Predictors of Preterm Birth in New Mexico: outcomes from 377,770 pregnancies over fifteen years

Background: Preterm birth (PTB) is a significant health problem both in New Mexico and nationally. It accounts for significant infant morbidity and mortality and it poses an economic burden to both individuals and the state. The goal of this study is to elucidate maternal risk factors for PTB in New Mexico, a poor state with a unique ethnic background. By doing this we hope to be able to identify women at increased risk and invite further study into targeted interventions among these high risk populations. Methods: This was a cross-sectional analysis of 377,770 singleton live births in the state of New Mexico from 1991-2005. The medical risk factors tracked were pulmonary, renal, cardiac, diabetes, eclampsia, oligo/polyhydramnios, hypertensive disorders, cervical incompetence, previous preterm delivery, tocolysis and isoimmunization. Gestational age of less than 37 weeks was defined as PTB. Multiple gestations and congenital anomalies were excluded. The Kotelchuck Index was used as a measure for level of prenatal care described as inadequate, intermediate, adequate, and intensive. Multivariate logistic regression was conducted using SAS 9.1 statistical software. Results: Of the live births analyzed, 28,036 of these were preterm (7.4%). Overall the PTB rate has risen from 1991-2005 at a rate of 0.18 percent per year. This was statistically significant (p = \u3c0.00004). Among patients with medical risk factors, PTB rate had a direct inverse relationship with an intensive level of prenatal care. High risk patients with intensive care were less likely to have a PTB delivery with an odds ratio of 0.74 than similar patients with low levels of care. The nadir for risk of PTB is among women aged 25-29 with significant increases in risk among women \u3c15 and \u3e40 years of age. Other risk factors are unmarried status, education less than high school,tobacco/alcohol use, Black, Asian, and White Hispanic ethnicity and the presence of one or more medical risk factors. Statistically significant protective factors for PTB are age 25-29, education surpassing high school, and Native American race. Counties with rising adjusted PTB rates are Chaves, Dona Ana, Grant, Hidalgo, Lea, Lincoln, McKinley, Mora, Otero, Rio Arriba, San Juan and San Miguel. Counties with decreasing PTB rates are Sandoval and Santa Fe counties. Conclusion: Even adjusted for known risk factors PTB is still a significant problem in New Mexico. A lack of prenatal care was a significant predictor of PTB in high risk patients. Other predictors include the known risk factors of age \u3c15 and \u3e40, single, tobacco/alcohol use, being of low socioeconomic status and White Hispanic, Asian and Black ethnicities. Interestingly, Native American patients have a lower PTB rate compared to other groups, even though this group is traditionally one of low socioeconomic status in New Mexico

An exploratory study of the variables impacting preterm birth rates in New Mexico

BACKGROUND: Preterm birth (PTB) is a substantial health problem that accounts for significant infant morbidity and mortality and poses an economic burden to both individuals and the state of residence. The goal of this study was to identify maternal risk factors for PTB in New Mexico, a poor state with a unique ethnic background, in order to identify populations at increased risk that would benefit from intervention. METHODS: This was a cross-sectional retrospective exploratory analysis of 377,770 singleton live births in the state of New Mexico from 1991-2005. Gestational age of less than 37 weeks was defined as PTB. The Kotelchuck Index was used as a measure for level of prenatal care described as inadequate, intermediate, adequate, and intensive. RESULTS: Of the live births analyzed, 28,036 of these were preterm (7.4%). Overall the PTB rate rose at a rate of 0.18% per year from 1991-2005. Among patients with medical risk factors, the absence of prenatal care was associated with higher odds for PTB as compared to adequate prenatal care. Other risk factors were unmarried status, education less than high school, tobacco/alcohol use, black, Asian, and white Hispanic ethnicity, and the presence of one or more medical risk factors. Statistically significant protective factors for PTB were age 25-29, education surpassing high school, and Native American race. CONCLUSIONS: This study identified several factors that correlate with increased PTB in New Mexico, in particular ethnicity and level of prenatal care. The finding that Native American patients have a lower PTB rate compared to other groups, even though this group is traditionally one of low socioeconomic status in New Mexico, signifies that other factors yet to be identified affect PTB

Molecular Profiling of Tumor Tissue in Mexican Patients with Colorectal Cancer

Colorectal cancer is a heterogeneous disease with multiple genomic changes that influence the clinical management of patients; thus, the search for new molecular targets remains necessary. The aim of this study was to identify genetic variants in tumor tissues from Mexican patients with colorectal cancer, using massive parallel sequencing. A total of 4813 genes were analyzed in tumoral DNA from colorectal cancer patients, using the TruSight One Sequencing panel. From these, 192 variants with clinical associations were found distributed in 168 different genes, of which 46 variants had not been previous reported in the literature or databases, although genes harboring those variants had already been described in colorectal cancer. Enrichment analysis of the affected genes was performed using Reactome software; pathway over-representation showed significance for disease, signal transduction, and immune system subsets in all patients, while exclusive subsets such as DNA repair, autophagy, and RNA metabolism were also found. Those characteristics, whether individual or shared, could give tumors specific capabilities for survival, aggressiveness, or response to treatment. Our results can be useful for future investigations targeting specific characteristics of tumors in colorectal cancer patients. The identification of exclusive or common pathways in colorectal cancer patients could be important for better diagnosis and personalized cancer treatment

Statins, ACE/ARBs drug use, and risk of pneumonia in hospitalized older patients: a retrospective cohort study

: The aims of this study is to evaluate the association between angiotensin-converting enzyme inhibitor (ACE-I), angiotensin II receptor blocker (ARBs) and/or statin use with the risk of pneumonia, as well as and with in-hospital and short-term outpatient mortality in hospitalized older patients with pneumonia. Patients aged 65 years or older hospitalized in internal medicine and/or geriatric wards throughout Italy and enrolled in the REPOSI (REgistro Politerapuie SIMI-Società Italiana di Medicina Interna) register from 2010 to 2019 were screened to assess the diagnosis of pneumonia and classified on whether or not they were prescribed with at least one drug among ACE-I, ARBs, and/or statins. Further study outcomes were mortality during hospital stay and at 3 months after hospital discharge. Among 5717 cases included (of whom 18.0% with pneumonia), 2915 (51.0%) were prescribed at least one drug among ACE-I, ARBs, and statins. An inverse association was found between treatment with ACE-I or ARBs and pneumonia (OR = 0.79, 95% CI 0.65-0.95). A higher effect was found among patients treated with ACE-I or ARBs in combination with statins (OR = 0.67, 95% CI 0.52-0.85). This study confirmed in the real-world setting that these largely used medications may reduce the risk of pneumonia in older people, who chronically take them for cardiovascular conditions