Medicine and Health Sciences Commons^™

Cost-Effectiveness Analysis Of Combined Cognitive And Vocational Rehabilitation In Patients With Mild-To-Moderate Tbi: Results From A Randomized Controlled Trial, Emilie Isager Howe, Nada Andelic, Silje C R Fure, Cecilie Røe, Helene L. Søberg, Torgeir Hellstrøm, Øystein Spjelkavik, Heidi Enehaug, Juan Lu, Helene Ugelstad, Marianne Løvstad, Eline Aas

Family Medicine and Population Health Publications

Background

Traumatic brain injury (TBI) represents a financial burden to the healthcare system, patients, their families and society. Rehabilitation interventions with the potential for reducing costs associated with TBI are demanded. This study evaluated the cost-effectiveness of a randomized, controlled, parallel group trial that compared the effectiveness of a combined cognitive and vocational intervention to treatment as usual (TAU) on vocational outcomes.

Methods

One-hundred sixteen participants with mild-to-moderate TBI were recruited from an outpatient clinic at Oslo University Hospital, Norway. They were randomized to a cognitive rehabilitation intervention (Compensatory Cognitive Training, CCT) and Supported Employment (SE) or TAU in a …

A “Behind-The-Scenes” Look At Interprofessional Care Coordination: How Person-Centered Care In Safety-Net Health System Complex Care Clinics Produce Better Outcomes, E. Marshall Brooks, Jodi M. Winship, Anton J. Kuzel

Family Medicine and Population Health Publications

Introduction: While the effectiveness of team-based care and wrap-around services for high utilizers is clear, how complex care clinics deliver effective, person-centered care to these vulnerable populations is not well understood. This paper describes how interactions among interprofessional team members enabled individualized, rapid responses to the complex needs of vulnerable patients at the Virginia Commonwealth University Health System’s Complex Care Clinic.

Methods: Researchers attended twenty weekly care coordination meetings, audio-recorded the proceedings, and wrote brief observational field notes. Researchers also qualitatively interviewed ten clinic team members. Emergent coding based on grounded theory and a consensus process were used to identify …

Association Between Breastfeeding Duration And Type Of Birth Attendant, Jordyn T. Wallenborn, Saba W. Masho

Family Medicine and Population Health Publications

Introduction. Healthcare providers play an integral role in breastfeeding education and subsequent practices; however, the education and support provided to patients may differ by type of provider. The current study aims to evaluate the association between type of birth attendant and breastfeeding duration. Methods. Data from the prospective longitudinal study, Infant Feeding Practices Survey II, was analyzed. Breastfeeding duration and exclusive breastfeeding duration were defined using the American Academy of Pediatrics’ national recommendations. Type of birth attendant was categorized into obstetricians, other physicians, and midwife or nurse midwife. If mothers received prenatal care from a different type of provider than …

Fostering Transformative Learning, Self-Reflexivity And Medical Citizenship Through Guided Tours Of Disadvantaged Neighborhoods, E. Marshall Brooks, Mary Lee Magee, Mark Ryan

Family Medicine and Population Health Publications

Background and objectives: Medical school curricula increasingly seek to promote medical students’ commitment to redressing health disparities, but traditional pedagogical approaches have fallen short of this goal. The objective of this work was to assess the value of using community-based guided tours of disadvantaged neighborhoods to fill this gap.

Methods: A total of 50 second-year medical students participated in a guided tour of disadvantaged public housing neighborhoods in Richmond, Virginia. Students completed self-reflexive writing exercises during a post-tour debriefing session. Student writings were analyzed to assess the tour’s effect on their awareness of poverty’s impact on vulnerable populations’ health …

Breastfeeding After Gestational Diabetes: Does Perceived Benefits Mediate The Relationship?, Jordyn T. Wallenborn, Robert A. Perera, Saba W. Masho

Family Medicine and Population Health Publications

Introduction. Breastfeeding is recognized as one of the best ways to decrease infant mortality and morbidity. However, women with gestational diabetes mellitus (GDM) may have breastfeeding barriers due to the increased risk of neonatal and pregnancy complications. While the prevalence of GDM is increasing worldwide, it is important to understand the full implications of GDM on breastfeeding outcomes.The current study aims to investigate the (1) direct effect of GDM on breastfeeding duration and (2) indirect effect of GDM on breastfeeding duration through perceived benefits of breastfeeding. Methods. Prospective cohort data from the Infant Feeding and Practices Study II was analyzed …

Do Successive Preterm Births Increase The Risk Of Postpartum Depressive Symptoms?, Timothy O. Ihongbe, Saba W. Masho

Family Medicine and Population Health Publications

Background. Postpartum depression and preterm birth (PTB) are major problems affecting women’s health. PTB has been associated with increased risk of postpartum depressive symptoms (PDS). However, it is unclear if PTB in women with a prior history of PTB is associated with an incremental risk of PDS. This study aims to determine if PTB in women with a prior history of PTB is associated with an incremental risk of PDS. Methods. Data come from the 2009–2011 national Pregnancy Risk Assessment Monitoring System. Study sample included 55,681 multiparous women with singleton live births in the index delivery. Multiple logistic regression was …

Leveraging Social Media To Promote Evidencebased Continuing Medical Education, Simone Flynn, Paul Hebert, Deborah Korenstein, Mark Ryan, William B. Jordan, Salomeh Keyhan

Family Medicine and Population Health Publications

Importance

New dissemination methods are needed to engage physicians in evidence-based continuing medical education (CME).

Objective

To examine the effectiveness of social media in engaging physicians in non-industry-sponsored CME.

Design

We tested the effect of different media platforms (e-mail, Facebook, paid Facebook and Twitter), CME topics, and different “hooks” (e.g., Q&A, clinical pearl and best evidence) on driving clicks to a landing site featuring non-industry sponsored CME. We modelled the effects of social media platform, CME topic, and hook using negative binomial regression on clicks to a single landing site. We used clicks to landing site adjusted for exposure and …

Antimicrobial Stewardship Practices In Virginia, Kimberly B. Lee, Jesus Aaron Ramirez, Rebeccah Collins, John Bucheit, Kakotan Sanogo, Michael P. Stevens

Family Medicine and Population Health Publications

The Society of Healthcare Epidemiology of America, the Centers for Disease Control and Prevention, and the President's Council of Advisors on Science and Technology recognize the need to combat antimicrobial resistance through the promotion of antimicrobial stewardship programs. Health care facilities in Virginia were surveyed using a 23-item survey focused on facility characteristics and antimicrobial stewardship strategies. Antimicrobial stewardship activities were highly variable and many are missing key personnel and resources.

Harnessing Information Technology To Inform Patients Facing Routine Decisions: Cancer Screening As A Test Case, Alex Krist, Steven H. Woolf, Camille Hochheimer, Roy T. Sabo, Paulette Kashiri, Resa M. Jones, Jennifer Elston Lafata, Rebecca S. Etz, Shin-Ping Tu

Family Medicine and Population Health Publications

PURPOSE Technology could transform routine decision making by anticipating patients’ information needs, assessing where patients are with decisions and preferences, personalizing educational experiences, facilitating patient-clinician information exchange, and supporting follow-up. This study evaluated whether patients and clinicians will use such a decision module and its impact on care, using 3 cancer screening decisions as test cases.

METHODS Twelve practices with 55,453 patients using a patient portal participated in this prospective observational cohort study. Participation was open to patients who might face a cancer screening decision: women aged 40 to 49 who had not had a mammogram in 2 years, men …

Coexisting Sickle Cell Anemia And Sarcoidosis: A Management Conundrum!, Fnu Nutan, Nagesh S. Gollahalli

Family Medicine and Population Health Publications

Sickle cell disease and Sarcoidosis are conditions that are more common in the African American population. In this report we share an unfortunate patient who had hepatic sarcoidosis but could not receive steroids since that precipitated acute liver failure. We have discussed potential therapy options but we need more options that improve mortality.

Interleukin-18 Mediates Cardiac Dysfunction Induced By Western Diet Independent Of Obesity And Hyperglycemia In The Mouse, S Carbone, P J H Lee, A G Mauro, E Mezzaroma, R Buzzetti, B Van Tassell, A Abbate, S Toldo

Family Medicine and Population Health Publications

Obesity and diabetes are independent risk factors for heart failure and are associated with the consumption of diet rich in saturated fat and sugar, Western diet (WD), known to induce cardiac dysfunction in the mouse through incompletely characterized inflammatory mechanisms. We hypothesized that the detrimental cardiac effects of WD are mediated by interleukin-18 (IL-18), proinflammatory cytokine linked to cardiac dysfunction. C57BL/6J wild-type male mice and IL-18 knockout male mice were fed highsaturated fat and high-sugar diet for 8 weeks. We measured food intake, body weight and fasting glycemia. We assessed left ventricular (LV) systolic and diastolic function by Doppler echocardiography …

Combined Cognitive And Vocational Interventions After Mild To Moderate Traumatic Brain Injury: Study Protocol For A Randomized Controlled Trial, Emilie I. Howe, Knut-Petter S. Langlo, Hans Christoffer Aargaard Terjesen, Cecilie Røe, Anne-Kristine Schanke, Helene L. Søberg, Unni Sveen, Eline Aas, Heidi Enehaug, Daniele E. Alves, Pål Klethagen, Kjersti Sagstad, Christine M. Moen, Karin Torsteinsbrend, Anne-Margrethe Linnestad, Tonje Haug Nordenmark, Birte Sand Rismyhr, Grete Wangen, Juan Lu, Jennie Ponsford, Elizabeth W. Twamley, Helene Ugelstad, Øystein Spjelkavik, Marianne Løvstad, Nada Andelic

Family Medicine and Population Health Publications

Background

A considerable proportion of patients with mild to moderate traumatic brain injury (TBI) experience long-lasting somatic, cognitive, and emotional symptoms that may hamper their capacity to return to work (RTW). Although several studies have described medical, psychological, and work-related factors that predict RTW after TBI, well-controlled intervention studies regarding RTW are scarce. Furthermore, there has traditionally been weak collaboration among health-related rehabilitation services, the labor and welfare sector, and workplaces.

Methods/design

This study protocol describes an innovative randomized controlled trial in which we will explore the effect of combining manualized cognitive rehabilitation (Compensatory Cognitive Training [CCT]) and supported employment …

Postpartum Visit Attendance Increases The Use Of Modern Contraceptives, Saba W. Masho, Susan Cha, Rashel Charles, Elizabeth Mcgee, Nicole Karjane, Linda Hines, Susan G. Kornstein

Family Medicine and Population Health Publications

Background. Delays in postpartum contraceptive use may increase risk for unintended or rapid repeat pregnancies. The postpartum care visit (PPCV) is a good opportunity for women to discuss family planning options with their health care providers. This study examined the association between PPCV attendance and modern contraceptive use using data from a managed care organization. Methods. Claims and demographic and administrative data came from a nonprofit managed care organization in Virginia (2008–2012). Information on the most recent delivery for mothers with singleton births was analyzed (N = 24,619). Routine PPCV (yes, no) and modern contraceptive use were both dichotomized. Descriptive …

Loneliness, Depression, And Inflammation: Evidence From The Multi-Ethnic Study Of Atherosclerosis, Briana Mezuk, Moon Choi, Amy S. Desantis, Stephen R. Rapp, Ana V. Diez Roux, Teresa Seeman

Family Medicine and Population Health Publications

Objective

Both objective and subjective aspects of social isolation have been associated with alterations in immune markers relevant to multiple chronic diseases among older adults. However, these associations may be confounded by health status, and it is unclear whether these social factors are associated with immune functioning among relatively healthy adults. The goal of this study was to examine the associations between perceived loneliness and circulating levels of inflammatory markers among a diverse sample of adults.

Methods

Data come from a subset of the Multi-Ethnic Study of Atherosclerosis (n = 441). Loneliness was measured by three items derived from the …

Association Between High School Students’ Cigarette Smoking, Asthma And Related Beliefs: A Population-Based Study, Resa M. Jones, Kara P. Wiseman, Marina Kharitonova

Family Medicine and Population Health Publications

Background

Smoking has a detrimental effect on the symptoms and severity of asthma, a common chronic disease among adolescents. The purpose of this study was to examine the association between asthma and smoking among high school students and assess provider-patient communication with asthmatic adolescents regarding smoking and adolescents’ beliefs about the harms of smoking.

Methods

In fall 2014, data from high school students, ages 14–18 years, completing the 2009-2010 Virginia Youth Tobacco Survey (N = 1796) were used in descriptive analyses and multivariable logistic regression models adjusting for model-specific confounders as appropriate.

Results

Overall, an estimated 19 % of …

Sex And Gender In Medical Education, And Proceedings From The 2015 Sex And Gender Education Summit, Eliza L. Chin, Marley Hoggatt, Alyson J. Mcgregor, Mary K. Rojek, Kimberly Templeton, Robert Casanova, Wendy S. Klein, Virginia M. Miller, Marjorie Jenkins

Family Medicine and Population Health Publications

The Sex and Gender Medical Education Summit: a roadmap for curricular innovation was a collaborative initiative of the American Medical Women's Association, Laura W. Bush Institute for Women’s Health, Mayo Clinic, and Society for Women's Health Research (www.sgbmeducationsummit.com). It was held on October 18–19, 2015 to provide a unique venue for collaboration among nationally and internationally renowned experts in developing a roadmap for the incorporation of sex and gender based concepts into medical education curricula. The Summit engaged 148 in-person attendees for the 1 1/2-day program. Pre- and post-Summit surveys assessed the impact of the Summit, and workshop discussions provided …

Pre-Pregnancy Obesity And Non-Adherence To Multivitamin Use: Findings From The National Pregnancy Risk Assessment Monitoring System (2009–2011), Saba W. Masho, Amani Bassyouni, Susan Cha

Family Medicine and Population Health Publications

Background

Although adequate folic acid or multivitamins can prevent up to 70 % of neural tube defects, the majority of U.S. non-pregnant women of childbearing age do not use multivitamins every day. Factors influencing consistent multivitamin use are not fully explored. This study aims to investigate the association between pre-pregnancy body mass index (BMI) and multivitamin use before pregnancy using a large, nationally representative sample of women with recent live births.

Methods

The national 2009–2011 Pregnancy Risk Assessment Monitoring System data were analyzed. The sample included women with recent singleton live births (N = 104,211). The outcome of interest …

Culture-Centered Approaches: The Relevance Of Assessing Emotional Health For Latinos With Type 2 Diabetes, Jeannie Belinda Concha, Brianna Mezuk, Bonnie Duran

Family Medicine and Population Health Publications

Objective

Within Latino culture, there is a belief that strong emotions can cause diabetes. Because of this belief and evidence regarding the bi-directional relationship between depression and diabetes, the objectives of this study were to determine if medical doctors are asking Latinos with diabetes about emotional problems and to assess attitudes toward professional help for emotional problems.

Research design and methods

Data come from the nationally representative National Latino and Asian American Study and the National Comorbidity Survey Replication study. Only Latino subsamples were included (n=3076). A smaller subsample with complete data (n=2568) was used for the inquiry outcome variable. …

Psychosocial Factors Of Caregiver Burden In Child Caregivers: Results From The New National Study Of Caregiving, Steven A. Cohen, Sarah Cook, Lauren Kelley, Trisha Sando, Allison E. Bell

Family Medicine and Population Health Publications

Background

Over 50 million informal caregivers in the United States provide care to an aging adult, saving the economy hundreds of billions of dollars annually from costly hospitalization or institutionalization. Despite the benefits associated with caregiving, caregiver stress can lead to negative physical and mental health consequences, or “caregiver burden”. Given these potential negative consequences of caregiver burden, it is important not only to understand the multidimensional components of burden but to also understand the experience from the perspective of the caregiver themselves. Therefore, the objectives of our study are to use exploratory factor analysis to obtain a set of …

Source Of Care And Variation In Long Acting Reversible Contraception Use, Lauren Groskaufmanis, Saba W. Masho

Family Medicine and Population Health Publications

OBJECTIVE: To examine variation in long acting reversible contraception (LARC) use by source of birth control services.

DESIGN: Cross-sectional study.

SETTING: Not applicable.

PATIENT(S): Sexually active women who received contraceptive services in the past 12 months, who were neither pregnant nor trying to become pregnant and who were not sterilized and nor were their partners sterilized.

INTERVENTION(S): Three multinomial logistic regression models assessed the relationship between source of services and LARC use, controlling for covariates. The odds of LARC use were compared with LARC nonuse, high-efficacy use, and low-efficacy use.

MAIN OUTCOME MEASURE(S): Reported …

Spatiotemporal Discordance In Five Common Measures Of Rurality For Us Counties And Applications For Health Disparities Research In Older Adults, Steven A. Cohen, Lauren Kelley, Alison E. Bell

Family Medicine and Population Health Publications

Introduction

Rural populations face numerous barriers to health, including poorer health care infrastructure, access to care, and other sociodemographic factors largely associated with rurality. Multiple measures of rurality used in the biomedical and public health literature can help assess rural–urban health disparities and may impact the observed associations between rurality and health. Furthermore, understanding what makes a place truly “rural” versus “urban” may vary from region to region in the US.

Purpose

The objectives of this study are to compare and contrast five common measures of rurality and determine how well-correlated these measures are at the national, regional, and divisional …

Supporting Practices To Adopt Registry-Based Care (Sparc): Protocol For A Randomized Controlled Trial, Rebecca S. Etz, Rosalind E. Keith, Anna M. Maternick, Karen L. Stein, Roy T. Sabo, Melissa S. Hayes, Purvi Sevak, John Holland, Jesse C. Crosson

Family Medicine and Population Health Publications

Background

Diabetes is predicted to increase in incidence by 42% from 1995 to 2025. Although most adults with diabetes seek care from primary care practices, adherence to treatment guidelines in these settings is not optimal. Many practices lack the infrastructure to monitor patient adherence to recommended treatment and are slow to implement changes critical for effective management of patients with chronic conditions. Supporting Practices to Adopt Registry-Based Care (SPARC) will evaluate effectiveness and sustainability of a low-cost intervention designed to support work process change in primary care practices and enhance focus on population-based care through implementation of a diabetes registry. …

Sex And Sexual Orientation Disparities In Adverse Childhood Experiences And Early Age At Sexual Debut In The United States: Results From A Nationally Representative Sample, Monique J. Brown, Saba W. Masho, Robert A. Perera, Briana Mezuk, Steven A. Cohen

Family Medicine and Population Health Publications

Adverse childhood experiences (ACEs) have been linked to early sexual debut, which has been found to be associated with multiple adverse health outcomes. Sexual minorities and men tend to have earlier sexual debut compared to heterosexual populations and women, respectively. However, studies examining the association between ACEs and early sexual debut among men and sexual minorities are lacking. The aim of this study was to examine the sex and sexual orientation disparities in the association between ACEs and age at sexual debut. Data were obtained from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions. Logistic and …

Suicide Risk In Nursing Homes And Assisted Living Facilities: 2003–2011, Brianna Mezuk, Matthew Lohman, Marc Leslie, Virginia Powell

Family Medicine and Population Health Publications

Objectives

We investigated the epidemiology of suicide among adults aged 50 years and older in nursing homes and assisted living facilities and whether anticipating transitioning into long-term care (LTC) is a risk factor for suicide.

Methods

Data come from the Virginia Violent Death Reporting System (2003–2011). We matched locations of suicides (n = 3453) against publicly available resource registries of nursing homes (n = 285) and assisted living facilities (n = 548). We examined individual and organizational correlates of suicide by logistic regression. We identified decedents anticipating entry into LTC through qualitative text analysis.

Results

Incidence of suicide was 14.16 …

Using Surveillance Data To Inform Community Action: The Effect Of Alcohol Sale Restrictions On Intentional Injury-Related Ambulance Pickups, Saba W. Masho, Diane L. Bishop, Torey Edmonds, Albert D. Farrell

Family Medicine and Population Health Publications

Youth violence disproportionately affects inner city, urban minority communities in the USA. This article illustrates the use of surveillance data to inform and evaluate community action directed at this serious problem. Community efforts in response to surveillance data indicating high rates of violence surrounding convenience stores with unrestricted alcohol beverage licenses provided a natural experiment to examine the impact of imposing licensing restrictions on intentional injury rates. Rates of ambulance pickups for intentional injuries in the 15- to 24-year-old population in five census tracts where alcoholic beverage sales were restricted were compared to five census tracts with similar demographic characteristics …

Electronic Health Record Functionality Needed To Better Support Primary Care, Alex H. Krist, John W . Beasley, Jesse C. Crosson, David C. Kibbe, Michael S. Klinkman, Christoph U. Lehmann, Chester H. Fox, Jason M. Mitchell, James W. Mold, Wilson D. Pace, Kevin A. Peterson, Robert L. Phillips, Robert Post, Jon Puro, Michael Raddock, Ray Simkus, Steven E. Waldren

Family Medicine and Population Health Publications

Electronic health records (EHRs) must support primary care clinicians and patients, yet many clinicians remain dissatisfied with their system. This manuscript presents a consensus statement about gaps in current EHR functionality and needed enhancements to support primary care. The Institute of Medicine primary care attributes were used to define needs and Meaningful Use (MU) objectives to define EHR functionality. Current objectives remain disease- rather than whole-person focused, ignoring factors like personal risks, behaviors, family structure, and occupational and environmental influences. Primary care needs EHRs to move beyond documentation to interpreting and tracking information over time as well as patient partnering …

Physical Activity And Sedentary Behavior Of Cancer Survivors And Non-Cancer Individuals: Results From A National Survey, Roy B. Kim, Allison Phillips, Kirsten Herrick, Marieka Helou, Carlin Rafie, Mitchell S. Anscher, Ross B. Mikkelsen, Yi Ning

Family Medicine and Population Health Publications

Increasing physical activity and decreasing sedentary behavior are associated with a higher quality of life and lower mortality rates for cancer survivors, a growing population group. Studies detailing the behavior of cancer survivors are limited. Therefore, we investigated physical activity and sedentary behavior of cancer survivors using data from the National Health and Nutrition Examination Survey (NHANES) 2007–2010. Participants were those who provided physical activity and sedentary behavior data. Those who were pregnant,old, or10,472 non-cancer participants. After adjustment for age, race, gender, education status, body mass index, and smoking status, cancer survivors (n = 10,472) reported significantly longer duration of …

Cam Use Among Overweight And Obese Persons With Radiographic Knee Osteoarthritis, Kate L. Lapane, Shibing Yang, Rachel Jawahar, Timothy Mcalindon, Charles B. Eaton

Family Medicine and Population Health Publications

Background

Obesity is associated with knee pain and is an independent predictor of incident knee osteoarthritis (OA); increased pain with movement often leads patients to adopt sedentary lifestyles to avoid pain. Detailed descriptions of pain management strategies by body mass index (BMI) level among OA patients are lacking. The objectives were to describe complementary and alternative medicine (CAM) and conventional medication use by BMI level and identify correlates of CAM use by BMI level.

Methods

Using Osteoarthritis Initiative baseline data, 2,675 patients with radiographic tibiofemoral OA in at least one knee were identified. Use of CAM therapies and conventional medications …

Association Between Adverse Childhood Experiences And Diagnosis Of Cancer, Monique J. Brown, Leroy R. Thacker, Steven A. Cohen

Family Medicine and Population Health Publications

Objective

Adverse childhood experiences (ACEs) are linked to multiple adverse health outcomes. This study examined the association between ACEs and cancer diagnosis.

Methods

Data from the 2010 Behavioral Risk Factor Surveillance System (BRFSS) survey were used. The BRFSS is the largest ongoing telephone health survey, conducted in all US states, the District of Columbia, Puerto Rico, Guam and the U.S. Virgin Islands, and provides data on a variety of health issues among the non-institutionalized adult population. Principal component analysis (PCA) was used to derive components for ACEs. Multivariable logistic regression models were used to provide adjusted odds ratios (OR) and …

Pre-Pregnancy Bmi And Weight Gain: Where Is The Tipping Point For Preterm Birth?, Saba W. Masho, Diane Bishop, Meaghan Munn

Family Medicine and Population Health Publications

Background

Obesity in pregnant women is a major problem affecting both the mother and her offspring. Literature on the effect of obesity on preterm birth is inconsistent and few studies have investigated the influence of weight gain during pregnancy. This study examined the effect of maternal pre-pregnancy BMI and weight gain during pregnancy on preterm birth.

Methods

Data from the Collaborative Perinatal Project (CPP) on 45,824 pregnant women with singleton, live-born infants with no severe congenital anomalies was analyzed. Primary outcome variables included preterm (< 37 weeks of gestation), categorized into spontaneous preterm with and without premature rupture of membrane (PROM) and indicated preterm. Maternal BMI was categorized into underweight (BMI < 18.50), normal weight (BMI =1 8.50 – 24.99), overweight (BMI = 25.00 – 29.99), and obese (BMI ≥ 30.00). Multinomial regression analysis was conducted and OR and 95% CI were calculated.

Results

The rate of spontaneous preterm birth with PROM among overweight women decreased with increasing …