representative sample of middle and older age adults in the Irish population

Author

Browne Gemma M, Eustace Joseph A, Fitzgerald Anthony P, Lutomski Jennifer E, and Perry Ivan J

Subjects
Chronic kidney disease, Glomerular filtration rate, Albuminuria, Population survey, Diseases of the genitourinary system. Urology, RC870-923
Abstract

Abstract Background The prevalence of chronic kidney disease (CKD) using available estimating equations with the Republic of Ireland is unknown. Methods A randomly selected population based cross-sectional study of 1,098 adults aged 45 years and older was conducted using data from the 2007 Survey of Lifestyle, Attitudes and Nutrition (SLÁN). Estimated Glomerular Filtration Rate (eGFR) was calculated from a single IDMS aligned serum creatinine using the CKD-EPI and the MDRD equations, and albumin to creatinine ratio was based on a single random urine sample. Results The sample clinical characteristics and demography was similar to middle and older age adults in the general Irish population, though with an underrepresentation of subjects >75 years and of males. All results are based on subjects with available blood and urine samples. Applying weighting to obtain survey based population estimates, using Irish population census data, the estimated weighted prevalence of CKD-EPI eGFR2 was 11.6%, (95% confidence interval; 9.0, 14.2%), 12.0% ( 9.0, 14.2%) of men and 11.2% (7.3, 15.2%) of women. Unweighted prevalence estimates were similar at 11.8% (9.9, 13.8%). Albuminuria increased with lower CKD-EPI eGFR category. 10.1% of all subjects had albuminuria and an eGFR≥60 mL/min/1.73 m2 giving an overall weighted estimated prevalence of National Kidney Foundation (NKF) defined CKD 21.3% (18.0, 24.6%), with the unadjusted estimate of 21.9% (19.5, 24.4%). MDRD related estimates for eGFR 2, and NFK defined CKD were higher than CKD-EPI and differences were greater in younger and female subjects. Conclusions CKD is highly prevalent in middle and older aged adults within the Republic of Ireland. In this population, there is poor agreement between CKD-EPI and MDRD equations especially at higher GFRs. CKD is associated with lower educational status and poor self rated health.

Published
2012
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18. Regional variation in obstetrical intervention for hospital birth in the Republic of Ireland, 2005–2009

Author

Lutomski Jennifer E, Morrison John J, and Lydon-Rochelle Mona T

Subjects
Caesarean section, Clinical practice variations, Epidural anaesthesia, ICD-10, Hospital discharge data, Gynecology and obstetrics, RG1-991
Abstract

Abstract Background Obstetrical interventions during childbirth vary widely across European and North American countries. Regional differences in intrapartum care may reflect an inpatient-based, clinician-oriented, interventional practice style. Methods Using nationally representative hospital discharge data, a retrospective cohort study was conducted to explore regional variation in obstetric intervention across four major regions (Dublin Mid Leinster; Dublin Northeast; South; West) within the Republic of Ireland. Specific focus was given to rates of induction of labour, caesarean delivery, epidural anaesthesia, blood transfusion, hysterectomy and episiotomy. Logistic regression analyses were performed to assess the association between geographical region and interventions while adjusting for patient case-mix. Results 323,588 deliveries were examined. The incidence of interventions varied significantly across regions; the greatest disparities were observed for rates of induction of labour and caesarean delivery. Women in the South had nearly two-fold odds of having prostaglandins (adjusted OR: 1.75, 95% CI 1.68-1.82), whereas women in the West had 1.85 odds (95% CI 1.77-1.93) of artificial rupture of membrane. Women delivering in the Dublin Northeast, South and West regions had more than two-fold increased odds of elective caesarean delivery relative to women delivering in the Dublin Mid Leinster region. The Dublin Northeast region had the highest odds of emergency caesarean delivery (adjusted OR: 1.36; 95% CI: 1.31-1.40). Conclusions Substantial regional variation in intrapartum care was observed within this small, relatively homogeneous population. The association of intervention use with region illustrates the need to encourage uptake of scientific based practice guidelines to better inform clinical judgment.

Published
2012
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19. Measurement properties of the EQ-5D across four major geriatric conditions : Findings from TOPICS-MDS

Author

Lutomski, Jennifer E., Krabbe, Paul F M, Bleijenberg, N., Blom, Jeanett, Kempen, Gertrudis I J M, MacNeil-Vroomen, Janet, Muntinga, Maaike E., Steyerburg, Ewout, Olde Rikkert, Marcel G M, Melis, René J.F., Blom, J. W., Melis, R.J.F., Muntinga, M. E., Steyerberg, Ewout W., Gussekloo, J., van den Brink, D., Lutomski, J.E., Qin, L., Kempen, G. I.J.M., Krabbe, P. F M, Buurman, B.M., van der Horst, H.E., de Rooij, S.E.J.A., Schols, Jos M. G. A., Schuurmans, M. J., Smilde, D. A., and TOPICS Consortium

Subjects
Quality of life, Joint diseases, EQ-5D, Urinary incontinence, Public Health, Environmental and Occupational Health, Journal Article, Hearing loss, Validation Studies, Dizziness
Abstract

Background: As populations age, chronic geriatric conditions linked to progressive organ failure jeopardize health-related quality of life (HRQoL). Thus, this research assessed the validity and applicability of the EQ-5D (a common HRQoL instrument) across four major chronic geriatric conditions: hearing issues, joint damage, urinary incontinence, or dizziness with falls. Methods: The study sample comprised 25,637 community-dwelling persons aged 65 years and older residing in the Netherlands (Data source: TOPICS-MDS, www.topics-mds.eu ). Floor and ceiling effects were examined. To assess convergent validity, random effects meta-correlations (Spearman's rho) were derived between individual EQ-5D domains and related survey items. To further examine construct validity, the association between sociodemographic characteristics and EQ-5D summary scores were assessed using linear mixed models. Outcomes were compared to the overall study population as well as a 'healthy' subgroup reporting no major chronic conditions. Results: Whereas ceiling effects were observed in the overall study population and the 'healthy' subgroup, such was not the case in the geriatric condition subgroups. The majority of hypotheses regarding correlations between survey items and sociodemographic associations were supported. EQ-5D summary scores were lower in respondents who were older, female, widowed/single, lower educated, and living alone. Increasing co-morbidity had a clear negative effect on EQ-5D scores. Conclusion: This study supported the construct validity of the EQ-5D across four major geriatric conditions. For older persons who are generally healthy, i.e. reporting few to no chronic conditions, the EQ-5D confers poor discriminative ability due to ceiling effects. Although the overall dataset initially suggested poor discriminative ability for the EQ-5D, such was not the case within subgroups presenting with major geriatric conditions.

Published
2017

20. Examining the construct and known-group validity of a composite endpoint for The Older Persons and Informal Caregivers Survey Minimum Data Set (TOPICS-MDS); A large-scale data sharing initiative

Author

Hofman, Cynthia S., Lutomski, Jennifer E., Boter, Han, Buurman, Bianca M., De Craen, Anton J M, Donders, A Rogier T, Rikkert, Marcel G M Olde, Makai, Peter, Melis, René J.F., Bleijenberg, N., Blom, J. W., Kempen, G. I J M, Krabbe, P. F M, Moll van Charante, E.P., Muntinga, M. E., Steyerberg, Ewout W., Gussekloo, J., van der Horst, H.E., Olde Rikkert, Marcel G M, de Rooij, S.E.J.A., Schols, Jos M. G. A., Schuurmans, M. J., Smilde, D. A., Van Den Brink, D., Qin, L., TOPICS-MDS research consortium, Steering Committee, Working group, Ethics, Law & Medical humanities, APH - Aging & Later Life, APH - Societal Participation & Health, General practice, APH - Mental Health, APH - Quality of Care, Geriatrics, and Amsterdam Movement Sciences

Subjects
Gerontology, Male, Comparative Effectiveness Research, Alzheimer`s disease Donders Center for Medical Neuroscience [Radboudumc 1], Stress-related disorders Donders Center for Medical Neuroscience [Radboudumc 13], lcsh:Medicine, Social Sciences, Otology, Care, Biochemistry, 0302 clinical medicine, Sociology, QUALITY-OF-LIFE, Medicine and Health Sciences, Medicine, 030212 general & internal medicine, lcsh:Science, Medicine(all), education.field_of_study, Minimum Data Set, HEALTH-STATUS, Multidisciplinary, Agricultural and Biological Sciences(all), 030503 health policy & services, Neurology, Caregivers, Research Design, Vertigo, Patient groups, Female, Metric (unit), 0305 other medical science, Research Article, PATIENT GROUPS, Quality of life, Clinical Research Design, Comparative effectiveness research, Population, MEDLINE, Research and Analysis Methods, Health status, Healthcare improvement science Radboud Institute for Health Sciences [Radboudumc 18], Education, 03 medical and health sciences, Quality of life (healthcare), Mental Health and Psychiatry, Journal Article, Adults, Dementia, Humans, education, Primary Care, Educational Attainment, Aged, business.industry, Biochemistry, Genetics and Molecular Biology(all), lcsh:R, Other Research Radboud Institute for Health Sciences [Radboudumc 0], Life satisfaction, Correction, ADULTS, CARE, medicine.disease, Health Care, Otorhinolaryngology, lcsh:Q, Geriatric Care, Health Statistics, Morbidity, business, Genetics and Molecular Biology(all)
Abstract

Contains fulltext : 174198.pdf (Publisher’s version ) (Open Access) BACKGROUND: Preference-weighted multi-faceted endpoints have the potential to facilitate comparative effectiveness research that incorporates patient preferences. The Older Persons and Informal Caregivers Survey-Composite endpoint (TOPICS-CEP) is potentially a valuable outcome measure for evaluating interventions in geriatric care as it combines multiple outcomes relevant to older persons in a single metric. The objective of this study was to validate TOPICS-CEP across different study settings (general population, primary care and hospital). METHODS: Data were extracted from TOPICS Minimum Dataset (MDS), a pooled public-access national database with information on older persons throughout the Netherlands. Data of 17,603 older persons were used. Meta-correlations were performed between TOPICS-CEP indexed scores, EuroQol5-D utility scores and Cantril's ladder life satisfaction scores. Mixed linear regression analyses were performed to compare TOPICS-CEP indexed scores between known groups, e.g. persons with versus without depression. RESULTS: In the complete sample and when stratified by study setting TOPICS-CEP and Cantril's ladder were moderately correlated, whereas TOPICS-CEP and EQ-5D were highly correlated. Higher mean TOPICS-CEP scores were found in persons who were: married, lived independently and had an education at university level. Moreover, higher mean TOPICS-CEP scores were found in persons without dementia, depression, and dizziness with falls, respectively. Similar results were found when stratified by subgroup. CONCLUSION: This study supports that TOPICS-CEP is a robust measure which can potentially be used in broad settings to identify the effect of intervention or of prevention in elderly care.

Published
2017
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23. Examining the construct and known-group validity of a composite endpoint for the Older Persons and Informal Caregivers Survey Minimum Data Set (TOPICS-MDS); A largescale data sharing initiative

Author

Hofman, Cynthia S., Lutomski, Jennifer E., Boter, Han, Buurman, Bianca M., De Craen, Anton J M, Donders, A Rogier T, Rikkert, Marcel G M Olde, Makai, Peter, Melis, René J.F., Bleijenberg, N., Blom, J. W., Kempen, G. I J M, Krabbe, P. F M, Moll van Charante, E.P., Muntinga, M. E., Steyerberg, Ewout W., Gussekloo, J., van der Horst, H.E., Olde Rikkert, Marcel G M, de Rooij, S.E.J.A., Schols, Jos M. G. A., Schuurmans, M. J., Smilde, D. A., Van Den Brink, D., Qin, L., TOPICS-MDS research consortium, Steering Committee, Working group, Hofman, Cynthia S., Lutomski, Jennifer E., Boter, Han, Buurman, Bianca M., De Craen, Anton J M, Donders, A Rogier T, Rikkert, Marcel G M Olde, Makai, Peter, Melis, René J.F., Bleijenberg, N., Blom, J. W., Kempen, G. I J M, Krabbe, P. F M, Moll van Charante, E.P., Muntinga, M. E., Steyerberg, Ewout W., Gussekloo, J., van der Horst, H.E., Olde Rikkert, Marcel G M, de Rooij, S.E.J.A., Schols, Jos M. G. A., Schuurmans, M. J., Smilde, D. A., Van Den Brink, D., Qin, L., and TOPICS-MDS research consortium, Steering Committee, Working group

Published
2017

24. Measurement properties of the EQ-5D across four major geriatric conditions: Findings from TOPICS-MDS

Author

UMC Utrecht, Verplegingswetenschap, Infection & Immunity, Pathologie, Unit Opleiding Aios, Healthcare Innovation & Evaluation, Circulatory Health, JC onderzoeksprogramma Methodologie, Lutomski, Jennifer E., Krabbe, Paul F M, Bleijenberg, N., Blom, Jeanett, Kempen, Gertrudis I J M, MacNeil-Vroomen, Janet, Muntinga, Maaike E., Steyerburg, Ewout, Olde Rikkert, Marcel G M, Melis, René J.F., Blom, J. W., Melis, R.J.F., Muntinga, M. E., Steyerberg, Ewout W., Gussekloo, J., van den Brink, D., Lutomski, J.E., Qin, L., Kempen, G. I.J.M., Krabbe, P. F M, Buurman, B.M., van der Horst, H.E., de Rooij, S.E.J.A., Schols, Jos M. G. A., Schuurmans, M. J., Smilde, D. A., TOPICS Consortium, UMC Utrecht, Verplegingswetenschap, Infection & Immunity, Pathologie, Unit Opleiding Aios, Healthcare Innovation & Evaluation, Circulatory Health, JC onderzoeksprogramma Methodologie, Lutomski, Jennifer E., Krabbe, Paul F M, Bleijenberg, N., Blom, Jeanett, Kempen, Gertrudis I J M, MacNeil-Vroomen, Janet, Muntinga, Maaike E., Steyerburg, Ewout, Olde Rikkert, Marcel G M, Melis, René J.F., Blom, J. W., Melis, R.J.F., Muntinga, M. E., Steyerberg, Ewout W., Gussekloo, J., van den Brink, D., Lutomski, J.E., Qin, L., Kempen, G. I.J.M., Krabbe, P. F M, Buurman, B.M., van der Horst, H.E., de Rooij, S.E.J.A., Schols, Jos M. G. A., Schuurmans, M. J., Smilde, D. A., and TOPICS Consortium

Published
2017

25. Examining the construct and known-group validity of a composite endpoint for the Older Persons and Informal Caregivers Survey Minimum Data Set (TOPICS-MDS); A largescale data sharing initiative

Author

UMC Utrecht, Verplegingswetenschap, Infection & Immunity, Healthcare Innovation & Evaluation, Circulatory Health, JC onderzoeksprogramma Methodologie, Hofman, Cynthia S., Lutomski, Jennifer E., Boter, Han, Buurman, Bianca M., De Craen, Anton J M, Donders, A Rogier T, Rikkert, Marcel G M Olde, Makai, Peter, Melis, René J.F., Bleijenberg, N., Blom, J. W., Kempen, G. I J M, Krabbe, P. F M, Moll van Charante, E.P., Muntinga, M. E., Steyerberg, Ewout W., Gussekloo, J., van der Horst, H.E., Olde Rikkert, Marcel G M, de Rooij, S.E.J.A., Schols, Jos M. G. A., Schuurmans, M. J., Smilde, D. A., Van Den Brink, D., Qin, L., TOPICS-MDS research consortium, Steering Committee, Working group, UMC Utrecht, Verplegingswetenschap, Infection & Immunity, Healthcare Innovation & Evaluation, Circulatory Health, JC onderzoeksprogramma Methodologie, Hofman, Cynthia S., Lutomski, Jennifer E., Boter, Han, Buurman, Bianca M., De Craen, Anton J M, Donders, A Rogier T, Rikkert, Marcel G M Olde, Makai, Peter, Melis, René J.F., Bleijenberg, N., Blom, J. W., Kempen, G. I J M, Krabbe, P. F M, Moll van Charante, E.P., Muntinga, M. E., Steyerberg, Ewout W., Gussekloo, J., van der Horst, H.E., Olde Rikkert, Marcel G M, de Rooij, S.E.J.A., Schols, Jos M. G. A., Schuurmans, M. J., Smilde, D. A., Van Den Brink, D., Qin, L., and TOPICS-MDS research consortium, Steering Committee, Working group

Published
2017

26. Measurement properties of the EQ-5D across four major geriatric conditions: Findings from TOPICS-MDS

Author

Lutomski, Jennifer E., Krabbe, Paul F M, Bleijenberg, N., Blom, Jeanett, Kempen, Gertrudis I J M, MacNeil-Vroomen, Janet, Muntinga, Maaike E., Steyerburg, Ewout, Olde Rikkert, Marcel G M, Melis, René J.F., Blom, J. W., Melis, R.J.F., Muntinga, M. E., Steyerberg, Ewout W., Gussekloo, J., van den Brink, D., Lutomski, J.E., Qin, L., Kempen, G. I.J.M., Krabbe, P. F M, Buurman, B.M., van der Horst, H.E., de Rooij, S.E.J.A., Schols, Jos M. G. A., Schuurmans, M. J., Smilde, D. A., Methods in Medicines evaluation & Outcomes research (M2O), Value, Affordability and Sustainability (VALUE), Geriatrics, APH - Aging & Later Life, APH - Quality of Care, Nursing, RS: CAPHRI - R1 - Ageing and Long-Term Care, RS: Academische Werkplaats Ouderenzorg, Health Services Research, Ethics, Law & Medical humanities, APH - Societal Participation & Health, General practice, APH - Mental Health, and Public Health

Subjects
Gerontology, Male, Alzheimer`s disease Donders Center for Medical Neuroscience [Radboudumc 1], Activities of daily living, Urinary incontinence, RESPONSIVENESS, 0302 clinical medicine, Quality of life, QUALITY-OF-LIFE, Surveys and Questionnaires, Activities of Daily Living, Health Status Indicators, 030212 general & internal medicine, POPULATION, Netherlands, education.field_of_study, 030503 health policy & services, Joint diseases, General Medicine, Convergent validity, Population study, Female, Public Health, URINARY-INCONTINENCE, medicine.symptom, 0305 other medical science, Population, MULTIMORBIDITY, Dizziness, Healthcare improvement science Radboud Institute for Health Sciences [Radboudumc 18], 03 medical and health sciences, AGE, EQ-5D, PEOPLE, Journal Article, medicine, Humans, Validation Studies, education, Geriatric Assessment, Aged, OLDER, business.industry, Research, Environmental and Occupational Health, Public Health, Environmental and Occupational Health, Construct validity, Reproducibility of Results, Hearing loss, HEALTH-CARE, Chronic Disease, PATTERNS, business
Abstract

Background As populations age, chronic geriatric conditions linked to progressive organ failure jeopardize health-related quality of life (HRQoL). Thus, this research assessed the validity and applicability of the EQ-5D (a common HRQoL instrument) across four major chronic geriatric conditions: hearing issues, joint damage, urinary incontinence, or dizziness with falls. Methods The study sample comprised 25,637 community-dwelling persons aged 65 years and older residing in the Netherlands (Data source: TOPICS-MDS, www.topics-mds.eu). Floor and ceiling effects were examined. To assess convergent validity, random effects meta-correlations (Spearman’s rho) were derived between individual EQ-5D domains and related survey items. To further examine construct validity, the association between sociodemographic characteristics and EQ-5D summary scores were assessed using linear mixed models. Outcomes were compared to the overall study population as well as a ‘healthy’ subgroup reporting no major chronic conditions. Results Whereas ceiling effects were observed in the overall study population and the ‘healthy’ subgroup, such was not the case in the geriatric condition subgroups. The majority of hypotheses regarding correlations between survey items and sociodemographic associations were supported. EQ-5D summary scores were lower in respondents who were older, female, widowed/single, lower educated, and living alone. Increasing co-morbidity had a clear negative effect on EQ-5D scores. Conclusion This study supported the construct validity of the EQ-5D across four major geriatric conditions. For older persons who are generally healthy, i.e. reporting few to no chronic conditions, the EQ-5D confers poor discriminative ability due to ceiling effects. Although the overall dataset initially suggested poor discriminative ability for the EQ-5D, such was not the case within subgroups presenting with major geriatric conditions. Electronic supplementary material The online version of this article (doi:10.1186/s12955-017-0616-x) contains supplementary material, which is available to authorized users.

Published
2016
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28. Kwetsbaarheid, dagelijkse beperkingen en ziektelast: samenhang met kwaliteit van leven en zorggebruik bij ouderen

Author

Lutomski, Jennifer E., Baars, Maria A. E., Boter, Han, Buurman, Bianca M., den Elzen, Wendy P. J., Jansen, Aaltje P. D., Kempen, Gertrudis I. J. M., Steunenberg, Bas, Steyerberg, Ewout W., Olde Rikkert, Marcel G. M., Melis, René J. F., Amsterdam Public Health, Amsterdam Movement Sciences, and Geriatrics

Subjects
humanities
Abstract

To assess the independent and combined impact of frailty, multi-morbidity, and activities of daily living (ADL) limitations on self-reported quality of life and healthcare costs in elderly people. Cross-sectional, descriptive study. Data came from The Older Persons and Informal Caregivers Minimum DataSet (TOPICS-MDS), a pooled dataset with information from 41 projects across the Netherlands from the Dutch national care for the Elderly programme. Frailty, multi-morbidity and ADL limitations, and the interactions between these domains, were used as predictors in regression analyses with quality of life and healthcare costs as outcome measures. Analyses were stratified by living situation (independent or care home). Directionality and magnitude of associations were assessed using linear mixed models. A total of 11,093 elderly people were interviewed. A substantial proportion of elderly people living independently reported frailty, multi-morbidity, and/or ADL limitations (56.4%, 88.3% and 41.4%, respectively), as did elderly people living in a care home (88.7%, 89.2% and 77,3%, respectively). One-third of elderly people living at home (31.9%) reported all three conditions compared with two-thirds of elderly people living in a care home (68.3%). In the multivariable analysis, frailty had a strong impact on outcomes independently of multi-morbidity and ADL limitations. Elderly people experiencing problems across all three domains reported the poorest quality-of-life scores and the highest healthcare costs, irrespective of their living situation. Frailty, multi-morbidity and ADL limitations are complementary measurements, which together provide a more holistic understanding of health status in elderly people. A multi-dimensional approach is important in mapping the complex relationships between these measurements on the one hand and the quality of life and healthcare costs on the other

Published
2014

31. Hyperemesis gravidarum: current perspectives

Author

McCarthy,Fergus P, Lutomski,Jennifer E, Greene,Richard A, McCarthy,Fergus P, Lutomski,Jennifer E, and Greene,Richard A

Abstract

Fergus P McCarthy,1 Jennifer E Lutomski,2 Richard A Greene2 1The Irish Centre for Fetal and Neonatal Translational Research, University College Cork, 2National Perinatal Epidemiology Centre, Cork University Maternity Hospital, Wilton, Cork, Ireland Abstract: Hyperemesis gravidarum is a complex condition with a multifactorial etiology characterized by severe intractable nausea and vomiting. Despite a high prevalence, studies exploring underlying etiology and treatments are limited. We performed a literature review, focusing on articles published over the last 10 years, to examine current perspectives and recent developments in hyperemesis gravidarum. Keywords: hyperemesis gravidarum, nausea, vomiting in pregnancy, pregnancy, antiemetics, adverse pregnancy outcomes

Published
2014

43. Hyperemesis gravidarum: current perspectives.

Author

McCarthy, Fergus P., Lutomski, Jennifer E., and Greene, Richard A.

Subjects
*MORNING sickness, *NAUSEA, *ETIOLOGY of diseases, *ANTIEMETICS, *PREMATURE labor, *HOSPITAL admission & discharge
Abstract

Hyperemesis gravidarum is a complex condition with a multifactorial etiology characterized by severe intractable nausea and vomiting. Despite a high prevalence, studies exploring underlying etiology and treatments are limited. We performed a literature review, focusing on articles published over the last 10 years, to examine current perspectives and recent developments in hyperemesis gravidarum. [ABSTRACT FROM AUTHOR]

Published
2014
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44. Establishing trimester-specific maternal thyroid function reference intervals.

Author

Khalid, Azy S, Marchocki, Zbigniew, Hayes, Kevin, Lutomski, Jennifer E, Joyce, Caroline, Stapleton, Mary, O’Mullane, John, and O’Donoghue, Keelin

Subjects
DURATION of pregnancy, GESTATIONAL age, THYROID gland function tests, THYROTROPIN, PREGNANT women
Abstract

The article presents a study which aims to establish reference intervals of trimester-specific thyroid function in pregnancy period. The study has examined thyroid function tests (TFTs) in 351 pregnant women without any thyroid-related disorders. Tables are presented which offers information regarding the percentiles of thyroid-stimulating hormone (TSH) in T3 and T4 of gestational week.

Published
2014
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45. Caesarean delivery and subsequent pregnancy interval: a systematic review and meta-analysis.

Author

O'Neill, Sinéad M., Kearney, Patricia M., Kenny, Louise C., Henriksen, Tine B., Lutomski, Jennifer E., Greene, Richard A., and Khashan, Ali S.

Subjects
CESAREAN section, PREGNANCY, HUMAN fertility, META-analysis, COHORT analysis, CROSS-sectional method
Abstract

Background: Caesarean delivery has increased worldwide, however, the effects on fertility are largely unknown. This systematic review aims to compare subsequent sub-fertility (time to next pregnancy or birth) among women with a Caesarean delivery to women with a vaginal delivery. Methods: Systematic review of the literature including seven databases: CINAHL; the Cochrane Library; Embase; Medline; PubMed; SCOPUS and Web of Knowledge (1945 - October 2012), using detailed search-strategies and reference list cross-checking. Cohort, case-control and cross-sectional studies were included. Two assessors reviewed titles, abstracts, and full articles using standardised data abstraction forms and assessed study quality. Results: 11 articles were eligible for inclusion in the systematic review, of these five articles which adjusted for confounders were combined in a meta-analysis, totalling 750,407 women using fixed-effect models. Previous Caesarean delivery was associated with an increased risk of sub-fertility [pooled odds ratio (OR) 0.90; 95% CI 0.86, 0.93]. Subgroup analyses by parity [primiparous women: OR 0.91; 95% CI 0.87, 0.96; not limited to primiparous women: OR 0.81; 95% CI 0.73, 0.90]; by publication date (pre-2000: OR 0.80, 95% CI 0.68, 0.94; post-2000: OR 0.90, 95% CI 0.86, 0.94); by length of follow-up (<10 years: OR 0.81, 95% CI 0.73, 0.90; >10 years: OR 0.91, 95% CI 0.87, 0.96); by indication for mode of delivery (specified: 0.92, 95% CI 0.88, 0.97; not specified: OR 0.81, 95% CI 0.73, 0.90); by cohort size (<35,000: OR 0.79, 95% CI 0.67, 0.92; >35,000: OR 0.90, 95% CI 0.87, 0.95), by definition of sub-fertility used divided into (birth interval [BI]: OR 0.89, 95% CI 0.84, 0.94; inter-pregnancy interval [IPI]: OR 0.91, 95% CI 0.85, 0.97; and categorical measures: OR 0.81, 95% CI 0.73, 0.90); continuous measures: OR 0.91, 95% CI 0.87, 0.96) were performed. Results of the six studies not included in the meta-analysis (which did not adjust for confounders) are presented individually. Conclusions: The meta-analysis shows an increased waiting time to next pregnancy and risk of sub-fertility among women with a previous Caesarean delivery. However, included studies are limited by poor epidemiological methods such as variations in the definition of time to next pregnancy, lack of confounding adjustment, or details of the indication for Caesarean delivery. Further research of a more robust methodological quality to better explore any underlying causes of sub-fertility and maternal intent to delay childbearing is warranted. [ABSTRACT FROM AUTHOR]

Published
2013
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46. Caesarean Delivery and Subsequent Stillbirth or Miscarriage: Systematic Review and Meta-Analysis.

Author

O'Neill, Sinéad M., Kearney, Patricia M., Kenny, Louise C., Khashan, Ali S., Henriksen, Tine B., Lutomski, Jennifer E., and Greene, Richard A.

Subjects
CESAREAN section, STILLBIRTH, MISCARRIAGE, LABOR complications (Obstetrics), SUBSEQUENT pregnancy, FETAL death
Abstract

Objective: To compare the risk of stillbirth and miscarriage in a subsequent pregnancy in women with a previous Caesarean or vaginal delivery. Design: Systematic review of the published literature including seven databases: CINAHL; the Cochrane library; Embase; Medline; PubMed; SCOPUS and Web of Knowledge from 1945 until November 11th 2011, using a detailed search-strategy and cross-checking of reference lists. Study Selection: Cohort, case-control and cross-sectional studies examining the association between previous Caesarean section and subsequent stillbirth or miscarriage risk. Two assessors screened titles to identify eligible studies, using a standardised data abstraction form and assessed study quality. Data synthesis: 11 articles were included for stillbirth, totalling 1,961,829 pregnancies and 7,308 events. Eight eligible articles were included for miscarriage, totalling 147,017 pregnancies and 12,682 events. Pooled estimates across the stillbirth studies were obtained using random-effect models. Among women with a previous Caesarean an increase in odds of 1.23 [95% CI 1.08, 1.40] for stillbirth was yielded. Subgroup analyses including unexplained stillbirths yielded an OR of 1.47 [95% CI 1.20, 1.80], an OR of 2.11 [95% CI 1.16, 3.84] for explained stillbirths and an OR of 1.27 [95% CI 0.95, 1.70] for antepartum stillbirths. Only one study reported adjusted estimates in the miscarriage review, therefore results are presented individually. Conclusions: Given the recent revision of the National Institute for Health and Clinical Excellence guidelines (NICE), providing women the right to request a Caesarean, it is essential to establish whether mode of delivery has an association with subsequent risk of stillbirth or miscarriage. Overall, compared to vaginal delivery, the pooled estimates suggest that Caesarean delivery may increase the risk of stillbirth by 23%. Results for the miscarriage review were inconsistent and lack of adjustment for confounding was a major limitation. Higher methodological quality research is required to reliably assess the risk of miscarriage in subsequent pregnancies. [ABSTRACT FROM AUTHOR]

Published
2013
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47. Sociodemographic, lifestyle, mental health and dietary factors associated with direction of misreporting of energy intake.

Author

Lutomski, Jennifer E, van den Broeck, Jan, Harrington, Janas, Shiely, Frances, and Perry, Ivan J

Subjects
*NUTRITIONAL assessment, *CALORIC content of foods, *FOOD consumption, *SOCIODEMOGRAPHIC factors, *LIFESTYLES, *SOCIAL status, *MENTAL health, *LOGISTIC regression analysis, *QUESTIONNAIRES
Abstract

ObjectiveTo estimate the extent of under- and over-reporting, to examine associations with misreporting and sociodemographic and lifestyle characteristics and mental health status and to identify differential reporting in micro- and macronutrient intake and quality of diet.DesignA health and lifestyle questionnaire and a semi-quantitative FFQ were completed as part of the 2007 Survey of Lifestyle, Attitudes and Nutrition. Energy intake (EI) and intake of micro- and macronutrients were determined by applying locally adapted conversion software. A dietary score was constructed to identify healthier diets. Accuracy of reported EI was estimated using the Goldberg method. ANOVA, χ2 tests and logistic regression were used to examine associations.SettingResidential households in Ireland.SubjectsA nationally representative sample of 7521 adults aged 18 years or older.ResultsOverall, 33·2 % of participants were under-reporters while 11·9 % were over-reporters. After adjustment, there was an increased odds of under-reporting among obese men (OR = 2·01, 95 % CI 1·46, 2·77) and women (OR = 1·68, 95 % CI 1·23, 2·30) compared to participants with a healthy BMI. Older age, low socio-economic status and overweight/obesity reduced the odds of over-reporting. Among under-reporters, the percentage of EI from fat was lower and overall diet was healthier compared to accurate and over-reporters. The reported usage of salt, fried food consumption and snacking varied significantly by levels of misreporting.ConclusionsPatterns in differential reporting were evident across sociodemographic, lifestyle and mental health factors and diet quality. Consideration should be given to how misreporting affects nutrient analysis to ensure sound nutritional policy. [ABSTRACT FROM AUTHOR]

Published
2011
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48. Risk of bias assessment of sequence generation: a study of 100 systematic reviews of trials

Author

HRB, Wuytack, Francesca, Regan, Maria, Biesty, Linda M., Meskell, Pauline, Lutomski, Jennifer E., O'Donnell, Martin, Treweek, Shaun, Devane, Declan, HRB, Wuytack, Francesca, Regan, Maria, Biesty, Linda M., Meskell, Pauline, Lutomski, Jennifer E., O'Donnell, Martin, Treweek, Shaun, and Devane, Declan

Abstract

peer-reviewed, Background: Systematic reviews of randomised trials guide policy and healthcare decisions. Yet, we observed that some reviews judge randomised trials as high or unclear risk of bias (ROB) for sequence generation, potentially introducing bias. However, to date, the extent of this issue has not been well examined. We evaluated the consistency in the ROB assessment for sequence generation of randomised trials in Cochrane and non-Cochrane reviews, and explored the reviewers’ judgement of the quality of evidence for the related outcomes. Methods: Cochrane intervention reviews (01/01/2017–31/03/2017) were retrieved from the Cochrane Database of Systematic Reviews. We also searched for systematic reviews in ten general medical journals with highest impact factors (01/01/2016–31/03/2017). We examined the proportion of reviews that rated the sequence generation domain as high, low or unclear risk of selection bias. For reviews that had rated any randomised trials as high or unclear risk of bias, we examined the proportion that had assessed the quality of evidence. Results: Overall, 100 systematic reviews were included in our analysis. We evaluated 64 Cochrane reviews which comprised of 984 randomised trials; 0.8% (n = 8) and 52.2% (n = 514) were rated as high and unclear ROB for sequence generation respectively. We further evaluated 36 non-Cochrane reviews which comprised of 1376 trials; 5.8% (n = 80) and 39.6% (n = 545) were rated as high and unclear ROB respectively. Ninety percent (n = 10) of non- Cochrane reviews which rated randomised trials as high ROB for sequence generation did not report an underlying reason. All Cochrane reviews assessed the quality of evidence (GRADE). For the non-Cochrane reviews, only just over half had assessed the quality of evidence. Conclusion: Systematic reviews of interventions frequently rate randomised trials as high or unclear ROB for sequence generation. In general, Cochrane reviews were more transparent than non-Cochrane reviews in RO

50. The Development of the Older Persons and Informal Caregivers Survey Minimum DataSet (TOPICS-MDS): A Large-Scale Data Sharing Initiative.

Author

Lutomski, Jennifer E., Baars, Maria A. E., Schalk, Bianca W. M., Boter, Han, Buurman, Bianca M., den Elzen, Wendy P. J., Jansen, Aaltje P. D., Kempen, Gertrudis I. J. M., Steunenberg, Bas, Steyerberg, Ewout W., Olde Rikkert, Marcel G. M., and Melis, René J. F.

Subjects
*OLDER people, *CAREGIVERS, *LARGE scale systems, *MEDICAL care surveys, *MEDICAL research, *QUALITY of life, *PRIMARY care
Abstract

Introduction:In 2008, the Ministry of Health, Welfare and Sport commissioned the National Care for the Elderly Programme. While numerous research projects in older persons’ health care were to be conducted under this national agenda, the Programme further advocated the development of The Older Persons and Informal Caregivers Survey Minimum DataSet (TOPICS-MDS) which would be integrated into all funded research protocols. In this context, we describe TOPICS data sharing initiative (www.topics-mds.eu). Materials and Methods:A working group drafted TOPICS-MDS prototype, which was subsequently approved by a multidisciplinary panel. Using instruments validated for older populations, information was collected on demographics, morbidity, quality of life, functional limitations, mental health, social functioning and health service utilisation. For informal caregivers, information was collected on demographics, hours of informal care and quality of life (including subjective care-related burden). Results:Between 2010 and 2013, a total of 41 research projects contributed data to TOPICS-MDS, resulting in preliminary data available for 32,310 older persons and 3,940 informal caregivers. The majority of studies sampled were from primary care settings and inclusion criteria differed across studies. Discussion:TOPICS-MDS is a public data repository which contains essential data to better understand health challenges experienced by older persons and informal caregivers. Such findings are relevant for countries where increasing health-related expenditure has necessitated the evaluation of contemporary health care delivery. Although open sharing of data can be difficult to achieve in practice, proactively addressing issues of data protection, conflicting data analysis requests and funding limitations during TOPICS-MDS developmental phase has fostered a data sharing culture. To date, TOPICS-MDS has been successfully incorporated into 41 research projects, thus supporting the feasibility of constructing a large (>30,000 observations), standardised dataset pooled from various study protocols with different sampling frameworks. This unique implementation strategy improves efficiency and facilitates individual-level data meta-analysis. [ABSTRACT FROM AUTHOR]

Published
2013
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