Risk of maternal and neonatal complications in subsequent pregnancy after planned caesarean section in a first birth, compared with emergency caesarean section: a nationwide comparative cohort study

To compare the difference in risks of neonatal and maternal complications, including uterine rupture, in a second birth following a planned caesarean section versus emergency caesarean section in the first birth. Prospective cohort study. Population-based cohort in the Netherlands. Linked data set of outcomes for term caesarean section in a first birth followed by a consecutive delivery. We conducted a prospective cohort analysis using data from the Dutch Perinatal Registry. We included primiparous women who gave birth to term singleton infants through planned or emergency caesarean from January 2000 through December 2007, and who had a second singleton delivery during the same period (n = 41,109). Odds ratios and adjusted odds ratios were calculated. Maternal and neonatal complications, specifically uterine rupture, in second births associated with planned and emergency caesareans in the first birth. Women with a history of a planned caesarean section in the first birth (n = 11,445) had a 0.24% risk for uterine rupture, compared with a 0.16% risk for women with a history of emergency caesarean section (n = 29,664; aOR 1.4, 95% CI 0.8-2.4). In multivariate logistic regression, women with planned caesareans in a first birth had a significantly increased risk of stillbirth (aOR 1.5, 95% CI 1.0-2.2) and postpartum haemorrhage (aOR 1.1, 95% CI 1.0-1.2) in second births, compared with women with emergency caesareans in the first birth. We found a moderately increased risk of postpartum haemorrhage and a small to moderately increased risk of uterine rupture and stillbirth as a long-term effect of prior planned caesarean delivery on second birth

Sleep Outcomes in Youth With Chronic Pain Participating in a Randomized Controlled Trial of Online Cognitive-Behavioral Therapy for Pain Management

Sleep disturbances are commonly reported in youth with chronic pain. We examined whether online cognitive-behavioral therapy (CBT) for pain management would impact youth’s sleep. Subjective sleep quality and actigraphic sleep were evaluated in 33 youth (M=14.8 years; 70% female) with chronic pain participating in a larger randomized controlled trial of online-CBT. The Internet treatment condition (n=17) received 8-10 weeks of online-CBT + standard care and the wait-list control condition (n=16) continued with standard care. Although pain improved with online-CBT, no changes were observed in sleep outcomes. Shorter pre-treatment sleep duration was associated with less improvement in post-treatment functioning. Findings underscore the need for further development in psychological therapies to more intensively target sleep loss in youth with chronic pain

Rational and responsible medicines use

Appropriate use of medicines in the last decade has had a positive influence on health that has decreased disease burden, reduced mortality, and improved the overall quality of life. Nevertheless, this has also given rise to irrational, inappropriate, and ineffective use of medicines. National medicine policies often govern rational medicine use in any country, but unfortunately the need for rational medicine use is higher in developing countries that have limited financial resources and multiple pressing needs. A multifaced intervention to promote rational and responsible medicine use appears to be more effective in these countries. However, the conflicting demands and weakened collaboration between health systems often hinder the implementation of effective interventions. Hence, combating irrational use of medicine requires institutionalization of an approach into the healthcare system with adequate investment in infrastructure development and capacity building

Carbon pricing of food in Australia: an analysis of the health, environmental and public finance impacts

Abstract Objective: To estimate the impact of integrating the price of greenhouse gas emissions into the price of food commodities on dietary and weight‐related risk factors and associated disease burden in Australia, as well as on national emissions reductions and public revenues. Methods: We used country‐specific data for Australia to build a coupled modelling framework that includes economic, environmental and health analyses. Data sources included the 2011‐12 Australian food and nutrition survey, meta‐analysis of food‐related lifecycle emissions, and price and income elasticities. Consumption‐related changes in disease burden were calculated using a comparative risk assessment framework with 11 disease states and seven diet and weight‐related risk factors. Results: Including a price of $23 per tonne of carbon dioxide equivalent (tCO2‐eq) – the starting price of the former Australian carbon pricing mechanism – into the price of food commodities in our model simulations led to 49,500 avoided disability‐adjusted life years (DALYs) (95$866 million. Conclusion: Incorporating the price of food‐related greenhouse gas emissions into the price of food commodities in Australia could be beneficial for population health, while generating public finance revenues and supporting Australia's emission‐reduction commitment. Implications for public health: Climate policies that integrate the price of greenhouse gas emissions into the price of food commodities in Australia are compatible with public health objectives to reduce diet‐related disease mortality