The lower prevalence of female genital mutilation in the Netherlands: a nationwide study in Dutch midwifery practices

OBJECTIVES: To determine the prevalence of female genital mutilation (FGM) in women giving birth in 2008 in the Netherlands. METHOD: A retrospective questionnaire study was conducted. The study covered all 513 midwifery practices in the Netherlands. The data were analysed with SPSS 17.0. RESULTS: The response from midwifery practices was 93% (n = 478). They retrospectively reported 470 circumcised women in 2008 (0.32%). The expected prevalence in the Netherlands based on the estimated prevalence of FGM in the country of birth was 0.7%. It is likely that there was underreporting in midwifery practices since midwives do not always enquire about the subject and may not notice the milder types of FGM. Midwives who checked their records before answering our questionnaire reported a prevalence of 0.8%. CONCLUSION: On the basis of this study, we can conclude that FGM is a serious clinical problem in Europe for migrant women from risk countries for FGM. These women should receive extra attention from obstetricians and midwives during childbirth, since almost half are mutilated and FGM involves a risk of complications during delivery for both women and children.Public Health and primary car

An overview of jets and outflows in stellar mass black holes

In this book chapter, we will briefly review the current empirical understanding of the relation between accretion state and and outflows in accreting stellar mass black holes. The focus will be on the empirical connections between X-ray states and relativistic (`radio') jets, although we are now also able to draw accretion disc winds into the picture in a systematic way. We will furthermore consider the latest attempts to measure/order jet power, and to compare it to other (potentially) measurable quantities, most importantly black hole spin.Comment: Accepted for publication in Space Science Reviews. Also to appear in the Space Sciences Series of ISSI - The Physics of Accretion on to Black Holes (Springer Publisher

Cost-effectiveness of extracorporeal cardiopulmonary resuscitation after in-hospital cardiac arrest

Background: This study aimed to estimate the cost-effectiveness of extracorporeal cardiopulmonary resuscitation (ECPR) for in-hospital cardiac arrest treatment. Methods: A decision tree and Markov model were constructed based on current literature. The model was conditional on age, Charlson Comorbidity Index (CCI) and sex. Three treatment strategies were considered: ECPR for patients with an Age-Combined Charlson Comorbidity Index (ACCI) below different thresholds (2–4), ECPR for everyone (EALL), and ECPR for no one (NE). Cost-effectiveness was assessed with costs per quality-of-life adjusted life years (QALY). Measurements and main results: Treating eligible patients with an ACCI below 2 points costs 8394 (95% CI: 4922–14,911) euro per extra QALY per IHCA patient; treating eligible patients with an ACCI below 3 costs 8825 (95% CI: 5192–15,777) euro per extra QALY per IHCA patient; treating eligible patients with an ACCI below 4 costs 9311 (95% CI: 5478–16,690) euro per extra QALY per IHCA patient; treating every eligible patient with ECPR costs 10,818 (95% CI: 6357–19,400) euro per extra QALY per IHCA patient. For WTP thresholds of 0–9500 euro, NE has the highest probability of being the most cost-effective strategy. For WTP thresholds between 9500 and 12,500, treating eligible patients with an ACCI below 4 has the highest probability of being the most cost-effective strategy. For WTP thresholds of 12,500 or higher, EALL was found to have the highest probability of being the most cost-effective strategy. Conclusions: Given that conventional WTP thresholds in Europe and North-America lie between 50,000–100,000 euro or U.S. dollars, ECPR can be considered a cost-effective treatment after in-hospital cardiac arrest from a healthcare perspective. More research is necessary to validate the effectiveness of ECPR, with a focus on the long-term effects of complications of ECPR

THE VALUE TO THE SURGEON OF PARATHYROID HORMONE ASSAYS IN PRIMARY HYPERPARATHYROIDISM

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/72424/1/j.1445-2197.1988.tb01084.x.pd

An Integrated TCGA Pan-Cancer Clinical Data Resource to Drive High-Quality Survival Outcome Analytics

For a decade, The Cancer Genome Atlas (TCGA) program collected clinicopathologic annotation data along with multi-platform molecular profiles of more than 11,000 human tumors across 33 different cancer types. TCGA clinical data contain key features representing the democratized nature of the data collection process. To ensure proper use of this large clinical dataset associated with genomic features, we developed a standardized dataset named the TCGA Pan-Cancer Clinical Data Resource (TCGA-CDR), which includes four major clinical outcome endpoints. In addition to detailing major challenges and statistical limitations encountered during the effort of integrating the acquired clinical data, we present a summary that includes endpoint usage recommendations for each cancer type. These TCGA-CDR findings appear to be consistent with cancer genomics studies independent of the TCGA effort and provide opportunities for investigating cancer biology using clinical correlates at an unprecedented scale. Analysis of clinicopathologic annotations for over 11,000 cancer patients in the TCGA program leads to the generation of TCGA Clinical Data Resource, which provides recommendations of clinical outcome endpoint usage for 33 cancer types