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Evidence-based restructuring of health and social care

PLoS Medicine - Ma, 14/11/2017 - 23:00

by Aziz Sheikh

In this Perspective, Aziz Sheikh discusses research to evaluate health policy changes in the provision of care, commenting on a study by James Lopez Bernal and colleagues that examined specialist-dominated hospital care versus community-based care in the United Kingdom.

Perinatal mortality associated with induction of labour versus expectant management in nulliparous women aged 35 years or over: An English national cohort study

PLoS Medicine - Ma, 14/11/2017 - 23:00

by Hannah E. Knight, David A. Cromwell, Ipek Gurol-Urganci, Katie Harron, Jan H. van der Meulen, Gordon C. S. Smith


A recent randomised controlled trial (RCT) demonstrated that induction of labour at 39 weeks of gestational age has no short-term adverse effect on the mother or infant among nulliparous women aged ≥35 years. However, the trial was underpowered to address the effect of routine induction of labour on the risk of perinatal death. We aimed to determine the association between induction of labour at ≥39 weeks and the risk of perinatal mortality among nulliparous women aged ≥35 years.

Methods and findings

We used English Hospital Episode Statistics (HES) data collected between April 2009 and March 2014 to compare perinatal mortality between induction of labour at 39, 40, and 41 weeks of gestation and expectant management (continuation of pregnancy to either spontaneous labour, induction of labour, or caesarean section at a later gestation). Analysis was by multivariable Poisson regression with adjustment for maternal characteristics and pregnancy-related conditions. Among the cohort of 77,327 nulliparous women aged 35 to 50 years delivering a singleton infant, 33.1% had labour induced: these women tended to be older and more likely to have medical complications of pregnancy, and the infants were more likely to be small for gestational age.Induction of labour at 40 weeks (compared with expectant management) was associated with a lower risk of in-hospital perinatal death (0.08% versus 0.26%; adjusted risk ratio [adjRR] 0.33; 95% CI 0.13–0.80, P = 0.015) and meconium aspiration syndrome (0.44% versus 0.86%; adjRR 0.52; 95% CI 0.35–0.78, P = 0.002). Induction at 40 weeks was also associated with a slightly increased risk of instrumental vaginal delivery (adjRR 1.06; 95% CI 1.01–1.11, P = 0.020) and emergency caesarean section (adjRR 1.05; 95% CI 1.01–1.09, P = 0.019). The number needed to treat (NNT) analysis indicated that 562 (95% CI 366–1,210) inductions of labour at 40 weeks would be required to prevent 1 perinatal death. Limitations of the study include the reliance on observational data in which gestational age is recorded in weeks rather than days. There is also the potential for unmeasured confounders and under-recording of induction of labour or perinatal death in the dataset.


Bringing forward the routine offer of induction of labour from the current recommendation of 41–42 weeks to 40 weeks of gestation in nulliparous women aged ≥35 years may reduce overall rates of perinatal death.

We found our galactic twin 180 million light years away

New Scientist - Ma, 14/11/2017 - 20:14
Astronomers have spotted a trio of galaxies that look remarkably like the giant spiral of the Milky Way and its two brightest companions, the Magellanic Clouds

How long should you let a pregnancy run before being induced?

New Scientist - Ma, 14/11/2017 - 20:00
If your pregnancy runs past its due date, how long should you wait for a natural birth? It may be safer to induce at 40 weeks, for older mums at least

NHS reforms have failed to boost community-based care in England

New Scientist - Ma, 14/11/2017 - 20:00
Re-organising the National Health Service in England has failed to reduce the proportion of people being referred for expensive hospital treatments

If we only ate organic it would be an environmental disaster

New Scientist - Ma, 14/11/2017 - 17:00
Organic food production requires more land, but a study claims cutting meat eating and food waste will solve this problem. It won’t

Prairie vole partners split up if one drinks more than the other

New Scientist - Ma, 14/11/2017 - 16:08
Prairie voles mate for life, but the bond is likely to break down if one partner drinks more alcohol than the other

Camera spots hidden oil spills and may find missing planes

New Scientist - Ma, 14/11/2017 - 15:46
For the first time, a polarising infrared camera – never before used on Earth – has been made small and light enough to detect concealed oil spills

Why people ruin others’ lives by exposing all their data online

New Scientist - Ma, 14/11/2017 - 15:40
Doxers causes devastation by revealing targets' sensitive information to the worst elements of the internet. Now the first study to examine doxing shows who is most affected – and a potential fix

Coffee and plant-based diets linked to lower heart failure risk

New Scientist - Lu, 13/11/2017 - 21:45
Drinking coffee, and diets consisting mostly of vegetables, fruit, beans and whole grains, have both been linked to a lower risk of developing heart failure

Big aftershocks could well hit Iran and Iraq in next 48 hours

New Scientist - Lu, 13/11/2017 - 19:30
The magnitude 7.3 quake that struck Iran and Iraq on Monday has already killed 400 and injured thousands, and more tremors could be on the way

Get closer to death to make the most of life

New Scientist - Lu, 13/11/2017 - 18:50
We distance ourselves from dying, but in doing so we could be missing out on the surprising upsides of mortality

In a Spotify world, why does anyone want to listen to cassettes?

New Scientist - Lu, 13/11/2017 - 18:43
A US cassette firm is spooling up production again to meet demand. Do people really want to go back to the flimsy magnetic tape of the 1980s, asks Paul Marks

Should we seed life through the cosmos using laser-driven ships?

New Scientist - Lu, 13/11/2017 - 17:58
Our galaxy may have billions of habitable worlds. A proposal to spread life says we should use giant lasers and light sails to send microbes out to them

Climate change blamed for Arabian Sea’s unexpected hurricanes

New Scientist - Lu, 13/11/2017 - 17:14
A flurry of hurricane-strength storms struck the Arabian Sea in 2014 and 2015, and climate change seems to have played a role

Monkeys learn to play ‘chicken’ in a virtual driving game

New Scientist - Lu, 13/11/2017 - 17:03
Macaque monkeys have been trained to play a computer version of “chicken”, driving virtual cards towards each other to see who flinches first

How social stress makes your brain vulnerable to depression

New Scientist - Lu, 13/11/2017 - 17:00
Bullying and other social stresses may make it easier for inflammatory substances to enter your brain, altering your mood and leaving you susceptible to depression

Tinfoil hat for your router stops bad guys snooping your Wi-Fi

New Scientist - Lu, 13/11/2017 - 16:21
Wireless signal shaper can put your Wi-Fi into the nooks and crannies of your home - and keep it from spilling out into the rest of the world

Gluten-sensitive? It may actually be a carb making you ill

New Scientist - Lu, 13/11/2017 - 11:30
Rather than gluten, fructan molecules seem to be to blame for sensitive guts. If true, gluten-free people could eat soy sauce and sourdough bread again

Your data is too valuable and sensitive to dish out for free

New Scientist - Lu, 13/11/2017 - 11:00
What you buy, watch and read online is scooped up ostensibly to tailor services to you, but it is often sold on. New EU rules will help people take back control
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