Is maternity care in Scotland equitable? Results of a national maternity care survey

Objective High-quality maternity care is key to long-term improvements in population health. However, even within developed welfare systems, some mothers and babies experience poorer care and outcomes. This study aimed to explore whether women’s experiences of maternity care in Scotland differs by their physical or sociodemographic characteristics. Design Secondary analysis of the 2015 Scottish Maternity Care Experience Survey. The questionnaire was based on the Care Quality Commission English maternity survey. Setting National Health Service maternity care in Scotland. Participants The survey was distributed to 5025 women who gave birth in Scotland during February and March 2015 with 2036 respondents (41%). Main outcome measures The questionnaire explored aspects of care processes and interpersonal care experienced from the first antenatal contact (booking) to 6 weeks following the birth. The analysis investigated whether experiences were related to age, parity, deprivation, rurality, self-reported general health or presence of a health condition that limited daily activities. Analysis used mixed effect multilevel models incorporating logistic regression. Results There were associations between parity, age and deprivation with gestation at booking indicating that younger women, women from more deprived areas and multiparous women booked later. Women reporting generally poorer health were more likely to describe poorer care experiences in almost every domain including continuity, pain relief in labour, communication with staff, support and advice, involvement in decision making, confidence and trust and overall rating of care. Conclusions We found few differences in maternity care experience for women based on their physical or socioeconomic characteristics. Our findings indicate that maternity care in Scotland is generally equitable. However, the link between poorer general health after childbirth and poorer experience of maternity care is an important finding requiring further study

Demonstration of sustained and useful converter responses during balanced and unbalanced faults in microgrids

In large power grids where converter penetration is presently low and the network impedance is predominantly reactive, the required response from converters during faults is presently specified by phrases such as “maximum reactive output”. However, in marine and aero power systems most faults are unbalanced, the network impedance is resistive, and converter penetration may be high. Therefore a balanced reactive fault current response to an unbalanced fault may lead to over-voltages or over/under frequency events. Instead, this paper presents a method of controlling the converter as a balanced voltage source behind a reactance, thereby emulating the fault response of a synchronous generator (SG) as closely as possible. In this mode there is a risk of converter destruction due to overcurrent. A new way of preventing destruction but still providing fault performance as close to a SG as possible is presented. Demonstrations are presented of simulations and laboratory testing at the 10kVA 400V scale, with balanced and unbalanced faults. Currents can be limited to about 1.5pu while still providing appropriate unbalanced fault response within a resistive network

Attention control comparisons with SLT for people with aphasia following stroke: methodological concerns raised following a systematic review

Objective: Attention control comparisons in trials of stroke rehabilitation require care to minimize the risk of comparison choice bias. We compared the similarities and differences in SLT and social support control interventions for people with aphasia. Data sources: Trial data from the 2016 Cochrane systematic review of SLT for aphasia after stroke. Methods: Direct and indirect comparisons between SLT, social support and no therapy controls. We double-data extracted intervention details using the template for intervention description and replication. Standardized mean differences and risk ratios (95% confidence intervals (CIs)) were calculated. Results: Seven trials compared SLT with social support (n  =  447). Interventions were matched in format, frequency, intensity, duration and dose. Procedures and materials were often shared across interventions. Social support providers received specialist training and support. Targeted language rehabilitation was only described in therapy interventions. Higher drop-out (P  =  0.005, odds ratio (OR) 0.51, 95% CI 0.32–0.81) and non-adherence to social support interventions (P  <  0.00001, OR 0.18, 95% CI 0.09–0.37) indicated an imbalance in completion rates increasing the risk of control comparison bias. Conclusion: Distinctions between social support and therapy interventions were eroded. Theoretically based language rehabilitation was the remaining difference in therapy interventions. Social support is an important adjunct to formal language rehabilitation. Therapists should continue to enable those close to the person with aphasia to provide tailored communication support, functional language stimulation and opportunities to apply rehabilitation gains. Systematic group differences in completion rates is a design-related risk of bias in outcomes observed

Spatial and temporal clustering of fault events on the GB transmission network

The UK is subject to changing weather patterns due to the global process of climate change. The full extent of these changes is not currently known; however, it is possible that the UK will be subject to more extreme or more frequent severe weather events (or both). As 50% of the faults on the transmission network in Britain are weather related it is likely that any change in weather patterns for the worse would increase the number of faults the network experiences. This paper describes a review of fault records in one region of the UK in order to understand the potential impact on system operation of clusters of weather related network faults. Based on the patterns of identified clusters, it suggests some potential impacts of climate change

Assessment of the relative performance of the EQ-5D-3L, ICIQ UI SF and POP-SS using data from the OPAL trial

Conducting economic evaluations alongside randomised controlled trials (RCTs) is an efficient way to collect cost-effectiveness data. Generic preference-based measures, such as EQ-5D, are often used alongside clinical data measures in RCTs. However, in the case of female urinary incontinence (UI), evidence of the relative performance of EQ-5D with condition-specific measures such as the International Consultation on Incontinence Questionnaire Urinary Incontinence Short Form (ICIQ-UI SF), measuring severity of UI, and Pelvic Organ Prolapse Symptom Score (POP-SS), measuring severity of prolapse symptoms, is limited. This study employed secondary analysis of outcome measures data collected during the Optimal Pelvic floor muscle training for Adherence Long-term (OPAL) RCT, which compared biofeedback-mediated pelvic floor muscle training to basic pelvic floor muscle training for women with UI. The relative performance of EQ-5D-3L and ICIQ-UI SF, and EQ-5D-3L and POP-SS was assessed for concurrent validity and known-groups validity. Data for 577 women (mean age 48) were available for EQ-5D-3L/ICIQ-UI SF, and 555 women (mean age 47) for EQ-5D-3L/POP-SS. Overall, EQ-5D-3L exhibited very weak association with the ICIQ-UI SF total score, or any subscale. EQ-5D-3L and POP-SS were found to be weakly correlated. EQ-5D-3L was able to distinguish between groups with known differences in severity of UI and also between types of UI. These findings provide useful information to guide researchers in selecting appropriate outcome measures for use in future clinical trials

Acessibilidade e utilização dos espaços verdes urbanos nas cidades de Coimbra (Portugal) e Salamanca (Espanha)

ACCESSIBILITY AND USE OF URBAN GREEN SPACES IN THE CITIES OF COIMBRA (PORTUGAL) AND SALAMANCA (SPAIN). In a society that values more and more wellbeing, health and free time, the introduction of urban green spaces (UGS) next to residential areas has become a citizen’s right and requirement. This paper analyses the distribution and accessibility of UGS in the cities of Coimbra and Salamanca and evaluates their influence on the needs of the resident populations, in terms of users’ age, frequency of usage, as well as of motivation and ways to enjoy the facilities. In Coimbra there is a concentration of UGS, whereas in Salamanca there is a dispersion of such spaces, which has resulted in the different usage that people make of them. In fact, although Coimbra offers more urban green space (per inhabitant), their usage is reduced as people go there mainly by car, contrary to what happens in Salamanca. Consequently, Coimbra’s inhabitants choose these green spaces because of the activities they can be used for, whereas Salamanca’s inhabitants choose them for their proximity

Stimulation of the tibial nerve: a protocol for a multicentred randomised controlled trial for urinary problems associated with Parkinson’s disease—STARTUP

Introduction Parkinson’s disease is the second most common chronic neurodegenerative condition with bladder dysfunction affecting up to 71%. Symptoms affect quality of life and include urgency, frequency, hesitancy, nocturia and incontinence. Addressing urinary dysfunction is one of the top 10 priority research areas identified by the James Lind Alliance and Parkinson’s UK. Objectives Conduct a randomised controlled trial (RCT) targeting people with Parkinson’s disease (PwP) who have self-reported problematic lower urinary tract symptoms, investigating the effectiveness of transcutaneous tibial nerve stimulation (TTNS) compared with sham TTNS. Implement a standardised training approach and package for the correct application of TTNS. Conduct a cost-effectiveness analysis of TTNS compared with sham TTNS. Methods and analysis An RCT of 6 weeks with twice weekly TTNS or sham TTNS. Participants will be recruited in 12 National Health Service neurology/movement disorder services, using a web-based randomisation system, and will be shown how to apply TTNS or sham TTNS. Participants will receive a weekly telephone call from the researchers during the intervention period. The trial has two coprimary outcome measures: International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form and the International Prostate Symptom Score. Secondary outcomes include a 3-day bladder diary, quality of life, acceptability and fidelity and health economic evaluation. Outcomes will be measured at 0, 6 and 12 weeks. A sample size of 208 randomised in equal numbers to the two arms will provide 90% power to detect a clinically important difference of 2.52 points on the Internatioanl Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF) and of 3 points in the International Prostate Symptom Score total score at 12 weeks at 5% significance level, based on an SD of 4.7 in each arm and 20% attrition at 6 weeks. Analysis will be by intention to treat and pre defined in a statistical analysis plan Ethics and dissemination East of Scotland Research Ethics Service (EoSRES), 18/ES00042, obtained on 10 May 2018. The trial will allow us to determine effectiveness, safety, cost and acceptability of TTNS for bladder dysfunction in PWP. Results will be published in open access journals; lay reports will be posted to all participants and presented at conferences. Trial registration number ISRCTN12437878; Pre-results

Roman mining on Exmoor: a geomorphological approach at Anstey's Combe, Dulverton

A survey of valley fills in south-facing combes (headwater valleys) along the south side of the Exmoor massif revealed an anomalously deep infill in one valley. This infill of up to 5 m depth had been gullied revealing a complex stratigraphy. Studies of the stratigraphy, clast orientation and shape suggested several accumulation episodes under different environmental conditions commencing in a periglacial climatic regime. Later units included sandy silts which can be dated using optically stimulated luminescence (OSL) of quartz grains. The OSL dates, indicate that the inter-gravel silts accumulated in two periods, the Romano-British period and the 16th-17th centuries AD. A survey of the very small valley catchment revealed a linear trench of a type associated with early iron mining. Given the anomalously high volume of accumulated sediment from such a small catchment and evidence of mining on the slope above the site, the geomorphic mechanism is almost certainly the downslope transport of mining debris from the slope to the valley floor. This study suggests that the systematic survey of headwater valleys in metalliferous uplands may be one way of locating areas of early mining activity and that such deposits could provide a chronology of working and abandonment

Individualised pelvic floor muscle training in women with pelvic organ prolapse: a multicentre randomised controlled trial

&lt;br&gt;Background: Pelvic organ prolapse is common and is strongly associated with childbirth and increasing age. Women with prolapsed are often advised to do pelvic floor muscle exercises, but supporting evidence is limited. Our aim was to establish if one-to-one individualised pelvic floor muscle training (PFMT) is effective in reducing prolapse symptoms.&lt;/br&gt; &lt;br&gt;Methods: A parallel‐group multicentre randomised controlled trial (ISRCTN35911035) in female outpatients with newly-diagnosed, symptomatic stage I, II or III prolapse, comparing five PFMT appointments over 16 weeks (n=225) versus a lifestyle advice leaflet (n=222). Treatment allocation was by remote computer allocation using minimisation. Our primary endpoint was participants’ self-report of prolapsed symptoms at 12 months. Group assignment was masked from outcome assessors. We compared outcomes between trial groups in an intention-to-treat analysis. The cost of PFMT and savings on subsequent treatments were calculated to estimate cost-effectiveness.&lt;/br&gt; &lt;br&gt;Findings: Compared to the control group, the intervention group reported fewer prolapse symptoms at 12 months (mean difference between groups in change score 1.52, 95% CI [0.46, 2.59], p=0.0053); reported their prolapse to be “better” more often (57.2% versus 44.7%, difference 12.6%, 95% CI [1.1%, 24.1%], p=0.0336); and had an increased but non-significant odds of having less severe stage of prolapse at their 6-month clinical examination, (OR 1.47, 95% CI [0.97, 2.27], p=0.07). The control group had a greater uptake of other prolapse treatment (49.6% versus 24.1%, difference 25.5%, 95% CI [14.5%, 36.0%], p &#60;0.0001). Findings were robust to missing data. The net cost of the 25 intervention was £131.61 per woman and the cost per one-point reduction in the symptom score was £86.59, 95% CI [£50.81, £286.11]. &lt;/br&gt