What causes the word gap? Financial concerns may systematically suppress child-directed speech

Parents with fewer educational and economic resources (low socioeconomic-status, SES) tend to speak less to their children, with consequences for children’s later life outcomes. Despite this well-established and highly popularized link, surprisingly little research addresses why the SES “word gap” exists. Moreover, existing research focuses on individual-level explanations with little attention to structural constraints with which parents must contend. In two pre-registered studies, we test whether experiencing financial scarcity itself can suppress caregivers’ speech to their children. Study 1 suggests that caregivers who are prompted to reflect on scarcity—particularly those who reflect on financial scarcity—speak to their 3-year-olds less than a control group in a subsequent play session. Study 2 finds that caregivers speak less to their children at the end of the month—when they are more likely to be experiencing financial hardship—than the rest of the month. Thus, above and beyond the individual characteristics of parents, structural constraints may affect how much parents speak to their children

What is the effect of a formalised trauma tertiary survey procedure on missed injury rates in multi-trauma patients? Study protocol for a randomised controlled trial

Background: Missed injury is commonly used as a quality indicator in trauma care. The trauma tertiary survey (TTS) has been proposed to reduce missed injuries. However a systematic review assessing the effect of the TTS on missed injury rates in trauma patients found only observational studies, only suggesting a possible increase in early detection and reduction in missed injuries, with significant potential biases. Therefore, more robust methods are necessary to test whether implementation of a formal TTS will increase early in-hospital injury detection, decrease delayed diagnosis and decrease missed injuries after hospital discharge. Methods/Design: We propose a cluster-randomised, controlled trial to evaluate trauma care enhanced with a formalised TTS procedure. Currently, 20 to 25% of trauma patients routinely have a TTS performed. We expect this to increase to at least 75%. The design is for 6,380 multi-trauma patients in approximately 16 hospitals recruited over 24 months. In the first 12 months, patients will be randomised (by hospital) and allocated 1:1 to receive either the intervention (Group 1) or usual care (Group 2). The recruitment for the second 12 months will entail Group 1 hospitals continuing the TTS, and the Group 2 hospitals beginning it to enable estimates of the persistence of the intervention. The intervention is complex: implementation of formal TTS form, small group education, and executive directive to mandate both. Outcome data will be prospectively collected from (electronic) medical records and patient (telephone follow-up) questionnaires. Missed injuries will be adjudicated by a blinded expert panel. The primary outcome is missed injuries after hospital discharge; secondary outcomes are maintenance of the intervention effect, in-hospital missed injuries, tertiary survey performance rate, hospital and ICU bed days, interventions required for missed injuries, advanced diagnostic imaging requirements, readmissions to hospital, days of work and quality of life (EQ-5D-5 L) and mortality. Discussion: The findings of this study may alter the delivery of international trauma care. If formal TTS is (cost-) effective this intervention should be implemented widely. If not, where already partly implemented, it should be abandoned. Study findings will be disseminated widely to relevant clinicians and health funders.Griffith Health, School of MedicineFull Tex

Metformin for prevention of hypertensive disorders of pregnancy in women with gestational diabetes or obesity: systematic review and meta‐analysis of randomized trials

Objective Metformin has been reported to reduce the risk of pre‐eclampsia. It is also known to influence soluble fms‐like tyrosine kinase‐1 level, which correlates significantly with the gestational age at onset and severity of pre‐eclampsia. The main aim of this systematic review and meta‐analysis of randomized trials was to determine whether metformin use is associated with the incidence of hypertensive disorders of pregnancy (HDP). Methods MEDLINE (1947 to September 2017), Scopus (1970 to September 2017) and the Cochrane Library (inception to September 2017) were searched for relevant citations in the English language. Only randomized controlled trials on metformin use, reporting the incidence of pre‐eclampsia or pregnancy‐induced hypertension, were included. Studies on populations with a high probability of metformin use prior to randomization (those with type II diabetes or polycystic ovary syndrome) were excluded. Random‐effects models with the Mantel–Haenszel method were used for subgroup analyses. Bayesian random‐effects meta‐regression was used to summarize the evidence. Results In total, 3337 citations matched the search criteria. After evaluating 2536 abstracts and performing full‐text review of 52 studies, 15 were included in the review. In women with gestational diabetes, metformin use was associated with a reduced risk of pregnancy‐induced hypertension when compared with insulin (relative risk (RR), 0.56; 95% CI, 0.37–0.85; I2 = 0%; 1260 women) and a non‐significantly reduced risk of pre‐eclampsia (RR, 0.83; 95% CI, 0.60–1.14; I2 = 0%; 1724 women). In obese women, when compared with placebo, metformin use was associated with a non‐significant reduction in risk of pre‐eclampsia (RR, 0.74; 95% CI, 0.09–6.28; I2 = 86%; 840 women). In women with gestational diabetes, metformin use was also associated with a non‐significant reduction in risk of any HDP (RR, 0.71; 95% CI, 0.41–1.25; I2 = 0%; 556 women) when compared with glyburide. When studies were combined using Bayesian random‐effects meta‐regression, with treatment type as a covariate, the posterior probabilities of metformin having a beneficial effect on the prevention of pre‐eclampsia, pregnancy‐induced hypertension and any HDP were 92.7%, 92.8% and 99.2%, respectively, when compared with any other treatment or placebo. Conclusions There is a high probability that metformin use is associated with reduced HDP incidence when compared with other treatments or placebo. The small number of studies included in the analysis, the low quality of evidence and the clinical heterogeneity preclude generalization of these results to broader populations. Given the clinical importance of this topic and the magnitude of effect observed in this meta‐analysis, further prospective trials are urgently needed

ISUOG Practice Guidelines: role of ultrasound in screening for and follow-up of pre-eclampsia.

Hypertensive disease of pregnancy affects up to 10% of pregnant women1 and the pooled global incidence of pre-eclampsia (PE) is approximately 3%2. Significant variations between developed and developing countries can be attributed to true differences or differences arising from data acquisition. PE and its complications are a major contributor to maternal and perinatal morbidity and mortality worldwide1, 3. Given that timely and effective care can improve the outcome of PE3, the development of effective prediction and prevention strategies has been a major objective of prenatal care and of research.Full Tex

Aspirin delays the development of preeclampsia

This is the author accepted manuscript. The final version is available from Elsevier via the DOI in this record.BACKGROUND: In the Combined Multimarker Screening and Randomized Patient Treatment with Aspirin for Evidence-Based Preeclampsia Prevention (ASPRE) trial risks of preterm preeclampsia (PE) were obtained from the competing risk model. Consenting women with risks of greater than 1 in 100 were randomised to treatment with aspirin or placebo. The trial showed strong evidence of an effect (odds ratio 0.38, 95% confidence interval 0.20 to 0.74) on the incidence of preterm-PE, which was the primary outcome of ASPRE. There was a small and insignificant effect on the incidence of term-PE which was one of the secondary outcomes (odds ratio 0.95, 95% CI 0.64 to 1.39). These differential effects on term and preterm-PE could reflect a mechanism in which the action of aspirin is to delay the delivery with PE thereby converting what would, without treatment, be preterm-PE to term-PE. OBJECTIVE: To examine the hypothesis that the effect of aspirin is to delay the time of delivery with PE. STUDY DESIGN: This was an unplanned exploratory analysis of data from the ASPRE trial. The delay hypothesis predicts that in groups for which preterm-PE, without aspirin, were infrequent relative to term-PE, a reduction in term-PE would be expected because few cases of preterm-PE would be converted to term-PE. In contrast, in groups for which preterm-PE were frequent relative to term-PE, the conversion of preterm-PE to term-PE by aspirin would reduce or even reverse any effect on the incidence term-PE. This is examined using the ASPRE trial data by analysis of the effect of aspirin on the incidence of term-PE stratified according to the risk of preterm-PE at randomization. Given that women were included in ASPRE with risks of preterm PE > 1 in 100, a risk cut-off if 1 in 50 was used to define higher risk and lower risk strata. A statistical model in which the effect of aspirin is to delay the gestational age at delivery was fitted to the ASPRE trial data and the consistency of the predictions from this model with the observed incidence was demonstrated. RESULTS: In the lower risk group (<1 in 50), there was a reduction in the incidence of term-PE (odds ratio 0.62, 95% confidence interval 0.29 to 1.30). In contrast, in the higher risk group (≥1 in 50) there was a small increase in the incidence of term-PE (odds ratio 1.11, 95% confidence interval 0.71 to 1.75). Although these effects fail to achieve significance, they are consistent with the delay hypothesis. Within the framework of the aspirin-related delay hypothesis, the effect of aspirin was to delay the gestational age at delivery with PE by an estimated 4.4 weeks (95% CI 1.4 to 7.1 weeks) for those that in the placebo group would be delivered at 24 weeks and the effect decreased by an estimated 0.23 weeks (95% CI 0.021 to 0.40 weeks) for each week of gestation so that at 40+0 weeks the estimated delay was by 0.8 weeks (95% confidence interval -0.03 to 1.7 weeks). CONCLUSIONS: The ASPRE trial data are consistent with the hypothesis that aspirin delays the gestational age at delivery with PE.National Institute for Health Research (NIHR