41 results on '"Sakkeus, L"'
Search Results
2. Socioeconomic differences in perinatal health outcomes: perinatal health surveillance through a health-equity prism
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Smith, L, primary, Farr, A, additional, Zurriaga, O, additional, Cuttini, M, additional, Verdenik, I, additional, Vidal Benedé, MJ, additional, Kearns, K, additional, Sakkeus, L, additional, Kyprianou, T, additional, and Barros, H, additional
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- 2022
- Full Text
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3. Using Robson's Ten‐Group Classification System for comparing caesarean section rates in Europe: an analysis of routine data from the Euro‐Peristat study
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Zeitlin, J., Durox, M., Macfarlane, A. J., Alexander, S., Heller, G., Loghi, M., Nijhuis, J., Sól Ólafsdóttir, H., Mierzejewska, E., Gissler, M., Blondel, B., Haidinger, G., Klimont, J., Vandervelpen, G., Zhang, W-H., Jordanova, E., Kolarova, R., Filipovic‐Grcic, B., Drausnik, Z., Rodin, U., Kyprianou, T., Scoutellas, V., Velebil, P., Mortensen, L., Sakkeus, L., Heino, A., Chantry, A., Deneux Tharaux, C., Lack, N., Antsaklis, A., Berbik, I., Bonham, S., Kearns, K., Sikora, I., Cuttini, M., Misins, J., Zile, I., Isakova, J., Billy, A., Couffignal, S., Lecomte, A., Weber, G., Gatt, M., Achterberg, P., Broeders, L., Hindori‐Mohangoo, A., Akerkar, R., Klungsøyr, K., Szamotulska, K., Barros, H., Horga, M., Tica, V., Cap, J., Tul, N., Verdenik, I., Bolumar, F., Jané, M., Alcaide, A. R., Vidal, M. J., Zurriaga, O., Kallen, K., Nyman, A., Berrut, S., Riggenbach, M., Rihs, T. A., Smith, L., Woods, R., Delnord, M., Hocquette, A., RS: GROW - R4 - Reproductive and Perinatal Medicine, MUMC+: MA Obstetrie Gynaecologie (3), Obstetrie & Gynaecologie, and Instituto de Saúde Pública da Universidade do Porto
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medicine.medical_specialty ,ten-group classification system ,Epidemiology ,RJ ,medicine.medical_treatment ,Population ,RT ,03 medical and health sciences ,0302 clinical medicine ,Pregnancy ,RA0421 ,medicine ,Humans ,Caesarean section ,Ten‐Group Classification System ,education ,perinatal health indicators ,reproductive and urinary physiology ,education.field_of_study ,030219 obstetrics & reproductive medicine ,Cesarean Section ,Singleton ,business.industry ,Obstetrics ,Obstetrics and Gynecology ,Gestational age ,Original Articles ,Corrigenda ,Robson classification ,Ten group classification system ,Europe ,Caesarean Birth ,Data quality ,health information systems ,Female ,Original Article ,Caesarean birth ,Observational study ,RG ,business ,Live Birth - Abstract
Objective Robson's Ten Group Classification System (TGCS) creates clinically relevant sub‐groups for monitoring caesarean birth rates. This study assesses whether this classification can be derived from routine data in Europe and uses it to analyse national caesarean rates. Design Observational study using routine data. Setting Twenty‐seven EU member states plus Iceland, Norway, Switzerland and the UK. Population All births at ≥22 weeks of gestational age in 2015. Methods National statistical offices and medical birth registers derived numbers of caesarean births in TGCS groups. Main outcome measures Overall caesarean rate, prevalence and caesarean rates in each of the TGCS groups. Results Of 31 countries, 18 were able to provide data on the TGCS groups, with UK data available only from Northern Ireland. Caesarean birth rates ranged from 16.1 to 56.9%. Countries providing TGCS data had lower caesarean rates than countries without data (25.8% versus 32.9%, P = 0.04). Countries with higher caesarean rates tended to have higher rates in all TGCS groups. Substantial heterogeneity was observed, however, especially for groups 5 (previous caesarean section), 6, 7 (nulliparous/multiparous breech) and 10 (singleton cephalic preterm). The differences in percentages of abnormal lies, group 9, illustrate potential misclassification arising from unstandardised definitions. Conclusions Although further validation of data quality is needed, using TGCS in Europe provides valuable comparator and baseline data for benchmarking and surveillance. Higher caesarean rates in countries unable to construct the TGCS suggest that effective routine information systems may be an indicator of a country's investment in implementing evidence‐based caesarean policies. Tweetable abstract Many European countries can provide Robson's Ten‐Group Classification to improve caesarean rate comparisons., Tweetable abstract Many European countries can provide Robson's Ten‐Group Classification to improve caesarean rate comparisons.
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- 2021
4. Preterm birth time trends in Europe: a study of 19 countries
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Zeitlin, J, Szamotulska, K, Drewniak, N, Mohangoo, A D, Chalmers, J, Sakkeus, L, Irgens, L, Gatt, M, Gissler, M, and Blondel, B
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- 2013
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5. Producing valid statistics when legislation, culture, and medical practices differ for births at or before the threshold of survival: Report of a European workshop
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Smith, L. K., Blondel, B., Zeitlin, J., Haidinger, G., Alexander, S., Kolarova, R., Rodin, U., Kyprianou, T., Velebil, P., Mortensen, L., Sakkeus, L., Gissler, M., Heller, G., Lack, N., Antsaklis, A., Berbik, I., Olafsdottir, H., Bonham, S., Cuttini, M., Misins, J., Isakova, J., Wagener, Y., Gatt, M., Nijhuis, J., Klungsoyr, K., Szamotulska, K., Barros, H., Horga, M., Cap, J., Tul, N., Bolumar, F., Gottvall, K., Kallen, K., Berrut, S., Riggenbach, M., Macfarlane, A. J., Zeitlin, J, Delnord, M., Durox, M., Hindori-Mohangoo, A., RS: GROW - R4 - Reproductive and Perinatal Medicine, MUMC+: MA Obstetrie Gynaecologie (3), Obstetrie & Gynaecologie, Department of Health Sciences [Leicester], University of Leicester, Equipe 1 : EPOPé - Épidémiologie Obstétricale, Périnatale et Pédiatrique (CRESS - U1153), Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité (CRESS (U1153 / UMR_A_1125 / UMR_S_1153)), Conservatoire National des Arts et Métiers [CNAM] (CNAM)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE)-Conservatoire National des Arts et Métiers [CNAM] (CNAM)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Euro-Peristat Scientific Committee: Gerald Haidinger, Sophie Alexander, Urelija Rodin, Theopisti Kyprianou, Petr Velebil, Laust Mortensen, Luule Sakkeus, Mika Gissler, Günther Heller, Nicholas Lack, Aris Antsaklis, István Berbik, Helga Sól Ólafsdóttir, Sheelagh Bonham, Marina Cuttini, Janis Misins, Jelena Isakova, Yolande Wagener, Miriam Gatt, Jan Nijhuis, Katarzyna Szamotulska, Henrique Barros, Mihai Horga, Jan Cap, Natasa Tul, Francisco Bolúmar, Karin Gottvall, Karin Källén, Sylvan Berrut, Mélanie Riggenbach, Alison Macfarlane, Marie Delnord, Mélanie Durox, Ashna Hindori-Mohangoo, Conservatoire National des Arts et Métiers [CNAM] (CNAM), HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE)-Conservatoire National des Arts et Métiers [CNAM] (CNAM), HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), and PHILIBERT, Marianne
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COUNTRIES ,Quality management ,Internationality ,STILLBIRTHS ,[SDV]Life Sciences [q-bio] ,Consensus Development Conferences as Topic ,Perinatal Death ,MEDLINE ,Legislation ,Gestational Age ,Population health ,DEFINITIONS ,03 medical and health sciences ,0302 clinical medicine ,FETAL-DEATH ,Environmental health ,Medicine ,Humans ,RATES ,ComputingMilieux_MISCELLANEOUS ,Perinatal Mortality ,Analysis of Variance ,030219 obstetrics & reproductive medicine ,business.industry ,Mortality rate ,International comparisons ,PRETERM BIRTHS ,Infant, Newborn ,Obstetrics and Gynecology ,Gestational age ,Public Reporting of Healthcare Data ,Stillbirth ,Quality Improvement ,3. Good health ,[SDV] Life Sciences [q-bio] ,Europe ,Vital Statistics ,Perinatal Care ,Commentary ,Gestation ,RG ,business - Abstract
Perinatal mortality is a major population health indicatorconveying important signals about the state of maternitycare and measures of the current and future health ofmothers and newborns. International comparisons are usedto encourage countries to improve their perinatal healthand health systems. However, extensive evidence highlightsmethodological challenges to ensuring valid and robustcomparisons, as a lack of standardised criteria can lead tobias and inappropriate inferences.One major issue is the wide international variation in the criteria for classification and registration of deaths as a stillbirth or neonatal death at the threshold of survival.Standard practice is to minimise this problem by using a gestational age cut-off of 24 or even 28 weeks for mortality rate calculations. However, this strategy excludes a significant number of stillbirths, at least one in five deaths before 24 weeks of gestation and over one in three deaths before 28 weeks.As the gestational age limit for initiation of neonatal care decreases, exclusion of these stillbirths limits the full evaluation ofcare provision and outcomes at early gestational ages. Fur-ther, it underestimates the burden of loss on parents’ men-tal and physical health.
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- 2019
6. Variations in rates of severe perineal tears and episiotomies in 20 European countries: a study based on routine national data in Euro-Peristat Project
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Blondel, B., Alexander, S., Bjarnadóttir, R.I., Gissler, M., Langhoff-Roos, J., Novak-Antolič, Ž., Prunet, C., Zhang, W.H., Hindori-Mohangoo, A.D., Zeitlin, J., Haidinger, G., Pavlou, P., Velebil, P., Andersen, A.M.N., Sakkeus, L., Lack, N., Antsaklis, A., Berbik, I., Ólafsdóttir, H.S., Bonham, S., Cuttini, M., Misins, J., Jaselioniene, J., Wagener, Y., Gatt, M., Nijhuis, J., Klungsoyr, K., Szamotulska, K., Barros, H., Horga, M., Cap, J., Bolúmar, F., Gottvall, K., Berrut, S., and Macfarlane, A.
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International comparisons ,Injury ,Time trends ,Anal canal ,Perineum ,Europe ,Obstetric labor complications ,Life ,Health ,Episiotomy ,CH - Child Health ,Tears ,ELSS - Earth, Life and Social Sciences ,Healthy for Life ,Healthy Living - Abstract
Introduction: Rates of severe perineal tears and episiotomies are indicators of obstetrical quality of care, but their use for international comparisons is complicated by difficulties with accurate ascertainment of tears and uncertainties regarding the optimal rate of episiotomies. We compared rates of severe perineal tears and episiotomies in European countries and analysed the association between these two indicators. Material and methods: We used aggregate data from national routine statistics available in the Euro-Peristat project. We compared rates of severe (third- and fourth-degree) tears and episiotomies in 2010 by mode of vaginal delivery (n = 20 countries), and investigated time trends between 2004 and 2010 (n = 9 countries). Statistical associations were assessed with Spearman's ranked correlations (rho). Results: In 2010 in all vaginal deliveries, rates of severe tears ranged from 0.1% in Romania to 4.9% in Iceland, and rates of episiotomies from 3.7% in Denmark to 75.0% in Cyprus. A negative correlation between the rates of episiotomies and severe tears was observed in all deliveries (rho = −0.66; p = 0.001), instrumental deliveries (rho = −0.67; p = 0.002) and non-instrumental deliveries (rho = −0.72; p < 0.001). However there was no relation between time trends of these two indicators (rho = 0.43; p = 0.28). Conclusions: The large variations in severe tears and episiotomies and the negative association between these indicators in 2010 show the importance of improving the assessment and reporting of tears in each country, and evaluating the impact of low episiotomy rates on the perineum. © 2016 Nordic Federation of Societies of Obstetrics and Gynecology
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- 2016
7. Linking databases on perinatal health: A review of the literature and current practices in Europe
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Delnord, M, Szamotulska, K, Hindori-Mohangoo, A D, Blondel, B, Macfarlane, A J, Dattani, N, Barona, C, Berrut, S, Zile, I, Wood, Rachael, Sakkeus, L, Gissler, M, and Zeitlin, J
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Life ,Health ,CH - Child Health ,ELSS - Earth, Life and Social Sciences ,RG ,Healthy for Life ,data linkage, perinatal health, Euro-Peristat, health information, routine databases, perinatal registers ,Healthy Living - Abstract
Background: International comparisons of perinatal health indicators are complicated by the heterogeneity of data sources on pregnancy, maternal and neonatal outcomes. Record linkage can extend the range of data items available and thus can improve the validity and quality of routine data. We sought to assess the extent to which data are linked routinely for perinatal health research and reporting. Methods: We conducted a systematic review of the literature by searching PubMed for perinatal health studies from 2001 to 2011 based on linkage of routine data (data collected continuously at various time intervals). We also surveyed European health monitoring professionals about use of linkage for national perinatal health surveillance. Results: 516 studies fit our inclusion criteria. Denmark, Finland, Norway and Sweden, the US and the UK contributed 76% of the publications; a further 29 countries contributed at least one publication. Most studies linked vital statistics, hospital records, medical birth registries and cohort data. Other sources were specific registers for: cancer (70), congenital anomalies (56), ART (19), census (19), health professionals (37), insurance (22) prescription (31), and level of education (18). Eighteen of 29 countries (62%) reported linking data for routine perinatal health monitoring. Conclusion: Research using linkage is concentrated in a few countries and is not widely practiced in Europe. Broader adoption of data linkage could yield substantial gains for perinatal health research and surveillance. © 2015 The Author. Published by Oxford University Press on behalf of the European Public Health Association.
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- 2016
8. Variations in multiple birth rates and impact on perinatal outcomes in Europe
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Heino, A. Gissler, M. Hindori-Mohangoo, A.D. Blondel, B. Klungsøyr, K. Verdenik, I. Mierzejewska, E. Velebil, P. Ólafsdóttir, H.S. Macfarlane, A. Zeitlin, J. Haidinger, G. Alexander, S. Pavlou, P. Mortensen, L. Sakkeus, L. Lack, N. Antsaklis, A. Berbik, I. Bonham, S. Cuttini, M. Misins, J. Jaselioniene, J. Wagener, Y. Gatt, M. Nijhuis, J. Van Der Pal, K. Klungsoyr, K. Szamotulska, K. Barros, H. Horga, M. Cap, J. Mandić, N.T. Bolúmar, F. Gottvall, K. Berrut, S. Klimont, J. Zhang, W.-H. Dramaix-Wilmet, M. Van Humbeeck, M. Leroy, C. Minsart, A.-F. Van Leeuw, V. Martens, E. De Spiegelaere, M. Verkruyssen, F. Willems, M. Aelvoet, W. Tafforeau, J. Renard, F. Walckiers, D. Cuignet, D. Demoulin, P. Cloots, H. Hendrickx, E. Kongs, A. Stylianou, D. Kyprianou, T. Skordes, N. Roos, J.L. Anderson, A.-M.N. Mortensen, L.H. Ritvanen, A. Colle, M.-H.B. Ego, A. Rey, G. Heller, G. Scharl, A. Drakakis, P. Bjarnadottir, R.I. Hardardóttir, H. Ragnarsdóttir, B. Stefánsdóttir, V. Haraldsdóttir, S. Mulligan, A. Tamburini, C. Boldrini, R. Prati, S. Loghi, M. Castagnaro, C. Marchetti, S. Burgio, A. Da Frè, M. Zile, I. Isakova, J. Gaidelyte, R. Jaselione, J. Billy, A. Touvrey-Lecomte, A. Van Der, K. De Bruin, P. Achterberg, P. Hukkelhoven, C. De Winter, G. Ravelli, A. Rijninks-Van Driel, G. Tamminga, P. Groesz, M. Elferink-Stinkens, P. Osen, A. Ebbing, M. Correia, S. Cucu, A. Novak-Antolič, Ž. Jane, M. Vidal, M.J. Barona, C. Mas, R. Alcaide, A.R. Lundqvist, E. König, C. Schmid, M. Dattani, N. Chalmers, J. Monteath, K. Climson, M. Marr, L. Gibson, R. Thomas, G. Osborne, R. Brown, R. Sweet, D. Evans, J. Magill, S. Graham, A. Reid, H. Falconer, T. McConnell, K. McComb, N. Euro-Peristat Scientific Committee
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Objective: Infants from multiple pregnancies have higher rates of preterm birth, stillbirth and neonatal death and differences in multiple birth rates (MBR) exist between countries. We aimed to describe differences in MBR in Europe and to investigate the impact of these differences on adverse perinatal outcomes at a population level. Methods: We used national aggregate birth data on multiple pregnancies, maternal age, gestational age (GA), stillbirth and neonatal death collected in the Euro-Peristat project (29 countries in 2010, N = 5 074 643 births). We also used European Society of Human Reproduction and Embryology (ESHRE) data on assisted conception and single embryo transfer (SET). The impact of MBR on outcomes was studied using meta-analysis techniques with randomeffects models to derive pooled risk ratios (pRR) overall and for four groups of country defined by their MBR. We computed population attributable risks (PAR) for these groups. Results: In 2010, the average MBR was 16.8 per 1000 women giving birth, ranging from 9.1 (Romania) to 26.5 (Cyprus). Compared to singletons, multiples had a nine-fold increased risk (pRR 9.4, 95% Cl 9.1-9.8) of preterm birth (
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- 2016
9. Varying gestational age patterns in cesarean delivery: An international comparison
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Delnord, M., Blondel, B., Drewniak, N., Klungsøyr, K., Bolumar, F., Mohangoo, A., Gissler, M., Szamotulska, K., Lack, N., Nijhuis, J., Velebil, P., Sakkeus, L., Chalmers, J., Zeitlin, J., Haidinger, G., XMartens, G., Misselwitz, B., Wenzlaff, P., Bonham, S., Jaselioniene, J., Gatt, M., Barros, H., Novak, Z., and Gottvall, K.
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Plurality ,Behavioural Changes ,Health ,CH - Child Health ,Euro-Peristat ,Mode of delivery ,Gestational age ,ELSS - Earth, Life and Social Sciences ,Healthy for Life ,Cross-national comparisons ,Healthy Living ,reproductive and urinary physiology ,Cesarean delivery (CD) - Abstract
Background: While international variations in overall cesarean delivery rates are well documented, less information is available for clinical sub-groups. Cesarean data presented by subgroups can be used to evaluate uptake of cesarean reduction policies or to monitor delivery practices for high and low risk pregnancies based on new scientific evidence. We studied differences and patterns in cesarean delivery rates by multiplicity and gestational age in Europe and the United States.Methods: This study used routine aggregate data from 17 European countries and the United States on the number of singleton and multiple live births with cesarean versus vaginal delivery by week of gestation in 2008. Overall and gestation-specific cesarean delivery rates were analyzed. We computed rate differences to compare mode of delivery (cesarean vs vaginal birth) between selected gestational age groups and studied associations between rates in these subgroups namely: very preterm (26-31 weeks GA), moderate preterm (32-36 weeks GA), near term (37-38 weeks GA), term (39-41 weeks GA) and post-term (42+ weeks GA) births, using Spearman's rank tests.Results: High variations in cesarean rates for singletons and multiples were observed everywhere. Rates for singletons varied from 15% in The Netherlands and Slovenia, to over 30% in the US and Germany. In singletons, rates were highest for very preterm births and declined to a nadir at 40 weeks of gestation, ranging from 8.0% in Sweden and Norway, to 22.5% in the US. These patterns differed across countries; the average rate difference between very preterm and term births was 43 percentage points, but ranged from 14% to 61%. High variations in rate differences were also observed for near term versus term births. For multiples, rates declined by gestational age in some countries, whereas in others rates were similar across all weeks of gestation. Countries' overall cesarean rates were highly correlated with gestation-specific subgroup rates, except for very preterm births.Conclusions: Gestational age patterns in cesarean delivery were heterogeneous across countries; these differences highlight areas where consensus on best practices is lacking and could be used in developing strategies to reduce cesareans.
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- 2014
10. European Perinatal Health Report. The health and care of pregnant women and babies in Europe in 2010
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Zeitlin, J., Mohangoo, A.D., Delnorn, M., Alexander, S., Blondel, B., Bouvier-Colle, M.H., Dattani, N., Gissler, M., Macfarlane, A., Pal, K. van der, Szamotulska, k., Zhang, W.H., Lack, N., Sakkeus, L., Cans, C., Curran, R., Loane, M., Greenless, R., and Dolk, H.
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Health ,CH - Child Health ,Healthy for Life ,Healthy Living ,BSS - Behavioural and Societal Sciences ,Human - Published
- 2013
11. Reporting of perinatal health indicators for international comparisons: enhancing the appearance of geographical plots
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Lack, N., Blondel, B., Mohangoo, A.D., Sakkeus, L., Cans, C., Bouvier-Colle, M.H., Macfarlane, A., and Zeitlin, J.
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Health ,CH - Child Health ,Healthy for Life ,Healthy Living ,BSS - Behavioural and Societal Sciences ,Human - Abstract
Background: Tabulating annual national health indicators sorted by outcome may be misleading for two reasons. The implied rank order is largely a result of heterogeneous population sizes. Distinctions between geographically adjacent regions are not visible. Methods: Regional data are plotted in a geographical map shaded in terms of percentiles of the indicator value. Degree of departure is determined relative to control limits of a corresponding funnel plot. Five methods for displaying outcome and degree of departure from a reference level are proposed for four indicators selected from the 2004 European Perinatal Health Report. Results: Spread of indicator values was generally largest for small population sizes, with results for large populations lying mostly close to respective European medians. The high neonatal mortality rate for Poland (4.9 per 1000); high low-birthweight rates for England and Wales (7.8%), Germany (7.3%) and Estonia (4.5%); and high caesarean section rates for Italy (37.8%), Poland (26.3%), Portugal (33.1%) and Germany (27.3%) were statistically significant exceptions to this pattern. Estonia also showed an extreme result for maternal mortality (29.6 per 100 000). Conclusion: Extreme deviations from EU reference levels are either correlated with small population sizes or may be interpreted in terms of differing medical practices, as in the case of caesarean section rate. EURO-PERISTAT has now decided to use 5-year averages for maternal mortality to reduce the variance in outcome. Use of two colours in three intensities and solid fill versus crosshatching is best suited to display rate and significance of difference. © 2013 The Author.
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- 2013
12. International Comparisons of Fetal and Neonatal Mortality Rates in High-Income Countries: Should Exclusion Thresholds Be Based on Birth Weight or Gestational Age?
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Mohangoo, A.D., Blondel, B., Gissler, M., Velebil, P., Macfarlane, A., Zeitlin, J., Haidinger, G., Alexander, S., Pavlou, P., Roos, J.L., Sakkeus, L., Lack, N., Antsaklis, A., Berbik, I., Bonham, S., Cuttini, M., Misins, J., Jaselioniene, J., Wagener, Y., Gatt, M., Nijhuis, J., Klungsoyr, K., Szamotulska, K., Barros, H., Chmelová, M., Novak-Antolic, Ž., Bolúmar, F., and Gottvall, K.
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Health ,CH - Child Health ,Healthy for Life ,Healthy Living ,BSS - Behavioural and Societal Sciences ,Human - Abstract
Background:Fetal and neonatal mortality rates are essential indicators of population health, but variations in recording of births and deaths at the limits of viability compromises international comparisons. The World Health Organization recommends comparing rates after exclusion of births with a birth weight less than 1000 grams, but many analyses of perinatal outcomes are based on gestational age. We compared the effects of using a 1000-gram birth weight or a 28-week gestational age threshold on reported rates of fetal and neonatal mortality in Europe.Methods:Aggregated data from 2004 on births and deaths tabulated by birth weight and gestational age from 29 European countries/regions participating in the Euro-Peristat project were used to compute fetal and neonatal mortality rates using cut-offs of 1000-grams and 28-weeks (2.8 million total births). We measured differences in rates between and within countries using the Wilcoxon signed rank test and 95% confidence intervals, respectively.Principal Findings:For fetal mortality, rates based on gestational age were significantly higher than those based on birth weight (p
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- 2013
13. New insights on kin availability, using the Generations & Gender Surveys
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Puur, A., Sakkeus, L., Schenk, N., Poldma, A., Pearl Dykstra, and Sociology
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- 2010
14. Family Constellations in Europe
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Puur, A, Sakkeus, L, Schenk, N (Niels), Põldma, A, and Sociology
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- 2010
15. Preterm Birth Time Trends in Europe
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Zeitlin, J., primary, Szamotulska, K., additional, Drewniak, N., additional, Mohangoo, A.D., additional, Chalmers, J., additional, Sakkeus, L., additional, Irgens, L., additional, Gatt, M., additional, Gissler, M., additional, and Blondel, B., additional
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- 2014
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16. Linking databases on perinatal health: a review of the literature and current practices in Europe
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Delnord, M, primary, Szamotulska, K, additional, Monhangoo, A, additional, Gissler, M, additional, Barona, C, additional, Barros, H, additional, Berrut, S, additional, Chalmers, J, additional, Dattani, N, additional, Sakkeus, L, additional, Zile, I, additional, and Zeitlin, J, additional
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- 2014
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17. Variations in very preterm birth rates in 30 high-income countries: are valid international comparisons possible using routine data?
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Delnord, M, Hindori‐Mohangoo, AD, Smith, LK, Szamotulska, K, Richards, JL, Deb‐Rinker, P, Rouleau, J, Velebil, P, Zile, I, Sakkeus, L, Gissler, M, Morisaki, N, Dolan, SM, Kramer, MR, Kramer, MS, Zeitlin, J, Haidinger, Gerald, Alexander, Sophie, Pavlou, Pavlos, and Mortensen, Laust
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PREMATURE labor ,DURATION of pregnancy ,PREMATURE infants ,LABOR complications (Obstetrics) ,OBSTETRICAL emergencies ,BIRTH rate ,COMPARATIVE studies ,GESTATIONAL age ,RESEARCH methodology ,EVALUATION of medical care ,MEDICAL cooperation ,PREGNANCY ,RESEARCH ,DEVELOPED countries ,EVALUATION research - Abstract
Objective: Concerns about differences in registration practices across countries have limited the use of routine data for international very preterm birth (VPT) rate comparisons.Design: Population-based study.Setting: Twenty-seven European countries, the United States, Canada and Japan in 2010.Population: A total of 9 376 252 singleton births.Method: We requested aggregated gestational age data on live births, stillbirths and terminations of pregnancy (TOP) before 32 weeks of gestation, and information on registration practices for these births. We compared VPT rates and assessed the impact of births at 22-23 weeks of gestation, and different criteria for inclusion of stillbirths and TOP on country rates and rankings.Main Outcome Measures: Singleton very preterm birth rate, defined as singleton stillbirths and live births before 32 completed weeks of gestation per 1000 total births, excluding TOP if identifiable in the data source.Results: Rates varied from 5.7 to 15.7 per 1000 total births and 4.0 to 11.9 per 1000 live births. Country registration practices were related to percentage of births at 22-23 weeks of gestation (between 1% and 23% of very preterm births) and stillbirths (between 6% and 40% of very preterm births). After excluding births at 22-23 weeks, rate variations remained high and with a few exceptions, country rankings were unchanged.Conclusions: International comparisons of very preterm birth rates using routine data should exclude births at 22-23 weeks of gestation and terminations of pregnancy. The persistent large rate variations after these exclusions warrant continued surveillance of VPT rates at 24 weeks and over in high-income countries.Tweetable Abstract: International comparisons of VPT rates should exclude births at 22-23 weeks of gestation and terminations of pregnancy. [ABSTRACT FROM AUTHOR]- Published
- 2017
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18. Linking databases on perinatal health: a review of the literature and current practices in Europe.
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Delnord, M., Szamotulska, K., Hindori-Mohangoo, A. D., Blondel, B., Macfarlane, A. J., Dattani, N., Barona, C., Berrut, S., Zile, I., Wood, R., Sakkeus, L., Gissler, M., and Zeitlin, J.
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CHILDREN'S health ,CLINICAL medicine ,MATERNAL health services ,MANAGEMENT of medical records ,MEDLINE ,ONLINE information services ,PUBLIC health surveillance ,RESEARCH ,RESEARCH funding ,SYSTEMATIC reviews ,ACCESS to information ,KEY performance indicators (Management) ,CONTENT mining ,DATA analysis software ,DESCRIPTIVE statistics - Abstract
Background: International comparisons of perinatal health indicators are complicated by the heterogeneity of data sources on pregnancy, maternal and neonatal outcomes. Record linkage can extend the range of data items available and thus can improve the validity and quality of routine data. We sought to assess the extent to which data are linked routinely for perinatal health research and reporting. Methods: We conducted a systematic review of the literature by searching PubMed for perinatal health studies from 2001 to 2011 based on linkage of routine data (data collected continuously at various time intervals). We also surveyed European health monitoring professionals about use of linkage for national perinatal health surveillance. Results: 516 studies fit our inclusion criteria. Denmark, Finland, Norway and Sweden, the US and the UK contributed 76% of the publications; a further 29 countries contributed at least one publication. Most studies linked vital statistics, hospital records, medical birth registries and cohort data. Other sources were specific registers for: cancer (70), congenital anomalies (56), ART (19), census (19), health professionals (37), insurance (22) prescription (31), and level of education (18). Eighteen of 29 countries (62%) reported linking data for routine perinatal health monitoring. Conclusion: Research using linkage is concentrated in a few countries and is not widely practiced in Europe. Broader adoption of data linkage could yield substantial gains for perinatal health research and surveillance. [ABSTRACT FROM AUTHOR]
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- 2016
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19. Self-reported activity limitations among the population aged 20-79 in Estonia: a cross-sectional study
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Altmets, K., primary, Puur, A., additional, Uuskula, A., additional, Saava, A., additional, Sakkeus, L., additional, and Katus, K., additional
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- 2010
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20. ESTONIAN FAMILY AND FERTILITY SURVEY: EXPERIENCE FROM THE TRANSFORMING STATISTICAL ENVIRONMENT
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Katus, K, primary, Pungas, E, primary, Puur, A, primary, and Sakkeus, L, primary
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- 2000
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21. DEMOGRAPHIC BEHAVIOUR PATTERNS OF IMMIGRANTS AND NATIONAL MINORITY OF THE SAME ETHNIC BACKGROUND: CASE OF ESTONIA
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Sakkeus, L, primary
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- 2000
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22. POPULATION DATA AND REORGANISATION OF STATISTICAL SYSTEM: CASE OF ESTONIA
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Katus, K, primary, Puur, A, primary, and Sakkeus, L, primary
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- 1997
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23. DEVELOPMENT OF NATIONAL MINORITIES Republic of Estonia up to 1944; pp. 221–246
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Katus, K, primary, Puur, A, primary, and Sakkeus, L, primary
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- 1997
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24. We only die once... but from how many causes?
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Désesquelles, A., Gamboni, A., Elena Demuru, Barbieri, M., Denissov, G., Egidi, V., Frova, L., Pappagallo, M., Goldberger, N., Grundy, E., Marshall, C., Meslé, F., Pechholdova, M., and Sakkeus, L.
25. Socioeconomic disparities in changes to preterm birth and stillbirth rates during the first year of the COVID-19 pandemic: a study of 21 European countries.
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Zeitlin J, Philibert M, Barros H, Broeders L, Cap J, Draušnik Ž, Engjom H, Farr A, Fresson J, Gatt M, Gissler M, Heller G, Isakova J, Källén K, Kyprianou T, Loghi M, Monteath K, Mortensen L, Rihs T, Sakkeus L, Sikora I, Szamotulska K, Velebil P, Verdenik I, Weber G, Zile I, Zurriaga O, and Smith L
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- Humans, Europe epidemiology, Female, Pregnancy, Adult, Socioeconomic Factors, Pandemics, Social Class, Health Status Disparities, Infant, Newborn, Pregnancy Outcome epidemiology, Socioeconomic Disparities in Health, Stillbirth epidemiology, COVID-19 epidemiology, Premature Birth epidemiology, SARS-CoV-2
- Abstract
Background: Despite concerns about worsening pregnancy outcomes resulting from healthcare restrictions, economic difficulties and increased stress during the COVID-19 pandemic, preterm birth (PTB) rates declined in some countries in 2020, while stillbirth rates appeared stable. Like other shocks, the pandemic may have exacerbated existing socioeconomic disparities in pregnancy, but this remains to be established. Our objective was to investigate changes in PTB and stillbirth by socioeconomic status (SES) in European countries., Methods: The Euro-Peristat network implemented this study within the Population Health Information Research Infrastructure (PHIRI) project. A common data model was developed to collect aggregated tables from routine birth data for 2015-2020. SES was based on mother's educational level or area-level deprivation/maternal occupation if education was unavailable and harmonized into low, medium and high SES. Country-specific relative risks (RRs) of PTB and stillbirth for March to December 2020, adjusted for linear trends from 2015 to 2019, by SES group were pooled using random effects meta-analysis., Results: Twenty-one countries provided data on perinatal outcomes by SES. PTB declined by an average 4% in 2020 {pooled RR: 0.96 [95% confidence intervals (CIs): 0.94-0.97]} with similar estimates across all SES groups. Stillbirths rose by 5% [RR: 1.05 (95% CI: 0.99-1.10)], with increases of between 3 and 6% across the three SES groups, with overlapping confidence limits., Conclusions: PTB decreases were similar regardless of SES group, while stillbirth rates rose without marked differences between groups., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Public Health Association.)
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- 2024
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26. Stillbirths: Contribution of preterm birth and size-for-gestational age for 125.4 million total births from nationwide records in 13 countries, 2000-2020.
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Okwaraji YB, Suárez-Idueta L, Ohuma EO, Bradley E, Yargawa J, Pingray V, Cormick G, Gordon A, Flenady V, Horváth-Puhó E, Sørensen HT, Sakkeus L, Abuladze L, Heidarzadeh M, Khalili N, Yunis KA, Al Bizri A, Karalasingam SD, Jeganathan R, Barranco A, van Dijk AE, Broeders L, Alyafei F, AlQubaisi M, Razaz N, Söderling J, Smith LK, Matthews RJ, Wood R, Monteath K, Pereyra I, Pravia G, Lisonkova S, Wen Q, Lawn JE, and Blencowe H
- Abstract
Objective: To examine the contribution of preterm birth and size-for-gestational age in stillbirths using six 'newborn types'., Design: Population-based multi-country analyses., Setting: Births collected through routine data systems in 13 countries., Sample: 125 419 255 total births from 22
+0 to 44+6 weeks' gestation identified from 2000 to 2020., Methods: We included 635 107 stillbirths from 22+0 weeks' gestation from 13 countries. We classified all births, including stillbirths, into six 'newborn types' based on gestational age information (preterm, PT, <37+0 weeks versus term, T, ≥37+0 weeks) and size-for-gestational age defined as small (SGA, <10th centile), appropriate (AGA, 10th-90th centiles) or large (LGA, >90th centile) for gestational age, according to the international newborn size for gestational age and sex INTERGROWTH-21st standards., Main Outcome Measures: Distribution of stillbirths, stillbirth rates and rate ratios according to six newborn types., Results: 635 107 (0.5%) of the 125 419 255 total births resulted in stillbirth after 22+0 weeks. Most stillbirths (74.3%) were preterm. Around 21.2% were SGA types (PT + SGA [16.2%], PT + AGA [48.3%], T + SGA [5.0%]) and 14.1% were LGA types (PT + LGA [9.9%], T + LGA [4.2%]). The median rate ratio (RR) for stillbirth was highest in PT + SGA babies (RR 81.1, interquartile range [IQR], 68.8-118.8) followed by PT + AGA (RR 25.0, IQR, 20.0-34.3), PT + LGA (RR 25.9, IQR, 13.8-28.7) and T + SGA (RR 5.6, IQR, 5.1-6.0) compared with T + AGA. Stillbirth rate ratios were similar for T + LGA versus T + AGA (RR 0.7, IQR, 0.7-1.1). At the population level, 25% of stillbirths were attributable to small-for-gestational-age., Conclusions: In these high-quality data from high/middle income countries, almost three-quarters of stillbirths were born preterm and a fifth small-for-gestational age, with the highest stillbirth rates associated with the coexistence of preterm and SGA. Further analyses are needed to better understand patterns of gestation-specific risk in these populations, as well as patterns in lower-income contexts, especially those with higher rates of intrapartum stillbirth and SGA., (© 2023 The Authors. BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd.)- Published
- 2023
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27. Neonatal mortality risk of large-for-gestational-age and macrosomic live births in 15 countries, including 115.6 million nationwide linked records, 2000-2020.
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Suárez-Idueta L, Ohuma EO, Chang CJ, Hazel EA, Yargawa J, Okwaraji YB, Bradley E, Gordon A, Sexton J, Lawford HLS, Paixao ES, Falcão IR, Lisonkova S, Wen Q, Velebil P, Jírová J, Horváth-Puhó E, Sørensen HT, Sakkeus L, Abuladze L, Yunis KA, Al Bizri A, Alvarez SL, Broeders L, van Dijk AE, Alyafei F, AlQubaisi M, Razaz N, Söderling J, Smith LK, Matthews RJ, Lowry E, Rowland N, Wood R, Monteath K, Pereyra I, Pravia G, Lawn JE, and Blencowe H
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Objective: We aimed to compare the prevalence and neonatal mortality associated with large for gestational age (LGA) and macrosomia among 115.6 million live births in 15 countries, between 2000 and 2020., Design: Population-based, multi-country study., Setting: National healthcare systems., Population: Liveborn infants., Methods: We used individual-level data identified for the Vulnerable Newborn Measurement Collaboration. We calculated the prevalence and relative risk (RR) of neonatal mortality among live births born at term + LGA (>90th centile, and also >95th and >97th centiles when the data were available) versus term + appropriate for gestational age (AGA, 10th-90th centiles) and macrosomic (≥4000, ≥4500 and ≥5000 g, regardless of gestational age) versus 2500-3999 g. INTERGROWTH 21st served as the reference population., Main Outcome Measures: Prevalence and neonatal mortality risks., Results: Large for gestational age was common (median prevalence 18.2%; interquartile range, IQR, 13.5%-22.0%), and overall was associated with a lower neonatal mortality risk compared with AGA (RR 0.83, 95% CI 0.77-0.89). Around one in ten babies were ≥4000 g (median prevalence 9.6% (IQR 6.4%-13.3%), with 1.2% (IQR 0.7%-2.0%) ≥4500 g and with 0.2% (IQR 0.1%-0.2%) ≥5000 g). Overall, macrosomia of ≥4000 g was not associated with increased neonatal mortality risk (RR 0.80, 95% CI 0.69-0.94); however, a higher risk was observed for birthweights of ≥4500 g (RR 1.52, 95% CI 1.10-2.11) and ≥5000 g (RR 4.54, 95% CI 2.58-7.99), compared with birthweights of 2500-3999 g, with the highest risk observed in the first 7 days of life., Conclusions: In this population, birthweight of ≥4500 g was the most useful marker for early mortality risk in big babies and could be used to guide clinical management decisions., (© 2023 The Authors. BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd.)
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- 2023
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28. Developing and testing a protocol using a common data model for federated collection and analysis of national perinatal health indicators in Europe.
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Zeitlin J, Philibert M, Estupiñán-Romero F, Loghi M, Sakkeus L, Draušnik Ž, Alcaide AR, Durox M, Cap J, Dimnjakovic J, Misins J, Bernal Delgado E, Thissen M, and Gissler M
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Context: International comparisons of the health of mothers and babies provide essential benchmarks for guiding health practice and policy, but statistics are not routinely compiled in a comparable way. These data are especially critical during health emergencies, such as the coronavirus disease (COVID-19) pandemic. The Population Health Information Research Infrastructure (PHIRI) project aimed to promote the exchange of population data in Europe and included a Use Case on perinatal health. Objective : To develop and test a protocol for federated analysis of population birth data in Europe. Methods: The Euro-Peristat network with participants from 31 countries developed a Common Data Model (CDM) and R scripts to exchange and analyse aggregated data on perinatal indicators. Building on recommended Euro-Peristat indicators, complemented by a three-round consensus process, the network specified variables for a CDM and common outputs. The protocol was tested using routine birth data for 2015 to 2020; a survey was conducted assessing data provider experiences and opinions. Results: The CDM included 17 core data items for the testing phase and 18 for a future expanded phase. 28 countries and the four UK nations created individual person-level databases and ran R scripts to produce anonymous aggregate tables. Seven had all core items, 17 had 13-16, while eight had ≤12. Limitations were not having all items in the same database, required for this protocol. Infant death and mode of birth were most frequently missing. Countries took from under a day to several weeks to set up the CDM, after which the protocol was easy and quick to use. Conclusion: This open-source protocol enables rapid production and analysis of perinatal indicators and constitutes a roadmap for a sustainable European information system. It also provides minimum standards for improving national data systems and can be used in other countries to facilitate comparison of perinatal indicators., Competing Interests: No competing interests were disclosed., (Copyright: © 2023 Zeitlin J et al.)
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- 2023
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29. Comparing the cognitive functioning of middle-aged and older foreign-origin population in Estonia to host and origin populations.
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Abuladze L, Sakkeus L, Selezneva E, and Sinyavskaya O
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- Male, Middle Aged, Humans, Female, Aged, Estonia epidemiology, Cross-Sectional Studies, Russia epidemiology, Cognition, Alcohol Drinking epidemiology
- Abstract
Background: In migration and health research, the healthy migrant effect has been a common finding, but it usually pertains to specific contexts only. Existing findings are inconsistent and inconclusive regarding the cognitive functioning of the (aging) foreign-origin population relative to the populations of their host and sending countries. Moreover, this comparison is an understudied design setting., Objective: We analyze the outcomes and associations of cognitive functioning outcomes of the non-institutionalized middle-aged and older population, comparing the Russian-origin population in Estonia with Estonians in Estonia and Russians in Russia in a cross-sectional design. We aim to estimate the (long-term) effects of migration on cognitive functioning in later life, contextualizing the findings in previous research on the healthy migrant effect., Data and Methods: We use data from face-to-face interviews conducted within the SHARE Estonia (2010-2011) and SAGE Russia (2007-2010) surveys. Respondents aged 50+ living in urban areas were grouped by self-identified ethnicity, including 2,365 Estonians, 1,373 Russians in Estonia, and 2,339 Russians in Russia (total N = 6,077). Cognitive functioning was measured using a 25-percentile cut-off threshold for the results of two cognition outcomes - immediate recall and verbal fluency - and the odds of impairment were estimated using binary logistic regression., Results: Russian men and women living in Estonia have significantly higher odds of impairment in immediate recall than Estonian men and women, though they do not differ from Russians in Russia in the final adjusted models. The differences between all groups are non-significant if age at migration is considered. There are no significant differences between the groups in verbal fluency., Conclusion: Contrary to the commonly found healthy migrant effect, the middle-aged and older foreign-origin population in Estonia fares initially worse than the native population in the immediate recall outcome, but does not differ from their sending country population, possibly due to Russia's higher mortality rate and therefore the selective survival of healthier people. Different results depending on the cognitive functioning outcome suggest that migration may affect temporary memory more than crystallized knowledge. However, there are no differences between the groups if defined based on age at migration, which suggests that the age profile differences explain most of the groups' differences in cognitive functioning., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Abuladze, Sakkeus, Selezneva and Sinyavskaya.)
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- 2023
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30. Vulnerable newborn types: Analysis of population-based registries for 165 million births in 23 countries, 2000-2021.
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Suárez-Idueta L, Yargawa J, Blencowe H, Bradley E, Okwaraji YB, Pingray V, Gibbons L, Gordon A, Warrilow K, Paixao ES, Falcão IR, Lisonkova S, Wen Q, Mardones F, Caulier-Cisterna R, Velebil P, Jírová J, Horváth-Puhó E, Sørensen HT, Sakkeus L, Abuladze L, Gissler M, Heidarzadeh M, Moradi-Lakeh M, Yunis KA, Al Bizri A, Karalasingam SD, Jeganathan R, Barranco A, Broeders L, van Dijk AE, Huicho L, Quezada-Pinedo HG, Cajachagua-Torres KN, Alyafei F, AlQubaisi M, Cho GJ, Kim HY, Razaz N, Söderling J, Smith LK, Kurinczuk J, Lowry E, Rowland N, Wood R, Monteath K, Pereyra I, Pravia G, Ohuma EO, and Lawn JE
- Abstract
Objective: To examine the prevalence of novel newborn types among 165 million live births in 23 countries from 2000 to 2021., Design: Population-based, multi-country analysis., Setting: National data systems in 23 middle- and high-income countries., Population: Liveborn infants., Methods: Country teams with high-quality data were invited to be part of the Vulnerable Newborn Measurement Collaboration. We classified live births by six newborn types based on gestational age information (preterm <37 weeks versus term ≥37 weeks) and size for gestational age defined as small (SGA, <10th centile), appropriate (10th-90th centiles), or large (LGA, >90th centile) for gestational age, according to INTERGROWTH-21st standards. We considered small newborn types of any combination of preterm or SGA, and term + LGA was considered large. Time trends were analysed using 3-year moving averages for small and large types., Main Outcome Measures: Prevalence of six newborn types., Results: We analysed 165 017 419 live births and the median prevalence of small types was 11.7% - highest in Malaysia (26%) and Qatar (15.7%). Overall, 18.1% of newborns were large (term + LGA) and was highest in Estonia 28.8% and Denmark 25.9%. Time trends of small and large infants were relatively stable in most countries., Conclusions: The distribution of newborn types varies across the 23 middle- and high-income countries. Small newborn types were highest in west Asian countries and large types were highest in Europe. To better understand the global patterns of these novel newborn types, more information is needed, especially from low- and middle-income countries., (© 2023 The Authors. BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd.)
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- 2023
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31. Neonatal mortality risk for vulnerable newborn types in 15 countries using 125.5 million nationwide birth outcome records, 2000-2020.
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Suárez-Idueta L, Blencowe H, Okwaraji YB, Yargawa J, Bradley E, Gordon A, Flenady V, Paixao ES, Barreto ML, Lisonkova S, Wen Q, Velebil P, Jírová J, Horváth-Puhó E, Sørensen HT, Sakkeus L, Abuladze L, Yunis KA, Al Bizri A, Barranco A, Broeders L, van Dijk AE, Alyafei F, Olukade TO, Razaz N, Söderling J, Smith LK, Draper ES, Lowry E, Rowland N, Wood R, Monteath K, Pereyra I, Pravia G, Ohuma EO, and Lawn JE
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Objective: To compare neonatal mortality associated with six novel vulnerable newborn types in 125.5 million live births across 15 countries, 2000-2020., Design: Population-based, multi-country study., Setting: National data systems in 15 middle- and high-income countries., Methods: We used individual-level data sets identified for the Vulnerable Newborn Measurement Collaboration. We examined the contribution to neonatal mortality of six newborn types combining gestational age (preterm [PT] versus term [T]) and size-for-gestational age (small [SGA], <10th centile, appropriate [AGA], 10th-90th centile or large [LGA], >90th centile) according to INTERGROWTH-21st newborn standards. Newborn babies with PT or SGA were defined as small and T + LGA was considered as large. We calculated risk ratios (RRs) and population attributable risks (PAR%) for the six newborn types., Main Outcome Measures: Mortality of six newborn types., Results: Of 125.5 million live births analysed, risk ratios were highest among PT + SGA (median 67.2, interquartile range [IQR] 45.6-73.9), PT + AGA (median 34.3, IQR 23.9-37.5) and PT + LGA (median 28.3, IQR 18.4-32.3). At the population level, PT + AGA was the greatest contributor to newborn mortality (median PAR% 53.7, IQR 44.5-54.9). Mortality risk was highest among newborns born before 28 weeks (median RR 279.5, IQR 234.2-388.5) compared with babies born between 37 and 42 completed weeks or with a birthweight less than 1000 g (median RR 282.8, IQR 194.7-342.8) compared with those between 2500 g and 4000 g as a reference group., Conclusion: Preterm newborn types were the most vulnerable, and associated with the highest mortality, particularly with co-existence of preterm and SGA. As PT + AGA is more prevalent, it is responsible for the greatest burden of neonatal deaths at population level., (© 2023 The Authors. BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd.)
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- 2023
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32. International versus national growth charts for identifying small and large-for-gestational age newborns: A population-based study in 15 European countries.
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Hocquette A, Durox M, Wood R, Klungsøyr K, Szamotulska K, Berrut S, Rihs T, Kyprianou T, Sakkeus L, Lecomte A, Zile I, Alexander S, Klimont J, Barros H, Gatt M, Isakova J, Blondel B, Gissler M, and Zeitlin J
- Abstract
Background: To inform the on-going debate about the use of universal prescriptive versus national intrauterine growth charts, we compared perinatal mortality for small and large-for-gestational-age (SGA/LGA) infants according to international and national charts in Europe., Methods: We classified singleton births from 33 to 42 weeks of gestation in 2010 and 2014 from 15 countries ( N = 1,475,457) as SGA (birthweight <10th percentile) and LGA (>90th percentile) using the international Intergrowth-21st newborn standards and national charts based on the customised charts methodology. We computed sex-adjusted odds ratios (aOR) for stillbirth, neonatal and extended perinatal mortality by this classification using multilevel models., Findings: SGA and LGA prevalence using national charts were near 10% in all countries, but varied according to international charts with a north to south gradient (3.0% to 10.1% and 24.9% to 8.0%, respectively). Compared with appropriate for gestational age (AGA) infants by both charts, risk of perinatal mortality was increased for SGA by both charts (aOR[95% confidence interval (CI)]=6.1 [5.6-6.7]) and infants reclassified by international charts from SGA to AGA (2.7 [2.3-3.1]), but decreased for those reclassified from AGA to LGA (0.6 [0.4-0.7]). Results were similar for stillbirth and neonatal death., Interpretation: Using international instead of national charts in Europe could lead to growth restricted infants being reclassified as having normal growth, while infants with low risks of mortality could be reclassified as having excessive growth., Funding: InfAct Joint Action, CHAFEA Grant n°801,553 and EU/EFPIA Innovative Medicines Initiative 2 Joint Undertaking ConcePTION grant n°821,520. AH received a PhD grant from EHESP., Competing Interests: No conflict of interest to disclose., (© 2021 The Authors.)
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- 2021
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33. Variations in very preterm birth rates in 30 high-income countries: are valid international comparisons possible using routine data?
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Delnord M, Hindori-Mohangoo AD, Smith LK, Szamotulska K, Richards JL, Deb-Rinker P, Rouleau J, Velebil P, Zile I, Sakkeus L, Gissler M, Morisaki N, Dolan SM, Kramer MR, Kramer MS, and Zeitlin J
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- Canada epidemiology, Developed Countries, Europe epidemiology, Female, Gestational Age, Humans, Infant, Newborn, Japan epidemiology, Pregnancy, United States epidemiology, Birth Rate, Pregnancy Outcome epidemiology, Premature Birth epidemiology
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Objective: Concerns about differences in registration practices across countries have limited the use of routine data for international very preterm birth (VPT) rate comparisons., Design: Population-based study., Setting: Twenty-seven European countries, the United States, Canada and Japan in 2010., Population: A total of 9 376 252 singleton births., Method: We requested aggregated gestational age data on live births, stillbirths and terminations of pregnancy (TOP) before 32 weeks of gestation, and information on registration practices for these births. We compared VPT rates and assessed the impact of births at 22-23 weeks of gestation, and different criteria for inclusion of stillbirths and TOP on country rates and rankings., Main Outcome Measures: Singleton very preterm birth rate, defined as singleton stillbirths and live births before 32 completed weeks of gestation per 1000 total births, excluding TOP if identifiable in the data source., Results: Rates varied from 5.7 to 15.7 per 1000 total births and 4.0 to 11.9 per 1000 live births. Country registration practices were related to percentage of births at 22-23 weeks of gestation (between 1% and 23% of very preterm births) and stillbirths (between 6% and 40% of very preterm births). After excluding births at 22-23 weeks, rate variations remained high and with a few exceptions, country rankings were unchanged., Conclusions: International comparisons of very preterm birth rates using routine data should exclude births at 22-23 weeks of gestation and terminations of pregnancy. The persistent large rate variations after these exclusions warrant continued surveillance of VPT rates at 24 weeks and over in high-income countries., Tweetable Abstract: International comparisons of VPT rates should exclude births at 22-23 weeks of gestation and terminations of pregnancy., (© 2016 Royal College of Obstetricians and Gynaecologists.)
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- 2017
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34. Varying gestational age patterns in cesarean delivery: an international comparison.
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Delnord M, Blondel B, Drewniak N, Klungsøyr K, Bolumar F, Mohangoo A, Gissler M, Szamotulska K, Lack N, Nijhuis J, Velebil P, Sakkeus L, Chalmers J, and Zeitlin J
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- Europe, Female, Humans, Infant, Newborn, Infant, Postmature, Live Birth, Pregnancy, Pregnancy, Multiple statistics & numerical data, Premature Birth surgery, Term Birth, United States, Cesarean Section statistics & numerical data, Gestational Age
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Background: While international variations in overall cesarean delivery rates are well documented, less information is available for clinical sub-groups. Cesarean data presented by subgroups can be used to evaluate uptake of cesarean reduction policies or to monitor delivery practices for high and low risk pregnancies based on new scientific evidence. We studied differences and patterns in cesarean delivery rates by multiplicity and gestational age in Europe and the United States., Methods: This study used routine aggregate data from 17 European countries and the United States on the number of singleton and multiple live births with cesarean versus vaginal delivery by week of gestation in 2008. Overall and gestation-specific cesarean delivery rates were analyzed. We computed rate differences to compare mode of delivery (cesarean vs vaginal birth) between selected gestational age groups and studied associations between rates in these subgroups namely: very preterm (26-31 weeks GA), moderate preterm (32-36 weeks GA), near term (37-38 weeks GA), term (39-41 weeks GA) and post-term (42+ weeks GA) births, using Spearman's rank tests., Results: High variations in cesarean rates for singletons and multiples were observed everywhere. Rates for singletons varied from 15% in The Netherlands and Slovenia, to over 30% in the US and Germany. In singletons, rates were highest for very preterm births and declined to a nadir at 40 weeks of gestation, ranging from 8.0% in Sweden and Norway, to 22.5% in the US. These patterns differed across countries; the average rate difference between very preterm and term births was 43 percentage points, but ranged from 14% to 61%. High variations in rate differences were also observed for near term versus term births. For multiples, rates declined by gestational age in some countries, whereas in others rates were similar across all weeks of gestation. Countries' overall cesarean rates were highly correlated with gestation-specific subgroup rates, except for very preterm births., Conclusions: Gestational age patterns in cesarean delivery were heterogeneous across countries; these differences highlight areas where consensus on best practices is lacking and could be used in developing strategies to reduce cesareans.
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- 2014
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35. Reporting of perinatal health indicators for international comparisons--enhancing the appearance of geographical plots.
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Lack N, Blondel B, Mohangoo AD, Sakkeus L, Cans C, Bouvier-Colle MH, Macfarlane A, and Zeitlin J
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- Cesarean Section statistics & numerical data, Data Interpretation, Statistical, Europe epidemiology, Geography, Medical, Humans, Infant, Low Birth Weight, Infant, Newborn, Quality of Health Care standards, Quality of Health Care statistics & numerical data, Health Status Indicators, Perinatal Mortality
- Abstract
Background: Tabulating annual national health indicators sorted by outcome may be misleading for two reasons. The implied rank order is largely a result of heterogeneous population sizes. Distinctions between geographically adjacent regions are not visible., Methods: Regional data are plotted in a geographical map shaded in terms of percentiles of the indicator value. Degree of departure is determined relative to control limits of a corresponding funnel plot. Five methods for displaying outcome and degree of departure from a reference level are proposed for four indicators selected from the 2004 European Perinatal Health Report., Results: Spread of indicator values was generally largest for small population sizes, with results for large populations lying mostly close to respective European medians. The high neonatal mortality rate for Poland (4.9 per 1000); high low-birthweight rates for England and Wales (7.8%), Germany (7.3%) and Estonia (4.5%); and high caesarean section rates for Italy (37.8%), Poland (26.3%), Portugal (33.1%) and Germany (27.3%) were statistically significant exceptions to this pattern. Estonia also showed an extreme result for maternal mortality (29.6 per 100 000)., Conclusion: Extreme deviations from EU reference levels are either correlated with small population sizes or may be interpreted in terms of differing medical practices, as in the case of caesarean section rate. EURO-PERISTAT has now decided to use 5-year averages for maternal mortality to reduce the variance in outcome. Use of two colours in three intensities and solid fill versus crosshatching is best suited to display rate and significance of difference.
- Published
- 2013
- Full Text
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36. Preterm birth time trends in Europe: a study of 19 countries.
- Author
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Zeitlin J, Szamotulska K, Drewniak N, Mohangoo AD, Chalmers J, Sakkeus L, Irgens L, Gatt M, Gissler M, and Blondel B
- Subjects
- Europe epidemiology, Female, Gestational Age, Humans, Infant, Newborn, Live Birth epidemiology, Multiple Birth Offspring statistics & numerical data, Pregnancy, Premature Birth epidemiology
- Abstract
Objective: To investigate time trends in preterm birth in Europe by multiplicity, gestational age, and onset of delivery., Design: Analysis of aggregate data from routine sources., Setting: Nineteen European countries., Population: Live births in 1996, 2000, 2004, and 2008., Methods: Annual risk ratios of preterm birth in each country were estimated with year as a continuous variable for all births and by subgroup using log-binomial regression models., Main Outcome Measures: Overall preterm birth rate and rate by multiplicity, gestational age group, and spontaneous versus non-spontaneous (induced or prelabour caesarean section) onset of labour., Results: Preterm birth rates rose in most countries, but the magnitude of these increases varied. Rises in the multiple birth rate as well as in the preterm birth rate for multiple births contributed to increases in the overall preterm birth rate. About half of countries experienced no change or decreases in the rates of singleton preterm birth. Where preterm birth rates rose, increases were no more prominent at 35-36 weeks of gestation than at 32-34 weeks of gestation. Variable trends were observed for spontaneous and non-spontaneous preterm births in the 13 countries with mode of onset data; increases were not solely attributed to non-spontaneous preterm births., Conclusions: There was a wide variation in preterm birth trends in European countries. Many countries maintained or reduced rates of singleton preterm birth over the past 15 years, challenging a widespread belief that rising rates are the norm. Understanding these cross-country differences could inform strategies for the prevention of preterm birth., (© 2013 The Authors. BJOG: An International Journal of Obstetrics & Gynaecology published by John Wiley and Sons on behalf of the Royal College of Obstetricians and Gynaecologists.)
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- 2013
- Full Text
- View/download PDF
37. Non-fatal injuries resulting in activity limitations in Estonia--risk factors and association with the incidence of chronic conditions and quality of life: a retrospective study among the population aged 20-79.
- Author
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Puur A, Altmets K, Saava A, Uusküla A, and Sakkeus L
- Abstract
Objectives: Evidence about the health and quality-of-life outcomes of injuries is obtained mainly from follow-up studies of surviving trauma patients; population-based studies are rarer, in particular for countries in Eastern Europe. This study examines the incidence, prevalence and social variation in non-fatal injuries resulting in activity limitations and outcomes of injuries in Estonia., Design: A retrospective population-based study., Setting: Estonia., Participants: 7855 respondents of the face-to-face interviews of the second round of the Estonian Family and Fertility Survey conducted between 2004 and 2005 based on the nationally representative probability sample (n=11 192) of the resident population of Estonia aged 20-79., Primary and Secondary Outcome Measures: The cumulative incidence and prevalence of injuries leading to activity limitations was estimated. Survival models were applied to analyse variations in the injury risk across sociodemographic groups. The association between injuries and the development of chronic conditions and quality of life was examined using survival and logistic regression models., Results: 10% (95% CI 9.4 to 10.7) of the population aged 20-79 had experienced injuries leading to activity limitations; the prevalence of activity limitations due to injuries was 4.4% (95% CI 3.9% to 4.9%). Significant differences in injury risk were associated with gender, education, employment, marital status and nativity. Limiting injury was associated with a doubling of the likelihood of having chronic conditions (adjusted HR 1.97, 95% CI 1.58 to 2.46). Injury exhibited a statistically significant negative association with most quality-of-life measures. Although reduced, these effects persisted after recovery from activity limitations., Conclusions: Substantial variation in injury risk across population groups suggests potential for prevention. Men and workers in manual occupations constitute major target groups for injury prevention in Estonia. The association of injury with the development of chronic conditions and reduced quality of life warrants further investigation.
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- 2013
- Full Text
- View/download PDF
38. Self-reported activity limitations among the population aged 20-79 in Estonia: a cross-sectional study.
- Author
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Altmets K, Puur A, Uusküla A, Saava A, Sakkeus L, and Katus K
- Subjects
- Activities of Daily Living, Adult, Age Factors, Aged, Chronic Disease, Cross-Sectional Studies, Estonia epidemiology, Female, Humans, Male, Middle Aged, Prevalence, Sex Factors, Socioeconomic Factors, Mobility Limitation, Self Report
- Abstract
Background: Along with population ageing, limitations in activities of daily living constitute a rising health-related burden in demographically advanced countries. The present study aims to assess the prevalence of self-reported activity limitations derived from chronic conditions and social variation of limitations in the subgroups of the population aged 20-79 years in Estonia., Methods: A cross-sectional study employs data from the second round of the Estonian Family and Fertility Survey, a national project in the framework of Gender and Generation Programme. The target population covers age groups of 20-79 years. A nationally representative probability sample was drawn from the 2000 population census. Face-to-face interviews (n = 7855) were conducted in 2004-05., Results: The estimated prevalence of activity limitations with chronic conditions is 18.5% (95% CI 17.6-19.4) and the prevalence of severe limitations is 10.6% (95% CI 9.9-11.3) among the population. The logistic regression model shows significant differences in activity limitations associated with age, educational attainment and marital status., Conclusions: Judging from our results and the EU structural indicators on health, the prevalence of activity limitations derived from chronic conditions is comparatively high in Estonia. The measures to prevent activity limitations and disability should receive a higher priority in Estonia.
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- 2011
- Full Text
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39. Perinatal health monitoring in Europe: results from the EURO-PERISTAT project.
- Author
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Gissler M, Mohangoo AD, Blondel B, Chalmers J, Macfarlane A, Gaizauskiene A, Gatt M, Lack N, Sakkeus L, and Zeitlin J
- Subjects
- Birth Weight, Delivery, Obstetric statistics & numerical data, Europe epidemiology, Female, Humans, Infant, Newborn, Maternal Age, Pregnancy, Pregnancy Outcome epidemiology, Vital Statistics, Data Collection methods, Perinatal Care statistics & numerical data, Population Surveillance methods, Registries statistics & numerical data
- Abstract
Data about deliveries, births, mothers and newborn babies are collected extensively to monitor the health and care of mothers and babies during pregnancy, delivery and the post-partum period, but there is no common approach in Europe. We analysed the problems related to using the European data for international comparisons of perinatal health. We made an inventory of relevant data sources in 25 European Union (EU) member states and Norway, and collected perinatal data using a previously defined indicator list. The main sources were civil registration based on birth and death certificates, medical birth registers, hospital discharge systems, congenital anomaly registers, confidential enquiries and audits. A few countries provided data from routine perinatal surveys or from aggregated data collection systems. The main methodological problems were related to differences in registration criteria and definitions, coverage of data collection, problems in combining information from different sources, missing data and random variation for rare events. Collection of European perinatal health information is feasible, but the national health information systems need improvements to fill gaps. To improve international comparisons, stillbirth definitions should be standardised and a short list of causes of fetal and infant deaths should be developed.
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- 2010
- Full Text
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40. The European data protection legislation and its consequences for public health monitoring: a plea for action.
- Author
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Verschuuren M, Badeyan G, Carnicero J, Gissler M, Asciak RP, Sakkeus L, Stenbeck M, and Devillé W
- Subjects
- Confidentiality legislation & jurisprudence, Databases, Factual legislation & jurisprudence, Humans, Systems Integration, Computer Security legislation & jurisprudence, European Union, Information Storage and Retrieval legislation & jurisprudence, Public Health Practice legislation & jurisprudence
- Published
- 2008
- Full Text
- View/download PDF
41. [Trends in interregional migration in Estonia since 1947].
- Author
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Sakkeus L
- Subjects
- Demography, Developed Countries, Emigration and Immigration, Estonia, Europe, Europe, Eastern, Population, Population Characteristics, USSR, Age Distribution, Age Factors, Population Dynamics, Public Policy, Transients and Migrants
- Abstract
Migration trends in Estonia since 1947 are reviewed. The analysis indicates that the country's age distribution began to change earlier than that of other Eastern European countries. "Immigration started earlier too, first with the influx from the Estonia hinterland into the capital, then, after the second world war, with the gradual common workforce influx from the Republics of the Soviet Union." The author concludes that in-migration, combined with greater migration among younger people, has resulted in increased demographic aging, a trend that has to be taken into account when developing social policy. (SUMMARY IN ENG AND SPA), (excerpt)
- Published
- 1991
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