Learning from a Rapid Health Impact Assessment of a proposed maternity service reconfiguration in the English NHS

<p>Abstract</p> <p>Background</p> <p>Within many parts of the country, the NHS is undertaking reconfiguration of services. Such proposals can prove a tipping point and provoke public protest, often with significant involvement of local and national politicians. We undertook a rapid Health Impact Assessment (HIA) of a proposed reconfiguration of maternity services in Huddersfield and Halifax in England. The aim of the HIA was to help the PCT Boards to assess the reconfiguration's possible consequences on access to maternity services, and maternal and infant health outcomes across different socio-economic groups in Kirklees. We report on the findings of the HIA and the usefulness of the process to decision making.</p> <p>Methods</p> <p>This HIA used routine maternity data for 2004–2005 in Huddersfield, in addition to published evidence. Standard HIA techniques were used.</p> <p>Results</p> <p>We re-highlighted the socio economic differences in smoking status at booking and quitting during pregnancy. We focused on the key concerns of the public, that of adverse obstetric events on a Midwife Led Unit (MLU) with distant obstetric cover. We estimate that twenty percent of women giving birth in a MLU may require urgent transfer to obstetric care during labour. There were no significant socio economic differences. Much of the risk can be mitigated though robust risk management policies. Additional travelling distances and costs could affect lower socio-economic groups the greatest because of lower car ownership and geographical location in relation to the units. There is potential that with improved community antenatal and post natal care, population outcomes could improve significantly, the available evidence supports this view.</p> <p>Conclusion</p> <p>Available evidence suggests that maternity reconfiguration towards enhanced community care could have many potential benefits but carries risk. Investment is needed to realise the former and mitigate the latter.</p> <p>The usefulness of this Health Impact Assessment may have been impeded by its timing, and the politically charged environment of the proposals. Nonetheless, the methods used are readily applicable to assess the impact of other service reconfigurations. The analysis was simple, not time intensive and used routinely available data. Careful consideration should be given to both the timing and the political context in which an analysis is undertaken.</p

A Roman Roadside Settlement at Healam Bridge: The Iron Age to Early Medieval Evidence

Evidence for pre-Roman Iron Age through to post-Roman activity was revealed during a major programme of archaeological investigation undertaken as an integral part of the construction scheme to widen the A1 trunk road between Dishforth and Leeming Bar in North Yorkshire. Significant archaeological remains were encountered at Healam Bridge, a scheduled Roman settlement located on Dere Street Roman road, midway between the walled towns of Isuriam Brigantum and Cataractonium (the modern villages of Aldborough and Catterick). This two-volume set presents the results and discussion of the excavations and analysis of the environmental and human remains (Volume 1), and the analysis of the artefactual assemblages (Volume 2). Evidence from Healam Bridge indicates activity dating from the early 2nd century AD into the Anglo-Saxon period. The location of the site astride the main Roman route to the north of England and Scotland was reflected in the wide range of pottery and other finds recovered, and activities such as iron-smithing are likely to have served the passing trade as much as the local community. The extensive animal bone assemblage suggested that horse, possibly mule, breeding was a significant activity at Healam Bridge throughout the Roman period. This archive presents appendices B-I and supplementary material resulting from the programme of archaeological works undertaken during the construction scheme to widen the A1 trunk road between Dishforth and Leeming Bar in North Yorkshire. The Iron Age to early medieval evidence from Healam Bridge, along with other evidence for Roman activity along the route is published in two volumes as: Ambrey, C., Fell, D., Fraser, R., Ross, S., Speed, G., and Wood, P. N. (2017) A Roman Roadside Settlement at Healam Bridge. The Iron Age to early medieval evidence. Volume 1: Archaeological narrative, environmental evidence, and human remains. Northern Archaeological Associates Monograph Series Volume 3. Barnard Castle: Northern Archaeological Associates. Ambrey, C., Fell, D., Fraser, R., Ross, S., Speed, G., and Wood, P. N. (2017) A Roman Roadside Settlement at Healam Bridge. The Iron Age to early medieval evidence. Volume 2: Artefacts. Northern Archaeological Associates Monograph Series Volume 3. Barnard Castle: Northern Archaeological Associates. This digital archive includes appendices referenced within the two volumes: Volume 1: title page, acknowledgements, and summary Volume 2: title page, acknowledgements, and summary Appendix B: Table 98 Field Numbers and Chainage Concordance Appendix C: Environmental Remains by Context Appendix D: Environmental Remains Tables 29 to 94 Appendix E: Measurement Archive of Vertebrate Remains Appendix F: Environmental Remains Raw Data, Healam Bridge Appendix G: Environmental Remains Raw Data, Non-Healam Bridge Appendix H: Pottery raw data and supplementary data to support figures in Volume 2 of the publication Appendix I: Key to Coin Catalogue and Table 128 Coin Catalogue The finds, paper, and full digital archive is hosted by the Yorkshire Museum, York Museums Trust. The accession number is YORYM : 2013.78

Range extension of the Short-beaked Echidna Tachyglossus aculeatus (Monotremata: Tachyglossidae) and the Northern Brown Bandicoot Isoodon macrourus (Marsupialia: Peramelidae) in Queensland: Mua (Moa Island), Torres Strait

Until recently there have been no confirmed records of medium-sized native terrestrial mammals from the Torres Strait Islands, far north Queensland. The Short-beake Echidna (Tachyglossus aculeatus Shaw, 1792) and the Northern Brown Bandicoot(Isoodon macrourus Gould, 1842) are reported here occurring on Mua (Moa Island). This is the most northerly known occurrence of these species in Australia; both also occur in New Guinea