Comparing very low birth weight versus very low gestation cohort methods for outcome analysis of high risk preterm infants

© 2017 The Author(s). Background: Compared to very low gestational age (<32 weeks, VLGA) cohorts, very low birth weight (<1500 g; VLBW) cohorts are more prone to selection bias toward small-for-gestational age (SGA) infants, which may impact upon the validity of data for benchmarking purposes. Method: Data from all VLGA or VLBW infants admitted in the 3 Networks between 2008 and 2011 were used. Two-thirds of each network cohort was randomly selected to develop prediction models for mortality and composite adverse outcome (CAO: mortality or cerebral injuries, chronic lung disease, severe retinopathy or necrotizing enterocolitis) and the remaining for internal validation. Areas under the ROC curves (AUC) of the models were compared. Results: VLBW cohort (24,335 infants) had twice more SGA infants (20.4% vs. 9.3%) than the VLGA cohort (29,180 infants) and had a higher rate of CAO (36.5% vs. 32.6%). The two models had equal prediction power for mortality and CAO (AUC 0.83), and similarly for all other cross-cohort validations (AUC 0.81-0.85). Neither model performed well for the extremes of birth weight for gestation (<1500 g and ≥32 weeks, AUC 0.50-0.65; ≥1500 g and <32 weeks, AUC 0.60-0.62). Conclusion: There was no difference in prediction power for adverse outcome between cohorting VLGA or VLBW despite substantial bias in SGA population. Either cohorting practises are suitable for international benchmarking

Development of mental health first aid guidelines for Aboriginal and Torres Strait Islander people experiencing problems with substance use: a Delphi study

<p>Abstract</p> <p>Background</p> <p>Problems with substance use are common in some Aboriginal communities. Although problems with substance use are associated with significant mortality and morbidity, many people who experience them do not seek help. Training in mental health first aid has been shown to be effective in increasing knowledge of symptoms and behaviours associated with seeking help. The current study aimed to develop culturally appropriate guidelines for providing mental health first aid to an Aboriginal or Torres Strait Islander person who is experiencing problem drinking or problem drug use (e.g. abuse or dependence).</p> <p>Methods</p> <p>Twenty-eight Aboriginal health experts participated in two independent Delphi studies (n = 22 problem drinking study, n = 21 problem drug use; 15 participated in both). Panellists were presented with statements about possible first aid actions via online questionnaires and were encouraged to suggest additional actions not covered by the content. Statements were accepted for inclusion in the guidelines if they were endorsed by ≥ 90% of panellists as either 'Essential' or 'Important'. At the end of the two Delphi studies, participants were asked to give feedback on the value of the project and their participation experience.</p> <p>Results</p> <p>From a total of 735 statements presented over two studies, 429 were endorsed (223 problem drinking, 206 problem drug use). Statements were grouped into sections based on common themes (n = 7 problem drinking, n = 8 problem drug use), then written into guideline documents. Participants evaluated the Delphi method employed, and the guidelines developed, as useful and appropriate for Aboriginal and Torres Strait Islander people.</p> <p>Conclusions</p> <p>Aboriginal health experts were able to reach consensus about culturally appropriate first aid for problems with substance use. Many first aid actions endorsed in the current studies were not endorsed in previous international Delphi studies, conducted on problem drinking and problem drug use in non-Indigenous people, highlighting the need for culturally specific first aid strategies to be employed when assisting Aboriginal or Torres Strait Islander people.</p

Trends in Outcomes for Neonates Born Very Preterm and Very Low Birth Weight in 11 High-Income Countries

Objective To evaluate outcome trends of neonates born very preterm in 11 high-income countries participating in the International Network for Evaluating Outcomes of neonates. Study design In a retrospective cohort study, we included 154 233 neonates admitted to 529 neonatal units between January 1, 2007, and December 31, 2015, at 24(0/7) to 31(6/7) weeks of gestational age and birth weight <1500 g. Composite outcomes were in-hospital mortality or any of severe neurologic injury, treated retinopathy of prematurity, and bronchopulmonary dysplasia (BPD); and same composite outcome excluding BPD. Secondary outcomes were mortality and individual morbidities. For each country, annual outcome trends and adjusted relative risks comparing epoch 2 (2012-2015) to epoch 1 (2007-2011) were analyzed. Results For composite outcome including BPD, the trend decreased in Canada and Israel but increased in Australia and New Zealand, Japan, Spain, Sweden, and the United Kingdom. For composite outcome excluding BPD, the trend decreased in all countries except Spain, Sweden, Tuscany, and the United Kingdom. The risk of composite outcome was lower in epoch 2 than epoch 1 in Canada (adjusted relative risks 0.78; 95% CI 0.74-0.82) only. The risk of composite outcome excluding BPD was significantly lower in epoch 2 compared with epoch 1 in Australia and New Zealand, Canada, Finland, Japan, and Switzerland. Mortality rates reduced in most countries in epoch 2. BPD rates increased significantly in all countries except Canada, Israel, Finland, and Tuscany. Conclusions In most countries, mortality decreased whereas BPD increased for neonates born very preterm

Illiberal democracy in Indonesia: The ideology of the family state

Illiberal Democracy in Indonesia charts the origins and development of organicist ideologies in Indonesia from the early 20th century to the present. In doing so, it provides a background to the theories and ideology that informed organicist thought, traces key themes in Indonesian history, examines the Soeharto regime and his ‘New Order’ in detail, and looks at contemporary Indonesia to question the possibility of past ideologies making a resurgence in the country. Beginning with an exploration of the origins of the theory of the organic state in Europe, this book explores how this influenced many young Indonesian scholars and ‘secular’ nationalists. It also looks in detail at the case of Japan, and identifies the parallels between the process by which Japanese and Indonesian nationalist scholars drew on European romantic organicist ideas to forge ‘anti-Western’ national identities and ideologies. The book then turns to Indonesia’s tumultuous history from the revolution to 1965, the rise of Soeharto, and how his regime used organicist ideology, together with law and terror, to shape the political landscape consolidate control. In turn, it shows how the social and economic changes wrought by the government’s policies, such as the rise of a cosmopolitan middle class and a rapidly growing urban proletariat led to the failure of the corporatist political infrastructure and the eventual collapse of the New Order in 1998. Finally, the epilogue surveys the post Soeharto years to 2014, and how growing disquiet about the inability of the government to contain religious intolerance, violence and corruption, has led to an increased readiness to re-embrace not only more authoritarian styles of rule but also ideological formulas from the past. This book will be welcomed by students and scholars of Southeast Asia, politics and political theory, as well as by those interested in authoritarian regimes, democracy and human right

Indonesianising Indonesia: Conservative indigenism in an age of globalisation

Positing that the key to understanding most ‘Asian values’ rhetoric lies at the level of domestic politics, this paper examines the manufacture and political uses of ‘indigenist’ discourses in Indonesia. It contrasts populist and conservative forms of indigenism and explores how President Soeharto deployed the latter against his leftist, Muslim and liberal critics. The paper suggests that the rise of an educated and globally connected middle class has eroded the government's ability to rely on old ideological formulas and led it to search for new legitimatory mechanisms. Domestic turmoil arising from the economic crisis sweeping Asia may, however, see a return to nationalism and with it a boost in the stocks of indigenism and ‘Asian values’

Magic memos, collusion and judges with attitude: Notes on the politics of law in contemporary Indonesia

Few would have predicted that two of the most popular public figures in Indonesia in 1996 would be senior judges. Judges have typically been seen as gormless and corrupt functionaries who do the government’s bidding in the government’s courts. Yet in May 1995 Administrative Court judge Benyamin Mangkoedilaga became an instant celebrity after his historic ruling that President Soeharto’s powerful Information Minister had acted beyond his powers when he banned the popular weekly magazine Tempo a year earlier. Benyamin’s courtroom in Jakarta erupted in jubilation at the decision, and the judge was for months in hot demand for appearances and interviews. More recently, the spotlight has turned to Adi Andojo Soetjipto, the Supreme Court judge whose bold denunciations of high level judicial corruption have severely embarrassed Indonesia’s top legal authorities. An unprecedented move by the Chair of the Supreme Court to dismiss Adi Andojo in June 1996 only increased the level of public admiration, if not adulation, for the ‘honest judge’ who continues to speak out against his colleagues with impunity. Between them, Benyamin Mangkoedilaga and Adi Andojo have been responsible for reviving hopes among the urban middle classes that the judiciary may one day take their place, implied in the constitution, as an independent power within the state

Face-off in Jakarta: Suharto vs the IMF

President Suharto won another five years in office from the 1,000 member People's Consultative Assembly on 10 March 1998. But his struggle to restore faith in his government's capacity to manage Indonesia's desperate currency crisis is far from over. The global spotlight is on Indonesia and the pictures are of riots, panic buying and Chinese traders grieving in their fire-gutted shops. A collapse of international confidence in the rupiah has sent the currency into free fall, leaving ordinary people angry, bewildered and uncertain about the future. At the heart of the drama is the 76 year old President Suharto and his titanic battle of wills with the world's banker of last resort, the International Monetary Fund (IMF). In October 1997, Suharto called in the IMF in an attempt to cushion Indonesia from the effects of the currency crisis then affecting Thailand, Malaysia and the Philippines. He accepted their advice to close down sixteen badly performing banks without warning and shelve several mega-projects the IMF said Indonesia could not afford

Why Indonesia had to explode

Since seizing power more than three decades ago, Suharto's military-backed regime has stifled every attempt to organise opposition. Now his 'New Order' government, and the country as a whole, is reaping the results. Angry crowds are out in the streets burning and looting because there are simply no viable political organisations for people to turn to in order to vent their intense frustrations about the collapsing economy. In Thailand and South Korea, the economic crisis saw old governments voted out and new reformist governments elected. This has been impossible in Indonesia because Suharto has built a political system in which power is concentrated almost completely in his own hands

Electoral system due for overhaul

After years of hacking, pruning and trimming, Suharto had the formal political system just as he wanted it. Every five years the government party Golkar would win the general elections with an absolute majority. Every five years Suharto's tenure was dutifully renewed by the People's Consultative Assembly. Not once did the good President have to endure the indignity of debating a rival candidate