Operative technique at caesarean delivery and risk of complete uterine rupture in a subsequent trial of labour at term. A registry case-control study

To estimate the relation of single-layer closure at previous caesarean delivery, and other pre-labour and intra-partum risk factors for complete uterine rupture in trial of vaginal birth after a caesarean (TOLAC) at term.Population-based case-control study. We identified all women (n = 39 742) recorded in the Danish Medical Birth Registry (DMBR) during a 12-year period (1997-2008) with a singleton pregnancy at term and TOLAC. Among these, all women with a complete uterine rupture were identified (cases). Information from the registry was validated against medical records. Controls were selected in the DMBR as the following two births with TOLAC at term and no uterine rupture. Detailed information from cases and controls was collected from manual review of medical records. Main outcome measure was complete uterine rupture during TOLAC at term.Upon validation, 175 cases and 272 controls met the above criteria. After adjustment for possible confounding factors there was no association between single layer closure and uterine rupture (aOR 1.38, CI: 0.88-2.17). Significant risk factors were: Induction with an unfavourable cervix (aOR 2.10 CI: 1.19-3.71), epidural (aOR 2.17 CI 1.31-3.57), augmentation by oxytocin for more than one hour (aOR 2.03 CI: 1.20-3.44), and birth weight ≥ 4000g (aOR 2.65 CI 1.05-6.64). Previous vaginal delivery (aOR 0.41 CI: 0.25-0.68) and inter-delivery interval of more than 24 months (aOR 0.38 CI: 0.18-0.78) reduced the risk of uterine rupture.Single-layer uterine closure did not remain significantly associated to uterine rupture during TOLAC at term after adjustment for confounding factors. Induction of labour with an unfavourable cervix, birth weight ≥ 4000g and indicators of prolonged labour were all major risk factors for uterine rupture

Systemic risk in the Danish interbank netting system

Central banks have become increasingly worried about systemic risks to the financial market and infrastructure stemming from payment systems. Failure to settle by a participant in a netting system can potentially jeopardize the settlement of other participants. The fear of a systemic crisis has been one of the primary motivations for the introduction of Real Time Gross Settlement systems around the world. This paper provides an assessment of the systemic risk inherent in the Danish interbank netting system. In accordance with similar empirical studies conducted in other European countries, the risk is found to be low

Understanding and Treating the Psychosocial Consequences of Infertility

Psychological distress and infertility are linked in a complex pattern, such that distress may be a cause of infertility and reduce the probability of achieving a pregnancy at the same time that infertility may be a cause of psychological distress. Although infertile women are not more likely to be characterized by psychopathology, they are more likely to experience higher levels of distress than comparison groups. Infertile men also experience psychological distress, but women experience more infertility distress than men. Both infertility and its treatment are stressors putting a heavy psychological strain on couple relationships. Whereas there is general agreement about the need for psychological interventions to treat infertility distress, little is known about the efficacy and effectiveness of psychosocial intervention. Given the prevalence of infertility and the fact that the numbers of individuals and couples seeking infertility treatments are increasing, it is essential that mental health professionals understand the emotional challenges faced by this population.https://digitalcommons.chapman.edu/mft_books/1002/thumbnail.jp

Data Resource: The National Pupil Database (NPD)

Introduction: The National Pupil Database (NPD) is a record-level administrative data resource curated by the UK government's Department for Education that is used for funding purposes, school performance tables, policy making, and research. Processes Data are sourced from schools, exam awarding bodies, and local authorities who collect data on an on-going basis and submit to the Department for Education either termly or yearly. Data contents NPD contains child-level and school-level data on all pupils in state schools in England (6.6 million in the 2016/17 academic year). The primary module is the census, which has information on characteristics and school enrolment. Other modules include alternative provision, exam attainment, absence and exclusions. Data from children's social care are also available on children referred for support and those who become looked after. Children's records are linkable across different modules and across time using a nationally unique, anonymised child-level identifier. Linkage to external datasets has also been accomplished using child-level identifiers. Conclusions The NPD is an especially valuable data resource for researchers interested in the educational experience and outcomes of children and young people in England. Although limited by the fact that children in private schools or who are home schooled are not included, it provides a near-complete picture of school trajectories and outcomes for the majority of children. Linkage to other datasets can enhance analyses and provide answers to questions that would otherwise be costly, time consuming and difficult to find

Impact of Pneumococcal Conjugate Vaccines on Pneumonia Hospitalizations in High- and Low-Income Subpopulations in Brazil.

BackgroundPneumococcal conjugate vaccines (PCVs) are being used worldwide. A key question is whether the impact of PCVs on pneumonia is similar in low- and high-income populations. However, most low-income countries, where the burden of disease is greatest, lack reliable data that can be used to evaluate the impact. Data from middle-income countries that have both low- and high-income subpopulations can provide a proxy measure for the impact of the vaccine in low-income countries.MethodsWe evaluated the impact of PCV10 on hospitalizations for all-cause pneumonia in Brazil, a middle-income country with localities that span a broad range of human development index (HDI) levels. We used complementary time series and spatiotemporal methods (synthetic controls and hierarchical Bayesian spatial regression) to test whether the decline in pneumonia hospitalizations associated with vaccine introduction varied across the socioeconomic spectrum.ResultsWe found that the declines in all-cause pneumonia hospitalizations in children and young and middle-aged adults did not vary substantially across low and high HDI subpopulations. Moreover, the estimated declines seen in infants and young adults were associated with higher levels of uptake of the vaccine at a local level.ConclusionsThese results suggest that PCVs have an important impact on hospitalizations for all-cause pneumonia in both low- and high-income populations

Evaluation of pushing out of children from all English state schools: Administrative data cohort study of children receiving social care and their peers

Background: Pushing out (off-rolling) occurs where pupils are illegally excluded from school. Those receiving children's social care (CSC) services (children in need (CiN), on child protection plans (CPPs) or looked after (CLA)) are thought to be at increased risk, but limited evidence inhibits understanding of this phenomenon. The extent of pushing out can be inferred from non-enrolment in administrative data. Objective: To estimate proportions of children not enrolled across secondary school (aged 11–16, up to year 11) and to explore the association between CSC history and non-enrolment in year 10/11. Participants and setting: >1 M pupils in year 7 (aged 11/12) in English state schools, 2011/12 and 2012/13. Methods: We estimated the proportion of children not enrolled across years 8 to 11, disaggregated by CSC history. We assessed with regression modelling the association between CSC history and non-enrolment in years 10/11. Results: Of children without CSC history, 3.8% had ≥1 year not enrolled by year 11. This was higher in those with a history CiN (8.1%), CPP (9.4%) or CLA (10.4%) status. The odds of non-enrolment in years 10/11 were higher among those with CLA history vs non-exposed peers (OR 4.76, 95% CI 4.49–5.05) as well as in those with CPP history (3.60, 3.39–3.81) and CiN history (2.53, 2.49–2.58). History of special educational needs further increased non-enrolment odds, including after confounder adjustment. Conclusions: Findings imply that children with CSC history are more likely to be pushed out from school than children without, especially those with special educational needs