Perinatale uitkomsten in de vier grote steden en de prachtwijken in Nederland

__Doel:__ Het verband tussen woonwijk, etniciteit en ongunstige perinatale uitkomsten analyseren bij zwangeren in de 4 grootste steden (Amsterdam, Rotterdam, Den Haag en Utrecht; G4) en in de rest van Nederland. __Opzet:__ Descriptief, retrospectief. __Methode:__ De perinatale uitkomst van 877.816 eenlingzwangerschappen in Nederland in de periode 2002-2006, vastgelegd in de Perinatale Registratie Nederland, werd geanalyseerd op etniciteit van de zwangere (westers of niet-westers) en op woonwijk (achterstandswijk (‘prachtwijk’) of niet) in de G4-steden en daarbuiten. Een ongunstige perinatale uitkomst was gedefinieerd als perinatale sterfte, congenitale afwijkingen, dysmaturiteit, vroeggeboorte, een apgar-score na 5 minuten < 7 en/of opname op een neonatale intensivecareunit. __Resultaten:__ Het perinatale sterftecijfer was in de G4-steden hoger dan in de rest van Nederland (11,1 versus 9,3‰; p < 0,001; 95%-BI van het verschil: 1,2-2,4‰). Hetzelfde gold voor het totaal van ongunstige perinatale uitkomsten (154,9 versus 138,9‰). In de G4-steden was de perinatale sterfte in de groep niet-westerse vrouwen hoger dan in de groep westerse vrouwen (13,2 versus 9,5‰). Het wonen in een prachtwijk gaat gepaard met een hogere perinatale sterfte dan in een niet-prachtwijk (13,5 versus 9,3‰). De relatieve risico’s van het wonen in een prachtwijk zijn groter bij westerse dan bij niet-westerse vrouwen. __Conclusie:__ Vrouwen in de G4-steden hebben een sterk verhoogde kans op een ongunstige perinatale uitkomst. Wonen in een prachtwijk vormt een nog groter risico, vooral voor westerse zwangeren. Deze bevindingen zijn van belang voor het vaststellen van nieuwe strategieën ter

Record Linkage: Making the Most Out of Errors in Linking Variables

This paper presents a refinement of the probabilistic medical record linking algorithm. We introduced “close agreement” to account for typical errors in administrative variables used for record linkage. Linking data on early pregnancy determinants with data on late child outcomes was used as a case study. We analyzed whether the addition of close agreement resulted in a higher discriminating power of the linking key reflected in a reduction of the number of links with an uncertain linking status. Incorporating close agreement for postal code and date of birth in the record linking algorithm resulted in a reduction of 95% of the number of pairs in the uncertain region. We showed that the extension of a third outcome “close” when comparing values of corresponding linking variables led to a major improvement in our probabilistic record linkage study. Similar improvements are likely in other studies because the frequency, nature, and type of errors in other large databases will not be substantially different

A physical activity questionnaire for the elderly.

A validated physical activity questionnaire for young adults was adapted and validated for use in free living, apparently healthy people, aged 63-80 yr. Test-retest reliability of the questionnaire on 29 participants was 0.89 as determined by Spearman's correlation coefficient. Further classification by tertiles of activity resulted in 72% of the participants being correctly classified and 0% grossly misclassified on two separate occasions. In a similar group of 31 subjects, classifications based on questionnaire activity scores were compared with classifications obtained by repeated 24-h activity recalls and pedometer measurements, showing Spearman's correlations of 0.78 and 0.73, for both methods, respectively. Seventy-one and 67% of the subjects, respectively, were classified in the same activity tertile for both methods. It is concluded that the questionnaire provides a reliable and valid method for classifying elderly subjects into categories of high, medium, and low physical activit

Spontaneous and iatrogenic preterm birth rates among unselected women in three consecutive pregnancies

Abstract not availableEsme I. Kamphuis, Anita C.J. Ravelli, Bouchra Koullali, Brenda Kazemier, Christianne J.M de Groot, Ben Willem J. Mo

Effect of a cluster randomised team training intervention on adverse perinatal and maternal outcomes: a stepped wedge study.

Objective: To study the effect of an intervention based on Crew Resource Management team training, including the SBARR tool for structured communication, on adverse perinatal and maternal outcomes. Design: Stepped wedge. Setting: the Netherlands. Population or sample: Registry data of 8 123 women referred from primary‐care to a hospital during childbirth, at ≥32.0 weeks of singleton gestation and with no congenital abnormalities, in the period 2012 to 2015. Methods: Obstetrical teams of five hospitals and their surrounding primary‐care midwifery practices participated in the intervention. In total 49 team training sessions were organised for 465 care professionals (75,5% participated). Adverse perinatal and maternal outcomes before, during and after the intervention were analysed using multivariate logistic regression analyses. Main Outcome Measures: Adverse Outcome Index (AOI – 5), a composite measure involving; intrapartum or neonatal death, admission to neonatal intensive care unit, APGAR <7 at 5 minutes, postpartum haemorrhage and/or perineal tear. Results: In total, an AOI‐5 score was reported in 11.3% of the study population. No significant difference was found in the incidence of the AOI‐5 score after the intervention compared to before the intervention (OR: 1.07: 95%CI 0.92 – 1.24)