Miscarriage is generally defined as the loss of a pregnancy before viability. An estimated 23 million miscarriages occur every year worldwide, translating to 44 pregnancy losses each minute. The pooled risk of miscarriage is 15•3% (95% CI: 12•5% -18•7%) of all recognised pregnancies. The population prevalence of women with one miscarriage is 10•8% (95% CI 10•3% -11•4%), two miscarriages is 1•9% (95% CI 1•8% -2•1%) and three or more miscarriages is 0•7% (0•5% -0•8%).Risk factors for miscarriage include very young or older female age, older male age, very low or very high body mass index, black ethnicity, previous miscarriages, smoking, alcohol, stress levels, night shift working, air pollution and exposure to pesticides. The consequences of miscarriage are both physical, such as bleeding or infection, and psychological.Psychological consequences include increases in the risk of anxiety, depression, post-traumatic stress disorder and suicide. Miscarriage, and especially recurrent miscarriage, is also a sentinel risk marker for obstetric complications, including preterm birth, fetal growth restriction, placental abruption and stillbirth in future pregnancies, and a predictor of longer-term health problems, such as cardiovascular disease and venous thromboembolism.The costs of miscarriage affect individuals, healthcare systems and society at large. The short-term national economic cost of miscarriage is estimated to be £471 million per year in the United Kingdom. As recurrent miscarriage is a sentinel marker for various obstetric risks in future pregnancies, women should receive care in pre-conception and high-risk obstetric clinics. As psychological morbidity is common after pregnancy loss, effective screening instruments and treatment options for mental health consequences of miscarriage need to be available. We recommend that miscarriage data are gathered and reported to facilitate comparison of rates amongst countries, to accelerate research, and to improve patient care and policy development.

Objective To evaluate the effectiveness of multifactorial assessment and intervention programmes to prevent falls and injuries among older adults recruited to trials in primary care, community, or emergency care settings. Design Systematic review of randomised and quasirandomised controlled trials, and meta-analysis. Data sources Six electronic databases (Medline, Embase, CENTRAL, CINAHL, PsycINFO, Social Science Citation Index) to 22 March 2007, reference lists of included studies, and previous reviews. Review methods Eligible studies were randomised or quasi-randomised trials that evaluated interventions to prevent falls that were based in emergency departments, primary care, or the community that assessed multiple risk factors for falling and provided or arranged for treatments to address these risk factors. Data extraction Outcomes were number of fallers, fall related injuries, fall rate, death, admission to hospital, contacts with health services, move to institutional care, physical activity, and quality of life. Methodological quality assessment included allocation concealment, blinding, losses and exclusions, intention to treat analysis, and reliability of outcome measurement. Results 19 studies, of variable methodological quality, were included. The combined risk ratio for the number of fallers during follow-up among 18 trials was 0.91 (95% confidence interval 0.82 to 1.02) and for fall related injuries (eight trials) was 0.90 (0.68 to 1.20). No differences were found in admissions to hospital, emergency department attendance, death, or move to institutional care. Subgroup analyses found no evidence of different effects between interventions in different locations, populations selected for high risk of falls or unselected, and multidisciplinary teams including a doctor, but interventions that actively provide treatments may be more effective than those that provide only knowledge and referral. Conclusions Evidence that multifactorial fall prevention programmes in primary care, community, or emergency care settings are effective in reducing the number of fallers or fall related injuries is limited. Data were insufficient to assess fall and injury rates. INTRODUCTIONFalls are a major health problem for older adults, through both immediate effects such as fractures and head injuries and longer terms problems such as disability, fear of falling, and loss of independence. 1Prevention of falls and injuries has been a major focus of research, stimulated by ageing populations and by growing awareness of the mortality and morbidity resulting from falls. Earlier reviews of randomised controlled trials of fall prevention interventions concluded that several types of intervention are effective, including training in strength and balance, modification of hazards at home, and withdrawal of psychotropic drugs.2 Multifactorial risk assessment of falls followed by targeting of interventions to an individual's risk factors is an attractive strategy as it could reduce several components of fall risk and would be e...

Data from 57 wetlands from around the world have been collated to investigate whether wetlands affect the nutrient loading of waters draining through them; the majority of wetlands reduced nutrient loading and there was little difference in the proportion of wetlands that reduced N to those that reduced P loading. However, some wetlands increased nutrient loadings by increasing the loading of soluble N and P species thus potentially driving aquatic eutrophication. Studies conducted over a period of a year or more, or that involved frequent sampling during high flow events, were more likely to indicate that the wetland increased nutrient loadings. Swamps and marshes differed from riparian zones in their nutrient function characteristics by being slightly more effective at nutrient reduction than riparian zones. The attributes that enable wetlands to be effective in reducing N and P loadings need consideration when constructing or managing wetlands to reduce nutrient loadings. Their wise use will be an important strategy for meeting the Water Framework Directive requirements for many water bodies.

1. Submerged plant richness is a key element in determining the ecological quality of freshwater systems; it has often been reduced or completely lost. 2. The submerged and floating-leaved macrophyte communities of 60 shallow lakes in Poland and the U.K. have been surveyed and species richness related to environmental factors by general linearised models. 3. Nitrogen, and more specifically winter nitrate, concentrations were most important in explaining species richness with which they were inversely correlated. Phosphorus was subsidiary. Such an inverse relationship is consistent with findings in terrestrial communities. Polish lakes, with less intensively farmed catchments, had greater richness than the U.K. lakes. 4. The richest U.K. communities were associated with winter nitrate-N concentrations of up to about 1-2 mg L )1 and may correspond with 'good' ecological quality under the terms of the European Water Framework Directive. Current concentrations in European lowlands are often much higher.

Throughout the world, wetlands are increasingly being recognised as important elements of the landscape because of their high biodiversity and goods and services they provide to mankind. After many decades of wetland destruction and conversion, large areas of wetlands are now protected under the International Convention on Wetlands (Ramsar) and regional or national legislation such as the European Union Habitats Directive. In many cases, there is a need to restore the ecological character of the wetland through appropriate water management. This paper provides examples of scientific knowledge of wetland hydrology that can guide such restoration. It focuses on the need for sound hydrological science on a range of issues including water level control, topography, flood storage, wetland connections with rivers and sustainability of water supply under climate change.