Characteristics of the overall cohort and the midwife-led and medical-led groups.

<p>Characteristics of the overall cohort and the midwife-led and medical-led groups.</p

Numbers and incidence rates of perinatal outcomes by 1,000 total and live births.

<p>Numbers and incidence rates of perinatal outcomes by 1,000 total and live births.</p

A Comparison of Midwife-Led and Medical-Led Models of Care and Their Relationship to Adverse Fetal and Neonatal Outcomes: A Retrospective Cohort Study in New Zealand

<div><p>Background</p><p>Internationally, a typical model of maternity care is a medically led system with varying levels of midwifery input. New Zealand has a midwife-led model of care, and there are movements in other countries to adopt such a system. There is a paucity of systemic evaluation that formally investigates safety-related outcomes in relationship to midwife-led care within an entire maternity service. The main objective of this study was to compare major adverse perinatal outcomes between midwife-led and medical-led maternity care in New Zealand.</p><p>Methods and Findings</p><p>This was a population-based retrospective cohort study. Participants were mother/baby pairs for all 244,047 singleton, term deliveries occurring between 1 January 2008 and 31 December 2012 in New Zealand in which no major fetal, neonatal, chromosomal or metabolic abnormality was identified and the mother was first registered with a midwife, obstetrician, or general practitioner as lead maternity carer. Main outcome measures were low Apgar score at five min, intrauterine hypoxia, birth-related asphyxia, neonatal encephalopathy, small for gestational age (as a negative control), and mortality outcomes (perinatal related mortality, stillbirth, and neonatal mortality). Logistic regression models were fitted, with crude and adjusted odds ratios (ORs) generated for each outcome for midwife-led versus medical-led care (based on lead maternity carer at first registration) with 95% confidence intervals. Fully adjusted models included age, ethnicity, deprivation, trimester of registration, parity, smoking, body mass index (BMI), and pre-existing diabetes and/or hypertension in the model. Of the 244,047 pregnancies included in the study, 223,385 (91.5%) were first registered with a midwife lead maternity carer, and 20,662 (8.5%) with a medical lead maternity carer. Adjusted ORs showed that medical-led births were associated with lower odds of an Apgar score of less than seven at 5 min (OR 0.52; 95% confidence interval 0.43–0.64), intrauterine hypoxia (OR 0.79; 0.62–1.02), birth-related asphyxia (OR 0.45; 0.32–0.62), and neonatal encephalopathy (OR 0.61; 0.38–0.97). No association was found between lead carer at first registration and being small for gestational age (SGA), which was included as a negative control (OR 1.00; 0.95–1.05). It was not possible to definitively determine whether one model of care was associated with fewer infant deaths, with ORs for the medical-led model compared with the midwife-led model being 0.80 (0.54–1.19) for perinatal related mortality, 0.86 (0.55–1.34) for stillbirth, and 0.62 (0.25–1.53) for neonatal mortality. Major limitations were related to the use of routine data in which some variables lacked detail; for example, we were unable to differentiate the midwife-led group into those who had received medical input during pregnancy and those who had not.</p><p>Conclusions</p><p>There is an unexplained excess of adverse events in midwife-led deliveries in New Zealand where midwives practice autonomously. The findings are of concern and demonstrate a need for further research that specifically investigates the reasons for the apparent excess of adverse outcomes in mothers with midwife-led care. These findings should be interpreted in the context of New Zealand’s internationally comparable birth outcomes and in the context of research that supports the many benefits of midwife-led care, such as greater patient satisfaction and lower intervention rates.</p></div

Crude and adjusted ORs (with <i>p</i>-value) for all outcomes comparing medical-led to midwife-led care.

<p>Crude and adjusted ORs (with <i>p</i>-value) for all outcomes comparing medical-led to midwife-led care.</p

Adjusted ORs of low Apgar and small for gestational age in relation to maternal characteristics.

<p>Adjusted ORs of low Apgar and small for gestational age in relation to maternal characteristics.</p

Adjusted ORs of PRM and birth asphyxia/hypoxia/neonatal encephalopathy in relation to maternal characteristics.

<p>Adjusted ORs of PRM and birth asphyxia/hypoxia/neonatal encephalopathy in relation to maternal characteristics.</p

Additional file 1: of Physical activity and risk of testicular cancer: a systematic review

Table S1. Papers included in meta-analysis of association between physical activity and testicular cancer risk, with study meta-data. Table S2. Extracted data relating to high vs. low physical activity. Table S3. Extracted data relating to high vs. low recreational physical activity at adolescence/early adulthood. Table S4. PICOS (Patient/Participant, Intervention, Comparator, Outcome, Study design) criteria for inclusion of studies. Table S5. List of excluded papers with reason for exclusion. Table S6. Assessment of study quality against Newcastle-Ottawa criteria for case-control studies. Table S7. Assessment of study quality against Newcastle-Ottawa criteria for cohort studies. (DOCX 134 kb

Maintaining cancer services during the COVID-19 pandemic: the Aotearoa New Zealand experience

COVID-19 caused significant disruption to cancer services around the world. The health system in Aotearoa New Zealand has fared better than many other regions, with the country being successful, so far, in avoiding sustained community transmission. However, there was a significant initial disruption to services across the cancer continuum, resulting in a decrease in the number of new diagnoses of cancer in March and April 2020. Te Aho o Te Kahu, Aotearoa New Zealand's national Cancer Control Agency, coordinated a nationwide response to minimise the impact of COVID-19 on people with cancer. The response, outlined in this paper, included rapid clinical governance, a strong equity focus, development of national clinical guidance, utilising new ways of delivering care, identifying and addressing systems issues and close monitoring and reporting of the impact on cancer services. Diagnostic procedures and new cancer registrations increased in the months following the national lockdown, and the cumulative number of cancer registrations in 2020 surpassed the number of registrations in 2019 by the end of September. Cancer treatment services - surgery, medical oncology, radiation oncology and haematology - continued during the national COVID-19 lockdown in March and April 2020 and continued to be delivered at pre-COVID-19 volumes in the months since. We are cautiously optimistic that, in general, the COVID-19 pandemic does not appear to have increased inequities in cancer diagnosis and treatment for Māori in Aotearoa New Zealand