Essay on Epidemiology

Question: Write an essay on Epidemiology. Answer: Introduction The study aims at examining the connection between gestational age and language outcomes by using sibling-control design procedure. To examine the connection between the gestational age and language outcome, the sibling-control design is used in the study. Methods Outcome variables (i) Child (ii) Gestational age at birth, weeks (iii) Boys (iv) Twins (v) Malformations at birth (vi) SGA (vii) Pregnancy (viii) Unplanned pregnancy (ix) Preeclampsia (x) IVF (LagerstroÃÅ'ˆm, 1991) Exposure variables (i) Gestational diabetes (ii) Recurrent urinary tract infections (iii) Bleeding between weeks (iv) Hypertensive state (v) Depressive symptoms (vi) Smoking during pregnancy (vii) Alcohol during pregnancy (viii) Maternal weight status (BMI) (ix) Demographics (x) Mothers completed education (xi) Marital status during pregnancy (xii) Age mother, years (Lopes, Santos, Pereira, Lopes, 2012) The Ultrasound Examination method is used in the statistical method. The way of the method executed as- first there were 4 groups i) early preterm ii) late preterm iii) early term and iv) full term. There were two onset types that are i) spontaneous ii) provider-initiated The statistical method was used as used by M-plus version is examined for the four models at 18 and 36 months. There were response theory approaches which are I) Main effect cohort analyses including all siblings were conducted to address possible inverse linear trends in associations between gestational age and the outcomes, and adjusted cohort analyses were examined for comparison purposes. II) The same associations were examined by first calculating unadjusted There were also some missing data. The missing data is estimating in multiple samples. The codes of pregnancy smoking and alcohol intake during pregnancy are the depressive symptoms BMI, SGA was included as variables (Strickland, Marsh, Darrow, 2014). The Pregnancy-specific child, mother or pregnancy factors that can vary between pregnancies and that preceded the exposure (Bere et al., 2012). Parity, smoking, alcohol intake, pregnancy-specific hypertensive state, bleeding recurrent urinary tract infections, unplanned pregnancy, gestational diabetes, in vitro fertilization, low and high body mass index (BMI), gender, multiple birth status, serious malformations at birth and small for gestational age are the method for co-founder definition. In figure 1 gestational diabetes and smoking are the two co-founders which are adjusted in the model. Yes, I do consider these variables for co-founders. because in the method it has told that Parity, smoking, alcohol intake, pregnancy-specific hypertensive state, bleeding recurrent urinary tract infections, unplanned pregnancy, gestational diabetes, in vitro fertilization, low and high body mass index (BMI), gender, multiple birth status, serious malformations at birth and small for gestational age are under co-founder definition ("Gestational Diabetes Mellitus", 1998). So in figure 1, it is showing that the gestational problem and smoking are the variables. So it is acceptable with the cause. Remarks Frequencies and sibling discordance of gestational age group and type of delivery onset are shown in Table 2. In the sibling-control analyses, the difference between the gestational age average of the sibling group and the individual score (e.g. for a trio we divide it by 3), provided deviations from the family means in any family (Pober et al., 2005). The cohort results in Table 4 shows that the language delays are less pronounced at 36 months. There were no effects of preterm group on language comprehension for spontaneous deliveries. For provider-initiated deliveries, there was an inverse linear tendency: the early preterm group and late preterm group both showed poorer language comprehension than the full term group, the former being different from the equivalent spontaneous group. These effects were not sustained in the sibling-control analyses, and the minor effect of spontaneous early term delivery in the unadjusted sibling-control model disappeared in the adjusted model. For language production, lower gestational age was still related to poorer levels in the unadjusted cohort results, with strongest effects in children from provider-initiated delivery, and with the early preterm group effect being different from the same spontaneous group (Pober et al., 2005). The confounder adjustments slightly reduced these effects. When comparing siblings across unadjusted and adjusted models, the language production delays in the spontaneous groups only remained for the early term group. In contrast, the language production delays in children from provider-initiated delivery were the same in the cohort and sibling models, except for the early term group where there was no longer strong evidence of an effect. Tests of linear trends are described in Supplementary text, available as Supplementary data at IJE online. Conclusion This study emphasizes the importance of sibling control designs when studying effects of preterm deliveries. First, we could ascertain robust inverse linear associations between gestational age at delivery and early language delays. Second, we found that these associations were particularly strong for provider-initiated deliveries. Third, even if language delays diminish between 18 and 36 months, the delays persist for the early preterm children, particularly those from provider-initiated delivery. Finally, we find that different factors probably underlie the language delays of preterm children delivered provider-initiated compared with spontaneous delivery. Indeed, this underlines the need for examining spontaneous and provider- initiated preterm births separately, to address issues of etiology,32 and future studies could aim to identify such factors, for example by comparing similarity in full and half siblings. References Gestational Diabetes Mellitus. (1998).Diabetes Care,21(Supplement_1), S60-S61. LagerstroÃÅ'ˆm, M. (1991).Pre- and perinatal factors in long-term development. Stockholm, Sweden: Dept. of Psychology, Stockholm University verby, N., Hillesund, E., Sagedal, L., Vistad, I., Bere, E. (2012). The Fit for Delivery study: rationale for the recommendations and test-retest reliability of a dietary score measuring adherence to 10 specific recommendations for prevention of excessive weight gain during pregnancy.Matern Child Nutr,11(1), 20-32. Pober, B., Lin, A., Russell, M., Ackerman, K., Chakravorty, S., Strauss, B. et al. (2005). Infants with Bochdalek diaphragmatic hernia: Sibling precurrence and monozygotic twin discordance in a hospital-based malformation surveillance program.Am. J. Strickland, M., Marsh, C., Darrow, L. (2014). Gestational Age-Specific Associations between Infantile Acute Bronchiolitis and Asthma after Age Five.Paediatr Perinat Epidemiol,28(6), 521-526.