48 results
Metformin in obese pregnancy has no adverse effects on cardiovascular risk in early childhood
- Liu Yang, Lauren Lacey, Sonia Whyte, Siobhan Quenby, Fiona C. Denison, Neeraj Dhaun, Jane E. Norman, Amanda J. Drake, Rebecca M. Reynolds
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- Journal:
- Journal of Developmental Origins of Health and Disease / Volume 13 / Issue 3 / June 2022
- Published online by Cambridge University Press:
- 17 June 2021, pp. 390-394
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Metformin is widely used in pregnancy, despite lack of long-term safety for children. We hypothesised that metformin exposure in utero is associated with increased cardiovascular risk. We tested this hypothesis in a follow-up study of children born to obese mothers who had participated in a randomised controlled trial of metformin versus placebo in pregnancy (EMPOWaR). We measured body composition, peripheral blood pressure (BP), arterial pulse wave velocity and central haemodynamics (central BP and augmentation index) using an oscillometric device in 40 children of mean (SD) age 5.78 (0.93) years, exposed to metformin (n = 19) or placebo (n = 21) in utero. There were no differences in any of the anthropometric or vascular measures between metformin and placebo-exposed groups in univariate analyses, or after adjustment for potential confounders including the child’s behaviour, diet and activity levels. Post-hoc sample size calculation indicated we would have detected large clinically significant differences between the groups but would need an unfeasible large number to detect possible subtle differences in key cardiovascular risk parameters in children at this age of follow-up. Our findings suggest no evidence of increased cardiovascular risk in children born to obese mothers who took metformin in pregnancy and increase available knowledge of the long-term safety of metformin on childhood outcomes.
165 Impact of Lemborexant on Insomnia Disease Severity and Fatigue: Results from the 6-Month Placebo-Controlled Period of the Phase 3 SUNRISE-2 Study
- Margaret Moline, Mikko Kärppä, Jane Yardley, Dinesh Kumar, Kate Pinner, Carlos Perdomo, Gleb Filippov, Norman Atkins, Jr
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- Journal:
- CNS Spectrums / Volume 25 / Issue 2 / April 2020
- Published online by Cambridge University Press:
- 24 April 2020, pp. 305-306
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Study Objective(s):
This study examined the effects of lemborexant (LEM) compared with placebo (PBO) on subject-reported insomnia disease severity, assessed by the Insomnia Severity Index (ISI), and fatigue, assessed by the Fatigue Severity Score (FSS), from the 6-month PBO-controlled period of SUNRISE-2.
Method:SUNRISE-2 (NCT02952820; E2006-G000-303) was a 12-month randomized, double-blind, PBO-controlled (first 6-months) Phase 3 study. After an ~2-week PBO run-in, subjects were randomized to PBO, LEM 5mg (LEM5) or LEM 10mg (LEM10) for 6 months. The ISI and the FSS were administered at baseline [BL] and at the end of Months 1, 3, and 6. The ISI daytime functioning score (DFS), based on the ISI items that assess the impact of insomnia symptoms specific to daily functioning (items 4-7), was also evaluated. Mean changes from BL in ISI total score (ISI TS), ISI DFS, and FSS total score (FSS TS) were analyzed using a mixed-effect model repeated measurement analysis, adjusted for relevant factors and BL score (ISI TS, ISI DFS, or FSS TS) as a covariate.
Results:949 subjects (PBO, n=318; LEM5, n=316; LEM10, n=315) were included in the full analysis set. Median age was 55y (range 18-88y). Mean ISI TS at BL for PBO, LEM5, and LEM10 was 19.0, 19.6 and 19.1, respectively. While mean ISI TS decreased (improved) from BL for all groups, decreases were significantly larger for both LEM5 and LEM10 vs PBO at Month 1 (least squares mean treatment difference [LSM TD]: LEM5, −1.5 [P=0.001]; LEM10, −1.9 [P<0.0001]), Month 3 (LSM TD: LEM5, −2.0; LEM10, −2.6 [both P<0.0001]), and Month 6 (LSM TD: LEM5, −2.1; LEM10, −2.4 [both P<0.0001]). Decreases from BL in mean ISI DFS were also significantly larger for LEM5 and LEM10 vs PBO at Month 1 (LSM TD: LEM5, −0.7 [P=0.014]; LEM10, −0.9 [P=0.001]), Month 3 (LSM TD: LEM5, −1.2 [P=0.0001]; LEM10, −1.4 [P<0.0001]), and Month 6 (LSM TD: LEM5, −1.3; LEM10, −1.3 [both P<0.0001]).
Mean FSS TS at BL was 35.2, 37.4, and 36.0 for PBO, LEM5, and LEM10, respectively. Mean FSS TS decreased (improved) from BL in all groups at the end of Month 1 (decreases were larger and significant for LEM10 vs PBO [LSM TD: –2.0 (P=0.026)]), and Month 3 (decreases were larger and significant for LEM5 [LSM TD: –2.2 (P=0.021)] and LEM10 [LSM TD: –3.0; (P=0.001)] vs PBO). At Month 6, mean FSS TS remained improved from BL in all treatment groups (PBO, –6.3; LEM5, –10.1; and LEM10, –8.9). These decreases were larger and significant for LEM5 (LSM TD: –2.5 [P=0.013]) and LEM10 (LSM TD: –2.6 [P=0.013]) vs PBO. LEM was well tolerated with most adverse events mild to moderate in severity.
Conclusions:In SUNRISE-2, LEM5 and LEM10 significantly reduced subject-reported disease severity and fatigue vs PBO after 6 months of treatment. Reduced severity in insomnia symptoms with LEM5 and LEM10 also translated to improved daytime functioning.
Funding Acknowledgements:Supported by Eisai Inc.
164 Pooled Analyses of Patient-Reported Sleep Onset and Maintenance from Two Phase 3 Studies of Lemborexant
- Russell Rosenberg, Gary Zammit, Jane Yardley, Kate Pinner, Carlos Perdomo, Margaret Moline, Norman Atkins
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- Journal:
- CNS Spectrums / Volume 25 / Issue 2 / April 2020
- Published online by Cambridge University Press:
- 24 April 2020, pp. 304-305
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Study Objective(s):
The dual orexin receptor antagonist, lemborexant (LEM), is being investigated for the treatment of insomnia disorder. Drugs targeting the orexin system, like LEM, may decrease wakefulness and promote sleep with fewer potential adverse effects (AEs) than some currently available pharmacological insomnia therapies. LEM has been studied in 2 pivotal phase 3 trials for insomnia disorder, SUNRISE-1 (NCT02783729; E2006-G000-304) and SUNRISE-2 (NCT02952820; E2006-G000-303). Analyses presented here are derived from patient-reported (subjective) efficacy data pooled from SUNRISE-1 and SUNRISE-2 during 1-month of treatment in adult and elderly (age ≥65y) subjects with DSM-5 insomnia disorder.
Method:SUNRISE-1 was a 1-month, double-blind, randomized, placebo (PBO)- and active-controlled (zolpidem tartrate extended-release 6.25mg [ZOL; not reported), parallel-group study in 1006 subjects (age ≥55y). SUNRISE-2 was a 12-month (6-month PBO-controlled, 6-month active treatment), double-blind study in 949 subjects (age ≥18y). In both studies, subjects were randomized to PBO, LEM5, or LEM10 (SUNRISE-1 subjects could also be randomized to ZOL; not included in pooled analysis) following a 2-week PBO run-in. Changes from baseline (BL) in subjective sleep onset latency (sSOL), subjective sleep efficiency (sSE), and subjective wake after sleep onset (sWASO) were analyzed using mixed effect model repeated measurement analysis. Sleep onset and sleep maintenance responders were analyzed via Cochran–Mantel–Haenszel test stratified by study, region and age group.
Results:The pooled analysis set comprised 1693 subjects (PBO, n=527; LEM5, n=582; LEM10, n=584). Reductions from BL in sSOL were significantly greater for LEM5 and LEM10 vs PBO during the first 7 days of treatment and at the end of Month 1 (all comparisons P<0.0001). Both doses of LEM significantly increased sSE from BL (P<0.001 both time points) more than PBO and reduced sWASO from BL (P<0.0001 first 7 days [both doses]; P<0.05 [LEM5] and P<0.001 [LEM10] at Month 1) more than PBO. After the first 7 days and at the end of Month 1, the proportion of sSOL responders (≤20 min if BL >30 min) was statistically significantly larger for LEM5 and LEM10 vs PBO (first 7 days: both P<0.0001; last 7 days of Month 1: both P<0.001) and the proportion of sWASO responders (≤60 minutes and a reduction from BL by >10 min, if BL >60 min) was statistically significantly larger for LEM5 and LEM10 vs PBO (first 7 days: both P<0.01; last 7 days of Month 1: both P<0.05). LEM was well tolerated. Most AEs were mild to moderate in severity, and rates of severe or serious AEs were low.
Conclusions:LEM improved sleep onset and sleep maintenance in adult and elderly subjects with insomnia disorder, and was well tolerated. Average values on sleep maintenance endpoints showed that subjects treated with LEM obtained >1 hour of additional sleep per night vs subjects who received PBO.
Funding Acknowledgements:Supported by Eisai Inc.
Chapter 28 - Clinical Interventions for the Prevention and Management of Spontaneous Preterm Birth in the Singleton Fetus
- from Preterm Birth of the Singleton and Multiple Pregnancy
- Edited by Mark D. Kilby, University of Birmingham, Anthony Johnson, Dick Oepkes
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- Book:
- Fetal Therapy
- Published online:
- 21 October 2019
- Print publication:
- 02 January 2020, pp 311-324
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Summary
Preterm birth, defined as delivery <37 weeks’ gestation, is a major public health issue worldwide. An estimated 15 million babies are born preterm every year [1]. Preterm birth and the associated complications are now the leading cause of mortality in children under the age of 5 worldwide, accounting for 1 million deaths per year [2]. In the US, 11–12% of deliveries occur preterm, and worldwide, this figure is increasing. Babies born at ‘term’ – conventionally designated as 37–42 weeks’ gestation – have consistently better morbidity and mortality outcomes than those born before 37 weeks. In the short term, organ immaturity predisposes the preterm neonate to complications such as intraventricular hemorrhage and periventricular leukomalacia, necrotizing enterocolitis, and respiratory distress syndrome. Immaturity of the immune system increases the risk of neonatal sepsis, meningitis, and pneumonia. In the longer term, preterm babies have an increased prevalence of neurodevelopmental delay and chronic lung disease, and later in life, higher rates of adult-onset disease, from diabetes to hypertension and obesity [3]. Whilst extremely preterm (<28 weeks) and very preterm (28–32 weeks) neonates are at the highest risk of complications, studies have demonstrated that even late preterm birth (34 – 36 + 6 weeks) confers an increased risk of morbidity and mortality [4]. These effects appear to be pervasive, and as such premature infants have been shown to have lower educational attainment and employment than those born at term [5, 6].
STRATEGIES FOR PREVENTION OF PRETERM BIRTH
- KAHYEE HOR, JANE E. NORMAN
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- Journal:
- Fetal and Maternal Medicine Review / Volume 24 / Issue 3 / August 2013
- Published online by Cambridge University Press:
- 18 October 2013, pp. 169-184
- Print publication:
- August 2013
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Notes on Contributors
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- By David Amigoni, Mark Asquith, Jane Bownas, Adelene Buckland, Carolyn Burdett, Pamela Dalziel, Christine DeVine, Tim Dolin, Roger Ebbatson, Trish Ferguson, Shanyn Fiske, Simon Gatrell, Sophie Gilmartin, William Greenslade, Ann Heilmann, Michael Herbert, John Hughes, Rena Jackson, Elizabeth Langland, Sarah E. Maier, Phillip Mallett, Francesco Marroni, Jane Mattisson, Andrew Nash, K. M. Newton, Francis O’Gorman, John Osborne, Patrick Parrinder, Andrew Radford, Fred Reid, Angelique Richardson, Mary Rimmer, Peter Robinson, Dennis Taylor, Jenny Bourne, Jane Thomas, Herbert F. Tucker, Norman Vance, Roger Webster, Rebecca Welshman, Glen Wickens, Melanie Williams, Keith Wilson, T. R. Wright
- Edited by Phillip Mallett, University of St Andrews, Scotland
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- Book:
- Thomas Hardy in Context
- Published online:
- 05 February 2013
- Print publication:
- 18 March 2013, pp ix-xvi
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Evaluation of an FFQ to assess total energy and nutrient intakes in severely obese pregnant women
- Nor A Mohd-Shukri, Jennifer L Bolton, Jane E Norman, Brian R Walker, Rebecca M Reynolds
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- Journal:
- Public Health Nutrition / Volume 16 / Issue 8 / August 2013
- Published online by Cambridge University Press:
- 10 September 2012, pp. 1427-1435
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Objective
FFQ are popular instruments for assessing dietary intakes in epidemiological studies but have not been validated for use in severely obese pregnancy. The aim of the present study was to compare nutrient intakes assessed by an FFQ with those obtained from a food diary among severely obese pregnant women.
DesignComparison of an FFQ containing 170 food items and a food diary for 4 d (three weekdays and one weekend day); absolute agreement was assessed using the paired t test and relative agreement by Pearson/Spearman correlation, cross-classification into tertiles and weighted kappa values.
SettingAntenatal metabolic clinic for severely obese women.
SubjectsThirty-one severely obese (BMI at booking ≥40·0 kg/m2) and thirty-two lean control (BMI = 20·0–24·9 kg/m2) pregnant women.
ResultsThe findings showed that nutrient intakes estimated by the FFQ were significantly higher than those from the food diary; average correlation was 0·32 in obese and 0·43 in lean women. A mean of 48·5 % of obese and 47·3 % of lean women were correctly classified, while 12·9 % (obese) and 10·0 % (lean) were grossly misclassified. Weighted κ values ranged from −0·04 to 0·79 in obese women and from 0·16 to 0·78 in lean women.
ConclusionsOverall, the relative agreement between the FFQ and food diary was lower in the obese group than in the lean group, but was comparable with earlier studies conducted in pregnant women. The validity assessments suggest that the FFQ is a useful tool for ranking severely obese pregnant women according to the levels of their dietary intake.
Motion in Place: a Case Study of Archaeological Reconstruction Using Motion Capture
- Edited by Mingquan Zhou
- Iza Romanowska, Zhongke Wu, Pengfei Xu, Philip Verhagen
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- Book:
- Revive the Past
- Published by:
- Amsterdam University Press
- Published online:
- 23 June 2021
- Print publication:
- 17 August 2012, pp 98-106
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Summary
Abstract:
Human movement constitutes a fundamental part of the archaeological process, and of any interpretation of a site's usage; yet there has to date been little or no consideration of how movement observed (in contemporary situations) and inferred (in archaeological reconstruction) can be documented. This paper reports on the Motion in Place Platform project, which seeks to use motion capture hardware and data to test human responses to Virtual Reality (VR) environments and their real-world equivalents using round houses of the Southern British Iron Age which have been both modelled in 3D and reconstructed in the present day as a case study. This allows us to frame questions about the assumptions which are implicitly hardwired into VR presentations of archaeology and cultural heritage in new ways. In the future, this will lead to new insights into how VR models can be constructed, used and transmitted.
Key Words: Motion Capture Data, Reconstruction, Virtual Reality, Experimental Archaeology
Introduction
Experimental archaeology is often cited as an important asset in the study of human interaction with material culture, especially in remote periods of history where there are few other sources of data on the human interventions which constitute the archaeological record. This has found many expressions in the discourse of archaeological theory, including the so-called chaîne opératoire, or ‘operational sequence’ theory (see e.g. Bar-Yosef and Van Peer 2009). However, due to an understandable desire to adhere to empirical evidence, means of inferring the human movement behind those interventions are rarely considered in the computational reconstruction of archaeological environments. The most obvious reason for this is that buildings, features and artefacts can be understood and reconstructed (whether digitally or not) from empirical archaeological remains, whereas there is little or no direct evidence for how people might have looked and moved through the spaces they created. Approaches which seek to go beyond this are methodologically fraught, resulting in a limitation of the scope of 3D reconstruction, both as a tool for archaeological research and as means of presenting cultural heritage to the public. The impact on the user's experience of those reconstructions is also limited. In a review of 3D visualization in archaeology, Gillings states: ‘[I]t is worth noting that one of the most striking things about archaeological Virtualmodels is the lack of people in them.
The consequences of obesity and excess weight gain in pregnancy
- Jane E. Norman, Rebecca Reynolds
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- Journal:
- Proceedings of the Nutrition Society / Volume 70 / Issue 4 / November 2011
- Published online by Cambridge University Press:
- 31 August 2011, pp. 450-456
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The prevalence of obesity in pregnancy is rising exponentially; about 15–20% of pregnant women now enter pregnancy with a BMI which would define them as obese. This paper provides a review of the strong links between obesity and adverse pregnancy outcome which operate across a range of pregnancy complications. For example, obesity is associated with an increased risk of maternal mortality, gestational diabetes mellitus, thromboembolism, pre-eclampsia and postpartum haemorrhage. Obesity also complicates operative delivery; it makes operative delivery more difficult, increases complications and paradoxically increases the need for operative delivery. The risk of the majority of these complications is amplified by excess weight gain in pregnancy and increases in proportion to the degree of obesity, for example, women with extreme obesity have OR of 7·89 for gestational diabetes and 3·84 for postpartum haemorrhage compared to their lean counterparts. The consequences of maternal obesity do not stop once the baby is born. Maternal obesity programmes a variety of long-term adverse outcomes, including obesity in the offspring at adulthood. Such an effect is mediated at least in part via high birthweight; a recent study has suggested that the odds of adult obesity are two-fold greater in babies weighing more than 4 kg at birth. The mechanism by which obesity causes adverse pregnancy outcome is uncertain. This paper reviews the emerging evidence that hyperglycaemia and insulin resistance may both play a role: the links between hyperglycaemia in pregnancy and both increased birthweight and insulin resistance have been demonstrated in two large studies. Lastly, we discuss the nature and rationale for possible intervention strategies in obese pregnant women.
Contributors
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- By Louise B. Andrew, Jane C. Ballantyne, Sadek Beloucif, David Clendenin, Maliha A. Darugar, Joanna M. Davies, Michael DeVita, Denise M. Dudzinski, Bernice Elger, Monica Escher, Joel E Frader, Kelly Fryer-Edwards, James Giordano, Allen Gustin, Rebecca M. Harris, Gerhard Höver, Steven K. Howard, Carl C. Hug, Samia Hurst, Steven Jackson, Nancy S. Jecker, Jonathan D Katz, Joseph Klein, W. Andrew Kofke, Ruth Landau, Craig D. McClain MD, Alex Mauron, Kelly N. Michelson, Cynthiane J. Morgenweck, William Notcutt, Michael Nurok, Susan K. Palmer, Joan G. Quaine, Michael A. Rie, Stanley H. Rosenbaum, David M. Rothenberg, Robert B. Schonberger, Mark D. Siegel, Jeffrey H. Silverstein, Murali Sivarajan, Karen Souter MD, Thomas Specht MD, Andrea Trescot, Gail A. Van Norman, A.M. Viens, Elizabeth K. Vig, David B. Waisel, Clarence Ward, James M. West, Richard L Wolman, Steve Yentis
- Edited by Gail A. Van Norman, University of Washington, Stephen Jackson, Stanley H. Rosenbaum, Susan K. Palmer
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- Book:
- Clinical Ethics in Anesthesiology
- Published online:
- 05 March 2012
- Print publication:
- 28 October 2010, pp xi-xiv
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Contributors
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- By Rose Teteki Abbey, K. C. Abraham, David Tuesday Adamo, LeRoy H. Aden, Efrain Agosto, Victor Aguilan, Gillian T. W. Ahlgren, Charanjit Kaur AjitSingh, Dorothy B E A Akoto, Giuseppe Alberigo, Daniel E. Albrecht, Ruth Albrecht, Daniel O. Aleshire, Urs Altermatt, Anand Amaladass, Michael Amaladoss, James N. Amanze, Lesley G. Anderson, Thomas C. Anderson, Victor Anderson, Hope S. Antone, María Pilar Aquino, Paula Arai, Victorio Araya Guillén, S. Wesley Ariarajah, Ellen T. Armour, Brett Gregory Armstrong, Atsuhiro Asano, Naim Stifan Ateek, Mahmoud Ayoub, John Alembillah Azumah, Mercedes L. García Bachmann, Irena Backus, J. Wayne Baker, Mieke Bal, Lewis V. Baldwin, William Barbieri, António Barbosa da Silva, David Basinger, Bolaji Olukemi Bateye, Oswald Bayer, Daniel H. Bays, Rosalie Beck, Nancy Elizabeth Bedford, Guy-Thomas Bedouelle, Chorbishop Seely Beggiani, Wolfgang Behringer, Christopher M. Bellitto, Byard Bennett, Harold V. Bennett, Teresa Berger, Miguel A. Bernad, Henley Bernard, Alan E. Bernstein, Jon L. Berquist, Johannes Beutler, Ana María Bidegain, Matthew P. Binkewicz, Jennifer Bird, Joseph Blenkinsopp, Dmytro Bondarenko, Paulo Bonfatti, Riet en Pim Bons-Storm, Jessica A. Boon, Marcus J. Borg, Mark Bosco, Peter C. Bouteneff, François Bovon, William D. Bowman, Paul S. Boyer, David Brakke, Richard E. Brantley, Marcus Braybrooke, Ian Breward, Ênio José da Costa Brito, Jewel Spears Brooker, Johannes Brosseder, Nicholas Canfield Read Brown, Robert F. Brown, Pamela K. Brubaker, Walter Brueggemann, Bishop Colin O. Buchanan, Stanley M. Burgess, Amy Nelson Burnett, J. Patout Burns, David B. Burrell, David Buttrick, James P. Byrd, Lavinia Byrne, Gerado Caetano, Marcos Caldas, Alkiviadis Calivas, William J. Callahan, Salvatore Calomino, Euan K. Cameron, William S. Campbell, Marcelo Ayres Camurça, Daniel F. Caner, Paul E. Capetz, Carlos F. Cardoza-Orlandi, Patrick W. Carey, Barbara Carvill, Hal Cauthron, Subhadra Mitra Channa, Mark D. Chapman, James H. Charlesworth, Kenneth R. Chase, Chen Zemin, Luciano Chianeque, Philip Chia Phin Yin, Francisca H. Chimhanda, Daniel Chiquete, John T. Chirban, Soobin Choi, Robert Choquette, Mita Choudhury, Gerald Christianson, John Chryssavgis, Sejong Chun, Esther Chung-Kim, Charles M. A. Clark, Elizabeth A. Clark, Sathianathan Clarke, Fred Cloud, John B. Cobb, W. Owen Cole, John A Coleman, John J. Collins, Sylvia Collins-Mayo, Paul K. Conkin, Beth A. Conklin, Sean Connolly, Demetrios J. Constantelos, Michael A. Conway, Paula M. Cooey, Austin Cooper, Michael L. Cooper-White, Pamela Cooper-White, L. William Countryman, Sérgio Coutinho, Pamela Couture, Shannon Craigo-Snell, James L. Crenshaw, David Crowner, Humberto Horacio Cucchetti, Lawrence S. Cunningham, Elizabeth Mason Currier, Emmanuel Cutrone, Mary L. Daniel, David D. Daniels, Robert Darden, Rolf Darge, Isaiah Dau, Jeffry C. Davis, Jane Dawson, Valentin Dedji, John W. de Gruchy, Paul DeHart, Wendy J. Deichmann Edwards, Miguel A. De La Torre, George E. Demacopoulos, Thomas de Mayo, Leah DeVun, Beatriz de Vasconcellos Dias, Dennis C. Dickerson, John M. Dillon, Luis Miguel Donatello, Igor Dorfmann-Lazarev, Susanna Drake, Jonathan A. Draper, N. Dreher Martin, Otto Dreydoppel, Angelyn Dries, A. J. Droge, Francis X. D'Sa, Marilyn Dunn, Nicole Wilkinson Duran, Rifaat Ebied, Mark J. Edwards, William H. Edwards, Leonard H. Ehrlich, Nancy L. Eiesland, Martin Elbel, J. Harold Ellens, Stephen Ellingson, Marvin M. Ellison, Robert Ellsberg, Jean Bethke Elshtain, Eldon Jay Epp, Peter C. Erb, Tassilo Erhardt, Maria Erling, Noel Leo Erskine, Gillian R. Evans, Virginia Fabella, Michael A. Fahey, Edward Farley, Margaret A. Farley, Wendy Farley, Robert Fastiggi, Seena Fazel, Duncan S. Ferguson, Helwar Figueroa, Paul Corby Finney, Kyriaki Karidoyanes FitzGerald, Thomas E. FitzGerald, John R. Fitzmier, Marie Therese Flanagan, Sabina Flanagan, Claude Flipo, Ronald B. Flowers, Carole Fontaine, David Ford, Mary Ford, Stephanie A. Ford, Jim Forest, William Franke, Robert M. Franklin, Ruth Franzén, Edward H. Friedman, Samuel Frouisou, Lorelei F. Fuchs, Jojo M. Fung, Inger Furseth, Richard R. Gaillardetz, Brandon Gallaher, China Galland, Mark Galli, Ismael García, Tharscisse Gatwa, Jean-Marie Gaudeul, Luis María Gavilanes del Castillo, Pavel L. Gavrilyuk, Volney P. Gay, Metropolitan Athanasios Geevargis, Kondothra M. George, Mary Gerhart, Simon Gikandi, Maurice Gilbert, Michael J. Gillgannon, Verónica Giménez Beliveau, Terryl Givens, Beth Glazier-McDonald, Philip Gleason, Menghun Goh, Brian Golding, Bishop Hilario M. Gomez, Michelle A. Gonzalez, Donald K. Gorrell, Roy Gottfried, Tamara Grdzelidze, Joel B. Green, Niels Henrik Gregersen, Cristina Grenholm, Herbert Griffiths, Eric W. Gritsch, Erich S. Gruen, Christoffer H. Grundmann, Paul H. Gundani, Jon P. Gunnemann, Petre Guran, Vidar L. Haanes, Jeremiah M. Hackett, Getatchew Haile, Douglas John Hall, Nicholas Hammond, Daphne Hampson, Jehu J. Hanciles, Barry Hankins, Jennifer Haraguchi, Stanley S. Harakas, Anthony John Harding, Conrad L. Harkins, J. William Harmless, Marjory Harper, Amir Harrak, Joel F. Harrington, Mark W. Harris, Susan Ashbrook Harvey, Van A. Harvey, R. Chris Hassel, Jione Havea, Daniel Hawk, Diana L. Hayes, Leslie Hayes, Priscilla Hayner, S. Mark Heim, Simo Heininen, Richard P. Heitzenrater, Eila Helander, David Hempton, Scott H. Hendrix, Jan-Olav Henriksen, Gina Hens-Piazza, Carter Heyward, Nicholas J. Higham, David Hilliard, Norman A. Hjelm, Peter C. Hodgson, Arthur Holder, M. Jan Holton, Dwight N. Hopkins, Ronnie Po-chia Hsia, Po-Ho Huang, James Hudnut-Beumler, Jennifer S. Hughes, Leonard M. Hummel, Mary E. Hunt, Laennec Hurbon, Mark Hutchinson, Susan E. Hylen, Mary Beth Ingham, H. Larry Ingle, Dale T. Irvin, Jon Isaak, Paul John Isaak, Ada María Isasi-Díaz, Hans Raun Iversen, Margaret C. Jacob, Arthur James, Maria Jansdotter-Samuelsson, David Jasper, Werner G. Jeanrond, Renée Jeffery, David Lyle Jeffrey, Theodore W. Jennings, David H. Jensen, Robin Margaret Jensen, David Jobling, Dale A. Johnson, Elizabeth A. Johnson, Maxwell E. Johnson, Sarah Johnson, Mark D. Johnston, F. Stanley Jones, James William Jones, John R. Jones, Alissa Jones Nelson, Inge Jonsson, Jan Joosten, Elizabeth Judd, Mulambya Peggy Kabonde, Robert Kaggwa, Sylvester Kahakwa, Isaac Kalimi, Ogbu U. Kalu, Eunice Kamaara, Wayne C. Kannaday, Musimbi Kanyoro, Veli-Matti Kärkkäinen, Frank Kaufmann, Léon Nguapitshi Kayongo, Richard Kearney, Alice A. Keefe, Ralph Keen, Catherine Keller, Anthony J. Kelly, Karen Kennelly, Kathi Lynn Kern, Fergus Kerr, Edward Kessler, George Kilcourse, Heup Young Kim, Kim Sung-Hae, Kim Yong-Bock, Kim Yung Suk, Richard King, Thomas M. King, Robert M. Kingdon, Ross Kinsler, Hans G. Kippenberg, Cheryl A. Kirk-Duggan, Clifton Kirkpatrick, Leonid Kishkovsky, Nadieszda Kizenko, Jeffrey Klaiber, Hans-Josef Klauck, Sidney Knight, Samuel Kobia, Robert Kolb, Karla Ann Koll, Heikki Kotila, Donald Kraybill, Philip D. W. Krey, Yves Krumenacker, Jeffrey Kah-Jin Kuan, Simanga R. Kumalo, Peter Kuzmic, Simon Shui-Man Kwan, Kwok Pui-lan, André LaCocque, Stephen E. Lahey, John Tsz Pang Lai, Emiel Lamberts, Armando Lampe, Craig Lampe, Beverly J. Lanzetta, Eve LaPlante, Lizette Larson-Miller, Ariel Bybee Laughton, Leonard Lawlor, Bentley Layton, Robin A. Leaver, Karen Lebacqz, Archie Chi Chung Lee, Marilyn J. Legge, Hervé LeGrand, D. L. LeMahieu, Raymond Lemieux, Bill J. Leonard, Ellen M. Leonard, Outi Leppä, Jean Lesaulnier, Nantawan Boonprasat Lewis, Henrietta Leyser, Alexei Lidov, Bernard Lightman, Paul Chang-Ha Lim, Carter Lindberg, Mark R. Lindsay, James R. Linville, James C. Livingston, Ann Loades, David Loades, Jean-Claude Loba-Mkole, Lo Lung Kwong, Wati Longchar, Eleazar López, David W. Lotz, Andrew Louth, Robin W. Lovin, William Luis, Frank D. Macchia, Diarmaid N. J. MacCulloch, Kirk R. MacGregor, Marjory A. MacLean, Donald MacLeod, Tomas S. Maddela, Inge Mager, Laurenti Magesa, David G. Maillu, Fortunato Mallimaci, Philip Mamalakis, Kä Mana, Ukachukwu Chris Manus, Herbert Robinson Marbury, Reuel Norman Marigza, Jacqueline Mariña, Antti Marjanen, Luiz C. L. Marques, Madipoane Masenya (ngwan'a Mphahlele), Caleb J. D. Maskell, Steve Mason, Thomas Massaro, Fernando Matamoros Ponce, András Máté-Tóth, Odair Pedroso Mateus, Dinis Matsolo, Fumitaka Matsuoka, John D'Arcy May, Yelena Mazour-Matusevich, Theodore Mbazumutima, John S. McClure, Christian McConnell, Lee Martin McDonald, Gary B. McGee, Thomas McGowan, Alister E. McGrath, Richard J. McGregor, John A. McGuckin, Maud Burnett McInerney, Elsie Anne McKee, Mary B. McKinley, James F. McMillan, Ernan McMullin, Kathleen E. McVey, M. 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- Edited by Daniel Patte, Vanderbilt University, Tennessee
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Study of progesterone for the prevention of preterm birth in twins (STOPPIT): Findings from a trial-based cost-effectiveness analysis—Erratum
- Oya Eddama, Stavros Petrou, Dean Regier, John Norrie, Graeme MacLennan, Fiona Mackenzie, Jane E. Norman
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- International Journal of Technology Assessment in Health Care / Volume 26 / Issue 4 / October 2010
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- 27 July 2010, pp. 473-474
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Index
- Edited by Sean Kehoe, James Neilson, University of Liverpool, Jane Norman, University of Edinburgh
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Declaration of personal interests
- Edited by Sean Kehoe, James Neilson, University of Liverpool, Jane Norman, University of Edinburgh
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Maternal and Infant Deaths
- Chasing Millennium Development Goals 4 and 5
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Millennium Development Goals (MDGs) 4 and 5, created under the auspices of the United Nations, challenged political, financial, medical and civil society leaders to improve both child and maternal health. The 58th RCOG Study Group brought together a range of experts - including midwives, obstetricians and gynaecologists, anaesthetists and paediatricians - to provide an up-to-date review of progress to date and the challenges around meeting these MDGs. This book presents the findings of the Study Group, with sections covering:the size of the problemclinical problems and solutions - maternalclinical problems and solutions - neonataltraining and developmentspecific challenges in specific countries (Afghanistan, Zimbabwe, Egypt and Sri Lanka).
21 - Consensus views arising from the 58th Study Group: Maternal and Infant Deaths: Chasing Millennium Development Goals 4 and 5
- from SECTION 6 - CONSENSUS VIEWS
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Summary
The study group identified many gaps in the evidence required to achieve the Millenium Development Goals 4 and 5. The three most important pieces of research in each area that would address these deficiencies are described below.
Assessing the problem
Audit of maternal deaths
1. All countries should actively enumerate and audit maternal and perinatal deaths.
Disease issues
Postpartum haemorrhage
Prophylaxis
2. Research is needed into the most appropriate components of the active management of the third stage of labour, including the role of controlled cord traction, the role of universal prophylaxis with oxytocics and the most appropriate prophylactic drug in each healthcare setting.
Management of retained placenta
3. Research is needed into the optimal management of retained placenta, including timing of therapeutic interventions.
Treatment of postpartum haemorrhage
4. Research is needed into the most clinically and cost-effective combination of medical and surgical therapy for the management of postpartum haemorrhage, including the role of the non-pneumatic shock garment.
Puerperal sepsis
Disease burden
5. Research is needed to quantify the disease burden related to puerperal sepsis.
Interventions
6. The effectiveness of interventions, particularly those that comprise multiple components related to influencing behaviour and creating improvements in the health system, should be rigorously tested. Research should ideally be conducted in settings where the risk of introducing infection is high.
Cost effectiveness
7. Evaluation of interventions should include analysis of cost effectiveness.
Participants
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SECTION 5 - SPECIFIC CHALLENGES IN SPECIFIC COUNTRIES
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Contents
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Frontmatter
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