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Angela Nannini

Publications and source records attributed to Angela Nannini.

6 recordsLinked to original sources
PubMed2006

Pregnancy-related deaths in four regions of Europe and the United States in 1999-2000: characterisation of unreported deaths.

OBJECTIVE: We compared official maternal mortality statistics with those from a special study covering all pregnancy-associated deaths in two European countries (Finland and France) and in two US states (Massachusetts and North Carolina) in 1999-2000 to characterize pregnancy-related deaths that are not included in official statistics. STUDY DESIGN: We linked the official ICD-10-based maternal mortality data for 84 deaths with study data on 404 pregnancy-associated deaths. RESULTS: Of the pregnancy-associated deaths, 151 were pregnancy-related. We found 69 pregnancy-related deaths that had not been included as maternal deaths, and two deaths coded as maternal deaths that did not meet our definition for a pregnancy-related death. In total, 58 of these 69 deaths were from medical causes and 11 were from external causes or injuries (10 postpartum depression-related suicides and one accidental drug poisoning). The unreported deaths due to medical causes included 27 direct, 15 indirect, and two direct/indirect pregnancy-related deaths and 14 possibly pregnancy-related deaths. The most common causes of the unreported deaths due to medical causes were intracerebral hemorrhage (7 deaths), peripartum cardiomyopathy (4), pulmonary embolism (4) and pregnancy-induced hypertension (4). CONCLUSIONS: The collection of data on pregnancy-related and pregnancy-associated deaths is useful for countries with low maternal mortality figures. The use of various data-collection methods may substantially increase the quality of maternal mortality statistics.

Female↗
PubMed2005

Identifying multiple gestation groups using state-level birth and fetal death certificate data.

PURPOSE: Birth and fetal death certificates classify individuals as twins or higher order multiples, but do not identify multiple gestation groups. As a result, multiple gestations are consistently excluded from maternal and child health research studies despite the surge in multiple births since the early 1980s and the health risks associated with them. A standardized methodology for states to identify multiple gestation groups is proposed to allow researchers to account for multiple gestations in analyses, improve the accuracy of the incidence of multiple gestations and further knowledge of the impact of multiple gestations on birth outcomes. METHODS: Using 3 years of Massachusetts birth and fetal death certificate data from 1998 to 2000 (247,959 births and 1358 fetal deaths), we assigned matching multiple gestation group numbers to records with identical combinations of mother's first name, last name, date of birth, and month of delivery. To validate our methodology, we calculated plurality and compared it to plurality reported on the existing birth and fetal death data. RESULTS: This method correctly identified 10,765 records out of 10,795 validated multiple gestation deliveries (99.8%). Our method identified 71 additional multiple gestation deliveries, which were not identified by the birth and fetal death files. This method resulted in only 4 false positives and 51 false negatives over 3 years. CONCLUSIONS: This algorithm provides much needed information on multiple gestation groupings, and as an additional benefit, improves the identification of multiple gestation deliveries. This method has proven easy to use, employs state-level data, and offers numerous new analytic opportunities.

Birth Certificates↗
PubMed2005

Underreporting of pregnancy-related mortality in the United States and Europe.

OBJECTIVE: Available maternal mortality statistics do not allow valid international comparisons. Our objective was to uniformly measure underreporting of mortality from pregnancy in official statistics from selected regions within the U.S. and Europe, and to provide comparable revised profiles of pregnancy-related mortality. METHODS: We developed a standardized enhanced method to uniformly identify and classify pregnancy-associated deaths from 2 U.S. states, Massachusetts and North Carolina, and 2 European countries, Finland and France, for the years 1999-2000. Identification method included the use of all data available from the death certificate as well as computerized linkage of births and deaths registers. All cases were reviewed and classified by an international panel of experts. RESULTS: Four-hundred-and-four pregnancy-associated deaths were identified and reviewed. Underestimation of mortality causally related to pregnancy based on International Classification of Diseases cause-of-death codes alone varied from 22% in France to 93% in Massachusetts. Underreporting was greater in the regions with lower initial maternal mortality ratios. The distribution of causes of pregnancy-related mortality was specific to each region. The leading causes of death were cardiovascular conditions in Massachusetts; hemorrhage, pregnancy-induced hypertension, and peripartum cardiomyopathy in North Carolina; noncardiovascular medical conditions in Finland; and hemorrhage in France. CONCLUSION: This study shows the limitations of maternal mortality statistics based on International Classification of Diseases cause-of-death codes alone. Linkage of births and deaths registers should routinely be used in the ascertainment of pregnancy-related deaths. In addition, extension of the definition of a maternal death should be considered. Beyond pregnancy-related mortality ratios, considering the specific distribution of causes-of-death is important to define prevention strategies.

Adult↗
PubMed2002

Pregnancy-associated mortality at the end of the twentieth century: Massachusetts, 1990-1999.

OBJECTIVES: 1) to report Massachusetts pregnancy-associated mortality ratios (PAMRs) and maternal mortality ratios (MMRs) from 1990 to 1999 and pregnancy-related mortality ratios (PRMRs) from 1995 to 1999; 2) to identify disparities in PAMRs by race and Hispanic ethnicity, payer at delivery, age, and age by medical and injury cause of death; 3) to report distributions of pregnancy-associated deaths by cause, preventability, and timing in relation to pregnancy. METHODS: Pregnancy-associated deaths from 1990 to 1999 were identified using enhanced methods, including linkage of vital records. Preventability and pregnancy relatedness were determined by case review (1995-1999). Trends in ratios and aggregate PAMRs by key characteristics were calculated. RESULTS: The 10-year PAMR and MMR were 27.2 and 3.3 per 100,000 live births, respectively, with no significant changes from 1990 to 1999. The PRMR was 6.1 for 1995 to 1999. The leading cause of pregnancy-associated death was homicide. The PAMRs for black non-Hispanic and Hispanic women were 3.1 and 1.8 times higher than that for white non-Hispanic women. The PAMR was 3.2 times higher for women with public than with private payers and 3.4 times higher among women age 40 to 44 than among women age 25 to 39. The injury PAMR for women younger than 25 was 3 times higher than it was for women age 25 to 39. Injuries caused one-third of pregnancy-associated deaths. Fifty-four percent of deaths from 1995 to 1999 were deemed preventable. CONCLUSIONS: Pregnancy-associated deaths are rare, yet many are preventable. Public health prevention strategies should extend beyond the traditional postpartum period and address disparities for black non-Hispanic and Hispanic women, low-income women, older women for medical causes, and younger women for injury causes.

Adult↗
PubMedDate not supplied

Sexual assault patterns among women with and without disabilities seeking survivor services.

INTRODUCTION: The primary research questions were 1) how do sexual assault patterns differ for women with disabilities as compared with women without disabilities and 2) how do patterns differ among women with different disabilities? METHODS: Study data were derived from initial encounters of 16,672 women survivors of sexual assault who sought state-funded sexual assault survivor services in Massachusetts from 1987 through 1995. Bivariate analyses and fixed effects logistic regression models compared sexual assault patterns including survivor responses for women with and without disabilities and among women with 5 different single disabilities. RESULTS: More than 10% of survivors reported > or =1 disability. If a woman had a history of a previous assault or was > or =30 at time of assault, she was significantly more likely to report a disability as compared to the referents (no history of assault or <30). Among women with a single disability, a survivor who delayed seeking services > or =6 months was more likely to have a mental health disability. In contrast, a survivor who had a cognitive disability was more likely to report sooner than 6 months compared with a survivor with other single disabilities. CONCLUSIONS: Differences were found between disabled and nondisabled groups as well as among women with different single disabilities. Some findings, such as those suggesting differential access, may require disability group-specific interventions, whereas other variations can be addressed at the individual client level. State-funded sexual assault survivor service providers may use these findings to improve outreach and service provision strategies.

Adult↗