The ideological divide in confidence in science and participation in medical research

Abstract In the United States, the wide ideological divergence in public confidence in science poses a potentially significant problem for the scientific enterprise. We examine the behavioral consequences of this ideological divide for Americans’ contributions to medical research. Based on a mass survey of American adults, we find that engagement in a wide range of medical research activities is a function of a latent propensity to participate. The propensity is systematically higher among liberals than among conservatives. A substantial part of this ideological divide is due to conservative Americans’ lower confidence in science. These findings raise important issues for the recruitment of subjects for medical studies and the generalizability of results from such studies

Woman-centred maternity care: what do women say? Protocol for a survey of women receiving maternity care in NSW

Background: Over the past decade or so, recommendations for improvements in maternity care have emphasised the importance of providing woman-centred care. Feedback from women about existing maternity services can help to identify whether services are currently meeting women’s needs. The present study aims to capture women’s expectations of, and experiences with maternity care, and to explore whether maternal and birth characteristics are associated with those experiences. Methods: A survey will be undertaken with a sample of approximately 2,000 women who have given birth over a 3-month period at seven public maternity units in two neighbouring health districts in New South Wales (NSW), Australia. The survey will be mailed out three-four months after birth. The study will also examine two strategies intended to increase survey response rates: use of two types of pre-notification letters, and request for consent from women to link survey responses with health information recorded at the time of birth. Data analysis will examine response rate, evidence of sample bias and effect of pre-notification letters; describe expectations and experiences with maternity care and associations with maternal and/or health characteristics; and where possible, compare results with maternity satisfaction data reported by others. Discussion: This study will provide, for the first time in NSW, comprehensive information about women’s expectations, experiences and satisfaction with maternity services in two local health districts. It will identify aspects of care that are meeting women’s needs, and areas where care and service provision may be improved in line with the aspirations of Towards Normal Birth. The survey tool may also prove to be appropriate for use by other health districts and/or state-wide.NHMR

Woman-centred maternity care: what do women say? Protocol for a survey of women receiving maternity care in NSW

Background: Over the past decade or so, recommendations for improvements in maternity care have emphasised the importance of providing woman-centred care. Feedback from women about existing maternity services can help to identify whether services are currently meeting women’s needs. The present study aims to capture women’s expectations of, and experiences with maternity care, and to explore whether maternal and birth characteristics are associated with those experiences. Methods: A survey will be undertaken with a sample of approximately 2,000 women who have given birth over a 3-month period at seven public maternity units in two neighbouring health districts in New South Wales (NSW), Australia. The survey will be mailed out three-four months after birth. The study will also examine two strategies intended to increase survey response rates: use of two types of pre-notification letters, and request for consent from women to link survey responses with health information recorded at the time of birth. Data analysis will examine response rate, evidence of sample bias and effect of pre-notification letters; describe expectations and experiences with maternity care and associations with maternal and/or health characteristics; and where possible, compare results with maternity satisfaction data reported by others. Discussion: This study will provide, for the first time in NSW, comprehensive information about women’s expectations, experiences and satisfaction with maternity services in two local health districts. It will identify aspects of care that are meeting women’s needs, and areas where care and service provision may be improved in line with the aspirations of Towards Normal Birth. The survey tool may also prove to be appropriate for use by other health districts and/or state-wide.NHMR

First trimester screening of serum soluble fms-like tyrosine kinase-1 and placental growth factor predicting hypertensive disorders of pregnancy

AbstractObjectiveTo assess the accuracy of first trimester soluble fms-like tyrosine kinase-1 (sFlt-1) and placental growth factor (PlGF) in predicting pregnancy hypertension and pre-eclampsia; and compare with the accuracy of routinely collected maternal and clinical risk factors.Study designIn this population-based cohort study, serum sFlt-1 and PlGF levels were measured in first trimester in 2,681 women with singleton pregnancies in New South Wales, Australia.Main outcome measuresPrediction of pregnancy hypertension and pre-eclampsia.ResultsThere were 213 (7.9%) women with pregnancy hypertension, including 68 (2.5%) with pre-eclampsia. The area under the curve (AUC) for both sFlt-1 and PlGF was not different from chance, but combined was 0.55 (P=0.005). Parity and previous diagnosed hypertension had better predictive accuracy than serum biomarkers (AUC=0.64, P<0.001) and the predictive accuracy for all maternal and clinical information was fair (AUC=0.70, P<0.001 for pregnancy hypertension and AUC=0.74, P<0.001 for pre-eclampsia). Adding sFlt-1 and PlGF to maternal risk factors did not improve the ability of the models to predict pregnancy hypertension or pre-eclampsia.ConclusionsMaternal first trimester serum concentrations of sFlt-1 and PlGF do not predict hypertensive disorders in pregnancy any better than routinely collected clinical and maternal risk factor information. Screening for sFlt-1 and PlGF levels in early pregnancy would not identify those pregnancies at-risk

Predicting date of birth: the best time to date a pregnancy?

Objective: To compare the estimated date of birth calculations from last menstrual period (LMP) and ultrasounds at varying gestations (<70, 70-106, 110-140, 141-196 and 200-276) against the actual date of birth (DOB). Methods: This cohort study in a single local health district, Australia included 18,708 women with spontaneous labor who gave birth to a single live born infant without major anomalies between 2007 and 2011. Data were sourced from a computerized population birth database. The outcome of interest was duration of pregnancy expressed as total days, and the difference between actual DOB and estimated date of birth by dating method. Results: Only 5% of births occurred on the estimated date of birth regardless of the timing of the estimate. Approximately 66% of births occurred +/-7 days of the estimated date of birth, and there was little difference between ultrasound gestational week bands. The 110-140 weeks of gestation ultrasound performed as well if not better than ultrasounds conducted at other gestations. Maternal factors such as ethnicity and smoking status during pregnancy influenced duration of pregnancy; however, their explanatory power was too low to support incorporating these characteristics in dating estimations. Conclusion: An early dating scan (10 weeks or earlier) is unnecessary if LMP is reliable.Australian National Health and Medical Research Council (NHMRC) Centre for Research Excellence Grant (#APP1001066), Sydney Medical School Summer Research Scholarship, NHMRC Senior Research Fellowship (#APP1021025)

First trimester screening of serum soluble fms-like tyrosine kinase-1 and placental growth factor predicting hypertensive disorders of pregnancy

AbstractObjectiveTo assess the accuracy of first trimester soluble fms-like tyrosine kinase-1 (sFlt-1) and placental growth factor (PlGF) in predicting pregnancy hypertension and pre-eclampsia; and compare with the accuracy of routinely collected maternal and clinical risk factors.Study designIn this population-based cohort study, serum sFlt-1 and PlGF levels were measured in first trimester in 2,681 women with singleton pregnancies in New South Wales, Australia.Main outcome measuresPrediction of pregnancy hypertension and pre-eclampsia.ResultsThere were 213 (7.9%) women with pregnancy hypertension, including 68 (2.5%) with pre-eclampsia. The area under the curve (AUC) for both sFlt-1 and PlGF was not different from chance, but combined was 0.55 (P=0.005). Parity and previous diagnosed hypertension had better predictive accuracy than serum biomarkers (AUC=0.64, P<0.001) and the predictive accuracy for all maternal and clinical information was fair (AUC=0.70, P<0.001 for pregnancy hypertension and AUC=0.74, P<0.001 for pre-eclampsia). Adding sFlt-1 and PlGF to maternal risk factors did not improve the ability of the models to predict pregnancy hypertension or pre-eclampsia.ConclusionsMaternal first trimester serum concentrations of sFlt-1 and PlGF do not predict hypertensive disorders in pregnancy any better than routinely collected clinical and maternal risk factor information. Screening for sFlt-1 and PlGF levels in early pregnancy would not identify those pregnancies at-risk

Angiopoietin 1 and 2 serum concentrations in first trimester of pregnancy as biomarkers of adverse pregnancy outcomes

Objective: To assess Ang-1, Ang-2 and the Ang-1/Ang-2 ratio levels in the first trimester of pregnancy, their association with adverse pregnancy outcomes; and their predictive accuracy. Study Design: This cohort study measured serum Ang-1 and Ang-2 levels in 4,785 women with singleton pregnancies attending first trimester screening in New South Wales, Australia. Multivariate logistic regression models were used to assess the association and predictive accuracy of serum biomarkers with subsequent adverse pregnancy outcomes (small for gestational age, preterm birth, preeclampsia, miscarriage >10 weeks and stillbirth). Results: Median (interquartile range) levels for Ang-1, Ang-2 and the Ang-1/Ang-2 ratio for the total population were 19.6 ng/ml (13.6-26.4), 15.5 ng/ml (10.3-22.7) and 1.21 (0.83-1.73), respectively. Maternal age, weight, country of birth and socio-economic status significantly affected Ang-1, Ang-2 and the Ang-1/Ang-2 ratio levels. After adjusting for maternal and clinical risk factors, women with low Ang-2 levels (90th centile) had increased risk of developing most adverse pregnancy outcomes. Compared to the Ang-1/Ang-2 ratio alone, maternal and clinical risk factors had better predictive accuracy for most adverse pregnancy outcomes. The exception was miscarriage [Ang-1/Ang-2 ratio area under ROC curve (AUC) =0.70; maternal risk factors AUC =0.58]. Overall, adding the Ang-1/Ang-2 ratio to maternal risk factors did not improve the ability of the models to predict adverse pregnancy outcomes. Conclusions: Our findings suggest that the Ang-1/Ang-2 ratio in first trimester is associated with most adverse pregnancy outcomes, but do not predict outcomes any better than clinical and maternal risk factor information.Australian National Health and Medical Research Council (NHMRC) Project Grant (#632653)

Maternity Care in NSW - Having Your Say 2013-14. A survey about women’s views of their maternity care

This report details the findings of a survey with women about their expectations and experiences of maternity care in public hospitals in New South Wales (NSW), Australia. The report provides background information about the survey project, and a summary of the responses from the women participating in the survey. The survey and this report have been structured around the three main maternity care periods: antenatal (pregnancy); birth; and postnatal (the first days and weeks after birth). All women who gave birth between 1 May and 31 July 2013 at seven public maternity units in NSW were eligible to participate in the survey. These seven maternity units account for approximately 11% of births in public hospitals in NSW, and represent a mixture of urban and regional, and tertiary and smaller health services. A total of 2048 women were mailed a survey. Survey packs were returned as undeliverable for 59 women, and 913 women returned a completed survey, representing a response rate of 46% (913/1989).NHMR

Maternity Care in NSW - Having Your Say 2013-14. A survey about women’s views of their maternity care

This report details the findings of a survey with women about their expectations and experiences of maternity care in public hospitals in New South Wales (NSW), Australia. The report provides background information about the survey project, and a summary of the responses from the women participating in the survey. The survey and this report have been structured around the three main maternity care periods: antenatal (pregnancy); birth; and postnatal (the first days and weeks after birth). All women who gave birth between 1 May and 31 July 2013 at seven public maternity units in NSW were eligible to participate in the survey. These seven maternity units account for approximately 11% of births in public hospitals in NSW, and represent a mixture of urban and regional, and tertiary and smaller health services. A total of 2048 women were mailed a survey. Survey packs were returned as undeliverable for 59 women, and 913 women returned a completed survey, representing a response rate of 46% (913/1989).NHMR

Rate of spontaneous onset of labour before planned repeat caesarean section at term

In an auditory lexical decision experiment, 5,541 spoken content words and pseudo-words were presented to 20 native speakers of Dutch. The words vary in phonological makeup and in number of syllables and stress pattern, and are further representative of the native Dutch vocabulary in that most are morphologically complex, comprising two stems or one stem plus derivational and inflectional suffixes, with inflections representing both regular and irregular paradigms; the pseudo-words were matched in these respects to the real words. The BALDEY data file includes response times and accuracy rates, with for each item morphological information plus phonological and acoustic information derived from automatic phonemic segmentation of the stimuli. Two initial analyses illustrate how this data set can be used. First, we discuss several measures of the point at which a word has no further neighbors, and compare the degree to which each measure predicts our lexical decision response outcomes. Second, we investigate how well four different measures of frequency of occurrence (from written corpora, spoken corpora, subtitles and frequency ratings by 70 participants) predict the same outcomes. These analyses motivate general conclusions about the auditory lexical decision task. The (publicly available) BALDEY database lends itself to many further analyses