Dataset Information

Early-onset group B Streptococcus (EOGBS) infection subsequent to cessation of screening-based intrapartum prophylaxis: findings of an observational study in West London, UK.

ABSTRACT: OBJECTIVES:To describe the impact on early-onset group B Streptococcus (EOGBS) infection rates following reversion from screening-based to risk-based intrapartum antimicrobial prophylaxis (IAP) for prevention. SETTING:Maternity services provided by secondary healthcare organisation in North West London. PARTICIPANTS:All women who gave birth in the healthcare organisation between April 2016 and March 2017. There were no exclusions. DESIGN:Observational study comparing EOGBS rates in the postscreening period (2016-2017) with prescreening (2009-2013) and screening periods (2014-2015). METHODS:Local guidelines for risk-based IAP were reintroduced in April 2016. Compliance with guidelines was audited. Gestational age, mode of delivery, maternal demographics and EOGBS rates in three time periods were compared using Poisson regression analysis. EOGBS was defined through GBS being cultured from blood, cerebrospinal fluid or other sterile fluids within 6 days of birth. PRIMARY OUTCOME:EOGBS rates/1000 live births in prescreening, screening and postscreening periods RESULTS: Incremental changes in maternity population were observed throughout the study period (2009 onwards), in particular the ethnic profile of mothers. Of the 5033 live births in postscreening period, 9 babies developed EOGBS infection. Only one of the mothers of affected babies had a risk factor indicating use of IAP. Comparison of postscreening period with screening period showed a fivefold increase in EOGBS rates after adjustment for ethnicity (1.79 vs 0.33/1000 live births; risk ratio =5.67, p=0.009). There was no significant difference between prescreening and postscreening periods with rates of infection reverting to their prescreening level. CONCLUSIONS:This study provides further evidence of efficacy of screening-based IAP compared with risk-based IAP in prevention of EOGBS in newborns in an area of high incidence.

SUBMITTER: Gopal Rao G

PROVIDER: S-EPMC5701994 | biostudies-literature |

REPOSITORIES: biostudies-literature

ACCESS DATA

Similar Datasets

Project description:The aims of this study were to describe the adherence to CDC guidelines for intrapartum antibiotic prophylaxis (IAP) and to identify possible factors influencing noncompliance with guidelines. We conducted a retrospective study in Italy. Our cohort included women in whom antenatal Group B Streptococcus (GBS) screening was not performed, was performed, but results were not available at the time of labor or delivery and women who were positive for GBS colonization. The indications for complete execution of IAP according to revised CDC guidelines was evaluated. It was considered adequate when performed with a recommended antibiotic at least four hours prior to delivery. The cohort included 902 women. Among those who had performed rectal and vaginal swabs (or recto-vaginal swabs), results were available in 86.9% of vaginal swabs and in 87.1% of rectal swabs and GBS was detected in 59.8% of vaginal swabs and in 71% of rectal swabs. 49.2% women had indication for GBS prophylaxis. Among these, 91.1% received an antibiotic during labor. Totally appropriate IAP was performed in 36.3% deliveries, an inappropriate antibiotic was administered in 10.4% women, the remaining 45.3% women received partially appropriate IAP; of these, 15.5% had received antibiotics through an inappropriate route of administration, 18.2% an inappropriate dosage regimen. Overall, 27.5% women received intrapartum ampicillin with inappropriate timing. Multivariate analysis showed that totally appropriate prophylaxis was significantly more likely in women who had no previous live birth, who had vaginal delivery, and a positive result at antenatal GBS screening. Despite satisfactory GBS screening implementation, there is still a substantial gap between optimal and actual IAP. We hypothesize that the complexity of the CDC guidelines may partially explain this shortcoming. Future efforts will include initiatives focused at enabling and reinforcing adherence to evidence-based prevention practices.

Project description:Background and aimNational social marketing campaigns have been shown to promote smoking cessation in England. There is reason to believe that regional and city-wide campaigns can play a valuable role in reducing smoking prevalence over and above any national tobacco control activity. This study aimed to assess the impact of the London Smoking Cessation Transformation Programme, a multi-component citywide smoking cessation programme, on quit attempts and quit success rates.Design and settingInterrupted time-series analyses, using Autoregressive Integrated Moving Average (ARIMA) and generalized additive models (GAM) of population trends in the difference between monthly quit attempts and quit success rates among smokers who made a quit attempt in London versus the rest of England before and during the first year of the programme.ParticipantsA total of 55 528 past-year adult smokers who participated in a monthly series of nationally representative cross-sectional surveys in England between November 2006 and August 2018. Twelve and a half per cent of smokers lived in London (intervention region) and 87.5% lived in the rest of England (control region).MeasurementsMonthly prevalence of quit attempts and quit success rates among smokers who made a quit attempt.FindingsThe monthly difference in prevalence of quit attempts in London compared with the rest of England increased by 9.59% [95% confidence interval (CI) = 4.35-14.83, P < 0.001] from a mean of 0.04% pre-intervention to 9.63% post-intervention. The observed increase in success rates among those who tried was not statistically significant (B = 4.72; 95% CI = -2.68 to 12.11, P = 0.21); Bayes factors indicated that these data were insensitive. GAM analyses confirmed these results.ConclusionThe promotion of the London Smoking Cessation Transformation Programme during September 2017 was associated with a significant increase in quit attempts compared with the rest of England. The results were inconclusive regarding an effect on quit success among those who tried.

Project description:Deprived communities in many cities are exposed to higher levels of outdoor air pollution, and there is increasing evidence of similar disparities for indoor air pollution exposure. There is a need to understand the drivers for this exposure disparity in order to develop effective interventions aimed at improving population health and reducing health inequities. With a focus on London, UK, this paper assembles evidence to examine why indoor exposure to PM2.5, NOx and CO may disproportionately impact low-income groups. In particular, five factors are explored, namely: housing location and ambient outdoor levels of pollution; housing characteristics, including ventilation properties and internal sources of pollution; occupant behaviours; time spent indoors; and underlying health conditions. Evidence is drawn from various sources, including building physics models, modelled outdoor air pollution levels, time-activity surveys, housing stock surveys, geographical data, and peer-reviewed research. A systems framework is then proposed to integrate these factors, highlighting how exposure to high levels of indoor air pollution in low-income homes is in large part due to factors beyond the control of occupants, and is therefore an area of systemic inequality.Policy relevanceThere is increasing public and political awareness of the impact of air pollution on public health. Strong scientific evidence links exposure to air pollution with morbidity and mortality. Deprived communities may be more affected, however, with limited evidence on how deprivation may influence their personal exposure to air pollution, both outdoors and indoors. This paper describes different factors that may lead to low-income households being exposed to higher levels of indoor air pollution than the general population, using available data and models for London (i.e. living in areas of higher outdoor air pollution, in poor-quality housing, undertaking more pollution-generating activities indoors and spending more time indoors). A systems approach is used to show how these factors lead to systemic exposure inequalities, with low-income households having limited opportunities to improve their indoor air quality. This paper can inform actions and public policies to reduce environmental health inequalities, considering both indoor and outdoor air.

Dataset Information

Early-onset group B Streptococcus (EOGBS) infection subsequent to cessation of screening-based intrapartum prophylaxis: findings of an observational study in West London, UK.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets