Anny-Claude Joseph - Academia.edu (original) (raw)

Papers by Anny-Claude Joseph

Research paper thumbnail of Computational Skills for Multivariable Thinking in Introductory Statistics

Journal of Statistics and Data Science Education, 2021

ABSTRACT Since the publishing of Nolan and Temple Lang’s “Computing in the Statistics Curriculum”... more ABSTRACT Since the publishing of Nolan and Temple Lang’s “Computing in the Statistics Curriculum” in 2010, the American Statistical Association issued new recommendations in the revised GAISE college report. To reflect modern practice and technologies, they emphasize giving students experience with multivariable thinking. Students develop multivariable thinking when they analyze real data in the context of investigating research questions of interest, which typically involve complex relationships between many variables. Proficiency in a statistical programming language facilitates the development of multivariable thinking by giving students tools to investigate complex data on their own. However, learning a programming language in an introductory course is difficult for many students. In this article, we recommend a set of computational skills for introductory courses, demonstrate them using R tidyverse, and describe a classroom activity to develop computational skills and multivariable thinking. We provide a tidyverse tutorial for introductory students, our course guide, and classroom activities. Supplementary materials for this article are available online at https://github.com/bryaneadams/Computational-Skills-for-Multivariable-Thinking-in-Introductory-Statistics.

Research paper thumbnail of 767: Evaluation of Intravenous Vancomycin Pharmacokinetic Parameters in Patients with Acute Brain Injury

Critical Care Medicine, 2016

U konstruktivističkoj psihologiji, fenomen pojmovne promene se istražuje i tumači u okviru dve gl... more U konstruktivističkoj psihologiji, fenomen pojmovne promene se istražuje i tumači u okviru dve glavne i uzajamno suprotstavljene teorijske perspektive-stanovište "znanje-kao-teorija" (Vosniadou, Chi), i stanovište "znanje-kao-element" (diSessa). U radu se razmatraju sličnosti i razlike između dva stanovišta u pogledu njihovih osnovnih teorijskih ideja i empirijskih podataka na kojima su zasnovani. Zajednička polazna osnova za obe koncepcije pojmovne promene jeste ideja prethodnog, naivnog znanja i konstruktivističko shvatanje procesa učenja. Ključno pitanje na kome se dva dominantna stanovišta razilaze jeste pitanje prirode i organizacije naivnog znanja-da li je prethodno znanje učenika organizovano kao jedinstven i koherentan sistem nalik teoriji, ili kao skup uzajamno nezavisnih elemenata znanja. U radu se, u završnoj diskusiji, razmatraju pedagoške implikacije dva stanovišta kao i različita moguća rešenja teorijskog konflikta između njih. U ovom pogledu se iznosi mišljenje da niti jedna teorija u ovom trenutku ne daje potpun odgovor na pitanje mehanizma pojmovne promene.

Research paper thumbnail of The timing of geographic power

Statistics in Medicine, 2020

In many studies on the spatial risk of disease, investigators use geographic locations at the tim... more In many studies on the spatial risk of disease, investigators use geographic locations at the time of disease diagnosis in spatial models to search for individual areas of elevated risk. However, these studies often fail to find a significant spatial signal. This may be due to the misspecification of the timing and location of pertinent exposures. Environmental exposures related to cancer risk vary over space and time, and many cancers have long latencies. When these factors are considered in conjunction with a mobile population, it is likely that the spatial signal related to relevant historic environmental exposures is obscured. To investigate this hypothesis, we conducted simulation studies to characterize the effect of residential mobility on the ability of generalized additive models to detect areas of significantly elevated historic environmental exposure. We generated data based on the residential histories of participants in the National Cancer Institute Surveillance, Epidemiology, and End Results non‐Hodgkin lymphoma study, and varied the duration and intensity of the environmental exposure. Results showed that the probability of detection, mean spatial sensitivity, and mean spatial specificity of models decreased steadily as the time since relevant exposure increased. This suggests that for diseases with long latencies, spatial areas of high risk due to high‐intensity exposure of relatively short duration will be difficult to detect over time when using residential locations at the time of diagnosis in mobile study populations.

Research paper thumbnail of The impact of population mobility on estimates of environmental exposure effects in a case‐control study

Statistics in Medicine, 2020

Research paper thumbnail of 410: A vital statistics study of birth weight centile and fetal death risk

American Journal of Obstetrics and Gynecology, 2020

RESULTS: 391 samples met quality standards e 121 with and 270 without CL shortening. 230 distinct... more RESULTS: 391 samples met quality standards e 121 with and 270 without CL shortening. 230 distinct operational taxonomic units at the species level were identified. There was no significant difference in alpha (using three distinct analysis measures) or beta diversity (p ¼ 0.07) between the two groups (Figure 1). While no communitylevel differences were observed, 29 taxa were significantly associated with CL shortening after covariate adjustment (Top 10 in Table). CONCLUSION: While multiple taxa-level differences were found in the CV microbiome of high-risk women who go on to have midtrimester CL shortening (versus not), community-level differences were not observed. Further studies should evaluate if CV microbial changes occur between initial CL evaluation and time of CL shortening and if the identified taxa are associated with a localized inflammatory response.

Research paper thumbnail of 149: Characteristics associated with Attempt of External Cephalic Version in the U.S. Birth Certificate Data

American Journal of Obstetrics and Gynecology, 2019

OBJECTIVE: Malpresentation is the indication for 10-15% of cesarean deliveries (CD). External cep... more OBJECTIVE: Malpresentation is the indication for 10-15% of cesarean deliveries (CD). External cephalic version (ECV) is a safe and effective procedure to reduce CD. We could not identify prior studies that investigated characteristics associated with attempt of ECV. Our objective is to detect associations between patient characteristics and ECV attempt to identify populations that may experience barriers to ECV. STUDY DESIGN: Data was obtained from the National Center for Health Statistics birth certificate data from 2014-2016. We analyzed singleton, live, non-anomalous births to women with 1 prior CD delivered at 36-42 weeks. We reasoned that subjects who either had ECV attempt (whether successful or unsuccessful) or were non-cephalic at the time of delivery constituted an ECV eligible cohort. Subjects with incomplete data on ECV, mode of delivery, or presentation at time of delivery were excluded. We examined the association between patient characteristics and ECV attempt using logistic regression to obtain odds ratios and 95% confidence intervals.

Research paper thumbnail of Prepregnancy Depression and Breastfeeding Duration: A Look at Maternal Age

Journal of Pregnancy, 2018

Background. In the United States, major depressive disorder affects one in five women aged 20-40 ... more Background. In the United States, major depressive disorder affects one in five women aged 20-40 years. During these childbearing years, depression can negatively impact maternal behaviors that are crucial for infant growth and development. This study examined the relationship between prepregnancy depression and breastfeeding duration by maternal age. Methods. Data from Phase 7 (2012-2013) of the Pregnancy Risk Assessment Monitoring System (N=62,483) were analyzed. Prepregnancy depression was dichotomized while breastfeeding duration was categorized as never breastfed, breastfed 8 weeks or less, and breastfed more than 8 weeks. Maternal age was a significant effect modifier; therefore, results were stratified by maternal age. Multinomial logistic regression was used to obtain odds ratios and 95% confidence intervals (CI). Results. For women aged 20-24, 25-29, and 30-34 years with prepregnancy depression, the odds of never breastfeeding and breastfeeding 8 weeks or less were signific...

Research paper thumbnail of Evaluation of Intravenous Vancomycin Pharmacokinetic Parameters in Patients With Acute Brain Injury

Journal of pharmacy practice, 2017

Vancomycin is a glycopeptide antibiotic that is primarily cleared by renal elimination. Patients ... more Vancomycin is a glycopeptide antibiotic that is primarily cleared by renal elimination. Patients with acute brain injury often exhibit augmented renal clearance which has been associated with subtherapeutic vancomycin concentrations. To determine whether population pharmacokinetics accurately predict vancomycin empiric dose frequency in patients with acute brain injury. This was a single-center, retrospective cohort study conducted following institutional review board approval at Virginia Commonwealth University Health System. Data were collected from patients 18 years of age or older admitted with acute brain injury. The primary outcome was the difference in the elimination rate constant of vancomycin between population predicted pharmacokinetics and patient-specific pharmacokinetics. A total of 158 patients were included in the analysis. A test of the paired differences between the mean population predicted and patient-specific elimination rate constants showed that the mean popul...

Research paper thumbnail of Shared risk modeling of non-Hodgkin lymphoma subtypes and UVR exposure

Introduction: Few studies have examined the association between ultraviolet radiation (UVR) expos... more Introduction: Few studies have examined the association between ultraviolet radiation (UVR) exposure and non-Hodgkin lymphoma (NHL) among NHL subtypes. In addition, no previous study has modeled th...

Research paper thumbnail of Assessing the Impact of Incorporating Residential Histories into the Spatial Analysis of Cancer Risk

I am the product of love and support, and I would like to extend my deepest gratitude to those wh... more I am the product of love and support, and I would like to extend my deepest gratitude to those who made this graduate school experience possible and productive. First, I would like to thank the Department of Biostatistics for their support during my stint as a student. A very special thank you to my dissertation advisor, Dr. Wheeler for his patience, direction, and commitment in getting me through this process. Thanks to my committee members: Drs. Fuemmeler, Green, McClish, and Sabo for their time and feedback. I would especially like to thank Dr. Sabo for his mentorship over the years, and for providing me with opportunities to learn and grow especially in teaching. I am very grateful for the open door policy of the professors in the department, and I would like to thank those who were always willing to help. Thank you to my department 'parents' Russ and Yvonne for being wonderful resources and just great listeners. I would also like to send special thank yous to Helen and Brian Bush for their extreme patience dealing with my myriad, often bizarre, technical issues over the years. Sincere gratitude to my friends Elizabeth, Jordyn, Sylvia, Tamala, and Whitney in the Epidemiology Department where I served as a research assistant for the last three years. I learned so much from each member of the team, and I was especially blessed to count our leader Dr. Saba Masho as a mentor and a friend while she was with us. I would also like to thank my friends Suemoy,

Research paper thumbnail of Cross-sectional analysis to explore the awareness, attitudes and actions of UK adults at high risk of severe illness from COVID-19

BMJ Open, 2020

Objectives This study explored the impact of COVID-19 on people identified as at high risk of sev... more Objectives This study explored the impact of COVID-19 on people identified as at high risk of severe illness by UK government, and in particular, the impact of lockdown on access to healthcare, medications and use of technological platforms. Design Online survey methodology. Setting UK. Participants 1038 UK adults were recruited who were either identified by UK government as at high risk of severe illness from COVID-19 or self-identified as at high risk with acute or other chronic health conditions not included in the UK government list. Participants were recruited through social media advertisements, health charities and patient organisations. Main outcomes measures The awareness, attitudes and actions survey which explores the impact of COVID-19, on including access to healthcare, use of technology for health condition management, mental health, depression, well-being and lifestyle behaviours. Results Nearly half of the sample (44.5%) reported that their mental health had worsened...

Research paper thumbnail of An investigation of the fundamental group and its use in classifying topological spaces

Research paper thumbnail of Prenatal Depression Severity and Postpartum Care Utilization in a Medicaid Population

Women's Health Reports

Background: Postpartum visits are a necessary continuum of medical care for women who are diagnos... more Background: Postpartum visits are a necessary continuum of medical care for women who are diagnosed with depression during pregnancy. However, postpartum care utilization is typically lower in populations who face adverse events and it is unclear to what extent having depression during pregnancy may compromise postpartum visit follow-up. Our study examined the association between severity of prenatal depression and postpartum care utilization among women on Medicaid. Materials and Methods: Data from a university-based, nonprofit managed care organization (2008-2012) were analyzed (N = 846). Prenatal depression severity and postpartum care utilization were determined using the International Classification of Diseases, Ninth Revision (ICD-9) codes, from medical claims records. Bivariate and multivariable logistic regression was conducted. Odds ratios and 95% confidence intervals (CIs) were calculated. Results: The majority (64.2%) of women received a mild/moderate prenatal depression diagnosis and 52.5% of the total sample attended their postpartum care visit. After adjusting for confounders, we found decreased odds of postpartum care utilization among women with less severe diagnoses. Women with a mild/moderate prenatal depression diagnosis were 12% less likely to attend the postpartum care visit compared with women with a severe prenatal depression diagnosis (adjusted odds ratio = 0.88, 95% CI = 0.65-1.19). However, this finding was not statistically significant. Conclusions: Our study did not yield evidence of a statistically significant relationship between prenatal depression severity and postpartum visit attendance among a sample of Medicaid beneficiaries. Additional research is needed to assess the association between prenatal depression severity and postpartum care use to enhance continuity of services for Medicaid-insured women into the postpartum period.

Research paper thumbnail of Prenatal Depression Severity and Postpartum Care Utilization in a Medicaid Population

Women's Health Reports

Background: Postpartum visits are a necessary continuum of medical care for women who are diagnos... more Background: Postpartum visits are a necessary continuum of medical care for women who are diagnosed with depression during pregnancy. However, postpartum care utilization is typically lower in populations who face adverse events and it is unclear to what extent having depression during pregnancy may compromise postpartum visit follow-up. Our study examined the association between severity of prenatal depression and postpartum care utilization among women on Medicaid. Materials and Methods: Data from a university-based, nonprofit managed care organization (2008-2012) were analyzed (N = 846). Prenatal depression severity and postpartum care utilization were determined using the International Classification of Diseases, Ninth Revision (ICD-9) codes, from medical claims records. Bivariate and multivariable logistic regression was conducted. Odds ratios and 95% confidence intervals (CIs) were calculated. Results: The majority (64.2%) of women received a mild/moderate prenatal depression diagnosis and 52.5% of the total sample attended their postpartum care visit. After adjusting for confounders, we found decreased odds of postpartum care utilization among women with less severe diagnoses. Women with a mild/moderate prenatal depression diagnosis were 12% less likely to attend the postpartum care visit compared with women with a severe prenatal depression diagnosis (adjusted odds ratio = 0.88, 95% CI = 0.65-1.19). However, this finding was not statistically significant. Conclusions: Our study did not yield evidence of a statistically significant relationship between prenatal depression severity and postpartum visit attendance among a sample of Medicaid beneficiaries. Additional research is needed to assess the association between prenatal depression severity and postpartum care use to enhance continuity of services for Medicaid-insured women into the postpartum period.

Research paper thumbnail of Computational Skills for Multivariable Thinking in Introductory Statistics

Journal of Statistics and Data Science Education, 2021

ABSTRACT Since the publishing of Nolan and Temple Lang’s “Computing in the Statistics Curriculum”... more ABSTRACT Since the publishing of Nolan and Temple Lang’s “Computing in the Statistics Curriculum” in 2010, the American Statistical Association issued new recommendations in the revised GAISE college report. To reflect modern practice and technologies, they emphasize giving students experience with multivariable thinking. Students develop multivariable thinking when they analyze real data in the context of investigating research questions of interest, which typically involve complex relationships between many variables. Proficiency in a statistical programming language facilitates the development of multivariable thinking by giving students tools to investigate complex data on their own. However, learning a programming language in an introductory course is difficult for many students. In this article, we recommend a set of computational skills for introductory courses, demonstrate them using R tidyverse, and describe a classroom activity to develop computational skills and multivariable thinking. We provide a tidyverse tutorial for introductory students, our course guide, and classroom activities. Supplementary materials for this article are available online at https://github.com/bryaneadams/Computational-Skills-for-Multivariable-Thinking-in-Introductory-Statistics.

Research paper thumbnail of 767: Evaluation of Intravenous Vancomycin Pharmacokinetic Parameters in Patients with Acute Brain Injury

Critical Care Medicine, 2016

U konstruktivističkoj psihologiji, fenomen pojmovne promene se istražuje i tumači u okviru dve gl... more U konstruktivističkoj psihologiji, fenomen pojmovne promene se istražuje i tumači u okviru dve glavne i uzajamno suprotstavljene teorijske perspektive-stanovište "znanje-kao-teorija" (Vosniadou, Chi), i stanovište "znanje-kao-element" (diSessa). U radu se razmatraju sličnosti i razlike između dva stanovišta u pogledu njihovih osnovnih teorijskih ideja i empirijskih podataka na kojima su zasnovani. Zajednička polazna osnova za obe koncepcije pojmovne promene jeste ideja prethodnog, naivnog znanja i konstruktivističko shvatanje procesa učenja. Ključno pitanje na kome se dva dominantna stanovišta razilaze jeste pitanje prirode i organizacije naivnog znanja-da li je prethodno znanje učenika organizovano kao jedinstven i koherentan sistem nalik teoriji, ili kao skup uzajamno nezavisnih elemenata znanja. U radu se, u završnoj diskusiji, razmatraju pedagoške implikacije dva stanovišta kao i različita moguća rešenja teorijskog konflikta između njih. U ovom pogledu se iznosi mišljenje da niti jedna teorija u ovom trenutku ne daje potpun odgovor na pitanje mehanizma pojmovne promene.

Research paper thumbnail of The timing of geographic power

Statistics in Medicine, 2020

In many studies on the spatial risk of disease, investigators use geographic locations at the tim... more In many studies on the spatial risk of disease, investigators use geographic locations at the time of disease diagnosis in spatial models to search for individual areas of elevated risk. However, these studies often fail to find a significant spatial signal. This may be due to the misspecification of the timing and location of pertinent exposures. Environmental exposures related to cancer risk vary over space and time, and many cancers have long latencies. When these factors are considered in conjunction with a mobile population, it is likely that the spatial signal related to relevant historic environmental exposures is obscured. To investigate this hypothesis, we conducted simulation studies to characterize the effect of residential mobility on the ability of generalized additive models to detect areas of significantly elevated historic environmental exposure. We generated data based on the residential histories of participants in the National Cancer Institute Surveillance, Epidemiology, and End Results non‐Hodgkin lymphoma study, and varied the duration and intensity of the environmental exposure. Results showed that the probability of detection, mean spatial sensitivity, and mean spatial specificity of models decreased steadily as the time since relevant exposure increased. This suggests that for diseases with long latencies, spatial areas of high risk due to high‐intensity exposure of relatively short duration will be difficult to detect over time when using residential locations at the time of diagnosis in mobile study populations.

Research paper thumbnail of The impact of population mobility on estimates of environmental exposure effects in a case‐control study

Statistics in Medicine, 2020

Research paper thumbnail of 410: A vital statistics study of birth weight centile and fetal death risk

American Journal of Obstetrics and Gynecology, 2020

RESULTS: 391 samples met quality standards e 121 with and 270 without CL shortening. 230 distinct... more RESULTS: 391 samples met quality standards e 121 with and 270 without CL shortening. 230 distinct operational taxonomic units at the species level were identified. There was no significant difference in alpha (using three distinct analysis measures) or beta diversity (p ¼ 0.07) between the two groups (Figure 1). While no communitylevel differences were observed, 29 taxa were significantly associated with CL shortening after covariate adjustment (Top 10 in Table). CONCLUSION: While multiple taxa-level differences were found in the CV microbiome of high-risk women who go on to have midtrimester CL shortening (versus not), community-level differences were not observed. Further studies should evaluate if CV microbial changes occur between initial CL evaluation and time of CL shortening and if the identified taxa are associated with a localized inflammatory response.

Research paper thumbnail of 149: Characteristics associated with Attempt of External Cephalic Version in the U.S. Birth Certificate Data

American Journal of Obstetrics and Gynecology, 2019

OBJECTIVE: Malpresentation is the indication for 10-15% of cesarean deliveries (CD). External cep... more OBJECTIVE: Malpresentation is the indication for 10-15% of cesarean deliveries (CD). External cephalic version (ECV) is a safe and effective procedure to reduce CD. We could not identify prior studies that investigated characteristics associated with attempt of ECV. Our objective is to detect associations between patient characteristics and ECV attempt to identify populations that may experience barriers to ECV. STUDY DESIGN: Data was obtained from the National Center for Health Statistics birth certificate data from 2014-2016. We analyzed singleton, live, non-anomalous births to women with 1 prior CD delivered at 36-42 weeks. We reasoned that subjects who either had ECV attempt (whether successful or unsuccessful) or were non-cephalic at the time of delivery constituted an ECV eligible cohort. Subjects with incomplete data on ECV, mode of delivery, or presentation at time of delivery were excluded. We examined the association between patient characteristics and ECV attempt using logistic regression to obtain odds ratios and 95% confidence intervals.

Research paper thumbnail of Prepregnancy Depression and Breastfeeding Duration: A Look at Maternal Age

Journal of Pregnancy, 2018

Background. In the United States, major depressive disorder affects one in five women aged 20-40 ... more Background. In the United States, major depressive disorder affects one in five women aged 20-40 years. During these childbearing years, depression can negatively impact maternal behaviors that are crucial for infant growth and development. This study examined the relationship between prepregnancy depression and breastfeeding duration by maternal age. Methods. Data from Phase 7 (2012-2013) of the Pregnancy Risk Assessment Monitoring System (N=62,483) were analyzed. Prepregnancy depression was dichotomized while breastfeeding duration was categorized as never breastfed, breastfed 8 weeks or less, and breastfed more than 8 weeks. Maternal age was a significant effect modifier; therefore, results were stratified by maternal age. Multinomial logistic regression was used to obtain odds ratios and 95% confidence intervals (CI). Results. For women aged 20-24, 25-29, and 30-34 years with prepregnancy depression, the odds of never breastfeeding and breastfeeding 8 weeks or less were signific...

Research paper thumbnail of Evaluation of Intravenous Vancomycin Pharmacokinetic Parameters in Patients With Acute Brain Injury

Journal of pharmacy practice, 2017

Vancomycin is a glycopeptide antibiotic that is primarily cleared by renal elimination. Patients ... more Vancomycin is a glycopeptide antibiotic that is primarily cleared by renal elimination. Patients with acute brain injury often exhibit augmented renal clearance which has been associated with subtherapeutic vancomycin concentrations. To determine whether population pharmacokinetics accurately predict vancomycin empiric dose frequency in patients with acute brain injury. This was a single-center, retrospective cohort study conducted following institutional review board approval at Virginia Commonwealth University Health System. Data were collected from patients 18 years of age or older admitted with acute brain injury. The primary outcome was the difference in the elimination rate constant of vancomycin between population predicted pharmacokinetics and patient-specific pharmacokinetics. A total of 158 patients were included in the analysis. A test of the paired differences between the mean population predicted and patient-specific elimination rate constants showed that the mean popul...

Research paper thumbnail of Shared risk modeling of non-Hodgkin lymphoma subtypes and UVR exposure

Introduction: Few studies have examined the association between ultraviolet radiation (UVR) expos... more Introduction: Few studies have examined the association between ultraviolet radiation (UVR) exposure and non-Hodgkin lymphoma (NHL) among NHL subtypes. In addition, no previous study has modeled th...

Research paper thumbnail of Assessing the Impact of Incorporating Residential Histories into the Spatial Analysis of Cancer Risk

I am the product of love and support, and I would like to extend my deepest gratitude to those wh... more I am the product of love and support, and I would like to extend my deepest gratitude to those who made this graduate school experience possible and productive. First, I would like to thank the Department of Biostatistics for their support during my stint as a student. A very special thank you to my dissertation advisor, Dr. Wheeler for his patience, direction, and commitment in getting me through this process. Thanks to my committee members: Drs. Fuemmeler, Green, McClish, and Sabo for their time and feedback. I would especially like to thank Dr. Sabo for his mentorship over the years, and for providing me with opportunities to learn and grow especially in teaching. I am very grateful for the open door policy of the professors in the department, and I would like to thank those who were always willing to help. Thank you to my department 'parents' Russ and Yvonne for being wonderful resources and just great listeners. I would also like to send special thank yous to Helen and Brian Bush for their extreme patience dealing with my myriad, often bizarre, technical issues over the years. Sincere gratitude to my friends Elizabeth, Jordyn, Sylvia, Tamala, and Whitney in the Epidemiology Department where I served as a research assistant for the last three years. I learned so much from each member of the team, and I was especially blessed to count our leader Dr. Saba Masho as a mentor and a friend while she was with us. I would also like to thank my friends Suemoy,

Research paper thumbnail of Cross-sectional analysis to explore the awareness, attitudes and actions of UK adults at high risk of severe illness from COVID-19

BMJ Open, 2020

Objectives This study explored the impact of COVID-19 on people identified as at high risk of sev... more Objectives This study explored the impact of COVID-19 on people identified as at high risk of severe illness by UK government, and in particular, the impact of lockdown on access to healthcare, medications and use of technological platforms. Design Online survey methodology. Setting UK. Participants 1038 UK adults were recruited who were either identified by UK government as at high risk of severe illness from COVID-19 or self-identified as at high risk with acute or other chronic health conditions not included in the UK government list. Participants were recruited through social media advertisements, health charities and patient organisations. Main outcomes measures The awareness, attitudes and actions survey which explores the impact of COVID-19, on including access to healthcare, use of technology for health condition management, mental health, depression, well-being and lifestyle behaviours. Results Nearly half of the sample (44.5%) reported that their mental health had worsened...

Research paper thumbnail of An investigation of the fundamental group and its use in classifying topological spaces

Research paper thumbnail of Prenatal Depression Severity and Postpartum Care Utilization in a Medicaid Population

Women's Health Reports

Background: Postpartum visits are a necessary continuum of medical care for women who are diagnos... more Background: Postpartum visits are a necessary continuum of medical care for women who are diagnosed with depression during pregnancy. However, postpartum care utilization is typically lower in populations who face adverse events and it is unclear to what extent having depression during pregnancy may compromise postpartum visit follow-up. Our study examined the association between severity of prenatal depression and postpartum care utilization among women on Medicaid. Materials and Methods: Data from a university-based, nonprofit managed care organization (2008-2012) were analyzed (N = 846). Prenatal depression severity and postpartum care utilization were determined using the International Classification of Diseases, Ninth Revision (ICD-9) codes, from medical claims records. Bivariate and multivariable logistic regression was conducted. Odds ratios and 95% confidence intervals (CIs) were calculated. Results: The majority (64.2%) of women received a mild/moderate prenatal depression diagnosis and 52.5% of the total sample attended their postpartum care visit. After adjusting for confounders, we found decreased odds of postpartum care utilization among women with less severe diagnoses. Women with a mild/moderate prenatal depression diagnosis were 12% less likely to attend the postpartum care visit compared with women with a severe prenatal depression diagnosis (adjusted odds ratio = 0.88, 95% CI = 0.65-1.19). However, this finding was not statistically significant. Conclusions: Our study did not yield evidence of a statistically significant relationship between prenatal depression severity and postpartum visit attendance among a sample of Medicaid beneficiaries. Additional research is needed to assess the association between prenatal depression severity and postpartum care use to enhance continuity of services for Medicaid-insured women into the postpartum period.

Research paper thumbnail of Prenatal Depression Severity and Postpartum Care Utilization in a Medicaid Population

Women's Health Reports

Background: Postpartum visits are a necessary continuum of medical care for women who are diagnos... more Background: Postpartum visits are a necessary continuum of medical care for women who are diagnosed with depression during pregnancy. However, postpartum care utilization is typically lower in populations who face adverse events and it is unclear to what extent having depression during pregnancy may compromise postpartum visit follow-up. Our study examined the association between severity of prenatal depression and postpartum care utilization among women on Medicaid. Materials and Methods: Data from a university-based, nonprofit managed care organization (2008-2012) were analyzed (N = 846). Prenatal depression severity and postpartum care utilization were determined using the International Classification of Diseases, Ninth Revision (ICD-9) codes, from medical claims records. Bivariate and multivariable logistic regression was conducted. Odds ratios and 95% confidence intervals (CIs) were calculated. Results: The majority (64.2%) of women received a mild/moderate prenatal depression diagnosis and 52.5% of the total sample attended their postpartum care visit. After adjusting for confounders, we found decreased odds of postpartum care utilization among women with less severe diagnoses. Women with a mild/moderate prenatal depression diagnosis were 12% less likely to attend the postpartum care visit compared with women with a severe prenatal depression diagnosis (adjusted odds ratio = 0.88, 95% CI = 0.65-1.19). However, this finding was not statistically significant. Conclusions: Our study did not yield evidence of a statistically significant relationship between prenatal depression severity and postpartum visit attendance among a sample of Medicaid beneficiaries. Additional research is needed to assess the association between prenatal depression severity and postpartum care use to enhance continuity of services for Medicaid-insured women into the postpartum period.